Treatment and Rehabilitation for Youth with Substance Use Problems

11. Treatment Principles and Values

11.1 Treatment Principles and Values: Key Expert Perspectives

Key experts identified 12 philosophical principles or operating values which they believe underlie successful youth treatment. Some of these have already been addressed (Section 10.0). They were described as being applicable to all youth in treatment.

Table 8: Treatment Principles and Values: Key Expert Perspectives

Principle	Key Expert Comments
1. Treatment planning and delivery should be highly individualized, client-centred and client-directed. Tools like the "Stages of Change" model and motivational interviewing support this approach.	• Go where, start where and respect where youth are at. • Treatment must be designed to meet individual treatment plans and to support residents to achieve goals.
2. While there is sometimes a struggle between the "harm reduction" and abstinence models, the harm reduction approach is most effective with and responsive to youth needs and stage of life. Teaching youth to "keep themselves safe" is the "cornerstone" of this approach.	• Keep the kids as safe as possible in terms of harm reduction. • If they are going to use, teach them how they can use safely. • Most individuals mature out of addiction. Provider's job is to ensure they come out of their addiction unharmed and intact.
3. Treatment should offer and be based on choice. A multi-dimensional, eclectic model is preferable to one which is based on an uni-dimensional treatment approach.	• Treatment providers must be cognizant of all approaches available - and move to one or another, if needed. • Offer a menu of opportunities.
4. Treatment should consider youths within a system - of family, peers, community and others (school teachers, counsellors and correctional staff).	• Kids must be linked to all members of their community, for example, elders. • Listen very carefully to what the client says about the community and who they feel the workers in the community are that they respect.
5. The climate of treatment should be caring, respectful, safe and open.	• In our program, there is no issue that cannot be brought to the table. • Give them a sense of community, living in a safe place, offering unconditional love. • Respect and treat them as human beings.
6. Wherever feasible, families should play an important part in treatment. If there is no current "stable" family, a family of "significant" adults should be created.	• Family has to be involved, and if youth has no family, you create one - a "family of choice." People from the community are chosen by youth to be family.
7. Treatment needs to consider the youths' spiritual, mental, emotional and physical self and needs.	• Must give these kids spiritual guidance. • Have them attend sweat lodge and sundance traditional ceremonies.
8. Programs should espouse the principle of "least intrusive treatment" as a first option (based on appropriate assessment and treatment matching).	• A mistake is to impose a heavy-handed, highly intensive program at the early stage.
9. Staff must respect and value youth in treatment, trusting in their basic motivation and value.	• Kids are okay, they may screw it up, but they'll work it out. • Help youth create a "thicker" story of themselves - that they are valuable, will get a job. • Show other ways of looking at self.
10. Wherever possible, learning should be experiential and be conducted in a variety of venues.	• Use activity-based treatment (for example, martial arts and sports) in community, exploring their interests and pushing them further to develop their interests.
11. Treatment should focus on positives, not deficits in the youth's life. The "Resiliency Model" is a useful approach.	• Focus on positives, not what needs fixing. Identify, focus and build on youth's positive strengths. • Avoid deficit thinking - build on skills already there. • Do not label as an addict - doesn't give room to grow.
12. Treatment should focus on the building of specific skills which enhance self-esteem.	• A key objective is to enhance child's competence in different aspects of his/her life that will help him/her become a good decision maker. • Provide youth with a toolbox to help them understand what they need to do for self, how (they) can make responsible decisions re: setting goals and achieving them.

11.2 Treatment Values and Philosophy: Literature Review

Spooner et al. (1996), in a comprehensive review of the literature on youth substance abuse treatment, coupled with extensive community and client consultation, identified three baseline principles of treatment directed towards youth. In the view of Spooner and colleagues, effective programs should:

• Be holistic and comprehensive. Address a variety of problems (e.g. practical problems, childhood abuse) with a range of strategies (counselling, skill training, support and referral);

• Encompass harm reduction. While abstinence is still a useful goal, most youth are unwilling to change their lives fundamentally; therefore, long-term abstinence is likely to be unrealistic. Even where abstinence is a goal, harm minimization strategies are required;
  
• Be appropriate for youth. Youth needs and experiences differ fundamentally from those of adults. An adult-oriented approach to treatment should be avoided.
  

Spooner and colleagues (1996) also identified other treatment principles or values, including the importance of:

• basing treatment on the developmental stages and needs of the youth;
  
• seeing treatment as a process, not a series of events;
  
• understanding that the use of substances has a function for youth. Training in skills development and coping strategies should address these needs;
  
• involving youth in the development, implementation and review of program rules and boundaries;
  
• avoiding negative labels for youth in treatment;
  
• designing a collaborative treatment system which takes pressure off youth to identify and access a range of resources for themselves.

Many of these summary comments are reflected in the best practices principles described (Section 11.1) by key experts.

A review of outcome-based research by Catalano et al. (1990 - 1991) supports the value of family support in treatment and the efficacy of skills teaching. A literature review on adolescent alcohol and drug treatment effectiveness by Faist and Harvey-Jansen (1994) also identified the following approaches which support the principles outlined above. This study stressed the importance of:

• flexible treatment;
  
• formalized assessments resulting in appropriate client/treatment matching;
  
• family involvement in therapy;
  
• the offering of a range of ancillary support services.
  

A broader study by Chinman and Linney (1998) identified the "empowerment model" as one that may be useful in improving youth outcomes in a variety of prevention and intervention settings. The empowerment model includes many of the optimal treatment values identified by key experts such as:

• a focus on youth strengths, not deficits;
  
• a collaborative (client-centred) approach to prevention and intervention;
• a focus on skill development which supports self-correction;
  
• the use of a developmental theory of change (new insights and abilities lead to new awareness which leads to new choices);
  
• the valuing of crisis and conflict as impetus for action and change;
  
• the use of empowerment language;
  
• the presence of supportive channels (activities, community participation) to support.