Valuable Videos

Both of the PBS videos shown below are excellent resources for understanding your kids' experience with learning differences and motivation issues bothe in the classroom and at home. Both of these are really eye-opening and illuminating! You can see both of these in their entirety on youtube. The Motivation Breakthrough is available both from PBS and amazon.com. Misunderstood Minds is out-of-print, but also can be viewed on youtube, and, we have a loaner copy of the DVD that you can borrow.

Misunderstood Minds
This video talks about the often painful experience that kids with learning differences have in the classroom and at home, and the strong connection between learning differences and behavior, self-esteem and motivation.

The Motivation Breakthrough
This video looks at the misconceptions that parents and teachers often have regarding kids' motivation in the classroom and at home. It discusses the ineffective and sometimes damaging ways that we often address kids' inconsistent performance, and really gets into individualized strategies for increasing motivation. Amazing!

DO PARENTS CAUSE ADHD?

February 9, 2012 By Kevin Roberts

www.empoweradd.org

A recent New York Times Op-Ed suggested that parents are a significant causative agent in ADHD. Wow! I cannot believe this type of neanderthalic diatribe is still filling our newspapers and airways. A retired professor of psychology, Dr. L. Alan Sroufe, in his Op-Ed, Ritalin Gone Wrong, asserted that too many kids are medicated, and that in many cases, poor parenting leads to the condition. Again I say, WOW!

To start with, yes, the family does exert a significant impact on how we develop. Family reactions to an ADHD child are known to play a significant role in the child’s development of self- esteem, as well as having a role in the development of certain secondary diagnoses, like Oppositional Defiant Disorder. Multiple studies confirm this. I refer inquisitive readers to Joel Nigg’s book What Causes ADHD? [1] and Barkley’s Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment [2]. These books are good amalgamations of the body of scientific research on ADHD. When you look deeper, and aspire to find the facts, you will see that any familial role, outside of genetic inheritance, is secondary to the development of ADHD. Research continues to point to differences in the brain as the precursors of ADHD symptoms, not problem parents.

For example, the ability to delay an impulse, or wait, is impaired in ADHD, and is, in fact, a diagnostic criterion. Struggling with waiting, or impulsivity, is, in part, linked to a brain region called the caudate. We know this because when victims of trauma suffer damage to the caudate, impulsivity often appears in people with no prior history of this trait. Research has also shown that many ADHD boys have irregularities in that part of the brain. The caudate does not change shape because of the actions of one’s parents. There are gene variants strongly associated with caudate difference in ADHD boys as well. This is just one of numerous examples that make a compelling case for differences in the structure, size, shape, and functioning of the brain as strongly underlying ADHD.

Further, it is well documented that ADHD involves the frontal dopamine circuits of the brain. Numerous brain imaging scans have demonstrated this, and the most common medications for ADHD, the stimulants, are known to improve the way the brain metabolizes dopamine. In addition, several variants of dopamine-involved genes are strongly associated with ADHD. ADHD is a neurobiological condition. As with any disorder, the way that parents deal with it does impact the way the child grows and develops. If the parent of a child with diabetes becomes an overprotective hypochondriac, that child might have some secondary “symptoms” that were precipitated by his or her parents’ behavior. That fact does not change the truth of the physical condition with which the child must cope. Blaming parents is counterproductive. What is needed is more awareness and education about ADHD.

One of the treatments for ADHD is medication and the above-mentioned Op-Ed piece asserts that children are being overmedicated. There is no research to support that. I can say, anecdotally, that I encounter more parents who fear medication and resist putting their children on it than I do parents who wholeheartedly embrace the practice. I suspect that there are some children who take ADHD meds who should not be taking them. This is part of a broader trend. Many parents are guilty, for example, of insisting their children be put on antibiotics, even when there is no clear-cut symptomology that warrants it, a fact which is contributing to antibiotic-resistant strains of bacteria. We still don’t have enough data to make an informed opinion about ADHD over-medication. Obviously, these are powerful drugs, and parents should go into such a decision with great deliberation and awareness of potential side effects. I am no great proponent of medication, but I have seen ADHD meds transform lives.

