Adolescent
Substance Abuse
Lori Holleran, Ph.D., CISW, ACSW
The University of Texas at Austin
School of Social Work
Experimentation
“The majority of
adolescents
who use
substances
do/ do not
develop a
substance use
disorder.”
(circle one)
(Newcomb, 1995)
BIO-PSYCHO-SOCIALSPIRITUAL MODEL
• Bio: genetics, tolerance,
cravings, brain chemistry,
blackouts
• Psycho: low esteem &
grandiosity, profound aloneness
• Social: Disconnected, better or
worse than, family disruption
• Spiritual: “Hole inside,” lack of
meaning, lack of belief in good
Developmental Issues
 Puberty
 Individuation
 Peers as primary reference group
 Emergence of sexual awareness and
identity
 Increased cognitive powers, formal
operational thought (e.g., logic,
future orientation, reasoning)
 Imaginary audience (self-centered
and self-critical)
Risk Factors
 Temperament
 Cognitive functioning
 Genetics
 Peer influence
 Parental use
 Divorce
 Discord
 Nondirectiveness; inconsistency
 Lack of closeness; bonding
 Life events
 Socio-economic Status
Resiliency and
Protective Factors
• Mediators of risk:
–
–
–
–
–
–
–
(Glantz & Sloboda, 1999)
Intelligence; Problem solving
Social Skills
Positive self esteem
Supportive family/community
Affect regulation
Commitment/bonds at school
Religious affiliation/activity
Warning Signs:
 family substance abuse
 truancy or sudden grade drop
 change in peer group;
 quitting important activities
 legal difficulties
 drug-related paraphernalia
 unknown source of income
 physical changes
 "hanging out" in strange places
Assessment/
Screening Tools
(1) CAGE:
Have you tried to Cut down?
Are you Annoyed by others’
complaints about your use?
Do you feel Guilty about use?
Do you have an Eye-opener?
(Ewing, 1984)
A fast, easy initial screening method.
More Assessment/
Screening Tools
(2) MAST
Michigan Alcohol Screening Test
(Miller, 1976; Selzer, Vinokur, & Van Rooijen, 1974)
(3) SASSI
(Miller, 1990)
(4) ASI
(McLellan et al., 1980; McLellan et al., 1985)
(5) TWEAK
(Russell, 1994)
Interviewing Informants
 Gather information on questions the
adolescent was unable to answer or
created confusion in your mind.
 Try to determine how the informant
has interacted with the problems.
 How well equipped is the informant
to help with the adolescent’s
problems?
 Provide the parent with a review of
your recommendations.
What are the
Stages of Change?
Pre-contemplation
“What problem?”
Contemplation
“Okay, so maybe I might have
a problem. But then again…”
Determination
“I need to do something about
this.”
Action
“This is what I plan to do…”
Maintenance
“I’d like to keep this up.”
Relapse
“I’ll have to get back on
track.”
Source: Miller, W. & Rollnick, S. (1991) Motivational Interviewing.
Prochaska, J.O. and DiClemente,C.C. (1982), Transtheoretical Therapy in Psychotherapy: Theory, Research and Practice, 19, 276-288.
Adolescent
• Confront &
expect power
struggle.
• Educate on the
disease model &
emphasize here
and now
• Referral to
young peoples
groups
• Goal: progress
Adult
• Confront denial
• Educate on the
disease model
• Counseling
based on 12Step model
• Referral to AA,
NA, CA, etc.
• Goal: Lifetime
abstinence
Effective Work with
Adolescent Substance
Abusers
 Form honest, trustworthy connection
 Power struggles are normative
 Set boundaries, rules, structure
 Stay aware of developmental stages
 Expect limit testing- be firm and
loving
 Diffuse/avoid lesser issues
 Be human, have fun & laugh at self
(Johnson, 1999)
How do you facilitate an
adolescent’s needs for:
POWER
NON-CONFORMITY
FREEDOM
STRUCTURE
PEER ACCEPTANCE
(Caviola & Caviola, 1989)
Families and
Substance Abuse
Boundaries: Rules & Roles
Communication styles
Homeostasis
Family Disease
“Don’t feel, Don’t think,
Don’t talk” (Claudia Black)
 Roles: Hero, Scapegoat,
Mascot, Lost Child, Chief
Enabler. (Wegsheider-Cruse model)
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Family Roles
Sharon Wegscheider (1981)
HERO
SCAPEGOAT
MASCOT
LOST/FORGOTTEN
Summary…
Build relationships!
Remember the Bio-psycho-social
model.
View adolescents in CONTEXT.
Don’t reinvent the wheel.
Use a positive, strengths focus
rather than pathology and scare
tactics.
Where to Get More
Information
 lorikay@mail.utexas.edu
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http://www.niaaa.hih.gov/publications/
http://www.nida.nih.gov
http://www.health.org
http://www.alcoholics-anonymous.org/
http:///www.nacoa.net/
http://www.samhsa.gov/
 PRS Confidential Employee Assistance Program (EAP):
1(800) 343-3822
or through INTRANET:
Click on ‘Human Resources’
then click on ‘Other Resources’