Texting, Tweeting and Robo-tripping:Substance use disorder treatment

for the teen of the 21st century

David R. Selden, LICSWDirector, SOAP

Health and Education Services, Inc.

Key Issues

• Short attention span• Tweet, Text and You

Tube• Co-occurring disorders• Family systems

The Ten Key Elements for Effective Treatment of Adolescent Substance Abuse

Community based, substance abuse focused

Individualized treatment

Self Help/12 Step Opportunities

From: SAMHSA

Evaluate Outcomes

Engage & Retain

Continuity of Care

School Liaison

Gender & Culture

Qualified Staff

Assessment at Beginning

Program Foundation Elements

Co-occurring disorder/CCISCCo-occurring disorder/CCISC Harm ReductionHarm Reduction

Needs of teens & Young adultsErikson's stages

TAY

Needs of teens & Young adultsErikson's stages

TAYMotivational

Enhancement Therapy

Motivational Enhancement

TherapyRelapse

Prevention

Relapse Prevention

Family WorkFamily Work Group TreatmentGroup TreatmentMilieu TherapyMilieu Therapy

Case ManagementCase Management

Self HelpSelf Help

The Needs of Teens & Young Adults

• Erikson’s Stages

– Ages 5-12: Industry vs. inferiority

– Adolescence: Identity vs. confusion

– Young adulthood: Intimacy vs. isolation

The Needs of Teens & Young Adults

• Transitional Age Youth– Engage– Tailor services and supports– Personal choice and social

responsibility– Safety-net of support– Enhance competencies to achieve

greater self-sufficiency and confidence

– Outcome focus– Involve young people, parents, and

other community partners

From: Transition to Independence Program,

Rusty Clark

Relapse Prevention

• The Stages of Relapse–Emotional–Mental –Physical

Relapse Prevention

“If you are not working on

your recovery, you are

working on a relapse”.

Harm Reduction

• The continuum of risk• Abstinence is final

step• Any change is positive• Not everyone may

attain sobriety• Goal= reduce harm of

habits as much as possible

Motivational Enhancement

• Express empathy• Develop discrepancy• Roll with resistance• Support self-efficacy

Group Treatment

• Provide positive peer support• Reduce sense of isolation• Learn to cope by allowing them to

see how others deal with similar problems

• Provide useful information• Offer positive family-like

experiences• Opportunity to learn or re-learn the

social skills they need to cope with every-day life instead of resorting to substance abuse

• Instill hope

From: Substance Abuse Treatment: Group Therapy. TIP41. US Dept of Health and Human Services

Co-occurring Disorders

• Comprehensive, Continuous, Integrated System of Care (CCISC)

• Kenneth Minkoff, MD• www.kenminkoff.com

Co-occurring Disorders/CCISC

1. Dual diagnosis is an expectation, not an exception

2. Empathic, hopeful, integrated and continuing relationships

3. Treatment must be individualized and structured

Co-occurring Disorders/CCISC

4. Balance case management and clinical care

5. Each disorder is “primary”

6. “Disease and recovery” model

1.Match to phase of recovery and stage of change

7. No one correct approach

Milieu Treatment

• Multi-disciplinary team• Individualized interactions and

understanding of the emotional conflicts that are activated in such human interactions

• Examination of client/client, client/staff and staff/staff interactions

Family Work

• Being Family Focused– Family involvement– Family-focused

treatment– Family driven– Broad definition of

family– Empowering parents– Family voice

• Ensuring ongoing family involvement– Family/parent support– Family/parent

counseling– Family team– Family preservation– Sibling services– Family/marriage

educationFrom: SAMHSA: Designing a Recovery-Oriented Care Model for Adolescents and Transition Age Youth with Substance Use or Co-occurring Mental Health Disorders

Case Management

• Planning • Linkage• Advocacy • Support• Monitoring• Assessment• Outreach

Self Help

• Counters feelings of isolation, powerlessness, alienation

• Reciprocal helping exchange

• Support sense of self-efficacy

• Provides resource to meet like-minded peers

• Provides sobriety focused activities

SOAP

• A two week intensive after-school program designed to meet the specific needs of teens and young adults. SOAP provides a safe place for teens and young adults to spend their after school hours where they can learn and develop skills to support recovery from substance use disorders.

SOAP Class Rooms

SOAP Class Rooms

SOAP Gym

SOAP Activity Room

SOAP Music Room

Monday Tuesday Wednesday Thursday Friday2:00-2:30 PM Staff Meeting Staff Meeting Staff Meeting Staff Meeting Staff Meeting

2:30-3:30 PM Individual andIntake Mtgs

Individual andIntake Mtgs

Individual andIntake Mtgs

Individual andIntake Mtgs

Individual andIntake Mtgs

3:30-3:45 PM Check-In Check-In Check-In Check-In Check-In

3:45-4:15 PM Personal Assessment Life Skills Personal Assessment Life Skills Personal Assessment

4:15-4:25 PM Break Break Break Break Break

4:25-4:55 PM Substance UseEducation

Therapy Group Activities Therapy Group Activities

4:55-5:05 PM Break Break Break Break Break

5:05-5:35 PM SobrietyPlanning/Using

the Steps

Relapse Prevention Family Group Relapse Prevention Weekend Planning

5:35-5:50 PM Wrap-up Wrap-up Wrap-up Wrap-up Wrap-up

Weekly Schedule

Web Sites

Mouse Party:http: //learn.genetics.utah.edu/content/addiction/drugs/mouse.html

Intoximeter: http: //www.intox.com/wheel/drinkwheel.asp

SAMHSA Report:http://www.chestnut.org/LI/downloads/SAMHSA_Recovery_Report_on_ Adolescents_and_Transitional_Age_Youth.pdf