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Group-Based Outpatient Treatment for Adolescent Substance Abuse Group-Based Outpatient Treatment for Adolescent Substance Abuse Elizabeth C. Katz, Ph.D.1 Emily A. Sears, M.S.1,2 Cynthia A. Adams, M.A.1,2 Robert J. Battjes, D.S.W.1 and The Epoch Counseling Center Adolescent Treatment Team2 The Social Research Center1 Friends Research Institute, Inc. 1040 Park Avenue, Suite 103 Baltimore, MD 21201 and Epoch Counseling Center2 800 Ingleside Avenue Catonsville, MD 21228 This manual was prepared under funding provided by grant no. KD1TI11874 from the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Administration (SAMHSA). The treatment model and approaches described in this manual are those of the authors and do not necessarily reflect views or policies of CSAT or SAMHSA. 1 Group-Based Outpatient Treatment for Adolescent Substance Abuse Elizabeth C. Katz, Ph.D., Emily A. Sears, M.S., Cynthia A. Adams, M.A., Robert J. Battjes, D.S.W., and The Epoch Counseling Center Adolescent Treatment Team This manual describes a moderate-intensity group-based approach to adolescent outpatient substance abuse treatment, implemented by the Epoch Counseling Center, Baltimore County, Maryland. The Group-Based Outpatient Treatment for Adolescent Substance Abuse (GBT) program combines a 20-week group counseling intervention with individual and family therapy and is designed to address the issues and problems commonly facing adolescent substance abusers ages 14 to 18 years old. This manual provides an overview of the theoretical basis for the intervention, a brief description of the outpatient drug-free treatment program within which the adolescent intervention was implemented, and a curriculum guide for implementing the treatment protocol. 2 Table of Contents Preface I. Introduction A. Adolescent Program Overview B. Theoretical Orientation II. Organizational Overview A. Administrative Structure B. Funding C. Adolescent Program Staffing D. Clinical Supervision E. Adolescent Clientele and Referral Sources F. Program Policies and Procedures G. Treatment Termination III. Overview of the Epoch Counseling Center GBT A. Inclusion/Exclusion Criteria for GBT B. Initial Screening C. Intake Assessment D. Treatment Planning E. Group Counseling F. Individual Counseling G. Family Therapy H. Parent Education and Support Group I. Time Course in Treatment IV. Curricula A. Group Counseling Phase I—Drug Education B. Group Counseling Phase II—Relapse Prevention C. Parent Education and Support Group V. Special Issues Regarding Program Implementation A. Behavioral Contracts B. Non-Compliance C. Continued Substance Use During Treatment D. Attending Treatment Sessions Intoxicated E. Lack of Parental Involvement in Treatment F. Co-Occurring Mental Disorders/Learning Disabilities VI. The Evaluation Project A. Overview of the Program Evaluation B. Focus of the Evaluation C. Assessment Instruments D. Integration of the Evaluation into the Epoch Adolescent Program E. Status of the Program Evaluation VII Appendices A. Appendix A – Phase I Drug Education Exercises B. Appendix B – Phase II Relapse Prevention C. Appendix C – Parent Education and Support Group 3 Preface This manual describes a moderate-intensity group-based approach to adolescent outpatient substance abuse treatment, implemented by the Epoch Counseling Center, Baltimore County, Maryland. The Group-Based Outpatient Treatment for Adolescent Substance Abuse (GBT) program combines a 20-week group counseling intervention with individual and family therapy and is designed to address the issues and problems commonly facing adolescent substance abusers ages 14 to 18 years old. This manual provides an overview of the theoretical basis for the intervention, a brief description of the outpatient drug-free treatment program within which the adolescent intervention was implemented, and a curriculum guide for implementing the treatment protocol. This group-based adolescent treatment model was developed jointly by Epoch Counseling Center’s adolescent treatment staff and clinical researchers at the Social Research Center (SRC), both of which are divisions of Friends Research Institute, Inc. The development and evaluation of this intervention was supported by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration, under its Adolescent Treatment Models (ATM) program. Robert J. Battjes, D.S.W. was the project’s principal investigator. Elizabeth C. Katz, Ph.D., and Emily A. Sears, M.S., had lead responsibility for development of the Group Counseling component, while Cynthia A. Adams, M.A., had lead responsibility for the Parent Education and Support Group component. The Epoch Counseling Center Adolescent Treatment Team contributed extensively to the development, testing, and implementation of this Group-Based