Adolescent Substance Abuse Treatment

Here's four great resources for finding effective adolescent substance abuse treatment programs (emphasis on residential), plus one on how to train clinicians in evidence-based treatment:

1. How to Find the Best Drug Treatment for Teens: A Guide for Parents -- This guide from TIME magazine is excellent to pass on to parents struggling with their teens' drug and alcohol issues. Among other things, it includes a link to Time to Get Help, an excellent website developed and hosted by The Partnership at Drug-Free.org. (I'm glad TIME got the word about about this -- while Steve Pasierb, CEO of the Partnership, did a post for us about Time to Get Help way back in December, there's no denying that TIME gets a little more traffic than we do. And I was unaware of the next two resources before I read the TIME article.)
2. Questions for Parents to Ask Before Entering a Youth in a Residential Program - these questions were developed by the Federal Trade Commission and apply to all sorts of residential programs, not just alcohol and drug treatment programs.
    
3. Ten Important Questions to Ask Teen Substance Abuse Treatment Program. 
4. Questions for Youth to Ask When Entering a Treatment Program - Imagine a set of questions youth might ask themselves and others before agreeing to enter a residential program. Questions that could help them adjust to treatment faster.  Now, you don't have to imagine, thanks to the Building Bridges Initiative of the Substance Abuse and Mental Health Services Administration (SAMHSA).  You can see similar tip sheets for parents and recommendations for treatment providers and adolescent substance abuse policy officials at the state level on how to use and disseminate them here. 
5. Strategies for Training Counselors in Evidence-Based Treatments - What's the most effective way to insure that your clinicians learn to implement evidence-based treatments?  Learn the answer(s) in this article, authored by Steve Martino of Yale University School of Medicine, which appeared in the December 2010 issue of Addiction Science and Clnical Practice. (Hat tip to Paul Savery.)

 
NOTE: This is an updated  version of a post that appeared in February 2011. 

Photo: hometownzero.

Good news! A few weeks ago, I asked you to submit comments to the Substance Abuse and Mental Health Services Administration (SAMHSA) in support of including adolescents in the state block grant guidelines for substance abuse treatment and mental health treatment.
(If you recall, SAMHSA had specified youth as a priority population. We were concerned, based on early comments, that they might be removed from the final guidelines. So far, that hasn't happened.)
It turns out all of those comments made a difference: according to the Federal Register:

772 comments from 522 individuals or organizations were received. The comments were (1) Supportive of the changes proposed to the FY 2012–2013 Block Grant Application, (2) requested clarification regarding certain areas or (3) requested specific changes to the Block Grant Application.

Among the items that SAMHSA received comments on, one of the most common was:

Commending SAMHSA on including adolescents as a target group that States can include in their needs assessment and State Plan.

So, great work! However, from what I hear, the process of finalizing the guidelines is still fluid, so SAMHSA may ask for comments. Stay tuned!

Does it really matter if we screen and assess teens for alcohol and drug problems?  Most adults, after all, started experimenting with alcohol or other drugs before they turned 21 -- and if they didn't, they almost certainly knew a lot of kids who did. And most of them (though not all) survived into adulthood.
So what's the big deal if we turn a blind eye to identify teen drinking or drugging?  Federally-funded research shows why it's a big deal from a public health standpoint:
 
(Click the image for a larger view.) It's taken from an excellent presentation, "Characteristics, Needs and Strengths of Substance Using Youth by Level of Involvement in the Juvenile Justice System," given by Dr. Michael Dennis, Senior Research Psychologist at Chestnut Health Systems, at the Reclaiming Futures Leadership Institute held in Miami last month. I'll be posting more slides from his presentation soon - stay tuned!
Here's Dr. Dennis' notes on the slide (emphasis added):
This figure shows ... the prevalence of these past year substance use and problems in the height of the graph by age along the bottom.
1- Substance use disorders typically [surface] during adolescence and young adulthood. In fact, 90% of all adults with dependence started using under the age of 18, half under the age of 15. Moreover, 90% met criteria for abuse or dependence by age 20 – thus it is primarily an adolescent onset disorder.
2- After several decades, the rates of abuse and dependence do decrease as people go into remission, incarceration or die. Epidemiological studies of people with lifetime substance dependence suggest that 58% eventually enter sustained recovery (i.e., no symptoms for the past year) -- a rate that is considerably better than the 39% average rate of recovery across psychiatric disorders (Kessler, 1994; see also Dawson, 1996; Robins & Regier, 1991).
3 – Notice how the rates of no use go up with age.
 
One caveat: remember that most youth in the juvenile justice system (at intake, detention, or in secure placement) don't have an alcohol and drug disorder -- though many do.  For more information, check out this post: How Prevalent are Substance Abuse and Mental Health Issues in Juvenile Justice? The Answer May Surprise You. 
Related post: Adolescents: What's the Difference Between Assessing "Risk" and "Need"?
 

This week, I've got a monster roundup of news, grant opportunities, and conferences related to the juvenile justice system and (a little) about adolescent substance abuse treatment and behavioral healthcare for kids. Here goes:

• Reclaiming Futures Nassau County: Football Star Andrew Quarless Speaks to Juvenile Drug Court Graduates
• U.S. Supreme Court Says Age Matters When it Comes to Miranda Warnings
  Miranda warnings must be given by police when a suspect is being interrogated in a custodial setting. What's considered custody or the degree to which a suspect is being restrained are what matters here: in this case, a 13-year-old in North Carolina was interrogated on school grounds by a police officer about alleged crimes committed off-campus. He was not read his Miranda rights; his lawyers argued that his subsequent confession was therefore inadmissible. North Carolina's Supreme Court said his age wasn't relevant -- arguing, as I understand it, that the youth was not in a custodial situation and could have left. In a 5-4 decision, the U.S. Supreme Court disagreed, writing that, “It is beyond dispute that children will often feel bound to submit to police questioning when an adult in the same circumstances would feel free to leave.” (Hat tips to the Juvenile Law Center and the National Juvenile Justice Network.)

