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www.mghcme.org Engaging Young People with Addiction in Treatment James McKowen, Ph.D. Addiction Recovery Management Service (ARMS) Orlando, FL 2016
www.mghcme.org
Engaging Young People with Addiction in Treatment
James McKowen, Ph.D.
Addiction Recovery Management Service (ARMS)
Orlando, FL 2016
www.mghcme.org
Disclosures
Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest
to disclose.
www.mghcme.org
Goals of Talk
Addiction Recovery Management Service
Adapting Traditional Models of Care
Developmental Challenges in Youth
Scope of Problem in Youth
www.mghcme.org
0
10
20
30
40
50
60
70
80
90
100
12
-13
14
-15
16
-17
18
-20
21
-29
30
-34
35
-49
50
-64
65
+
Light Alcohol Use Only
Any Infrequent Drug Use
Regular AOD Use
Abuse
Dependence
Severity Category
NSDUH 2007; https://nsduhweb.rti.org
Perc
enta
ge o
f sa
mp
le
Age
Substance Use By Age
www.mghcme.org
0
10
20
30
40
50
60
70
80
90
100
12
-13
14
-15
16
-17
18
-20
21
-29
30
-34
35
-49
50
-64
65
+
Light Alcohol Use Only
Any Infrequent Drug Use
Regular AOD Use
Abuse
Dependence
Severity Category
NSDUH 2007; https://nsduhweb.rti.org
Perc
enta
ge o
f sa
mp
le
Age
Substance Use By Age
www.mghcme.org
0
10
20
30
40
50
60
70
80
90
100
12
-13
14
-15
16
-17
18
-20
21
-29
30
-34
35
-49
50
-64
65
+
Light Alcohol Use Only
Any Infrequent Drug Use
Regular AOD Use
Abuse
Dependence
Severity Category
NSDUH 2007; https://nsduhweb.rti.org
Perc
enta
ge o
f sa
mp
le
Age
Substance Use By Age
www.mghcme.org NSDUH 2014; https://nsduhweb.rti.org
Impact of Psychological Distress on Use
www.mghcme.org
Very few young adults engage in treatment
21% of youth need treatment for a substance use disorder (SAMHSA, 2009)
96% do not perceive the need to attend treatment (SAMHSA, 2009)
Only 10% of youth with substance use disorders enter treatment (NSDUH, 2013)
Only half finish treatment with mean length of time in treatment is 50 days (Dennis, 2005)
WHY ARE YOUTH SO AT RISK?
Cognitive Development
WHY SO AT RISK?
Cognitive Development
Social Influences
WHY SO AT RISK?
Cognitive Development
Social Influences
Access & Availability
WHY SO AT RISK?
Cognitive Development
Social Influences Family Factors
WHY SO AT RISK?
Access & Availability
www.mghcme.org
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Traditional Treatment Models of Care
Traditional Treatment Pediatric Adult
Pediatric Transitional Age Youth
(TAY) Adult
Age 18
Age 15 to 25
New
Approach
www.mghcme.org
• Youth with addiction differ from adults:
– Less physical & psychological dependence than older adults
– Fewer negative consequences & severity
– More likely to relapse due to social factors
– More dependent on family
– More likely to drop out of care
Why Rethink Traditional Treatment Models of Care?
www.mghcme.org
Different Use Profiles
Support Effective
Individuation
Understand Emerging Executive Control
Different Reinforcement
of Use and Change
Novel Engagement
Opportunities
Understand Contextual
Factors
Newer Models of Care For TAY
www.mghcme.org
Newer Models of Care: ARMS
• Recovery Management Philosophy
• Established in 2007
• Focuses on 14 – 26 year olds and their parents
• Patient centered care: motivational model
• Evidence-based psychosocial treatments
• Medication Management
www.mghcme.org
Treatment at ARMS: Flow of patient engagement
Ready for Sobriety Not ready for
sobriety
Evaluation
- Readiness Group
- Motivational Therapy
- Medication
-Intensive Outpatient Program
- Therapy
- Medication Long-term Recovery Group
Parent Engagement
Initial Youth Engagement:
- Call/text
- Meet & Greet
• Rapidly engage – capitalize on motivational window
• Risk Adjusted Intake Process
• “Meet and greet” option
• Modify intake length/content
Referral
• Evidence-base youth treatments – ACRA/ACC
• Contingency Management
• Family Engagement - CRAFT
• Match treatment to readiness
• Support functional goals not just substance outcome
• Consider Shorter Sessions and Adapt Frequency
Treatment
Engaging Youth at ARMS
• Educate staff on unique aspects to TAY
• Accept waxing/waning readiness
• Individuation issues – experiential learning
• Risk Rounds
• Consider overall reduced caseload
Clinician Adaptations
• Transparent consent for communication
• Care Coordination: school, college, court
• Peer facilitators link to mutual help
• Recognize markers of goal attainment
• Voicemail is dead!
• Provide snacks!
Other Considerations
Programmatic Adaptations Supporting TAY
www.mghcme.org
Further ARMS Goals with TAY
• Data collection on TAY
• Predictors of Engagement & Retention
• Community Linkage to Recovery Supports
• Recovery Coaches
• Technology
• Social media
• Location of engagement
www.mghcme.org
Take Homes
Early intervention reduces morbidity and mortality
Traditional models of care are inadequate
Different risk factors, neurodevelopmental issues, substance use profiles, and motivators of change
Novel strategies are needed to foster engagement and retention
www.mghcme.org
Thank You
• Contact: James McKowen, Ph.D.
• Email: [email protected]
• Twitter: @DrJamesMcKowen