I agree with Dr. Sroufe that medication is proving not to be a good long-term strategy for a significant segment of ADHD people. Trying to find common ground, I believe that parent training, like that offered by groups like CHADD, is highly beneficial. Few of us have the natural inclinations to effectively handle the atypical behavioral profile of an ADHD child. Positive and productive responses can be taught, but those responses, as well-intentioned and executed as they may be, cannot reverse the symptoms of ADHD. They can help to create a more well-adjusted child, and perhaps minimize some of the troubling secondary conditions that arise with the disorder. Parents are not to blame. They deserve compassion and understanding. Most parents of ADHD children who I deal with have spent incredible energies trying to help their children succeed. Dr. Sroufe’s article does not help them. It only pushes them further into shame and inadequacy, emotional states that will certainly not help them or their children.

1. Nigg, J. (2006). What Causes ADHD?: Understanding What Goes Wrong and Why,

New York : Guilford Press.

2. Barkley, R. (2006). Attention Deficit Hyperactivity Disorder: A Handbook for

Diagnosis and Treatment. New York : Guilford Press.

The following studies further back up the scientific claims I make in this posting.

Bidwell, L., Willcutt, E., McQueen, M., DeFries, J., Olson, R., Smith, S., Pennington, B. (2011). A family-based association study of DRD4, DAT1, and 5HTT and continuous traits of Attention-Deficit Hyperactivity Disorder. Behavior Genetics, 41(1): 165-174.

Depue, B., Burgess, G., Willcutt, E., Bidwell, L., Ruzic, L., Banich, M. (2010). Symptom-correlated brain regions in young adults with combined-type ADHD: Their organization, variability, and relation to behavioral performance. Psychiatry Research: Neuroimaging Section, vol. 182 Issue 2, 96-97.

Durston, S., Hulshoff, P., Schnack, H., Buitelaar, J., Steenhuis, M., Minderaa, R. et al., (2004). Magnetic resonance imaging of boys with attention deficit disorder and their unaffected siblings. Journal of the American Academy of Child and Adolescent Psychiatry. 43(3): 332-340.

Swanson, J., Floodman, P., Kennedy, J., Spence, M., Moyzis, R., Schuck, S. (2000). Dopamine genes and ADHD. Neuroscience and Biobehavioral Reviews, 24.

Tripp, G., Wickens, J. (2010). Neurobiology of ADHD. Neuropharmacology, v. 57 issue 7/8, p. 579-589.

Volkow, N., Wang, G., Fowler, J., Logan, J., Franceschi, D., & Maynard, L. (2002).Relationship between blockade of dopamine transporters by oral methylphenidate and the increases in extracellular dopamine: Therapeutic implications. Synapse, 43: 181-187.

Williams, N., Zaharieva, I., Martin, A., Langley, K., Mantripragada, K., Fossdal, R.,Stefansson, H., Stefansson, K., Magnusson, P., Gudmundsson, O., Gustafsson, O., Holmans, P., Owen, M., O’Donovan, M., Thapar, A. (2010). Rare chromosomal deletions and duplications in attention-deficit hyperactivity disorder: a genome-wide analysis. Lancet, 2010; DOI: 10.1016/S0140-6736(10)61109-9.

Yang, M., Ishii, J., McCracken, J., McGough, J., Loo, S., Nelson, S., Smalley, S.(2005). Temperament and character profiles and the dopamine D4 receptor gene in ADHD. American Journal of Psychiatry, v. 162, issue 5, 2005, 906-914.

Potomac Pathways drug tests now include "spice" (synthetic cannabinoids).

For more info about spice, synthetic cannabinoids, click here.

Info from our lab, NMS Labs:

Synthetic Cannabinoid Metabolites (Qualitative), Urine Test (4280U)

Analysis Code	4280U
Test Name	Synthetic Cannabinoid Metabolites (Qualitative), Urine
Test Includes	JWH-018 Hydroxy-metabolites [LC-MS/MS], JWH-073 Hydroxy-metabolites [LC-MS/MS]
Compound Synonym(s)	K2 Space Spice Spike Synthetic Cannabinoids Yucatan Fire
Purpose	Exposure Monitoring/Abuse Monitoring
Category	Synthetic Cannabinoid
Method(s)	High Performance Liquid Chromatography/Tandem Mass Spectrometry (LC-MS/MS)

13 Myths about Substance Abuse Treatment

Myth #1: Drug addiction is voluntary behavior.
A person starts out as an occasional drug user, and that is a voluntary decision. But as times passes, something happens, and that person goes from being a voluntary drug user to being a compulsive drug user. Why? Because over time, continued use of addictive drugs changes your brain -- at times in dramatic, toxic ways, at others in more subtle ways, but virtually always in ways that result in compulsive and even uncontrollable drug use.

