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The Future of Teen Addiction Treatment--Trends and Predictions from Jeff Nalin, Psy.D.
By: Meghan Vivo
An Interview with Jeff Nalin, Psy.D., of Echo Malibu
The relationship between people and drugs dates back to the 19th century when scientists discovered how to extract the active ingredients to create morphine, laudanum, and cocaine. By the early 1900s, there were an estimated 250,000 addicts in the United States, many of whom were teenagers and young adults. Early efforts to halt drug addiction included anti-drug educational campaigns, federal and state legislation addressing the possession, manufacture, and distribution of illegal drugs, and early forms of drug rehab.
The first addiction treatment programs, or “sanitariums,” focused primarily on the process of detoxification, and little on psychological or emotional support. In the 1930s and 1940s, a handful of facilities started to integrate the AA/NA 12-Step philosophy and weekly individual and group counseling.
Since their humble beginnings, substance abuse treatment programs have become increasingly sophisticated. Starting in the mid-1990s, adolescent substance abuse treatment established its own identity as a specialty distinct from adult addiction treatment. Increases in the number of adolescent substance abusers, the proliferation of research in the field, and the realization that the standard, community-based addiction treatment program wasn’t meeting the needs of this group led to a revolution in the methodologies used to treat drug-addicted and alcoholic teens.
The commitment of federal organizations to increase funding and research, combined with the expansion of teen-focused programs that acknowledged the unique developmental and treatment needs of adolescents has resulted in a new regime of highly effective, empirically supported drug rehab centers.
In this article, Jeff Nalin, Psy.D., co-founder and executive director of Echo Malibu, an innovative residential treatment program for adolescents in Malibu, California, weighs in on the trends in the field and makes predictions about what changes we can anticipate in the years ahead.
Expanded Aftercare Services
According to Dr. Nalin, one area that generally needs improvement in residential treatment is long-term aftercare for adolescents in early recovery. Because battling drug or alcohol addiction is a long-term process with great potential for relapse, young people need more therapeutic services for a longer period of time than what is currently offered at most drug rehab centers.
At Echo Malibu, clients receive extensive aftercare services free of charge indefinitely. Parents and teens are invited to attend family day, group sessions, and 12-Step meetings at no charge, and can participate in an active alumni group that coordinates sober living activities like Superbowl parties and movie nights for any interested Echo graduates.
“It’s never our goal to say goodbye after 30 days of treatment,” says Nalin. “Our clients stay very connected, sharing their successes and missteps with us along the way. We’re here to build enduring relationships and to make sure our clients’ successes are long-lasting.”
The Availability of Alternative Therapies
In order to reacquaint young people with their passions and find new ways to express themselves, residential treatment centers increasingly have begun to incorporate alternative therapies into their approach to addiction treatment. The founders of Echo Malibu recognized the value of expressive therapies, body therapies, and recreational therapy long ago, and now offer one of the most expansive collections of these therapies available.
“The expressive arts are essential to our treatment philosophy,” states Nalin. “Teenagers are less defensive and make emotional connections they haven’t experienced before when they are given the opportunity to express themselves nonverbally. Our goal in offering a broad range of therapies is to find the one or two that make our students tick.”
For young people who are emotionally withdrawn or who learn best visually or kinesthetically, Echo offers a variety of expressive therapies, ranging from art, drama, music, and dance to poetry, writing, and canine and equine therapy. Those who are in detox or who are dealing with trauma often benefit from body-centered therapies, including nutritional assessments, acupuncture, chiropractic care, biofeedback, yoga, martial arts, and massage therapy. These therapies, in addition to recreational outings, social events, and sober activities, contribute to a recovery experience that is both therapeutic and appealing to adolescents.
Intensive Group and Individual Therapy
Most substance abuse treatment programs offer regular individual and group therapy, usually once or twice a week, but the modern trend is toward more frequent visits with a therapist. At Echo Malibu, for example, adolescents attend individual therapy sessions every day of the week.
“When you’re working to change lives in an intense residential treatment setting, important emotional shifts are happening every five minutes,” Nalin observes. “One moment a student is angry, the next she’s bored or sad, and before you know it, you’ve missed 500 opportunities to have a meaningful intervention. At Echo, we believe that brief ‘hallway interventions’ can make a difference. My prediction is that five years from now, every program will do individual therapy every day, because it makes all the clinical sense in the world.”
Greater Involvement With Families
Although many addiction treatment programs currently offer family therapy, Dr. Nalin believes more intensive family systems work will be a hallmark of addiction programs of the future. Rather than offering families one phone call a week and one weekend visit, he advises the better approach is to offer more frequent and more intensive family therapy and greater interaction between families and their loved one.
“When we opened Echo years ago, we knew one of the most vitally important pieces of treatment was the family,” states Nalin. “When a problem has reached a point that requires residential treatment, you have to pick up the intensity a bit. The kids didn’t get here by themselves, and they won’t leave here by themselves.”
Because adolescents who are admitted for substance abuse are often using drugs or alcohol to cope with anxiety or depression associated with traumatic experiences like loss of a loved one or their parents’ divorce, the issue is usually bigger than the student alone. To address the complete family unit, Echo offers parent effectiveness training to all families, as well as two group therapy sessions and two individual therapy sessions for parents each week.
“So much of this place is about modeling what family is,” says Nalin. “I’m the executive director and doctor, but I rinse off my plate after lunch and help out with clean-up or get food for the staff when they’re busy. The message is we’re all equals who are working on the same team. Because we’re equals, this is a safe place to be who you truly are, whether you’re happy, sad, or somewhere in between.”
Educational Services
One of the biggest reasons parents wait to admit their teenager into residential treatment is the fear that he will get even further behind in school. In order to help young people get caught up academically and reintegrate into public school while receiving the treatment they need, some drug rehab centers are offering educational services.
The program at Echo Malibu incorporates a strong academic component with an onsite accelerated learning classroom, educational sessions on the disease of addiction and family dynamics, and individualized tutoring from college students at the University of California, Los Angeles.
Better Oversight, Better Treatment
Dr. Nalin also predicts that we can anticipate stronger legislation around boot-camp style programs and greater federal oversight of adolescent treatment centers, which he believes is long overdue.
“These changes will force programs to do better work, spend more time with the students, and hire more sophisticated clinicians,” Nalin explains. “Our approach has always been to empower youth with the skills they need to make better choices for themselves, to build them up with affirmation and hope, and capitalize on their innate strengths and abilities. We believe this empowerment model elicits better long-term outcomes that make sense ethically, financially, and morally.”
He continues, “This is the point in my career where I sit back and smile a bit. After being laughed at for years, many in the field are now doing what we do. We got into this field to raise the bar. We’re a small program, but we’re making a big buzz. If that saves kids from getting poor treatment, I’m all for it.”
Source: CRC Health Group
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