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Is the treatment approach for adolescents different than adults?

Many differences exist between adolescent and adult alcoholics. Adolescents typically tend to be problem drinkers or alcohol abusers and have not yet developed a pattern of regular daily heavy drinking. Consequently, they are rarely alcohol dependent and are therefore less apt to develop physiological withdrawal symptoms compared with adult alcoholics. Adolescents generally have not settled on one or two drugs of choice. They tend to abuse many drugs in addition to alcohol. Additionally, adolescent alcoholics have higher rates of secondary psychiatric disorders, particularly anxiety disorders and most notably PTSD, as many of them have a history of physical and/or sexual abuse. Another psychiatric disorder associated with higher rates of alcoholism and other addictions among adolescents is attention deficit hyperactivity disorder (ADHD). A great deal of controversy has been aroused around the use of psychostimulant medications such as Ritalin or Dexedrine in treating ADHD, with some people believing that these medications may lead to problems with addiction. These medications are frequently abused, and these medications may cause addiction problems. Many studies have repeatedly demonstrated that having the diagnosis of ADHD is an independent risk factor for the development of substance abuse and alcoholism whether or not the ADHD is treated with psychostimulants. In fact, more recent studies have demonstrated that the risk of drug and alcohol use increases without treatment for ADHD.

Alcohol Treatment for Adolescents

Because of the differences between adolescents and adults, treatment tends to be more aggressive in its approach to the underlying psychiatric conditions, whereas it is more conservative in treating the substance abuse or alcohol problem. Peer-oriented groups focus on the adolescent's developmental challenges. Medications such as naltrexone (ReVia), acamprosate calcium (Campral), or disulfiram (Antabuse) for drug or alcohol problems, as described in Questions 47-52, have not been examined thoroughly in this age group and should be used only in the most extreme treatment-resistant cases. Psychotherapeutic approaches are paramount and include all forms from 12-step down to individual therapy. Although improved function despite continued use may satisfy some clinicians, controlled use in this population should never be the goal of treatment. Most adolescents will interpret this as permission to continue to use as long as they function better. ASAM patient placement criteria also exist for adolescents and generally follow similar guidelines as those used for adults.

Psychostimulant "Psycho" pertains to the brain and its cognitive functions. A stimulant is an agent or drug that increases the functional activity or efficiency of an organ.

Ritalin the trade name for methylphenidate. It is used to treat ADHD.

Dexedrine a psychostimulant that is prescribed to treat ADHD.

ReVia trade name for naltrexone.

Campral a drug used to maintain alcohol abstinence.

Disuifiram generic name for Antabuse, which is the most widely used medication for alcoholism in this country.

What exactly is an "intervention"?

Interventions have become the subject of sitcoms and soap operas as depicted in Seinfeld and the Sopranos. Regardless of the humor or bathos associated with them, they can be an effective approach at getting a loved one into treatment. Interventions should be orchestrated in advance, preferably by a professional who is a skilled interventionist so that nothing is left to chance and all anticipated countermeasures have been considered and are ready to be implemented. The key term is leverage. Unfortunately, most alcoholics are in denial about their problem and stridently object to the idea that they have a problem with alcohol until they are in jeopardy of losing something more valuable than their alcohol.

The major touchstones include the following:

1. The intervention should be linked in time to a recent alcohol related incident so that the connection between the drinking and the negative consequences are blatantly obvious.

2. The intervention needs to occur when the individual is sober.

3. A specific narrative should be prepared as to how this, as well as past incidents of drinking, has negatively impacted you. The reason for the intervention is to get the alcoholic into treatment.

4. Explain the future consequences of continued drinking in terms of your relationship with him or

her. Tell the person that until he or she seeks specific treatment to maintain sobriety you are prepared to carry out your plans. Do not threaten! Threatening will be viewed as merely inflammatory. Make only promises that you are absolutely prepared to act on and explain that you are doing this to protect yourself. This may range from refusing to go to any alcohol-related social activities to moving out of the house. Involving other loved ones who have also been directly affected by the person's alcohol use may strengthen the leverage. They should be prepared to discuss their own negative experiences with the alcoholic. Having some loved ones who are also in recovery can be particularly persuasive.

5. Be prepared to have treatment options. Plan to have a bed ready in advance for inpatient detoxification and/or rehabilitation. If outpatient treatment is appropriate, names and appointments should be made in advance. Offering to accompany the alcoholic to the initial appointment or first AA meeting is very helpful, as it demonstrates your support.

 
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