Timothy Daty, University of New Haven
Substance abuse among adolescents is a growing public health concern within the United States. While adolescents account for roughly 8% of all substance abuse treatment admissions (SAMHSA, 2016), Winters and colleagues (2013) assert that only 10% of adolescents in need of drug therapy are actually receiving treatment. While illicit drug use extends across multiple age groups, initiation during adolescence can prove especially harmful to these youth. For adolescents, early substance use makes them more susceptible to drug addiction and dependence (Hurd, Michaelides, Miller, & Jutras-Aswad, 2013). In addressing this issue, national policies often center around two principle facets: drug education and applying standard treatment for teenage abusers. Unfortunately, current policies for these two facets are proving to be inferior and even ineffective when applied to this issue. Policymakers should reevaluate these policies and explore new avenues, particularly those in drug prevention and treatment. For adolescent substance abuse, superior policy alternatives exist that are better suited for adolescent substance abuse.
Adolescent Substance Abuse
Drug addiction has become a prominent concern within the United States. When analyzing teenage drug addicts, 85% of these individuals began using drugs before they turned 15 years old (Liddle et al., 2009). When compared to their adult counterparts, adolescents are far more vulnerable to the adverse effects of substance use (Hurd et al., 2013; Tanner-Smith, Wilson & Lipsey, 2013). Adolescence is often characterized as a period of physical and psychological development (Hurd et al., 2013; Tanner-Smith, Wilson & Lipsey, 2013). When introduced to drugs at this age, adolescent development is impeded which can result in long-term damage (Tanner-Smith, Wilson & Lipsey, 2013). More specifically, drug dependency and psychiatric disorders during adulthood become common future outcomes for these adolescents (Hurd et al., 2013).
At its core, the cause of drug addiction among adolescents can range from a host of issues such as family, peer, and school influences (Liddle et al., 2009). However, recent research suggests that the relationship between parent and child is a strong predictor of adolescent drug abuse (Hummel et al., 2012; Liddle, 2016; Winters et al., 2012). In most cases, teenage substance abuse occurs unbeknownst to the parent or caregiver (Liddle, 2016). However, Hummel and colleagues (2012) argue that drug use detection is often linked to the parent and child relationship. In instances where the parent is highly engaged with their child, child behavior is frequently monitored and the likelihood of youth substance use is significantly lower. Unfortunately, when children have poor relationships with their parents, they behave more recklessly with little intervention on the parent’s part (Hummel et al., 2012). For treatment to occur, parents and school officials must actively engage youth and recognize common drug abuse behaviors such as aggression, delinquency, and truancy (Hummel et al., 2012; Rigter et al., 2013). Once detected, parents play an instrumental role in the drug treatment of their child, particularly within family-based treatments. Research suggests that when parents actively engage in treatment alongside their child, it produces more positive outcomes toward drug recovery (Winters et al., 2012).
When exploring policy implications, it is important to consider the unique attributes of teenage drug abusers and the current policies that address this issue. First, the usefulness of certain drug education programs within schools should be called into question. School programs such as D.A.R.E have proven highly ineffective in the prevention of drug use (Singh et al., 2011). Second, new forms of juvenile drug treatment, such as Multidimensional Family Therapy (MDFT), should be considered as a new and effective form of treatment.
When analyzing adolescent drug policy, two weaknesses can be observed in the context of drug education and drug treatment. First, national drug policies often have favored drug education, where youth are taught the dangers of substance abuse. Over the years, significant resources have been dedicated to drug education programs such as D.A.R.E. Unfortunately, programs like D.A.R.E have proven highly ineffective in deterring youth from drugs. In more extreme cases, youth who participate in D.A.R.E report higher incidence of drug use than youth who do not participate in the program (Hanson, 2014).
From a fiscal standpoint, D.A.R.E is commonly funded by local, state, and federal sources and incurs a national cost over $1 billion per year (Hanson, 2014). Designating this much money towards D.A.R.E. is an enormous policy oversight. Newer drug programs have proven successful in adolescent drug use prevention. The Department of Education endorses several targeted programs such as the LifeSkills Training Program and Project ALERT. Both of these programs employ a science-based approach and have proven quite effective within specific populations. Rather than simply teaching students about the harms of drug use, these programs take a holistic approach. Youth are encouraged to develop new skills and identify any troublesome behaviors that may result in poor decision making (Botvin LifeSkills Training 2018; Project ALERT, 2018). By improving these behaviors, these youth are better equipped to make positive decisions, particularly with drugs. While drug prevention programs are important, policies should consider greater attention to drug treatment.
