Psychotherapy

Volume 32/Spring 1995/Number 1

ADOLESCENT CHEMICAL DEPENDENCE: ASSESSMENT,

TREATMENT, AND MANAGEMENT

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

ROBERT MARGOLIS
Smyrna, Georgia
Successful treatment of chemically
dependent adolescents presents a unique
set of challenges and requires a multipronged approach. This article focuses
on assessment, treatment, and
management of this most difficult
population. Specifically, a theoretical
model for assessment and treatment of
these patients is offered. In addition, the
role of psychological testing, structured
questionnaires, and the diagnostic
interview in the assessment process is
discussed. Individual, group, and family
therapy techniqueswhich are specific
to this populationare also explored.
The article is intended for the clinician
who works with this population. As such,
itfocuses on practical information which
can be utilized in a treatment center or
individual private practice setting.
Successful treatment of chemically dependent
adolescents presents a unique set of challenges.
Compared with the same group a generation ago,
substance abuse in adolescents is more prevalent
and adolescents begin use at an earlier age. Most
often, substance abuse of a single chemical progresses rapidly to poly-substance abuse. In addition, the denial system is often stronger, and many
adolescents come to treatment as unwilling participants. These challenges and difficulties are
often humbling and can be overwhelming for an

Correspondenceregardingthis article should be addressed

to Robert Margolis, Ridgeview Action Center, 3995 S. Cobb
Dr., Smyrna, GA 30080.

172

inexperienced therapist. In light of these challenges and difficulties it is essential for the therapist to keep focusto be clear about the potential
for change, as well as the limitations one is facing
in dealing with this problem. The therapist who
works with this particular population can provide
a structure of hope and support, set appropriate
limits with the help of the family, teach specific
coping skills, address deficits in delays which
result from drug use, and encourage the entire
family to begin their own process of recovery. In
so doing, the therapist is often a vital link in the
total recovery process.
Special characteristics are inherent in working
with adolescents. First, adolescent drug abuse
manifests itself through problem behaviors rather
than overt signs of drug abuse. Typically, family
members come for consultation about school or
home problems instead of drug use. Second, the
disorder progresses more rapidly in adolescents
than it does in adults. Adults may take two to
seven years to progress from first use to full chemical dependency. Adolescents often make this
progression in six to eighteen months. Third, adolescents abuse more than one drug; they may have
a "drug of choice," but they almost always use
several drugs. Fourth, adolescents experience
stronger denial because they have not experienced
the years of negative consequences that an adult
has experienced. They have difficulty connecting
their school and family problems to their drug
use. Fifth, the enabling system surrounding adolescents is stronger than is usually found with
adults. Usually drug use is universally accepted
in their peer group. "But everyone does it" is a
very typical statement. Sixth, adolescents experience developmental delays directly caused by
drug use. When drug abuse begins, the normal
maturation and growth process slows down or
ceases. These adolescents fall behind their age
group in academics, social skills development,
impulse control, and tolerance for delayed grati-

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Adolescent Chemical Dependence

fication. The diagnosis and treatment of these adolescents must take these delays into account because addressing these delays is the single
greatest factor in the success of treatment. Treatment must be longer and more intense for adolescents than for adults.
The impact of developmental delays was a major consideration in the development of the Comprehensive Assessment and Treatment Model
(Figure 1). The model is based upon the assumption that as the chemical dependence increases,
functioning in all areas of life decreases. This
model can be used in the assessment, treatment,
and aftercare phases of recovery. In addition, outcome studies and follow-up questionnaires can be
keyed to the domains of functioning contained in
the model.
Assessment of the adolescent for chemical dependency requires an evaluation of each of the
areas on the comprehensive model. It is necessary
to determine if the presenting problem is due to
drug or alcohol use and where, along the progression fromfirstuse to full dependency, a particular
adolescent falls. The main tools are psychological
testing, structured questionnaires, urine drug
screens, and the diagnostic interview.

