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Intervention in Adolescent Addicts
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In the last section, we discussed the six key guidelines to help parents stop enabling and disengage from their chemically addicted teenager. These guidelines are, don’t take it personally, don’t confront, don’t say things you don’t mean, don’t nag, don’t clean up, and don’t make excuses. We also discussed the "Learning Ignoring Skills" technique.
In this section, we will discuss the four ‘C’s of confrontation in an intervention with a chemically addicted teenager. These are choices, consequences, contracts, and control.
The Four C's of Confrontation
♦ #1 - Choices
In my experience, the first ‘C’ for parents to learn when preparing to confront their teenager about his or her substance abuse problems is choices. I find it important to explain to parents that confrontation is not punishment. As you know, it does not use violence, threats, shouting, judging, moralizing, or humiliation. It is based on respect, and elicits the teenager’s cooperation and involvement in the intervention process.
In my experience, it is essential to offer choices, and never put the teenager in a corner with no way out. As you are well aware, there are three areas in which parents should be prepared to offer choices to their teenagers: when they are addressing a specific behavior, when they are determining consequences, and when they are enforcing consequences.
Joni, a physical therapist, saw me about her son Brian’s marijuana use. Brian recently broke his curfew by three hours, and Joni asked me how she should address this behavior. I stated, "Give Brian a choice. Tell him he can either come in three hours early next Friday night, or he can stay at home for the next three weeknights. Ask him what he wants to do."
♦ #2 - Consequences
The second C in my experience is consequences. As you are aware, confrontation is not punishment, but it is not permissive. It involves well-defined rules, and set consequences for breaking these rules. I find that there are three essential qualities to an effective rule. An effective rule is specific, reasonable, and enforceable. For example, the rule "No alcohol use whatsoever" is simple, reasonable since underage use is against the law, and enforceable, since the teenager lives in the parent’s home.
In my experience, consequences for breaking rules come in two forms, natural or logical.
a. Natural consequences are events such as having a hangover after drinking, and the parent simply needs to let events take their course, as long as the teenager is not in immediate danger.
b. Logical consequences require action on the parent’s part, and are related to the incident, such as confiscating a teenager’s keys after driving when drunk.
Clearly, logical consequences need to be reasonable and set up in advance, so that the teenager knows what the consequences of their actions will be. I explain to parents that these consequences must be enforced calmly, without anger, and with respect.
♦ #3 - Contracts
In my experience, the third C is contracts. Contracts involve the supervision and monitoring of behaviors at home, at school, and in the community. Behaviors, and consequences for not abiding by these behaviors, are set out clearly in the contract. As you know, contracts are important because they help the chemically addicted teen take responsibility for themselves, they give the teenager some control over their environment, they help the teen develop trust because the consequences are always consistent, and they allow teenagers to prove they are not chemically dependent by abiding by the rules.
I find that contracts can also help parents and counselors determine if the teenager needs to be placed in a more protective environment to treat their substance use.
There are three types of contracts:
(1) Simple contracts include basic, non negotiable rules, such as no drug use, and no skipping of class. Possible consequences for breaking a simple contract include the choice between a chemical dependence evaluation in an in-patient or out-patient setting.
(2) A turf contract includes all of the rules of a simple contract, and also outlines specific behaviors for keeping certain privileges at home; for example, keeping school performance up in order to keep the use of the telephone. Consequences for breaking a turf contract include the choice between treatment in an in-patient or out-patient setting.
(3) Finally, in my experience, a bottom-line contract outlines specific behaviors necessary for the chemically addicted teen to stay living at home. It may include all of the elements of both the simple and turf contracts. The consequences for breaking a bottom-line contract include the choice between two available and reputable in-patient treatment centers.
♦ #4 - Control
In addition to choices, consequences, and contracts, I find that the fourth C of confrontation is control. I explain to my clients that by setting rules, determining consequences, and spelling them out in contracts, they are taking back their environment, and reestablishing control over what happens in it. As you may have experienced, this does not mean parents are controlling their teen’s behaviors, feelings, and decisions. What they are saying is, "if you choose to break the rules of the contract, this is how I will change the environment".
As you are well aware, how the parents change the environment depends on the teenagers needs and behaviors. If the teenager has overdosed or become violent, more immediate changes in the environment, such as calling the police or ambulance, are necessary. Sometimes, the consequences involve removing the teenager from home and school. I find that in this case, it is important to remind the parents that this is not the same as abandoning or turning their backs on their teenager, it is another way of being responsible towards the teenager who can no longer be responsible for him or herself.
♦ "Setting an Effective Rule" Technique
After Joni and I discussed Brian’s marijuana use and curfew breaking, I asked her to try the "Setting an Effective Rule" exercise.
a. First, I asked Joni what rule she would like to set, reminding her to make it specific, reasonable, and enforceable. Joni stated, "How about, no marijuana use?" I told Joni this was a good choice; it is a simple rule, reasonable because marijuana is illegal, and enforceable because Brian lived in her home.
b. Next, I asked Joni what logical consequence she would set for Brian. Joni stated, "Well, a logical consequence to me would be no staying out past 9 at night. That’s when all the parties he goes to to smoke start." Joni and I agreed that this consequence was directly related to Brian’s behavior, and was reasonable because it would effectively prevent Brian from getting to his main source of marijuana.
c. Finally, we agreed that Joni would explain this rule and consequence to Brian that afternoon, so that Brian would know in advance what to expect if he smoked marijuana.
In this section, we have discussed the four ‘C’s of confrontation in an intervention with a chemically addicted teenager. These are choices, consequences, contracts, and control.
In the next section, we will discuss the three essential confrontation skills. These are monitoring skills, giving feedback, and consequating. We will also discuss the "Simple Chart" technique for assisting the parents of addicted teens with these three confrontation skills.
Peer-Reviewed Journal Article References:
Baer, J. S., Beadnell, B., Garrett, S. B., Hartzler, B., Wells, E. A., & Peterson, P. L. (2008). Adolescent change language within a brief motivational intervention and substance use outcomes. Psychology of Addictive Behaviors, 22(4), 570–575.
Bauer, C. J. (2001). Review of Addiction intervention: Strategies to motivate treatment-seeking behavior [Review of the book Addiction intervention: Strategies to motivate treatment-Seeking behavior, by R. K. White & D. G. Wright, Eds.]. Psychiatric Rehabilitation Journal, 24(3), 308–309.
O'Leary-Barrett, M., Castellanos-Ryan, N., Pihl, R. O., & Conrod, P. J. (2016). Mechanisms of personality-targeted intervention effects on adolescent alcohol misuse, internalizing and externalizing symptoms. Journal of Consulting and Clinical Psychology, 84(5), 438–452.
What are the Four Cs of Confrontation?
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