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Rehab for Teenagers

In the UK, ‘14,485 young people’ were ‘in contact with alcohol and drug services between April 2018 and March 2019.’ [1]

When you consider the impact that an early substance use disorder can have, this begins to seem like a very real problem. It may be getting better – after all, 10 years ago there were a lot more young people in treatment (24,053) – but there is still a long way to go.

So, how can we go about dealing with some of the issues posed by teenage SUDs? What are the best treatment approaches to take? And what should you do if you suspect that your child might have a problem with substances?

In this article, we try to answer these questions and more.

Why do teenagers develop substance use disorders?

There are many factors that could lead a teenager to start using substances.

One of the biggest factors is hormones. Hormones cause the body to change during puberty; they also have an effect on emotions and cause mood swings. These mood swings are a direct result of the sex hormones, namely, testosterone, oestrogen and progesterone. [2]

Scientists have found evidence that hormones produce other effects, too. For example, studies have shown that ‘higher testosterone levels […] are associated with increased aggression and risk-taking.’ [3] [4] This would give a good explanation of why adolescent boys, in particular, are more likely to use substances to a dangerous degree.

Other factors come into play, too. Many teenagers experience problems at home, ranging from abuse to family conflict, to divorce. If a teenager is unable to relax and feel safe when they are in their home environment, that can have an adverse impact on their development.

Peer pressure is another common factor that can lead to substance use. If a teenager finds themselves spending time with other teenagers who also use substances, it can be very difficult for them to avoid giving in to peer pressure.

Poor grades at school. Some adolescents are less academic than others, yet all adolescents are made to go to school and, in many cases, enter a competitive environment in which teachers judge you based on your academic ability. It can very demoralising for teenagers to go to school every day and be told that they are lazy, or stupid. Some teens will inevitably respond to this by turning to substances.

Lack of role models. When an adolescent does not have anyone to look up to, it can give them a skewed value system. They may start to see things like ‘being cool’ or ‘using substances’ as desirable, and things like ‘getting good marks at school’ or ‘staying fit’ as less desirable. It is the responsibility of the parents to be good role models for their child so that they develop a good view of the world.

What effects can substance use have on a teenager?

Part of the reason why teenage SUDs pose such a big risk is that teenagers’ brains have yet to fully develop. In fact, scientists now think that teenagers’ brains continue to develop into early adulthood, with the end of development occurring in the mid-20s. [5]

What does this mean for substance use? Well, if teenagers’ brains are still developing when they develop a SUD, that’s very bad news. Substance use disorders are very damaging to the brain. Scientists do not know exactly what SUDs do to teenage brains, but there is some evidence that they impact learning negatively. [6] This is only a preliminary finding, and there could well be further impacts on the brain that we do not yet know about.

What other effects can a SUD have on a teenager? Firstly, SUDs frequently go hand-in-hand with mental health issues. A teenager who begins using substances is much more likely to develop a mental health problem like depression or anxiety.

Secondly, many substances are illegal, so SUDs can lead to problems with the law. Even alcohol, which is legal for over-18s in the UK, is illegal for teenagers. Alcohol can also lead to antisocial behaviour, which is another way in which teenagers can get in trouble with the police.

Finally, substance use can lead to physical health problems, such as withdrawal symptoms, malnutrition and more. The combination of mental and physical health problems caused by SUDs is an especially dangerous mix.

It is also worth pointing out that the vast majority of teenagers with a substance use disorder do not get treatment. 1.5 million teens meet the criteria for a SUD, yet only 111,000 (7%) get treatment. [7] When you have that many people with untreated SUDs, it is bound to cause problems, both for the adolescents themselves and for society.

Substance use in the adolescent population

In the UK, and in most countries, cannabis is the most widely-misused substance. 88% of young people in the UK who received treatment for substance use came into treatment for cannabis addiction, compared with 44% for alcohol and 14% for ecstasy. [8]

Why is it that young people seem to develop cannabis problems more than alcohol or other substances? One explanation could be that cannabis is perceived as less harmful than other drugs.

SAMHSA (the Substance Abuse and Mental Health Administration) found that among people aged 12 or older, only 30.6 percent perceived a great risk in smoking cannabis once or twice a week, compared with 86.5 percent who perceived taking cocaine once or twice a week as a great risk. For comparison, 68.5 percent of people thought that having four or five drinks of alcohol most days constituted a great risk. [9]

Is cannabis as harmless as people think? Recent studies suggest that it might not be. Some of the scientific literature has found links between cannabis and schizophrenia. [10] This has yet to be fully proven, but there is enough evidence to suggest that the growing number of countries who have legalised cannabis might come to regret it.