Drug treatment programs report high success rates in the rehabilitation of adolescent substance abusers. Unfortunately, the cost of treatment can be an obstacle for many youth and families. The money used on ineffective programs like D.A.R.E could be better utilized in government subsidized drug treatment. The government subsidization of drug treatment has proven both cost-effective and successful in addressing drug addiction. In New York, funding towards drug treatment programs has saved the state nearly $270 million per year and rehabilitated countless people (American Addiction Center, 2018). The success of government subsidized drug treatment has tremendous applicability with juvenile populations. Funding towards ineffective drug education programs has incurred costs well above a billion dollars. State and federal policies should reallocate these funds into effective drug prevention programs and into subsidized juvenile drug treatment. Redistributing a higher portion of money into drug treatment could impact countless families struggling to afford rehabilitation for their child. This leads into the second weakness of current policy.
Drug treatment programs for adolescents are quite costly. Common treatment for adolescent substance abuse can include behavioral therapy, psychoeducational therapy, and peer group therapy (Liddle & Ritger, 2013; Tanner-Smith et al., 2013). While these programs have proven effective in the treatment of drug addiction, other program alternatives exist that are both cost efficient and effective. Recently, Multidimensional Family Therapy (MDFT) has emerged as one such drug treatment program.
Multidimensional Family Therapy (MDFT) focuses on the youth and his/her caregiver(s) (Liddle, 2016). A clinician visits the child’s home and delivers the treatment to the adolescent within a familiar setting. The clinician then assesses the relationship between the child and the caregiver. Through counseling, the clinician offers strategies to build communication between these two groups and address underlying issues contributing to the substance abuse (Liddle, 2016). This is quite distinguishable from other types of adolescent drug treatment. In other types of treatment, the adolescent is often coerced into drug recovery where they have little motivation to fulfill the program objectives (Liddle & Rigter, 2013). For MDFT however, youth motivation serves as a guiding principle. Early into treatment, MDFT facilitators build trust with the adolescent and encourages them to actively pursue drug recovery (Liddle & Ritger, 2013; Liddle, 2016; Rigter et al., 2013).
In many ways, the multidimensional approach of MDFT is uniquely designed to address substance abuse among juvenile populations (Liddle, 2016). Initiation into drugs can stem from a host of issues such as psychological, social, familial, or biological influences. Through MDFT, therapists seek to identify these influences and work with the youth in developing effective solutions (Liddle, 2016; Liddle & Ritger, 2013; Ritger et al., 2013). When compared to behavioral therapy, psychoeducational therapy, and peer group therapy, participants in family therapy have reported superior outcomes in long-term drug abstinence and positive behaviors (Liddle, 2016; Liddle & Ritger, 2013; Tanner-Smith et al., 2013). In addition to being an effective drug treatment program, the delivery of MDFT is also cost efficient. The use of MDFT is 55% cheaper than common outpatient treatments (Rowe, 2010). For lower income families especially, treatment that is both effective and affordable can be tremendously helpful. Moreover, by offering government subsidized MDFT in place of other treatments, more than twice the number of youth can be treated.
Moving forward, policymakers should consider three recommendations when making changes to youth drug addiction policy. First, policymakers should reconsider the value and appropriateness of D.A.R.E. in the United States. In theory, educating youth on the dangers of substance use should be a powerful preventative measure. Unfortunately, youth are underdeveloped and don’t always behave rationally (Hurd et al., 2013; Tanner-Smith, Wilson & Lipsey, 2013). As such, educating youth about the dangers of drugs may not produce the desired effect that policymakers are seeking. In response, policymakers should consider more skill-based programs in place of the D.A.R.E. program. The Department of Education endorses several drug prevention programs that have proven quite effective in lowering drug use among adolescents. Programs such as LifeSkills Training and Project ALERT employ a science-based approach that is specifically designed for varying groups of youth. Unlike drug education, these programs engage the youth and promote positive skill development. Through this approach, these types of programs have displayed high success rates. On a national level, policymakers should consider replacing D.A.R.E with effective drug prevention programs.
