An Integrated Treatment Approach For Adolescents with Co-Occurring Mental Health (MH) and Substance Use Disorders (SUDs)
Child and Adolescent Behavioral Health (C&A) treats adolescents who are experiencing problems related to mental health and substance use. There are many substances teenagers experiment with or become addicted to; the most common today are alcohol and marijuana. Adolescents tend to use substances to help them cope with feelings of depression or anxiety most often.
What is a Substance Use Disorder?
A substance use disorder (SUD) develops when the use of one or more substances leads to significant problems, emotional distress or failure to meet one\'s responsibilities at home, school or in the community. It is not unusual that substance use may be related to stress, negative peer interactions or trauma; however, a variety of factors contribute to the use of substances. Studies show that almost half of the people diagnosed with a SUD are also diagnosed with an additional mental health disorder.
C&A's Integrated Treatment Approach
C&A utilizes an integrated treatment approach when addressing co-occurring mental health and substance use disorders. Integrated treatment involves coordinating care with psychiatry, mental health counseling, substance use counseling, group counseling and family therapy. Integrated treatment is correlated with reduced substance use, fewer arrests, improved mental health, better daily functioning and an improved quality of life.
Treatment for SUD is determined based on the severity of the substance use, is customized to the needs of the person and is guided by an individualized treatment plan. According the American Society of Addiction Medicine (ASAM), treatment generally is offered in four levels of care: Outpatient, Intensive Outpatient, Residential, and Imminent Danger (Detox). C&A provides services for the first two levels of care: Outpatient and Intensive Outpatient.
What services does C&A provide?
Outpatient Services (Level 1) may include weekly individual therapy and may also include weekly, short term group therapy. Individual therapy is scheduled at the convenience of the individual typically for one hour a week. Outpatient services are designed to help the individual make changes in their substance use and/or addictive behavior. Treatment addresses lifestyle, attitudes and behaviors that may interfere with treatment goals.
Group therapy provides the opportunity to learn information and encourage interaction with and support from others. Outpatient groups meet weekly and cover topics such as: preparing to change, substance use facts, anger management, self-worth, family and other relationships, and healthy coping skills to name a few. Groups are one hour long and include a workbook that facilitates further thought and action.
Alternatives is one outpatient group offered by C&A. Alternatives is a drug and alcohol intervention service for adolescents with risky behavior or suspicions of drug or alcohol use or addiction. Early intervention services explore and address problems or risk factors and help the youth recognize the harmful consequences of high-risk substance use and/or addictive behavior.
Alternatives is indicated for youth who are caught with vape pens, drug paraphernalia, minor drugs or alcohol, who may be facing suspension from school, criminal charges or who exhibit behaviors indicative of substance use.
The Alternatives program is six sessions long. Each session is 60 minutes. Adolescents are given facts, tools and support and are taught strategies for taking personal responsibility and making positive, long-lasting behavioral changes.
Outpatient Services Criteria
- Persons with both mental health and substance use concerns
- Individuals mandated into treatment and not interested in recovery
- Individuals interested in making a change but may not have taken the necessary steps yet
- Persons in need of education about addiction or substance use
- People in recovery who require ongoing monitoring and relapse prevention
Intensive Outpatient Program (IOP):
Intensive Outpatient (IOP) is a Level 2 service of care and often includes similar treatment services as outpatient but with increased clinical contact. IOP generally provides structured programming for a minimum of six hours per week. Services typically include group and individual therapy, educational groups, medication management and family therapy. All services are based on a treatment plan developed with individualized goals. Participants are encouraged to apply newly learned skills to their present-day environments.
- A diagnosis for substance use and/or other addictive disorder
- The adolescent is not experiencing or at risk of acute withdrawal
- Biomedical conditions are stable or will not interfere with treatment
- At least one of the following occurs:
- Mild risk of dangerous behaviors to self or others
- Recovery efforts are affected by emotional, behavioral, or thinking problems in a negative way
- Mild or moderate difficulty managing daily living or responsibilities at home, school, or work
- The adolescent is likely to become unstable without frequent monitoring and accountability
- At least one of the following occurs:
- The adolescent verbalizes readiness to change but may have unrealistic expectations or does not demonstrate consistent behaviors
- The adolescent has not been successful at a lower level of care or is at risk of relapse
- There is a lack of positive social supports or supportive environment
The length of stay in IOP varies based on the issues being addressed and the adolescent\'s response to treatment. Typically, IOP services take from four to eight weeks and then continue at the outpatient level for as long as needed.
