An Innovative Treatment Program for Adolescent Female Substance Users

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Table of Contents

Introduction
Offender Population
Addressing the Risks and Special Needs of Offenders
Service Providers & Team Members involved in Treatment
Addressing Potential Complications during the Implementation Phase
Case Study Example of the Program in Practice
How the Treatment Program can utilize a Case Management Approach
Conclusion
Reference List

Introduction

Researchers have cited the high rate of illicit drug use, misuse, and dependence as one of the foremost triggers of adolescent morbidity and mortality in the U.S., and a critical primary public health challenge facing the youth across the world (Sussman et al., 2008; Meyers et al., 2010).

In one study conducted in 2004, the proportions of 8^th, 10^th, and 12^th graders who disclosed that they had engaged in some form of illicit drug use and abuse in the preceding 12 months were 15%, 31%, and 39%, respectively, with subsequent studies on the population demonstrating that these data have not oscillated by more than 2% since the original study was concluded (Sussman et al., 2008).

In substance use and addiction, a number of studies have focused on the critical role played by family environments in the development and entrenchment of adolescent drug problems (Hogue & Liddle, 2009).

As a result, clinical practice guidelines for adolescent drug treatment programs put forth by interested stakeholders underline the significance of involving care givers, family, and members of informal networks in which the drug user subscribes.

The problem of adolescent drug use, dependence, and abuse is even more entrenched in American juvenile correctional facilities, with various studies demonstrating evidence that the prevalence of substance use disorders is disproportionately high among incarcerated adolescents (Dembo et al., 2004; Erickson & Butters, 2005).

A holistic treatment program for adolescent drug abusers, therefore, need to incorporate a juvenile diversion program that not only effectively intervene with these youth and their families, but also provides a framework through which to deal with the system inefficiencies that are characteristic of the many agencies that interact with these adolescents (Cocozza et al., 2005).

It is against this background that this paper aims to propose an innovative treatment program that incorporates substance abuse treatment, family treatment, and an ambitious juvenile diversion program to provide holistic treatment to adolescent drug user exhibiting delinquent behaviors.

Offender Population

This innovative treatment program will target adolescent girls between the ages of 11 and 19 with a recorded diagnosis of substance use, misuse, and dependence, and exhibiting delinquent behaviors.

It is a well known fact that substance abuse disorders among adolescent girls often co-occur with other mental and emotional health disorders, including depression, suicide ideation, stress, and anxiety (Nissen, 2006), not mentioning the fact that mental and emotional health disorders further complicate and exacerbate the psychological suffering related to substance abuse disorders among this particular group of the population (Dembo et al., 2004).

Moreover, substance use, misuse, and abuse have been positively correlated to recidivism among female juvenile offenders (Ericson & Butters, 2005). These disclosures inform the need to develop the integrative treatment program.

Addressing the Risks and Special Needs of Offenders

The main objective of this treatment program is to modify the behaviors of adolescent girls with the twin purposes of strengthening their resolve to abstain from drugs and curtailing further involvement in delinquent behaviors.

In order to modify substance abusing and delinquent behaviors, this innovative program will purposely target modifiable risk factors that are to a large extent linked to the formation and progression of these behaviors.

Dembo et al (2004) and Sussman et al (2008) identify parent-child conflict, unsuccessful parenting practices, negative socialization processes, deviant peer association, academic challenges, insufficient cognitive and social skills, distress linked to past victimization, and leisure and social activities related to disruptive behavior, as some of the risk factors that are directly or indirectly associated with drug dependence and other delinquent behaviors.

According to Erickson & Butters (2005), “…youth who are detained in custodial institutions may have treatments needs identified around their use of drugs and their mental health, as well as other areas that may need attention” (p. 958).

Cocozza et al (2005) observes that adolescents involved with the juvenile justice system usually exhibits unique needs that require the attention of other service systems, including psychological and mental health drug user treatment, social support, child welfare, re-socialization, and other social services agencies.

The family system and juvenile assessment centers will be used to identify the risk factors and special needs of the adolescent drug users.

Upon systematic and standardized screening and evaluation of the youth, a decision-tree model will be used to basically establish a level of need and risk for each adolescent with the intention of linking them to appropriate treatment services and supervision (Cocozza et al., 2005).

Family history and occurrences of delinquency will be evaluated using the family model to establish the risk factors and special needs of these youth (Hogue & Liddle, 2009).

Adolescents drug users who score high on needs evaluation and risks evaluation will be placed in a high need/risk category and referred to the most intensive treatment and interventions principally designed to attend to their substance abuse and psychological/mental health needs as well as their delinquent risk factors (Cocozza et al., 2005).

It is proposed that these youth be sent to a highly structured in-home family intervention services to achieve successful treatment. To address the risks and needs facing this sub-set of the population, it is proposed that the in-home family intervention strategies utilize the cognitive-behavioral therapy and a therapeutic community model of service delivery.

According to Hall et al (2008), cognitive-behavioral therapy is grounded on the proposition that thoughts, value systems, mores, beliefs, attitudes, expectations, and emotional experiences individually or collectively determines an individual’s behavioral orientation, and that the formed orientation principally determines the individual’s thought system and emotional experiences.

Consequently, this therapy is central to any behavior modification process aimed at dealing with high-risk adolescent female offenders in addition to addressing their special needs.

These outcomes will be achieved through teaching the offenders about the thought-emotion-behavior link and availing to them techniques and approaches that could be employed to modify their distorted and often defective mind-sets, viewpoints, and attitudes, hence altering their maladaptive behavior or responses (Dembo et al., 2004).

Indeed, most prevention and cessation strategies against substance abuse encourage “…adoption of new, healthy behavior” (Sussman et al., 2008, p. 1807).

Schroder et al (2009) observe that the therapeutic community model is particularly effective in modifying and reinforcing behavior in that it not only provide intensive and all-inclusive services that empower the target group to actively participate in the management of the program, but it also provides a framework through which services aimed at behavior modification can be implemented in a self-contained residential community, effectively limiting contact between the target group and the rest of the population.

As such, therapeutic community meetings will afford the incarcerated girls included in the program with a framework to share aspects of treatment that have borne positive outcomes, share testimonies of growth, and, most important, make use of the framework to confront peers for the purpose of problem solving and developing ideas and solutions to challenges or situations that are affecting the whole group.

Lastly, Gender-specific services will be offered by underlining the unique needs of girls and their development, assisting them to develop a vision, and by assessing the influence and importance of societal relationships, empowerment, and independence.

Likewise, adolescent drugs users who score moderate ranges of need assessment and risk assessment will be referred to less intensive services and interventions intended to modify behavior. Here, it is recommended that the youth be subjected to individual, group, and family counseling that utilize the biopsychosocial/spiritual model of substance use and addiction and the therapeutic community model.

Formulated in 1977 by Engel, this model principally highlights the significance of the interaction among biological, psychological, and social aspects in modifying behavior (Nissen, 2006).

In addition, this model brings into the fore the spiritual needs of individuals, especially in respect to the meaning and value that these individuals attach to their lives, hence its importance in addressing the risk factors and needs associated with these offenders.

Lastly, adolescent drug users with very minimal ranges of need and risk assessments will be sanctioned, counseled, and released.

Service Providers & Team Members involved in Treatment

The service providers for this program include extensively trained and skilled primary care physicians, psychologists, psychiatric nurses, religious leaders, behavioral therapists, social workers, and substance abuse counselors.

Primary care providers and psychiatrist nurses will function to assess the offenders about any preexisting medical conditions, while psychologists, behavioral therapists and substance abuse counselors will use the theoretical frameworks described in this paper to modify and reinforce behavior.

The religious leaders will offer the much needed spiritual and emotional nourishment while social workers will be tasked with the role of following the treatment progress upon the release of these offenders from detention.

The team members will consist of selected members of staff of the juvenile correctional facilities, police, members of the offender population, and their parents.

Addressing Potential Complications during the Implementation Phase

It is expected that complications will arise during the implementation phase of a drug use treatment program, especially one that deals with the rehabilitation of delinquent youth (Erickson & Butters, 2005). Some of the offenders, for instance, may not readily agree that they have a problem that needs to be solved, while others may drop out of the treatment program before the desired outcomes are achieved.

Relapsing into previous behaviors is also expected. Complications in substance user screening may present in juvenile assessment centers due to lack of objective assessment instruments and risk assessment tools (Cocozza et al., 2005).

To address the potential complications in substance user screening in juvenile screening center, this innovative program will utilize a standardized, normed, and psychometrically viable screening and assessment tools that could effectively be used to evaluate the needs and risk factors of this group of the population.

The utilization of a decision-tree model will solve any presenting challenges in needs and risks assessment as well as in allocating resources to the adolescents (Cocozza et al., 2005). To ensure adherence to the treatment program, law enforcement authorities and the family members will be involved.

To further eliminate needs and risk-factors miscomprehension, service providers will conduct rigorous and comprehensive evaluations that cover psychological and medical challenges, perceived learning deficiencies, family functioning, and other components of the offenders’ lives with the intention of developing a solid foundation of their background and the best ways to deal with the challenges presenting (Nissen, 2006).

It is also necessary for the service providers to develop a climate of trust and mutual respect as this might optimally engage and retain the adolescents in treatment. Lastly, the program will put in place effective follow-up strategies to avoid relapse (Sussman et al., 2008).

Case Study Example of the Program in Practice

Some strategies of this multi-component innovative drug use treatment program have been piloted in several juvenile correctional facilities and found to be effective in assisting adolescent female offenders to shed off their old ineffective behaviors and maladaptive mind-sets and embrace drug-free living.

In the piloting of the therapeutic community model, for instance, it was agreed that daily one-hour community sessions were to be lead by the female drug abusers forming the group, and each was allocated a session. The task of the service providers was to encourage and support the girls to discuss and share aspects of treatment that were bearing positive outcomes and those that were hard to follow.

The girls were also encouraged to share their testimonies of growth on daily basis for a period of two months. In these meetings, the service providers also took time to educate the girls about family conflicts, peer association, effects of drugs, and how to develop adaptive coping strategies.

The girls were also educated on self empowerment and how to confront some stereotypes which had been highlighted during the sessions as stress-points for the girls. Additionally, the girls were encouraged to confront their friends for the purpose of problem solving and developing solutions to drug-related challenges that were affecting the whole group.

After the lapse of the two months of sustained therapeutic meetings, an assessment was done to determine how the behaviors of these young female offenders had been modified.

It was found that around 65 percent of girls in the group had developed strong coping mechanisms, and had replaced their previously overwhelming drug use requirement with more focused, mature, and responsible behaviors.

Three follow-up visits by the social workers upon the integration of the girls back into the society showed that only 8 percent developed recidivism. This demonstrates that the therapeutic community model is effective in assisting young female drug users to get out of the destructive habit and develop new and effective behaviors and thought patterns.

According to Sussman et al (2008), such a treatment approach limits the nature of addiction whilst fostering the patient’s mental capacity to sustain will power.

How the Treatment Program can utilize a Case Management Approach

Most studies in drug use treatment programs agree that a case management approach is more appropriate in the treatment of drug abusers by virtue of the fact that these people have individualized needs that need to be met for the program to bear fruit (Rhodes & Gross, 1997).

According to Sussman et al (2008), individuals in drug use treatment programs need to be considered along variables such as ethnicity, gender, drug use history, social-environmental contexts, and access or receptivity to different treatment options, hence the need for an enhanced intervention strategy.

It is imperative to note that substance addicts are faced with a set of unique barriers and challenges. Rhodes & Gross (1997) observes that this group of the population has “…the reputation of being the least desirable group with which to work, the most unstable, the most uncooperative, and the least understood” (p. 3).

This observation informs the need to utilize a case management approach to provide a comprehensive individualized treatment program for the incarcerated adolescent female drug abusers.

Although some elements of case management approach have been incorporated elsewhere in this paper, it is imperative to mention that this treatment program will utilize the components of assessment, treatment planning, monitoring, counseling therapy, social support, linkage, and advocacy to avail to the adolescent offenders a comprehensive individualized treatment program (Rhodes & Gross, 1997).

Participation in the program will not be done using coercive means so as to achieve maximum outcomes. The program is at liberty to hire case managers, who will then identify and bring into the team skilled supervisory staff (service providers) in addition to arranging for their training.

It is believed that such a team will be effective in providing a comprehensive individualized treatment program for the offenders, particularly through undertaking needs assessment, treatment planning, counseling therapy, social support, effective follow-up, and clinical monitoring.

Conclusion

From the statistics cited in this paper, it is evident that a significant number of youth needs professional assistance to drop their drug dependence and other delinquent behaviors (Nissen, 2006).

This paper has elaborated on an innovative treatment program which makes use of the biopsychosocial model, cognitive-behavioral therapy, and the therapeutic community model to assist adolescent female offenders shed off their drug-dependent behavior.

The proposed model also takes into heart the developmental concerns of the girls in order to form a solid background through which this group can be empowered to develop adaptive coping strategies to the challenges facing them, and which in most occasions leads them into drug use and delinquency.

A case study of one of the components of the treatment program has indeed demonstrated that the program can be effective in reinforcing drug-free behavior.

Reference List

Cocozza, J.J., Veysey, B.M., Chapin, D.A., Dembo, R., Walters, W., & Farina, S. (2005). Diversion from the juvenile justice system. The Miami-Dade juvenile assessment center post arrest diversion program. Substance Use & Misuse, 40(7), 935-951. Retrieved from Academic Search Premier Database.

Dembo, R., Schmeidler, J., & Walters, W. (2004). Juvenile assessment centers: An innovative approach to identify and respond youth with substance abuse and related problems entering the justice system. In A.R. Roberts (Eds.), Juvenile justice sourcebook: Past, present, and future. Oxford: Oxford University Press.

Erickson, P.G., & Butters, J.E. (2005). How does the Canadian Juvenile system respond to detained youth with substance use associated problems? Gaps, challenges, and emerging Issues. Substance Use & Misuse, 40(7), 953-973. Retrieved from Academic Search Premier Database.

Hall, J.A., Smith, D.C., Easton, S.D., Hyonggin, A., Williams, J.K…Mijin, J. (2008). Substance abuse treatment with rural adolescents: Issues and outcomes. Journal of Psychoactive Drugs, 40(1), 109-120. Retrieved from Academic Search Premier Database.

Hogue, A., & Liddle, H.A. (2009). Family-based treatment for adolescent substance abuse: Controlled trials and new horizons in services research. Journal of Family Therapy, 31(2), 126-154. Retrieved from Academic Search Premier Database.

Meyers, R.J., Roozen, H.G., & Smith, J.E. (2010). The community reinforcement approach: An update of the evidence. Alcohol Research & Health, 33(4), 380-388. Retrieved from MasterFILE Premier Database

Nissen, L. (2006). Effective adolescent substance abuse treatment in juvenile justice settings: Practice and policy recommendations. Child & Adolescent Social Work Journal, 23(3), 298-315. Retrieved from Academic Search Premier Database.

Rhodes, W., & Gross, M. (1997). Case management reduces drug use and criminality among drug-involved arrestees: An experimental study of an HIV prevention Intervention. Retrieved from <https://www.ncjrs.gov/pdffiles/155281.pdf>

Schroder, R., Sellman, D., Frampton, C., & Deering, D. (2009). Youth retention: Factors associated with treatment drop-out from youth alcohol and other drug treatment. Drug & Alcohol review, 28(6), 662-668. Retrieved from Academic Search Premier Database.

Sussman, S., Skora, S., & Amos, S.L. (2008). Substance abuse among adolescents. Substance Use & Misuse, 43(12/13), 1802-1828. Retrieved from Academic Search Premier Database.

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