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Teen Detox Programs

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A recent survey looking at drug use in American adolescents found that 5.4% of 8th graders, 9.8% of 10th graders, and 14.3% of 12th graders used illicit drugs other than marijuana.1 Additionally, they commonly abuse alcohol and tobacco.2

There are many reasons why teens begin to use different substances—including wanting to experiment, peer pressure, and stress—but continued use can lead to significant problems. Substance use may progress to a substance use disorder (SUD) when repeatedly abusing alcohol or drugs causes significant impairment in functioning—physically, socially, and at school, work, or home.3 Estimates state that approximately 1.5 million teenagers meet the criteria for an SUD, yet only 7% of them receive treatment.4 However, many treatment programs exist for teens, and some of these may include detox as the first treatment component.

The main purpose of a detox program is to safely manage symptoms of withdrawal. Detox programs tend to be the first step in the recovery process and typically range from 3 to 5 days, though they could last longer for certain substances and significantly severe cases of physical dependence.5,6 Some detox programs incorporate a medical component that includes intensive medical monitoring while your body rids itself of the substances you have been abusing.5,6 Detox programs may also provide brief intensive counseling and prepare you for longer-term treatment options.6

What to Look For

When looking for an effective detox program, there are several factors to consider, such as if medical services are offered (which is especially important if your teen has been using alcohol or benzodiazepines); if the program is able to handle dual diagnoses when mental health issues are also present; the thoroughness of the screening and assessment process; the use of evidence-based practices; the training of clinicians and staff members; and ethical standards.

Medical Services

Some detox programs offer medical services, in which they use medications to reduce the discomfort or danger associated with certain withdrawal symptoms. More medically based programs may also provide access to surgeons, neurologists, psychiatrists, anesthesiologists, and other specialized medical providers, depending on how severe the withdrawal symptoms are, or if co-occurring physical issues are present. If you are detoxing from alcohol, sedative-hypnotics, or opioids, hospitalization or some form of medical care may be necessary since withdrawal symptoms tend to be more severe and/or dangerous with these substances.7 

Dual Diagnosis Treatment

It is also important to consider whether or not a detox program can work with those who have dual diagnoses, which is having both a substance use disorder and a mental health disorder, such as depression or anxiety. This is important because the physical detoxification process tends to lead to challenging psychological symptoms, and substance abuse in general can exacerbate mental health issues.7 Detox treatment facilities should know how to handle situations where teens are on mental health medication and also need detox medications, since there could be harmful interactions. Also, withdrawal symptoms sometimes mimic symptoms of psychiatric conditions; a qualified teen detox facility will have experience monitoring and evaluating patients to make proper judgments regarding the course of treatment.7

Assessment and Screening

The major components of assessment and screening within a detox program are evaluation, stabilization, and guidance into longer-term treatment programs.7,8

  • Evaluation includes testing for substances within the bloodstream and measuring the concentration of these substances. It also includes assessing your medical conditions, psychological concerns, and social situation to help you find the most appropriate level of treatment following detox. This step is key to forming your initial treatment plan.7
  • Stabilization involves the medical and psychosocial process of helping you through acute intoxication and withdrawal to achieve medical stability in a substance-free state, which may be done with or without medications. This part of the process may also include educating you about your role in treatment and recovery. Clinicians may try to get your family, friends, and others who are important to you involved in your care at this stage.
  • Lastly, clinicians may assist in preparing you to enter long-term substance abuse treatment programs by emphasizing how important it is to follow through with your treatment plan and continuing treatment options. To effectively plan for these options, a comprehensive drug use history and in-depth assessment of your strengths and any weaknesses that need to be addressed may take place. Appropriate treatment planning considers factors such as: medical and mental health history, psychological development, risk of severe withdrawal symptoms, relationships with family members, relationships with friends and peers, academic performance, participation within the community, cultural and ethnic considerations, gender considerations, physical issues, transportation concerns, and legal involvement.

Various screening instruments that may be used in this process include:5

  • The Substance Abuse Subtle Screening Inventory (SASSI).
  • The Personal Experience Screening Questionnaire (PESQ).
  • The Comprehensive Addiction Severity Index for Adolescents (CAS-I).
  • The Global Assessment of Individual Needs (GAIN).

Evidence-Based Practices

It is also important for detox programs to use evidence-based treatment options to ensure best outcomes. These kinds of practices are those that have been studied and have research that supports their effectiveness. Research evidence combined with clinical expertise and client values lead to optimal treatment outcomes.9 Depending on the substance(s) you are detoxing from, there may be different evidence-based detox treatment methods available (e.g., medication management for opioid detox). 

Training and Ethical Standards

Because the detoxification process may include unpleasant and potentially dangerous physical symptoms, such as restlessness, agitation, anxiety, nausea, vomiting, loss of appetite, insomnia, intense dreaming, nightmares, hallucinations, delusions, or even seizures (e.g., the symptoms of alcohol withdrawal), it is important to work with providers who have proper training and can identify whether hospitalization or other forms of medical care are necessary.7 For this and other reasons, feeling comfortable with and trusting a program is very important. Working with clinicians and staff who are appropriately trained in addiction treatment; who have experience working with teens; who understand adolescent development; and who value your input may increase your comfort level with the programs you consider. Staff should also be able to recognize psychiatric issues, since many adolescents who have an SUD have a co-occurring mental health disorder.5 It is equally important that clinicians and staff are able to work effectively with families. Additionally, finding a program that has clearly stated and followed ethical standards is important in building trust with that program.

