Learnings about the Circle of Courage (Part II Intro) of Reclaiming Youth

The authors, Larry Brendtro, Martin Brokenleg, and Steve Van Bockern, introduce Part II by introducing the history and rationale for the Circle of Courage. They start by speaking about how Native Americans have passed down from generation to generation in a verbal tradition some basic values that provide the underpinnings of developing a positive culture for youth. Often, we do not know how to do that. What does a positive peer culture mean among a culture geared toward individualism? They refer back to 15,000 years of civilization of oral tradition from Native Americans. Since the time of conquering the Native Americans through military and technological superiority, many of us believe that the native civilization has nothing to offer us. Yet it does.

To help us see how Native values are "ready made" for positive cultural changes for schools and programs (and, I believe, our general culture), the authors discuss Stanley Coopersmith's work on self-esteem. He felt that the four basic components of self-esteem are:

1. "Significance is found in the acceptance, attention, and affection of others. To lack significance is to be rejected, ignored, and not to belong." The native practice of belongingness within a clulrual milieu nurtures significance.
2. "Competence develops as one masters the environment. Success brings innate satisfaction and a sense of efficacy, while chronic failure stifles motivation." The native focus on mastery ensures the sense of competence.
3. "Power is shown in the ability to control one's behavior and gain the respect of others. Those lacking power feel helpless and without influence." Expressing independence can result in a sense of power.
4. "Virtue is worthiness judged by the values of one's culture and significant others. Without feelings of worthiness, life is not spiritually fulfilling." Generosity is a value that reflects virtue. In other words, to feel worthy, to have a sense of a spirtually fulfilling life, one can be generous.

The authors point out how the number four has a sacred meaning to Native people because it sees a person standing in a circle surrounded by the four directions.

Learnings from Reclaiming Youth Part 1, Chapter: Loss of Purpose

This chapter starts with a quote that indicates that the millions of children are not safe physically, educationally, economically, or spiritually, stating that it is the same for those who grow up in the ghetto as for those who grow up in mansions. It states that young people cannot develop a sense of value unless they can be of value to others. Instead of being able to give to others, the focus of our culture is upon selfishness, on competition instead of coperation and caring.

The first section of this chapter discusses how children no longer work to contribute to their family but to feed their desire for material goods. Because youth have more disposable income, they are vulnerable. They can buy cars to escape the influence of parents. They can buy substances to increase their excitement or decrease their stress.

The next section is about The Misery of Unimportance. In the past, all family members were necessary for each other's survival. Now, only about 25% of youth spend 3 or more hours per month giving to another person. Because they are more focused on consumption than on geniune contribution, children can feel unimportant. The authors, contrast how we value our use of time over relationships.

The last section of this chapter is about The Depersonalization of Education, in which schools have become less personal, following the trends of business because people believe that these organizations will work better if they are driven by data and cost efficiency. Fortunately, some organizations are attempting to create positive organizational cultures based on shared values.

Learnings from Reclaiming Youth at Risk: Part I, Chapter 3: Learned Irresponsibility

In this chapter, I learned about the myth of how obedience training producing responsible adults. In contrast, they paraphrase WEB Dubois, indicating that only responsibility teaches responsibility. The authors refer to Ruth Benedict, an anthropologist, who criticized our culture for excluding youth from responsibility only to blame them for being irresponsible (e.g., youth who exhibit learned helplessnes, the defiant teen, the narcissitism of an affluent generation, the negative peer subcultures of gangs). By punishing children for rebellion, they learn how to manipulate and deceive to escape authority.

This chapter provides a Profile of Discouragement: A Youth Counterculture that speaks about those who studied gang members in Bogota, Columbia. To summarize this section, these children demonstrate remarkable talents and resourcefulness in order to survive because, "given their choice between enslavement in a pseudo-home and misery with liberty in the streets," they embrace freedom. Interestingly, as William Glasser has written, one of our needs is to have freedom (as well as fun, freedom, power, and belonging). No wonder these young people choose freedom over obedience.

Another section in this chapter indicates discusses the Tyranny of Indulgence. Many children seem to get everything they want. There are a good number of adults who are permissive with their children. They get the child whatever he wants. The authors list three problems with permissiveness, indicating:

1. Self-esteem may decrease because a child does not know what is of value and what behaviors are acceptable.
2. "Delinquency may be reinforced as adults keep giving 'another chance.'"
3. Aggresion increases if permissiveness is assoiciated with adult hostility.

