While evidence regarding effective treatments
for addiction and co-occurring trauma disorders
is limited, psychotherapeutic approaches,
typically involving CBT and a
psychoeducational component, appear to be
quite effective.^34
Adolescents ......................................................................................................................
Treatment approaches for adolescents must be
tailored to the profound neurochemical,
physical, cognitive, emotional and social
changes that take place during adolescent
development and to the heightened influence of
family and peers relative to adult patients.^41
Because early initiation of substance use is
related so strongly to the risk of addiction,^42
interventions for young people demonstrating
early signs of risky substance use and treatment
for addiction is imperative.^43 Treatment
approaches with a strong evidence base in adult
populations are not necessarily applicable to the
treatment needs of adolescents with addiction.^44The clinical presentation of addiction often
differs in adolescents compared to adults:
adolescents typically do not demonstrate the
same extent of physical dependence (i.e.,
tolerance and withdrawal) symptoms;
progression from use to addiction often is more
rapid; and co-occurrence with mental health
disorders is more common.^45Treatment programs for adolescents should be
developmentally appropriate and family
oriented.^46 Special care should be taken when
providing group-based therapy to adolescents
who may be more vulnerable than adults to
potential negative peer influences; this is
especially true when the group contains
members with significant behavioral problems.^47
A significant proportion of adolescents with
addiction have histories of trauma or adverse life
experiences as well as co-occurring disorders
that must be addressed in treatment.^48Tobacco Cessation .....................................................................................................
A range of effective options exists for teen
smoking cessation, including NRT,^49 educational
programs that offer life-skills training and
counseling interventions.^50 A meta-analysis of
48 smoking cessation program studies from
1970 to 2003 for adolescents ages 12-19 found
that the odds of quitting for smokers in these
programs increased by 46 percent. Higher quit
rates were found in programs that includedIntegrated Treatment for
Co-occurring DisordersOriginally developed to treat patients with a
serious mental illness, Assertive Community
Treatment (ACT) was modified in the late 1990s
to serve patients with co-occurring addiction and
mental health disorders.^35 The ACT model is an
effective way of delivering integrated dual
disorders treatment (IDDT), also known as
integrated treatment for co-occurring disorders.
This integrated approach to treatment for people
with mental illness and addiction should include
the following components: staged interventions,
assertive outreach, motivational interventions,
counseling, social support interventions, a long-
term perspective to treatment, comprehensiveness
and cultural sensitivity and competence.^36 The
approach relies on a multidisciplinary team of
providers and intensive outreach activities--
including providing services to patients in their
homes and communities--to keep participants
actively engaged in a high-intensity outpatient
treatment model.^37 The services provided
combine treatment approaches such as
motivational interviewing (MI) or cognitive
behavior therapy (CBT) with support services
such as psycho-educational instruction about
addiction, 12-step mutual support programming
and life skills training.^38 Patients are monitored
closely and have access to crisis intervention
services 24 hours a day.^39Participation in this type of program is associated
with reduced alcohol and other drug use (based on
clinicians’ reports), reduced hospital utilization,
lower post-treatment relapse rates and improved
quality of life.^40