Psychological testing is primarily useful in developing treatment plans. Psychological tests will
not reveal chemical dependence per se, but they
do highlight psychological and interpersonal
problems that will need to be addressed in
treatment.
Structured questionnaires regarding drug and
alcohol use can be helpful if they are designed
for adolescents. Questionnaires, such as the
Michigan Alcoholism Screening Test (MAST),
that are designed for adults, are not appropriate
for adolescents and are not effective for them. The
Personal Experience Inventory (PEI) (Winters &
Henley, 1989) is designed for adolescents and
asks information about patterns of drug use as
well as behaviors associated with drug use.
The PEI provides two sets of norms: one that
compares an individual with a group of normal
adolescents; a second that compares an individual
with a subgroup of adolescents who appear in
treatment centers. Theresultsof this test can help
to decrease denial effectively when an adolescent's score is similar to the second norm.
An initial urine drug screen and subsequent
random drug screens are an essential part of the
assessment process. The individual screens must

Biogenetic
Peers

Family

Drug Affected

Health

Life Style

Vocation

Lega

Psychological

Figure 1. Comprehensive assessment and treatment model for adolescent substance abuse and chemical dependence. The
presented figure depicts the scope of diagnostic and treatment domains associated with adolescent substance abuse and chemical
dependence. The model facilitates a viablefitbetween the assessment, treatment, and aftercare services offered by the programs.

173

This document is copyrighted by the American Psychological Association or one of its allied publishers.
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R. Margolis
occur on a truly random as well as regular basis.
Since the quality of drug screens is variable, there
are some specific points that need to be emphasized. First, since most adolescents are poly-drug
users, the test should screen for a panel of drugs
and not just one or two drugs. Second, certain
drugs leave the system almost immediately, while
others remain for extended periods of time. Cocaine is often undetectable after 24 to 48 hours.
Marijuana, on the other hand, is detectable for at
least 4 or 5 days and may remain in the system
for two weeks.
The diagnostic interview is the most significant
and crucial part of the assessment phase. It enables the clinician to target questions to the areas
contained in the Comprehensive Assessment and
Treatment Model. Certain areas of discussion are
best addressed with the parents and adolescent
together. Other areas are best addressed with the
adolescent alone.
In the joint interview the clinician can investigate the history of the presenting problems, family history of chemical use, and developmental
problems of the child. In many instances parents
do not identify alcohol and drug use as the presenting problem. The parents usually speak of the
problem as related to school difficulties, family
conflicts, or behavioral problems. The clinician
must get a complete history of these problems
and especially look for shifts in behavior, mood,
interpersonal style, or peer group.
Family history of alcohol and drug problems
and psychiatric problems is particularly significant. It also can be difficult to obtain. It requires
asking questions in such a way that the family
thinks of the issues in a new light. Frequently,
addiction and psychiatric problems are "in the
closet" and emerge only after thorough questioning. It can be helpful to ask specifically about
extended family members and people who were
not identified or treated as chemically dependent.
The family history often establishes a genetic susceptibility to the disorder. If there is chemical abuse
in the immediate family it points to a negative environmental influence in that the parents are modeling
chemically dependent behavior for the child.
Inquiries should be made about the overall
health and developmental history of the adolescent. Once again, the clinician is looking for
marked shifts that may have followed the onset)
of chemical use. Learning disorders and attention
deficit disorder appear to correlate with later
chemical use.

