As technology and social media become more prevalent, mental health and subsequent drug abuse cases are rising. Young people are swamped by artificial lifestyles which the majority of people will never be able to attain. These lead to flawed expectations and propagate feelings of low self-esteem and diminished confidence. In the UK, 10% of children and young people aged five to sixteen have a clinically diagnosable mental health problem; and 50% of mental health problems are established by the age of 14.[1] As these mental health issues materialise, many adolescents turn to illegal substances as a solution.

While recovery institutes and therapists are trying their best, too many young people are failing to complete their recovery. In the United States, it is a serious issue. Research illustrates there is a general trend of substance relapse and subsequent treatment readmission among adolescents. And one study found that 61.1% of adolescents who completed a 28-day inpatient treatment programme, relapsed to pre-treatment usage levels within 12 months of treatment. These are worrying numbers for such young people.[2]

The issue is complex. Young people need support from their families but, in many cases, they also need space. Mental health issues or addictions are personal and need to be addressed by that particular individual as families and therapists can only do so much. The balance is a fine line; many get it wrong. This article aims to look at youth recovery and why it is such a precarious issue, the role of families and what they can be doing to ensure their child has the best chance to fully recover.

Why is there a problem with young people and recovery?

Youth recovery is difficult because it is different. Historically, substance abuse for young people was grouped alongside adult recovery. Results were underwhelming, as cases were worlds apart. Now, practitioners and research view adolescents under a different framework – they are no longer viewed as ‘miniature adults.’[3] They require considerably different approaches and must take into account a number of factors that may initiate a relapse. These factors include: severity of substance addiction; individual motivation and skills for abstinence; co-occurring mental illness; a safe and supportive family; and having peers that are supportive of one’s recovery environment.[4] Adolescents need sustained support that meets the same level of treatment required for chronic diseases. Like many things with young people, staying focused is an issue. It is what happens after treatment that defines the recovery process. This is why families are so important – they are there to nurture their loved ones back to normality. But their role during recovery is also complex.

What is the family’s role?

Family members often provide the best support and care. More often than not, they are encouraged to be central to their loved one’s recovery, especially when it concerns an adolescent. Despite this, the general benefit of family-based interventions is relative to each particular case. For many therapists, engaging families and managing the right level of support can be one of the greatest challenges.[5] It is common for adults to misunderstand issues with their children, often perceiving them to be lazy, lacking in motivation or wilfully misbehaving.[6] The family’s role can both support and impede recovery.[7]

There are also potential risks associated with how a family may allow a child’s condition to manifest. Are they a cause of the mental disorder or substance issue? As Dr Kevin Wandler, Chief Medical Officer, Advanced Recovery Systems suggests: “The family has to be a part of the solution. The exception is, of course, if the parents are a part of the problem.”[8]

Family involvement should be based on the therapist’s recommendation. There are, however, some basic forms of support families can follow – a necessary toolbox for helping young people who may find themselves in volatile situations with mental health and substances.

Cooperation and Reflection

Families should also cooperate with the therapist and identify where deeper issues may lie. Remember, adolescent behavioural disorders can sometimes reflect larger maladaptive family interactions.[9] In the context of substance abuse, this process is what, Dr Jose

Szapocznik, calls ‘Brief Strategic Family Therapy’. He refers to this particular stage as joining and tracking.[10] Joining is the start of collaboration. It is where the therapist moves from being a peripheral figure in the recovery, to a central member of the therapeutic team, including the family. From here, the therapist must empathise with the family’s needs, while the family cooperates accordingly.

The tracking process is a case of identifying issues within the family. It is a ‘diagnostic enactment intervention, utilised to systematically identify the family’s interactional strengths and weaknesses.’ With these in mind, families and adolescents have access to a unique treatment plan, shaped around what works and what is ineffective within that specific family.[11]

A Positive Environment

Firstly, families must create a motivational context for change. This is required when children are both in and out of treatment. It is all about generating a positive and constructive atmosphere, making the child feel comfortable and driven to find a solution.[12] Negativity is one of the strongest predictors of early dropout for both children and their families during therapy[13] – so it is vital that family members do their best to maintain a positive environment. Families can help establish this motivational context post-treatment, by encouraging their children to participate in healthy and proactive hobbies.[14] Activities with an end goal occupy the mind and provide some meaning and purpose. It is too easy to be overwhelmed by a substance or mental health issue; hobbies are a necessary respite, and a doorway to real change.

