AARC's Role

The research on youth addiction and the impacts on their families is relatively new. Many different approaches have evolved, based on the researcher's experience or theoretical orientation. Unfortunately, they are often short-sighted and narrow in scope. A broad-based, multidimensional program, involving the cooperation of the various components for treatment of severely addicted adolescents has not emerged from the research. Treatment for these youth and their families should include a broad range of activities, which integrate a number of components.

Research proves that management of adolescents with drug and/or alcohol problems requires more specialized treatment programming and greater diversity of services than adult programming. Clinical experience has discovered that adolescents tend to require greater lengths of treatment than adults, due to the greater complexity of their problems and the inherent developmental issues of adolescence, which is often displayed in turbulent or chaotic behaviour, passive or aggressive non-compliance with intervention attempts, or significant life problems, in addition to any alcohol or drug use.

For adolescents who are experiencing addiction, treatment is compounded because of the adolescent's age, immaturity, general lack of non-chemical coping skills, and the emotional and developmental lag that occurs secondary to prolonged drug use during the time of supposed emotional maturation. In essence, adolescents who are chemically dependent do not achieve maturation and do not develop the emotional maturity necessary to cope with life, because the process of growth was arrested by significant chemical use.

Adequate time to effectively accept treatment methods must be considered in adolescents who have experienced regular, compulsive use. Complete detoxification, in which the body is chemically free, can take up to 3 months. The direct physiological effect of poly-drug use will inhibit adolescents from thinking clearly, and it will take time before they can begin to understand some of the basic concepts necessary for recovery.

As research indicates, chemically dependent youth are extremely difficult to treat. Adolescents are regularly referred to outpatient facilities, short-term treatment facilities, or programs of lesser intensity and structure. Adolescents who fail to progress in these levels of care often find themselves at the end of available access to treatment. The prognosis for their success in life at this point is very dismal. As stated by a local medical doctor, Dr. Alan Stanhope, M.D. of Calgary, who provides medical care for clients at AARC, "Children are dying on the streets of Calgary, and a program such as this (AARC) will unquestionably save lives."

Treatment most often takes place at the stages of misuse, abuse and chemical dependency. Treatment progresses from the least restrictive; outpatient family and individual therapy, to the most intensive form of therapy; long-term treatment. In AARC's case, long-term treatment meets the needs of those adolescents where the negative consequences to their lives have progressed to the stage of chemical dependency and where returning to the home and/or the community is unrealistic. Long-term treatment provides these adolescents with a structured environment in which their drug and/or alcohol problems can be addressed, not only by therapy, but also by facilitating their habilitation: that is, the development of age-appropriate skills either lost through their substance abuse or never actually developed as a result of their substance abuse.

It is a long-term habilitation process that teaches adolescents the living and social skills that promote their commitment to remaining free from drugs and/or alcohol and leading a productive life upon returning to the community. Many adolescents have a history of unsuccessful treatment that is most often based on categories of misuse, abuse and dependency. These adolescents have tried outpatient family therapy treatment, outpatient primary treatment, and, in the end, inpatient short-term treatment.

• Provides on-going intervention and treatment in a structured and organized process that makes available on-going therapy and facilitates the habilitation of the adolescent. The goal is to enable the adolescent to develop age-appropriate skills lost, or never developed, as a result of drug use.
• Allows for the long-term habilitation process to teach them the living and social skills, promotes the commitment to remaining free of drugs or alcohol and leading a productive life upon returning to the community.
• Continuing aftercare component is designed to help maintain the motivation of the adolescent when the initial excitement about being drug or alcohol-free begins to subside.

Cavailoa, Schiff, and Kane-Cavailoa (1990) assert that successful recovery is also an ongoing process. They explain, "Emert (1988) points out that adolescents often find a 'rush' from the acceptance and self-discovery that they experience while in a residential treatment program. He adds, 'too many of these youngsters are floating out of treatment and crashing into the harsh realities of home, school and street life, after graduation from treatment'." As a result, "Most, if not all of the articles reviewed regarding adolescent chemical dependency treatment advocate for extended or continuing care following residential treatment." Catalano et al (1990-1991) adds: "Time in treatment was positively related to during and post-treatment outcomes in residential treatment settings. Keeping adolescents in residential treatment exposes them to more of the treatment regimen, as well as removing them from environmental influences to use drugs."

"Surveys of the literature within the field of adolescent addiction repeatedly point up to the need to treat addiction within the family context" (Wright 1988). Schools of family therapy, in particular, have had difficulty merging with existing addiction models. In isolation, family therapy and addiction programs have generally failed to understand and help each other. The role of family in the treatment of addicted adolescents is only beginning to be addressed. "Very little valid and concrete research is available in regard to family therapy for parents of adolescent substance abusers" (Sorensen and Bernal, 1987). Although the evidence for specific techniques is sporadic and limited, what is available suggests that strategic family therapy, when utilized with other proven modalities of addiction treatment, combines to improve outcomes.

Morrison (1988) explains family therapy is "absolutely mandatory" for the treatment of chemically dependent adolescents. "The family must become involved in the process of their own recovery, as well as the adolescent's recovery, because the illness affects every member of the family. Each member of the family develops his or her own illness in response to the addicted adolescent disease."

