Crucial role of the family. At F.A.I.R., we make it clear from the beginning of the program that high levels of parent involvement will be expected. We spend considerable energy engaging parents in a positive manner. At the same time, we make it clear that we won't accept or keep adolescents in the program without parent involvement.
Engaging parents and teens. Different strategies are needed to engage the teen and the parents. With the teenagers, we spend considerable energy getting kids to come clean about the extent and length of their chemical use. This is particularly important because we usually only have a commitment for an initial drug evaluation.
Special handling of parents. Although we are usually remarkably successful in getting teens to admit significant use, it is often still difficult to break through parental denial. We even get parents claiming that their teen is exaggerating the extent of their use. While such parents are frustrating, we have found it crucial to avoid blaming of parents. It is almost automatic for parents to read blame into their being referred for treatment together with the teen. In such circumstances, it is not enough for a therapist to be neutral - the therapist must actively assert that parents have positive motives; that they would like to help their child but need direction. With support from other parents, they can be part of the solution instead of part of the problem.
Establishing and monitoring goals. Initially parents and teens meet with staff for an evaluation to see whether the history and extent of use is sufficient to warrant intensive outpatient (IOP) treatment. To meet criteria, the teen needs to be using regularly and extensively, with clear social, legal, family, and/or academic consequences.
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Marijuana is the most prevalent drug of choice, although it is rare these days to find a teen smoking pot extensively who has not at least tried a variety of other drugs such as psychedelic mushrooms, cocaine, or abuse of powerful prescription medications. Alcohol is usually a very significant part of the picture, but unfortunately parents are rarely alarmed about alcohol use unless there have been significant legal or medical consequences.
When confronted by skillful drug counselors, teens admit to a surprising degree of drug use, although of course this may be in part because teens know their urine will be screened. An initial behavioral contract will be established with the parents stipulating program attendance and minimal standards of behavior at home, including provisions for drug testing and consequences for continued use or other breaches of the contract.
Program components. During IOP, teens are expected to attend four times per week, with an additional "in house" 12 step meeting on Fridays. The core of this program is group therapy with peers, led by professional counselors and peer counselors. Adolescents are also expected to participate fully in the family program.
The family program meets Wednesday night and Saturday morning; we hope that both parents will attend both sessions together when possible, but they often split the two meetings, either because of scheduling conflicts or tense post-divorce relationships. During this program, parents attend lectures about chemical dependency, meet with other parents in parents' group and Families Anonymous, and attend multiple family group with their teen. We wish that siblings would be involved routinely, but this is rare. Case managers also provide individual and family therapy sessions as part of the IOP recovery process.
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My name is Silvia and I was the girl in middle school who would tattle on kids who cheated on their spelling tests or cut ahead of others in the lunch line. I used to get straight A's, along with my group of Lisa Frank-loving friends. Thinking back on all the endless reading I did on my free time, I can honestly say I was a nerd. I thought I could handle anything. When the D.A.R.E. police program visited my school in 6th grade, I remember not considering drugs or alcohol a realistic threat. My mindset prevented me from thinking I was susceptible to addiction because I thought only gangs and uneducated people become drug addicts or alcoholics. I was wrong. My journey is proof that I am indeed an addict and began only a year after that D.A.R.E. program.
When my parents decided to move in my 7th grade, I was crushed. My life I knew disappeared and I could not adjust. Maybe I was being stubborn and unwilling to accept a different life, but all I recall was deep sadness from my self-pity. I don't remember my first drink, but I do know that rummaging through my parent's alcohol cabinet and swallowing what was in it made me feel warm and good. By the time 8th grade came around, I was drinking every night alone. I became a silent, angry girl, blasting Korn and Slipknot in my room. Not many things made me happy at this point in my life except drinking, stealing, and boys. My parents lost a lot of trust in me that year and began taking me to social workers. They would catch me sneaking out, drinking with twenty-year old boys, stealing things that I didn't have to, like deodorant. I tried smoking pot that year and became friends with a girl who would two years later die of an oxy-cotton overdose. The last straw for my parents was when I couldn't walk down the isle for my 8th grade graduation due to me being utterly intoxicated for the celebration dance in the school gymnasium.
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