Group-Based Outpatient Treatment for Adolescent

Group-Based Outpatient Treatment for Adolescent Substance Abuse

Group-Based Outpatient Treatment for Adolescent Substance Abuse

INDRODUCTION

This research paper will discuss the strategies needed when using group therapy for treatment of adolescent substance or alcoholic dependence. Included in the discussion will be an introduction to the group-based outpatient therapy and a discussion of its significance to group work. 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.

The purpose of this session is to help clients make the connection between stress and coping mechanisms. People often use substances to cope with stress, perhaps not realizing the short-term solution this act may provide, nor understanding that drugs and alcohol may worsen a situation rather than relieve it. Stress can be managed effectively using appropriate strategies, however, these strategies that are more effective in handling stress need to be learned. Through developing an understanding of current stress levels and identifying how their bodies respond to stress adolescents can heighten their personal awareness of stress they experience, how to cope with it, and how to control it for their emotional and physical health.

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 when they were exposed to a light-drinking model.

Conditioning theory, both operant and classical, explains substance use escalation and maintenance. Consistent with the theory of operant conditioning, which specifies that behaviors that are followed by reinforcement are repeated (Skinner, 1958), adolescents continue to use substances because, once they have initiated use, they are reinforced by the positive effects of the substance. Through classical conditioning (Pavlov, 1927) substance use becomes associated with a myriad of cues (e.g., people, places, and things) that are present in the environment whenever the adolescent ...