The document describes a treatment program that provides methadone maintenance treatment and family therapy to adolescents diagnosed with heroin abuse or dependence. The program aims to help adolescents cease heroin use and reduce relapse risk by treating the individual and family system concurrently for a minimum of one year. Adolescents receive methadone treatment, individual therapy, family therapy, and psychoeducation. Failure to participate in therapy or misuse of methadone may result in temporary cessation of methadone treatment. The program utilizes a brief strategic family therapy model to improve family relationships and support systems.

1. The Methadone and Family Therapy Clinic for
Adolescents

2.  Providemethadone maintenance treatment
(MMT) and concurrent family oriented
psychotherapy services and psychoeducation
to adolescents with DSM-IV-TR diagnosed
heroin abuse/dependence
 Yes, you read correctly…adolescents.

3. Provide early, comprehensive treatment to
heroin dependent/abusing adolescents in an
effort to cease future heroin usage as well as
reduce the likelihood of complications
associated with heroin use. Focus is placed
upon the family unit.

4.  Stanton, et al. (1978), proposed that the heroin’s chronic relapse
nature is explainable from the viewpoint of family system’s
theory
 Estimated yearly cost of untreated addiction of opiates – 20
billion (2)
 Estimated 1 million persons for opiate addiction (including
heroin) (2)
 Provide early methadone treatment for adolescents with heroin
abuse/dependence to aid these persons in ceasing heroin usage
 Provide psychotherapy services to adolescents
 “…families of young adult heroin addicts tend to differ from
normal families or other dysfunctional families in a number of
ways” (10)
 There is a relationship between family functioning and drug
abuse (11)
 Research indicates family dysfunction after substance abuse
treatment completion can lead to relapse (11)

5.  Methadone treatment is beneficial, however, many individuals do not
remain in active methadone treatment for the minimum period of one
year – most of these individuals will replapse (2)
 It is not uncommon for individuals to continue using upon treatment
admission to methadone maintenance programs (2)
 Financially, untreated opiate addicts rack up about $20 billion (2)
 Methadone maintenance is a valid treatment approach (2)
 Estimated cost of methadone treatment per day is $13 (5)
 Single doses of methadone can last up to 36 hours depending on dose of
course – significantly longer time period than heroin (7)
 There is also possibility for addiction to methadone, which psychotherapy
will help to address this potential issue
 Methadone is low cost compared to other potential drug treatments (8)
 Methadone considered to be choice treatment for opiate addiction (9)
 Detoxification from methadone relapse rates are quite high ranging
anywhere from 50-90% one year after treatment – hence inclusion of
mandatory psychotherapy (9)
 OVERALL: methadone will stabilize the client for psychotherapy

6.  Minimum duration of treatment as indicated by
studies is 12 months continuous use (2)
 Average daily dosage range 60 to 120 mg (2)
 Noteworthy potential benefits are not just
beneficial to society but also the individual (2)
 Reduction/ceasation of injectable drug use
 Common diseases acquired through injected drugs
include: HIV, STDs, hepatitis C/B, bacterial
infections, etc (2)
 Reduction in overdose risk
 Reduction in mortality risk
 Family stability improvements
 Possible reduction in criminal activity

7.  Outpatient Treatment Program
 1 Year minimum treatment duration
 Treatment must be concurrent:
psychotherapy in conjunction with
methadone maintenance
 Services provided by substance abuse experts
as well as family therapy trained
psychotherapists
 Weekly drug test screenings

8.  The treatment program will be broken down into
3 phases (adapted in part from source 3)
 Phase 1: Stabilization
 Consists of recognition of need for drug abstinence,
initial administration of methadone, struggles with
continued heroin use, psychotherapy to address
struggles, etc.
 Minimum duration of 8 weeks
 Phase 2: Transition
 Targeted at learning about and the management of
addiction process (including withdrawal), motivation
development, increased focus on family infrastructure
and client’s role in family
 Phase 3: Community
 Focus upon development of prosocial community and
family connections

