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Environmental Factors in Treatment of Adolescent Substance Use
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In the last section, we discussed reintegration into a non-using lifestyle after an intervention with a chemically addicted teen.
In this section, we will discuss 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.
As you know, many teenagers come home from treatment excited about discovery a program that has helped others to stay straight, about the new friends they have made in treatment, and about reconnecting with their family, but this excitement often cools down soon after returning home.
Many parents ask me "What do I expect from my recovering teenager?" I tell my clients that the biggest thing that they can expect is that the teenager will be struggling with the four basic tasks of adolescence, as we discussed in Section 5. As you are well aware, the delusion caused by chemical dependence prevents teenagers from achieving these four tasks, and makes it impossible for their basic self-esteem needs to be met.
In my experience, each of these four tasks is compounded by the added task of staying sober.
♦ Four Basic Tasks of Adolescence
(1) Achieving independence for the recovering teen may involve starting to learn simple living skills, such as cooking and buying groceries, or looking for work without having acquired any job skills.
(2) Developing integrity might involve involvement in 12-step groups several times a week, and learning what to do in leisure time without getting drunk or high. As you are well aware, relearning how to use leisure time is a daunting task for anyone in recovery, and especially so for teens who may not have had the opportunity to develop adult hobbies before their involvement with alcohol or other drugs.
(3) Experiencing intimacy may involve changing old, using friends for new ones. In my experience, these friends are often met through treatment or 12-step programs. Experiencing intimacy also may involve learning the difference between affection and seduction for the first time, and establishing trust with his or her parents. As you area aware, the teen in recovery must start from scratch to build trust with their family.
(4) In addition to independence, integrity, and intimacy, developing individuality may involve learning how to deal with feelings, especially anger, in assertive and constructive ways, and facing unresolved grief issues due to past losses and abuses.
In my experience, there are three ways parents of recovering teens can develop a household that is supportive for these four tasks.
Three Ways to Create a Supportive Household
♦ #1 - Give Encouragement
The first of these is to give encouragement. As you may have experienced, a recovering teen must now meet his or her self-esteem needs without chemicals, and they need praise and encouragement. I encourage the parents of recovering teens to be positive, and to smile as much as possible. As you are well aware, simple praise, such as "I really respect the way you have been concentrating on your homework," or "I really appreciate that you mowed the lawn" goes a long way.
♦ #2 - Listen
The second way to develop a supportive household is to listen. As you know, the recovering teen may have trouble identifying his or her own feelings. I encourage parents to rephrase the words they use, and bounce back the feeling they think he or she is experiencing, and also to pay attention to what the teen is not saying. As you are well aware, learning to really listen takes time, concentration, and the willingness to admit that you don’t always have all of the answers.
♦ #3 - Practive Problem Solving Skills
In addition to giving encouragement and listening, I find that the third way to create a supportive household is to practice problem solving skills as a family. This skill is essential for the teenager in recovery, and if they learn it successfully, they will be able to carry it with them their whole life. I usually recommend to my clients that they have weekly family meetings to practice problem solving.
In my experience, these meeting work best if the meeting starts with everyone giving each other positive feedback, ends with a special treat or game, and includes planning at least one fun activity. In the meeting, I encourage families to review the coming week’s activities, and write up a family calendar. As you may have experienced, this is a great opportunity to problem-solve as a family any concerns or troubles that come up during planning for the coming week.
♦ "DIGEDDE" Technique
One strategy I recommend to parents for problem-solving is the "DIGEDDE" technique.
Mark, 18, had been out of treatment for five months, and was making great progress. His father, Thomas, approached me when Mark asked him if he could go to a party where some of his friends would be drinking. Thomas told me "My concern is not that Mark will drink. He’s going to meeting regularly, and really doing good. But I’m worried that he’ll end up in a car with friends who have been drinking." I suggested that Thomas and Mark use the DIGEDDE technique.
(1) The first step is to determine a time and place to meet. I stated, "before you sit down to eat, tell Mark that you would like to meet with him after dinner to discuss the party."
(2) In my experience, the second step is to identify the problem. For Mark and Thomas, the problem was Thomas’ concern about Mark returning from the party.
(3) I explained to Thomas that the third step is to generate alternatives. In this step, he should let Mark list options, and listen to the options without dismissing or discounting any of them. Mark stated "I could call a taxi, or you could pick me up. Or could see if there’s anyone who isn’t drinking could bring me home."
(4) Fourth, he should evaluate each alternative, being honest about his feelings. Thomas stated to Mark, "I could pick you up. If you call a taxi, I will pay half of the fare. And I feel comfortable with your ability to find someone who isn’t drinking to drive you home."
(5) Fifth, Thomas and Mark should decide on a plan, being as specific as possible. Mark and Thomas agreed that Mark would try to find someone who had not been drinking to bring him home, and that if he could not, he would call a taxi.
(6) The sixth step is to do it! Finally, I told Thomas that after the party, he and Mark should set a time to evaluate the outcome. Thomas and Mark agreed to meet the next morning after breakfast to discuss how the strategy worked.
In our next session, Thomas told me, "It worked great! Mark couldn’t find a friend who hadn’t been drinking, but he called a taxi, and I paid or half like we agreed. He was home on time, and didn’t drink at all. We had a good discussion about it the next day, and it looks like this will be a good strategy if he goes to parties in the future."
In this section, we have discussed 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 also discussed the "DIGEDDE" technique.
Peer-Reviewed Journal Article References:
Bornovalova, M. A., Hicks, B. M., Iacono, W. G., & McGue, M. (2013). Longitudinal twin study of borderline personality disorder traits and substance use in adolescence: Developmental change, reciprocal effects, and genetic and environmental influences. Personality Disorders: Theory, Research, and Treatment, 4(1), 23–32.
Garner, B. R., Godley, M. D., Funk, R. R., Dennis, M. L., & Godley, S. H. (2007). The impact of continuing care adherence on environmental risks, substance use, and substance-related problems following adolescent residential treatment. Psychology of Addictive Behaviors, 21(4), 488–497.
Godley, M. D., Kahn, J. H., Dennis, M. L., Godley, S. H., & Funk, R. R. (2005). The Stability and Impact of Environmental Factors on Substance Use and Problems After Adolescent Outpatient Treatment for Cannabis Abuse or Dependence. Psychology of Addictive Behaviors, 19(1), 62–70.
What are the three steps in creating a supportive household for the recovering teen?
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