Trish Caldwell, MFT, LPC, CCDPD, CAADC, CCTP

Director of Family Services Recovery Centers of America

Brain Development

• Adolescence is a period of significant brain change.

• The developmental period extends into the mid-20s

• During adolescence ‘pruning’ occurs, leaving a brain that is faster and more efficient.

• There is differential effectiveness of various regions in the brain until the ‘pruning’ is complete

Images of Brain Development in

Healthy Children and Teens (Ages

5-20)

• The image depicts top and side views of the developing brain.

• The prefrontal cortex is the last area of the brain to mature.

• The brain continues to develop through early adulthood. Mature brain regions at each developmental stage are indicated in blue.

• The prefrontal cortex (red circles), which governs judgment and self-control, is the last part of the brain to mature.

Source: PNAS 101:8174–8179, 2004.

Brain Development

• Brain plasticity and critical period for learning emotion regulation –

implications for window of optimal intervention (Dahl, 2004)

• Vulnerability as opportunity

• Risk taking, intensity, arousal/sensation seeking and emotional vulnerability

as normative with context as a mediating valuable toward dysfunction

• Not everyone on the same place on the continuum of risk and thrill seeking

A look at Today’s Substances Use Crisis

In Context

In Context..

Young Adults are those Most Impacted Today

Source: Drug Facts 2008

A Change in Treatment for Families

The Importance of Family

• Addiction is a disease of isolation,

and the healing of this disease is

through the connection to others

and themselves

• All of our patients can be better

understood in the context of others

• We are not a vacuum

National Institute on Drug Abuse

• Recently published a research-based guide to addiction treatment for adolescents and young adults, mapping the key components that every young adult treatment facility should consider when treating a young patient.

• It is clear that early addiction treatment should be approached differently than drug treatment for adults over the age of 25.

Uniqueness of the Family System with YA

• Because so many of the young adults are still living in their homes, it is

imperative to include the family system throughout treatment, despite the

reluctance of the young adult.

• Caregivers who are involved in treatment, understand its importance,

work with treatment providers, and are engaged in recovery are more likely

to see successful recovery in their loved one than those who aren’t

involved, National Child Traumatic Stress Network (NCTSN).

Family Programming for Young Adults

• Working with young adults makes it particularly important for families and loved ones to provide constant support and encouragement. Conversations with the young adults and family’s needs to be a significant part of treatment to discuss boundaries, setting realistic goals and setting up parameters to help the young adult achieve these goals.

• Weekly family therapy and contact• Psychoeducational seminars • Multifamily DBT

Young adult Substance Use treatment should comprise of:

• Early Intervention: Going into the community, speaking at local high schools, colleges/ Universities and offering support and education to the community about early intervention and the necessity for treatment as soon as an issue is noticed.

• A Customized, Personalized Treatment Plan with special attention to co-occurring disorders (anxiety, ADHD and depression)

Young adult addiction treatment should comprise of:

• Behavioral Therapy and CBT: Behavioral therapy and CBT work to provide concrete skills while challenging distorted thought patterns perpetuating old behaviors.

• Contingency Management (CM)- explore ways to utilize this for the young adults who need immediate gratification.

• Staff knowledge of Young adults development needs, which are unique to those over ages 23-25. Motivational Enhancement Therapy (MET)

• Twelve-Step Facilitation Therapy

Special

Considerations

for Families of

Young Adults

Families develop patterns of behaviors which become integrated into the family structure.

Families organize around the use, often times prior to knowing of the SUD and create patterns of behaviors that may perpetuate use

Because the family roles have been compromised the family takes on additional behaviors to “protect” the child- “enabling and codependency”

Renegotiating relationshipsbetween child and parent

Families were not done “raising” their child when the addiction started and set in

As a result families are often times confused

with how to help support and raise their

child

Increase effective communication

Removing the shame associated with the

behaviors- for families and the young adult

See the behaviors as a sign of the disease

Family Patterns

Role changes and reversals

Control and power struggles

“Family energy” surround the substance

use and its sequelae

Family defenses of ambivalence and denial

Social withdrawal and isolation

“Fear of shame”

The Role

of Trauma

on

Impacted

Families

Similar to their loved one, the brains of family members become hijacked by addiction and the parts of the brain organized around addiction and “survival” are strengthened

This leads to families behaviors to “save” their child, despite the behaviors compromising their recovery

How Should Families be Involved

• Addiction centers for young adults should encourage family involvement at every step of the treatment plan.

• Professionals should further facilitate communication and relationships with parents, siblings, and friends to better strengthen that essential support system.

• Family Engagement and Education: Offer weekly family sessions.

Family Sessions- Do’s

• The family approach makes an effort to bring families and loved ones back together instead of focusing solely on the individual battling addiction

• Family therapy sessions and family-based approaches emphasize that changes may need to be made to the family dynamic in order to support recovery.

• One of the developmental tasks of emerging adults is to develop independence from their parents.

• The developmental task of launching is often interrupted by addiction and Family therapy can help prepare both the young adult and the family to be able to successfully achieve this milestone

• Support and education on the ability to develop healthy boundaries

• May mean having separate meetings with the emerging adult and families with a different focus for each

• Families need their own treatment to help them understand the disease, to help their child individuate

• Families need to learn to ask themselves before engaging in a behavior “who is it going to benefit”

• Education and support on “protecting the disease” versus enabling

Family Sessions- Do’s

Family Session “Don’ts”

• Traditional family therapy, which may focus on how the emerging adults’ substance use disorder impacts parents and other family members, may be counterproductive.

• Such an approach may lead emerging adults to feel angry or hostile and will unintentionally keep them in the role of adolescent as the parents scold them for what they have been doing wrong

How to

help

Families

Support

Their

Loved

One

Provide educational groups for families regarding diagnosis and symptoms of relapse

Teach skills to improve relationships

Bring family into therapy sessions to help with communication and boundary setting

Offer advice regarding relationships and how to support recovery behaviors as opposed to addictive or crisis oriented behaviors