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.
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.
posted by Max Stager, MA, LPC, NCC @ 12:33 AM
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