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Effective and Innovative Young Adult Treatment

In Drug Court

National Development & Research Institutes, Inc - The Training Institute –

Andrew Osborne, Director

Ninth Annual Treatmet Court Training Conference,

November 17-19,2004

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The Ideal Program: Treatment Components

Initial Assessment

Treatment Planning

Treatment Approaches

The Treatment Team

Program Design

Program Evaluation

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Why Implement Best Practices Now?

Prevalence of use at earlier agesAges 12-20 – Rates of “past-month use” more than doubled

Alcohol from 20% to 75%Marijuana from 8% to 27%

Lowered ages at first use63% report marijuana use before age 15 71% have used other drugs

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Why Implement Best Practices Now?

Emerging trends in drugs of choiceXtasy, Sextasy, Rolls

New breed of amphetaminesCotton and Scramble

New breed of opiates, low grade heroinA & E

New breed of hallucinogensFry Sticks

New takes on old favorites

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Why Implement Best Practices Now?

Increased co-morbid disorders- Combined marijuana and alcohol users are

4 to 47 times more likely to have wide range of problems

- 70-90% of youth with substance use disorders had 3 or more diagnoses for disruptive behavior, mood disorder, anxiety disorder

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Why Implement Best Practices Now?

Increased admission rates to treatment, decreased engagement rates

- Under 50% stay 6 weeks

- 75% stay less than the 3 months recommended by NIDA

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Why Implement Best Practices Now?

Unsustained recovery patterns after graduation

40% of treatment graduates have continuous substance abuse problems

29% have intermittent problems

Only 15% sustain recovery for 12 months or more

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Interventions Associated with No or Minimal Change

Passive Referrals

Educational Units Alone

Probation Services As Usual

Unstandardized Outpatient As Usual

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Interventions Associated with Deterioration

Treatment in groups including one or more highly deviant individuals

Treatment of adolescents in adult units and/or with adult models/materials (particularly outpatient)

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Initial Assessment

NADCP’s 10th Annual Drug Court Training Conference

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Performance Objectives

Identify the goals and principles of assessment

Identify characteristics of a strength-based assessment

Compare the GAIN assessment instrument with current JDC practices

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Instrument Selection

The instruments for use with adolescents should be: (1) reliable and valid;

(2) developmentally appropriate;

(3) considered by the type of setting in which the instrument was developed;

(4) chosen based on the purpose of the instrument.

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Assessor Characteristics

Outcome influenced by assessor skill and ability

Capacity to establish trust

Integrity

Active listening

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Purposes of the Assessment

Accurately identify who needs treatment

Determine severity

Learn about the nature, correlates and consequences of the substance-using behavior

Flag other related problems

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Purposes of the Assessment

Examine how the family can be involved in the assessment and in subsequent interventionsIdentify the youth’s strengths and how they can be used in the treatment planDevelop an appropriate written report that can help frame the planning process

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On Going Assessment

More frequent – changing drugs

30 days

Phase movement

Move to higher level of care

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Assessment Domains

Strengths

History of substance use

Medical health

Developmental issues

Mental health

Family history

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Assessment Domains

School history

Vocational history

Peer relationships

Juvenile justice involvement

Social service agency involvement

Leisure activities

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Models and Approaches to Treatment

NADCP’s 10th Annual Drug Court Training Conference

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Knowledge Base of Current Studies: Lessons Learned

Improvements generally came during active treatment and were sustained for 12 or more months

Family therapies were associated with less initial change but more change post active treatment (and the same in long-term results)

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Knowledge Base of Current Studies: Lessons Learned

Effectiveness was associated with therapies that were:

manual guided, developmentally appropriate, clinically focused and supervision/quality

assurance achieved therapeutic alliance, early positive

outcomes successful in engaging adolescents in

aftercare, support groups, positive peer reference groups and more supportive recovery environments.

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The Response to Findings

Developing manualized treatment models

Creating systems of care

Building partnerships and strategic alliances

Continuing research to obtain longer term results.

