Developmental TasksArtwork courtesy of KidsPeace
Adolescent Aftercare -- a phrase that strikes fear into the hearts of many an addictions counselor! Others embrace it like a long lost child who has just returned home. Aftercare at any level can be challenging. It can bring many rewards, but also many disappointments. Those who choose to work with adolescents need to review from time to time those things that make aftercare for this group uniquely challenging.
Developmental TasksLet's start with the obvious -- age. Adolescents struggle with specific developmental tasks related to achieving independence from their families:
Separating from one's family emotionally, learning to be self-governing, figuring out who you are and what you believe in and, finally, discovering how all that will fit in with the rest of society can be a daunting task for anyone. Add addictive behavior into the mix, and you have a recipe for many potential problems.
We know that the addictive use of mood-altering chemicals distorts or short-circuits this developmental process in adolescents. Addiction counselors often treat adolescents who operate emotionally at a much younger age. This can lead to unrealistic expectations about the behavior and level of maturity of these clients if the counselor fails to take this emotional immaturity into consideration.
Some clients in our system started practicing addictive behaviors at such an early age that emotionally they have yet to reach adolescence. They often react to limits/ boundaries placed on them by treatment facilities by exhibiting childhood behaviors such as temper tantrums. These patients need help learning how to react in an emotionally healthy manner. The addiction counselor's expectations and treatment planning will be crucial in the clients' attempts at recovery, as well as their level of motivation to overcome their addictive behaviors.
With increasing frequency, we recognize and deal with dual diagnoses when treating other addictive behaviors or mental health issues. Other addictive behaviors we see in young people include pathological gambling, Internet addiction and eating disorders. Mental health issues an adolescent might bring to the aftercare setting include:
Each of these disorders has its own set of symptoms which serves to complicate the treatment process. A solid interdisciplinary approach can effectively identify these issues and begin to address them at the primary treatment level. Well-developed treatment plans with specific goals and interventions can greatly assist a client in understanding how his or her differing diagnoses are intertwined.
When adolescents are given an opportunity to learn that choices exist in how one reacts to life as it reveals itself on a daily basis, often they will begin to make different choices. This, like all phases of treating addictive disorders, is a dynamic process. No single approach works for everyone. When treating addictive behavior, remember to treat the individual as well. With dual-diagnosed clients, the addiction counselor should always involve other appropriate disciplines, such as psychiatrists and physicians. It's appropriate to involve clients in different treatment tracks to address other addictive behaviors. This should also carry over to the aftercare process.
Although adolescence is a time to begin separating from
family and discovering who you are as an individual, young adults are
still primarily connected with their parents. Therefore, it is
imperative that parents remain involved in the aftercare process.
Often the parents need as much ongoing education and support as the adolescent. Some parents look for, and on some level even expect, treatment professionals to give them a magic answer for why their child is acting the way he or she does. Some look for a parenting recipe that will cause their children to stop making decisions which endanger their lives. It's safe to say that accepting they are powerless over their children's addictive behaviors is just as difficult for most parents as it is for the addict.
Parents by nature are protective. Most believe their job is to instill values in their children and provide them with tools that will enable them to survive and be productive as adults. When dealing with an addicted child, parents will struggle with feelings of anger, fear, frustration, guilt and a sense of failure. In the parents' eyes, the child obviously can't make appropriate choices, so they will initially want to protect and control their child. Unfortunately, this behavior serves to enable the addictive process rather than help counteract it.
Providing a forum for parents to come together as a group with their children on a regular basis during the aftercare process gives parents a chance to see they are not alone in their struggles and their family is not unique.
In this type of forum, they have a better chance of covering ways to cope with their feelings and understand the disease/recovery process. They can learn what they, as parents, are and are not responsible for with regard to the child's recovery. They also have an opportunity to receive feedback from others on how their interactions with their child may be affecting his or her recovery.
Family involvement also provides the clinician with insight into the home environment from a perspective other than the child's. Often, a parent can see a potential for relapse the child hasn't noticed.
