Teenagers and Alcohol Abuse: A Study on the Effects and Treatment

Alcohol related mishaps and accidents remain the largest concern of society and in response to this more and more sectors of society have been implementing rules to curb the negative effects of teenage drinking.  There is no doubt that society has seen the negative consequences of teenage drinking.  In a national probability sample of 4,023 adolescents between the ages of 12 and 17, it was found that 15% of the sample used alcohol, 10% used marijuana, and 2% reported hard drug use in the past year (Farrell, 2006, p 284)).  This means that the problem of underage or teenage drinking is even more prevalent than other substances. Although some alcohol consumption among adolescents is considered normative, there is great concern for the number of teens who are exhibiting signs of alcohol abuse or dependence with 7% of the above sample meeting diagnostic criteria for alcohol, marijuana, or hard drug abuse or dependence. Trends in alcohol use reported in the Youth Risk Behavior Survey indicate that binge drinking (five or more drinks on one occasion during the 30 days prior to the survey) has shown little variation over the past several years, ranging from 31.3% in 1991 to 33.4% in 1997 to 31.5% in 1999 (Eaton, 2005, p. 79). Drinking continues to be a problem among youth and needs to be targeted specifically.  This drinking problem has led to a number of problems such school absenteeism and failure, depression, risky behaviors (especially driving under the influence), addiction, and death.

Working as a school counselor for this age group, I agree with the American Academy of Child and Adolescents Psychiatry’s Report (2007) which states that the following groups are most at risk for alcohol abuse: 1) teenagers with a family history of addiction, 2) teenagers suffering from depression, 3) teenagers suffering with low self-esteem, and 4) teenagers that have academic problems.  It has been shown that from the following groups the teenagers with a history of alcohol have higher rates of alcohol addiction with over 42% of the sample size coming from that background.  The next group is that of those who were drinking because they were upset with a rate of 40% while the rest admitted that they usually drink because of low self-esteem and peer pressure which accounts for 25% of the teenagers (Farrell, 2006, p.284).  The number of teenagers that drink due to academic problems has steadily been on the rise since 1998 and is now at a rate of 25% of the teenagers.  From the list, one could argue that most teenagers have been in one or more of its categories at one time in their lives.

From my experience, I have been personally involved with many students who frequently use alcohol and are enduring family separation/divorce or death, domestic violence, and financial problems. Their frequent re-action to these stressors is frustration, anger, and depression, which all can be pre-cursors to alcohol use/abuse.  Because the teenager’s family and peers prove to be the most influential in his/her life, I frequently question if caregivers, teachers, and counselors have the knowledge and the tools to deal with drinking effectively. My experience has been that intervention programs are the key to curb or prevent drinking, because they address the reasons and circumstances which lead, or may lead, the teenager to drink. These reasons need to be  addressed with the teenager’s family, with the end result of resolution. While many rehabilitation programs exist, three models will be presented, because of their effectiveness: Multi-dimensional Family Therapy (MDFT), Multi-systemic Treatment (MST), and Contingency Management (CM).

The Multi-dimensional Family Therapy Approach (MDFT) is anchored on the school counselor’s efforts to build a significant emotional bond with the troubled teenager and his/her family, in order for an intervention to be successful (Ken & David, 2007, p. 2). The steps in implementing MDFT are: (1) the school counselor, the teenager, and his/her family organize priorities and formulate decisions, (2) establish trust between the school counselor and the teenager/the teenager’s family (called “healing bonds“), (3) “Linking” the sessions together, in order to be able to focus the treatment of teens in evidence-based treatments in relation to teen alcohol abuse 4) “Modeling” appropriate behavior for the teenager’s parents, and (5) “Shifting domains of specialization”(Liddle, 2003, p. 32).

While the concept of MDFT as an intervention for substance abuse is not necessarily very new, the approaches used to administer this intervention have been consistently developed and refined throughout the years.  First developed in 1972, the MDFT approach began as a multi-component treatment for adolescent drug abuse and related problems.  Over the years, the MDFT program has received favorable reviews from different studies such as that of Brannigan, Schackman, Falco, & Millman, in 2004.  It also received the highest rating of available research-based intervention program in 2005 (Brounstein, 2000, p. 15).  The ratings of the reviews are based on the effectiveness of the programs and the relapse rate among teenagers.  Under this system, the highest rating that is given is five (5).  The MDFT scored a 4.3 rating out of this, thus proving the effectiveness of such a program (Brounstein, 2000, p.16).

