Friday September 30th 2016

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Court ordered rehab for teens: Does it help, or not?

Can mandatory addiction treatment help teens who have problems with drugs or alcohol? We explore here in an exclusive interview with California based Thunder Road Adolescent Treatment Center on best practices here. Then, we invite your questions, comments, or feedback at the end.

The juvenile justice system and rehab

Early intervention is critical when working with adolescents who have had contact with the juvenile justice system. Every young person involved in the juvenile justice system (regardless of the charges she faces) should undergo thorough screening and assessment. So, when substance use disorders need treatment…does court ordered rehab work?

We think so. From our reading, having court-ordered treatment and monitoring may be the most effective approach to addressing substance use disorder services for many adolescents. It is almost impossible to intervene unless the youth is removed from the environment that brought her into conflict with the juvenile justice system in the first place-that is, the home neighbourhood. But we wanted to learn more from the field. So, we went to the experts.

We asked the experts

Thunder Road Adolescent Treatment Center has been working with teens and the justice system for decades. The center’s mission? To assist youth and their families in the challenges to recover from the abuse of alcohol, drugs and nicotine, and to support their growth as healthy, connected, and honorable members within our neighbourhoods and communities.

Today we invited Gina Chirichella, Long Term Program Supervisor at Thunder Road, to share more about their experiences as a youth addiction treatment program, as well as the best practices in serving teens going through court ordered rehab.

At the end, we invite you to share your thoughts and questions on this topic in the comments section below. In fact, we try to respond to all comments with a personal, prompt response.

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ADDICTION BLOG: To begin, what percentage of teens that attend your programs are court ordered? Do you think that this percentage is fairly common of the status of adolescent treatment across the country, or it is specific to your locality?

THUNDER ROAD: The percentage of teens that are mandated to attend our program varies, but usually around 60-65% of our population at any time is court ordered.

There are not many programs like ours, which treats co-occurring addiction and mental health disorders, so it is hard to say what the national average is. Because we are located in a large urban area, it is possible that we see a slightly higher percentage of court mandated treatment referrals, but I imagine most programs see at or around what we do.

ADDICTION BLOG: What do you think it takes to run a successful program targeting teens with substance use disorders? What kinds of structure, curriculum, and/or peer support are necessary?

THUNDER ROAD: Structure.

From the time they wake up until the time they go to bed, our teens are following a fairly rigid schedule. Their meals, school, groups and rec time are all scheduled into each day, with designated times for breaks and outings. The schedule gives the kids stability, which many of them have not had in their lives. They know what to expect every day and when they finally complete the program, we help them to structure their lives outside of treatment.

We also have a comprehensive mental health program including:

  • Process groups
  • DBT/skill building groups
  • 12 step groups
  • Multi-family groups

The group process is really important – all of our teens start the program at different times, so in any given group, there are kids in the beginning, middle and end of treatment. Hearing and seeing peers work the program and change is powerful for our clients, more powerful than anything a therapist or counselor might say.

Our program is based on basic behavioral therapy techniques – we use a lot of positive reinforcement and, although we hold a strict structure, we don’t use a lot of punishments/consequences. We try to reward the clients for each thing they’re doing well instead of pointing out what they’ve done wrong (that said, there are certain behaviors that are not tolerated and do warrant a consequence).

Further, the use of rewards works well for teens – these kids haven’t fully developed their brains yet and are operating more like children than adults when it comes to consequential thinking. The reward system seems to provide enough reinforcement for the clients to buy into whatever we’re asking them to do.

ADDICTION BLOG: What are some of the real needs that teens have in addiction treatment? How do you meet them?

THUNDER ROAD:  At a very simple level, many of our clients have not been getting even their most basic needs met, so we start with making sure everyone has appropriate clothing and food. They also need a safe space. We create that as best as we can by having supportive staff and giving kids their own living space. They need to know that we have their best interest in mind (even if they don’t like being here) and that we’re going to take care of them.

And then they have the same needs as any other teen – they need to socialize, go out and learn how to be in society without using drugs. We try to do as much as we can. We go to the movies, go on hikes and field trips, sporting events.

ADDICTION BLOG: What does it take for a kid “going through the system” to succeed in addiction recovery?

THUNDER ROAD: It’s a challenge.

