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  • Introductions

Adolescent Adolescent Presentation Transcript

  • Adolescents Clinical Practice with Addictive Disorders Renee Hillsman Tamara Robinson Tracy Tarbutton Tammy Wilbanks
  • Treatment Considerations Family Individual Developmental Stages School Stages of Change Demographics Peer Community
    • View From Within The Whirlwind
    • “ With adolescence, many kinds of development occur - physical, emotional, intellectual, academic, social and spiritual-and they don’t always occur in tandem.”
    • Pipher, M. (1994). Reviving Ophelia: saving the selves of adolescent girls. New York, NY: Ballantine Books.
    • “ Family is the essential presence-
    • the thing that never leaves you even if you have to leave it”
    • Buford, Bill (1955). The Family. New York: Granta Books
    • Detached - “mall orphans”
    • Parental substance use
    • Low affection/stability
    • No Parental Monitoring
    • “ Schools are better at pulling weeds than at planting flowers”
    • Eisner, E. (1990). Who Decides What Schools Teach? Phi Delta Kappan 71: 523-526.
    • Islands of stability or arenas for battle?
    • Negative school climate
    • Traumatic experiences
    • Rejection/isolation/exclusion/alienation
    • “ Every citizen shares the responsibility of
    • creating communities in which
    • all youth can thrive and grow.”
    • Seita, J.R. & Brendtro, L.K. (2005). Kids who outwit adults.
    • Complacent/permissive norms
    • Drug availability
    • Lack of neighborhood attachment
    • Low socioeconomic status
    • “ And why does he hang out with his friends? Because any one of these kids would take a bat to your head if he asked them to. It’s called loyalty”
    • Sean, Maguire, Will Hunting’s therapist, Good Will Hunting
    • Peer influence: a powerful social need
    • Youth increase freedom from adult authority
  • Rules of Engagement
    • The Distrust Lens
    • “ Do unto others”
    • vs.
    • “ tit for tat”
    • Private Logic
    • I am….
    • Other people are…
    • The world is….
    • Therefore I am….
    • Flight/Fight/Fool
    “ Teenagers often perceive the acts of volunteering information about themselves and communicating approval for a therapist as large concessions of power, and such concessions are dispensed sparingly by teenagers who feel a need to exert control over the session” “ I want them (parents, teachers, therapists, everybody) to know how angry/unhappy/frightened/confused I am. And if I stop yelling/cutting/running away/drinking/pouting, they’ll think everything’s fine”
    • “ Adolescents need help from therapists in FINDING EXIT STRATEGIES from their problems that keep intact their sense of dignity”
  • Questions Teenagers Hate
    • “ How does that make you feel?”
    • “ Do you think that’s such a good idea?”
    • “ Why do you think you did that?”
  • How We End Up NOT Helping
    • Soliciting the adolescent’s APPROVAL
    • Presenting oneself as too helpful
    • Being too careful: THINK CANDOR AND CONNECTION
    • Trying to mask the fact that you’re stumped
    • Trying to exert control over the therapeutic process
  • Continuum of Use Abuser Prevention Intervention Treatment Regular User Recreation User Substance Dependent Non-User Experimental User
  • Adolescent Substance Use ¼ of youth age 10-17 say their friends “huff” 10.4 million current drinker of alcohol are age 12 to 20 Youth age 16 to 17 have 2 nd highest rate of current illicit drug use Youth age reported marijuana as the most frequently used illicit drug 1.1 million of youth age 12-17 are dependent on illicit drugs Title Scope Of Problem More than half of 12 th graders have tried an illicit drug
  • Signs of Drug Use
    • Negative changes in schoolwork; missing school or declining grades
    • Increased secrecy about possessions of activities
    • Use of incense, room deodorant or perfume to hide smoke or chemical odors
    • Subtle changes in conversation with friends, e.g., more secretive, using “coded” language
    • New friends
    • Change in clothing choices – new fascination with clothes that highlight drug use
    • Increase in borrowing money
    • Evidence of inhaling products and accessories, such as hairspray, nail polish, correction fluid, paper bags, common household products
    • Bottles of eye drops, which may be used to mask bloodshot eyes or dilated pupils
    • New use of mouthwash or breath mints to cover up the smell of alcohol
    • Missing prescription drugs – especially narcotics and mood stabilizers
    • Lack of interest in personal appearance
  • Consequences Traffic Accidents Physical/Mental Consequences Developmental Problems Juvenile Crime School-Related Problems Risky Sexual Behavior Delinquent Behavior Future Use Disorder Adolescent Substance Use
  • Treatment Setting Partial Hospitalization In-patient Hospitalization Long-Term Residential Intensive Outpatient Outpatient Insurance & Managed Care Issues
    • Cognitive-Behavioral
    • Problem-Solving
    • Self-Monitoring
    • Goal Setting
    • Decision Making Skills
    • Family-Based
    • Behavioral Approach
    • Contingency Contracting
    • Family Management
    • Parenting Strategies
    • Communication Training
    • Strategic and Structural
    • Symptoms of the Family
    • Restructuring Problematic
    • Relationships
    • Integrative Models
    • Ecosystem Model
    Effective Therapeutic Approaches
  • Resources
    • DiClemente, C.C. (2003). Addiction and change: How addictions develop and addicted people recover. New York: The Guilford Press.
    • Edgette, J.S. (2006). Adolescent therapy that really works: Helping kids who never asked for help in the first place. New York, NY: W.W. Norton.
    • Sampl, S & Kadden, R. (2001) Motivational enhancement and behavioral therapy for adolescent cannabis users: 5 sessions. Retrieved June 1, 2007 from http://www.kap.samhsa.gov/products/manuals/cyt/pdfs/cyt1.pdf .
    • Seita, J.R. & Brendtro, L.K. (2005). Kids who outwit adults.
    • Bloomington, ID: National Education Services.
    • Straussner, S. L. (Ed.). (2004). Clinical work with substance-abusing clients. 2nd ed. New York: The Guilford Press. Edgette, J.S. (2006). Adolescent therapy that really works: Helping kids who never asked for help in the first place. New York, NY: W.W. Norton.
  • Adolescents Clinical Practice with Addictive Disorders Renee Hillsman Tamara Robinson Tracy Tarbutton Tammy Wilbanks