Myth #2: More than anything else, drug addiction is a character flaw.
Drug addiction is a brain disease. Every type of drug of abuse has its own individual mechanism for changing how the brain functions. But regardless of which drug a person is addicted to, many of the effects it has on the brain are similar: they range from changes in the molecules and cells that make up the brain, to mood changes, to changes in memory processes and in such motor skills as walking and talking. And these changes have a huge influence on all aspects of a person's behavior. The drug becomes the single most powerful motivator in a drug abuser's existence. He or she will do almost anything for the drug. This comes about because drug use has changed the individual's brain and its functioning in critical ways.

Myth #3: You have to want drug treatment for it to be effective.
Virtually no one wants drug treatment. Two of the primary reasons people seek drug treatment are because the court ordered them to do so, or because loved ones urged them to seek treatment. Many scientific studies have shown convincingly that those who enter drug treatment programs in which they face "high pressure" to confront and attempt to surmount their addiction do comparatively better in treatment, regardless of the reason they sought treatment in the first place.

Myth #4: Treatment for drug addiction should be a one-shot deal.
Like many other illnesses, drug addiction typically is a chronic disorder. To be sure, some people can quit drug use "cold turkey," or they can quit after receiving treatment just one time at a rehabilitation facility. But most of those who abuse drugs require longer-term treatment and, in many instances, repeated treatments.

Myth #5: We should strive to find a "magic bullet" to treat all forms of drug abuse.
There is no "one size fits all" form of drug treatment, much less a magic bullet that suddenly will cure addiction. Different people have different drug abuse-related problems. And they respond very differently to similar forms of treatment, even when they're abusing the same drug. As a result, drug addicts need an array of treatments and services tailored to address their unique needs.

Myth #6: People don't need treatment. They can stop using drugs if they really want to.
FACT: It is extremely difficult for people addicted to drugs to achieve and maintain long-term abstinence. Research shows long-term drug use actually changes a person's brain function, causing them to crave the drug even more, making it increasingly difficult for the person to quit. Especially for adolescents, intervening and stopping substance abuse early is important, as children become addicted to drugs much faster than adults and risk greater physical, mental and psychological harm from illicit drug use.

MYTH #7: Treatment just doesn't work.
FACT: Treatment can help people. Studies show drug treatment reduces drug use by 40 to 60 percent and can significantly decrease criminal activity during and after treatment. There is also evidence that drug addiction treatment reduces the risk of HIV infection (intravenous -drug users who enter and stay in treatment are up to six times less likely to become infected with HIV than other users) and improves the prospects for employment, with gains of up to 40 percent after treatment.

MYTH #8: Nobody will voluntarily seek treatment until they hit ‘rock bottom.’
FACT: There are many things that can motivate a person to enter and complete substance abuse treatment before they hit "rock bottom." Pressure from family members and employers, as well as personal recognition that they have a problem, can be powerful motivating factors for individuals to seek treatment. For teens, parents and school administrators are often driving forces in getting them into treatment once problems at home or in school develop but before situations become dire. Seventeen percent of adolescents entering treatment in 1999 were self- or individual referrals, while 11 percent were referred through schools.

MYTH #9: You can't force someone into treatment.
FACT: Treatment does not have to be voluntary. People coerced into treatment by the legal system can be just as successful as those who enter treatment voluntarily. Sometimes they do better, as they are more likely to remain in treatment longer and to complete the program. In 1999, over half of adolescents admitted into treatment were directed to do so by the criminal justice system.

MYTH #10: There should be a standard treatment program for everyone.
FACT: One treatment method is not necessarily appropriate for everyone. The best programs develop an individual treatment plan based on a thorough assessment of the individual's problems. These plans may combine a variety of methods tailored to address each person's specific needs and may include behavioral therapy (such as counseling, cognitive therapy or psychotherapy), medications, or a combination. Referrals to other medical, psychological and social services may also be crucial components of treatment for many people. Furthermore, treatment for teens varies depending on the child's age, maturity and family/peer environment, and relies more heavily than adult treatment on family involvement during the recovery process. "[They] must be approached differently than adults because of their unique developmental issues, differences in their values and belief systems, and environmental considerations (e.g., strong peer influences)."

