Key experts were asked to identify effective treatment approaches and methods which address the major issues of youth with substance use problems. Approaches and methods were explored in relation to the following areas of need:
Substance abuse impacts directly and indirectly on the health of users, although the substance abuse literature primarily addresses long-term effects on adults. Health impacts vary according to the substances used, dose, frequency and duration of use, manner of (substance) administration or results of use.
Health-related problems associated with alcohol/drug use in youth and adults (summarized by Spooner et al., 1996) include:
An Australian study (English and D'Arcy cited in Spooner et al., 1996) found that 18.3% of all deaths in Australia (1992) among youth (15 - 19 ) were substance abuse related. Alcohol abuse was related to both road accidents and suicide. People who are heavily involved in substance abuse during adolescence have five times the mortality rate during early adulthood in comparison with those who are not. However, many of the additional health effects of substance abuse occur after years of regular use.
Key experts identified the following approaches to addressing youth health issues while in treatment. These include:
We use a broad screening tool that identifies eating disorders and (other) mental health issues.
There's a medical assessment prior to starting treatment -many of them are on medication - they are taken to appointments (i.e. nutritionist, physician, allergist, psychologist).
Health issues usually have been approached by an educational/behavioural approaches, that makes sense for a healthy lifestyle. For example, protected sex, maintain health, eat, sleep and exercise.
There is a strong association between substance use and mental health disorders. Key experts were asked to identify treatment approaches and methods which effectively address issues related to mental health. In most cases, recommendations for best practices were directed toward youth with less serious disorders (lack of confidence, poor self-esteem).
Although there was a range of responses to this question, there was consensus on only one approach - that the optimal method of addressing personal issues is a skill-building approach which supports the development of positive identity and enhanced self-esteem. Key experts defined skill building as being:
There appears to be a strong association between substance use problems and problematic family relationships.
In a study of 1,483 youth (ages 12-19) who had attended treatment programs in the United States, 73% said that they used substances to handle or escape family problems, 54% to "belong with friends" (Bergmann, 1995:455). A significant proportion of these youth came from families described as dysfunctional; 24% reported physical abuse and 38% parental (father) substance abuse.
Key experts stressed the importance of incorporating families in treatment through a variety of means, including family support, family therapy and parent education. The recommended structures for involving families varied. They included:
The importance of involving elders and the family was stressed for Aboriginal youth. A smaller group of respondents identified the importance of using peer groups and interactions to support exploration of interpersonal issues (See Section 15.2).
We promote learning from peers and use peer groups for modelling and practicing skills.
Relapse prevention and management is seen by key experts as an integral part of treatment. Six elements of best practices supporting relapse management or prevention were identified:
Downplay relapse - don't make it look like a loss, it is part of cleaning up. Abstinence may not be the only route they're going. If they want to go completely clean, go through what happened when they can learn from it.
The development (with the client) of a treatment plan and a set of personal goals, small, short-term achievable goals which are visible to the client and which support feelings of success;
|Areas of Best Practice||Key Expert Themes|
|Physical health issues||
|Personal (mental) health, self-esteem, developmental issues||
A focussed review of the treatment literature broadly supports the opinions of key experts, although there is an acknowledgment that "research into treatment methods needs to be increased considerably before the efficiency of one procedure over another can be identified and given recognition" (Spooner et al., 1996:6 - 14).
Catalano et al. (1990 - 1991) noted that youth post-treatment relapse rates are high (35% to 85%) and the process of relapse is variable.
Lapses may be infrequent single uses or infrequent episodes of heavy use for several days. Neither invariably lead to uncontrolled, compulsive use. Some suggest that these lapses may even constitute positive learning experiences (Brownell et al., and Marlatt and Gorden cited in Catalano et al., 1991:1105).
Catalano et al. (1990 - 1991) review of treatment outcome research associated the following elements with treatment success:
Bergmann et al.'s (1995) post-treatment study of 1,483 youth in more than 30 in-patient and residential treatment programs in North America found that youth with the poorest outcomes at six months post-treatment had the fewest relapse coping strategies and skills.
Emrich (as cited in Bergmann et al. 1995) found that continued therapy and aftercare following completion of in-patient treatment have been predictive of successful treatment outcome. Family support in the recovery process was also strongly associated with post-treatment success. However, Bergmann et al. (1995) noted that family involvement in treatment must be individualized to meet client needs:
Family participation, in general, is a very important predictor of positive outcome. A structured "one-size-fits-all" family program, however, will never realize its potential effect on treatment outcome. Among certain subgroups of males, the primary family issues on which to focus should revolve around parental substance use, issues of abuse, and establishing behavioural parameters while living at home to facilitate recovery. For females, the family program may be most effective if it is centred around issues of self-esteem, anxiety and providing a supportive environment for recovery. (Bergmann et al., 1995:469)
In a meta-analysis and literature review, Stanton and Shadish (as cited in Weinberg et al., 1998) supported the superiority of family therapy (as opposed to family psychoeducation or support groups) for youth in treatment. Joanning et al. (1992) noted the effectiveness of structural-strategic family therapy (SSFT) which involves all family members, whether or not they are involved in treatment. Other integrated models (multi-dimensional family therapy) have also demonstrated treatment success. Azrin et al., (1994), in a controlled group study, found that cognitive-behavioural approaches (including therapist modelling, rehearsal, self-recording and written therapy assignments, stimulus and urge control and social control/contracting) were associated with post-treatment success.
Although Spooner et al. (1996) acknowledged a lack of research defining effective treatments, on the basis of a review of 17 studies, they concluded that:
Treatment strategies tend to favour family therapy, skills training and cognitive-behavioural therapy, all of which appear to have some effect on treatment outcome. With family therapy, however, not all adolescents have sufficient support from their families to facilitate treatment outcome, thus diminishing the value of this form of treatment for some adolescents. (Spooner et al., 1996:6 - 14)