Adults vs. Teens: Substance Abuse Treatment

Drug abuse and addiction treatment for both adults and teensWhen it comes to substance abuse treatment, experts agree that the outcome is most likely to be positive if the treatment plan is personalized based on the individual’s specific needs. One of the sets of criteria on which this is based is the person’s developmental needs, many of which are determined by age. As a result, diagnosis, treatment, and outcome are different for teenagers than they are for adults.

Because teenagers have different developmental, mental, and physical needs compared to adults, and because this is the time period when most people first experiment with drugs and alcohol, treatment must be finely tuned to fit the mental, physical, and emotional needs of younger people. When treatment is specialized in this manner, it offers the best chance for the individual to emerge from treatment in recovery that can be maintained for many years to come.

The following comparison demonstrates some of the ways in which diagnosis, treatment, and outcomes are different for adults than they are for teenagers when it comes to substance abuse.

Treating Adults

Diagnosing Substance Abuse

The Diagnosis of substance abuse in adults is based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which has an established set of 11 criteria used to determine the presence and severity of a substance use disorder. As described by Psych Central, these criteria include:

  • Using more of the substance or using it longer than intended
  • Needing more of the substance over time to get the same effect
  • Craving the substance
  • Spending large amounts of time using or seeking the substance
  • Developing relationship issues over substance use
  • Having physical or psychological problems related to substance use
  • Spending less time in favorite activities due to substance use
  • Neglecting work, home, or school responsibilities due to substance use or its effects
  • Using the substance in dangerous situations
  • Being unable to stop using the substance even in the face of consequences
  • Experiencing withdrawal symptoms if substance use is stopped

For adults, the severity of the disorder is determined through the number of symptoms that are present. Two to three of these signs indicate a mild substance use disorder, while four or five indicate moderate severity, and six or more indicate a severe disorder.

Adults substance abuse treatment

Treatment Types and Placement

Adults are placed in treatment programs using a different set of criteria that has been established by the American Society of Addiction Medicine (ASAM). These criteria use six dimensions of assessment, including the individual’s relapse risk and readiness to change behaviors, to help determine the intensity of treatment that is required for adults. The treatment types across this continuum of care include, in order of intensity:

  • Outpatient treatment: advised for people with a relatively low relapse risk
  • Intensive outpatient or partial hospitalization: for adults with special needs or a low to moderate relapse risk
  • Residential or inpatient services: for people with a higher relapse risk, including having relapsed previously, or for higher severity of abuse
  • Medically managed services: for those in crisis situations or with long-term, severe abuse with multiple relapses

There are other levels of service within each of these basic types, depending on the individual’s particular needs, co-occurring conditions, and other factors.

Aftercare and Relapse Prevention

The main goal of treatment is relapse prevention. As such, the levels of aftercare provided for most adults once they leave rehab are based on the degree of relapse risk. If an adult is considered to have a higher risk of relapse, more intense aftercare may be required. However, for adults with a low risk, aftercare may be minimized; for some, it may not be considered as intensely necessary as for others.

Nevertheless, some form of aftercare can always be helpful for adults in dealing with the potential stressors and negative life situations that can lead to weak moments and the possibility of giving in to cravings. Because of this, most adults can benefit from involvement in a 12-Step support group or other regular relapse prevention program that provides continual motivation to remain abstinent.

Treating Teenagers

Diagnosing Substance Abuse

Many of the signs that make up the criteria for the DSM-5 diagnosis of a substance use disorder are normative behaviors for teenagers. For this reason, sometimes the beginning of a substance use disorder in adolescents is missed because the behaviors are overlooked as being a part of “normal” teenage development. Based on this fact, a study from Addiction recommends that care be taken in applying the following criteria when diagnosing teenagers:

  • Tolerance: Teenagers may more quickly and more easily develop tolerance for substances for a variety of reasons, especially when moving from experimentation to more regular use. Care should be taken in applying this criterion.
  • Risky behavior: Adults are more likely to engage in hazardous activities while using drugs or alcohol than teenagers are, partly because teens are less likely to have access to these activities. Also, abuse of some drugs, like tobacco, does not necessarily occur in hazardous situations. As a result, this criterion may not apply, even though a substance use disorder is present.
  • Withdrawal: Withdrawal symptoms usually begin to appear after years of drug abuse, making them less likely to occur in teenagers, even with frequent heavy use. Therefore, lack of withdrawal symptoms does not necessarily mean that a substance use disorder is not present.
  • Cravings: The existence of cravings and how they are defined in teenagers may be vague. Some teens who use heavily report cravings, but the definition of cravings for younger people may affect whether or not they are reported accurately. This criterion also benefits from deeper scrutiny before diagnosis.

Because of this, scrutiny should also be applied to defining a substance use disorder using two or more of the DSM-5 criteria. Because some of the criteria are normal behavior for teens, there may be diagnosis of a disorder where only mild use is present, requiring a clearer definition of how each criterion applies to decide whether prevention measures are more appropriate than dedicated treatment.

Treatment for teenage drug abuse

Treatment Types and Placement

The ASAM criteria for adolescents are revised to reflect different levels of severity, while still based on the same basic scale. This is because, for the most part, teens with substance use issues are considered to be at a lower level of abuse than adults from the start. In addition, teenagers in stable living environments are less likely to need residential care because family members can contribute to monitoring use and providing high levels of care due to the teenager not living alone. A number of similar factors are taken into account when determining the appropriate level of care for teenagers who are struggling with drug or alcohol abuse.

For example, according to the ASAM Continuum decision engine, while the ASAM level 3.5 services for adults are considered to be high-intensity residential treatment, adolescents at this level are considered to need only medium-intensity residential treatment.

As part of treatment, family participation is considered to be extremely important in helping teens reduce their drug or alcohol use, as explained in the book Reducing Underage Drinking: A Collective Responsibility.

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Aftercare and Relapse Prevention

According to Reducing Underage Drinking: A Collective Responsibility, studies show that about one-third of adolescents who relapse do so within the first month after treatment, and two-thirds do so within the first six months. In addition, teenage relapse risk is based on peer pressure and the feeling that continuing to abuse substances contributes to social standing. This is in marked contrast to adults, who tend to relapse due to stress or other negative emotional effects.

For this reason, aftercare is considered to be vital for preventing relapse in teens, even more than in adults. Continuing care for a substance use disorder must be provided for all levels of care in teens to help counter the social pressure and challenges that lead to a higher risk of relapse in young people.

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By paying attention to the differences between treatment for adults and methods for helping adolescents, it may be possible to improve the chances that teens will emerge from rehab able to avoid the pitfalls that lead to more severe problems with alcohol and drugs as adults. Giving young people the tools and support needed to build a lifelong ability to resist alcohol or drug relapse can contribute to a brighter future for people of all ages.

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