MYTH #11: If you've tried one doctor or treatment program, you've tried them all.
FACT: Not every doctor or program may be the right fit for someone seeking treatment. For many, finding an approach that is personally effective for treating their addiction can mean trying out several different doctors and/or treatment centers before a perfect "match" is found between patient and program.

MYTH #12: People can successfully finish drug abuse treatment in a couple of weeks if they're truly motivated.
FACT: Research indicates a minimum of 90 days of treatment for residential and outpatient drug-free programs, and 21 days for short-term inpatient programs to have an effect. To maintain the treatment effect, follow up supervision and support are essential. In all recovery programs the best predictor of success is the length of treatment. Patients who remain at least a year are more than twice as likely to remain drug free, and a recent study showed adolescents who met or exceeded the minimum treatment time were over one and a half times more likely to abstain from drug and alcohol use. However, completing a treatment program is merely the first step in the struggle for recovery that can extend throughout a person's entire lifetime.

MYTH #13: People who continue to abuse drugs after treatment are hopeless.
FACT: Drug addiction is a chronic disorder; occasional relapse does not mean failure. Psychological stress from work or family problems, social cues (i.e. meeting individuals from one's drug-using past), or their environment (i.e. encountering streets, objects, or even smells associated with drug use) can easily trigger a relapse. Addicts are most vulnerable to drug use during the few months immediately following their release from treatment. Children are especially at risk for relapse when forced to return to family and environmental situations that initially led them to abuse substances. Recovery is a long process and frequently requires multiple treatment attempts before complete and consistent sobriety can be achieved.

Study: Marijuana use potential trigger for psychosis

2/9/11

The Archives of General Psychiatry has published a study (full text available here) that provides additional evidence for a relationship between cannabis use and earlier onset of psychotic illness.

Conducted by Matthew Large, BSc (Med), MBBS, FRANZCP, Swapnil Sharma, MBBS, FRANZCP, Michael T. Compton, MD, MPH, Tim Slade, PhD, and Olav Nielssen, MBBS, MCrim, FRANZCP, the study supports the hypothesis that cannabis use plays a causal role in the development of psychosis in some patients and suggests the need for renewed warnings about the potentially harmful effects of cannabis.

The results found that the age at onset of psychosis for cannabis users was almost three years younger than for non-users. For those with broadly defined substance use, the age at onset of psychosis was two years younger than for non-users.

Differences in the proportion of cannabis users in the substance-using group made a significant contribution to the heterogeneity in the effect sizes between studies, which researchers believe confirms an association between cannabis use and earlier mean age at onset of psychotic illness.

Alcohol use was not associated with a significantly earlier age at onset of psychosis.

Spice-- the marijuana alternative

The growing buzz on 'spice' -- the marijuana alternative

By Michael W. Savage
Washington Post Staff Writer
Saturday, July 10, 2010; A01

In the small backroom of Capitol Hemp, a head shop in Adams Morgan, a worker dutifully arranges an array of ceramic pipes displayed in a well-lit glass case. Another clerk helps a couple of customers as they peruse a selection of bongs and vaporizers.

Stored behind the counter is another amply stocked product whose popularity is booming: "spice," the generic name for a legal "synthetic marijuana." Capitol Hemp owner Adam Eidinger said that in the 18 months since he began stocking spice, demand has doubled each month, and its sales now represent a third of his revenue. On some Fridays, he said, his two District stores can bring in $10,000 from the sale of spice alone.

In the District and most states across the country, it is legal to buy and sell spice, whose crushed green leaves are sprayed with various man-made chemicals. When smoked, the treated leaves can produce a marijuana-like high.

But alarmed by its growing use and questions about its safety, lawmakers in a number of states have begun taking action.

Last week, Missouri Gov. Jay Nixon (D) became the latest to sign a state ban. In March, Kansas was the first state to outlaw the product, followed by Kentucky, Alabama, Tennessee and Georgia. Lawmakers in other states, including Iowa, Michigan, Illinois and Louisiana, are working on bans. Similar legislation has not come up in Virginia, Maryland or the District.

Gil Kerlikowske, President Obama's drug czar, said in an interview that the substance is "on our radar" but added that he thought state legislatures are dealing well with the issue.

But others decry what they see as a knee-jerk reaction from lawmakers, making the synthetic marijuana product the latest substance at the center of an ongoing debate about the merits of prohibition.