174

In an interview with the adolescent alone the

clinician should get a chemical use profile, the
history and progression of that use, and a mental
status exam. The profile can be done either
through questionnaires or through dialogue with
the adolescent. In dialogue, simply asking the
adolescent what drugs he or she has done is not
sufficient. Although one may begin in this manner, the clinician needs to ask about specific drugs
that the adolescent may consider unimportant. For
example, adolescents frequently consider alcohol
use to be trivial and unproblematic. Inhalants and
stimulants such as diet pills are frequently not
mentioned in their initial response.
The history of chemical use involves a variety
of specific questions about the progression. How
old was the adolescent when he or shefirstbegan
to use drugs? With whom did he/she use drugs?
What is the progression of use fromfirstuse until
the present time? Have there been significant periods of sobriety? Has the adolescent ever found
the need to cut down use on their own? If so,
why? Has the person ever behaved in a way which
is inconsistent with their own value system such
as sexual acting-out, violence, or illegal acts
while they were under the influence of chemicals?
Has the person ever said or thought, "There are
certain things I would never do like using I.V.
drugs, mixing different types of drugs, using
'hard' drugs?" Questions such as these help the
clinician to assess the degree of unmanageability
and severity of the adolescent's drug use as well
as help the adolescent to think about the consequences of their drug use and how far the chemical use has progressed.
A final element of the diagnostic interview with
the adolescent is the mental status exam. The
clinician should pay attention to sudden, unexplained mood swings, as well as unexplained difficulties with judgment and insight. The adolescent's affective state and motivation for treatment
are important elements of the mental status exam.
In doing the diagnostic interview there are a
number of troublesome signs that the clinician
should watch. An adolescent who begins to use
drugs will usually shift to a peer group composed
solely of other drug-using adolescents. Parents
often register this shift in peer group as a major
concern and source of friction in the family. The
adolescent frequently complains, "You don't like
any of my friends."
Problems with compliance with family and
school structure also may be a telling sign of

This document is copyrighted by the American Psychological Association or one of its allied publishers.
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Adolescent Chemical Dependence

chemical use. As chemical use increases, the individual's life becomes more and more unmanageable. Initially, the person can hide and cover the
use of drugs or alcohol, but as the dependence
progressed the ability to hide and cover up decreases. If there are signs of marked deterioration
in conduct, family functioning, and academic performance, the adolescent's chemical use may
have progressed so that covering up is no longer
possible. Sometimes the adolescent tries to avoid
the parents as much as possible to prevent detection. Parents in these cases may complain that
their child is increasingly secretive, spends large
amounts of time alone in the bedroom, and never
wants to be with the family.
Indicators that drug use is rapidly progressing
out of control include running away, legal difficultiesespecially if related to possession, sale,
or distribution of drugs, and the total inability to
function at school or job. In these cases immediate intervention is necessary to reverse a rapidly
deteriorating process.
In the feedback portion of the diagnostic interview the parents, adolescent, and clinician meet
together again to discuss the findings. The clinician can review the findings stressing the salient
points. For example, there is a positive family
history of addiction. Johnny's drug use has progressed to a point where he began using on weekends and he is now smoking marijuana before
school. His grades have deteriorated. He has been
sneaking out at night. His peer group has changed
and many of his peers have either dropped out
of school or are having significant difficulties.
Although Johnny has tried to cut back on several
occasions and has even been successful for a period of several months, his use has progressed
and increased over the last several years.
It is, of course, essential to obtain the adolescent's permission to share this information with
the parents. If the adolescent is reluctant to share
specifics, perhaps he or she will give permission
to generally share concerns about the progression
of drug use so that the parents can have some
understanding of the problem.
The issue of confidentiality is a difficult judgment call, especially when adolescents are engaged in high-risk or life-threatening behavior. If
the therapist intends to violate the adolescent's
confidentiality to ensure the patient's safety, it is
important to inform the adolescent of what one
is about to do and the therapist's reasons for this
breach of the confidential relationship. The issue

