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  -- Losing a Battle (Jim)
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  -- Residential Treatment

How Residential Treatment Works: Clearing a New Path
By Judy Shepps Battle

"It finally happened. Joan is now in a residential treatment center for her alcohol and drug problems. It was hard to send our 14-year-old daughter away but she was so out of control. Curfew meant nothing and we started noticing things missing around the house -- small items like her brother's Walkman and my watch.

"Last weekend, she went to a friend's birthday party and passed out from acute alcohol poisoning. We were so scared that she would die. I'm not exactly sure how this treatment facility is going to help Joan, but I know her mother and I are at our wit's end."
                                                                          ~Mr. Robert J~

Adolescence -- even without alcohol and drug abuse -- is a difficult maturational passage. It is the bridge between the dependency of childhood and adult identity. It is a time of rebellion, "trying on" adult behaviors and extensive limit testing in all areas.

Unfortunately, when alcohol and drugs are involved, many youngsters are unable to handle the physical and emotional consequences. The limits that are broken -- legal and physical -- often leave a teen in dangerous situations.

Residential treatment is often the last stop for an out-of-control substance-abusing teenager. It offers a "time out" from situations that trigger self-destructive behavior, a chance to experience predictable and consistent consequences of behavior, an opportunity to participate in community, and for family bonds to be repaired. In the process, self-esteem -- the major antidote to alcohol and drug use  is increased.

How does this happen? Let's follow Joan J. through several aspects of her treatment experience.

Creating a "Time Out"
Joan's entrance into a residential facility immediately separated her from alcohol and drugs, peers using these substances and ineffective parental rules. In their place was a world that was structured, supervised, therapeutic and substance-free.

Joan was not happy with this change. She began to experience mild to moderate withdrawal symptoms and spent her first days detoxing. When this discomfort ended she was enraged at losing her freedom.

"I hate my mother and my father for putting me here. I hate myself for getting caught and not being able to handle the booze and coke. I see the other kids here kidding around with each other and hate them too."

Her parents, hearing about the daily schedule of school, community meetings, chores and therapy sessions were sure Joan would either run away or refuse to participate. But, despite her anger, Joan did not fight the new rules.

"She seems almost relieved that something bigger than her is in charge," said Mrs. J. "Maybe she is as tired of fighting as we are."

Predictable and Consistent Consequences
The heart of most residential treatment programs is the "level system." During orientation, Joan was made aware of four stages of increasing responsibility and privileges. To advance to the next level, she had to demonstrate responsibility, self-awareness, and make a positive contribution to the general community.

She began at level one -- orientation -- and had no privileges. It was easy to move to level two. All she had to do was accept a job, be on time for individual and family counseling sessions, and attend community meetings, and she could leave her unit and make phone calls.

Level three required a note from her job supervisor that she was doing well, making a positive contribution to all counseling sessions, and participating in community meetings. Rewards included weekend family passes, the right to spend money at the commissary, and a one-hour-later bedtime.

The fourth level involved taking a leadership role in the community. It meant leading an orientation session for newcomers, writing out the reasons why she came to be in residential treatment and what needed to change when she got home so that she would not need additional residential treatment. The reward was to countdown the days before she could go home and enjoy a fairly nonrestrictive time on her unit.

In order to advance to a higher level, a resident had to present his case to the entire community, staff and teens. If there were negative votes, he could not advance. Each negative vote had to be explained face-to-face to the applicant.

Like most teens, Joan would advance a level or two and then break a rule and return to level one. She was testing to see if the counselors meant what they said. Once she was finally convinced of the consistency of consequences, she advanced to the fourth level.

Joan was proud of her newly acquired leadership skills, and her parents and counselors noticed the dramatic increase in her self-esteem.

Participation in Community
Recovery from substance abuse requires that the chemical high be replaced by some other source of feeling good. In addition, the psychological pain that is medicated by alcohol and other drugs must be faced therapeutically and healed.

"I'm learning about natural highs," says Joan. "This morning we did this really neat trust exercise where we each took turns climbing a platform and falling backwards into the arms of the entire group. The first time I did it I was really scared they would drop me. But they didn't. And the second time I just shut my eyes and loved it!"

Joan also spends time daily with her counselor identifying and talking about her feelings. She is beginning to talk about how afraid she is that her parents will divorce and that no boy will ever want to date her. She loves to write in her journal and draws pictures of a little girl who used to be sad but is starting to smile.

Repairing Family Bonds
Before a youth can go home, the bonds between parent and child so severely strained during the height of teen alcohol and drug abuse need to be repaired. This is accomplished through the involvement of family members in the treatment process.

Family therapy sessions are held on a regular basis. Feelings of anger, fear, shame and love are expressed. Strategies for conflict resolution are developed. The rules of the home are stated and clear consequences for violation outlined. A reward system is developed for good behavior. Finally, a list of therapeutic resources is drawn up in case a third party is needed for mediation.

Some facilities have an evening or a day designated as Family Day. It is a time of sharing of food, watching an educational presentation and discussing how this lesson applies to the family unit. Topics may cover the nature of addiction, self-help groups, or how families resolve conflicts.

Joan's father summed it up nicely:

"I am so happy that we found help for Joan but in reality our whole family has been positively affected by her treatment. We talk to one another and are learning to listen. Both my wife and I have decided to enter individual therapy to address our own issues. If Joan can risk growing, we can, too."

Studies consistently show that treating alcohol and drug abuse in teens is a wise investment.  Not only is heavy drinking and drug use diminished but adolescents receiving treatment have fewer thoughts of suicide, lower hostility and higher self-esteem. They also report better-than-average grades.

Copyright 2006 Judy Shepps Battle


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