BBC: Addiction – Afghanistan’s Secret Shame
Does drug treatment really work?
It is encouraging that most interventions are effective. Large-scale studies demonstrated efficacy in terms of drug use reduction, criminality, and improved overall functioning. A very important aspect of treatment is the attitude of treating clinicians. Dealing with adolescents who have abused drugs creates special challenges and strong reactions even from treating providers, which can make treatment difficult at the outset. For the adolescent, this is particularly difficult, as engagement in treatment is significantly more erratic and dictated by outside forces.
The Cannabis Youth Treatment study evaluated then effectiveness and cost-effectiveness of five short-term outpatient interventions for adolescents who used cannabis.
Treatment included Motivational Enhancement Therapy, Cognitive Behavioral Therapy (see Question 86), family education and therapy components (Family Support Network), an adolescent community reinforcement approach, and Multidimensional Family Therapy. Six hundred cannabis users also had other substance use, legal issues, and family issues. All five interventions demonstrated significant effects by decreasing drug use. The most cost-effective interventions were Motivational Enhancement Therapy, Cognitive Behavioral Therapy, and the adolescent community reinforcement approach.
In 2009, another study large study demonstrated efficacy of treatment of substance abuse among adolescents with ADHD. This is very encouraging, as the study involved screening of 1334 youngsters, of whom 300 were included in the study. The study covered 11 sites across the country.
To make the study as authentic as possible, it addressed the need to include as many individuals who are usually in community settings as possible in addition to those individuals who were only seen in hospital and study settings. As parents know, it is particularly challenging for adolescents to get engaged and be retained in treatment. Compliance of individuals in this study proved to be excellent-even better than those in the Cannabis Youth Treatment study. Because parents have expressed concern that stimulants can be abused, the Osmotic Release Oral System (OROS) methylphenidate (Concerta) was chosen to be used in this study because it is proven to have a good safety profile with a low abuse potential. Emergent side effects are usually mild and transient.
Melissa’s comment:
I am more hopeful for my child. It’s been difficult to even find help for my daughter. I don’t know anything about drugs, or at least I didn’t before we all got help. The professionals gave me options and, of course, I have done my own reading.
There are treatments that specifically address the needs of my child and at the same time, help us to cope with her problems.
A very important aspect of treatment is the attitude of treating clinicians.
What is the goal of treating my son?
The goal is achieving and maintaining abstinence from drug use. Risk factors are identified, and areas of concern in psychopathology, social skills, family functioning, academic and school functioning, and involvement in prosocial activities stress the multidimensional approach to treatment. Treatment is therefore aimed at improving overall psychosocial functioning in addition to resolution of symptoms. It is important to assist him in fulfilling his developmental roles and expectations. As treatment can be on a longer term, his needs have to be met in the least restrictive level based on need.
What are the features of treatment facilities that I should look for?
Characteristics of treatment facilities should be intensive and sufficient enough to achieve changes in attitude and behavior; the duration of treatment depends on the severity of problems. There are ways to engage adolescents and retain them in treatment. Aftercare follow-up should be provided; this serves as a means to further help adolescents in applying learned skills once they are back in the real world. This also allows for extending the duration of treatment to support longer term sobriety. The program should be as comprehensive as possible and target psychosocial dysfunction in multiple areas. This includes treating coexisting psychiatric disorders; addressing vocational and educational needs; and providing recreational/leisure time activities, birth control services, and information about substance use/medical issues, particularly HIV/AIDS. In a number of situations, this may initially be the reason to hook youths into treatment. Facilities should also be sensitive to cultural issues; there are certain challenges that are particularly important to certain groups (Hispanics, Asian, African Americans, people from the Caribbean, those with issues of religion and spirituality, Anglo Saxons, etc.). They must encourage family involvement, which is a key component, especially with adolescents. I emphasize that parents need to be involved and know what is going on with their children’s treatment, as not knowing what is happening can be used to undermine the treatment.
Parents should form part of the individualized Relapse Prevention Plan that will be developed during treatment. Parents should feel at ease so that monitoring and checking their kids should come as naturally as possible. Lastly, facilities should have access to social link to additional services, especially during the aftercare planning.
Once an addict, always an addict. Is there any truth to this statement?
There is truth to this, which can be viewed as a double-edged sword. Some can view this in a negative way such that no recovery is possible. In order to be helpful in maintaining sobriety, one must believe recovery is possible. This is a reminder that individuals need to be vigilant and always on guard for any early relapse signs so that use or a full-blown relapse can be avoided. It is also important that following treatment, parents continue to be part of their child’s sobriety through constant monitoring for any recurrence or early warning signs, which parents should have learned during their child’s treatment.
Are there other things issues that should be addressed?
While medication has a role in treatment, it must be combined with counseling and skill building. This is particularly important as your child starts to hang out with his or her friends again, especially when it comes to learning to assert oneself. It is likely that he or she will have difficulty avoiding those who smoke weed or use drugs. Adolescents will need to be able to refuse drugs if offered, and even assert themselves to their friends and asking them to respect their sobriety by not using in their presence. Lack of problem solving, communication and interpersonal skills, and self esteem are, by themselves, identified as triggers for drug use that can be improved to lessen the likelihood of relapse. Ways to improve some of these skills are described in manuals or how-to books, though of course, improving these skills is facilitated by trained counselors. High-risk situations (situations that increase the likelihood of drug use) can be rehearsed in role plays so that ways to deal with these situations can be anticipated.