must be handled delicately in order to preserve

the therapeutic relationship with the adolescent,
and also to help the parents understand the need
and the specific recommendations for treatment.
When the psychological testing, structured
quesionnaires, urine drug screens, and diagnostic
interview are completed, the therapist faces three
possible conclusions. First, the adolescent is
clearly chemically dependent and requires some
type of structured treatment. Second, the adolescent is not chemically dependent and the presenting problem is not drug related. Third, the role
of drugs in the presenting problem is possible or
probable, but not yet clearly determinable. Unfortunately, this last conclusion is the most common.
It calls for an extended assessment process in
order to define more fully the role which chemical
use plays in the adolescent's life.
The extended assessment is based on the fact
that the disorder progresses to greater unmanageability. Adolescents who are moving from first
use to full dependency will continue to use despite
therapy, behavioral contracts, and urine drug
screens. The only way to separate the adolescent
who is experimenting from the adolescent who is
dependent is to ask the adolescent to stop. Those
who can stop will stop if the consequences are
severe enough. Those who cannot stop will continue to use despite the negative consequences.
The family and the therapist draw up a behavioral
contract with specific limits and consequences.
The parents are asked to assist in monitoring the
adolescent's drug use. The adolescent is given a
clear unequivocal message that any type of drug
or alcohol use is unacceptable at this point. The
therapist may state that he or she does not work
with adolescents who use alcohol or drugs because it undermines the therapeutic process.
This conversation sometimes engenders resistance and anger from the adolescent, but the anger
or alienation is usually short-lived. Adolescents
who are never forced to come face-to-face with
the consequences of their chemical abuse lose
respect for the therapist and adults involved. They
also lose respect if the therapist is easily manipulated. The therapist may become a "professional
enabler" if he or she gives the impression that
something is being accomplished (i.e., psychotherapy) when in fact the adolescent is continuing
to use drugs at greater and greater levels. As the
disorder progresses, the parents become even more
reluctant to confront the child, since they feel secure
that the therapist is addressing the problem.

175

This document is copyrighted by the American Psychological Association or one of its allied publishers.
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R. Margolis
In addition to a behavioral contract, group therapy is of tremendous value in the extended assessment period. It is particularly valuable if the
group has recovering adolescents who are chemically free and engaged in an ongoing recovery
process. The recovering adolescents are particularly adept at eliciting information from other adolescents who are in denial or trying to hide their
chemical use. Often by simply sharing their personal experiences they normalize the process of
talking about drug use in an open, nonjudgmental
manner. They will often do much of the therapist's work by confronting the adolescent and encouraging him or her to share more information.
These adolescents can also introduce the adolescent to a recovering lifestyle. They can encourage the adolescent to attend community support
groups with them. Often, the adolescent who is
in denial begins to see the positive effects of recovery and the obvious difference between the
drug lifestyle and the recovering lifestyle.
Finally, the adolescent will continue to be monitored by random urine drug screens during the
extended assessment period. The drug screens
should not be on the same day as the day of group
therapy. It becomes too easy for the adolescents
to time their drug use to be drug free for the group
therapy. All adolescents in the group need to be
tested. For the protection and integrity of the
group, regular drug screening is essential.
The extended assessment period may continue
for a period of weeks or months. During this time
the therapist should continue to focus on the role
which chemical dependence plays in the adolescent's life. Often ongoing therapeutic efforts can
be undermined by chronic drug use which is undiagnosed and undetected. The therapist should
have a healthy skepticism and continually listen
for signs of drug use.
In designing a treatment plan for chemically
dependent adolescents, we return to the Comprehensive Assessment and Treatment Model, which
emphasizes the impact of substance abuse on
functioning and development.
Therapeutic interventions are structured to address the different spheres which have been impaired, and to assist the adolescent to move to a
higher level of functioning in each of these
spheres. Unless these specific deficits are addressed, long-term sobriety is likely to be compromised. Unlike adults, who often arrive at the
chemically dependent stage with a range of coping strategies and social skills, adolescent sub-