A lot of the kids we see in our program come from families with mental health or addiction problems and when we send our clients home, sometimes it’s to an environment that isn’t conducive to sustaining a successful recovery. They have to work really hard and stay focused on their goals.

It helps for them to have healthy hobbies – sports and other extracurricular activities – that helps fill their time and keeps them engaged in something other than using drugs. And they have to get out of the system and stay out of the system. Our court mandated clients usually leave the program still on probation, sometimes they have to complete community service, or pay restitution, but it doesn’t always end here.

ADDICTION BLOG: What kinds of qualities, traits, or personal strengths do you notice in teens and try to build on?

THUNDER ROAD: Our kids are incredibly resilient. A lot of the behaviors they have, even if they seem unhealthy or maladaptive, have developed to help them survive whatever situations they’ve been in. We try to build on that resiliency and help the kids to use it to take their lives in a more positive direction.

They are also incredibly smart, not always just “book smart” but knowledgeable and skilful in a a lot of areas. We help kids discover their own skill set and apply it to their lives – this means anything from helping them find jobs in a desired field, start community college, enter a vocational program, even having them help with tasks around the building (cooking, building things). Then they leave treatment with some skills that can really help them move along in the world.

Finally, most of our kids have some sort of motivation to at least finish the program. Our court mandated clients typically have to finish a comprehensive program (usually 9-12 months) to get off of probation. Even if they don’t think they want to change, they do have to do some work to complete their program. It’s our job to find this small piece of motivation in the kids and build on it from every angle – without even realizing it, the kids start making real changes in themselves.

ADDICTION BLOG: Do most teenagers diagnosed with substance abuse disorders need longer term residential treatment? What about dual diagnosis cases?

THUNDER ROAD: All of our teens are dual diagnosis cases and I think the longer term stay is really important.

In general, the more time we can work with a client while they’re actually sober, the better the outcome. It takes a while, sometimes months, for clients to really start to understand the program and work with us. That’s when treatment really starts and we can begin addressing not only behavioral goals, but longer term clinical goals.

When we see clients for shorter lengths of stay (sometimes 30,60 or 90 days) their treatment looks very different. We spend a majority of the time focusing on discharge plans and don’t always get to the roots of the problem.

ADDICTION BLOG: What are some of the main determining factors that you consider when recommending a longer term stay?

THUNDER ROAD: We take everything into consideration. If a client has:

  • had multiple placements
  • been in the system for a long time
  • has minimal family support
  • is struggling with mental health issues
  • hasn’t been going to school,

…these are all things that we look at. It takes a while to put the pieces back into place, especially if they’ve been out of control for a long time. These are the times when long term treatment is necessary.

Every case is different, though, and our admissions team spends a lot of time doing intake assessments and talking to families, social workers, and probation officers, before giving a recommendation for treatment.

ADDICTION BLOG: How can people in the community be a part of adolescent or youth addiction treatment programs?

THUNDER ROAD: I think by being aware of what these programs are doing and the impact it has on the community is the first step. We are fortunate that we have a lot of community support and we’ve been in Oakland for decades.  We have community members volunteer for us and see what we’re all about. There are a lot of people out there who want our kids to come see things in the community (local events, games, festivals) and help us in that regard. We also have members of the local 12 step community come into the building twice a week and run in-house 12 step meetings for the kids. These groups help the clients see what recovery looks like in the “real world” outside of treatment.

ADDICTION BLOG: What kinds of successes in teen rehab have you seen in the past decades? Can you share with us some of your victories?

THUNDER ROAD: We have former clients call or come visit all the time. The best moments are when former clients let us know that they’re sober, maybe they’re starting a family, finishing school, holding down a job. Sometimes former clients want to come speak to current clients and help them in their process, which is really touching.

Even when former clients call us and they’re not doing well or need some extra suppert, this is still a success. The fact that people are comfortable reaching out to us years after they finished treatment means that they trust us, that Thunder Road was, and is, a safe space for them.
A few days ago a former client called and let us know that she was spending her Friday night home, with her 6 month old baby watching a movie. It’s the little things that keep us fighting for these kids day after day.

ADDICTION BLOG: Is there anything else you would like to share with our readers?

THUNDER ROAD: Thank you for taking the time to read about this type of treatment. Residential care is becoming less and less common, but what we’re doing really works and is the last chance for some of these kids.

Photo credit: succo

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