1.  
Giving teens the opportunity to regain their future!

2.  As of 2009:
o 32.0 percent of all substance related reports in emergency
department visits made by patients ages 12 to 17.
• were alcohol related and 18.7 percent were marijuana related.
o 21.6 percent of sexually-active high school students report
having used alcohol or other drugs before their last sexual
experience
o 1 out of 5 teens and young adults report having unprotected sex
after drinking or using other drugs.
 As of 2011:
o 46.1% of high school students admitted to currently using
alcohol or another drug.
o 11.9% have a diagnosable clinical substance use disorder.
(CASA, 2011)

3.  Violent Crimes - Due to possible:
o Increased paranoia
o Acceptance in subcultures
 Vehicle Accidents & Injuries
o 23% of high school car accidents were driving under the influence.
 Academics
o High school academic performance dramatically reduces
o Poor high-school performance decreases the chances of higher education.
 Cost of Association – Teens (even those who are not using) report that someone else’s
substance use has been associated with:
o someone personally who has gotten into trouble with parents, their school or the authorities (41.0
percent)
o who has gotten into an accident (26.8 percent)
o whose ability to perform school or work activities has been disturbed (24.5 percent)
o who has been injured or harassed (19.4 percent each)
o who has had an unintended pregnancy (13.8 percent)
o who has experienced physical abuse (11.1 percent)
o who has been sexually assaulted or raped (7.0 percent)
(Sempe, 2007; King, Meehan,
Trim, & Chassin, 2006; CASA.
2011)

4.  Adult Substance Use
o 9 out of 10 adults with substance abuse disorders started using before 18.
o 1 out of 4 who started before 18 are likely to be addicted vs. 1 out of 25 who did not.
 Critical Developmental Periods – Many areas of critical development are delayed or
stunted from substance use
o Brain
• Still considerable maturing process until 20s
• prefrontal cortex, limbic system and white matter still developing
• important for decision making
• Substances reduce white matter
• Cause changes in volume (pre-frontal cortex and hippocampus
o Cognitive
• Verbal and language abilities
• Decision making
• Planning
• Attention
• Abstract reasoning
• Problem solving
• Memory (short and long term)
o Forebrain and reward pathways still developing. Impacted by highly addictive substances which
increase the sensitivity to these effects.
(Bava, & Tapert, 2010; Kirby,
2010; CASA, 2011)

5.  $467.7 billion per year--almost $1,500 for every person in America--driven primarily by
those who began their use as teens.
 $68.0 billion associated with underage drinking alone
 $14.4 billion associated with substance-related juvenile justice programs annually.
 Multiple sources cause fiscal impact including:
o health care
o criminal justice
o family court
o education services
o social service systems
o Accidents
o Diseases
o Crimes
o child neglect and abuse
o unplanned pregnancies
o Homelessness
o unemployment
(CASA, 2011)

6.  Any kind of Victimization
o Sexual Assault
o Physical Assault (including bullying)
o Witnessed Violence
 Family History of Alcohol or Drug Abuse
 A genetic predisposition
 Neglect
 Co-occurring mental health problems
 Other un-healthy behaviors
 Violence or Aggressive behavior
 Exposure by media
 Need for social acceptance – Peer Pressure
 Low socioeconomic status
 Adolescent LGBT is at even greater risk (190% more likely)
(Kilpatrick et al., 2000; CASA, 2011;
Sempe, 2007; Lopez, Katsulis, and
Robillard, 2009; Marshal et al., 2008)

7.  AA/NA
o Developed for adults
o 7 year longitudinal trajectory showed that only 14% of teens
stayed in AA/AA.
 High rates of comorbidity
o Depression
o Anxiety
o BiPolar
o ADHD
o Conduct Disorder
(Chi, Campbell, Sterling, & Weisner,
2012; Deas & Thomas, 2002;
Goldstein, 2008)

8.  During this time, adolescents are going through a phase of
separation and initiation.
 Separating from parents and family to discover their own
identity.
 Evolutionary need to test their limits and seek out risky
behaviors. This inhibits support from authorities and increases
susceptibility with problem behavior peer groups.
 Efficacy of family systems oriented therapy shows relational
confusion, loss and needs of teens through this transitional
time.
 Incarcerated teenage girls who used drugs together with their
parents are seeking relational bonding that is otherwise not
achieved. (Kirby, 2010b; Baldwin, Christian & Shadish,
 Psychosocial need for risk behaviors andK. A., Bell, belonging2009;
2012; Lopez, Katsulis, & Robillard,
Kerksiek,
group N. J., & Harris, K. S.
2008)

