February 2006
What are some effective treatments for adolescent co-occurring disorders?
Below are descriptions of three treatments that have been found to be effective for treating adolescents with co-occurring disorders:
1. Motivational Enhancement Therapy (MET) with Cognitive Behavioral Therapy (CBT)
The therapeutic relationship between client and provider is an essential feature of a treatment practice known as Motivational Enhancement Therapy (MET) which, integrated with CBT, has proven effective in treating adolescents with co-occurring disorders (Dennis, 2000). MET is a client-centered approach in which clinicians build positive relationships with clients to help them develop awareness, resolve ambivalence about engaging in treatment, and strengthen their motivation for recovery and behavior change. CBT involves teaching patients strategies to change or discard unhealthy or unwanted behaviors. By combining the two treatments, the clinician assists patients in making their own changes by facilitating their movement through the stages of change. MET/CBT techniques are particularly useful in treating adolescents, who are typically resistant to more directive approaches and tend to be more hesitant about committing to behavior change. In fact, many youth do not even recognize their substance use as a problem and are being mandated to treatment.
2. Multisystemic Therapy (MST)
Family engagement is another critical element in the prevention and treatment of co-occurring disorders among adolescents. Parents represent one of the most important influences in adolescents’ lives. Multisystemic Therapy (MST), an evidenced-based practice, is a family-based intervention developed for youth with substance abuse disorders and histories of violence. MST is delivered in the home, where the provider works closely with the adolescent and his or her parent(s). The treatment also involves other important influences in the youth's environment, including peers, school, and the neighborhood. Using MST, the provider is able to gather a comprehensive evaluation of the adolescent’s risk and protective factors to help develop individualized treatment strategies. In addition, parents are taught skills to help improve their child’s behavior, reduce his or her substance abuse, and enhance overall family functioning. MST has consistently proved effective for decreasing adolescent substance use and psychiatric symptoms, improving family relations and family functioning, increasing mainstream school attendance, and reducing long-term rates of re-arrest and out-of-home placements (Henggeler, 1999; Henggeler et. al, 2003).
3. Community Reinforcement Therapy (CRT)
Positive outcomes are also reported for youth with multiple problems when treated with Community Reinforcement Therapy (Azrin et. al, 1994, Godley et. al, 2001). This treatment recognizes the important role of environment in encouraging or discouraging drug use. The therapy teaches individuals specific problem-solving techniques to manage challenges in his or her environment without resorting to substance use. The adolescent is taught to make major lifestyle changes in social networks and activities, family relationships, and school. The therapist also helps the adolescent to develop treatment goals and strategies to reach these goals, and encourages healthy, positive behaviors to replace former activities related to substance use.
References:
Azrin, N. H., Donohue, B., Besalel, V. A., Kogan, E. S. et al. (1994). Youth drug abuse treatment: A controlled outcome study. Journal of Child & Adolescent Substance Abuse, Vol 3(3): 1-16.
Dennis, M. L., Babor, T. F., Diamond, G., Donaldson, J., Godley, S. H., Titus, J. C. et al. (2000). Cooperative Agreement for a Multisite Study of the Effectiveness of Treatment for Cannabis (Marijuana) Dependent Youth. Rockville, MD: Center for Substance Abuse Treatment. Retrieved October, 2005 from http://chestnut.org/LI/cyt/findings/Final%209-7-00%20CYT%20PF%20Report2.pdf
Godley, S. H., Meyers, R. J., Smith, J. E., Karvinen, T., Titus, J. C., Godley, M.D., Dent, G., Passetti, L. & Kelberg, P. (2001). The Adolescent Community Reinforcement Approach for Adolescent Cannabis Users, Cannabis Youth Treatment (CYT) Series, Volume 4. DHHS Pub. No. 01–3489. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 2001. Retrieved October, 2005 from http://chestnut.org/LI/cyt/products/ACRA_CYT_v4.pdf
Henggeler, S. W. (1999) Multisystemic treatment of serious clinical problems in children and adolescents. Clinicians Research Digest, Supplemental Bulletin 21. American Psychological Association.
Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C., Sheidow, A. J., Ward, D. M., Randall, J., Pickrel, S. G., Cunningham, P. B., & Edwards, J. (2003).One-year follow-up of multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis. Journal of the American Academy of Child & Adolescent Psychiatry, 42(5): 543-551.