176

stance abuse is such that the development of these

coping strategies is curtailed at the stage in which
they began abusing chemicals.
As a result of the intensity and complexity of
adolescent treatment, Morrison and colleagues
(1989) stress the need for a continuum of care
(Figure 2) when treating adolescent substance
abusers. In the past, most chemically dependent
adolescents were treated in inpatient settings.
Within the past several years, more adolescents
have been treated in other settings, including partial hospitalization programs, day programs, recovery residences, and even traditional psychotherapy in an outpatient practice. If outpatient
treatment is the foundation for the treatment plan,
it is important to emphasize the possibility of continued use of chemicals and the accompanying
risks. This possibility needs to be weighed and
routine urine drug screening is essential.
Zweben (1993) has addressed the issue of urinalysis by stating, "Drug and alcohol testing
should be presented as something taken for
granted given the nature of addictive disorders,
not a personal issue for mistrust in the individual
case" (p. 264). This is an important point, since
many therapists arereluctantto utilize urine drug
screens, fearing loss of trust or a destruction of the
therapist-patient bond. In my experience, it is the
therapist's attitude and degree of comfort with urinalysis which most determines whether the therapist-patient bond is negatively impacted.
The continuum of care should be in place before the therapist begins to work with adolescent
substance abusers. The therapist should have a
relationship with a treatment center that provides
this continuum for those adolescents who are unable to maintain sobriety through traditional outpatient treatment.
Sometimes nonmedical psychotherapists have
a degree of discomfort in functioning as a member
of a multidisciplinary team. The therapist should
seek out a treatment center which provides highquality care and is sensitive to the needs of nonmedically trained therapists to direct the clinical/
behavioral aspects of the patient's treatment.
Within the addiction field, there is a controversy between traditionally trained, psychodynamic psychotherapists and addiction-oriented
therapists working from a disease model. Zweben
(1993) elaborates this controversy, "While conventional psychotherapy has usually erred in the
direction of promoting exploration without stating
clear expectations about action toward absti-

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Adolescent Chemical Dependence

1 I I I fI

Entry
Foint

Entry
Point

Entry
Point

Entry
Point

Entry
Point

Entry
Point

Figure 2. Continuum of treatment services.

nence, addiction treatment personnel often become quickly frustrated by this ambivalence and
may justify early termination on the grounds of
avoiding collusion and drug using behavior" (p.
261).
By examining the contributions of each point
of view, it is possible to integrate the best characteristics of each approach.
Whether one is trained in the Minnesota model
or traditional psychodynamic psychotherapy, the
therapist needs a constant awareness of the struggle which the recovering patient experiences on
a daily basis in the early stages. In an earlier
article, Margolis (1993) compared the addict's
struggle to maintain sobriety with a child who is
first learning to ride a two-wheel bicycle. When
a child first views a two-wheeler lying on its side,
the concept that this will stay upright seems beyond belief. It is only through the parent's gentle
coaching and support that the child takes a leap
of faith and has the courage to get on the bike
and begin pedaling. The paradox is that the faster
one pedals, the more stable one becomes. In much
the same light, early recovery for adolescents
seems unattainable. It is only through immersing
oneself in a recovery-oriented lifestyle based on
non-chemical coping skills that the adolescent is
able to achieve any stability in his or her life.
Early-stage treatment with the adolescent must
incorporate many nurturing parent skills such as
gentle coaching and specific techniques for
achieving sobriety.
At the same time, however, early-stage therapy
must be more directive. The therapist must offer
specific strategies to the adolescent such as, "Let

me help you find a support group," "Avoid old

using grounds and other potential trigger experiences," etc. Traditional limit-setting is also an
important aspect of early-stage therapy; the therapist must be prepared to intervene when the adolescent is careening out of control. Some therapists have difficulty identifying the need for clear
limits and appropriate intervention. The therapist
learns to recognize when limits are necessary by
referring back to the functional impairment model
of addiction.
Psychotherapy with chemically dependent adolescents requires the ability to switch between a
nurturing, self-exploration based therapy to a
limit setting, directive, or even confrontive
stance, as appropriate. The appropriate technique
is dictated by the adolescent's ability to comply
with clear therapeutic goals. For those adolescents whose behavior indicates that they cannot
achieve therapeutic goals, a more confrontive approach is indicated with appropriate recommendations for more intensive levels of care.
Through individual therapy the adolescent derives the courage and support to take the first steps
toward abstinence and bonding with a community
support group. Through group therapy the adolescent benefits from the "mirror image" that the
experience of others provides, and derives a sense
of support and an awareness of the healing process of recovery. Adolescents can place themselves along a continuum of recovery and realize
that recovery progresses in stages, each with its
own set of rewards and complications.
Family therapy is essential. Adults are free to
leave dysfunctional families, but most adoles-

