Adolescent Treatment: Advancing as a Specialty

In 2004, 19.1 million Americans, or 7.9% of the population 12 or older, were current illicit drug users.1 The report from which these numbers are derived goes on to suggest that 21.1 million people who needed treatment for their drug use did not receive treatment. These statistics have been consistent since about 2002 and have led some researchers to suggest that roughly 10% of the adolescent population could transition from experimental use of substances to more frequent use or abuse, or both.2,3,

In response to the data, there has been a growing call for more research around adolescent substance use. Ahmed and colleagues suggest that when working with adolescents it is essential to understand the conflicts existing in their world that affect the issue of substance use; these researchers call for a set of developmentally appropriate criteria when considering adolescent assessment versus adult assessment of substance use disorders.4 Lowman likewise suggests that treatment should include developmentally appropriate interventions for adolescents, as opposed to simply taking existing treatment interventions and “modifying” them for an adolescent.5

Substantial research in recent years has encouraged the use of developmental psychology as a basis for treating adolescents with a substance use diagnosis.6,7,8,9,10 Given not only the call for additional cooperation between researchers and practitioners, but also hearing what clients in treatment are clearly reporting they need for effective treatment,11,12,13,14,10 all of this, served as a basis for convening a group of individuals that would be known as the Adolescent Specialty Committee of NAADAC, The Association for Addiction Professionals.

Association for a vital purpose

The NAADAC Adolescent Specialty Committee began in the spring of 2004. From the start this has been a collaborative work in NAADAC by those holding the view that adolescents in treatment should have sufficient clinical care that is easy to access and uniquely tailored to their needs. The ASC mission statement was written out of this vision: “To advocate for effective clinical services addressing prevention and treatment for adolescent substance use disorders.” Working within NAADAC, the committee does this through:

• Promoting public and professional understanding of the impact of adolescent substance use disorders upon families, schools, juvenile justice, peer influences, and the overall health and emotional wellness of the adolescent;

• Advocating for adequate substance abuse prevention, education, and intervention services;

• Supporting best practice clinical efforts by NAADAC treatment professionals; and

• Encouraging acceptance of the clinical uniqueness of today's adolescents and their families.

Building on their initial momentum, several committee members met with the editor of Addiction Professional at the 2004 NAADAC conference. The ensuing conversation resulted in an ongoing column about adolescents and their treatment, with the first column (published in the magazine's May 2005 issue) addressing Motivational Interviewing with adolescents. To maintain communication among ASC members across the United States, a Yahoo! group e-mail exchange has been regularly utilized to examine ongoing issues related to adolescent treatment.

The committee's vital purpose expanded through collaborative work with NAADAC staff and NAADAC's National Certification Commission on a mutual interest in recognizing clinicians who have worked in depth with adolescents. ASC leadership teamed up with the National Certification Commission on developing a formal endorsement—an acknowledgement of addiction counselors and mental health practitioners who have demonstrated a fine measure of clinical capability in working with adolescents in substance abuse treatment.

Steady efforts to pursue a clinically focused list of questions for an endorsement test ensued; this also involved some collaboration with the federal Center for Substance Abuse Treatment (CSAT) on the test bibliography. Last April, a NAADAC poster presentation about the “Adolescent Specialist Endorsement” took place at the federally sponsored Joint Meeting on Adolescent Treatment Effectiveness in Washington, D.C. After this, ASC leadership met with NAADAC, National Certification Commission staff, and Sallyann Henry, PhD, President of Professional Testing Corporation (https://www.ptcny.com), for a thorough review of each test question. Professionals with a current alcohol and other drug credential or license, as well as experience in working with the adolescent population, now may pursue the Adolescent Specialist Endorsement, which is being overseen by the National Certification Commission.

Adolescent treatment's future

It is important to note that the impetus for developing the Adolescent Specialist Endorsement came from a “call from the field.” Service providers and representatives from private and public agencies have collectively advocated the establishment of higher standards for educational preparation to work with adolescents, as well as for provider clinical competence. In itself, working out an endorsement represents one move toward setting up a more usable knowledge base in adolescent treatment work. We see the endorsement as an initial descriptive springboard for establishment of the clinical standards needed for adolescent substance abuse treatment counselors. As such, it is a first step in the further development of professional norms for this clinical practice.

We also see the endorsement as helping to jump-start the rest of the substance use disorder treatment profession as a grassroots provider initiative. At the core, better care is needed for our adolescents, and we hope that state and local governments will see the necessity to ensure that the best treatment options and most capable clinicians are in place for youths.

In order to continue to achieve productive change, providers need support and opportunity to bring about improvement in clinical delivery. With the development of a stronger support network for adolescent treatment counselors, the profession can rightly expect NAADAC and other training bodies to devote a portion of their educational offerings to adolescent topics. In turn, families and clients can expect more expertise for adolescent treatment issues. Those who are passionate about working with adolescents and their families look to a future that includes both competence-based standards for addiction professionals and competence-based supervision; this will create an ongoing learning community of care.

The benefits of continuing attention to clinical standards for adolescent treatment are clear. First, this helps place a focus on crucial issues needing considerably more attention: co-occurring disorders; adolescent social development; research in adolescent neurology and its impact on behavior; networking among treatment specialists with input about prevention and clinical intervention; and further initiatives in using evidence-based practices rather than treatment as usual. Next, consider the gains from efforts in these areas: adolescent practitioners who are better equipped to address changing trends in substance use; increased public understanding of adolescent substance use disorders and their effects; and a treatment system that has more impact. n

References

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