is a companion to the Drug Strategies publication Treating
Teens: A Guide to Adolescent Drug Programs, which
was supported by a grant from the Robert Wood Johnson Foundation.
The guide is designed to help parents, teachers, judges, counselors
and other concerned adults make better choices about teen
substance abuse treatment. To order the 60-page Treating
Teens publication, which includes practical resources
for parents such as Ten Important Questions to Ask a Treatment
Program (excerpted below),
section provides a searchable database with extensive information on how teen substance abuse treatment programs implement the nine key elements of effective adolescent treatment determined by Drug Strategies' panel of specialists. When Treating Teens was published in 2003, the guide highlighted 144 programs across the country. This online list has been modified to reflect the 17 programs that have since closed, and the 2 that no longer provide services to teens.
section provides articles commissioned by Drug Strategies on important
topics related to adolescent substance abuse, as well as the survey
instruments used to create the treatment program profiles.
Ten Important Questions to Ask a Treatment Program
1. How does your program address the needs of adolescents?
Most treatment programs are designed for adults, not adolescents.
Although adolescent treatment capacity has recently begun to expand,
relatively few teens can get help for substance abuse in programs
that specifically address the unique challenges of adolescence. Experts
agree that adolescent treatment cannot just be adult treatment modified
for kids. The program should be developmentally appropriate for adolescents.
It should also actively engage the family, which is the primary provider
of financial support and the dominant force in the adolescentís life.
In addition, the program should address the many different contexts
which shape the teenís environment, such as school, healthcare, recreation,
peer groups and where necessary, juvenile court and probation. For
residential treatment programs, it is important to know how teens
continue their education. Do they attend school in the local community,
or does the program include regular onsite classes approved by the
local school district with credits that can be transferred to the
studentís home school? The nine key elements of effectiveness discussed
in Treating Teens provide a framework for assessing how well
a treatment program addresses the needs of adolescents.
2. What kind of assessment does the program conduct of the
When a parent or other concerned adult contacts a program—often
in response to an immediate crisis—program staff will ask a
brief set of screening questions to explore the severity of the youthís
problems and to determine whether a more thorough assessment is required.
Screening helps sort out what the teen needs, the severity of the
problem, and whether the parent or other referring adult should contact
a different kind of program.
Assessment provides a road map for developing an effective treatment
plan tailored to the adolescentís specific needs. Most programs do
not use standardized, scientifically-sound screening and assessment
instruments. Rather they rely on questionnaires they develop in-house
that may have questionable reliability. If the program does not have
the necessary services indicated by the assessment, such as intensive
psychiatric or medical care, the teen may either be referred to a
different program or retained in the original program but sent elsewhere
for these services.
3. How often does the program review and update the treatment
plan in light of the adolescent's progress?
The treatment plan, which the program develops after initial comprehensive
assessment of the adolescent and his family, provides a guide to recovery
that is tailored to the adolescentís specific needs. These needs will
change as the adolescent progresses through the treatment process.
Experts suggest that the treatment plan should be reviewed within
the first thirty days, and again after sixty and ninety days. In addition,
the plan should be reviewed in light of significant developments,
such as urinalysis tests that show drug use. As the adolescent nears
completion of treatment, the plan should be modified to include continued
care and relapse prevention strategies. Follow-up after the teen leaves
the program is also important in improving the likelihood that gains
made in treatment will not be lost.
4. How is the family involved in the treatment process?
Family involvement in the adolescentís treatment is critically important
for treatment success. Engaging parents—or in the absence of
family, the responsible caregiver—increases the likelihood that
a teen will stay in treatment and that treatment gains will be sustained
after treatment has ended. Programs should encourage parents to participate
in counseling, group meetings, drug education and other activities
offered by the program. Some programs involve intensive interventions
with teens and their families not only at the program, but also at
home, school, juvenile facility, probation office and workplace. Occasional
telephone calls from program staff to parents are not enough. The
more the family is involved, the better the treatment outcomes will
5. How do you engage adolescents so that they stay in treatment?
Both the length and the intensity of the treatment vary widely depending
on the adolescentís specific needs. Keeping adolescents in treatment
is critically important since completion of treatment is closely related
to better outcomes. Retention rates are an important measure of program
success. How many clients drop out? How long do they stay in treatment?
How many actually complete treatment?
The initial assessment process can engage the teen in treatment by
helping him or her to recognize that he or she does have substance
abuse and other problems. Motivational interviewing and feedback also
help engage the teen, particularly if he or she sees that treatment
can address some of the pressing issues in his or her life, including
school performance and family relationships. Creative program content
targeted to adolescents in terms of examples and developmental appropriateness
can make treatment more relevant. The key is to address the everyday
concerns of the adolescent so that he or she will be motivated to
make the necessary effort to change fundamental behavior patterns.
Practical assistance, such as transportation to the program and other
service providers, also helps keep teens in treatment. So, too, do
recreational activities, sports events, mentors, after-school tutoring
and reward systems, such as vouchers for drug-free urine tests.