9.  To provide successful care and support for the treatment
of adolescent substance use disorders through the
integration of evidence based treatments.
 To assist families in creating better dynamics as well and
support.
 To reduce adult recidivism and psychiatric comorbidity
 To optimize their integration into society, academic
performance and social aptitude.
 To contribute to the greater community through quality
research

10.  Comprehensive Assessments –vital in guiding
treatment
o Cognitive – Cognitive abilities show us the strengths and
weakness of an individual and may guide treatment and
academic needs that precipitate use.
o Psychiatric – Comorbid assessment not only provides
diagnostic guidance, but information regarding coping strategies
and possible uses for substances.
o Physiological
• Neuroelectrical imbalances as well as autonomic dysregulation
have been shown to be associated with impulsivity, lack of inhibition
and poor decision making;
• Blood levels of substances
o Functional Analysis of antecedents and consequences to
target circumstances that maintain the behaviorsKofoed, 1991;
(McCrady, Smith, 1986;
Peniston, & Kulkosky, 1989; Mathias, &
Stanford, 2003; Tuten, Jones, Schaeffer, &
Stitzer, 2012)

11.  Family Therapy - shown to be effective in Tx of adolescence with substance abuse
o Foster healthy family dynamics to ensure greatest familial support and reduce home stressors for teen
o Family sessions without the teen to provide support and realistic expectations to aid in the overall treatment
process
o Direct liaison service with social workers to aid in additional resources
 Self – Acceptance and Commitment Therapy (ACT)
o Acceptance based skills to counter Experiential Avoidance
• Effective in anxiety and depressive symptoms
• Cannot change the past or anyone else
• Self
o Value based Actions to counter the need for only good feelings
• Building a sense of identity
• Who they are
• Who they want to be
• Values that relate to identity
o Mindfulness coping strategies to counter Fusion
• Working through Negative Automatic Thoughts through diffusion
• Urge Surfing
• Cognitive Distortions
(Baldwin et al., 2012; Petersen, & Zettle, 2009)

12.  Biofeedback
o Heart Rate Variability (HRV) Biofeedback has been shown to balance the autonomic nervous
system which decreases sensitivity to stressors as well as sympathetically mediated impulsivity.
o Neurofeedback (optional) has been shown to decrease impulsivity, increase attention and
inhibition with frontal control.
 Community
o Social network that is solely made up of teens and a staff monitor.
o Creates accountability
o Opportunity for social and relational skill building
 Tutoring and Academic Support
o Enable teens to stay caught up through school
o Work through any learning challenges that deterred them from school to begin with
 Teen Activity Center
o Video game consoles, music and entertainment centers, pool tables, billiards
o Events to celebrate successful milestones for families and teens
o Teens need a safe place to mingle and “chill”
o Removes the need to find something to do
o Positive reinforcement is effective in maintaining target behaviors.
(Peniston, & Kulkosky, 1989; Knox et al.,
2011;
Wills, Vaughan, 1989; Bryant, Schulenberg,
O'Malley, Bachman, & Johnston, 2003;

13.  Promises to be at the forefront of adolescent structured
research to give back the field
o Randomized Controlled Trials with particular treatment
modalities
o Correlational studies for matching, personality and temperament
o Longitudinal data on all clients willing to participate
 Will help further guide funding and treatment procedures

14.  Reduce rates of recidivism
 Reduce future incarcerations
 Reduce future health care cost in substance abuse
 Reduce conduct disorders

15. ???

