PurposeThe purpose of adolescent substance use treatment is to provide interventions that address the needs of young people who exhibit problems associated with substance use. The primary aim of treatment may be cessation of use, detoxification or controlled use. In addition, there are usually broader objectives, such as reduction of criminal activity and risk behaviour (e.g. safer routes of administration and reduction in equipment sharing and unsafe sex), increased school performance, vocational preparation, improved family functioning, improved living and interpersonal skills and self-care and improved physical and psychological health.
GoalsA suitable goal for treatment with young people is to increase the capacity of the young person involved in treatment to manage their life more effectively. There may need to be a reconsideration of the traditional abstinence goal of many programs in situations other than those that involve physical or organ damage of the young person. This is particularly pertinent for young people, as a focus solely on abstinence from substance use may have the effect of undermining other gains and thus decrease the value of those gains for the young person, their family or the treating agent.
A range of treatment options is essential (Gowing et al., 2001; Howard, 1994; Howard & Arcuri, 2003b; Kaminer, 1994; Spooner, Mattick & Howard, 1996; Wagner & Waldron, 2001), the intensity of which should ideally be matched to the severity of the young person's substance use and the level of impairment in personal, school, social and family functioning (see Table 14) (Winters, 1999).
Table 14: Types of treatment options available for adolescentsTable 14 is presented as a list in this HTML version for accessibility reasons.
- Primary prevention
Client assessment criteria: No history of current use.
Typical treatment options: Individuals, family, school or community interventions including psychoeducation, brief CBT or FT and ST. Top of page
- Early intervention
Client assessment criteria: No history of or low levels of use, with few problems arising from substance use.
Typical treatment options: Counselling or brief individual, group or family interventions including psychoeducation, HR, MI, CBT and FT and ST.
- Outreach and drop-in centres
Client assessment criteria: Low to severe levels of use, for difficult to engage young people (treatment non-completers, pre-contemplators) and support treatment completers.
Typical treatment options: Emphasis on engagement with young people and improved health and access to services, interventions may include psychoeducation, HR, MI, brief CBT and FT, counselling, recreational activities and ancillary services (e.g. educational and vocational activities, legal assistance and support).
- Outpatient treatment
Client assessment criteria: Low to moderate levels of substance use/dependence with problems resulting from use with largely intact social supports (ie. family, accommodation and school/ employment).
Typical treatment options: Individual, group and family counselling, or interventions including psychoeducation, MI, HR, CBT, FT and ST (educational/vocational activities, life/living skills).
- Semi-supported residential
Client assessment criteria: Low to severe levels of substance use or dependence with problems resulting from use and there is a need for residential support.
Typical treatment options: These include hostels or group homes and can be used to accommodate young people who are attending a day program, or exiting a residential unit.
- Short-term residential (usually less than three months)
Client assessment criteria: Moderate to severe levels of misuse or dependence, usually requiring detoxification or ongoing assessment and respite, with problems resulting from substance misuse and and few social supports.
Typical treatment options: Detoxification, individual, group and family counselling and interventions including MI, HR, CBT, FT and ST (educational/vocational activities life/living skills).
- Longer-term residential (usually three months)
Client assessment criteria: Severe substance misuse or dependence usually requiring detoxification, limited social supports and health concerns are elevated (including mental health).
Typical treatment options: As above but are usually 'therapeutic communities' adapted to better suit the needs of young people.
Note: CBT: Cognitive Behavioural Therapy; FT: Family Therapy; ST: Skills Training; MI: Motivational Interviewing; and HR: Harm ReductionTop of page
Youth friendly?Whatever the intervention, access issues require attention, as does engagement. The WHO has distilled the features of effective youth friendly services, which include the active involvement of young people and policies that guarantee confidentiality. In line with relevant legislation, they recommend that parental consent is not required and that provision of services or products should not be withheld in the absence of parental consent.
Easy registration, prompt screening and assessment, short waiting times, 'drop-ins' with or without prior appointment possible, and strong linkages to other social service providers are important ingredients that have been identified as increasing the attractiveness of services to young people. Further, there is a need for increased participation by young people in all aspects of interventions including prevention, treatment, assessing need, planning, delivery of interventions, monitoring and evaluation (Kirsch, 1995; World Health Organisation, 1999; World Health Organisation, 2001).