From the point of view of teenagers, cannabis is clearly causing some issues, since such a huge number of them are receiving treatment for a cannabis SUD. That alone is evidence that cannabis is harmful. In fact, the public perception of cannabis as harmless might make it more harmful, since it could lead more teenagers to use the substance without appreciating the risks.

Treatment approaches for teens with substance use disorders

Should we treat substance use disorders in teenagers the same as we treat it in adults? This is one of the biggest questions faced by those who want to treat teens for their substance use.

There are several differences between teens and adults with SUDs which add weight to the argument that treatment for teens and adults should be different. For example, ‘adolescents present higher rates of binge use, lower problem recognition, and higher rates of comorbid psychiatric problems […] are likely to be more susceptible to peer influence and are more highly focused on immediate concerns.’ [11]

In essence, adolescent substance use is very different to adult substance use. That should be reflected in how we treat adolescent SUDs.

Signs that your teenager may have a substance use disorder

If you are the parent of a teenager, and you are worried that they might have a substance use disorder, it can be difficult to know for sure. It is even harder when your teenager does not communicate with you.

There are, however, some signs to look out for that will tell you whether your teenager might be suffering from a SUD. We’ve listed some of them below:

  • Physical symptoms: If your teenager looks different or seems constantly ill, that could be a sign of substance use. Physical symptoms include sweating, red eyes, weight loss and pale skin. Symptoms vary for each substance
  • Trouble with the police: If your child has had problems with the police, that suggests they are engaging in antisocial behaviour. Substances have always gone hand-in-hand with antisocial behaviour. Your child may even have got in trouble for drug use. If so, the police will be able to inform you
  • Poor performance at school: As mentioned earlier in this article, drug use has been shown to have a negative impact on learning. Cannabis, especially, can cause sluggishness and a lack of motivation which tends to lead to poor academic performance. If your teenagers’ grades start to slip, that could be a sign they are experimenting with drugs
  • Isolation: Teenagers who spend a lot of time on their own, having been sociable before, maybe doing so because they have developed a substance use disorder. If so, it is likely that they are now prioritising using substances over socialising with friends. This is a very dangerous habit to get into

A brief summary of the teen rehab process

Assessment. Before going to rehab, every teenager needs to be assessed. At ADT Healthcare, we hold a thorough assessment before admission in which we go through your teenager’s history of substance use, as well as discussing any mental health problems they suffer from. Only once this assessment is complete will we refer your child to treatment. That treatment might not be rehab: it could be outpatient services if that is what your teenager needs (outpatient services take place in a clinic near you, whereas inpatient services are residential in nature).

  • Detox. When your teenager goes into treatment, the first step will be to detox. Detoxing refers to getting rid of all the drugs and toxins from your body. This normally takes up to a week. It can be difficult and may involve some withdrawal symptoms. However, at our rehabs, you can be sure of round-the-clock medical care and treatment.
  • Therapy. After detox, comes therapy. Teen therapy involves a range of approaches and treatments, which we discuss at greater length below.
  • Aftercare. Once your teenager leaves rehab, they will enter aftercare. Aftercare is a form of treatment that takes place after rehab, on an outpatient basis. It can involve therapy, 12-step meetings, support groups and more. At ADT Healthcare we offer 12 months of aftercare as standard.

Rehab treatment for teenagers

What are the best forms of treatment for teenagers with SUDs?

The most common are family therapy, group therapy, Cognitive Behavioural Therapy (CBT) and motivational interviewing. Medication (or pharmacotherapy) is sometimes used but is not very common.

In the following sections, we go through each of these forms of therapy, explain what they are, and outline why and how they might benefit adolescents with SUDs.

Family therapy for teens

Family therapy is a form of therapy where the patient’s family are included in the therapeutic process. Members of the family set in on sessions and contribute to proceedings. Family members may be asked to explain the impact their teenager’s drug use is having on them, or explain the changes they have seen in their teenager since he or she started using substances.

Family therapy has been shown to be effective with adults and teenagers. It is the most studied therapeutic approach to teenagers with SUDSs. [12] A range of studies has found it to be effective, although some concluded that more evidence was needed in order to properly compare different forms of treatment for adolescents. [13].

