Counselors who deal with the several million American youth with alcohol and other drug problems often face hard choices. What kind of treatment do their teen clients need? Can the counselor provide that treatment, or are different programs indicated? Even more fundamental is the question of availability and affordability. Are there programs designed for adolescents that meet the specific needs of the individual client? And can the client afford treatment either through health insurance or personal resources? Perhaps most important is the question of effectiveness: how does the counselor know whether a particular program works?

Research on adolescent drug treatment is still in its infancy, and only a handful of programs have reliable outcome data. Several major federally funded studies evaluating various approaches to teen treatment are now underway and results will be reported over the next few years. However, even in the absence of controlled evaluation studies, we have already learned a good deal about the key elements that are linked to program effectiveness. Counselors can build on this knowledge to make more informed choices about drug treatment for teens.

Treating Teens: A Guide to Adolescent Drug Programs, recently published by the non-profit research institute Drug Strategies, identifies nine elements that are crucial to effective adolescent treatment. These elements, which bring together current research and clinical practice, were developed with guidance from an advisory panel of 22 nationally recognized experts in adolescent treatment, including leading academics, clinical researchers, treatment providers, and development specialists.

Key elements
Counselors can use these elements to judge for themselves the quality of particular programs they may be considering for teen clients. The key elements include:

1. Assessment and treatment matching: Does the program use a nationally recognized assessment instrument, such as the Global Assessment of Individual Needs (GAIN) or the Comprehensive Addiction Severity Index for Adolescents (CASI-A)? Does the program use the assessment to determine if the adolescent’s needs match the services available at the particular program as well as the level of treatment intensity?

2. Comprehensive, integrated treatment approach: Does the program address the full range of the teen’s treatment needs, including not only substance abuse but also mental health problems, family dysfunction, learning disabilities, school failure, and physical health concerns? Can the program connect the teen and his family to community services as needed?

3. Family involvement in treatment: Does the program engage the family and/or caregivers in treatment so that the teen will be more likely to remain in treatment and that treatment gains will be sustained after formal treatment has ended? Do families participate in regular meetings with counselors, other parents and their teens?

4. Developmentally appropriate program: Teenagers are not just younger versions of adults. Does the program address the biological, behavioral, and cognitive changes teenagers experience as well as the impact that these developmental issues have on substance abuse?

5. Ways to engage and retain teens in treatment: Is the program relevant to teenagers and their needs and interests? Does the program develop a climate of trust, confidence and acceptance between the teen and the counselor?

6. Qualified staff: Do the staff possess training and experience in diverse areas, such as adolescent development, delinquency, depression, anxiety, learning problems? Does the program have a low staff to client ratio so that caseloads can effectively be managed?

7. Gender and cultural competence: Does the program address the range of issues arising from differences in gender, sexual orientation and racial and ethnic background?

8. Continuing care: Treatment does not stop when the client leaves the program. Does the program plan for follow-up, community referrals, and periodic check-ups after completing treatment to help teens avoid relapse and recidivism?

9. Treatment outcomes: Does the program measure its own effectiveness with its teen clients? Most programs do not collect any outcome data; even fewer follow their clients for a year or longer after treatment. Yet this kind of information is critically important in assessing the success of a program as well as in determining which aspects of the program need to be strengthened.

The nine elements previously described are discussed in greater detail in Treating Teens: A Guide to Adolescent Drug Pro-grams, which provides a basic framework that counselors and other professionals can use to select programs for their clients. Counselors can also use these elements to assess their own programs (if they are working in a program setting).
This framework of key elements can become a vehicle of change, moving the field towards commonly accepted standards that are built on research and clinical practice. If programs are held to account both by professionals and by consumers (teen clients and their families), they will modify their approach to treatment by incorporating most if not all of the nine key elements.

These changes will not occur over-night, since some of the elements, like developing qualified staff and collecting treatment outcome data take considerable investments of time and money. Other elements, like family involvement and assessment/treatment matching, can be implemented more quickly. For example, standard screening and assessment tools are readily available and can immediately be substituted for questionnaires developed in-house.

Treating Teens is the first comprehensive guide to drug treatment programs for teens. The nine key elements identified by nationally recognized experts are then used to assess 144 adolescent treatment programs across the country. Counselors and other addiction specialists can build their own assessments using the same nine elements. As this process extends to include all professionals dealing with teens who have substance abuse problems, the field itself will improve as will the quality of adolescent treatment programs.

More information about Treating Teens as well as a complete profile of the 144 programs reviewed in the guide are available at Drug Strategies’ web site located at www.drugstrategies.org

Mathea Falco, an attorney, is president of Drug Strategies. She served as Assistant Secretary of State for International Narcotic Matters from 1977-1981.

This article is published in Counselor, The Magazine for Addiction Professionals, June 2003, v.4, n.3, pp. 60-61

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