To fully benefit from the treatment process they ex-perience as a result of their child being treated for an addictive behavior, parents need to take care of themselves and be involved in a recovery program of their own.
The number of enablers an adolescent has in his or her life usually far exceeds that of an average adult. The more collateral people in an adolescent's life that are involved in the treatment experience the better. The more these people educate themselves and become aware of the child's issues, the less likely they are to allow the addict to continue to manipulate them.
Some of the more important collateral people in the child's life, other than family, include:
All collaterals should be utilized to whatever degree necessary to enhance a child's recovery.
If you want to see how the addiction process has affected the family dynamic, check out an adolescent aftercare group. There you will find heroes, scapegoats, lost children and mascots all practicing their crafts. Adolescents are great enablers of one another. Most view the world from an "us against them" point of view. To that end, they go to great lengths to protect each other from looking at weaknesses in their respective recovery programs.
"Heroes" often become overly involved in others' recovery programs and can easily avoid addressing their own issues. The "scapegoat," left unchecked, can and will disrupt the group process and inhibit attempts to deal with serious early recovery issues -- their own as well as others'. The "lost child" will inevitably get lost in the group and continue the process of ignoring any feelings he or she might experience. And finally, the "mascot," with all the good intentions in the world, will try to short- circuit the expression of uncomfortable feelings by trying to make everyone laugh. "After all," they'll reason, "it's no big deal. Get over it already."
Counselors must identify problematic behaviors and develop treatment plans to address them. Redirect the "hero" to focus on himself or herself. Set limits with "scapegoats" regarding their behavior. Give assignments to the "lost child" that will draw him or her out. Provide a safe environment to discuss feelings so the "mascot" will begin to trust that uncomfortable feelings are not bad.
Aftercare is the bridge from primary treatment to reintegration back into everyday life. For people leaving primary treatment, aftercare is essential to enhance their chances of achieving ongoing abstinence from an addictive behavior. For adolescents, aftercare sometimes is the only link to a sober peer group early in recovery. Aftercare groups need to focus on early recovery issues such as the relapse process and signs/symptoms of relapse. Is the client attending 12-step meetings on a regular basis, and is he or she making appropriate use of them? Is the client developing new leisure activities to avoid boredom? Recovering addicts also need to continue developing the ability to identify and express their feelings in an appropriate manner.
Adolescents in early recovery struggle with the question of what to do about old friends who continue to use mood- altering chemicals or engage in other addictive behaviors. They also struggle with an issue that probably played a part in their beginning to use chemicals: the feeling they are different or out of step with their peers. Many don't feel they fit in anywhere. Many adolescents describe periods of loneliness in which they believe they are the only kids not involved in some addictive behavior. Some wonder if they will ever find friends "who don't use..."
Empowering young people with the concept of choice seems to help. At some time on some level, a person recovering from an addiction has to make the choice to stop their addictive behavior in order to achieve abstinence. Something as simple as giving the adolescent the responsibility to make the choice can be very powerful for them.
Many adolescents feel victimized by life. This seems to be especially true for young adults struggling with addictions. This victimization and feeling of powerlessness can cause a lot of resistance that can create problems for counselors facilitating young adult aftercare groups. It can manifest itself as frustration in the counselor or inhibit those young people moving toward healthier lifestyles from sharing their successes with the group.
The role of aftercare counselor for an adolescent group can be very challenging and, at times, frustrating. But it is also very rewarding to be a part of the success stories. Individualized treatment planning, involvement of families and other significant collaterals, addressing dual-diagnosis issues, focusing on early recovery issues in group, empowering our clients and understanding the function of resistance in adolescence all serve to enhance the client's chances of recovery.
1. "Preventing Adolescent Relapse," Tammy Bell, Herald House/Independence Press, Independence, MO pg. 39, (1990).
Phil Scherer is an assistant clinical coordinator at the Illinois Institute for Addiction Recovery at Proctor Hospital. He has worked in the addictions field since 1991 and is certified through the Illinois Alcohol and Other Drug Abuse Professional Certification Association (IAODAPCA). See Spotlight in Paradigm Fall 1997.
