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Seeking treatment
With her bright pink nail polish, pancake makeup and
darting, penciled eyes, Sarah looks older than 16. But being too old has
never been her problem -- not since the age of 11, when she sought help
from a California drug treatment program for adolescents and was turned
away for being too young. By then, she had already been smoking crystal
meth for at least a year. She had been expelled from the sixth grade
after 17 suspensions; run away from five foster homes; and was, in her
own later estimation, looking "pretty gross" -- skinny as a stick, with
five different hair colors and a face full of self-inflicted scars.
Ineligible for a program "developmentally targeted"
for teens, an adolescent Sarah fell through the cracks. Although a
social worker from Child Protective Services, familiar with her case,
offered alternative counseling, it was years before Sarah quit, and then
it was on her own terms. The overwhelming fact is that of the 1.6
million young people between the ages of 12 and 18 with serious alcohol
and drug problems, fewer than one in 10 receive treatment. Of the
estimated 175,000 who do, only about 25 percent stay in treatment for
three months, as recommended by the National Institute on Drug Abuse;
less than 50 percent stay for even six weeks, according to the Office of
Applied Statistics in 2005.
In New Jersey, about 65,000 people ages 12 to 17 had
drug and alcohol problems, according to 2003 and 2004 data provided by
federal Substance Abuse and Mental Health Services Administration, the
most recent data available. About 38,000 needed but did not receive
treatment for drug use; about 41,000 needed but did not receive
treatment for alcohol use. Last year in Passaic County, 142 residents
ages 12 to 18 were admitted to drug and alcohol treatment programs, said
state Department of Human Services spokewoman Suzanne Esterman. In
Bergen County, the number of admissions in the same age range was 255.
And there is virtually no continuing care for
teenagers who struggle to stay straight once back in the larger
community. A 2002 study in the Journal of Substance Abuse Treatment
found almost 80 percent of teenagers relapse within a year of treatment.
There is an explanation for this public health embarrassment: The
epidemic of drug and alcohol abuse among young people was until recently
an invisible problem, either unrecognized, ignored or wishfully
dismissed as too awful to be true. Until 1997, there were only 14
studies published in the field of adolescent drug treatment, and those
were widely regarded as being of questionable quality.
Today, the field is moving from an uninhabited
backwater to a state-of-the-art discipline, with dozens of new federal
grants, hundreds of published studies, promising new interventions and
-- finally -- evaluated program outcomes.
One of the most telling developments is the rapid
growth of recovery high schools and colleges -- some with waiting lists
-- whose main focus is abstinence and recovery for students after
treatment. At the high school level, there are 30 of these schools for
abusers around the country, each built on a 12-Step model, offering
mentorship and concrete rules for staying straight, as well as the sort
of peer bonding that reinforces new patterns of positive behavior,
something that generally isn't possible in a typical high school. "To
think a teenager is going to go for treatment for 30 days and then come
back to his old environment -- where he bought his drugs, where his
peers are using and where he was seen as a drug user ... that's not
realistic for the vast majority of kids," says Andrew Finch, executive
director of the Association of Recovery Schools, which represents the 30
recovery high schools, from Alabama to Alaska. Finch says the programs
work: Between 20 and 30 percent of the young participants relapse, but
that's a substantial improvement over the national norm of 80 percent.
The field is exploding with new knowledge about
adolescence and substance abuse. It is now understood, for example, that
the vast majority of teen substance abusers -- more than 80 percent of
girls, according to some recent academic studies -- have been sexually,
physically or emotionally abused. With that in mind, many experts have
put out a call for routine screening for sexual abuse when young drug
and alcohol users show up for treatment. "The issue of traumatic
victimization is an unspoken elephant in the counseling rooms," writes
Michael L. Dennis, a research psychologist at Chestnut Systems, a
research and treatment center in Bloomington, Ill., and author of
well-regarded drug assessment tests. "Physical, sexual and emotional
abuse is the norm."
Many adolescent substance abusers -- federal estimates
say 70 percent -- also have a mental health issue, such as attention
deficit disorder, bipolar disorder or post-traumatic stress disorder. In
a Catch-22 scenario, mentally ill youths and adults are routinely turned
away from drug and alcohol treatment centers, told, typically, that they
have to get their depression under control before being treated for
their addictions.