This section as indicates that some adults are not really permissive. They are indifferent, "care-less." In other words, this person is not interested in his role as parent, teacher, or counselor. Other indifferent adults are distracted by their own problems. Other adults gain some satisfaction from a child's out-of-control behavior.

The next section, about the Tyranny of Obedience, starts by stating that "The saga of discipline of Western civilization is a litany of futile attempts to compel the young person to obedient behavior." The authors cite how the educational system has replaced relationships with an elaborate system of rules, with formal codes of conduct, which outline what is allowable and what will be punished. The authors begin to introduce another viewpoint, that of the Native American, who do not value obedience. The authors states how this group believe that men are the same,, that no one is superior to another. In contrast, they encourage an abundant freedom that is designed to give the child sufficient opportunity to learn from experience and natural consequences. This chapter ends with the thought-provoking idea that rules are important but that why someone follows the rules is equally important. If children are forced to follow rules, the will only do so if they are policed. This implies that if children internalize responsibility, they will not require "policing."

Learnings from Part 1: Seeds of Discouragement, Chapter 2: Climates of Futility

This section opens with a quote of how troubled children are "throw-away" children. Having worked with teens and adults, I can see where this concept comes from. It seems that some people are just in the way, that it would be easier just to throw them away.

The theme of this section involves comparing the prevalent pessimism with the optimism of the pioneers in working with children.

Profile in Discouragement: An Unfriendly School

This part of this chapter, identifies four concepts, negative expectations, punitiveness, boredom, and irresponsibility. The book warns how our negative expectations can become true in how we look at children and how children respond. It talks about how Horace Mann suggested that teachers respond to difficult students like physicians who are looking to solve the challenge of a difficult case. He apparently stated that punishing these children is like the physician attacking a body part he was attempting to treat. I find it interesting that, when we discuss not punishing, people assume that the child will get out of control. Youth have little adventure so they have boredom. Children thrive in an environment of challenge and adventure. This chapter also encourages youth to be useful, to be responsible instead of irresponsible.

The chapter continues by discussing professional pessimism. They compare Floyed Starr's 1913 Creed for The Star Commonwealth for Boys: "We believe there is no such thing as a bad boy, that badness is not a normal condition but the result of misdirected energy. We believe that every boy will be good if given an opportunity in an environment of love and activity." In contrast,, the book charts the 10 Ds of Deviance in Approaches to Difficult Youth:

Theory; Problem; Typical Response
Primitive; Deviant; Blame, attack, ostracize
Folk Religion; Demonic; Chastise, exorcise, banish
Biophysical; Diseased; Diagnose, drug, hospitalize
Psyhoanalytic; Disturbed; Analyze, treat, seclude
Behavioral; Disordered; Assess, condition, time out
Correctional; Delinquent; Adjudicate, punish, incarcerate
Sociological; Deprived; Study, resocialize, assimilate
Social Work; Dysfunctional; Intake, case-manage, discharge
Educational; Disobedient; Reprimand, correct, expel
Spec Educ; Disabled; Label, remediate, segregate

The chapter continues discussing futility in the section heading Naive Personal Theories of Behavior. For example, some people take a child's behavior personally. It provides two tables illustrating attribution theory, one outlining the impact of negative personal theories and the other outlining the impact positive personal theories. Both assume that cognition leads to affect which leads to action.

The negative cognitions include demeaning labels (about child's traits), such as the child being inferior, incapable, or impotent, and blaming labels (about the child's deviance), such as disrespectful, disturbing, and indifferent. The affective result for the demeaning labels include repulsion and apathy while the affective result for the blaming labels are distress and anger. The action or resultant behavior include avoidance and neglect as a result of the demeaning labels and punishment and coercion for the blaming labels.

The impact of positive personal theories of behavior include the cognitions of esteeming labels (traits of the child), including worthy, competent, and strong, result in the affect of atraction and affection, which result in actions or behaviors of nurturing or empowering. Empathizing labels, which are about the challenges youth experience, include seeing the child in light of experiencing rejection, frustration, and discouragement. The resulting affect is sympathy and concern. This results in actions of befriending and encouragement.

While the context of the following quote is important, the quote itself is a good one. Goethe observed, "everything important has been thought before--the difficulty is to think of it again."

