Pioneer in adolescent care reflects on time-tested approach

David Gust decided to co-author what would become many addiction treatment professionals' guide to establishing adolescent outpatient services because some voices in the field were questioning the effectiveness of outpatient care for young people. Now commemorating the 20th anniversary year of the book, Effective Outpatient Treatment for Adolescents, Gust, a state and nationally certified counselor and founder of New Directions Counseling Associates in the Sacramento, Calif., area, says there is little he would change about the treatment strategies outlined in his work.

“The one thing I would change is in Chapter 1 in terms of describing the problem, because there is so much more now that we know about the brain,” says Gust, who co-authored the book with the late Ted Smith.

One could argue that the book needs few revisions today because it was so ahead of its time then. Gust began working in the addiction field in the late 1970s, when the concept of an adolescent treatment system did not even exist. Even when prominent programs finally began establishing adolescent outpatient tracks in response to reports of warehousing of young people in inpatient programs, they simply applied to youths the employee assistance model they had used to build the adult outpatient treatment system, Gust says.

“The first attempts ended up being ineffective,” he says.

Yet Gust had been involved with tailored adolescent outpatient services in the Sacramento area since the early 1980s, so he took notice when a professional publication in the field suggested in the early '90s that outpatient treatment for young people should be abandoned entirely. “That triggered something inside me,” he says.

The book he and Smith would work on in response, published by Learning Publications, would become a time-tested guide for assisting adolescents from the time of the initial family phone call through program discharge.

Gust is still involved in speaking out. New Directions has begun publishing a monthly electronic newsletter that will tackle issues in substance use counseling, and Gust says this summer the publication will feature a multi-part series on marijuana.    

Treatment standards

Gust began working with adolescents (he now works exclusively with adult males) at a time when there was little consensus about what adolescent treatment should look like. It took a long time for operators of adolescent treatment programs to realize they were better served by hiring staff with direct experience in youth services and then training them in chemical dependency topics, and even longer for them to consider the components of thorough assessment, intervention and family involvement as essential to the success of their efforts, he says.

Gust says that if anything about adolescent treatment has changed in the two decades since the book's publication, it is the increased awareness of overall health in the equation. “I look at programs and ask, 'What do you do to treat the physical illness, as this is a disease of preoccupation, obsession, compulsion and craving?” says Gust. He believes the integration of diet, supplementation and exercise will continue to take on added importance in treatment.

Along those lines, Gust shakes his head over a common flaw he sees in treatment programs today. “I cannot believe in this day and age that there still are adolescent programs that are allowing nicotine use,” he says.