177

R. Margolis

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

cents must deal with the individual family members and the dynamics that exist within their home
structure. Drug or alcohol abuse by parents or
other family members is of the utmost concern
and must be assessed thoroughly. Returning an
adolescent to a home in which there is active
chemical abuse is a recipe for failure.
Early family therapy sessions usually center
around limit-setting and appropriate rules and
consequences. As mentioned in the extended assessment section, a behavior contract is drawn up
with specific limits and consequences. The rules
are geared as closely as possible to normal adolescent rules, taking into account the parents' ability
to set limits appropriately. The therapist can meet
separately with the parents if they are at odds
with each other or have difficulty with setting
rules. In the early part of treatment the family
needs to learn about the dynamics of addictive
disorder. Didactic lectures on the nature and
stages of chemical dependence can be very helpful. The educational approach sensitizes the parents to the child's experience and helps them to
avoid shaming responses.
As therapy progresses, discussion usually
evolves from limit-setting to family dynamics.
Frequently the roles of the parents have become
polarized with one parent assuming an enabler
role and the other parent assuming the role of
enforcer. Much conflict and distress between the
parents results. The therapist can help the parents
to see how they got into this position and help
them to move toward a middle ground. Real
change for the parents occurs as they struggle
individually with their own personality styles and
childhood situations. As they come to greater understanding they view the change not as a defeat
or surrender, but as a movement toward health
and centering. They come to accept that parenting
a chemically dependent adolescent is virtually impossible and to release their own guilt and shame.
Parents are encouraged to develop their own
support network (e.g., Alanon or Naranon).
These meetings provide the parents with a recovery model similar to the one the adolescent is
learning. They help the parents to understand the
unmanageability of chemical dependence and the
need to "detach with love." The adolescent receives a powerful message of trust and support
as he or she watches his or her parents recover.
As stated earlier, adolescents who abuse chemicals experience specific developmental delays.
This is the primaryreasonwhy the therapist must

178

consider utilizing more intensive interventions

along the continuum of care, since comprehensive
treatment programs can usually address the full
complement of developmental delays experienced
by adolescents.
For example, many adolescents experience educational delays as a result of their chemical
abuse. To place these adolescents back into normal public school, even schools with resources
classes, can set them up for failure. Comprehensive treatment programs can offer individualized
educational programs which are designed to address the educational deficits. Not only the delay
in achievement scores, but also the lack of appropriate study skills, inability to set and achieve
long-term goals, and a lack of awareness about
appropriate classroom behavior causes problems
for these adolescents. Comprehensive treatment
centers are aware of these problems and provide
specific academic and behavioral goals for the
adolescents to meet. Often, level systems are effective in structuring an adolescent's behavior in
a more positive direction.
In addition to educational delays, many adolescents have glaring deficits in social skills. Comprehensive treatment programs provide social
skills groups which are an essential part of reintegrating back into a larger world. For many adolescents, the concept of socializing without chemicals to relieve anxiety is a foreign experience.
The self-consciousness and lack of self-confidence experienced by these adolescents is often
masked by a gruff or "macho" facade. Many adolescents who do not develop appropriate social
skills are likely to slip back into the drug culture,
where acceptance is based on one criterion, the
use of chemicals. The issue of sexual relationships is a major factor in adolescent recovery.
Many early-stage recovering individuals, especially adolescents, begin to use sexual behavior
as self-medication in order to alleviate psychological/emotional pain. Through milieu-based, group
psychotherapy, these adolescents can look at the
dysfunctional nature of these relationships. The
therapist can point out how these relationships
can easily lead back to chemical abuse, since
they are keeping the adolescent from developing
appropriate coping skills and they serve the same
function as chemicals for the adolescent.
A final set of coping skills which must be addressed in treatment include the inability of the
early-stage recovering person to deal with their
own feelings. This is an area where more tradi-