6. What are the qualifications of program staff and what kind
of clinical supervision is provided?
Qualified staff is critically important to treatment effectiveness.
The relationship between the teen and his or her counselor greatly
influences the extent to which the program will be able to motivate
change and to retain the teen in treatment. In addition to training
in substance abuse treatment, staff should be trained to recognize
psychiatric problems, understand adolescent development and to work
with families. They should also have practical experience in dealing
with adolescents and be responsive to the way young people think.
Staff to client ratio is also important: experts suggest that one
counselor should treat no more than 20-25 adolescent in outpatient
programs, 10-15 clients in intensive outpatient programs, and 4-8
clients in residential programs. In addition, programs should provide
regular clinical supervision several times a week by more experienced
staff to provide guidance for counselors as well as to monitor progress
in staff-client interactions.
7. Does the program offer separate single sex groups as well
as male and female counselors for girls and boys?
Recent research points to significant differences between male and
female adolescent drug users. Girls with drug abuse problems are more
likely to have serious mental health problems, particularly depression,
anxiety and post-traumatic stress disorder. They are also more likely
to be the victims of sexual and physical abuse, often by family members
or older friends. Boys more often have conduct disorders, including
aggressive, disruptive and even violent behavior, and they, too, may
have been victims of sexual abuse.
Single sex group sessions provide the opportunity to focus on issues
that might be difficult to discuss in co-ed groups. Teenage girls
often strive for approval from males rather than focusing on their
own problems. In addition, they may be reluctant to talk freely in
front of males about their experiences, which many regard as shameful.
Working with women counselors and with other girls in group therapy
provides girls with a psychological safe haven to explore problems
related to their substance abuse. Boys, too, can benefit from single
sex group focus on disruptive behaviors, date rape, HIV risks, and
understanding the responsibilities of becoming an adult. They can
also learn new behaviors and attitudes from male counselors who provide
positive role models.
8. How does the program follow up with the adolescent and
provide continuing care after treatment is completed?
The period following treatment is vitally important in consolidating
the gains made in treatment. Most adolescents relapse in the first
three months after treatment. However, effective continuing care services
substantially increase the teenís chances of successful, sustained
recovery. These services include relapse prevention training, follow-up
plans and referrals to community resources. In addition, the program
should schedule periodic check-ups with the adolescent at one month,
three months and one year after completing treatment. Wherever possible,
more frequent contact is preferable; both to monitor the teenís progress
and to make sure the teens and his or her family are receiving the
necessary services in the community.
Most programs provide referrals to community resources, including
Twelve Step meetings and group therapy, where available. Some programs
offer continuing services, such as counseling and education, after
the period of formal treatment is completed. Less frequently, programs
develop a comprehensive continuing care plan while the teen is still
in treatment so that the transition back into the community is as
seamless as possible.
9. What evidence do you have that your program is effective?
Very few programs have formal, scientific outcome evaluations that
measure treatment success. However, in the absence of such evaluations,
other information can shed light on the effectiveness of a program.
For example, completing treatment is closely related to positive outcomes.
Retention rate is an important indicator of effectiveness. How many
teens drop out? How long do they stay? How many actually complete
treatment? Even without formal evaluations, programs should be able
to provide accurate information on client retention and completion.
Programs should also be able to demonstrate how they measure the individual
teenís progress through treatment. Does the program routinely report
on key indicators of behavioral change? Do urine tests come back clean?
Is school performance improving? Is aggressive behavior diminishing?
Are family relationships getting stronger? In short, can the program
show that the trajectory of the teenís life has changed for the better?
10. What is the cost of the program?
The cost of drug treatment programs varies widely, depending on the
program, its location and the type of care offered. Residential programs
are generally the most expensive option, since they provide live-in
facilities and around the clock supervision by trained counselors.
For example, the rates charged by three of the programs described
in this guide, Chestnut Health, Hazelden and Thunder Road, range from
$500 to over $800 per day. Outpatient treatment is much less expensive,
since the adolescent lives at home. For example, MDFT (Multidimensional
Family Therapy), an outpatient program which is described in this
guide, costs $164 per week. An intensive version of MDFT is more expensive
($384 per week) because of the additional services provided.
Health plans have not generally offered full coverage for substance
abuse treatment, though recently enacted federal legislation requires
group health insurance plans that cover addiction and/or mental illness
to provide these benefits on par with benefits provided for other
illnesses; while the law does not require insurance plans to offer
addiction or mental health treatment, it does restrict group health
insurance plans from setting higher co-payments or deductibles for
these services in comparison to those charged for medical or surgical
Medicaid coverage for substance abuse treatment varies by state. Some
states provide Medicaid coverage for a full range of treatment options,
while others cover only inpatient detoxification. The recently passed
Patient Protection and Affordable Care Act expands eligibility for
Medicaid coverage and requires that newly eligible Medicaid recipients
receive substance abuse and mental health services on par with medical
services. For adolescents under the jurisdiction of the juvenile justice
system, costs for participation in certain treatment programs are
covered by the juvenile justice system.