"We have never had any complaints or concerns from customers," Eidinger said. He added that he began stocking spice products after several requests from customers. "We always ask the manufacturers if there is anything illegal in the products. We only use the products we trust, and if it is made illegal in D.C., we will stop selling it."

At his shop, customers show ID to prove that they are 18 or older, then enter a room where they can study a sheet of paper listing the available brands of spice. For $55, they can buy three grams of K2 Summit, packaged in shiny foil. Those wanting a fruity option can go for Pep Pourri at $22.50 a gram.

Scott Rupp, a Missouri state senator, said he backed the ban for good reason. "We were getting reports from local law enforcement that this was exploding among the youth population," the Republican said. "We were getting reports of kids hurting themselves and showing up in the emergency room as they were sick from it."

The fact that spice cannot be detected by drug screening has also made it popular with other groups, including parolees, according to drug experts. Eidinger said many of his customers are in the armed forces. "They sometimes buy a $400 batch before going on tour," he said.

A lack of data and controlled testing make it difficult to determine the drug's safety. And there are no official estimates of its growing use. But there has been a significant bump in calls to poison centers concerning spice. Nationwide, the American Association of Poison Control Centers logged 567 cases across 41 states in which people had suffered a bad reaction to spice during the first half of 2010. Just 13 cases were reported in 2009.

In the Washington area, where several stores stock spice, the National Capital Poison Center has received six to eight reports from people who had taken the legal drug since the beginning of the year, said Cathleen Clancy, a doctor at the center.

Manufacturing questions

Drug Enforcement Administration officials say spice products are manufactured both in the United States and in foreign countries, but little is known about how the products are made or who makes them. Wholesaler Web sites are secretive about where they obtain the product, and wholesalers themselves did not return calls seeking comment.

The packages containing spice state that it is to be used as incense and not meant for human consumption or to be smoked, a point reiterated by many who sell it. "Smoke inhalation may cause light-headedness and be harmful to your health," reads one package of K2.

On Internet forums, users have reported a range of experiences after smoking spice -- from feeling little to feeling the same kind of euphoria, increased heart rate or paranoia that marijuana can trigger. Some have reported more extreme reactions, such as hallucinations.

According to police reports cited in news accounts, one person in Texas suffered seizures after smoking two types of spice together. In Iowa, an 18-year-old suffered a panic attack and committed suicide after smoking spice with friends last month, police said.

"We're getting extreme anxiety in many patients, agitation, heightened heart rate and blood pressure," said Anthony Scalzo, medical director of the Missouri Poison Center. "I've done emergency medicine for 28 years and toxicology for 22, and I don't see that kind of effect generally from a patient who comes in having taken marijuana."

The DEA has begun to test the products, but it is difficult because several substances are being used to create spice.

Marilyn Huestis, chief of chemistry and drug metabolism at the National Institute on Drug Abuse, said the chemicals had been developed by several university medical researchers to study the part of the brain responsible for hunger, memory and temperature control. The compounds, known as synthetic cannabinoids, mimic the effects of tetrahydrocannabinol (THC), the ingredient in cannabis that gives users a high. They were not, however, designed for human consumption.

"These different, synthetic compounds are up to 100 times more potent than THC and have not been tested on humans," she said. "When people take it, they don't know how much they're taking or what it is they're taking."

Internet-fueled sales

DEA Special Agent Gary Boggs said the chemicals can be purchased in pure form on the Internet, which has helped them spread across the country. "We think there is potential for long-term, adverse effects on the brain, the lungs and the heart," he said.

Others are skeptical of the dangers. Peter Rugg, a writer for the Pitch, a Kansas City weekly newspaper, gathered with a group of volunteers last year to test the drug. One regular pot smoker said it was similar to weak marijuana, according to Rugg. An occasional cannabis user became nauseated. When Rugg smoked it, he said, it reproduced the effects of marijuana for a short time.

"I do think the reaction from some states has been a bit hysterical, but it seems to be the sort of thing we should really study for a little bit before we decide it is dangerous," Rugg said in an interview. "I smoked it a couple of times from different batches, and there was never a moment where I thought I was going to hallucinate or go and do anything crazy."

Lawmakers ought to take up more pressing concerns, he said. "Kansas and Missouri both have huge budget shortfalls but, despite everything on their plates, this became the number-one priority," he said. "To me, it was such a silly thing to get so riled up about."

