Evidence-Based Approaches to Adolescent Substance Use Disorders

Though as school psychologists and teachers, we will likely not be undergoing a large amount of actual treatment for substance abuse disorders, it is important to know what the evidence-based treatments and interventions are.

The National Quality Forum published a document (link below) called “Evidence Based Treatment Practices for Substance Use Disorders” outlining recommended practices, background, and much more, which may serve as a starting point for research on the topic.

http://www.apa.org/divisions/div50/doc/Evidence_-_Based_Treatment_Practices_for_Substance_Use_Disorders.pdf 

This document recommends that treatment for SUDs is part of a continuum of services that includes screening and assessment, active treatment, and continued engagement as part of a long-term plan

Important recommendations included in this document include:

  • Screening: whenever there is an opportunity
  • Initial Brief Intervention: and then referral as needed
  • Treatment Plans: written recommendations for further care and the quantity/time/etc of the service
  • Psychosocial interventions: motivational interviewing, motivational enhancement therapy, CBT, structured family/couples therapy, contingency management, community reinforcement therapy, and/or 12 step facilitation therapy
  • Pharmacotherapy: in addition to psychosocial, if needed for withdrawal/detox
  • Patient Engagement and Retention: both of which are crucial
  • Recovery/Post-care: on-going follow-up and management is also crucial

An “Initial Brief Intervention” may be the extent of our role as school psychologists in many cases. This involves (p. 6):

  1. Give feedback about screening results, relating the risks of negative health effects to the patient’s presenting health concerns.
  2. Inform the patient about safe consumption limits and offer advice about change.
  3. Offer to involve family members in this process to educate them and solicit their input (consent is required).
  4. Assess the patient’s degree of readiness for change (e.g.,“How willing are you to consider reducing your use at this time?”).
  5. Negotiate goals and strategies for change.
  6. Schedule an initial follow-up appointment in two to four weeks.
  7. Monitor changes at follow-up visits by asking patient about use, health effects, and barriers to change.
  8. If the patient declines referral to specialty evaluation or treatment, continue to encourage reduction or cessation of use and reconsider referral to specialized treatment at subsequent visits.

Specific DON’Ts include:

  • Detox as a standalone
  • Acupuncture, relaxation therapy, didactic group education, or biological monitoring as a standalone treatment (and may not be very helpful at all).
  • Individual psychodynamic therapy
  • Unstructured group therapy
  • Confrontation
  • Discharge from treatment in response to a relapse

 

 

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