Over the years, new procedures have been added to the MDFT in order to allow a better treatment for the patient.  It has been found that the MDFT program can be used as an effective community-based prevention program.  The development of the MDFT “treatment system” as opposed to the previous “one size fits all” program has allowed it to become more flexible and reactive to the needs to the subject.  Another new development is the “transportation” process which is basically a collaborative adaptation process.  The current trend in MDFT treatment is the development of therapy sessions, particularly in juvenile delinquency cases.

The first step, in my opinion, must be recognized as the most crucial, since it is in this stage that the school counselor helps decide on what style will be employed for the intervention. Implementing different styles is important, because the teenager gets an individualized treatment approach to coincide with his/her unique problem(s). The school counselor gathers information about the issue(s) affecting the teenager and the family unit, and then  sets the treatment plan in motion in order for the teenager to be able to address the problem(s) with their families. The teenager is encouraged to talk openly with their  families and, ultimately, in a group setting with his/her peers and their families.

The second stage refers to obtaining “healing bonds”, which refers to the relationship between the teenager and his/her family. By implementing these healing experiences, the school counselor gains the trust of the student, in order to be a support system when the teenager must confront his/her parent(s). The school counselor, after gaining the teenager’s trust, can help the student speak openly to his/her family members by using role play. The school counselor takes the role of the parent, or vice-versa. With this method, the school counselor coaches the teenager into expressing him/herself with confidence. In addition, the school counselor assures the teenager that he/she will be mediating the meeting. However, it is important to remember that teenagers have an innate ability to ascertain when a counselor is not genuinely concerned; therefore, in order for healing to occur, the counselor must be emotionally invested in the teenager’s recovery.

The third step, “linking“, is utilized as an instrument of change, where the school counselor strives to highlight the progress the teenager and his/her family made by providing associations between current and past session(s) (Eaton, 2005, p. 79). The importance of this is to show that growth can and does occur, while maintaining communication between the teenager and his/her family. Hopefully, all parties involved will see the positive influence that the sessions have provided.  The reason for this is that linking allows the teenager to pinpoint the nodes that have created changes.  The positive aspects of linking allow for a point of reference to chart the progress that the teenager has had in relation to the problem.  It has been shown that this is one of the most crucial steps in the process since over 85% of the candidates have revealed that “linking” is highly beneficial because it “allows them to see the change that they have undergone.” (Brounstein, 2000, p. 21)

The fourth step, called “modeling”, necessitates that the school counselor acts as an example for the family to aspire to. As the counselor stabilizes the teenager while he/she is in a crises, creates a supportive and caring atmosphere for the teenager, and actively  listens to the teenager (by acknowledging what he/she is saying), the parents will be  exposed to a different style of communication. One example of modeling behavior is requesting that the parents deal with the teenager in a logical format, instead of getting angry over how the teenager expresses him/herself, tell them to listen to what is being said. This can be modeled through active listening; asking the teenager for clarification on what he/she is trying to communicate. Once the parent(s) learn this skill, the teenager will become more trusting and open towards his/her family, which may alleviate future opportunities for making bad decisions.

The last step of MDFT, termed by Liddle as “shifting domains of specialization”, is, in my opinion, the second most crucial. This step, in effect, reconciles the teenager and his/her parent(s), especially if the alcohol problem was caused by painful events from the past.  This has been shown by different researchers to be the most difficult part because it needs to full preparation of the teenager and the parents.  The success rate at this level is highly determined by the preparation level of parents.  As shown in recent studies, parents who are unwilling to compromise with their teenagers experience a higher relapse rate in the teenager in relation to alcohol and substance abuse.  Over 57% of teenagers have experienced relapses due to the improper execution or absence of this process (Farrell 2006).  The relevance of this lies in the fact that the reinforcement that the teenager needs at this point must come from the parents.  53% of the teenagers have mentioned that they are more likely to relapse into alcohol and substance abuse when the parents are not willing to change or provide moral support.