Slowly, local public agencies across the country are
responding, some even consolidating mental health and substance abuse
agencies into single entities, its counselors expected to be trained to
deal with both. Multi-tiered programs are becoming the new norm: A teen
meets regularly with counselors, parents, clergy, probation officers;
everyone is around the same table, considering the teen's interests.
Among the findings on alcohol's effects: A teen with a
family history of alcoholism has a 50 percent risk of becoming an
alcoholic. When a teenager drinks large amounts of alcohol, his brain is
changed; researchers suspect that specific proteins are activated,
increasing the susceptibility to alcohol throughout life. Adolescents
who begin drinking before age 15 are four times more likely to become
alcohol-dependent later in life.
Despite the flood of information pouring in from
academia, families and adolescents with problems all too often face
questionable practices and scant alternatives. Parents can go broke
looking for help, since private insurers don't cover the cost of
treatment. Even for the few who can afford to pay the typical $20,000
cover charge of a 30-day private residential treatment program, there
are few effective programs available and no guarantees from those that
do exist.
In 2004, an expert panel evaluated 144 of the "most
highly regarded" drug programs for adolescents and concluded that most
of them failed to address the key elements of successful treatment:
individual assessment at the start of treatment; tailored therapy for
teens with psychiatric disorders; gender and cultural differences;
continuity of care; staff evaluation; and treatment outcomes. What the
study neglected to mention is that there are, in fact, no licensing
standards for adolescent drug counselors. A handful of states, including
California, Washington and Colorado, are now working to establish them.
"If I were a parent trying to navigate something for my child, even I --
knowing everything I do -- would have a very hard time trying to figure
it out," admits Yolanda Perez-Logan, project director of the Reclaiming
Futures program in Santa Cruz, Calif.
Introduced in 10 cities, Reclaiming Futures is a
five-year initiative funded by the Robert Wood Johnson Foundation in
response to the "treatment gap" that occurs when an increasingly
drug-dependent teen winds up in trouble with the law. The gap is more
like a canyon: Four out of five teen arrests involve the use of drugs or
alcohol, while 80 percent receive no treatment for the problem that got
them there. By far, the majority of youths in residential treatment are
sent there through the criminal justice system. Even then, parents have
to shoulder a huge part of the financial burden.
For those who can get to private treatment, many youth
programs are now moving away from the classic 12-Step model, as embodied
by Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). A
philosophical split has emerged in the treatment community, with some
on-the-ground programs endorsing alternatives to 12-Step and its
insistence on total abstinence. "Many treatment programs are using new
evidence-based practices that meet youth where they are with their
current substance abuse and help them make a decision what they're going
to do about it," says Randy Muck, lead public health adviser for
Adolescent Treatment Programs at the federal Substance Abuse & Mental
Health Services Administration.
Many experts argue that the language of 12-Step
programs, with their starting point of sobriety, grew out of a
therapeutic model aimed at adult males. Its requisite call to a "higher
power" is often a major sticking point with teens who, in the words of
one probation officer, often "think they are the higher authority." "For
years, the problem we've encountered is that treatment for kids is
basically treatment for adults repackaged," says Scott Reiner, program
development manager in the Virginia Department of Juvenile Justice.
Small wonder, then, that an 11-year-old girl like
Sarah could be told to come back for treatment when she turned 14. Sarah
now takes classes at The New School, an alternative high school largely
comprising former gang members and drug addicts in Watsonville, Calif.,
that offers some services you won't find at your typical high school --
including rides to nearby AA and NA meetings, after-school 12-Step
classes, routine urine testing and a dog that comes in to sniff
backpacks a few times a year. "I'd run away from a group home and no one
knew where I was for a month. One day I came home and my niece asked me,
'Are you going back to jail?' That made me feel really bad because she
was only 6 years old. "I saw my niece going through the same exact thing
I went through. Fighting with her mom, her mom always hitting her,"
Sarah says. "And I thought, how am I going to help her if I don't stop?"
Richard Scheinin with Ed Beeson
29 August 2006
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