Monitor Behaviour

The post-treatment phase is perhaps the most difficult to navigate. There are fewer sessions and interaction with therapists is restricted. These are, however, some of the most important stages to ensure a long-term recovery. The family’s role is vital. They have essentially taken the reigns of recovery at this point and must remain committed to their child’s needs.

As an adolescent is reintroduced to normal life, they are incredibly vulnerable. Exposure to ‘the wrong crowd’, online platforms and potential temptations are unavoidable; it is how families manage these, that makes the real difference. They should be aware of online activity. If a recovering child is exposed to drug use or anything associated to their issue online, this may trigger a relapse.[15] Families should also closely monitor a child’s peer group: if they are surrounded by the wrong people, relapse is almost inevitable. These may feel intrusive, but they are necessary. Any significant changes in behaviour during recovery suggest something is not right. By closely monitoring behaviour, families can prevent these behavioural changes from materialising.

The recovery process is incredibly taxing; when it involves families, even more so. Relationships and familial bonds can be broken by mental health issues and cases of substance abuse. The emotional drain is usually why so many families become disengaged from the entire process – it is a real test of strength. It is a daunting process, but it is manageable. Families and adolescents in recovery must try their best to create positive environments and a motivational context for change. This means sometimes assessing the family’s role in enabling or accommodating a child’s issue. It is a case of collaboration and intense commitment. At times it is an uphill battle. But in the end, a reunited and healthy family makes it all worthwhile.

Sources:

[1] Mental Health Foundation. Webpage. Mental health statistics: children and young people, [online], available at: https://www.mentalhealth.org.uk/statistics/mental-health-statistics-children-and-young-people [accessed 27/7/2020]

[2] Fisher, E. A. 2014. Recovery Supports for Young People: What Do Existing Supports Reveal About the Recovery Environment? [online], available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078875/ [accessed 27/7/2020]

[3] Fisher, E. A. 2014. Recovery Supports for Young People: What Do Existing Supports Reveal About the Recovery Environment? [online], available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078875/ [accessed 27/7/2020]

[4] Fisher, E. A. 2014. Recovery Supports for Young People: What Do Existing Supports Reveal About the Recovery Environment? [online], available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078875/ [accessed 27/7/2020]

[5] Szapocznik, J. 2013. Brief Strategic Family Therapy: Engaging Drug Using/Problem Behavior Adolescents and their Families into Treatment, [online], available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995135/ [accessed 27/7/2020]

[6] Cramm, H. et al. 2013. Broadening the Occupational Therapy Toolkit: An Executive Functioning Lens for Occupational Therapy With Children and Youth. Am J Occup Ther, [online], available at: https://doi.org/10.5014/ajot.2013.008607 [accessed 27/7/2020]

[7] Waller, S., Reupert, A., Ward, B., McCormick, F. and Kidd, S. 2019. Family‐focused recovery: Perspectives from individuals with a mental illness. Int J Mental Health Nurs, [online], available at: doi:10.1111/inm.12528

[8] DrugRehab.com. Webpage. Chris Elkins. Blog. 2020. Teen Recovery. [online], available at: https://www.drugrehab.com/teens/recovery/ [accessed 27/7/2020]

[9] Szapocznik, J. 2013. Brief Strategic Family Therapy: Engaging Drug Using/Problem Behavior Adolescents and their Families into Treatment.

[10] ibid.

[11] ibid.

[12] ibid.

[13] ibid.

[14] DrugRehab.com. Webpage. Chris Elkins. Blog. 2020. Teen Recovery. [accessed 27/7/2020]

[15] ibid.