Another approach to recovery treatment refers to an intensive home and community-based rehabilitation program for teenagers with severe behavioral problems grounded on substance abuse (Ogden and Hagen, 2006, p. 131). Multi-System Treatment (MST) works as an individualized treatment model where family members define specific goals of the rehabilitation process in partnership with the school counselor or therapist (depending  upon the severity of the problem).  This means that for those teenagers who have an alcohol dependency that is more severe than others such as those who frequently indulge in binge drinking (more than 5 drinks) a different approach is done.  The other teenagers who do not have such a severe problem are given a less intensive course.  This process involves the identification of problematic behavior, as well as the corresponding factors which triggered such behavior, with the end results of implementing solutions which will attenuate the conditions (Ken & David, 2007, p. 11).

The MST model is a pragmatic and goal focused treatment program that aims at addressing the factors that abound in the teenager’s social network.  The program therefore aims to improve certain discipline practices for the caregivers, deal with family related relations, target the interaction of teenagers with deviant peers, improve interaction with pro-social teenagers, improve school performance, and develop an indigenous support network from the community.  Specific treatment techniques used to facilitate these gains are integrated from those therapies that have the most empirical support, including cognitive behavioral, behavioral, and the pragmatic family therapies.

The advantage of this model is that these services are usually taken in context of the natural environment of the teenager such as the school, the home and the neighboring community.  It is essential, however that this treatment plan be instituted with the help of the family since it is family driven and not therapist driven.  This family based treatment is therefore one that focuses on the well-being of the teenager in relation to the external factors that are outside of the community.  It places a lot of emphasis on the family approach then extends this to the circle of friends and finally the community.  Under the MST program, when family members of the teenager work in synergy with school counselors and other therapists to develop and execute interventions, rehabilitation is not a remote possibility.

Finally, contingency management (CM) is another family-based rehabilitation program which applies behavioral methods to guide the teenager in avoiding circumstances which may be associated with the use of alcohol and encourages him/her to take part in group activities that do not promote alcohol or drug use. The end result will facilitate the transformation of the teenager’s perceptions and sentiments with respect to drinking and the consequences surrounding this action (Donahue and Azrin, 2001, p. 9).

Prevention of specific risk behaviors requires community coordination and varied input. Parents, teachers, school officials, health care workers, and community workers need to be part of strategies to prevent risk behaviors. Community organizations and resources have learned to work collaboratively on a number of issues, including violence, alcohol, drug use, and the prevention of pregnancy. Collaboration and coordination helps to reduce costs and improve efficiency as well as build community. The growing research provides evidence that youth may possess a number of concurrent risk factors for any of the behaviors that are outlined in this discourse (Donahue and Azrin, 2001, p. 9). There is overlap among the risk factors and behaviors and, therefore, prevention programs need to better consider the clustering of these components and develop programs that will address a number of these issues simultaneously.  This is something that the CM is able to accomplish due to its process of properly identifying the risk level of the teenager and the other circumstances that may add to the problem.

Multi-dimensional family therapy (MDFT), multi-systemic treatment (MST), and contingency management (CM) are family-based approaches generally used by school counselors, psychologists, psychiatrists and other professionals involved in the rehabilitation of teenage drinkers and alcoholics. These intervention techniques are significant because, primarily, the family has been recognized as a paramount influence on an individual during the period of adolescent, and secondly, growing research evidence has pinpointed that teenagers resort to alcohol as a refuge against disappointments and problems encountered within the family.

According to recent studies on teenage alcoholism, the most effective manner of dealing with the problem is by creating an environment where the teenager does not need to resort to drinking.  The main cause for teenage drinking has been found to be family related problems which accounts for 42% of the sample size coming from teenagers with that background.  Intervention and prevention programs have been weak in helping youth to manage risk and anticipate risky situations in advance (Eaton, 2005, p. 79). Because all risks cannot be eliminated, youth need to learn how to manage them. Prevention programs that make youth aware of how they may be at increased risk in certain situations and provide skills to deal with or avoid the situation may be most promising.

