Reaching the 18-to-25 Demographic

At age 20, Zack dropped out of college after only one semester. He had failed each of his classes, although he had been an above-average student in high school. When Zack returned home to live with his parents, his mood was unpredictable, and he engaged in bizarre behavior. He became angry easily. He seemed depressed. He often slept all day.

When confronted by his father, Zack admitted to some drug use but offered few details. Zack later informed his father that the house phones had been bugged with a monitoring device and that the family may be in danger.

Zack's parents sought professional help and staged an intervention. With the help of a facilitator, friends, and other family members, Zack's parents confronted their son about his substance abuse, irresponsibility, and recent changes in mood and behavior. The intervention ended with a simple message: “We love you too much to sit back and watch you self-destruct.”

Twelve hours after the intervention, Zack was admitted to an inpatient treatment center with a provisional diagnosis of alcohol abuse and methamphetamine abuse, and to “rule out” substance-induced mood disorder as set out in the DSM-IV, meaning that the question of whether the mood disorder was substance-related would be determined later.

Zack is part of a population whose presence is becoming more common in treatment centers in the United States. Young adults between the ages of 18 and 25 make up approximately 21% of people receiving treatment for substance abuse in hospitals, inpatient and outpatient rehabilitation facilities, and mental health clinics.1

Special challenges

Clients such as Zack present a number of challenges for counselors. Young adults often perceive substance abuse treatment as a punishment imposed by others, not a personal choice. Many young adults generally perceive recovery values as an infringement on independence and an unwanted extension of parental authority. Young adult clients may communicate ambivalence to treatment interventions in ways that frustrate counselors and threaten other adult clients in the group counseling environment.

Since young adult clients usually depend on family members for financial support, the troubled relationships that many have with parents or relatives may generate additional challenges for counselors. Family members often will constitute an integral part of a young adult client's treatment at every stage, from the admissions process to aftercare planning. Family members may present complications to counselors by way of unrealistic expectations of the treatment process, poor boundaries with the client, or personal preferences that they wish to impose upon their child or relative.

Finally, the 12-Step model itself may present difficulties for counselors attempting to address young adult clients' needs. Traditional concepts such as “hitting bottom” need to be modified for younger clients. The usual consequences that older adults use to mea-sure the severity of their substance abuse, such as worsening physical health or the loss of a meaningful career, may not be applicable to clients ages 18 to 25. In fact, the concept of “recovery” itself may need to be modified, in that many young adult clients will not have established a measurement of health or success in life that they desire to regain or recover.

By informing counselors about current research pertaining to young adults' developmental needs, this article intends to help counselors intervene effectively on some of the more predictable problems presented by clients ages 18 to 25 with substance abuse problems.

Ambivalence and motivation for change

Professionals must present the recovery process as a method for young adults to achieve the goals they most often expect from themselves.2 At this juncture, an updated understanding of developmental needs for individuals between the ages of 18 and 25 is essential to treatment planning and problem solving.

A recent study shows that many young adults do not deeply value the traditional notions of adulthood as much as they do the notion of self-sufficiency.3 Completing an education, establishing a career, getting married, and starting a family are often ranked lower by young adults than are the desires to make decisions independently and to achieve financial independence.

Counselors can assist young adult clients in learning how to recognize substance abuse and other behavioral health disorders as barriers that, when not properly treated, prevent true self-sufficiency. This stance alone may improve counselors' likelihood of achieving a therapeutic alliance with young adult clients.

Even in alliance with counselors, however, young adults often will experience ambivalence toward the treatment process. Ambivalence, and the manner in which it is expressed, is most effectively intervened on within the context of a “readiness to change” model.4 Within such a model, a client's readiness to change may be rated on a continuum of possibilities ranging from “not ready to change” to “actively trying to change.” If young adult clients are not able to recognize behaviors such as substance abuse as undesirable and in need of change, counselors must create treatment plans based on the concept of discovery instead of recovery.

Young adults are particularly good candidates for discovery-oriented treatment interventions. Research indicates that one of the most important developmental tasks for young adults is the exploration and creation of a worldview.5 Many young adults' propensity for debating and challenging ideas should not be dismissed as merely “treatment-resistant behavior.” This readiness to engage in debate is appropriate developmentally and should be harnessed toward the task of establishing and clarifying a young adult client's strengths, needs, abilities, and preferences.6

The family system

In regard to accomplishing developmental milestones, such as completing postsecondary education, entering a romantic relationship, or achieving full-time employment, research indicates that preadult family history tends to be a greater predictor of problems in this area than substance abuse alone for adults ages 18 to 25.7 Young adults who reported having lived with an alcoholic parent, having experienced parents' divorce, or having suffered from childhood sexual abuse also demonstrated the most difficulty in achieving traditional developmental milestones, even when not abusing substances.

Since substance abuse alone does not account for all aspects of poor psychological and social development, counselors must be prepared to help young adult clients address additional issues, including past traumas and family dynamics. Many young adults who remain ambivalent about their readiness to quit using substances are not as ambivalent about other contributing factors such as past sexual abuse or parental conflicts. If these issues are explored thoroughly and clients experience investment in resolving them, the issue of substance abuse will invariably emerge, but not as a separate, truncated problem.

Young adult clients must learn to understand the conditions that contribute to substance abuse, as well as the manner in which substance abuse exacerbates existing problems. Exploring and attempting to resolve conflicted family relationships provide an essential vehicle for achieving this goal.

The 12-Step model and developmental needs

Young adult clients with substance abuse problems may need more assistance from counselors than older adult clients would in regard to addressing demographic differences in 12-Step meetings. According to a 2001 Alcoholics Anony-mous (AA) membership survey, the average member of AA was 46 years old.8 A similar survey showed that the average age of a Narcotics Anonymous member was 37.9

Although young adult clients may report a lack of identification with older adults in 12-Step meetings and group counseling sessions, it is important to note that young adult clients may be experiencing difficulty identifying with any peer group, regardless of age differences. In fact, one of the developmental tasks for young adults between the ages of 18 and 25 is learning how to establish intimate relationships and to address successfully the inherent isolation associated with independence from family relationships.10

Young adult clients who report problems of identification with others may benefit from interventions designed to help them explore their strengths and preferences, as well as their worldview and vocational aspirations.11 Examining these areas often will interest young adults, as well as direct them toward barriers and deficits—including substance abuse—that need to be addressed in their lives.

If young adult clients meet the diagnostic criteria for substance abuse or substance dependency, the 12-Step model for recovery offers a number of benefits. In addition to being free of charge and readily available in most areas, the 12-Step program has values that correlate with the developmental needs of young adults in regard to establishing mature relationships. Individuals capable of achieving intimacy in relationships have been characterized as being tolerant of differences in others, believing in the value of interdepen-dence as a way to work through difficulties, and being willing to commit to relationships that demand some degree of sacrifice.12 On an interpersonal level, these are the very concepts the 12-Step model of recovery reinforces. Young adults who participate actively in 12-Step support meetings may benefit greatly from exposure to these ideals.

Conclusion

An accurate understanding of developmental needs allows counselors to empathize more deeply with clients. Counselors are also more likely to establish authentic relationships with young adults and to hold them in positive regard if developmental needs are appropriately assessed. More importantly, counselors can avoid the mistake of pathologizing normal stages of psychological development and can actually help clients negotiate through the difficult stage of young adulthood.

References

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