Group therapy for teens

Besides family therapy, group therapy is one of the most common forms of therapy for adolescents. Group therapy is a form of therapy in which a group of patients engage in a discussion with a therapist. Group therapy has several benefits, as well as a few drawbacks, compared to individual therapy.

One of the main benefits is that it allows patients to be with their peers, and to converse with people who are going through the same ordeal. One drawback, on the other hand, is that patients may feel less able, to be honest in front of a group of their peers.

Among teenagers, the benefits and drawbacks of group therapy are heightened. Teenagers – especially ones with SUDs, who might have issues with authority – need to be with their peers. There may be limits to what a therapist can achieve in a one-to-one session with a teenager since they are likely to be less engaged. This makes group therapy much more desirable as a form of treatment.

However, the issue of self-expression in a group context might also be greater with teenagers. Adolescents do not tend to like expressing themselves. This might be accentuated in a group context, where the teenagers involved do not necessarily know each other very well. This does not make group therapy a bad option at all; however, it is an issue which therapists must be aware of in order to overcome it.

Cognitive Behavioural Therapy for teens

CBT has become one of the most popular forms of therapy for all ages. It is just as popular in the world of treatment for adolescents, only rivalled by the likes of family therapy and group therapy as the chief treatment modality for teenagers.

What is CBT? It is a form of therapy that helps patients to identify negative thought patterns and disrupt them before they lead to negative actions, such as using substances.

Why might CBT be helpful for teenagers? Teenagers, by virtue of their age, may not be as well-equipped with coping mechanisms and techniques to control their thoughts as adults. Teenagers with SUDs are prone to mood swings and powerful emotions. CBT promises to help teenagers control these emotional states.

Does the evidence support CBT for teenagers? This study [14] found CBT to be the most effective form of treatment for adolescents, resulting in the longest period of abstinence after treatment.

The critical literature seems to be divided between CBT and family therapy as the two most effective forms of treatment for adolescents. The best solution from the point of view of the teenagers themselves is probably to decide who merits what form of treatment based on the facts of each individual case. Some teens might benefit more from CBT, others from family therapy, some from group therapy, and some from a mixture of several different forms of treatment.

Motivational Interviewing for teens

Much like CBT, Motivational Interviewing (and brief intervention) techniques have enjoyed a lot of popularity in recent years, not just for adults but for teenagers too.

Motivational Interviewing (MI) is all about focusing on what the patient values and using these core values or motivations to encourage change. Motivational interviewing is non-confrontational, which means that the therapist does not judge or disagree with the client. They simply listen and help them create goals for the future.

Why might MI be useful for teenagers? One reason is that the non-confrontational nature of MI might suit teenagers, who (perhaps more than most) resent being contradicted, judged or told what they have to do.

Medication (pharmacotherapy) for teens

One final option for teens in drug and alcohol treatment is medication. There are several medications available which suppress cravings or, in some cases, produce an unpleasant reaction when the patient drinks alcohol.

However, it must be said that these medications should be approached with caution. Medications like naltrexone and acamprosate produce some side effects, and disulfiram is quite controversial. [15]

Final thoughts

Teenagers are complicated individuals, with complicated needs – sometimes more so than adults. Treatment for teens with SUDs needs to reflect this. It is crucial that teens get the right therapy for their individual case.

Luckily, there is a growing understanding of the nature of teen substance use disorders, and professionals in the rehab industry are beginning to get a feel for the root causes and the best solutions for teen SUDs.

References

[1] https://www.gov.uk/government/publications/substance-misuse-treatment-for-young-people-statistics-2018-to-2019/young-peoples-substance-misuse-treatment-statistics-2018-to-2019-report

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539143/

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539143/

[4] https://pubmed.ncbi.nlm.nih.gov/16631757/

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892678/

[6] https://pubmed.ncbi.nlm.nih.gov/10817843/

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166985/

[8] https://www.gov.uk/government/publications/substance-misuse-treatment-for-young-people-statistics-2018-to-2019/young-peoples-substance-misuse-treatment-statistics-2018-to-2019-report

[9] https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442038/

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166985/

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989619/

[13] https://pubmed.ncbi.nlm.nih.gov/11444159/

[14] https://pubmed.ncbi.nlm.nih.gov/20048247/

[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653998/

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