Treatment for youths must adjust to social disconnection

By all means, the most effective way to treat any chronic illness is to work on preventing it in the first place. Rehab programs such as Ashley exist precisely because of the difficulty other social programs are having in predicting and intervening with addiction. Five million youths, from the ages of 12 to 20, have admitted to binge drinking in the past few months. Although we as a nation have exercised tremendous resources into preventative programs for youths, the effectiveness of these programs has been questionable at best, and trends in usage are growing. We’re now facing an unprecedented addiction epidemic where children and teens, in their most vulnerable years, are at highest risk. Our job is to identify the youths who could not be prevented from addiction, diagnose them, and develop treatment techniques that take into consideration their unique circumstances.

There is no question that we should be doing everything we can to prevent minors from abusing drugs and alcohol, but under current circumstances we need to be putting substantial resources into caring for those who are already afflicted. One of the most crucial aspects of this is distinguishing treatment modalities between adults and youths (under the age of 25).

Brain plasticity is its highest leading up to the age of 18, meaning traumatic events such as substance abuse have a window for serious damage to a developing teenager, and could still have a particularly strong effect up to age 25. Certain drug exposure during that 25-year period of brain development is linked to long-term psychiatric disabilities and short-term attention deficits, which fuel nicotine usage. It’s an infinite feedback loop where addiction causes damage to the brain that makes further drug abuse more likely.

The question of why we become addicted is far older than the history of rehabilitation facilities. One of the prevailing modern arguments is that addiction is a response to being socially disconnected. Other models link it more heavily toward stress or trauma, but those models don’t account for why the largest increases in opioid overdoses we’ve seen were in cities (54%) and the American Midwest (70%), areas where social disconnects were severe in their own ways.

The Midwest is the least densely populated region of the U.S., with social disconnect being a geographical phenomenon—simply too much area is farmland with small families managing giant acres of crops. In the cities, a mix of technology and finances plays a larger role in the isolation. The cost of living in these areas has skyrocketed so immensely above salaries that working two or three jobs has become commonplace, even with dual-income families. In response to the financial crisis of 2008, many Millennials also feel disposable at their workplace, putting in more hours and forfeiting 26% more vacation time that any other generation. At the same time, Americans have been spending 100 million hours a day watching videos on Facebook alone.

The picture painted is that of a young generation that went through the most critical part of brain development while feeling they have no control over their lives, no stability in their finances, who work longer hours and don’t take time off for friends or family, and are spending more and more time online by themselves. All the while, their addiction numbers are growing exponentially. If the social model for addiction is correct, then as addiction professionals we have little control over inflation, low wages, or technology use among youths. What we can do is to prepare them to better handle these factors as they transition to sobriety.

Social, spiritual and motivational activities are going to be key elements of youth addiction recovery. Programs such as goat and equine therapy give them a chance to interact with animals, which has been shown to be especially effective among at-risk teens. Outdoor activities such as whitewater rafting and community volunteering with like-minded teens in recovery are particularly effective at getting them reconnected with others and giving them a sense of adventure, purpose and belonging in the world, which is so often lost in big cities and rural farmlands. Motivational interviewing, goal-setting, and family-based therapy are also critical parts of establishing strong social connections and giving them a sense of control over their lives. Meanwhile, mindfulness training and a sense of spirituality can ease anxiety and build on their sense of community, leading to long-term wellness as well as ongoing brain development.

It’s important to note that a lot of the stress of our youngest generations is social and financial, and is experienced during their most critical times of their brain development. It’s important to be patient, and to build their confidence and sense of belonging in a world from which many of them have felt entirely disconnected. While many tried-and-true tools such as AA and the 12 Steps are essential for addicted youths, the best thing we can do for them is to meet them where they are at by offering a variety of mutual help organizations such as 12-Step organizations, Refuge Recovery and SMART Recovery, rather than a single method.