ADOLESCENT ALCOHOL ABUSE: APPROACHES TO TREATMENT

BY: ALISSA WULFF

BACKGROUND
By 12 th grade 71% of youth in the U.S. have tried alcohol 54% have reported being drunk

An estimated 1.4 million teens have an alcohol or illicit drug problem only 10% are receiving treatment

S u s s m a n , S . ( 2 01 1 ) . P r e v e n t i n g a n d t r e a t i n g s u b s t a n c e a b u s e a m o n g a d o l e s c e n t s . T h e P r eve n t i o n R e s e a r c h e r, 1 8 ( 2 ) , 3 - 7.

PREDICTORS
Genetics: 25-65%
Personality Traits

Age of initiation Family dynamics

Monitoring Support Norms

Peers Cultural influence Resources Stress Co-occurring disorders

16-50% affective disorders
Bauman, S. (2008). Essential topics for the helping professional. Boston, MA: Pearson.

PROTECTIVE FACTORS
Strong anti-alcohol attitudes Involvement in extracurricular attitudes High self-esteem Social support Religious commitment Parental monitoring

CONSEQUENCES
Poor academic performance Violence Legal Suicide Unprotected sexual activity Family disruption Death Development of psychopathology

THE GENDER GAP: RISK FACTORS

Boys:
At greater risk for earlier alcohol initiation More influenced by family environment Higher prevalence of ADHD Enhances social desirability more than counterparts

Girls:
Depression Suicide Eating disorders History of physical or sexual abuse Early physical maturation More receptive to interpersonal and peer influences

COMPONENTS OF EFFECTIVE TREATMENT FOR ADOLESCENTS

Match of assessment and individuals needs Address all other areas of life Parents should be involved Reflect developmental level of individual Trust and safe environment for adolescents Staff should be qualified and trained for this specific group Reflection of cultural and gender differences Include continuing/post treatment care Provide measureable outcomes to address future services

T YPES OF TREATMENT PROGRAMS

Residential care In-patient care Out-patient care Group counseling Individual counseling

PREDICTIVE OUTCOMES OF PROGRAMS

Long-term residential programs Length of stay Degree of parental involvement Aftercare participation Realistic attitude Social support Ease of post-treatment contact with professionals
S u s s m a n , S . ( 2 01 1 ) . P r ev e n t i n g a n d t r e a t i n g s u b s t a n c e a b u s e a m o n g a d o l e s c e n t s . T h e P r eve n t i o n R e s e a r c h e r, 1 8 ( 2 ) , 3 - 7.

GOALS OF TREATMENT
Long Term
Abstinence/Sobriety Relapse prevention After care

Short Term
Develop skills
Addressing peer norms and pressure Identity formation and values Positive coping Communication Self-esteem Assertion training

Family support and education

DISCHARGE FROM TREATMENT

Addiction can be controlled and overcome; but not cured
Lifelong process of managing addiction and triggers

Relapse Prevention Programs and PostTreatment Support Groups

Aim to lower the chances of relapse Creates a supportive environment while adjusting back to daily life

A CASE STUDY: JENNIFER

JENNIFERS BACKGROUND
15 year old Caucasian female from an upper middle -class, educated family living in the suburbs outside of a large city Family
Youngest of three siblings; has two older brothers both in college out of state Parents happily married; father works full -time and long hours; mother doesnt work but has full -time social calendar Very active in community through social clubs Family infamous for being the life of the party by hosting over the top parties (dinner, sports events, birthdays, just for fun) Non-religious

School life
In the past has done average academically; grades have been slipping recently Aspires to be a socializing, stay at home mother; doesnt desire to go to college as it s a waste of money Got kicked off the soccer team for missing too much practice

JENNIFERS PRESENTING ISSUES

Jennifers parents are seeking treatment for her due to some recent occurrences
Partying
Over past year, Jennifer increased drinking alcohol from almost every weekend with friends, to during the week by herself as well, often coming home vomiting or blacked out She has been caught using a fake ID to go out with her older brothers friends She doesnt like socializing with people her age; would rather hang out with older, more mature crowds. Doesnt have many friends her own age Parents keep finding empty liquor bottles under her bed

School
Over this time her grades began to drop and attendance dwindled No motivation to do well in school because she doesnt want to have to work Soccer practice was a waste of time and she wasnt missing the obligation

Legal Run-In
Six months ago she stole her moms car at night and drove drunk without a license, was pulled over and arrested. Parents were friends with the officer, so no legal sanctions were given Since then her parents have hidden the car keys

JENNIFERS PERSPECTIVE
Partying
Her parents drink, her brothers drink, so why cant she? Theyve let her have sips of their drinks before and the house always has alcohol in it. She isnt hurting anyone if shes drinking at home. She is bored, especially without her brothers at home and without soccer; has a lot of free time to hang out. People her age are lame and a waste of her time.

Legal Issues
Bad luck with her fake ID, but has been able to talk her way out of it every time without getting in trouble She shouldve been more careful driving, but no one got hurt

School
An education isnt important when you have the personality and life skills to be successful Knows a lot of successful people who can help build her image

IMPLICATIONS

What themes or issues need to be addressed?

To what degree do you believe her actions are typical of a normal teenage rebellion versus problematic abuse?
How easily can you distinguish the two?

IMPLICATIONS

What are some short term goals you could suggest? What are some long term goals you could suggest?

TREATMENT SUGGESTIONS
What treatment would you suggest? Multidimensional Family Therapy (MDFT)
Outpatient, family based treatment Sessions: individual, family, or multi-family Individual skill development 5 Intervention Modules Interventions with adolescent Interventions with parent(s) Interventions to change parent-adolescent interaction Interventions with other family members Interventions with systems external to the family

TREATMENT DISCHARGE

What would the completion of treatment for Jennifer look like?

REFERENCES
Bauman, S. (2008). Essential topics for the helping professional. Boston, MA: Pear son. Kosterman , R., Hawkins, J., Catalano, R.F., & Abbott, R.D. (2000). The dynamics of alcohol and marijuana initiation: Patterns and predictors of fir st time use in adolescence. American Journal of Public Health, 90( 3), 360-366. Maggs, J.L., Patrick , M.E., & Feinstein, L. (2008). Childhood and adolescent predictors of alcohol use and problems in adolescence and adulthood in the National Child Development Study. Society for the Study of Addiction, 103, 7-22. Perera, D.M., & Perr y, J.C. (2011). Screening for adolescent substance related disorders using the SASSI - A2: implications for nonrepor ting youth. Journal of Addictions and Of fender Counseling, 31, 66-79. Sussman, S. (2011). Preventing and treating substance abuse among adolescents. The Prevention Researcher, 18( 2) , 3-7. Wu, N.S., Lu, Y., Sterling, S., & Weisner, C. (2004). Family environment factor s and substance abuse severity in an HMO adolescent treatment population. Clinical Pediatrics, 323333.

THANK YOU!