Obemeier and Henry (1989) recommended that it is essential that the family component be part of any inpatient treatment model. They assert, "Most families are not aware of their dysfunctional systems of operation and need as much time as possible to interact with other parents in family groups, partake in parenting seminars, and be involved in family therapy, with their child... Family residential treatment allows families to experience that therapeutic process, thereby gaining better insight into the changes their child is experiencing, and preparing themselves as a family unit to resolve those dysfunctional qualities which may hinder their child's recovery."

In the AARC program, family therapy serves to empower parents who feel impotent and stuck in helping their adolescents face their addiction and other behaviourial difficulties. Parents are provided with the opportunity to learn effective techniques and establish a healthy environment in which to live. An integration of the family-systems therapy approach with adolescent chemical-addiction treatment capitalizes on the positive aspects of both fields. Further clinical refinement and research is needed to increase treatment efficacy and profit from the strengths and resources of both areas.

Families are heavily involved in the AARC treatment process. Alcohol and drug abuse are considered family disorders and are often as damaging to family members as they are to the addicts themselves. The family program is both educational and experiential. It includes lectures, groups, and active involvement in running their own recovery home. Lectures and group therapy include information, not only about drugs and addiction, but also more effective ways of communicating in recovery. It is designed to help the family and significant others develop an understanding of how chemical dependency affects the entire family system, learn new and different ways to bring healthy changes to the entire family system, and provide continuous structured support for all members during the treatment period. The family, through their active involvement in the treatment program, learns about their own recovery, as well as that of their chemically dependent youth.

The AARC program is a therapeutic community consisting of a newcomer youth living with families of a child of the same sex and age, who is further along in their recovery. This phase allows the family to disengage from conflict and the host family to provide a home with a warm, supportive environment, rather than a sterile institutional one. As a youth progresses in treatment, they will earn the right to return to living at home and will begin to rebuild the family relationship. Next, they will learn the privilege of working with new youth in treatment by bringing them home at night. Through this process, we believe we can provide a caring and comprehensive family program, which will assist the whole family on the road to recovery.

Families in recovery, who are successfully confronting the problems of chemical dependency, can play an integral part in supporting new youth in AARC treatment. Family members model behaviour that indicates that recovery is possible. They provide the newcomer with hope for the future, and this hope is reinforced by the oldcomer: a member of the recovery home's family. The AARC qualitative and quantitative research substantiated the view that the recovery homes played an integral part in successful treatment. Clients at all levels stated that the recovery homes were significant in the AARC model. Clients claimed that recovery homes were essential because they provided the client with unconditional love, security, and safety. All clients come from dysfunctional homes, and by using recovery homes, they experience what it is like to live in a family that is healing a dysfunctional past.

Dr. Lloyd Earl Rootes, Ph.D., consulting psychologist and evaluator of chemical dependency treatment programs in Minnesota, commented on his experience and evaluation of the AARC recovery model and offered the following comments regarding use of recovery homes. "I spent two nights as a guest in one of your recovery homes, which provided me with a great deal of insight as to how this key aspect of your program relates to your overall treatment objectives for your adolescent patients... The support that individual patients receive from peer staff and families in the recovery homes provided the best possible environment for these adolescents to recover from their addictive and self-destructive behaviours... Adolescents in treatment usually lack the social stability which is predictive of successful treatment (continued abstinence)... Your use of recovery homes provides these adolescents with some semblance of social stability and also serves as a bridge between the treatment program and the community. In addition, these homes afford your patients an opportunity to learn and practice social skills and interpersonal skills in a supportive setting."

Dr. Alan Stanhope goes on to comment in support of the need for AARC's unique services, in a letter to Mr. Jim Dinning, written September 2, 1993: " I am the medical officer who looks after the children who are in care at this establishment. During the course of my work, I have been involved with a number of alcohol and drug rehabilitation centres, and thus, I feel qualified to express some opinions on AARC. As you well know, there are very few treatment centres available in this province and, in fact, throughout Canada. Therefore, it is very fortunate that the Alberta Adolescent Recovery Centre was founded... I have been able to observe the program and to form some opinions as to the efficacy of this treatment... I can state without any hesitation that this is one of the finest treatment centres I have come across, and it is in fact unique in its particular format."

Dr. Lloyd Rootes stated in a letter to Jim Dinning dated September 15,1993: "The AARC is a well designed adolescent treatment program, which is solidly based in what we already know about effective treatment for substance abuse. However, this program goes beyond conventional treatment, and has developed a model which is unique and demands the highest commitment from staff, clients and the families that comprise the recovery homes... There is a great need for continued innovation in the treatment of substance abuse, as evidenced by the persistent low rates of recovery, particularly among adolescent populations. I think that the AARC program shows excellent promise of developing an effective treatment model for substance abuse among adolescents."