9.  Methadone Maintenance treatment
 Mandatory weekly physician appointment
 Methadone to be administered on a daily in-
person basis by a licensed medical professional
with the proper credentials
 Substance abuse/dependence group
therapy, minimum of 1 hour per week
 Therapy Services
 Individual therapy, minimum of 1 hour per week
 Family therapy, minimum of 1 hour per week
 Psychoeducation, minimum of 1 hour per week

10.  Topicsinclude, but are not limited to
methadone treatment, substance abuse, role
of the family, etc. Specific topic examples
can be (partially adapted from source 3):
 Treatment regulations for methadone
 Problem solving
 Relapse prevention
 The addiction cycle
 Owning one’s addiction
 Blood born pathogens
 Stress management
 Relationship boundaries

11.  Potential clients can be referred via
parent(s), physician, agency, or self-referred
providing parental consent is acquired
 Potential clients will complete a diagnostic
evaluation
 Family involvement/caregiver
involvement, at least one family
member/caregiver must be actively engaged
in the treatment process with the adolescent

12.  Family therapy model
 Focus primarily – Brief Strategic Family Therapy
 Robbins, et al. (2011), found when compared to
treatment as usual community based programs that
this brief approach yields higher retainment of
adolescents and improved family functioning according
to parents
 Is an effective model for adolescent substance abuse
(12)
 Primary aim is to “reduce adolescent behavior
problems by improving within-family relationships
between family members and other important systems
that influence the youth’s behavior…” (12)
 Support exists for effectiveness in minority families as
well (12)

13.  Parental consent/child assent
 Adolescents ages 14 to 19
 Failure to attend 2 consecutive
psychotherapy sessions (whether
family, individual, or psychoeducational) will
result in temporary cessation of methadone
administration, after one week of continuous
attendance for psychotherapy, methadone
treatment will resume.

14.  Automatic termination upon age of 19
(referred/transferred to another program)
 Failure to sufficiently attend psychotherapy
 Misuse of methadone (sharing, selling, etc)
 Complete lack of caregiver/family
involvement – treatment process targets
family involvement, therefore, at least one
member must be actively engaged in the
treatment process with the adolescent

15.  Methadone maintenance is effective to a
degree, however, it is not a comprehensive
treatment approach by itself. It may help
wean the person off of heroin, however,
there is the potential for long term use.
Methadone maintenance is a temporary
bridge to psychotherapeutic treatment.
Family based therapy will aid in repairing
dysfunctions in the family with emphasis on
the client.

16.  (2) Center for Disease Control. (2002). Methadone maintenance treatment.
http://www.cdc.gov/idu/facts/MethadoneFin.pdf
 (9) Craig, R.J. & Olson, R.E. (2004). Predicting methadone maintenance treatment outcomes using
the addiction severity index and the mmpi-2 content scales (negative treatment indicators and
cynism scales). The American Journal of Drug and Alcohol Abuse, 30, 823-839.
 (8) Eder, H., & et al. (2005). Comparative study of the effectiveness of slow-release morphine and
methadone for opioid maintenance therapy. Society for the Study of Addiction, 100, 1101-1109.
 (5) Methadoneclinic.com. (unknown). Methadone treatment approaches. http://www.methadone-
clinic.com/treatments.php
 (3) New Brunswick Addiction Services. (2009). Methadone maintenance treatment policies and
procedures. http://www.gnb.ca/0378/pdf/methadone_policies-e.pdf
 (12) Robbins, M.S., & et al., 2011). Brief strategic family therapy versus treatment as usual:
results of a multisite randomized trial for substance using adolescents. Journal of Consulting and
Clinical Psychology, 6, 713-727.
 (11) Rowe, C.L. (2012). Family therapy for drug abuse: review and updates 2003-2010. Journal of
Marital and Family Therapy, 38, 59-81.
 (1) Stanton, M.D., et al. (1978). Heroin addiction as a family phenomenon: a new conceptual
model. American Journal of Drug and Alcohol Abuse, 5, 125-150.
 (7) University of Maryland. (2005). Methadone.
http://www.cesar.umd.edu/cesar/drugs/methadone.asp
 (10) Volk, R.J., Edwards, D.W., Lewis, R.A., & Sprenkle, D.H. (1989). Family systems of adolescent
substance abusers. Family Relations, 38, 266-272.