The main focus of multi-dimensional family therapy (MDFT) is the establishment of  “healing bonds” between the teenager and the family which precipitated the pain experienced by the teenage alcoholics, carried out by involving the family in the rehabilitation process. Multi-systemic treatment (MST) engages the family of the teenage alcoholic in tracing the roots of the alcoholism problem and ways by which such problems can be addressed. Finally, contingency management (CM), which is the most different of the three family-based intervention approaches, centers the spotlight on prevention measures and techniques to avoid situations which prompt the use of alcohol, with the support of the immediate family.

As shown in this brief discourse, all three intervention schemes are the most relevant programs in teenage alcoholism cases.  In the studies that were cited in this discussion, the treatment in working with teenagers involved with alcohol abuse required a hybrid scheme where the best features of each of the three intervention practices were collectively utilized to produce successful outcomes. These features include the “healing” powers of MDFT, the family-based problem solving feature of MST, and the preventive measures of CM.

The success rate of this multi faceted approach is quite high.  More than (52%) half of the teenagers who were under the hybrid scheme treatment program have maintained their sober rate (Eaton, 2005, p. 79).  It has been shown that most of efforts in helping students and their drinking problems were successes, because in each case, the families of the students were an integral part in addressing the alcohol problem of the students.  It is therefore argued that interest from the family members is the most vital aspect in eradicating alcohol use amongst teenagers.

The family remains the most significant unit in society.  As the most basic and important unit, the family also has many responsibilities.  One of these responsibilities, as shown in this brief discourse, is the assistance to troubled youth.  As the main component to curb teenage alcohol use, many researchers believe that preparing a pamphlet that is addressed to family members will be the best way to resolve this issue (Eaton, 2005, p. 79).  These are among the many things that the family can do to address this issue.

Given that there are many rehabilitation programs such as the CM, MDFT and MST, that have also proven to be successful, the challenge that lies before most researchers and therapists now is in identifying what program will be most effective in helping the teenagers.  At the end of the day, it does not really matter which program is used.  The most important thing is getting the rehabilitation of the troubled teens underway and helping them recover from their addiction.

References:

American Academy of Child and Adolescent Psychiatry (2007). Teens: Alcohol and Other Drugs. Retrieved September 22, 2007 from http://aacap.org/cs/root/ facts_for_families/ teens_alcohol_and_other_drugs.

Brounstein, P.J., & Zweig, J.M. (2000). Understanding substance abuse prevention. Toward the 21st century: A primer on effective programs. Washington, DC: Substance Abuse and Mental Health Services Administration.

Donohue, B. & Azrin, N.H. (2001). Family behavior therapy. In E.F. Wagner & H.B. Saldron (Eds.) Innovations in Adolescent Substance Abuse (pp. 205-227). New York: Pergamon.
(Ken & David 2007), Social-economic decline due to substance abuse by teens: An intelligence approach to teen physiology through counter brain measures. Goldman Intelligence, Nairobi p1-5

Eaton, Danice K. (2005) Youth Risk Behavior Surveillance. Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion. pages 1-107

Farrell, A.D., Kung, E.M., White, K.S., & Valois, R.F. (2006). The structure of selfreported aggression, drug use and delinquent behaviors during early adolescence. Journal of Clinical Child Psychology, 29(2), 282-292.

Laursen, B., & Williams, V. (1997). Perceptions of interdependence and closeness in family and peer relationships among adolescents with and without romantic partners. New Directions for Child Development, 78, 3-20.

Liddle, H. A. (2003). Multidimensional Family Therapy for Early Adolescent Substance Abuse Treatment Manual. Center for Treatment Research on Adolescent Drug Abuse, Department of Epidemiology and Public Health. Miami, Florida: University of Miami School of Medicine.

Ogden, T. & Hagen, K. A. (2006). Multisystemic treatment of serious behavior problems in youth: Sustainability of effectiveness two years after intake. Child and Adolescent Mental Health. Volume 11 Number 3. Malden, Massachusetts: Blackwell Synergy.

YRBSS: Youth Risk Behavior Surveillance System (2005). Retrieved October 27th from:

 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5505a1.htm