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Adolescent Chemical Dependence

tional, psychodynamic group psychotherapy can
be beneificial. In an atmosphere of acceptance
and caring, the adolescent is encouraged to explore his or her feelings in a nonjudgmental way.
These feelings, which have often been medicated
for years by the adolescent, are scary and potentially overwhelming. The rate at which affective
material is exposed needs to be monitored by the
therapist. Patients are encouraged to move at their
own rate of uncovering. Techniques such as
allowing the adolescent who is threatened by feelings to physically relocate themselves within the
group room, either closer or further away from
the group as needed, give the adolescent a sense
of control, and a feeling that they can uncover
affective material without being overwhelmed.
Although not every adolescent must go through
a formal treatment program, these are modalities
which should not be overlooked, given the massive developmental delays which many adolescents experience. The therapist who chooses to
work in a less structured setting must design a
treatment plan which addresses these developmental delays. For example, working closely with
the schools to develop appropriate resource
classes might be an option. In addition, providing
structured outpatient group experiences for the
adolescent to work through social skills and to
develop feeling-oriented coping skills is also crucial. A therapist who chooses not to affiliate with
a treatment program, however, must develop appropriate guidelines for when to refer. In many
cases this therapist should confine his or her practice to assessment and early-stage intervention
rather than full treatment and management of
this disorder.
Conclusion
The goals of therapeutic intervention with
chemically dependent adolescents are first, abstinence, and second, a sober state of mind with

non-chemical coping skills. Achievement of these

goals requires a continuum of care from inpatient
structured treatment centers to outpatient private
practice. The therapist should be willing and able
to use the appropriate level of care as indicated
by the adolescent's behavior. The therapist should
also use individual and group psychotherapy,
urine drug screens, and family therapy to achieve
the goals.
Finally, an attitude of humility on the part of
the therapist is essential. Stephanie Brown (198S)
states "Therapists must recognize loss of control
for the alcoholic and must accept their own loss of
control in being able to make the patient change.
Therapists who recognize their own limits can
then begin to help the alcoholic accept the diagnosis of alcoholism, the lack of control that goes
with it, and the abstinence required. Therapists
can then help the patient learn how to stay abstinent" (p. 15). Ultimately the therapist is not in
control of whether the patient uses or remains
sober. In this process the therapist participates as
the lives of the adolescents and their families
move from failure to success, chaos to order,
despair to hope.
References
BREHM, N. M. & KHANTZIAN, E. J. (1992). A psychodynamic

perspective. In J. H. Lowinson, P. Ruiz, and R. B. Millman

(Eds.), Substance abuse: A comprehensive textbook (pp.
106-117). Baltimore: Williams & Wilkins.
BROWN, S. (1985). Treating the alcoholic: A developmental
model of recovery. New York: John Wiley.
MARGOUS, R. (1993). Recovery: Leaps of faith for addicts
and psychologists. Psychotherapy, 30(2), 187-193.
MORRISON, M. A., KNAUF, K. I., & HAYES, H. R. (1989).

A comprehensive treatment model. Alcoholism and Addiction, Nov., 12-17.

WINTERS, K. C. & HENLEY, G. A. (1989). Personal experience inventory manual. Los Angeles: Western Psychological Services.
ZWEBEN, J. E. (1993). Recovery oriented psychotherapy: A
model for addiction treatment. Psychotherapy, 30(2),
259-268.

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