Eidinger, who is also known locally as an advocate for D.C. statehood, said banning spice would simply push it underground. He also said that laws criminalizing cannabis have driven people to use the murky alternative.

Scalzo, whose Missouri poison center has received 60 calls this year from people who have used spice, urged caution.

"I'm concerned we don't know what's in there, or the quantities that are in there," he said. "Some people may argue you shouldn't ban something when you don't know what's in it. But when the public health is of concern, I think it's right to act."

Staff writer Aaron C. Davis contributed to this report.

Clinical information for parents and professionals: evidence-based rationale for Potomac Pathways programs

Brooke Brody, LCSW-C, LCADC

There are a variety of factors related to adolescent treatment that suggest the need for the Potomac Pathways approach to adolescent treatment:

• Friends: Many teens relapse because they lack a group of friends who are clean and sober (Winters, K. C. et al, 2009).Potomac Pathways provides a place to go to meet with peers-in-recovery and take part in a range of clean and sober, supportive activities in a welcoming environment, with both structured and unstructured (but supervised) settings.

• Peer mentors: Potomac Pathways’ peer mentors are young adults or teens who have successfully completed a year or more of recovery. The peer mentors attend all the groups and activities and counteract the effect of the “deviant peer contagion effect” (Dembo, R. & Muck, R. D., 2009) that often occurs in conventional treatment groups, whereby more dominant anti-social youths have a negative influence on their peers. The peer mentors are positive kids that model for their peers the idea that “recovery is more ‘cool’ than drug-using and anti-social behavior.”

• “Cool”: Conventional drug treatment is not “cool.” Potomac Pathways has a distinct “cool factor” which is attractive to adolescent clients. For example, the program eliminates concrete block walls and fluorescent lights in favor of natural environmental elements and comfortable furniture. The program incorporates experiential elements like drumming, yoga, meditation, outdoor adventure activities, music, technology and more. Plus, the therapy uses and teaches a strengths-based, solution-focused approach which the clients experience as warm, supportive, and empowering, rather than primarily a lecture format. Potomac Pathways has identified many of these elements as important for increasing client retention and improving positive outcomes for the “subpopulations of youth” which we serve (Dembo, R. and Muck, R. D., 2009).

• Homework: Most outpatient programs focus exclusively on substance use and ignore some of the other irritating factors in the teen’s life that contribute to the problem situation. Sobriety is only one part of an overall recovery program, which includes addressing problems in school, in the family, and for the individual (Brannigan et al, 2004). Many of our clients struggle with learning differences or ADHD, poor grades, poor school attendance, and need support for homework completion. Potomac Pathways currently provides an ADHD support group for teens and is expanding to be able to do more to give support to teens after school. In this supportive environment, students are able to learn positive skills that can contribute to their success in school.

• Outdoors: Outdoor programming has been shown to increase teens’ motivation in treatment (Russell, K., 2005). Potomac Pathways provides a host of outdoor adventure activities for clients in recovery, including: high- and low- ropes course activities, caving, canoeing, kayaking, Native American ceremony on Adventure Island, climbing wall, hiking, skiing/snowboarding, horseback riding. The events include therapeutic work around processing the recovery metaphors that the clients get out of the activities. The events help teens discover the fun in sobriety. And it occasionally happens that a client decides to develop a career in outdoor adventure programming because of these events!

Enhanced effectivness of Potomac Pathways programs

Potomac Pathways programs exemplify these “key elements in effective adolescent substance abuse treatment” (Branningan, R. et al., 2004):

• Assessment and Treatment Matching: Program conducts comprehensive assessments that cover psychiatric, psychological, and medical problems, learning differences, family functioning, and other aspects of the adolescent’s life.

• Comprehensive, Integrated Treatment Approach: Program services address major aspects of the adolescent’s life including substance abuse, learning differences, family relationships, co-occurring depression, anxiety and other mental health issues.

• Family Involvement in Treatment: Research shows that involving parents in the adolescent’s drug treatment produces better outcomes. Programs includes a high level of family involvement.

• Developmentally Appropriate Programs: Activities and materials reflect the developmental differences between adults and adolescents.

• Engaging and Retaining Teens in Treatment: A strong therapeutic alliance is required for engaging and retaining teens (Winters et al., 2009; Diamond et al., 2006). Treatment program builds a climate of trust between the adolescent and the therapist, and between peers.

• Qualified Staff: Staff members are trained in adolescent development, co-occurring mental disorders, substance abuse, and addiction.

