Enthusiastic sobriety shapes addictions treatment for adolescents

In recovery from a heroin addiction as a 27-year-old in the early 1970s, Bob Meehan was inspired to stay sober by encouraging teenagers to hang out with a church group instead of using drugs.

His idea — “enthusiastic sobriety” — was to simply show his peers who wanted to rebel by taking drugs and push the boundaries of addiction that sobriety could be fun.

In his treatment approach, Meehan encouraged rehabilitation on three levels that substance use disorder affects: physical, emotional and spiritual.

Adolescents are one of the hardest groups to treat for substance abuse problems because first, they don’t see a problem with the decisions they make to use drugs, Meehan says. Second, teenagers aren’t interested in talk therapy and those with addiction tend to be self-centered, he adds.

Enthusiastic sobriety teaches individuals in recovery to be others-centered instead. This means bonding with a community of recovering teenagers and giving back through volunteer work as well as encouraging peers. This lines up with the original idea behind Alcoholics Anonymous, in which those in recovery from alcohol addiction stay sober by helping others. They can’t do it alone. Only, Meehan’s idea focused on adolescents and discouraged group treatment with adults at all. Even the counselors conducting one-on-one treatment are younger, with many having graduated recovery programs a few years earlier.

Part of the giving back idea comes into play when graduates train to become counselors, though this isn’t required.

Enthusiastic sobriety wasn’t originally based in psychotherapy of any form. It evolved organically and through trial and error into a modified 12-Step approach.

Recovery programs in Arizona, Missouri, Colorado, North Carolina and Georgia teach people aged 13 to 25 that they need more than a role model.

Adolescents need an outlet to push limits and rebel, while learning how to cope with stress and manage anxiety.

Qualified staff counselors work with positive adolescent peer groups and family support systems during and after treatment to achieve success. Weekend activities encourage continued abstinence and peer support, while a weekly parents’ meeting helps the adults in charge guide their adolescents without being overly controlling.

It takes one to know one

Most young substance users are not seeking help; a loved one is bringing them in for evaluation, says Steve Winkelmann, CAC, CADC, CSAC, the program director of the Charlotte, N.C., Insight Program. This makes treatment an obstacle for young chemical users whereas older adults who have suffered the consequences of addiction are much more willing to change.

Winkelmann, who struggled with addiction and recovered at age 16, says teens starting down the path toward addiction need an immediate payoff that replaces that which they get with drugs and alcohol.

“There has to be a draw,” Winklemann said. “There has to be a carrot.”

For a recovery program to reach those who are experimenting with mind-altering chemicals, it must be high intensity, says Steven L. Jaffe, MD, clinical director of Atlanta’s Insight Program.

“But it has to follow laws and earn parents’ trust,” Jaffe adds. “This is life and death. We never lose sight of that.”

The program director in the Atlanta program, Matt Meyer, relates to the teenagers starting treatment because he, too, struggled with an addictive personality at a young age.

Meyer explains that when he started drinking alcohol and smoking marijuana at age 15, he felt like his parents were interrupting him mid-party.

“Being an angry, young addict that I was at the time, I didn’t feel like I related to them. It was a conspiracy,” Meyer says. “They were on my parents’ payroll, and I didn’t listen to anything they said to me.”

Enthusiastic sobriety first establishes trust with adolescents by showing them that they are among peers and counselors who know specifically what dealing with an addiction means for people in this age group.

For a 15-year-old, an “unmanageable” life as referenced in Step 1 would mean failing math, getting grounded or getting arrested for underage drinking at a party. It’s much different than the experience of a 40-year-old who loses a job, family and residence after 20 years of drug and alcohol abuse.

So the first step in the enthusiastic approach is tweaked slightly, Meyer says, to admit that mind-changing chemicals have caused at least part of the adolescent’s life to become unmanageable because the reality is that no 15-year-old is in charge of his or her life. Even after age 18, adolescents must yield to parents much more than older adults would.

That 15-year-old who consumes alcohol with friends a few times might never develop a full-blown alcohol addiction, but the diathesis-stress model of behavior tells therapists that once a teenager starts drinking, any predisposition toward addiction could rear its head.

“We know there’s a genetic predisposition,” Jaffe said. “If mom and dad are addicts or alcoholics, the chance is 50% or higher their kids would get addicted if they tried (drugs or alcohol).”

The push for parental involvement also differentiates the treatment approach in enthusiastic sobriety. Jaffe says 70% of children with involved parents enrolled complete the 8-to-12-week enthusiastic sobriety program.

Weekly parents meetings teach similar techniques for validating those in recovery and helping them cope with stress without taking control. Parents are taught to guide their children and act as support.

Adolescents and decision-making

Early substance use weakens the prefrontal cortex, which is the part of the brain responsible for decision-making, impulse control and personality, Jaffe says.

Using cognitive behavioral therapy techniques, adolescents learn to deal with sadness and anxiety instead of using drugs to dull emotional pain, which deteriorates the brain’s ability to function properly.

The enthusiastic sobriety approach helps young people in recovery from substance use disorder recognize triggers for relapse and uses motivational enhancement therapy to encourage teens to look at their lives and assess the effects of drugs.

Step 2 in the modified enthusiastic sobriety approach reminds adolescents to “stick with winners” and carefully choose the company they keep. This is an added step to the traditional 12 Steps.

The idea of community is crucial in most recovery programs, and enthusiastic sobriety teaches that if a young person continues to associate with those with substance use disorders, chances of recovery are slim.

Knowing the boundaries

The doctors overseeing recovery programs that use the enthusiastic sobriety approach are cautious when it comes to those with dual diagnoses. Up to 80% of adolescents in recovery have a diagnosis of bipolar disorder, depression or ADHD that requires treatment with medication, Jaffe says.

“Most of the kids, I’m able to take off their antipsychotics and medications, though,” Jaffe says.

Counselors strive to convince adolescents who love getting high that there’s something better than a buzz or avoiding emotional pain. The enthusiastic approach allows teenagers to be themselves, have fun with a peer group and establish self-worth, confidence and integrity.

Supporters of the enthusiastic sobriety approach believe adolescents will attach to the program and connect with peers, while learning to detach safely from parents and find their place in healthy society.

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A modified version of the 12 Steps, courtesy "Beyond the Yellow Brick Road" by Bob Meehan:

1. We admitted that mind-changing chemicals have caused at least part of our lives to become unmanageable.
2. We have found it necessary to “stick with winners” in order to grow.
3. We realized that a Higher Power, expressed through our love for each other, could help restore us to sanity.
4. We made a decision to turn our will and our lives over to the care of God, as we understand Him.
5. We made a searching and fearless moral inventory of ourselves.
6. We admit to God, to ourselves, and to another human being the exact nature of our wrongs.
7. We became willing to allow our Higher Power, through the love of the group, to help change our way of thinking and humbly ask Him to help us change.
8. We made a list of all persons we have harmed and became willing to make amends to them all.
9. We made direct amends to such people, whenever possible, except when to do so would injure them, others, or ourselves.
10. We have continued to look at ourselves and when wrong, promptly admitted it.
11. We have sought through prayer and meditation to improve our conscious contact with out Higher Power, that we have chosen to call God, praying only for knowledge of His will for us and the courage to carry that out.
12. We, having had a spiritual awakening as a result of these steps, tried to carry our love and understanding to others, and to practice these principles in our daily lives.

Ellen Eldridge is a freelance writer based in Georgia.