Wednesday, January 4, 2017
By RICK GANLEY & MICHAEL BRINDLEY
A new treatment program for adolescents battling drug and alcohol addiction opens in Concord Wednesday.
The program is called Choices, and will offer outpatient substance abuse treatment to teens 14 and older. The program is part of the Riverbend Community Mental Health network.
Audrey Clairmont, Choices’ lead clinician, spoke to NHPR’s Morning Edition about the program and the unique approach required when working with teens dealing with substance abuse issues.
Can you talk about the demand and need for this type of program?
I think with substance use, it’s obviously been in the news everywhere. The demand is very high. In addition with adolescents, the demand is very high because what few treatment programs we did have, have closed down. The reason they’re closing is partially because of funding, but also adolescents are a notoriously hard population to engage. So the need is there, tenfold more so than we would like it to be. However, getting the adolescent to come here every day and engage in treatment, that’s the challenge.
Why is it such a challenge to reach that demographic?
To put it very simply, they don’t want to come here. The big difference is because a lot of the times, they haven’t gotten to that stage where my marriage hasn’t failed, I haven’t lost my kid, I haven’t lost my job, I haven’t lost my house that you do see with adults. They’re not connecting, they don’t have the motivation. The time we want to intervene is when they’re young. Hopefully we’re catching them before their disease has progressed to affect their children, their job, their housing. If we can change that with an adolescent, it’s really preventative care.
What do we know works? Can you talk about some of the research when it comes to treating teens versus adults?
One thing that I have found and research shows that can be more effective is motivational interviewing. That’s an effective strategy with adults as well, but what I like about motivational interviewing is it really puts the client in the driver’s seat. That’s very important with adolescents. They don’t like to be told ‘don’t do drugs, it’s bad for you.’ And they’re smart. An adolescent that comes in, they know just as much about marijuana as I do, and I’ve been to school for six years. So there’s no fooling them about what’s bad and what’s not bad. You really have to let them come to their own conclusions about their goals and how their substance abuse is affecting them.
This is outpatient treatment, so what’s the role and responsibility of the family in terms of support?
The family can play such an instrumental role in treatment. We hope that all families will participate in our treatment. By that I mean they’ll be welcome to call clinicians and if they need to meet with us individually or with their child, they’re welcome to do that. We’re also starting a family support group. It will be combination between education about the disease and what their loved one is going through, as well as a therapeutic piece.
Can you talk about what types of services specifically are offered and how they’re adapted to a teen demographic?
Our biggest service is the IOP, or intensive outpatient program, and what that will look like is Monday, Wednesday, Friday, from 3 to 6, teens will come and it will be primarily group therapy, both educational groups and therapeutic groups. After about four weeks, they would drop to the phase two portion of the IOP, and that’s one evening a week. That’s the most intensive model of treatment you can get and still be outpatient, which is a wonderful thing because they’re still able to stay in school, they’re able to stay with their families. If we can be successful in outpatient, that’s what we want to go for.
In addition to the IOP, there will be the family therapy group. We’re also looking to start an adventure group. So the adventure group with individual counseling might be a good way to kind of way to teach teens they can have fun without using substances. They’ll get some basic refusal skills and some basic education around substance use.
We’re also partnered with CHIP, which is Riverbend’s Children’s Intensive Program. They offer individual therapy, psychiatry, case management. So because we have that close working relationship, it’s a very easy referral process. So we’re able to kind of offer wrap around and dual diagnosis care.
What about medication-assisted treatment?
Our medical director prescribes Suboxone and Vivitrol. As far as with adolescents, I do know there’s a big stigma with medication-assisted treatment. It can be very polarized. My perspective is the bottom line is it can save a life. It by no means is our first option. We’re not going to get a 16-year-old in here and say here’s your medicine. That’s not the theory. We’re very committed to the fact that medication-assisted treatment can be effective alongside therapy. So it can help prevent that overdose, or those cravings to relapse while we’re working on the behaviors and the trauma and the underlying issues as to why they picked up in the first place.
What do you anticipate as far as numbers are concerned? How many clients can you have under your care at any one time?
The numbers is a tricky piece because the need and who’s going to engage is very different. I’ve been meeting with a lot of members in the community and almost everywhere I go, they tell me they’re so glad we’re opening, that they have 15 kids they can be referring. But out of those 15, 10 drop out, four refuse, and maybe we get one. As far as what we have the capacity to hold, we’re looking to keep our IOP groups at about eight. However, we do have the ability to run multiple groups at a time. We have the space, we have the staff, so we can grow as the need grows and as the engagement grows.