• Gender and Cultural Competence: Program addresses the distinct needs of adolescent boys and girls as well as cultural differences among minorities.

• Continuing Care: Program includes relapse prevention program, aftercare planning, referrals to community resources, and follow-up.


Clinical Treatment Model

Most adolescent substance abuse treatment models, including those primarily based on 12-step treatment, are essentially integrated models that utilize elements of several therapeutic program elements (Winters, K. et al., 2009; Hall, J. et al., 2008). Potomac Pathways programs contains elements of the following therapeutic models or approaches to treatment:

• Motivational Enhancement Therapy
Counselors are trained in a motivational enhancement approach in order to meet the clients where they are at, help to bring them to the next level of motivation, and help to reduce the sense of being forced into treatment (Miller, W. & Rollnik, S., 1991).

• Solution-focused approach
The program uses the strengths-based approach of “solution-focused therapy” in order to boost self-esteem, encourage positive interactions between peers in the treatment groups (deShazer, S.,1988).

• Experiential Education
The program uses elements throughout the groups that can appeal to teens with a kinesthetic learning style. Drumming, meditation, yoga, and a variety of props—help break up the monotony of therapy groups and keep clients more engaged.

• Strengths-Oriented Family Therapy
The program offers a series of multifamily and conjoint family sessions that are based on the “manualized” strengths-oriented family therapy (SOFT) treatment model. “SOFT” family therapy includes “a heavy emphasis on solution-focused language, a formal strengths assessment, a pre-treatment motivational session,” as well as a skills-training curriculum (Hall, J. et al., 2008)

• Relapse Prevention Therapy
The program utilizes certain curriculum materials from Terence Gorski, MA based on a cognitive therapy approach to treatment and relapse prevention.

• Spiritual Counseling (Richards, P. & Bergin, A. (eds.), 2004).
Potomac Pathways does not shy away from promoting values such as honesty, integrity, compassion, and love. Many teens have adopted unsavory values, and benefit from hearing about the positive values of their peers who are further along the recovery path. Positive values, such as those enumerated in “The Four Agreements” or in Native American cultures, form the foundation of the Potomac Pathways treatment environment.


References

Barkley, R. (2008). Advances in ADHD: theory, diagnosis, and management (recorded seminar). Lancaster, PA: J & K Seminars.

Brannigan, R., Schackman, B., Falco, M., Millman, R. (2004). The quality of highly regarded adolescent substance abuse treatment programs: results of an in-depth national survey. Archives of Pediatric and Adolescent Medicine, 158, 904-909.

Dembo, R. & Muck, R. D. (2009). Adolescent outpatient treatment. In Leukefeld et al. (Eds.), Adolescent substance abuse: evidence-based approaches to prevention and treatment, New York, NY: Springer.
deShazer, S. (1988). Clues: investigating solutions in brief therapy. New York: Norton.

Diamond, G. S., Godley, S., Liddle, H., Sampl, S., Webb, C., Tims, F. at al. (2002). Five outpatient treatment models for adolescent marijuana use: a description of the Cannabis Youth Treatment Interventions. Addiction, 97, S70-S83.

Hall, J., Smith, D., & Williams, J. (2008). Strengths-oriented family therapy (SOFT): A manual guided treatment for substance-involved teens and families. In LeCroy, C (ed.), Handbook of Evidence-based treatment manuals for children and adolescents, New York, NY: Oxford University Press.

Miller, W. & Rollnik, S. (1991). Motivational interviewing: preparing people to change addictive behavior. New York: Guilford.

Richards, P. & Bergin, A. (2004). A spiritual strategy in counseling and psychotherapy, Washington, DC: American Psychological Association.

Russell, K., 2005. Preliminary results of a study examining the effects of outdoor behavioral healthcare treatment on levels of depression and substance use frequency. Journal of Experiential Education, 27 (3), 305-307.

Stevens, S. & Morral, A., (eds.) (2003). Adolescent substance abuse treatment in the United States: exemplary models from a national evaluation study. New York, NY: Haworth.

Winters, K., Botzet, A., Fahnhorst, T., Stinchfield, R., & Koskey, R (2009). Adolescent substance abuse treatment: a review of evidence-based research. In Leukefeld et al. (Eds.), Adolescent substance abuse: evidence-based approaches to prevention and treatment, New York, NY: Springer.