Adolescent substance abuse treatment best practices for maintaining sobriety

Viele Hände als Turm gestapelt als Symbol für Unterstützung und Teamwork

Substance use has become an epidemic among teenagers. American adolescents and young adults, ages 12 to 29, need treatment for drug and alcohol problems, according to the 2013 National Survey on Drug Use and Health. A prompt and effective intervention is particularly crucial in this special population. In fact, it’s urgent to do so as soon as you know the person is using.

On the bright side, teens who receive early and comprehensive treatment with ongoing support can and do recover from substance abuse. Diagnosis and treatment of underlying mental health problems during addiction treatment further improve survival chances. A strong maintenance plan is essential to preserve long-term sobriety.

Healthy lifestyle habits and relapse prevention techniques are gradually introduced over the course of treatment. By the time of discharge, new lifestyle habits and a maintenance plan are in place. This plan is often in the form of a seven-day schedule that accounts for all time throughout the day. A well-designed maintenance plan consists of a detailed schedule and program elements.

Professional care appointments

Psychologists, psychiatrists, therapists, group therapy, family therapy and primary health care providers are all part of a successful maintenance team. Psychiatrists, primary health care providers and pharmacists should stay in communication to provide optimal care.

Medications when necessary

Medication should include education for the teen and family prior to discharge. An estimated duration of pharmacological treatment should be provided.

Self-care activities

A successful self-care regimen includes six healthy habits:

  1. Sleep: The body repairs itself during sleep. Yet sleep disturbances can continue for months after stopping alcohol and drug use. Patient education measures for sleep include relaxation techniques and bedtime rituals
  2. Nutrition: Patients in early recovery are generally malnourished. Sugar cravings are common because sugar and other addictive substances stimulate the brain’s reward center. Dietary counseling should include elements of a nutritious diet, avoidance of foods and drinks with high sugar content, healthy snacks and meal plans
  3. Exercise: Daily exercise is a well-established adjunctive treatment for patients with depression, anxiety, psychosis and mood disorders. Studies suggest that exercise decreases cravings and drinking behavior in patients with substance use disorders. Exercise also increases oxygen delivery to the brain, liver and heart and promotes healing
  4. Relaxation techniques: Mindfulness exercises, prayer, meditation, yoga, journaling, reading recovery literature, music and hobbies should be included in the daily schedule
  5. School/work: School and work commitments need to be balanced and included in the daily schedule on an individualized basis
  6. Peer group meetings: Peer groups should only include others who never drink or use drugs. This is a difficult and dangerous transition for most, so the sooner local sober friends are found, the better

More on peer support

The importance of social life and peer groups was illustrated in a study that examined the qualities of support groups that had the lowest relapse rates over two years. Successful groups had members who formed friendships that extended beyond the group, and participated in group special events and activities like outreach, volunteering and fundraising.

Developing lasting friendships in a sober support group is the cornerstone of lasting recovery. Many peer support groups are 12-step programs. Non-12-step groups are available as well, such as SMART Recovery; although no long-term data is available for these groups.

The 12-step solution

Support groups are not a substitute for drug treatment, but rather an important part of the maintenance program. The National Institute of Drug Abuse Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide includes a discussion on support groups for adolescents. This discussion highlights that 12-step groups can reinforce abstinence and other changes made during treatment and provide a sense of community and lifelong support. Group leaders are cautioned to direct discussions away from extolling drug use, a common tendency in teen group dynamics.

Too often, teens leave treatment without completing the 12 steps, which include a personal moral inventory and making amends. Therefore, they still might feel empty inside. They cannot wait to return to their friends to feel whole again. Their friends are still drinking and/or using and they relapse.

Getting to meetings and becoming part of a group must start immediately after discharge from treatment. Treatment counselors usually set up meeting times and locations on the maintenance schedule. The more after-meeting chat, the better, because that is when friendships are formed. The friendships, meetings and sponsors/sponsees completing the 12 steps together appear to be why the program works.

Prior to discharge, information to share with teens regarding 12-step programs include:

  • Alcoholics and Narcotics Anonymous (AA and NA, which are combined to form Teen Anon for teens and young adults): members attend regularly, even after 10, 20 or 40 years after recovering from their addiction. Teens who attend meetings with senior members can benefit from hearing their experiences
  • The sponsor: a mentor who has done the 12 steps and is willing to provide guidance through the process, someone with whom the teen feels comfortable and ideally trusts and admires. Completing the steps promptly is more important than finding the perfect person
  • The sponsee: a mentee who is the beneficiary of the 12th step, which is to reach out and help newcomers because, through helping others, the desire to drink or use drugs is lifted and recovery occurs. The practice of the 12 steps and helping others to recover has helped millions of people worldwide achieve lifelong sobriety

Successful transition from treatment to a new, healthy lifestyle with adequate support depends on a consistent daily recovery program. Multi-faceted, detailed maintenance plans in schedule-form should be completed for each patient prior to discharge. Treatment counselors include the teen and family when formulating the plan. The plan also includes ways to avoid common pitfalls and relapse triggers. The miraculous changes teens experience by adhering to the maintenance plan help to reinforce healthy, positive behaviors.

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