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The Purpose of CYT

Learn more about the characteristics and needs of adolescent marijuana usersAdapt evidence-based, manual-guided therapiesEvaluate the relative effectiveness, cost and cost-effectivenessProvide validated models to address the pressing demands for expanded and more effective services

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The CYT Study

More than 600 teens and their families were treated

Preliminary findings showed that each therapy worked

Results so encouraging the protocol manuals have been replicated nationwide

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The CYT Manuals

The manuals include:

Rationale for each approachEffective assessment tools to help plan effective treatmentInformation on the staff requirements and training suggestionsForms to track treatment deliveryInformation on the CYT study

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The CYT Manual How-To’s

Precise procedures for using the approaches

Detailed session guidelines

Examples of conversations between clients and counselors

How to do roleplays

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The CYT Manual How-To’s

Suggested topics for group exercises

Information handouts such as skill guidelines, reminder sheets, and take-home exercises for teens and their parents or caregivers.

Posters for use in the session

“Talking points” for counselors

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CYT : Study Group Topics

Motivational Enhancement Therapy and Cognitive Behavioral Therapy

Family Support Network

The Adolescent Community Reinforcement Approach

Multidimensional Family Therapy

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Expressive and Experiential Therapies

NADCP’s 10th Annual Drug Court Training Conference

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Performance Objectives

Identify a variety of expressive and experiential media and interventions in order to help drug court participants become motivated for, engage and be retained in a dynamic therapeutic environment

Determine how to apply/integrate these approaches with current treatment practices

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ExpressiveTherapies: Their Efficacy for Treating

Adolescent Substance Abusers

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Music Therapy: Using Music to Achieve Treatment Goals

Integrating elements of music with specified therapeutic goals

Using the sensory stimulation evoked by music to provoke responses due to familiarity, predictability and feelings of security associated with it

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Music Therapy: Using Music to Achieve Treatment Goals

Creating a sound mirror. Sound mirrors first reflect the client’s self-reported inner state or feelings and then reflects the desired mood or feeling the client is hoping to attain.

Transforming the client’s rhythm orientation to a lyrical/process orientation. By so doing the client learns to experience the music, not merely listen to it.

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Applying Music Therapy Principles

Select the appropriate music

Sequence the music

Let the music fill the room

Prepare the clients to listen

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Applying Music Therapy Principles

Listen to the entire musical selection first

Allow time to process

Create a safe place to dialogue

Encourage clients to listen alone and journal

Encourage parents to listen to the music

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Dance/Movement Therapy

When integrated into a substance abuse treatment regimen, dance/movement therapy can effect changes in:

feelings

cognition

physical functioning

behavior

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Art Therapy

“At the deepest level, the creative process and the healing process arise from a single source. When you are an artist, you are a healer, a wordless trust of the same mystery is the foundation of your work and its integrity.”

Rachael Naomi Remen, MD

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Art therapy can help adolescents:

Express feelings too difficult to talk about

Increase self-esteem and confidence

Develop healthy coping skills

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Art therapy can help adolescents:

Identify feelings and blocks to emotional expression and growth

Provide an avenue for communication

Make verbal expression more accessible

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Journaling Techniques

Dialoguing

List making

Dream documenting

Clustering

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Bibliotherapy Goals

To develop accuracy and understanding in perceiving self and others

To develop creativity, self-expression and greater self- esteem;

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Bibliotherapy Goals

To vent overpowering emotions and release tension

To find new meaning through the exploration and re-exploration of ideas and insights

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Guidelines for Using Bibliotherapy

Select a recognizable piece of written work

Create a non-threatening atmosphere to share feelings

Be willing to explore sensitive details

Ensure connections are made and provide closure

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Issues/Situations for Dramatization

Confrontation with peers

Rejection

Patterns of interpersonal interaction

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Issues/Situations for Dramatization

Ways to establish credibility, trust and legitimacy

Sexual expression

Assumptions, prejudices, stereotypes and expectations of others

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Wilderness Therapy:Phases of Treatment

Cleansing

Social and personal responsibility

Transition and aftercare

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Recreational Therapies

Team Building

Problem Solving (independent vs. group)

Accepting Loss

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Process Questions

How do we utilize this information as well as the techniques and approaches to enhance our treatment services?

How do we ensure that this process or practices is continuously effective? Culturally, developmentally and gender appropriate?

How do we integrate the family?

How do we integrate the juvenile justice professionals in this process/practice?