Inpatient or Outpatient? How to Find and Evaluate Adolescent Treatment

by Michael Dennis, Ph.D.

Summary

• In a given year, approximately one in 10 teens with a substance use disorder receives needed treatment.
• Early intervention programs work to make treatment accessible to adolescents by being in or convenient to schools.
• Residential treatment usually serves adolescents with health complications or high-risk recovery environments.
• Look for program elements that address teens' co-occurring mental health problems while treating the substance use disorder.

Adolescence is the time when most people become addicted. Some 80-90% of the people with substance abuse or dependence disorders started using under the age of 18 (half under the age of 15) and end up using for several decades.

While most of the adolescents who try using alcohol, marijuana or other drugs do not become addicted; one in four who start under the age of 15 end up developing abuse or dependence problems and do not stop until they have gone to treatment 3-4 times over several years. Substance abuse and dependence mean that use has led to subjectively unpleasant problems to the teens and/or their families (withdrawal, giving up other things they care about, getting into fights, not meeting their responsibilities).

Unfortunately, only one in 10 adolescents who've had a substance use disorder in the last year are receiving treatment. It is important to not give up hope, however, because most teens eventually quit and recover. Moreover, getting kids into treatment sooner, making sure they complete it and re-intervening as soon as possible after relapse significantly reduces how long it takes to get them to stable recovery. If treatment commences within the first decade of use this typically cuts in half the time it takes one to achieve recovery.

Early intervention or student assistance programs try to work with teens before they develop substance use disorders or in the first 1-2 years of use. By being in or convenient to schools, these programs make participation easier and less threatening for teens. Eighty percent of the programs offer outpatient or intensive outpatient treatment and may involve a combination of individual, family and group therapy. The programs may involve an hour of therapy weekly. Or they may be far more intensive, ranging up to 10 or more hours each week. Some extend the treatment of teens into their homes.

Residential treatment is typically reserved for teens who have intoxication, medical or psychiatric complications or have high-risk recovery environments such as those in which the teen is homeless or abused or in which family members or close peers are using drugs. Other candidates for residential treatment are those who have kept using in spite of outpatient treatment. Residency can last from a few days (for detox only) to 30-45 days and, for long-term treatment, up to a year. The latter are typically limited to kids who have not responded to shorter treatment, are involved in the juvenile justice system (and are likely to commit crimes if released) and/or who have very unstable home lives (such as multiple foster care placements).

Keeping adolescent addicts abstinent during the initial period of re-entry after residential treatment is probably the best single predictor of long-term recovery. There should be a continuing care outpatient program after residency, as relapse is particularly common in the first 90 days after discharge. Unfortunately only about 10% of adolescents coming out of residential treatment successfully start continuing care outpatient treatment, even when it is readily accessible. Research shows that involvement in adolescent-oriented self-help groups, substance-free structured activities and recovery- oriented schools or school programs also helps. In many communities only some of these levels of care may be available.

The majority of adolescents with substance use disorders also have one or more co-occurring psychiatric problems such as depression, anxiety, traumatic memories, self-mutilation or suicidal thoughts; behavioral problems including inattention, hyperactivity and conduct disorder; crime or violence problems; and/or have multiple sexual partners or other HIV risks. Only a small percent have only one problem and over half have five or more. The more of problems an adolescent has the more likely they are to relapse. Addressing these other problems simultaneously is often a key part of successful treatment. Some of the key program features that help with co-occurring disorders include: standardized assessment for other problems, providing on-site services, case management to help teens and their families get access to services, having agreements or electronic record systems to help coordinate the various people working with the teen.