Tailoring Treatment to Adolescents

As noted above, treatment for adolescents with substance use disorders works best when it is provided and implemented with their particular needs and concerns in mind. In this TIP, the Revision Panel used a broad definition of treatment. Treatment is defined as those activities that might be undertaken to deal with problem(s) associated with substance involvement and with individuals manifesting a substance use disorder . Although the Panel recognizes that primary or secondary prevention of substance use is included in expanded definitions of treatment, the Panel limited the continuum of interventions to what is traditionally viewed as acute intervention, rehabilitation, and maintenance. The elements of the continuum primarily reflect the treatment philosophies of providers, with less emphasis on settings and modalities.

Regardless of which specific model is used in treating young people (e.g., 12-Step-based programs, family therapy, therapeutic communities), there are several points to remember when providing treatment for adolescents.

Adolescents must be approached differently than adults because of their unique developmental issues, differences in their values and belief systems, and unique environmental considerations (e.g., strong peer influences).
Not all adolescents who use substances are, or will become, dependent. Programs and counselors must be careful not to prematurely diagnose or label adolescents or otherwise pressure them to accept that they have a disease: This may do more harm than good in the long run.
Programs should be developed to take into account the different developmental needs based on the age of the adolescent; younger adolescents have different needs than older adolescents.
Some delay in normal cognitive and social-emotional development is often associated with substance use during the adolescent period (Newcomb and Bentler, 1989). Treatment for these adolescents should identify such delays and their connections to academic performance, self-esteem, and social considerations.
In addition to age, treatment for adolescents must also take into account gender, ethnicity, disability status, stage of readiness to change, and cultural background.
Programs should make every effort to involve the adolescent client's family because of its possible role in the origins of the problem and its importance as an agent of change in the adolescent's environment.
Although it may be a necessity in certain geographic areas where availability of youth treatment programs is limited, using adult programs for treating adolescents is ill-advised. If this must occur, it should be done only with great caution and with alertness to the inherent complications that may threaten effective treatment for these young people.
Many adolescents have explicitly or implicitly been coerced into attending treatment. However, coercive pressure to seek treatment is not readily conducive to the behavior change process. Consequently, treatment providers must be sensitive to motivational barriers to change at the outset of intervention. There are several strategies suggested by Miller and Rollnick for encouraging reluctant clients to consider behavioral change (Miller and Rollnick, 1991).

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