Second, policymakers should consider a greater allocation of funding to subsidized drug treatment. Currently, only 10% of youth in need of drug addiction therapy are receiving treatment (Winters et al., 2013). The cost of recovery could account for this underutilization of treatment. Lower income families may lack the resources to fund juvenile drug care. As such, these adolescents are not properly treated for their addiction. By devoting more money towards government subsidized treatment, policymakers could make a significant impact on adolescent drug addicts and their long-term success.
Lastly, more research should be conducted on Multidimensional Family Therapy and its utility among adolescent drug addiction. As previously noted, MDFT has proven to be both a superior and cost-effective treatment for this population of youth (Liddle, 2016; Liddle & Ritger, 2013; Rowe, 2010; Tanner-Smith et al., 2013). However, as an emerging treatment option, knowledge of this program is limited within schools, clinics, and households. Due to this limited knowledge, schools and clinics will likely recommend other treatments when faced with a juvenile drug addict. By increasing awareness of this treatment, communities may find MDFT to be a more suitable treatment option. In many cases, the child’s relationship to his/her parents is a core determinant in adolescent drug abuse. In cases such as these, family therapy may be the strongest option for families to pursue (Hummel et al., 2012; Liddle, 2016; Winters et al., 2012). By strengthening these core areas, national policies can more adequately respond to this growing public health concern and provide effective drug programs to youth in need.
American Addiction Centers. Public Assistance Options for Drug & Alcohol Treatment Centers. Retrieved April 16, 2018, from https://americanaddictioncenters.org/rehab-guide/public-assistance/
This source discusses the value of public assistance options for drug and alcohol treatment from a cost-savings standpoint. Drug treatment can be quite costly. However, this research source discusses how subsidized drug treatment treats a greater number of people and is also saves the government money.
Botvin LifeSkills Training [LST] Overview (2018). Retrieved April 30, 2016 from https://www.lifeskillstraining.com/lst-overview/
Botvin LifeSkills Training program is a substance abuse training program designed for youth. The program focuses on skill building and teaches students how to handl challenging situations. An overview of program components, target participants and implementation strategies is discussed.
Hanson, D.J. (2014). Alcohol Abuse Prevention. Retrieved April 30, 2016 from https://www.alcoholproblemsandsolutions.org/alcoholfacts.org/DARE.html
Hanson provides an overview of the D.A.R.E. program in the United States. Overall, D.A.R.E. have proven ineffective within schools. Hanson provides facts and statistics for D.A.R.E. and highlights several other drug programs that have proven successful.
Hummel, A., Shelton, K. H., Heron, J., Moore, L., & Bree, M. (2013). A systematic review of the relationships between family functioning, pubertal timing and adolescent substance use. Addiction, 108(3), 487-496.
Hummel and colleagues discuss how family functioning and pubertal timing may influence substance abuse among adolescence. The researchers determined that both facets play a role in adolescent substance abuse. More specifically, adolescents with poor family relationships and off-time pubertal timing represent the highest at-risk group for drug abuse.
Hurd, Y. L., Michaelides, M., Miller, M. L., & Jutras-Aswad, D. (2014). Trajectory of adolescent cannabis use on addiction vulnerability. Neuropharmacology, 76, 416-424.
Hurd and colleagues discuss the relationship between adolescent brain development and adolescent substance abuse. During adolescence, brain function is still undergoing development. The researchers argue that for adolescents, substance abuse during this period makes them more susceptible to drug addiction.
Liddle, H. A., Rowe, C. L., Dakof, G. A., Henderson, C. E., & Greenbaum, P. E. (2009). Multidimensional family therapy for young adolescent substance abuse: Twelve-month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology, 77(1), 12.
Liddle and colleagues (2009) discuss the results of their experiment in which they examine the effectiveness of Multidimensional Family Therapy on teenage drug addicts. The treatment group were placed into Multidimensional Family Therapy while the control group received Peer Group Therapy. The results showed that the participants in Multidimensional Family Therapy displayed superior drug treatment outcomes than those in Peer Group Therapy.
Liddle, H. A. (2016). Multidimensional family therapy. Handbook of Family Therapy, New York City, New York. Routledge. 231-249.