16.  Bava, S., & Tapert, S. (2010). Adolescent brain development and the risk for alcohol and other drug problems.
Neuropsychology Review, 20(4), 398-413.
 Baldwin, S. A., Christian, S., Berkeljon, A., & Shadish, W. R. (2012). The Effects of Family Therapies for Adolescent
Delinquency and Substance Abuse: A Meta-analysis. Journal of Marital & Family Therapy, 38(1), 281-304. doi:
10.1111/j.1752-0606.2011.00248.x
 Bryant, A. L., Schulenberg, J. E., O'Malley, P. M., Bachman, J. G., & Johnston, L. D. (2003). How Academic Achievement,
Attitudes, and Behaviors Relate to the Course of Substance Use During Adolescence: A 6-Year, Multiwave National
Longitudinal Study. Journal Of Research On Adolescence (Blackwell Publishing Limited), 13(3), 361-397. doi:10.1111/1532-
7795.1303005
 Chi, F. W., Campbell, C. I., Sterling, S., & Weisner, C. (2012). Twelve-Step attendance trajectories over 7 years among
adolescents entering substance use treatment in an integrated health plan. Addiction, 107(5), 933-942. doi:10.1111/j.1360-
0443.2011.03758.x
 Deas, D., & Thomas, S. (2002). Comorbid Psychiatric Factors Contributing to Adolescent Alcohol and Other Drug Use.
Alcohol Research & Health, 26(2), 116-121.
 Goldstein, B. I. & Levitt, A. J. (2008).The specific burden of comorbid anxiety disorders and of substance use disorders in
bipolar I disorder. Bipolar Disorders,10(1), pp. 67-78
 Kerksiek, K. A., Bell, N. J., & Harris, K. S. (2008). Exploring Meanings of Adolescent and Young Adult Alcohol/Other Drug
Use: Perspectives of Students in Recovery. Alcoholism Treatment Quarterly, 26(3), 295-311.
doi:10.1080/07347320802072008
 Kilpatrick, D. G., Acierno, R., Saunders, B., Resnick, H. S., Best, C. L., & Schnurr, P. P. (2000). Risk factors for adolescent
substance abuse and dependence: Data from a national sample. Journal Of Consulting And Clinical Psychology, 68(1), 19-
30. doi:10.1037/0022-006X.68.1.19
 Kirby, A (2010a, August 10). Substance Abuse and the Adolescent Brain, Part III: Brain Parts. Retrieved on April, 21 2012,
from http://www.youtube.com/watch?feature=player_embedded&v=_fKFjt0IISo#!.
 Kirby, A (2010b, September 24). Substance Abuse and the Adolescent Brain, Part V: Adolescent Susceptibility. Retrieved on
April, 21 2012, from http://www.youtube.com/watch?feature=player_embedded&v=_fKFjt0IISo#!.
 Knox, M. M., Lentini, J. J., Cummings, T. S., McGrady, A. A., Whearty, K. K., & Sancrant, L. L. (2011). Game-based
biofeedback for paediatric anxiety and depression. Mental Health In Family Medicine, 8(3), 195-203.
 Kofoed, L. (1991). Assessment of comorbid psychiatric illness and substance disorders. New Directions for Mental Health
Services, (50), 43-55.
 Lopez, V., Katsulis, Y., & Robillard, A. (2009). Drug use with parents as a relational strategy for incarcerated female
adolescents. Family Relations, 58(2), pp. 135-147.

17.  Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., . . . Morse, J. Q. (2008). Sexual orientation and
adolescent substance use: a meta-analysis and methodological review. Addiction, 103(4), 546-556. doi: 10.1111/j.1360-
0443.2008.02149.x
 Mathias, C. W., & Stanford, M. S. (2003). Impulsiveness and arousal: Heart rate under conditions of rest and challenge in
healthy males. Personality And Individual Differences, 35(2), 355-371. doi:10.1016/S0191-8869(02)00195-2
 McCrady, B.S., Smith, D.E., (1986). Implications of Cognitive Impairment for the Treatment of Alcoholism Issue. Alcoholism:
Clinical and Experimental Research, 10(2), 145–149.
 National Center on Addiction and Substance Abuse at Columbia, U [CASA]. (2011). Adolescent Substance Use: America's
#1 Public Health Problem. National Center On Addiction And Substance Abuse At Columbia University.
 Peniston, E.G., & Kulkosky, P.J. (1989). Alpha-theta brainwave training and beta-endorphin levels in alcoholics. Alcoholism,
Clinical and Experimental Research, 13(2), 271-279
 Petersen, C. L., & Zettle, R. D. (2009). Treating inpatients with comorbid depression and alcohol use disorders: a
comparison of acceptance and commitment therapy versus treatment as usual. Psychological Record, 59(4), 521-536.
 Sempe, M.D. (2007). Relationship between adolescent substance abuse and violence in Batho policing area (Master’s
Thesis). Tshwane University of Technology, Pretoria West, South Africa.
 Stivers, C. (1994). Drug prevention in Zuni, New Mexico: creation of a teen center as an alternative to alcohol and drug use.
Journal Of Community Health, 19(5), 343-359.
 King, K., Meehan, B., Trim, R., & Chassin, L. (2006). Substance use and academic outcomes: Synthesizing findings and
future directions. Addiction (Abingdon, England), 101(12), 1688-1689.
 Tuten, L., Jones, H. E., Schaeffer, C. M., & Stitzer, M. L. (2012). Conducting a functional assessment of substance use. In ,
Reinforcement-based treatment for substance use disorders: A comprehensive behavioral approach (pp. 43-56).
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 Wills, T., & Vaughan, R. (1989). Social support and substance use in early adolescence. Journal of Behavioral Medicine,
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