Teenage Addiction Treatment: 6 Factors to Consider When Deciding between Residential and Outpatient Care

Your adolescent son or daughter has a problem with drugs or alcohol. You are probably very worried about the situation and you know he or she needs some sort of help.

But what kind of help does your teenager need?

Does he need to go to a rehab program for teenagers? Would she do OK if she just worked with a therapist or addiction counselor? What about a wilderness camp for behavioral change…?

You have many options to choose from, the tricky part is knowing which option best meets your family’s needs.

Well, to start with, consider the following few facts:

Fact 1: Although we tend to think of addiction in very black and white terms, the truth of it is more complicated. You may want to know if your son is or is not an alcoholic/addict, but unfortunately, this basic 'either/or labeling' doesn't really match the complexities of the situation. Adolescent drug and alcohol use actually occurs along a long continuum of severity, from very mild experimentation to more recreational use to increasingly regular and more problematic use and ultimately to daily and very problematic use and dependency.

Fact 2: Teen substance abuse treatment also occurs along a continuum of care, and for best chances of a positive outcome it’s important to match your son or daughter to an appropriate level of care. Levels of treatment along the continuum of care range from counseling or outpatient addiction treatment programs to more intensive and structured day-long outpatient addiction treatment programs to residential addiction treatment programs and ultimately to hospital based inpatient treatment.

Fact 3: In some cases, moderate consumption (not abstinence) is an appropriate treatment goal.

Fact 4: As a general rule, experts usually recommend starting with the least intrusive level of care (outpatient counseling, for example) unless the person is at serious risk of harm. Factors that might require an upping of intensity to residential care include the co-presence of another mental illness like depression, suicidal ideation or the regular engagement in very high risk activities while intoxicated. Examples of high risk activities include drunk driving, unprotected sex, crime or aggressive behaviors, among many other possible behaviors.

So if it’s important to match the level of care to the situation, how can you know which level of care is needed for your son or daughter?

Finding the Right Level of Care – 6 Details to Consider:

Learning more about the ways professionals determine appropriate levels of care should help to demystify the addiction treatment process and may help you to make a better decision about where your son or daughter needs to be.

That being said, you don’t have the experience or third-person neutrality of a knowledgeable addiction professional and there is great value in getting a professional to do an assessment and make a treatment recommendation before committing to any course of action. Some of the factors a professional would likely consider when making a treatment needs assessment are:

1. The severity of the drug or alcohol use problem
2. The age of the adolescent
3. Personal risk factors
4. The young person’s preferences
5. Any existing mental health issues
6. The degree of stability and support in the young person’s home and social environment

The Severity of the Drug or Alcohol Use Problem

When determining the severity of the problem experts tend to weigh 2 variables:

1. The frequency and quantity of consumption
2. The seriousness of consequences arising from the drug or alcohol use

Based on information on consumption and consequences, from the adolescent and from family and friends, an expert might try to classify the adolescent into 1 of 4 groups:

1. An experimental user – a person who has used drugs or alcohol once or a couple/few times and has yet to experience any adverse consequences from that use.
2. A recreational user – a person who uses drugs or alcohol occasionally, likely at special events. A recreational user probably won’t have experienced any significant consequences from their use and they won’t be preoccupied with getting or using drugs or alcohol.
3. A regular user – A regular user takes drugs or alcohol on a regular basis, sometimes during the middle of the week, and use is not limited to any special recreational events. This person is likely preoccupied with getting and using, is often drunk or high or hung-over and is starting to experience negative consequences from their use
4. A dependent user – Teens dependent on drugs or alcohol will use almost every day (or daily). They will experience negative consequences from their use and they will continue to use despite an awareness of these negative consequences. They may also experience physical withdrawal symptoms when they do not or cannot take drugs or alcohol.

There are no hard and fast rules, but as a very general guide, experimental and recreational users will probably do well in outpatient treatment, regular users may require more intensive treatment, such as day treatment and dependent users may require residential care. These recommendations, however, will vary based on the individual circumstances to be discussed below, for example:

• A 13 year old recreational user would probably require more intensive treatment than an 18 year old recreational user
• A regular user with co-occurring depression or anxiety might require residential care while a regular user without mental illness might do better in day treatment.

The Young Person’s Age

Younger teen drug and alcohol users may require more intensive treatment than older teen users.

• The younger an adolescent starts using/abusing drugs or alcohol the greater their likelihood of developing problems down the line.¹
• Substance abuse during the early teen years may impair a young person’s ability to resolve the necessary developmental tasks of adolescence.
  

Based on these two risk factors, a younger teen might require more intensive treatment than an older teen, even if these two young people were using similar amounts of drugs and or alcohol.

Personal Risk Factors

Certain risk factors may increase a teen’s susceptibility to substance abuse and or addiction, and so the presence of predisposing risk factors may factor into a decision about treatment placement.

Examples of personal risk factors that increase an adolescent’s vulnerability include:

• Substance abuse in the family
• Having a learning disability
• Developmental delays
• Low social skills
• Having a history of behavioral problems
• Others

The Adolescent’s Preferences

If at all possible, it is preferable to listen to and incorporate a teen’s goals and preferences into a treatment plan.

Recommending a course of action that contrasts with a teen’s treatment wishes and goals can backfire as the young person may become more oppositional and less interested in participating in the treatment process.

If following a teen client’s wishes isn’t considered advisable (for example, she wants no treatment and wants to continue with drinking and the treatment assessment indicates a need for residential care and abstinence) it may be best to make some compromises and to work towards a goal that is at least acceptable to all parties (for example day treatment and working towards reducing the harms of use through moderate drinking strategies).

The Co-Existence of Mental Health Problems

Mental health problems frequently co-occur with substance abuse and addiction. Unfortunately, when psychiatric symptoms arise, it’s sometimes hard to know whether they are caused by true mental illness or as a side effect of the ingestion of drugs and or alcohol.

• The presence of a known mental illness increases the appropriateness of residential treatment.
• If mental illness is suspected and the adolescent will not maintain sobriety, then it is difficult to know what’s really causing what. In this situation, a period of residential treatment and enforced abstinence is probably warranted to allow for an accurate assessment of the situation.

Environmental Stability and Support

Teens with a high degree of social stability and support are better candidates for outpatient treatment. Environmental variables that professionals might consider when looking and stability and support include:

• Does the adolescent have a stable and supportive living environment?
• Is he or she working or attending school?
• Does the client have non drug or alcohol abusing supportive friends?
• Does the client participate in any healthy social activities, such as at school, through community sports or at church?²