The writers used this quote because they were observing how we can go back to "important thoughts" of the past to help children. Instead of focusing on making the predators accountable, one can see "wayward youth" as seeking to satisfy unmet needs for love in inappropriate or ineffective ways. Instead of seeing punishment as a good thing, one can see that modern youth are discouraged and that punishment fuels that discouragement. We know that punishment tends to lead to hiding behavior.

Learnings from Part 1: Seeds of Discouragement, Section 1: Destructive Relationships

This section provides a profile in discouragement where a child who is not connected to others expressed the magnitude of his loneliness. While we could consider this youth someone who would not help himself, he, in fact was moved from foster home to foster home, who started feeling disconnected from others. This boy states that he did not want to love anymore because he had been hurt "too many times." At 17 years of age, this boy hang himself.

This section, which started by talking about Karl Menninger's post-retirement work with youth, talks about Children without Belongings. It states that many parenting skills and resources are insufficient to meet a child's needs. It adds that modern communities (formerly tribes) have group resources, including relgious, social, business, and educational ones. However, the one best poised to help is often an impersonal bureaucracy where there are highly structured 50-minute activity that is controlled by the teacher. I remember the lost feeling I had in junior high and high school.

Instead of partnering, parents can blame schools, and schools can blame parents.

Learnings from Part I Intro for "Reclaiming Youth at Risk"

At the center of the issue is a family under pressure stating that parents are too stressed, schools are too impersonal, and a community which is too disorganized.

Shortly later, this section of the book attempts to move away from negative traits or labels for troubled children to transactions within their environment. They describe four ecological hazards:

1. Destructive Relationships
2. Climates of Futility
3. Learned Irresponsibility
4. Loss of Purpose

Review of Introduction of the Book "Reclaiming Youth at Risk"

Key "Learnings" from the Introduction: The Century of the Child.

• While the Swedish sociologist Ellen Key predicted, in the early 1900s, the twenitieth century as the "Century of the Child" because of confidence in the progress of science.
• Instead, Fritz Redl used the phrase "Love of Kids, Neglect of Children, Hatred of Youth" to describe the twentieth century.
• It is lamentable that the behavioral sciences have not experienced any "step jump in technology." A step jump can refer to an original invention but, more commonly, refers to a recombination of previously existing knowlege. The book is an attempt to look at the experience of youth workers (versus just theory) and Native American philosophies of child rearing.
• Personally, I enjoy the contrast of courage versus discouragement. While I understand the definitions of both words, I frequently do not consider them the antithesis of each other. In fact, when I think of discouragement, I do not consider it the state of being without courage.
• The concept of "Reclaiming" originated with Martin Woolins of the University of California, Berkeley.
• A reclaiming environment is one that creates changes the meet the needs of both the young person and the society. To reclaim means to recover, redeem, restore to value (of something that was devalued).
• Features of a powerful reclaiming environment include:

1. Experiencing the BELONGING in a supportive community, rather than being lost in a depersonalized bureaucracy.
2. Meeting one's needs for MASTERY, rather than enduring inflexible systems designed for the convenience of adults.
3. Involving youth in determining their own future while recognizing society's need to control harmful behavior.
4. Expecting youth to be caregivers rather than just helps recipients overly dependent on the care of adults.

• As a society, we can no longer afford the economic drain of disposable people. Having worked with adults who know one seemed to care about, who were placed into the criminal justice system or lived on the street where they are vulnerable. Children, even children from affluent homes, can become those disposable people if they do not fit with society.
• Of course, a woman told me, recently, that people are genetically endowed with the ability to achieve and move forward. I believe that "success" is more complex than that. However, we try to keep things simple to keep ourselves from struggling with complexities of these kind of problems.
• The goal of the book is to blend practice into theory.
• The authors quote Janusz Korczak, who wrote:

This book is designed to be as short as possible because it is addressed primarily to a young colleague, who, suddenly thrown into the whirlpool of the most difficult educational problems, the most involved conditions of life, and now stunned and resentful, has sent out a cry for help.

A fatigued (compare to "burned-out") person cannot study thick volumes on education at night. One who is unable to get enough sleep will be incapable of implementing the precious principles he has learned. This shall be brief so that your night's rest may not be spoiled.