Decisions group is an IOP service offered by C&A. The ideal candidate in this group is:
- An adolescent who has a substance use, abuse and/or dependency concern
- An adolescent who verbalizes readiness to change but may have unrealistic expectations or does not demonstrate consistent behaviors
- An adolescent who has not been successful in outpatient treatment or is at risk of relapse.
- An adolescent who is not in active withdrawal
- An adolescent with whom all medical concerns are stable
- An adolescent who lacks positive social supports or a supportive environment
- An adolescent for whom the one of following occurs - mild risk of dangerous behaviors to self or others; recovery efforts are affected by emotional, behavioral or thinking problems in a negative way; mild or moderate difficulty managing daily living or responsibilities at home, school or work; or is likely to become unstable without frequent monitoring and accountability
The program typically lasts for four to six weeks. Time varies based on the issues being addressed and the adolescent\'s response to treatment.
For youth needing higher levels of care, C&A will assist clients and families in identifying the right treatment program to meet their needs.
Substance Treatment and Recovery
C&A is proud to have joined Stark County Family Court in providing treatment for youth involved in Substance Treatment and Recovery (STAR) Court. STAR serves youth between the ages of 13-17, charged or adjudicated for problems related to substances and found to be in the moderate-high risk categories according to the Youth Level of Service Inventory (YLSI) and Ohio Youth Assessment System (OYAS). Once referred to C&A, teens are assessed for co-occurring mental health and substance use disorders and recommended for treatment based on ASAM's continuum of care. Participation in STAR Court combines formal accountability and the development of skills through weekly involvement in court services and group attendance.
The STAR Court uses a hybrid of evidence-based practices, principally Motivational Interviewing, but also elements of Cannabis Youth Series and Transition to Independence Process. Youth who participate in treatment-oriented programs as opposed to incarceration have a higher likelihood of developing skills that will remain long-term. Treatment, along with intensive supervision, provides youth the opportunity to change criminal and addictive thinking patterns, core beliefs, and ultimately behavior.
The program takes place in five phases decreasing in restriction as treatment progresses. As youth progress in the program, they will be expected to assume more responsibility and recognize their achievements. STAR Court provides immediate, graduated, and individualized incentives when participants have success. Sanctions will be imposed by the court and may be immediate, graduated, and individualized. Involvement in the program ends if the teen graduates or if the youth fails to consistently follow the guidelines and all options are exhausted
ALTuRNATIVES is a group for youth with cannabis, alcohol, tobacco or any other substance USE (not abuse or dependence) diagnoses or they have used substances but do not meet the criteria for a Use diagnosis. These are youth that have been dabbling with vapes or other substances, maybe they’ve used a few times, been caught with stuff at school, reported they used out of curiosity or someone gave it to them to try. These youth are not addicted; they’re generally experimenting or have begun to use but are not that sophisticated and easily caught.
This is a 4-week group that meets 1 hour on Wednesday’s at 1 p.m. There will be two sessions, the first session will meet June 15-July 6, the second session runs from July 20-August 10. Both sessions are the same.
The purpose of the group is to provide facts, tools and support for those under 18 years of age that have been caught using substances. Participants learn strategies for taking personal responsibility and making positive, long-lasting behavior changes that will lead to better choices in the future. Youth will not be required to report on their substance use but rather to look at how their use impacts their lives. Teens that have attended this group in the past have shown a 98% rating of wanting to change and developing a plan to do so.
WAM (What About Marijuana?) is a group specifically for clients with a cannabis ABUSE or DEPENDENCE diagnoses and a history of marijuana use. This group is designed to help youth consider their marijuana use and what they choose to do about it in the future. This group is best for youth in the pre-contemplative, contemplation, preparation, or action stages of change.
The group begins June 15 and meets every Wednesday at 11 a.m. for one hour. The last group session is August 15. This is an open group which means they can start and stop at any time. Youth must attend 4-6 times (based on diagnosis or treatment needs) for a Certificate of Completion.
Topics include the ever-changing social context of cannabis (medical marijuana and decriminalization), potential risks, considering change, and strategies for change. Out-of-session activities are expected.
Karita Nussbaum Ph.D., LISW-S, LICDC
Gemini Program Manager