Liddle discusses how research related to adolescent substance abuse has increased over the years and the applicability of Multidimensional Family Therapy in addressing this issue. Multidimensional Family Therapy (MDFT) was developed by Liddle and he provides a detailed account of how treatment is administered to youth and the core tenets of MDFT.
Liddle, H., & Rigter, H. (2013). How developmental research and contextual theory drive clinical work with adolescents with addiction. Harvard Review of Psychiatry, 21(4), 200-204.
Liddle and Rigter discuss the driving theories behind adolescent substance abuse and the utility of Multidimensional Family Therapy in addressing this issue. Liddle and Rigter discuss the core components of Multidimensional Family Therapy and the distinct approaches MDFT utilizes in adolescent populations.
Project ALERT. Substance abuse prevention for grades 7 & 8. (2018). Retrieved from https://s3.amazonaws.com/project_alert/upload/project_alert_at_a_glance.pdf
Project ALERT is a skill-based substance abuse prevention program for seventh and eighth graders. Project ALERT employs a science-based approach and has proven successful in schools across the United States.
Rigter, H., Henderson, C. E., Pelc, I., Tossmann, P., Phan, O., Hendriks, V., Schuab, M., & Rowe, C. L. (2013). Multidimensional family therapy lowers the rate of cannabis dependence in adolescents: A randomized controlled trial in Western European outpatient settings. Drug & Alcohol Dependence, 130(1), 85-93.
Rigter and colleagues discuss the success of Multidimensional Family Therapy in several Western European countries. In Europe, there is a lack of evidence-based programs for adolescents struggling with drug dependency. This article discusses how Belgium, France, Germany, The Netherlands and Switzerland tested Multidimensional Family Therapy on several sample populations. MDFT proved quite successful across the test sites in reducing overall cannabis use among the participants.
Rowe, C. L. (2010). Multidimensional family therapy: addressing co-occurring substance abuse and other problems among adolescents with comprehensive family-based treatment. Child and Adolescent Psychiatric Clinics, 19(3), 563-576.
Rowe discusses core issues related to adolescent substance abuse and how these issues are often co-occuring. Rowe discusses how Multidimensional Family Therapy is uniquely suited to treat adolescent drug abusers with multiple interacting risk factors.
Singh, R. D., Jimerson, S. R., Renshaw, T., Saeki, E., Hart, S. R., Earhart, J., & Stewart, K. (2011). A summary and synthesis of contemporary empirical evidence regarding the effects of the Drug Abuse Resistance Education Program (DARE). Contemporary School Psychology: Formerly" The California School Psychologist", 15(1), 93-102.
Singh and colleagues discuss the history of the D.A.R.E. program. In this article, the researchers discuss the overall effectiveness of D.A.R.E and how empirical evidence suggests that it is highly ineffective in preventing drug use among juvenile populations. The article discusses how D.A.R.E. has recently refined its program composition. However, empirical support for “new D.A.R.E.” is still mixed.
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2016). Treatment Episode Data Set (TEDS): 2004–2014. National Admissions to Substance Abuse Treatment Services. No. BHSIS Series S-84, HHS Publication No. SMA 16–4986.
This SAMHSA report provided statistics on current substance abuse treatment trends within the United States. More specifically, it outlines trends with adolescent populations and current treatment statistics for this group.
Tanner-Smith, E. E., Wilson, S. J., & Lipsey, M. W. (2013). The comparative effectiveness of outpatient treatment for adolescent substance abuse: A meta-analysis. Journal of Substance Abuse Treatment, 44(2), 145-158.
Tanner and colleagues conduct a meta-analysis of existing research related to outpatient treatment for adolescent substance abuse. While all treatment programs proved effective in the adolescent substance abuse recovery, the researchers determined that family therapy was the most effective treatment option.
Winters, K. C., Fahnhorst, T., Botzet, A., Lee, S., & Lalone, B. (2012). Brief intervention for drug-abusing adolescents in a school setting: Outcomes and mediating factors. Journal of Substance Abuse Treatment, 42(3), 279-288.
Winters and colleagues discuss the effectiveness of brief intervention for adolescents struggling with drug abuse. The authors discuss factors related to adolescent substance abuse and the value of school-based intervention programs.
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