engaging young people with addiction in...

www.mghcme.org

Engaging Young People with Addiction in Treatment

James McKowen, Ph.D.

Addiction Recovery Management Service (ARMS)

Orlando, FL 2016

www.mghcme.org

Disclosures

Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest

to disclose.

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Goals of Talk

Addiction Recovery Management Service

Adapting Traditional Models of Care

Developmental Challenges in Youth

Scope of Problem in Youth

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0

10

20

30

40

50

60

70

80

90

100

12

-13

14

-15

16

-17

18

-20

21

-29

30

-34

35

-49

50

-64

65

+

Light Alcohol Use Only

Any Infrequent Drug Use

Regular AOD Use

Abuse

Dependence

Severity Category

NSDUH 2007; https://nsduhweb.rti.org

Perc

enta

ge o

f sa

mp

le

Age

Substance Use By Age

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0

10

20

30

40

50

60

70

80

90

100

12

-13

14

-15

16

-17

18

-20

21

-29

30

-34

35

-49

50

-64

65

+

Light Alcohol Use Only

Any Infrequent Drug Use

Regular AOD Use

Abuse

Dependence

Severity Category

NSDUH 2007; https://nsduhweb.rti.org

Perc

enta

ge o

f sa

mp

le

Age

Substance Use By Age

www.mghcme.org

0

10

20

30

40

50

60

70

80

90

100

12

-13

14

-15

16

-17

18

-20

21

-29

30

-34

35

-49

50

-64

65

+

Light Alcohol Use Only

Any Infrequent Drug Use

Regular AOD Use

Abuse

Dependence

Severity Category

NSDUH 2007; https://nsduhweb.rti.org

Perc

enta

ge o

f sa

mp

le

Age

Substance Use By Age

www.mghcme.org NSDUH 2014; https://nsduhweb.rti.org

Impact of Psychological Distress on Use

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Very few young adults engage in treatment

21% of youth need treatment for a substance use disorder (SAMHSA, 2009)

96% do not perceive the need to attend treatment (SAMHSA, 2009)

Only 10% of youth with substance use disorders enter treatment (NSDUH, 2013)

Only half finish treatment with mean length of time in treatment is 50 days (Dennis, 2005)

WHY ARE YOUTH SO AT RISK?

Cognitive Development

WHY SO AT RISK?

Cognitive Development

Social Influences

WHY SO AT RISK?

Cognitive Development

Social Influences

Access & Availability

WHY SO AT RISK?

Cognitive Development

Social Influences Family Factors

WHY SO AT RISK?

Access & Availability

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14

Traditional Treatment Models of Care

Traditional Treatment Pediatric Adult

Pediatric Transitional Age Youth

(TAY) Adult

Age 18

Age 15 to 25

New

Approach

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• Youth with addiction differ from adults:

– Less physical & psychological dependence than older adults

– Fewer negative consequences & severity

– More likely to relapse due to social factors

– More dependent on family

– More likely to drop out of care

Why Rethink Traditional Treatment Models of Care?

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Different Use Profiles

Support Effective

Individuation

Understand Emerging Executive Control

Different Reinforcement

of Use and Change

Novel Engagement

Opportunities

Understand Contextual

Factors

Newer Models of Care For TAY

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Newer Models of Care: ARMS

• Recovery Management Philosophy

• Established in 2007

• Focuses on 14 – 26 year olds and their parents

• Patient centered care: motivational model

• Evidence-based psychosocial treatments

• Medication Management

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Treatment at ARMS: Flow of patient engagement

Ready for Sobriety Not ready for

sobriety

Evaluation

- Readiness Group

- Motivational Therapy

- Medication

-Intensive Outpatient Program

- Therapy

- Medication Long-term Recovery Group

Parent Engagement

Initial Youth Engagement:

- Call/text

- Meet & Greet

• Rapidly engage – capitalize on motivational window

• Risk Adjusted Intake Process

• “Meet and greet” option

• Modify intake length/content

Referral

• Evidence-base youth treatments – ACRA/ACC

• Contingency Management

• Family Engagement - CRAFT

• Match treatment to readiness

• Support functional goals not just substance outcome

• Consider Shorter Sessions and Adapt Frequency

Treatment

Engaging Youth at ARMS

• Educate staff on unique aspects to TAY

• Accept waxing/waning readiness

• Individuation issues – experiential learning

• Risk Rounds

• Consider overall reduced caseload

Clinician Adaptations

• Transparent consent for communication

• Care Coordination: school, college, court

• Peer facilitators link to mutual help

• Recognize markers of goal attainment

• Voicemail is dead!

• Provide snacks!

Other Considerations

Programmatic Adaptations Supporting TAY

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Further ARMS Goals with TAY

• Data collection on TAY

• Predictors of Engagement & Retention

• Community Linkage to Recovery Supports

• Recovery Coaches

• Technology

• Social media

• Location of engagement

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Take Homes

Early intervention reduces morbidity and mortality

Traditional models of care are inadequate

Different risk factors, neurodevelopmental issues, substance use profiles, and motivators of change

Novel strategies are needed to foster engagement and retention

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Thank You

• Contact: James McKowen, Ph.D.

• Email: jmckowen@partners.org

• Twitter: @DrJamesMcKowen