Treatment Approaches

Knowing which treatment approaches a detox program uses allows you to better assess if it will be a good fit for you. The following treatment approaches may be used briefly during detox programs but are especially effective when they are used over longer periods of time, after the initial detoxification period. The following sections include some of the most common treatment approaches.5,6,7

Medication Management

Medications can help reduce certain withdrawal symptoms, assist in reestablishing typical brain function, and help decrease cravings. There are currently medications available for easing the symptoms of detox from opioids, tobacco, and alcohol, while medications for stimulants and cannabis are currently being researched and developed. Medication may also be needed for co-occurring disorders, such as depression, anxiety, and bipolar disorder. This treatment should be provided by a qualified medical clinician.

Individual Therapy

Cognitive behavioral therapy (CBT) is often the treatment modality provided, which primarily focuses on your thoughts and feelings and how they impact your behavior. Motivational Interviewing (MI) may also be used to help you find and strengthen your internal motivation to work toward making positive changes around your addiction. It may be effective in motivating you to engage in longer-term programs after completing detox too. It is important to remember that because detox programs are short-term, the techniques mentioned above will be used briefly to address current concerns and to assist with effective treatment planning. These techniques may be continued after you complete your detox program.

Family Therapy

During a detox program, family therapy may be brief and used to increase the effectiveness of treatment planning (e.g., gaining a more well-rounded picture of the patient through information shared by family members, friends, and others who are important to them). Family therapy may be continued after the detox program has ended and may focus on improving communication with other family members and cultivating decision-making skills, problem-solving skills, negotiation, and coping mechanisms for stress. Family therapy aims to foster support within the family environment.

Multisystemic Therapy (MST)

MST is a heavily researched family- and community-based intensive treatment that has proven to reduce drug use and criminal behavior.

Education

Educating adolescents about withdrawal symptoms and the dangers of intoxication and withdrawal may encourage them to get help, such as attending a detox program, when they notice such symptoms. Educating teens about the risks and consequences associated with substance use may also guide them toward making healthier decisions after they complete detox.

A combination of these treatment approaches is often used. It is important to remember that detox programs tend to be the first step in the recovery process and that they are shorter-term programs that can prepare you for longer-term treatment options.6

Age-Specific Considerations

Detox programs that are appropriate for adults may not be best suited for adolescents, since the 2 age groups have different psychological, developmental, and social needs. When considering a teen detox program, evaluate age-specific factors, such as:4,5

  • Family involvement, since parents’ involvement in their child’s treatment and recovery increases the likelihood of a successful treatment experience.
  • Strategies to engage teens and assist them in recognizing the value of getting help for their problems.
  • Hands-on techniques relevant to adolescents’ concerns and developmental stages (e.g., incorporating technology into treatment).
  • Positive reinforcement.
  • Whether the program is tailored to the needs of younger adolescents (12- to 15-year-olds) or older adolescents (16- to 18-year-olds).
  • Sexual issues.
  • Healthy coping mechanisms for stress, especially stress related to school and peers.
  • Emotional regulation.
  • The role friends and other peers have on a teen, and the influence they may have on substance use.
  • Academic performance and how it may be impacted by substance use.
  • Collaboration with teachers during detox.
  • Case management to assist the teen with remembering and participating in appointments.
  • Clinicians and other staff who are experienced in working with adolescents and who understand how to engage and motivate them.

When working with adolescents, it is especially important to work as a team. Not only does the teen need to be included in their own treatment, but their parents or legal guardians do, as well, to have a well-rounded recovery experience. Everyone should be able to give input, which allows a more complete picture of the teen to emerge and, subsequently, tailored treatment planning. When everyone on the team works together, the teen may feel more supported, from the detoxification period through the transition to longer-term substance abuse treatment.

Sources

  1. National Institute on Drug Abuse. (2016). Monitoring the Future Survey: High school and Youth Trends.
  2. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: What Drugs Are Most Frequently Used by Adolescents?
  3. Substance Abuse and Mental Health Services Administration. (2015). Substance Use Disorders.
  4. Winters, K.C., Botzet, A.M., & Fahnhorst, T. (2011). Advances in Adolescent Substance Abuse Treatment. Current Psychiatry Reports, 13(5), 416–421.
  5. Brannigan, R., Falco, M., Dusenbury, L., & Hansen, W.B. (2004). Reducing Underage Drinking: A Collective Responsibility. Washington (DC): National Academies Press (US).
  6. National Institute on Drug Abuse. (2016). Treatment Approaches for Drug Addiction.
  7. Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol TIP 45.
  8. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Principles of Adolescent Substance Use Disorder Treatment.
  9. Duke University Medical Center. (2017). What Is Evidence-Based Practice (EBP)?

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