Review the Foreward of the Book "Reclaiming Youth at Risk"

The Foreward is Titled "Our Hope for the Future" and is written by Archbishop Desmund Tutu.

Important Concepts or Ideas:

• "We seem to have forgotten that people matter more than things."
• "We have taught them (children) that success is everything, no matter how ruthless you might be in achieving your results.
• "We have based our whole society on power, portraying compassion, gentleness, and caring as 'sissy' qualities.
• "I fear that our wonderful expressions of concern for young people are just so much baloney." How does he know this? Deeds speak more than words.

Bipolar and Anxiety: What is There to Be Worried about?

Let's tie together worry and bipolar symptoms. Manic symptoms can include (but these are not all the symptoms):

1. Irritability,
2. Goal-directed behavior (socially, work, school, or sexually),
3. Feeling pressured to speak,
4. Distractability

When someone is irritable, he or she can worry about being "edgy", about how being grumpy may be impacting others (even though it feels as if little can be done about it).

When someone is goal-directed, they worry about others getting in their way. Some people want to marry that someone special even though there is no mutual interest. Children may want to go play, and they worry that mom and dad will stop them so they lie (either lying by commission or omission , don't tell mom or dad where they are going, he doesn't stop by the house, or she doesn't call mom or dad. This person believes that he must finish that household project even though others are trying to sleep.

When someone feels pressured to talk, he can worry that someone is going to interrupt him, especially with something less important (cf. to the symptom of having an inflated self-esteem or having grandiosity). She can worry that it all won't get said.

If a person is highly distractable, trying to remember that last great idea worries him or her.

Depressive symptoms, the down side of bipolar disorder, include symptoms (these are not all the symptoms of depression) such as:

1. Feeling guilty or worthless,
2. Having difficulty concentrating
3. Feeling exhausted or tired
4. Feeling agitated or restless

When people are feeling guilty, they have regrets. They are anxious about what they have done or haven't done. They worry about who they are or about who they are not. They suffer from the pain of anxiety.

Those who cannot concentrate, focus, or make decisions struggle with anxiety, too. They could think clearly before, but, now, they can't. They worry about why that is, what is stopping their brain from working. They feel anxious, thinking they may never snap out of it.

Those who feel exhausted and tired, feel anxiety because they tend to worry about what has happened to all the energy they may have had before. Will they ever feel like themselves again?

Of course, when I feel restless or physically agitated, I usually feel anxious.

Of course, this isn't a comprehensive list. There are lots of things people can worry or feel anxiety about. On the other hand, people do not need to feel anxious. There is hope. It doesn't always feel like it, but there is.

Anxiety and Bipolar Disorder: What Is Anxiety?

Anxiety can be difficult to define. Sometimes, when people talk about anxiety, they use words like stressed, distressed, overwhelmed, worried, nervous, or fearful. Obviously, there are differences between these emotions. In other ways, they can be slight variations of a single emotion.

There are several components to anxiety, depending on how you look at this emotion. For example, psychological studies have found that anxiety and excitement are similar in the way the body responds. While the physical sensations are similar, the labels (anxiety or excitement) are different. To some extent, labeling or re-labeling physical responses may help those who feel unnecessary anxiety. In order to illustrate this, think about (or remember) what it was like to date a new person. Some of us were anxious and some of us were excited. It depended on how one was predicting (see the future orientation) how the date would go. If we were confident or a risk taker, we may have been excited about how well a date may go. If we were worried, lacked confidence, or were unsure how a date may go, we may have been anxious. We were getting ready, making sure our clothes looked appropriate, our hair looked a certain way, and that we were buffed and shined (showered, shaved, brushed our teeth, etc.), but we were hoping that the date would go well. Who knows, we may not like this person after we got to know him or her. Worse yet, he or she may not like us.

It is important to realize that anxiety is an important emotion. Certain amounts of it help us to prepare for certain events, like a date with a new person, a job interview, a presentation, a speech, or an examination. If we didn’t have enough of this emotion, we may not care very much, we may feel unmotivated. We won’t prepare. I once had a roommate who was so “laid back”, it seemed that he had little motivation. As I recall, he had some trouble with his supervisor because it seemed like he didn’t care about doing a good job.

