Evidence-based programs and practices

Less than 10% of youth who are using alcohol or other drugs receive early intervention or treatment services in any given year. Unfortunately, adolescents are often treated as if they are “little adults” and receive the same assessment and treatment protocols as adults. However, adolescents differ greatly from adults in their physiological, emotional, and psychosocial development and cognitive abilities. Adolescents’ values and belief systems and the importance adolescents place on family and peers do not conform to the norms of adult treatment programs.

Since the 1990s, researchers and program developers have been working to improve treatment for adolescents with substance use disorders. The National Institute of Drug Abuse (NIDA) and the Center for Substance Abuse Treatment (CSAT) have developed clinical practice guidelines to improve the consistency of treatment from one agency to another. Treatment Improvement Protocol 32, Treatment of Adolescents with Substance Use Disorders (CSAT, 1999) and Principles of Effective Drug Treatment (NIDA, 1999) are examples of such guides. Researchers and program developers have also developed evidence-based practices. These are “programs that are proven practices in treatment of adolescent substance use and behavioral rehabilitation” (Southern Coast Addiction Technology Transfer Center [ATTC], 2004). Clinical practice manuals such as CSAT’s Cannabis Youth Treatment series and Adolescent Treatment Models are examples of these.  

We believe people have the power to change their lives for the better and that ultimately, any lasting positive change and life-skill development must come from within – it cannot be forced upon or granted to an individual from the outside. While the real work of change must be completed by each individual, research demonstrates that the likelihood of success can be enhanced through support, structure and guidance. The following evidence-based programs and practices have been adopted by The Bridge.  

ADOLESCENT OUTPATIENT AND INTENSIVE OUTPATIENT TREATMENT FOR SUBSTANCE ABUSE

The Chestnut Health Systems-Bloomington Adolescent Outpatient (OP) and Intensive Outpatient (IOP) Treatment Model is designed for youth between the ages of 12 and 18 who meet the American Society of Addiction Medicine's criteria for Level I or Level II treatment placement. The Bloomington model incorporates outpatient and intensive outpatient programs and is based on a blended therapeutic approach, drawing on four theoretical frameworks (Rogerian, behavioral, cognitive, and reality) for behavioral and emotional change. The program emphasizes an individualized treatment plan that includes the family unit as well as the adolescent.

The two primary treatment approaches in this model are skill-building and counseling groups:

• Skill-building is offered in a group format and covers fourteen different topics weekly. Topics include relapse prevention, life skills, self-esteem, family issues, recovery lifestyle, and recreation/leisure. Assignment to the number and type of skill-building groups is based on an individualized Master Treatment Plan (MTP) for each adolescent. Each type of group is comprised of at least 12 different presentations that are 35-40 minutes long and repeat in a continuous cycle.
   
• Group counseling sessions provide an opportunity for adolescents to discuss personal issues in a group format. Adolescents are encouraged to focus on how they can effectively deal with problems and issues in their lives, with peers providing feedback and relating the issues discussed to their own personal experiences. Group counseling sessions occur weekly and are 35-40 minutes long.

All staff members who provide direct services to adolescents are licensed (e.g., LCPC or LCSW), certified (e.g., Certified Alcohol and Drug Counselor), or working towards licensure or certification. The Chestnut-Bloomington OP/IOP model is offered at various dose levels with different components depending on the needs of the individual client.

This model of treatent is utilized by the Recovery Center for Teens programs in Ashville, Cullman, Mobile and Tuscaloosa.

ADULT INTENSIVE OUTPATIENT TREATMENT FOR SUBSTANCE ABUSE

- MATRIX IOP Model is utilized by the Fort Payne Adult Recovery Center. The Matrix grew from the need for a structured, evidence-based treatment for clients who abuse or are dependent on stimulant drugs. The model incorporates elements of relapse prevention, cognitive-behavioral, psycho-educational, and family approaches, as well as 12-Step program support (Obert et al. 2000). The effectiveness of the Matrix IOP approach has been evaluated numerous times since its inception (Rawson et al. 1995; Shoptaw et al. 1994). The model was developed with an awareness of the diversity of factors that contribute to drug and alcohol problems and has been found equally beneficial for clients abusing or dependent on substances other than stimulants. SAMHSA found the results of these studies promising enough to warrant further evaluation (e.g., Obert al. 2000; Rawson et al. 2004). The model provides substance abuse treatment professionals with a year long intensive outpatient model for clients and their families: 16 weeks of structured programming and 36 weeks of continuing care. Clients receive information, assistance in structuring a substance-free lifestyle, and support to achieve and maintain abstinence from drugs and alcohol.

This model of treatent is utilized by the Fort Payne Adult Recovery Center. 
 

RESIDENTIAL TREATMENT FOR SUBSTANCE ABUSE

 
- Transtheoretical model of change is a "process involving progress through a series of six stages":

• Precontemplation - "people are not intending to take action in the foreseeable future, usually measured as the next 6 months"
• Contemplation - "people are intending to change in the next 6 months"
• Preparation - "people are intending to take action in the immediate future, usually measured as the next month"
• Action - "people have made specific overt modifications in their life styles within the past 6 months"
• Maintenance - "people are working to prevent relapse," a stage which is estimated to last "from 6 months to about 5 years"
• Termination - "individuals have zero temptation and 100% self-efficacy... they are sure they will not return to their old unhealthy habit as a way of coping"

In addition, the researchers conceptualized "relapse" which is not a stage in itself but rather the "return from action or maintenance to an earlier stage

- Motivational interviewing (MI) recognizes and accepts the fact that clients who need to make changes in their lives approach counseling at different levels of readiness to change their behavior. If the counseling is mandated, they may never have thought of changing the behavior in question. Some may have thought about it but not taken steps to change it. Others, especially those voluntarily seeking counseling, may be actively trying to change their behavior and may have been doing so unsuccessfully for years.

Motivational interviewing interviewing is non-judgmental, non-confrontational and non-adversarial. The approach attempts to increase the client's awareness of the potential problems caused, consequences experienced, and risks faced as a result of the behavior in question. Alternately, therapists help clients envission a better future, and become increasingly motivated to achieve it. Either way, the strategy seeks to help clients think differently about their behavior and ultimately to consider what might be gained through change.

- The KIDS Journal System created by The Change Companies for youth, keeps it simple through the use of short copy 
   blocks and age appropriate graphics. The Journals focus on evidence-based motivational strategies to encourage change.
   Self-efficacy is stressed along with personal responsibility. All nine processes of change from the Transtheoretical Model
   are applied with special emphasis on consciousness raising, social liberation and helping relationships to assist young
   abusers out of an early state of precontemplation.

- VOICES A Program of Self-discovery...and Empowerment for Girls. VOICES was created by The Change Companies to
  assist adolescent girls in exploring themes of self, connection with others, health and their journeys ahead. Created by
  Stephanie S. Covington, Ph.D., a leading expert in women and girls' programming, this program helps young girls
  strengthen their sense of self and build skills for healthy development.