A few weeks ago, I had the opportunity to attend the “Widening The Door of Entry to Recovery for Young People” webinar that was previously promoted on Reclaiming Futures.
The presentation was given by Anne Thompson, a board member of the Association of Recovery Schools and Greg Williams, Youth Co-Director of Connecticut Turning to Youth and Families (CTYF). Anne and Greg started out the presentation by sharing inspirational stories of their own recovery and highlighted the importance of the programs they represent.
A resounding theme throughout the presentation was the need for support in recovery, especially peer-to-peer support for youth. Every September, the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) celebrates National Recovery Month (Recovery Month). Recovery Month recognizes and lauds the gains made by individuals in recovery from substance use disorders and mental health problems. It also recognizes the efforts of treatment providers and families who support those in recovery. 
I encourage those in recovery, especially young people, to look for Recovery Month events in their area and to spread the word among their peers. Just as Greg Williams explained in an interview last June (as part of our Road to Recovery series), recovery can occur at any age, and young people can and do recover.
For more information about Greg’s story and the resources available for youth in recovery, watch the interview.
 

About the Author: Sarah Ikenberry is a Public Health Advisor at SAMHSA.

If you care about adolescent substance abuse treatment (and mental health treatment), this is really important.
As I posted recently, SAMHSA is proposing big changes to its mental health and alcohol and drug treatment block grants. They want your comments by this Friday, June 3, 2011 June 9, 2011.
Ho-hum, right?
Far from it. We need you and everyone you know to submit comments to support SAMHSA's inclusion of adolescents/youth as a target population by Friday (see below for a draft message you can use or adapt).

>>Submit your email comments to SAMHSA the easy way, using this action alert from sparkaction.

• Does Your Youth Program Work?
  An OJJDP publication. Dates from 2000, but it provides a great introduction to evaluating success. (Hat tip to Paul Savery.)
• Reclaiming Futures in the News: "Drug Courts Restore Addicts"
  A great piece profiling the adult and juvenile drug courts and the accomplishments of Reclaiming Futures in Hocking County, Ohio. The article originally appeared in the Logan Daily News, but you can find the full article on the Reclaiming Futures website.
• Improving Educational Outcomes of Youth in Juvenile Justice and Child Welfare Systems Through Interagency Communication and Collaboration
  Maybe you read that headline and thought to yourself, "Got it covered: we're already collaborating and communicating as well as we can." I can tell you from experience with multiple sites implementing the Reclaiming Futures model that there's always room for improvement -- and investing time and attention in this sort of collaboration pays off big time for kids, families, agencies, and service providers. So be sure to check out this comprehensive, 20-page "practice guide" put out in May 2011 by the (deep breath) National Evaluation and Technical Assistance Center for the Education of Children and (don't forget to breathe) Youth Who Are Neglected, Delinquent, or At-Risk (NDTAC). (Hat tip to Paul Savery.)

Sharon Smith’s daughter Angela died in 1998 of a heroin overdose. She was 18 years old. For four years before her death, Angie (see photo, left) was in and out of 11 treatment centers, stood before a half dozen judges, and lived at one juvenile detention center. 
Sharon (shown at right) formed MOMSTELL in 2000 to advocate for more effective, accessible drug treatment and greater family involvement across the continuum of care and in the policy-making process. “Because no family should have to face the disease of addiction alone,” MOMSTELL is committed to identifying and removing barriers to treatment, many of which Sharon encountered when trying to find help for her daughter. 
Sharon was one of the organizers of the "national dialogue" sponsored in 2009 by SAMHSA for Families of Youth with Substance Use Disorders. Here, she illustrates some of those barriers specific to juvenile justice.

Reclaiming Futures just sponsored a webinar by Dr. Howard Liddle on the clinical importance of working with the families of teens in the justice system as well as the young people themselves -- follow the link to listen to the webinar or download the slides -- but family involvement is critical in other areas as well, from program planning to policy-making. 
And as it happens, the Substance Abuse and Mental Health Services Administration (SAMHSA) is seeking comments on its proposed changes to its block grants (including target populations) -- comments are due this Friday, June 3, 2011 -- so it seems like a good time to remind everyone that in 2009, SAMHSA convened a group of family members from all across the country to look at barriers to their involvement, opportunities for change, and to make recommendations for improvement. 

SAMHSA has revamped its block grant applications for substance abuse treatment and mental health treatment services. You can submit comments by emailing Summer King, SAMHSA Reports Clearance Officer on or before June 9, 2011. [We were incorrectly informed June 3rd was the deadline.]
What are the proposed changes?  Here's the SAMHSA press release (with minor edits):
 
SAMHSA Introduces Guidance Changing Its Block Grant Programs to Reflect New Opportunities Provided by Parity, Health Reform and Emerging Science
The Substance Abuse and Mental Health Services Administration (SAMHSA) announced a new approach for the Substance Abuse Prevention and Treatment Block Grant (SABG) and the Community Mental Health Services Block Grant (MHBG) in the April 11, 2011 Federal Register.
 
[...]

Under this new approach states and territories will have the opportunity to use block grant dollars for prevention, treatment, recovery supports and other services that supplement services covered by Medicaid, Medicare and private insurance. The block grant funds will be directed to four purposes: