Take a moment to consider the following fundamentals of the chemical dependency treatment template: Step 1, sponsorship, and changing people, places, and things. Without these three items, we argue, the chemically dependent patient has no legitimate chance for lasting recovery. We systematically repeat this mantra throughout a patient’s treatment and continue the message within the 12-Step fellowships. Are we establishing a realistic vision of the recovery process for our adolescent population? Or, are we making a fundamental error in our roadmap for adolescent treatment and recovery by using a system created for adult alcoholics by adult alcoholics?

Step 1 requires an individual to accept powerlessness in relation to alcohol and drug use. This requires humility, conscious reflection, and willingness to admit defeat. When was the last time the face of an adolescent popped to mind when you thought of these? Isn’t the very essence of adolescence the opposite of Step 1? Risk-taking, impulsivity, recklessness, and, at minimum, curiosity, are often associated with adolescents. And this applies to the non-using ones! Throw together a cocktail of these personality traits with alcohol and other drug use, abuse, and dependency, and what is the result? Often, it is a volatile, grandiose, oppositional, self-defeating tornado of a teen who actually believes he or she is gaining strength and power.

Between the ages of 13 and 22, a young person can be promiscuous, violent, and downright criminal and increase his or her social standing. Being a partier can and will create an image that appeals to adolescents of both sexes. Young people who shoplift, fight, and/or deal drugs are neither avoided nor ostracized. In fact, the reverse is often the result — increased attention, feelings of power and importance, and more attention from the opposite sex. Using psychology, we can see how rewarding this lifestyle becomes. Add in the adolescent’s task of identity development, and one begins to understand why so many adolescents engage in and increase this mode of behavior.

On the other hand, adults who sell drugs, get drunk, have criminal records, and behave in these ways often find themselves unemployed, broke, lonely, and immensely unappealing. Adults have a much easier time accepting Step 1 and internalizing the pain caused by their addiction and its accompanying lifestyle. A move in the opposite direction is and will be a much more promising endeavor.

But what about the shy, awkward kid with braces who transforms into a teen with increased social standing and a notorious, though rewarding, social identity? This individual will not ease into Step 1 so readily. Those of us who treat adolescents encounter
illustrations of their seemingly illogical thought everyday. From our adult vantage point, we recognize the self-destruction, poor choices, and ongoing deficit that addicted young people have created. We see the intense desire that many adolescents retain in their efforts to run from treatment and dive eagerly back into their using styles. Parents are desperate, school administrators are punitive, and clinicians seek to initiate change. Logic dictates our treatment planning and efforts to promote change. What about the adolescents’ view? Does it not make sense to return to a style of living that, in many ways, was quite gratifying? Or, do they return to a lifestyle that moves them back toward feelings of isolation, awkwardness, and uncertain identity? As clinicians, we must consider these dynamics when evaluating Step 1 work with adolescent patients.

Choosing a sponsor and following direction without reservation are generally considered to be at the top of the list for any person seeking recovery. In the treatment field, it is understood that the best outcomes almost always have a connection to 12-Step involvement and sponsorship. It is also undeniable that adolescents who complete treatment have woefully low rates of 12-Step involvement and even lower rates of sponsorship acquisition. Should we be surprised by these factors? No.

Adolescents have never been known as advocates for mentoring programs, Big Brother/Big Sister initiatives, and 12-Step sponsorship. With good intensions, generosity, and care, adults develop and emphasize these programs for young people in need. There is no question that young people can and do benefit from these designed relationships, but do kids seek out relationships of this sort? Are adolescents, using or abstinent, actively seeking more adults and/or authority figures to enter their lives? In the majority of cases, the answer is no. They have a choice in the matter, unlike other situations such as family and school, in which they do not.

Speaking of choice, patients are taught to change people, places, and things in their environment. In choosing to make these changes, the recovering person promotes safety, decreases temptation, and strives for a new identity in fresh surroundings. If only this process were so simple for adolescents seeking recovery.

An adult in recovery has much more freedom than an adolescent in relation to this fundamental principal. For example, the adult can quit a job, leave a spouse, move away from the family of origin, or perhaps move back in with the family of origin (depending on circumstances). The bulk of adolescents leaving treatment and/or attempting recovery has very limited options in this regard. Once one turns 18, the options increase. But, with adolescents, there is usually no choice. It is our experience at Caron that the majority of adolescent patients must return to their schools, families, and peers. A panel of experts could easily list these three entities as the top relapse triggers faced by adolescents in early recovery. No matter how comprehensive a treatment experience may be, is it reasonable to expect emotional and behavioral stability from a teen returning to the scene of his or her chemical usage?

The field of chemical dependency treatment is young, and adolescent treatment younger still. It is imperative for us to question traditional approaches and philosophies regarding our patient population. The medical field found out that research conducted on men did not serve the needs of women. The chemical dependency treatment community must proceed in parallel fashion with its adolescent population by inquiring about the appropriateness of traditional, adult-driven treatment modalities. As our vision improves, our patients’ paths become clearer.

David Rotenberg, MA, CAC, is Program Director at the Caron Foundation Adolescent Treatment Center, where he oversees daily operations, including staff development/ supervision, patient care, crisis management, and pet therapy.

This article is published in Counselor,The Magazine for Addiction Professionals, April 2004, v.5, n.2, pp. 57-58.

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