If we have too much anxiety, we may feel immobilized, want to run away, or even feel edgy or belligerent. In this case, we may be in a fight-flight-freeze response, which is usually related to a perceived threat. A perceived threat is not necessarily a real threat. If someone is angry or disappointed with us, we may think this is a threat. Even if someone yells at us, we may not truly be threatened. Being yelled at is uncomfortable, unpleasant, and we may feel insulted or disrespected. Yelling is more aggressive than calmly expressing feelings while it is less aggressive than making a fist. (Of course, this assumes that the person yelling is not saying things like “I’ll hurt you” or “I’m going to kill you” and intends, which can be difficult to determine, on following through on those comments.)

We can see where anxiety can lead to problems, like fighting and arguing. It can also lead us to “run away” or avoid are problems. Some people actually leave by divorcing, running away from their parents, partner, or job. Many others turn to drugs or alcohol to manage this emotion.

In order to make progress, it is important to note how often we run into actual threats. How often does this really occur? It can occur in car accidents or near misses. It can occur in war settings, like those in Iraq. It can occur in the woods if we are faced with a mountain lion. It can happen if we are involved with the wrong crowd, with those who carry weapons and brandish them. However, how often do we actually face real threats? For most of us, on a day-to-day basis, we don’t face life threatening situations, situations that “threaten” our life or well-being.

There is more to say about anxiety, what it is, what it looks like, how it impacts us, but those ideas will have to wait for another day.

Others may be asking about how anxiety relates to bipolar, which is the current theme. While anxiety is broader than bipolar disorder, which means many people struggle with varying degrees of anxiety, many of those with bipolar disorder have large amounts of anxiety. But for now, those questions will have to wait.

Bipolar Disorder and Anxiety: Introduction and Physiological Responses

Often those with bipolar disorder feel anxious. For some, they retreat into their own world, afraid of being hurt by another (being yelled at, laughed at, insulted, and taken advantage of). Others are afraid of how they might act out on others so they isolate themselves. It leads some to yell, to argue, to get into fights. Sometimes, people turn to drugs and/or alcohol because of that anxiety.

Anxiety doesn’t feel good at all. It is a tough emotion. Our stomach can get a sinking feeling or can feel like it has butterflies in it. Worse yet, we can feel nauseous, like we want to throw up, or we can get diarrhea. Our palms can get sweaty, or they can get cold and clammy. Some of us get a tingling feeling in our hands, feet, or face. We can feel warm or hot all over our body. Our heart rate can increase. Our chest can get tight, or it can just hurt, making us think that we are having a heart attack. We can get palpitations or irregular heartbeats. Our hands can shake. Our legs or knees can feel weak, like we are going to fall. We can feel shaky or like we could faint. We can feel like we are partially paralyzed. Our mouth can get dry, like it has cotton balls stuck in it. We can get a lump in our throat. We can hyperventilate. Sometimes, we feel dizzy or lightheaded. At other times, we can feel like life is unreal, like we are in a dream. We can feel detached from our current situation, as if we are floating away. We can be unable to think clearly. Our vision can get blurry.

After Care & Recovery:What's Important After Treatment for Adolescents?

After care or continuing care is needed whether one is working on sobriety whether while in a 12-Step group or following long-term residential treatment, intensive (short-term) inpatient, intensive outpatient, outpatient whether for antisocial, oppositional and defiant, or drug and alcohol issues. Follow-up is essential in most situations to ensure continued success. Why spend all the time, effort, and money only to stop short.

First - Make Sure They "Finished" Treatment

Hopefully, your son or daughter successfully completed his or her program.  In other words, they graduated.  They did not leave against clinical advice.  Some only could attend a program that lasted four to six weeks (e.g., intensive inpatient treatment).  Others have gone to outpatient or have been utilizing a 12-Step program (AA, NA, CA, CMA, MA).Other youth have spent a significant amount of time in treatment, six, nine, twelve months or even more.  (While this is more costly, there is some evidence that the longer programs have more "sticking power".)When someone decides to make those changes, some would say that it takes six months to figure out what works and another six months to practice it.  It takes a while to successfully treat youth who are struggling with problems of substance abuse, chemical dependence, who have been behaving in antisocial ways, or have been extremely oppositional and defiant.  What happens to youth who either complete a short treatment program or who have been pulled prematurely from longer programs (when it looks like they have made some progress)?  They quickly return to their old behaviors.  In fact, they seem to start where they left off.  Then, they get worse very quickly.That's why after care or continuing care is essential.

