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.
