Adolescent SUD Patients Require Innovative Treatment Interventions

Because the adolescent brain is still developing, engaging teenagers in addiction treatment can pose additional challenges for providers.

Interventions that have demonstrated efficacy with adults may not be as effective with adolescents, says Drew Dutton, MEd, MBA, LPC-S, LCDC, ACPS, president and CEO of Phoenix House Texas, a not-for-profit organization in Fort Worth, Texas, that specializes in adolescent substance use treatment and prevention services.

At the West Coast Symposium on Addictive Disorders on Saturday in Palm Springs, California, Dutton led a workshop on the neuroscience of adolescent addiction and innovative approaches to treatment. Ahead of his session, Dutton spoke with Addiction Professional about the unique challenges of working with adolescent SUD patients, the additional issues created by the adolescent brain still developing, and treatment options for younger patients that are worth investigating.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional: What challenges related to substance use disorders are unique to adolescent populations?

Drew Dutton: It's a particularly vulnerable population to begin with. The adolescent brain is highly neuroplastic and malleable, so it's able to rewire and reshape itself as that reward system gets hijacked through the process of addiction, making it really susceptible to it. Additionally, in a lot of instances of addiction, you experience what's called, "hypofrontality,” where you don’t have the ability to use your prefrontal cortex, and adolescents, by default, have an underdeveloped prefrontal cortex. Even a fully healthy, non-using adolescent has half the capacity of the prefrontal cortex as an adult, so their ability to weigh the pros and cons, think rationally, and respond in that manner is at a disadvantage from the get-go.

Further, access to care for adolescents is just so much harder to find. I know in Texas specifically, where I reside, there's so few resources for kids to access residential or intensive outpatient treatment, especially for those without the means to afford those services or lacking insurance to access quality care.

AP: Does the fact that the adolescent brain is still developing create additional issues when you're trying to treat substance use disorder?

DD: Yeah, it makes it highly susceptible to bad approaches. And when I say bad, I mean those rooted in the moral model and highly stigmatized lenses. A lot of adolescent behavior is, especially with addiction, actually the manifestation of symptoms. I think that addiction is one mental health disorder where we've criminalized its symptoms—a lot of the symptoms tend to be very antisocial and abrasive. Whereas we find it easier to have empathy with someone who's grieving or going through depression or anxiety, we tend to lack that level of empathy with individuals suffering from substance use disorders and what those behaviors might look like, whether it's something we categorize as manipulation or theft or possession or these different things. Adolescents display a significant amount of those "misbehaviors," so it's really easy for providers, as well as society at large, to get frustrated and disgruntled and think that it's just a bad kid misbehaving, not recognizing that there are underlying issues here. They're at a huge disadvantage compared to the behavioral control and executive function that an adult might have, or someone not struggling with addiction might have.

A lot of the research is adult-dominated as well. There's just not enough information out there about what is effective with adolescents compared to the research that exists for adults. A lot of the approaches that we've seen have just been watered-down adult approaches or assumptions that adult approaches apply. What we certainly know is that there's a lot to be said for empathic and person-centered approaches, and really working to meet the patient where they're at, understand their goals, and non-confrontational approaches, but it's not a lot of what we see in practice. But we still see a lot of heavy-handed, highly disciplinary, almost shame-based models that kids are subjected to, where it's treated more through a criminal justice lens than a healthcare lens.

AP: Are there any emerging treatment modalities that practitioners should explore that would be particularly useful with an adolescent population?

DD: I think strengths-based approaches have a lot of promise for this population, given what we know about how adolescent behavior responds to rewards and positive reinforcement. We are able to focus on what an adolescent’s particular set of strengths are. There are a variety of tools out there. We're partial to the VIA Character Strengths Survey developed through the Positive Psychology Institute at UPenn when we work with adolescents. We build a treatment plan around resiliency and strength factors, and focus on rewarding desired behaviors instead of punishment, and avoid just strictly going after undesired behaviors as if it's bad choices, bad people.

AP: Would you consider the practice of providing positive reinforcement to reward desired behaviors as you’ve described here to be similar to contingency management?

DD: To some extent, yeah. I don't know how it is elsewhere, but in Texas, in our administrative code, it still outlines a really misunderstood therapeutic community model where it says it's intended to treat criminal and anti-social behavior, that they're here to learn right living and the appropriate morals and values. It's just so antiquated and misinformed around what these kids are going through and what you as the provider are there to address.

Reference

Dutton D. The neuroscience of adolescent addiction and innovative approaches. Presented at West Coast Symposium on Addictive Disorders; June 1-3, 2023; Palm Springs, California.