Ok, Now What?

Let's assume that the youth successfully completed treatment, or he or she is going to a 12-Step group.  What's next?  Is the youth prepared to return to his family, neighborhood, school, community?  While the teen may have made the necessary changes internally in his thinking and attitudes as well as his outward behavior, will he or she be able to maintain these changes?  It depends.What will help his or her continued success?

Research and Experts -- The "Lucky" Seven

Research and experts indicate that youth need to have follow-up after they return home. What needs to be included in this follow-up?

1.  Follow-Up to Review Skills and PlansYouth need to continue to use their skills.  They spent time learning them, and, now is the time to use them.  Review of those skills, such as communication skills, problem-solving skills, and refusal skills can help the youth continue in the right direction.  Under stress, it is not easy to use those skills so reminders and refreshers can help.Support or therapy groups with a partial psychoeducational focus (combined with an emotionally supportive atmosphere) can help the teen with their skill sets.  Sitting with others who are struggling can help them not feel alone.  Talking with others who are being successful can provide a role model.Individual counseling can also be beneficial for many.  During weekly sessions, the therapist can review situations that have been tempting or troublesome.It may also be important to review one's relapse prevention plan, which should be carried with the person every day for the first year.  Those ideas and commitments should be close by for easy reference.  And, it is good to go over them and adjust them as necessary.  Sometimes, some plans look good on paper, but, in the person's life, not be adequate.  This is normal while someone is attempting to maintain sobriety.  It takes practice to stay sober.  Some plans work and some don't.  Some adjustments, little or big, may be in order.  The plan has to work for the individual.

2.  12 - Step Groups for those with drug and alcohol problemsIt is fairly difficult to have a youth attend a 12-Step Group.  They often need some encouragement and support to do so.  Parents and a professional can help the youth choose meetings (it is usually good to try many meetings) and assist with planning transportation to and from a meeting (or, at least, meet them there to demonstrate support).Why is it important to attend these meetings?  One of the biggest reasons is that the youth can develop relationships with positive or working friends.  Of course, he or she needs to be careful about who they choose to relate to after those meetings.  However, one of the biggest influences on adolescent's drug use is their peers.  Peers are highly influential.The people at 12-Step meetings are working or want to work a program of sobriety.  Usually, those with drug and alcohol problems can relate to others with similar problems.  The youth needs to keep attending.Of course, the youth should attend 90 meetings during the first 90 days he or she is back in his community.  This keeps the person focused on working the program.  As they say, "It works if you work it.  It's worth it."  They also say, "Keep coming back."  It is not magical, but it is spiritual.  It can have a cumulative effect.

3.  Youth need to continue to have family treatment.The family is a key component.  Hopefully, by this time, parents realize that successful treatment includes them.  It was not just the "kid's fault".  Besides that, the youth needs the parent.They need the parent to maintain some of the firm and caring atmosphere that facilitated their change in the first place.  Parents need to implement changes, too.  Those who are too permissive need to be more structured.  Those who have been too rigid need to allow adequate room for the adolescent to meet his or her needs.There will be challenges.  Old patterns of interaction will appear.  There will be stress and disagreements.  Those are normal.  How they are handled usually need to be different.  Maybe, the parent learned how to interact differently, but, under stress, reverts to old methods.Are the new rules and expectations being kept.  Are the parents, whether married or divorced, able to work more effectively?  Are they a team, or do they continue to fight and argue?  Are the old roles of the rule "enforcer" and the "softie" still being used?  Or do the parents realize that they need to come to an agreement and work together as a team?Furthermore, parents, like everyone else, need reinforcement when they are practicing new skills.  It is difficult to change parenting styles without any help.  A therapist can encourage their use and increase their effectiveness.As one can see, continued family treatment is important to make sure that the family unit and thereby the youth are maintaining the gains of treatment.

4.  Help with the eco-system (e.g., the neighborhood and school) and other systems (e.g., probation).Parents can benefit from someone helping to check by phone or in person on the youth at school, in the neighborhood, and with probation.  Usually, parents are working hard and don't have time to follow up, at least, not as much as they would like to.How is the teen adjusting to school?  Who is she hanging out with?  How are the teachers and the youth interacting?  What is the kid doing for fun?  What is she doing with her spare time?Is the youth working, staying busy, if it is the summer?  Where is he working?  What are the co-workers like?  Boredom can lead to relapse.If the youth is on probation, is he making his scheduled appointments?  Is he following through on required activities (e.g., community service)?