Treatment curriculum. The Epoch Adolescent Treatment Team included: Richard Bateman, Teal Beatty, Gary Brown, Susan Chirichillo, Chris Collins, Stacy Frank, Diana Givens, Charles Hall, Judith Horst, Jerome Johnson, Wayne Lawson, Barbara Lingenfelter, Donna Lucker, Jan Marshall, Kathleen Nunn, Claudia Reynolds, Anna Soisson, Robert Storey, Gail Swanbeck, Marsha Swilley, and Judy Walsh. Other individuals who contributed to the implementation and evaluation of this adolescent treatment model included: The Motivational Interviewing Team: Joseph Ciarrocchi, Supervisor; Stacy Louk, Donna Lucker, Manette Mapa, Colin Rhoades, and Stephanie Van Duesen. The Counseling Overview Team: Marc Transparenti and Anna Soisson The Research Team: Robert Battjes, Principal Investigator; Timothy Kinlock, Co- Investigator; Michael Gordon, Project Manager; Kathryn Couvillion, Sharon Kelly, Donna Lucker, and Karen Murphy, Research Interviewers; Heather Schacht Reisinger, Ethnographic Project Manager; Trevor Bush and Alejandra Colon, Ethnographers; and Thomas Young, Administrative Assistant. In addition to the above individuals, the authors wish to thank Randolph Muck and Jutta Butler of CSAT for their assistance throughout this project; Mark Senior, Program Coordinator, Services Research Office, University of Arizona, for his helpful suggestions regarding an earlier draft of this manual; and Melissa Harris for assistance in manuscript preparation. Requests for information may be directed to Ms. Emily Sears, Social Research Center, 1040 Park Avenue, Suite 103, Baltimore, MD 21201; (410) 837-3977; [email protected]. Robert J. Battjes, D.S.W. Diana Givens, M.S. 4 Director Director Social Research Center Epoch Counseling Center Friends Research Institute, Inc. Friends Research Institute, Inc. 5 I. Introduction A. Adolescent Program Overview Epoch Counseling Center’s Group-Based Outpatient Treatment for Adolescent Substance Abuse (GBT) is a 20-week program that consists primarily of group counseling, with limited individual counseling and family therapy incorporated into the program. In addition, Parent Education and Support Groups are an optional component of treatment. While the treatment program is designed as a 20-week program, length of participation can vary depending on individual client need and attendance. The Epoch GBT is categorized as an Adolescent Level I treatment program according to the American Society of Addiction Medicine Patient Placement Criteria (ASAM-PPC, ASAM, 1996). The Epoch GBT is designed for youth ages 14 through 17, with 18 year olds included if they are still in high school. It is intended for youth whose treatment needs can largely be met through a moderate intensity, group treatment approach. While the program is primarily a group intervention, individual sessions are included for treatment planning purposes and crisis intervention, and family therapy is provided to address family conflict and communication problems and to teach parents appropriate parenting skills, discipline, and other behaviors needed to help adolescents achieve and maintain abstinence. B. Theoretical Orientation The Epoch Counseling Center adolescent treatment program is based on the premise that substance use is primarily learned behavior (Bigelow, Brooner, & Silverman, 1998). Although the role of genetics is acknowledged, it is not emphasized in the Epoch program. The Epoch program has its foundations in social learning theory (Abrams & Niaura, 1987; Bandura, 1977), which primarily explains initiation and progression of use, and conditioning theory (i.e., instrumental and classical conditioning) (Pavlov 1927; Skinner, 1953), which explains progression and maintenance of substance use. Consistent with social learning theory, adolescents develop beliefs about substance use through modeling, that is, by observing salient role models’ (e.g., parents, siblings, or peers) use of substances and experience of consequences. It is these beliefs about the consequences of drinking or drug use (called outcome expectancies), which develop in the absence of personal drinking experience, that influence subsequent use. Research has shown, for example, that children with little or no prior drinking experience hold outcome expectancies for alcohol (Miller, Smith, & Goldman, 1990; Query, Rosenberg, & Tisak, 1998). These early expectancies influence drinking onset such that children with positive expectancies begin drinking earlier than those who hold negative expectancies for alcohol (Killen et al., 1996; Smith, Goldman, Greenbaum, & Christiansen, 1995). Modeling also influences the escalation of substance use. For example, Collins and Marlatt (1981) demonstrated that social drinkers consumed more alcohol in the presence of a heavy-drinking model than
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