~ By Colette
In April of this year, we published an issue titled “Adolescent Substance Abuse: Prevention, Intervention, and Recovery.” Having a history of conducting research on drug and alcohol prevention, this is a topic that remains near to our hearts. However, as I was reading the current research and working to put this issue together, I found myself captivated by the research on teen substance abuse intervention and―most especially―recovery.
Since publishing that issue, our staff has remained intrigued by the topic of supporting teens in treatment and recovery. Early in May Brooke posted a podcast with Greg Williams about peer support in drug and alcohol recovery, and later that month we made Greg’s article “Youth in Recovery” (which he coauthored with John de Miranda) available for free download. Still we feel the need to continue exploring this important topic.
After working on our issue, I was left with many unanswered questions about how youth get into treatment programs and how we can support them to facilitate success. Since research is not available to answer those questions, I looked elsewhere. Fortunately, one of our Advisory Board members, Crystal Morrison, works with youth in a drug treatment program in Houston, Texas, and she agreed to provide her perceptions and experiences based on her work. Hopefully, the interview below will generate thought and discussion on how we, as caring adults, can support youth in treatment and recovery.
Colette: A recent report by CASA shows that almost half of the youth who enter treatment are referred by the criminal justice system. However, 16.5% refer themselves, 11.2% are referred by their school, and another 12% by another community referral source. Of those youth not mandated to seek treatment, from your experience, what are the primary motivating factors which finally bring them in the door?
Crystal: Two reasons immediately come to mind. When teens feel scared, they sometimes ask for help. In my years of doing initial assessments here at The Council on Alcohol and Drugs—Houston, I have met quite a few adolescents who have used drugs or alcohol to the point where they were not able to stop or received consequences they never anticipated. These events really scared them and they asked their parents or someone safe for help.
The other reason is that they may be actively seeking a way to remove consequences imposed on them by parents or schools. Here at The Council, we offer a high risk behavior class and give teens a certificate of completion they can turn in to their school. Sometimes, students have agreed to attend this class and have actively participated to earn that certificate. I call these “golden moments,” times when we as caregivers have a small window of opportunity to act on behalf of a willing adolescent who is asking for help, for whatever reason. Many times, parents or school administrators fail to take action during these golden moments in hopes that a smaller consequence will get the adolescent through what they hope is a phase. I caution adults not to miss these opportunities. The sooner parents and schools take action, the more likely their actions will have an impact on teens. The credibility parents and schools earn when they act swiftly is invaluable. Many published research studies have indicated that young people who start drinking or using drugs in their teens are more likely to become dependent during their lives than if they had waited until age 21. This information scientifically justifies getting involved in delaying adolescent use and hopefully eases fears about overreacting too soon.
Colette: As youth are going through treatment, what types of supports do they need from their parents to help them they stay in treatment?
Crystal: During treatment, adults can be supportive by consistently making contact with youth and attending all family participation opportunities available. Building their own recovery program is vital. We have seen that when parents attend their own recovery meetings such as parent support groups or Al-Anon, they begin to understand how their behavior exacerbated their child’s negative behavior. Making changes in their own behavior and learning recovery principles increases the chances of successfully altering the entire family system thus increasing the adolescent’s recovery chances. When youth struggle in treatment, it helps if parents can say they are working hard in their own program too.
Colette: When youth finish treatment, what is the best type of environment for them? How can parents and other adults help create this environment?
Crystal: Consistent love and limits has been the mantra I teach parents and supporters of adolescents in and out of treatment. So often, I’ve watched parents fail to continue the behavior modification programs that teens learn to follow while in treatment. This is a set-up for failure, so much so that I have nicknamed the 30 days post-treatment the “Kamikaze Period.” Adolescents graduating from treatment crash and burn upon return home if a support system is not in place. Sometimes parents hope the behavior is “fixed” and may come to believe this when they see how well their children do while in treatment. However, it is vital that parents attempt to learn how to create a similar structure for the adolescent to transition in to upon return to home and school. The structure provided by treatment makes adolescents feel safe. They learn how to succeed with this support. Self-trust returns as they make better decisions, partly because their choices are limited while in treatment. When they go home, their old environments may be laden with stress and triggers. Without structure and support in place at home or school, adolescents quickly return to impulsive decision making. Parents can remedy this by having a family contract in place that includes rewards and consequences for new behavior, such as attending 12-step support meetings and staying sober. Family contracts outline what recovering adolescents will lose if they return to poor choices. Thus, the structure they flourished in while in treatment continues at home.
Colette: How can parents support their teen’s recovery?
Crystal: Recovery must be more fun than using drugs or alcohol. Parents can support their teen’s recovery by making sure their needs for fun and socialization are met by enrolling them in an adolescent support group. Many 12-step programs host “young people’s” meetings. These can be located by asking their counselor for a referral or by calling the local intergroup office of Alcoholics Anonymous. At first, teens may resist attending groups such as these due to poor social skills or a desire to return to old friends. It is vital for parents to insist and require them to attend. Attendance at recovery meetings can be included and reinforced in their family contract. Usually, within a few weeks, these groups become self-reinforcing and teens will want to attend more. This may require a lot of driving to and from meetings, coffees, dances, etc. If these are sober functions, the effort is worth it!
Colette: I know you are very passionate about Alternative Peer Groups. Can you briefly explain what Alternative Peer Groups are and why they are necessary?
Crystal: The Alternative Peer Group (APG) model encompasses the necessary ingredients for successful treatment of adolescents struggling with substance abuse or drug addictions. This model was created in Houston, Texas about forty years ago. Alternative Peer Groups were created to address the emotional, psychological, spiritual, and social needs of teens struggling with substance abuse. The APG model integrates important peer connections with clinical practice through intervention, support, education, and parent involvement. The foundation of this model is the basic assumption that peer relationships, much like the ones that initiate and support drug and alcohol use, are necessary to facilitate recovery. The ultimate goal is to remove the teen from a negatively pressured environment and offer them a new group of friends that exert positive peer pressure and provide support for the necessary changes they need to make in order to recover.
Several key factors inherent in the APG model contribute to the recovering adolescent’s success. The first is the fun factor. While enrolled in an APG, the adolescent still gets to be a kid. They are encouraged to learn how to have as much sober fun as possible within healthy boundaries. Alternative Peer Groups strive to develop healthy decision making through fun and challenging activities. The APG incorporates a variety of weekday and weekend social activities into the recovery process so that adolescents can learn how to have fun while remaining sober. Recovery has to be as much fun if not more than using drugs in order to get adolescents “hooked.” In this model, APG faculty and youth staff reward adolescents for sobriety, honesty, and integrity with fun, sober activities. Staff create safe, loving environments while demanding accountability and enforcing consequences. In this way, the APG environment offers a healthy balance of love and limits.
Colette: Thank you, Crystal, for helping me understand these important strategies for supporting youth in treatment and recovery.
Crystal Morrison, is the Director of Youth Services and Clinical Development at the Council on Alcohol and Drugs—Houston. Crystal has been working with adolescents and adults who struggle with alcohol and drug abuse for the past 20 years. Her mission is to provide holistic therapy that addresses a teen’s cognitive, emotional, physical, social, and spiritual development – and to make sobriety as fun as possible for her clients.
National Center on Addiction and Substance Abuse at Columbia University. (2011). Adolescent Substance Use: America’s #1 Public Health Problem. Author. Downloaded June 29, 2011 from http://www.casacolumbia.org/upload/2011/20110629adolescentsubstanceuse.pdf