Heavy drinking rates fell from 33.8 percent to
20.3 percent. The rate of criminal activity also
declined and indicators of psychosocial
adjustment, school attendance and academic
performance improved significantly.^65
As is true for adults, comprehensive and
continuing care is critical for adolescents with
addiction. Assertive continuing care (ACC) is a
method of enhancing engagement in treatment
by moving responsibility for service utilization
from adolescents and their caregivers to
treatment providers.^66 ACC is characterized by
at least weekly face-to-face sessions conducted
in the home or community settings that are
convenient for the adolescent and increase the
likelihood of retention and low patient-to-
provider ratios. Interventions used in ACC
include an adolescent-oriented community
reinforcement approach (A-CRA) and intensive
case management.^67 Research on this approach
demonstrates that adolescents receiving ACC
were significantly likelier to be abstinent from
marijuana following discharge from residential
treatment than adolescents who did not receive
ACC;* they also had higher rates of retention in
aftercare services.^68
Very few studies have examined the use and
effectiveness of pharmaceutical interventions for
the treatment of adolescent patients with
addiction involving alcohol or other drugs;^69 best
practice suggests that if they are employed they
should be used as a supplement to psychosocial
therapies.^70
Women
A considerable body of evidence demonstrates
the importance of addressing gender differences
in the treatment process, particularly for women
with histories of trauma and those who are
pregnant or parenting.^71 Women often smoke,
drink and use other drugs for different reasons
than men and addictive substances affect women
- All participants received referrals to adolescent
outpatient treatment providers for continuing care in
their communities following discharge from
residential treatment.
differently than men; this may indicate different
treatment needs.^72 Because the life roles and
responsibilities of women typically differ from
men, their support service needs may differ as
well.^73 Women with addiction have high rates
of co-occurring mental health disorders,
including mood, anxiety and eating disorders
that should be addressed in the treatment
process, and high rates of trauma histories that
can influence treatment outcomes.^74Gender-specific treatment programs appear to be
particularly beneficial for women with a history
of sexual abuse and domestic violence.^76
Women who were abused as children suffer
from substance-related problems that are more
severe than those of their peers, including
lifetime use of a greater number of substances,
higher alcohol and other drug severity scores†
and greater financial and interpersonal
problems.^77 Women who report exposure to
physical, sexual or emotional abuse during
childhood are more prone to relapse than other
treatment patients, and may be less likely to
improve during and after treatment.^78 Women
with trauma histories require a more
empowering and less confrontational approach;
being told that they are powerless over their
addiction--a common tactic in many treatment
programs that are centered on the 12-step model-
-can bring back feelings of powerlessness from
sexual and other abuse.^79Pregnant Women ........................................................................................................
Pregnant women require special consideration in
stabilization, acute treatment and disease
management protocols, particularly with regard† Based on the Modified Michigan Alcohol-Drug
Screening Test.The safety and security of ‘all female’
[programs] allow women to disclose things that
are very difficult and that may be impossible
within a co-ed arrangement. It enhances a
woman’s ability to feel understood and accepted
without judgment, shame or guilt.^75