Adolescent chemically dependent patients relapse at
a much higher rate than adults.
indicate that approximately 42% of adolescents who complete inpatient
treatment for chemical dependence maintain total abstinence from alcohol
or other drugs during the year following treatment.
This is much lower than the 66% abstinence rate reported for
adult inpatient programs with similar treatment philosophy and
Seventy-eight per cent of adolescents who relapse
(45% of all adolescents treated) do so during the first six months of
recovery. The good news is
that 77% of those who made it through the first six months of recovery
without relapsing maintained their abstinence for the entire year.
Of the patients who relapsed during the first six months, 28%
were abstinent for the second six months.
Of those adolescents who relapse (58% of all adolescents
treated), approximately 40% (23% of all adolescents treated) have
short-term and low consequence relapses and rapidly return to sobriety.
The other 60% (34% of the population) have long-term, high
There are significant differences between adult and
adolescent chemical addictions and the failure to recognize these
differences can be an important contributor to adolescent relapse.
Most chemically dependent adolescents have three coexisting
problems that increase relapse risk:
(1) Chemical Addictions (Adolescent Substance use Disorders)
(2) Normal Problems With Adolescent Development, and
(3) Adolescent Mental Disorders.
Adolescent Substance Disorders
Many chemically dependent adolescents relapse
because they fail to recognize that they are chemically dependent and
need to abstain from alcohol and drugs.
This is especially true for adolescents who are in the early
stages of their addiction or lack a long history of alcohol and drug
related problems. Forcing early stage adolescents into harshly
confrontational inpatient programs against their will can create high
relapse rates after discharge.
Many of these adolescents go into compliance and passively resist
treatment and, although on the surface many appear to be model patients,
after discharge they rapidly return to alcohol and drug use because they
have failed to recognize and accept their addiction.
Recovery rates can be improved by using outpatient motivational
counseling techniques and substituting intensive outpatient treatment
for inpatient treatment.
Some adolescent programs focus exclusively upon the
chemical addiction while minimizing or ignoring problems with normal
adolescent development or adolescent disorders which can lead to
relapse. Many adolescent
programs, for example, set behavioral standards that would be
appropriate for adults but are inappropriate for adolescents in certain
stages of development. Since the onset of chemical addiction causes many
adolescents to stop normal emotional development, treatment centers can
overcome this problem by assessing the stage of adolescent development
and setting appropriate behavioral expectations and treatment goals.
Normal Problems With Adolescent
It can be easy to forget that adolescent substance abusers are
children who are not capable of functioning up many adult standards.
Normal adolescence is a difficult period of adjustment. Hormones
go on line and start to rage. Social relationships become more
complicated. Pressure from peers to conform and pressure from
parents and teachers to excel can weight heavily on many if not most
teenagers. Effective adolescent treatment programs take the stage
of adolescent development into account and design treatment plans that
are appropriate to the adolescent's current developmental level.
Failure to do so can significantly increase the risk of relapse
Coexisting Psychosocial Problems
Typical chemically dependent adolescents have three
major life problems in addition to their chemical addiction to contend
with when they enter treatment.
The most common problems include school problems (58%),
dysfunctional relationships with one or both parents (38%), parental
substance abuse (35%), physical abuse (30%), sexual abuse (37% of
females and 5% of males), depression (29%), and suicide attempts (16%).
If left untreated, these other problems can create ongoing pain
and dysfunction which lead to relapse.
While treating these other problems, however, it is important to
keep an addiction focus. To treat these other problems without helping
the adolescent to recognize the role that their alcohol and drug
dependence has in creating and maintaining these problems can also
contribute to relapse. The
correct relapse prevention approach is to provide balanced treatment for
adolescents that focuses upon diagnosing and treating their chemical
addiction, the normal tasks of adolescent development that they need to
cope with in sobriety, and other major life problems that can jeopardize
important that adolescents be matched to an appropriate treatment
setting. There is the
mistaken belief that the preferred treatment setting for all adolescents
is a long-term inpatient treatment environment.
Many adolescents, especially those in the earlier stage of
addiction with less severe coexisting problems and supportive families,
do better in outpatient environments where they can maintain their
academic and family lives than in long-term inpatient programs that
disrupt the normal course of their lives.
For adolescents with late stage chemical addiction with numerous
severe, coexisting problems and little or no family support, inpatient
treatment may be necessary.
Ongoing outpatient treatment is vitally important
in preventing adolescent relapse.
The majority of adolescents relapse in the first six months with the
second highest risk period being the second six months.
Adolescents who are not involved in outpatient treatment that
includes family involvement for at least one year following discharge
from inpatient are at high risk of relapse.
The final factor that contributes to an increased
relapse rate among adolescents is the failure of many treatment centers
to teach the adolescent patients and their families how to identify and
manage relapse warning signs.
Relapse is a process that begins long before adolescents begin drinking
and drugging again. There
are progressive and predictable warning signs that indicate that the
adolescent is getting into trouble with his or her recovery.
The typical sequence of warning signs normally begins when a
situational problem triggers the adolescent to react with old addictive
ways of thinking. The
addictive thinking creates painful and unmanageable feelings.
In order to cope with these feelings, the adolescents begin
reverting to alcohol and drug seeking behaviors which put them back in
contact with other adolescents who are drinking or drugging.
Once in this environment, return to use is inevitable.
Teaching adolescents and their families to
recognize and intervene upon the early warning signs can prevent
Helping the adolescent, the family members, and other concerned persons
to intervene as soon as addictive use begins can help assure that
adolescents will experience short term and low consequence relapses.