Can Adolescents Benefit from Recovery Coaches?

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Substance Abuse Programs for Teens Lacking in U.S.

Few substance abuse programs in the U.S. offer high-quality treatment designed specifically for adolescents, a new study finds.

Of the more than 700 treatment programs the study surveyed, less than one-third had specialized services for teenagers — with some excluding underage patients altogether and others integrating them with adult patients.

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Can Adolescents Benefit from Recovery Coaches?

Written by Mark Sanders, LCSW, CADC

Tuesday, 22 July 2008 08:02

In addiction recovery there is something magical about 90 days. Research reveals that 90 days is the minimum recommended service dosage for those receiving chemical dependence treatment, and the great majority of chemically dependent clients who relapse do so within the first 90 days after leaving treatment (GLATTC Bulletin, 2005), with aftercare often being relegated to an “afterthought” by the treatment community. Surveys reveal that, among those referred to 12-step groups by the treatment community, the great majority discontinue their attendance within 90 days (Nowinski, et al, 1992 & 1999).

The use of recovery coaches with adults is achieving promising results in helping clients with early recovery and beyond (GLATTC.org, 2005). In Connecticut, Phil Valentine is director of a recovery support services volunteer program. He has recruited 150 recovering volunteers who visit treatment centers and ask clients if they can call them once a week for 12 weeks (90 days) to offer recovery support upon their discharge. According to Valentine, 80 percent of these individuals receiving telephonic recovery support are sober at the end of the 90-day period (GLATTC.org, 2007). This is significantly higher than national averages. A recovery coach is often the person who serves as a guide in supporting individual recovery. His or her primary credential is not possession of an advanced degree; it is the fact that he or she has “been there.” This coach is a lifestyle consultant whose individual story is proof that recovery is possible. The recovery coach differs from a sponsor in that a sponsor primarily supports one pathway to recovery, namely the 12-Step approach, while the recovery coach is charged with supporting multiple pathways to recovery. The recovery coach differs from a therapist in that he or she does not do a lot of probing, uncovering unconscious material, delving into the interactions between the id and superego, or making diagnoses. Instead, he or she provides recovery support ongoing in the client’s natural environment (White, et al., 2006). This is significant, because the great majority of treatment centers often have only one or two contacts with clients following discharge.

The use of recovery coaches is a micro-strategy that falls under the umbrella of the larger approach — recovery management. By definition, recovery management is an approach that shifts from treating addiction in short-term acute episodes toward how we traditionally treat other chronic and progressive illnesses (diabetes, cancer, etc.) (GLATTC Bulletin, 2005). There is evidence that substance use disorders, particularly substance dependence, are chronic illnesses (McClellan & White, 2002). Yet, we have historically treated them as though they are acute illnesses, i.e., three days of detox, 14 days of residential treatment, three weeks of intensive outpatient treatment, etc. According to the American Medical Association, chronic illnesses are considered to be in remission after five years of stability. There are very few five-year chemical dependence programs in the country, leaving most clients with an inadequate service dose.

Thus far, most of the emphasis on recovery management and recovery coaching has focused on adult populations. Can adolescents benefit from a recovery coach? My answer is yes, for a number of reasons.

• The majority of adolescents with substance use disorders have co-occurring conditions requiring recovery support to help manage the multiple stresses (Riggs & Davies, 2002).
• Like adults, the great majority of adolescents who relapse do so within the first three months of leaving treatment (Mayeda & Sanders, 2007).
• Navigating relationships with peers can be a major relapse trigger for adolescents; they can use support in this area (Liddle & Rowe, 2003).
• For adolescents, who are the most difficult to reach, there often exists a combination of risk factors that increases the chances of relapse and incarceration, including living in high-risk communities, where there are high crime and poverty rates. Residential treatment can temporarily remove these adolescents from their living environment. They eventually go home, and they can often benefit from support in designing a course to stay sober. Support from a recovery coach who is comfortable interacting with teens in their natural environment can be helpful (Mayeda & Sanders, 2007).
• Substance use disorders are “family illnesses” (Sanders, CADC Preparation Manual, 2003). A great majority of adolescents can benefit from recovery support when interacting with their family of origin. In a recent focus group with adolescents who have substance use disorders, they revealed that problems within their families was their number one stressor when leaving treatment.
• School stress — academic problems are particularly stressful for adolescents with substance use disorders (Liddle & Rowe, 2003). Many have been expelled or have dropped out of school as a result of problems caused by their substance use. They can use recovery support in their efforts to be reengaged with the school climate and to deal with high-risk situations, which can trigger their urge to use.
• Adolescents also need social recovery support. In many communities it is seen as “cool” for adolescents to get high. Some of the teens in the focus group said that in their communities it seems as though almost everyone gets high. They mention how difficult it is to stay sober in such an environment. A recovery coach can help them learn how to navigate social situations that increase their risk of relapse.

