Young adult treatment should be collaborative and developmental

Approaching young adults in a more collaborative and developmental manner has the potential to increase efficacy of treatment, according to Gary Hees, MA, LPC, clinical director, Decision Point. He says that 18 to 34-year-olds struggling with substance abuse should not only be treated firmly and respectfully as adults during treatment, but they should also be given opportunities to make their own choices.

“There’s a rich irony that we often have in this industry that we address substance use disorder, but if you act like you have one we’ll throw you out,” Hees said at the Institute for Clinical Excellence in Tempe, Ariz. this past week. “You cannot disrespect a person into sobriety.”

He said it’s important to help young adults go through a process of natural growth, differentiation, or evolution by successive changes so they can develop traits conducive to positive life functioning as well as develop and adhere to an internal value system. When young people have little internal sense of identity, he adds, they’re more susceptible to the impact of others and more vulnerable to addiction. Similarly, the level of “self” rarely changes unless a person makes a structured and long-term effort to change it, according to the Bowen Center.

“That’s why treatment needs to be a contrived and developmental process,” Hees said, recommending the use of objective measurements rather than self-reporting to determine client treatment effectiveness. While there are none for quality of sobriety, there are characteristics that contribute to the continuation of addiction. “By changing these characteristics, patients can be objectively measured.”

For example, a visual-learning patient at Decision Point who wasn’t complying with written assignments was instructed to watch a film and give a verbal report on it in his group session.

“He trusted himself, did it himself (autonomy), proved himself to his peers, and took initiative,” Hees said, adding that the patient began to work on his assignments consistently following the report.

At Decision Point, patients are placed into a primary treatment group after a 15-day assessment but must agree with staff that they need to stay. This is followed by a 30-day commitment and CORE programming that includes character education, trauma work, and principals of recovery.

Staff observe and report on patients—there are no interventions—and all issues are handled in this primary group, Hees said. Consequences are given with no judgment but disrespect is not tolerated. He said that while it’s best to be authoritative and firm, eliminate finger wagging and patronization. “Clients are told from the beginning that they are capable and expectations will be high.”