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  1. 1. Adolescents Clinical Practice with Addictive Disorders Renee Hillsman Tamara Robinson Tracy Tarbutton Tammy Wilbanks
  2. 2. Treatment Considerations Family Individual Developmental Stages School Stages of Change Demographics Peer Community
  3. 3. <ul><li>View From Within The Whirlwind </li></ul><ul><li>“ With adolescence, many kinds of development occur - physical, emotional, intellectual, academic, social and spiritual-and they don’t always occur in tandem.” </li></ul><ul><li>Pipher, M. (1994). Reviving Ophelia: saving the selves of adolescent girls. New York, NY: Ballantine Books. </li></ul>
  4. 4. <ul><li>“ Family is the essential presence- </li></ul><ul><li>the thing that never leaves you even if you have to leave it” </li></ul><ul><li> Buford, Bill (1955). The Family. New York: Granta Books </li></ul><ul><li>Detached - “mall orphans” </li></ul><ul><li>Parental substance use </li></ul><ul><li>Low affection/stability </li></ul><ul><li>No Parental Monitoring </li></ul>
  5. 5. <ul><li>“ Schools are better at pulling weeds than at planting flowers” </li></ul><ul><li>Eisner, E. (1990). Who Decides What Schools Teach? Phi Delta Kappan 71: 523-526. </li></ul><ul><li>Islands of stability or arenas for battle? </li></ul><ul><li>Negative school climate </li></ul><ul><li>Traumatic experiences </li></ul><ul><li>Rejection/isolation/exclusion/alienation </li></ul>
  6. 6. <ul><li>“ Every citizen shares the responsibility of </li></ul><ul><li>creating communities in which </li></ul><ul><li>all youth can thrive and grow.” </li></ul><ul><li>Seita, J.R. & Brendtro, L.K. (2005). Kids who outwit adults. </li></ul><ul><li>Complacent/permissive norms </li></ul><ul><li>Drug availability </li></ul><ul><li>Lack of neighborhood attachment </li></ul><ul><li>Low socioeconomic status </li></ul>
  7. 7. <ul><li>“ 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” </li></ul><ul><li> Sean, Maguire, Will Hunting’s therapist, Good Will Hunting </li></ul><ul><li>Peer influence: a powerful social need </li></ul><ul><li>Youth increase freedom from adult authority </li></ul>
  8. 8. Rules of Engagement <ul><li>The Distrust Lens </li></ul><ul><li>“ Do unto others” </li></ul><ul><li> vs. </li></ul><ul><li> “ tit for tat” </li></ul><ul><li>Private Logic </li></ul><ul><li>I am…. </li></ul><ul><li>Other people are… </li></ul><ul><li>The world is…. </li></ul><ul><li>Therefore I am…. </li></ul><ul><li>Flight/Fight/Fool </li></ul>“ 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”
  9. 9. <ul><li>“ Adolescents need help from therapists in FINDING EXIT STRATEGIES from their problems that keep intact their sense of dignity” </li></ul>
  10. 10. Questions Teenagers Hate <ul><li>“ How does that make you feel?” </li></ul><ul><li>“ Do you think that’s such a good idea?” </li></ul><ul><li>“ Why do you think you did that?” </li></ul>
  11. 11. How We End Up NOT Helping <ul><li>Thinking that CREDIBILITY = LIKEABILITY or TRUSTWORTHINESS </li></ul><ul><li>Soliciting the adolescent’s APPROVAL </li></ul><ul><li>Presenting oneself as too helpful </li></ul><ul><li>Being too careful: THINK CANDOR AND CONNECTION </li></ul><ul><li>Trying to mask the fact that you’re stumped </li></ul><ul><li>Trying to exert control over the therapeutic process </li></ul>
  12. 12. Continuum of Use Abuser Prevention Intervention Treatment Regular User Recreation User Substance Dependent Non-User Experimental User
  13. 13. 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
  14. 14. Signs of Drug Use <ul><li>Negative changes in schoolwork; missing school or declining grades </li></ul><ul><li>Increased secrecy about possessions of activities </li></ul><ul><li>Use of incense, room deodorant or perfume to hide smoke or chemical odors </li></ul><ul><li>Subtle changes in conversation with friends, e.g., more secretive, using “coded” language </li></ul><ul><li>New friends </li></ul><ul><li>Change in clothing choices – new fascination with clothes that highlight drug use </li></ul><ul><li>Increase in borrowing money </li></ul><ul><li>Evidence of inhaling products and accessories, such as hairspray, nail polish, correction fluid, paper bags, common household products </li></ul><ul><li>Bottles of eye drops, which may be used to mask bloodshot eyes or dilated pupils </li></ul><ul><li>New use of mouthwash or breath mints to cover up the smell of alcohol </li></ul><ul><li>Missing prescription drugs – especially narcotics and mood stabilizers </li></ul><ul><li>Lack of interest in personal appearance </li></ul>
  15. 15. Consequences Traffic Accidents Physical/Mental Consequences Developmental Problems Juvenile Crime School-Related Problems Risky Sexual Behavior Delinquent Behavior Future Use Disorder Adolescent Substance Use
  16. 16. Treatment Setting Partial Hospitalization In-patient Hospitalization Long-Term Residential Intensive Outpatient Outpatient Insurance & Managed Care Issues
  17. 17. <ul><li>Cognitive-Behavioral </li></ul><ul><li>Problem-Solving </li></ul><ul><li>Self-Monitoring </li></ul><ul><li>Goal Setting </li></ul><ul><li>Decision Making Skills </li></ul><ul><li>Family-Based </li></ul><ul><li>Behavioral Approach </li></ul><ul><li>Contingency Contracting </li></ul><ul><li>Family Management </li></ul><ul><li>Parenting Strategies </li></ul><ul><li>Communication Training </li></ul><ul><li>Strategic and Structural </li></ul><ul><li>Symptoms of the Family </li></ul><ul><li>Restructuring Problematic </li></ul><ul><li>Relationships </li></ul><ul><li>Integrative Models </li></ul><ul><li>Ecosystem Model </li></ul>Effective Therapeutic Approaches
  18. 18. Resources <ul><li>DiClemente, C.C. (2003). Addiction and change: How addictions develop and addicted people recover. New York: The Guilford Press. </li></ul><ul><li>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. </li></ul><ul><li>Sampl, S & Kadden, R. (2001) Motivational enhancement and behavioral therapy for adolescent cannabis users: 5 sessions. Retrieved June 1, 2007 from . </li></ul><ul><li>Seita, J.R. & Brendtro, L.K. (2005). Kids who outwit adults. </li></ul><ul><li>Bloomington, ID: National Education Services. </li></ul><ul><li>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. </li></ul>
  19. 19. Adolescents Clinical Practice with Addictive Disorders Renee Hillsman Tamara Robinson Tracy Tarbutton Tammy Wilbanks