Treating Substance Abuse Without Substance Abuse Treatment

Many of the juveniles referred for services come with a package of delinquent behaviors that typically includes substance abuse of some sort. If substance use is not a referral behavior, it often contributes to the other referral behaviors. Research tells us that the same elements that predict other delinquent behaviors also predict juvenile subatnce abuse. Specifically, we know that  associating with other juvenile delinquents is a direct predictor of delinquent behavior, whether that behavior is stealing, fighting or substance abuse. We also know that there are factors in the family and the school that, when not working well, are predictive of the aformentioned peer association.

From a treatment perspective, if we are able to work with the elements of the ecology to be more effective, family and school, then we can expect to see some changes in the peer association. By doing so, we reduce the probability that the youth will be stealing and fighting if we remove them from that social setting. By doing so, we also reduce the probability of substance abuse because the same relationships were supporting the substance abuse that were supporting the other behavior. Substance abuse is frequently considered a "superbehavior" that requires extraordinary measures, but the research on the causes and correlates  of juvenile substance abuse tell us otherwise.

I worked with a child that I'll call Jeff. Jeff was referred for services for a package of delinquent behaviors that had resulted in his being placed on juvenile probation. The probation officer was clear that the main concern was Jeff's stealing. We knew that Jeff was using drugs as a result of urine screens but the level of theft was significant and needed to be controlled quickly, so that was our primary focus initially.

The bulk of the work centered around helping Jeff's mother, with support of family and friends, to be more effective in monitoring where he was and with whom he was associating. She also set firm limits on where he was allowed to go and with whom he could associate. In addition, she worked very hard to improve her discipline strategies. After a period of a few weeks, Jeff's mother was much more effective in controlling his whereabouts and peer asscociations. His probation officer was pleased that the theft seemed to have stopped and there had been no further complaints from local stores.

Following the reduction in the stealing, Jeff's probation officer administered a urine screen, and Jeff's test was negative for substance use. Continued random screens revealed the same result. How did this happen with no direct intervention on the substance abuse? Jeff's mother was successful in removing the influences that promoted or maintained the stealing behavior, and those were the same influences that sustained the substance abuse. If Jeff's rate of theft had not been so acute, the substance abuse may have warranted the referral itself, but that behavior was brought under control as a by-product of the focus on the stealing. This is because the same challenges in the family that were predicting the delinquent peer association and the the stealing, were having the same effect for substance abuse. Jeff's mother was able to address the behavior without sending him to an institution and without the high costs associated with such treatments. She was also able to do so without ongoing, time-consuming efforts that would actually prevent him from becoming involved with prosocial activities. In addition, the changes are more likely to last because the agent of change was a parent with improved awareness and skills that will always be present versus an intervention that ends on the discharge date.

Utah Referee Case - Sports/Jobs Not Always the Answer for Delinquent Teens

I have spoken before about the fact that the two direct predictors of delinquent behavior are past offenses and associating with delinquent peers. In attempts to remove some of that peer influence, therapists and families often work to involve kids in prosocial activities, and they should. However, not all activities are created equal.

The recent case of the soccer referee in Utah who was killed when he was punched by a player reminded me of a caution I give to therapists and families. In the Utah case, there was a history of violence in the soccer league toward officials in the form of player violence and fan fury. In such situations, the soccer team and the fans may support violent behavior and negate the effort to remove the child from such an influence.

In other cases, it's very common for parents and therapists to push for a child to be employed, a seemingly good choice. However, there may be other kids employed at the same place who are also getting into trouble and use breaks at work as a time to use drugs.

I don't want to suggest that sports are bad or that employment is bad. I am suggesting that if your child has a history of getting into trouble, you may not want to accept at face value that the new activity is a step in the right direction. I have had clients say they wanted a job and found out that their friends all worked at the same place, and the manager sold drugs. Just as you should diligently assess your child's friends, you must also assess the new activity. Are the kids on the team violent or is that prevalent in the league? Who are the child's coworkers? What do they do on breaks or when they take out the trash at work? Each of these questions may require you to go and investiage, take names, ask about people, watch what's going on and make your assessment.

If you are trying to get a child involved in a prosocial activity; that's great. I only offer these words of caution so that your tremendous effort yields the result you want for you and your family.