Dr. Lewis Andrews, Ph.D., of Redding Ridge, Connecticut, states his acknowledgement of the unique services required for treating adolescents: "For more than five years now, I have been writing and lecturing widely on the connection between values and recovery from addiction. I work not only throughout the United States, but also in Canada, the U.K., Australia, and New Zealand... The more you know about this field, the more you discover that the success in treating the pressing and growing social problem of addiction, especially among adolescents, requires unusually focused institutions with dedicated and educated staffs, of which there are sadly very few in the world. The Alberta Adolescent Recovery Centre is one of a handful of programs which I would recommend unequivocally."

Adequate and effective services to treat intermediate to acute chemical addiction in adolescents (categorized as Levels 3 and 4 addiction) are limited. This population requires intense, multidisciplinary, well-structured, and long-term treatment to overcome the effects of chemical addiction.

There are various models which have emerged in an attempt to help addicted adolescents. Alcoholics Anonymous is the largest, most organized, and widely recognized as the most successful group addressing addiction and recovery anywhere. However, it was not designed specifically to address adolescent denial and developmental issues. Consequently, young people often fail to maintain quality sobriety in its unstructured environment (Forrest, 1984.)

Numerous non-residential (outpatient) programs have been established, where, after an assessment, patients are directed towards programs that best suit their needs. Although this is suitable for youth in the early stages of addiction, it is not intense nor structured enough for the later stages. The outpatient program is usually flexible, which has it merits. However, inherent in flexibility is the fact that patients have access to their previous drug-using peer group, which, in recovery, may set them up for failure. Although these programs have been conscientiously planned and implemented, there is very little research available on their effectiveness. What evidence there is seems to indicate that they are inadequate. While research shows that participants appear to be involved in more positive activities, they are still involved in dysfunctional behaviour and are abusing drugs and alcohol (Thompson, Dyer, Hewitt, 1988).

Traditionally, residential (inpatient) treatment programs are built around the 30-day model. While this kind of treatment works for many adults, it has questionable value for adolescents. The short-term (four to eight weeks) treatment models seem to be effective during the period of residence, but there is insufficient time for any internalization of new behaviours. In many cases, patients have not fully detoxified, nor do they have the opportunity to receive the kind of therapy necessary for thorough habilitation. In addition, these models do not have the kind of aftercare necessary to support "graduated" patients in their recovery, and as a result, the incidence of relapse is high.

A Toronto professional, who visited Calgary in the summer of 1993 to look at treatment models in the hopes of locating an appropriate model for the Adolescent Medicine Substance Abuse Program at The Hospital For Sick Children, evaluated the AARC program, and states in a letter to Diane Mirosh, dated August 24, 1993, "I would like to commend the individuals responsible for their efforts in creating this program, which provides health care professionals an effective and workable model in their efforts to address the needs of this often misunderstood, under-served segment of the population... I feel this program needs to be supported and recognized as a valued asset, not only for Calgarians, but for Canadians."

AARC can provide leading edge foundation for adolescent chemical dependency research and treatment methodology.

"At present, Canadian professionals are struggling to address how to treat addicted youth. While there are several different approaches, none is clearly the most effective" (Overy, J.M., Overy, N.M., 1985). As Russell (1990) concludes, "The area of substances abuse and adolescence is not well researched and is characterized by extreme philosophical/theoretical differences which determine treatment approaches."

Although studies are emerging which successfully describe the chemically dependent youth, research is virtually non-existent on programs that are successful in treating these youth and their families. General consensus has been that chemical dependency is an appropriate diagnosis for adolescence. However, much controversy and confusion remains among professionals, which undercuts a clear direction for the treatment of adolescents. It is difficult to find solutions to this dilemma. Drastic and expensive practices have left adolescent treatment itself open to charges of sloppy assessment, over-diagnosis, and ineffective and inappropriate programs (Nakken, 1991).

Russell's (1990) work makes clear that the study of adolescent addiction has been very much neglected. She indicates a need for sound research which would address the developmental stages of adolescence and which would be based on empirical evidence.

A Project Demonstrating Excellence (PDE), based on the AARC treatment model, which is accompanied by a contextual document researching adolescent addiction is part of a Ph.D., has been successfully completed by AARC's Executive Director, F. Dean Vause. This extensive study, which is the evolution of the AARC model, addresses the historical, clinical, and theoretical issues surrounding treatment for chemically dependent youth and their families. It discusses treatment areas such as type of therapy, adolescent development, client variables, therapist variables, diagnostic and assessment issues, components of treatment, family dynamics and involvement, relapse, treatment matching and evaluation.

Dr. Robert McAndrews, Professor at the Union Institute and second core reader of the Ph.D. by F. Dean Vause, stated in a letter date May 3, 1994: "Now that I see the 'hard' evidence and follow your thorough analysis, as a critical reviewer I am convinced that your model and actual program is one worth replicating everywhere possible... Your PDE research is scholarly, thorough, extensive, and analytical. I believe it may be the most complete piece of research available on youth addiction and treatment options."

The AARC model provides substantial data and information on how to successfully treat chemically dependent youth and their families. In an area where the research is limited and sometimes contradictory, the PDE describes specific characteristics of successful treatment.

AARC is a valuable asset to Albertans and Canadians as a provider of ongoing research and empirical studies in this field.