Successful substance-abuse treatment might seem like an either/or proposition: either a client is still using drugs or alcohol or not. But that distinction rests on a number of hard-to-measure, incremental factors.
For that reason, evidence-based practices have proven particularly useful for programs serving substance-abusing young clients. “We know from research that [substance abuse recovery success] comes from working in an individualized, case-by-case manner,” says Margo Levi LCSW, Clinical Director for Huckleberry House in San Francisco. Evidence-based practices help you address those individual cases while keeping everyone under the same data-supported umbrella. Here are a few of the best-known practices for treating adolescent substance abuse, found in the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-Base Programs and Practices, or NREPP:
Partners for Change Outcome Management System
Partners for Change Outcome Management System allows staff to measure clients’ “therapeutic alliance,” their relationship and fit with their counselors. Youth are asked to begin each session by identifying how positively or negatively they feel about four different areas in their life:
- Personal wellbeing
- Interpersonally (family, peers)
- Socially (work, school, friendships)
- Overall (gut reaction)
And at the end of the session, they are asked to spend another two minutes to honestly rate their counselor based on their comfort with them, help with personal goals, the counselor’s treatment approach, and their overall feeling about the person.
Motivational Interviewing, or MI, helps clients understand where they are in their recovery, and what their triggers for substance use are. A counselor asks open-ended questions aimed at guiding youth through the stages of behavior change, however linear or nonlinear their path may be.
A key goal of MI is to move the youth from external to internal motivation. “We want to hear change talk from youth,” says Gale Sandoval, Certified Alcohol and Drug Counselor at Huckleberry Youth Programs’ treatment center in Marin, CA. “Not, ‘My mom is so upset,’ but, ‘I feel upset when I see the consequences of my actions.’ When youth desire change for themselves it is easier to speak to action and maintenance.” To that end, interviews are designed to move clients through a Stages of Change process:
- Pre-contemplation: Avoidance of the addiction.
- Contemplation: Acknowledging that there is a problem but still weighing pros and cons and the benefits and barriers to change.
- Preparation/Determination: Taking steps to begin changing behavior.
- Action/Willpower: Actual behavioral change, with recognition that such change is a process.
- Maintenance: Maintaining the new lifestyle.
Adolescent Community Reinforcement Approach and Assertive Continuing Care
Adolescent Community Reinforcement Approach, or ACRA, and Assertive Continuing Care, or ACC, seek to uncover the factors at each level (family, school, etc.) that contribute to and perpetuate substance use. Counseling typically starts with the two-hour "Global Appraisal of Individual Needs." Then, youth attend about ten 45- to 60-minute weekly ACRA sessions and an additional two sessions with a parent or caring adult connection in the room.
Each session covers one to two topics from a list of 19 procedures, such as problem solving, communication and anger management. Counselors take cues from their clients when selecting which procedures to cover when.
In each session the counselor and youth also agree upon a simple homework assignment, for example, attending school each day of the week. Cortney Meyer, a clinician at The H Group in Frankfort, IL, says that maintaining a positive approach is essential. “If a kid meant to abstain from substance use for 7 days but still used 5 out of those 7, we say, ‘It’s really good that you didn’t use those 2 days – what helped you do that?”
Sessions are recorded with the client’s permission, Meyer says, and counselors choose a few to submit to ACRA staff for feedback. “As positive as we’re supposed to be with the clients, [ACRA staff] use the same positive approach with us. It makes everyone more willing to positively change what they are doing.”