Teen Substance Use Treatment: Strategies for Successful Youth Counseling
When young people begin substance use treatment there is often an assumption that they are strongly motivated to make changes in their substance using behaviors. Counselors who press teens to make quick decisions to quit right away are often unsuccessful, as many youth entering substance use treatment believe they have a drug solution not a drug problem. They might experience substances as helping with problems like sleep, fitting in socially, or feelings of boredom, sadness and anxiety; therefore, at least in the short-term, they are often not very motivated to make changes. Youth who are mandated by parents, schools, or courts to attend counseling, sometimes simply want to “get it over with.” Developmental issues connected to autonomy can easily create additional barriers when talking to adults. The perception that adults are trying to take away their autonomy or control them can often lead young people to lie, disengage, or increase resistant behaviors.
The foundation of any good counseling intervention starts with the development of a strong therapeutic relationship. From a clinical point of view, the most valuable and pertinent information about a young person’s substance use habit, and what he or she thinks about it, is going to come from that young person. What most effectively encourages honest communication between the counselor and the young person is the safety fostered by a therapeutic relationship based on trust and respect. For these reasons, therapists will often proceed slowly early in treatment, taking the time to develop the strong relationship and feeling of safety that will support the therapeutic change process going forward. At the same time, counselors use the opportunity provided by this “getting to know you” period to learn more about other areas of a young person’s life.
Substance use often presents as a secondary reaction to chronic stressors, such as depression, trauma, educational issues or family conflict. Gathering information about these areas allows the counselor to better understand co-occurring psychological and situational issues, as the context within which the substance using behavior is occurring. As mentioned earlier, external pressures to change substance use habits are also an important factor in treatment. Whether they are legal, academic or family-based, these pressures may be helpful in motivating youth to enter treatment, and can also provide opportunities to reflect on the impacts of substance using behavior, but are not usually enough on their own to motivate lasting behavioral change. Lasting change becomes more likely when it is connected to a young person’s internally generated motivations and goals.
Engaging clients about things in their lives that they are struggling with or might want to change allows treatment to focus on the person, not just the drug use. This can help the client find their own motivations for change and helps the counselor structure treatment in a way that that connects to those motivations. Counseling sessions can then focus on helping the youth improve their lives in ways that make sense to them, while also creating a relevant context for discussing alternative strategies for satisfying needs and solving problems that do not involve substances.
Bert Klavens is a Licensed Alcohol and Drug Counselor and our Healthy Youth Programs Director.