5.  Those youth who abused drugs and/or alcohol need to be monitored with urine tests.Probably the shorter the treatment episode or period, the more often the youth needs regular urine testing.  Dr. Kevin McCauley (www.addictiondoctor.com) encourages a Urine Analysis (UA) every three days.  While this may seem expensive, it is a relatively effective way to keep the youth clean.  And, considering the cost of additional treatment, it is an  less expensive way to maintain sobriety.  These urine tests could cost from about $1500 to $4000 per year (100 drug tests x $15 or $40).  However, 28 days of treatment can cost around $7000 or more.Random UAs are an option, but they are not as effective as regular ones.  Drug abusers report that they start to guess when these tests will happen (e.g., if the receive a drug test today, they may assume that the next one will not occur for another week).

6.  Visits with other professionalsReturning to a community can be difficult.  For a teen, the stress, especially of peer pressure can be great.  He or she may need regular individual sessions to manage the stress.  The young man or woman probably needs someone to confide in.  A sponsor (someone with several years of sobriety, of the same gender, who is working their program) can be one support while a therapist, who can handle the deeper or bigger mental health issues, which may contribute to the problem, can be another.An addictionologist, a medical doctor who specializes in the treatment of addictions, can provide expertise about recovery (e.g., the impact of the drugs on mood, motivation, the brain and body, etc.) as well as medications (if necessary) that make recovery more comfortable and more likely.

7.  Fun is very importantThe youth has needed to make many changes and has worked really hard.  The old ways of having fun are not beneficial.  He or she may need to learn how to have fun in new ways in the old environment.  The teen may need to be encouraged and helped to have fun.  This is important.  To stay on this new path, some of his or her new life needs to be enjoyable and fun.  Otherwise, he may decide to go back to his old life, or she may go back to using drugs and alcohol in order to feel good again.

Resources

Dr. Kevin McCauley - Presentation (see his website for additional information).

Godley, S. H., Godley, M. D., Karvinen, T., & Slown, L.L (2001).  The Assertive Continuing Care (ACC) Protocol: A Case Manager's Manual for Working with Adolescents After Residential Treatment of Alcohol and Other Substance Use Disorders.

Cocaine Withdrawal Symptoms

What are the withdrawal symptoms of cocaine?

Initially, for the first couple weeks, the person may sleep more, act impulsively, or feel depressed, anxious, shameful, fearful, confused, or self-doubt. Cravings to use cocaine are strong, and the client may have trouble concentrating or coping with stress. He or she may become irritated easily with other people.

The depression can be accompanied by suicidal feelings.

Later, the person may feel reduced physical or sexual energy, depressed, anxious, irritable, or bored; he or she may have trouble concentrating, and feels strong cravings or thoughts about using cocaine.

Detox and Alcohol Withdrawal Symptoms

What is detox? Detox stands for detoxification.

Ok, so what is detoxification? According to the National Institute of Drug Abuse, it is a process in which allows the body to get rid of a drug while helping the person manage symptoms of withdrawal.

What are some of the symptoms of withdrawal? It depends on the drug you are referring to.

Today, let’s review symptoms for alcohol withdrawal.

Mild to moderate psychological symptoms include: jumpiness or nervousness, shakiness, anxiety, irritability, easily excitable, rapid emotional changes, depression, fatigue, difficulty thinking clearly, and bad dreams.

Mild to moderate physical symtpoms include: a general, pulsating headache, sweating (especially the palms or the face), nausea and vomiting, loss of appetite, rapid heart rate, enlarged pupils, clammy skin, hand tremors, pale or gray skin, involuntary movement of the eyelids.

Severe symptoms include delirium tremens, which is a state of confusion and visual hallucinations, agitation, fever, convulsions, and black outs (forgetting what happened during a drinking episode).

Alcohol withdrawal can range between two extremes, mild and uncomfortable to a serious, life-threatening situation. The symptoms begin within 12 hours of the last drink, peak in 48-72 hours, and can last as long as a week or more. Some symptoms can persist for three to 12 months.

General references:
Medline Plus (http://www.nlm.nih.gov/medlineplus)
National Institute of Drug Abuse (http://www.drugabuse.gov)