With adult populations, recovery coaches are often adults who have been sober for at least one year or longer. Who qualifies to serve as a recovery coach for teens? Is the ideal coach an adolescent who has been sober for at least one year, an adolescent who has been sober for two or more years, a young adult in recovery who can share his or her recovery experience, an adult in his or her thirties (recovering or not) or a trained psychotherapist, etc? This question was posed to teens in the aforementioned focus group. The consensus was that an ideal recovery coach would be a young adult, aged 25 or younger, with two or more years of recovery. They indicated that, because someone with these criteria was still young, he or she would be someone to whom they could relate — young enough to understand their concerns, yet experienced in recovery. When asked what they considered an “older” recovery support specialist, the teens said “anyone over 35.” They also said they would be receptive to receivingrecovery support from “older adults” if they were sincere, willing to be honest and had a “good vibe.”

My interview was with one group of adolescents. It is necessary to continue to explore the question of who qualifies to be a recovery coach with adolescents. Things to consider include:

• What is the appropriate age of the coach?
• How important is gender-pairing?
• Cultural competence
• Sobriety status (Must the coach be a recovering person?)
• Does the coach need to be technology savvy, as many adolescents today communicate via technology (cell phones, text messages, MySpace, etc.)?
• Should the recovery support specialist be called a “coach”? Perhaps adolescents would be more comfortable with different language, such as “peer recovery support specialist, etc.”
• What knowledge do recovery coaches need about adolescents in order to be effective?
• Should we use an individualized approach in pairing youth with recovery coaches, with the youth having the final say?

It is commonly said that adolescents are our future, but they are also our present, our right now! As adolescents develop substance use disorders, they are important enough for us to create the best possible services for them, making sure that they have a voice in the process.

Mark Sanders, LCSW, CADC, is on the faculty of the addictions studies program at Governors State University. He is a consultant for Great Lakes ATTC and CEO of On The Mark Consulting, an international training and consulting organization.

References

GLATTC Bulletin, September 2005, http://www.glattc.
org
Liddle, H. & Rowe, S. (2005) Adolescent Substance Abuse: Research and Clinical Perspectives, Oxford Press
Mayeda, S. & Sanders, M. (2007) Counseling Difficult-to-Reach Chemically Dependent Adolescent Males. Counseling Magazine
Mayeda, S. & Sanders, M. (2007) Counseling Difficult-to-Reach Adolescent Males With Substance Use Disorders: A Strength-Based Approach. Counselor Magazine. Vol 8, No.3.
McClennan, T., White, W.L. (2002) Alcohol Problems in the United States: 20 Years of Treatment Perspectives, Hawthorne Press, New York, NY.
Nowinski, J., Baker, Stuart, C. (1992) The Twelve-Step Facilitation Handbook; A Systematic Approach to Recovery from Substance Dependence. Hazelden Foundation, 1992.
Nowinski, J., Baker, S., Carroll, K. (1999) Twelve Step Facilitation Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence. U.S. Department of Health and Human Services, National Institutes of Health.
Riggs, P.D., Davies, D.R. (2002) A clinical approach to integrating treatment for adolescent depression and substance abuse. American Academy of Child and Adolescent Psychiatry. 41:1253-1255.
White, W. (2007) An Interview with Phillip Valentine, GLATTC.org.
White, W.L., Ernest K., and Sanders, M. (2006) Recovery Management. Great Lakes ATTC Monograph.
White, W. (2006) Sponsor, Recovery Coach Addiction Counselor: The Importance of Role Clarity and Role Integrity. Philadelphia, PA. Philadelphia Behavioral Health and Mental Retardation Services.

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