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Relapse Prevention in Adolescent Substance Use
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In the last section, we discussed the professional’s role in an intervention with a chemically addicted teenager, as well as the six steps to preparing for an intervention. These are, choosing a group leader, going over the data on the teen’s behavior gathered by the intervention group, deciding speaking order and seating arrangements, decide on a location for the intervention, choose a person to act as the teen during the rehearsal, and the rehearsal itself.
In this section, we will discuss reintegration into a non-using lifestyle after an intervention with a chemically addicted teen.
As you know, during reintegration the recovering teen learns to work through the painful feelings of being an adolescent without the use of addictive substances. I also find that during this stage, the family members of the addict start to regain the power they lost or gave away while the teenager was using alcohol or other drugs.
In my practice, I refer to reintegration as the "Letting Go" stage. This stage continues the work parents have done during the disengagement stage, as discussed in Section 9: letting go of trying to control their teenager’s behaviors, feelings, and decisions.
As you know, part of this stage also involves parents letting go of their expectations for their teenager, which, as you are well aware, is hard enough for the parents of teenagers who have not been through an addiction. In my experience, many parents of teens in recovery expect their teenager to shed all of the objectionable and rebellious behaviors he or she exhibited while using.
Do you have a client who believes that since the use has stopped, the behaviors should as well?
As you know, objectionable and rebellious behaviors are normal for adolescents. I find that behaviors related to using may be hard for the teen to change, and if the behaviors do go away, they are likely to be replaced with another set of behaviors the parents do not like or understand. I remind all my clients who are working with a teenager in recovery that they should not expect their son or daughter to be perfect.
In my experience, many parents of chemically addicted teens believe that once their teenager has gone through treatment, he or she will stay straight. As you are well aware, treatment doesn’t always solve the problem the first time around.
Do you have a client who should be reminded that some teens may need to go back to treatment once, twice, or even more times?
I always recommend to my clients that the teen attend a structured aftercare for at least 1-2 years after treatment, and I also recommend attendance at a local 12-step program.
♦ Case Study Analysis: Nina's Reintegration
My client Nina was first brought to treatment after attempting suicide in jail at the age of 17. After psychiatric assessment at the hospital, she was found to have an addiction to alcohol, and was transferred to a treatment center. At the center, Nina only went through the motions. When she was asked to write the history of her drug use, Nina copied her story from her roomate’s journal and changed a few of the details.
Three days after arriving back home, Nina became drunk again, and was sent back to treatment the next day. This time, Nina chose to stay sober. She began opening up emotionally with me, and started becoming honest with members of her group. Still, when I talked to Nina, she stated, "I want to stay sober when I go home. But I don’t buy this whole addiction thing. I mean, come on, I’m only 17." This time, Nina was placed in a group home.
After three weeks of sobriety, Nina got drunk at a party. This time, Nina’s friends took her to an open AA meeting. Nina told me, "that’s where it really hit me. I was hungover, I was miserable, I hated everything… and I heard this guy speaking laughing at himself. I just thought… that’s what I want to be able to do, you know?"
Nina has been sober ever since that night. In fact, she just celebrated her fifth anniversary of sobriety. I often share Nina’s story with the parents of addicted teens- although Nina was successful, she first went through jail, a hospital, two sessions of in-patient treatment, and a group home. As you are well aware, recovery can be a long process.
As you know, you cannot control when and where a teenager will accept the reality of their situation. All that the parents can do to help is keep controlling themselves and the environment. As you know, parents quickly become discouraged if their teenager begins using again after returning home from treatment. This is natural, as both they and the teenager have invested a great deal of time and energy in the treatment process. I find it very important to remind the parents not to take it personally.
I remind the parents of chemically addicted teens that intervention and recovery are processes. I encourage parents to keep the Bottom-Line contract in place for the first two weeks after the teen returns from treatment, and to keep enforcing the "No Use" rule after that. In my experience, it is important for the parents to remind the teenager once they return home that the consequences of breaking the contract will mean treatment again.
♦ "Focusing on Me" Technique
One technique I used with Nina’s parents, Ray and Dinah, was the "Focusing on Me" technique.
First, I asked Ray and Dinah to focus on what changes, small or large, they had made in their lives over the past 6 months, and how they had grown as a result of these changes.
I next asked, "Which of these changes are you the most proud of?"
Ray stated, "I think I’m most proud of how we can follow up when we draw up a contract with Nina. We always used to give her chance after chance, and all that happened was that things got worse for all of us."
I asked Ray and Dinah to come up with a list of the five most valuable changes they had made, and decide on how they should reward themselves.
Dinah stated, "I think we should go stay at a bed & breakfast for a weekend. We’ve always wanted to do that!"
By focusing on their accomplishments, Ray and Dinah were able to keep in mind how much progress they had made, even when Nina’s recovery seemed to be off track. Additionally, they were able to look at their list and remind themselves how much good they had done for themselves and their daughter when they started to blame themselves for Nina’s relapses.
In this section, we have discussed reintegration into a non-using lifestyle after an intervention with a chemically addicted teen.
In the next section, how to support the recovering teen through the four tasks of adolescence, as well as the three steps to creating a supportive, creative home environment. These three steps are, giving encouragement, listening, and problem solving. We will also discuss the "DIGEDDE" technique.
Peer-Reviewed Journal Article References:
Roos, C. R., Bowen, S., & Witkiewitz, K. (2017). Baseline patterns of substance use disorder severity and depression and anxiety symptoms moderate the efficacy of mindfulness-based relapse prevention. Journal of Consulting and Clinical Psychology, 85(11), 1041–1051.
Van Zundert, R. M., Ferguson, S. G., Shiffman, S., & Engels, R. (2012). Dynamic effects of craving and negative affect on adolescent smoking relapse. Health Psychology, 31(2), 226–234.
Witkiewitz, K., & Bowen, S. (2010). Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of Consulting and Clinical Psychology, 78(3), 362–374.
If a teenager begins using again after returning home for treatment, what is it important to remind the parents about?
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