Treatment for Adolescents with a Primary Substance Use Disorder

We recently heard a statistic and I am trying to “track down” the source but here is the statistic:

>> 15% of folks who are in treatment for 30 or 60 days sustain long term sobriety. If you sustain treatment for a year that number leaps to 85%.

When we look at the “recovery world” in the United States, there is a model for treatment, based upon work with adults that is often copied. This is the model: step 1) primary care for 30 to 60 days. This is a very intense treatment time, in a hospital like setting, in which a person gets sober, gets intense one on one and group therapy. The person is kept away from drugs and alcohol by nature of being in a very contained environment for 24-7. Once chemically “sober” the step two is often called a “step down” program and can include living in house with other sober people. Step down program vary greatly from some that are full service with therapists, addicitonologists (MD’s who specialize in treating addictions), therapy, and can often be “dual diagnosis” meaning they treat both the disease of addiction and other mental illnesses. These programs are often expensive because they are so comprehensive and include education on healthy eating, healthy exercise, and sober fun. Other models at the less intense side of the spectrum can be sober apartment homes or sober houses that include support but expect the individual to pay separately for therapy and medical supervision. These less intense programs still have a strong recovery focus, a sober peer group, often teach life skills and expect the residents to either get a job or go to school.


Here is the problem with these models for adolescents: there are recovery focused primary care programs of 30 to 60 days and some even will have descriptions on their websites telling you that their programs can be extended for “up to 160 days”. The problem with this is that the program is really still in the “primary care” step one mode. An adolescent cannot “step down” to a sober house as they are still minors and cannot really be left on their own to manage their recovery. What is needed instead is a full-fledged residential program with 24-7 staff.   If we know the statistic above and believe it to be true, then an adolescent really needs closer to a year to have the “habits” of sobriety begin to be habit and not something imposed upon them. They need a gradual chance to integrate back into a community. They need to be “tempted” by others who approach them and want to use/”party”. Only a very few programs in our country offer this longer term, intensive second step. Without it, we are setting up our young people for ultimate relapse and either death or a return to addiction.

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