What works?

[odie]

I figured its about time I asked this question. I've seen all the negative responses to the different treatment modalities but nothing said of anything that works. Let me give an example of a ficticious case and I'd like to hear what people think is the best way to handle the person.
14 yo girl that has been drinking a six pack of beer on weekends and 4 or 5 joints with it since she was 12 years old. Has been to outpatient counseling for a year but continues to use. Grades have been falling for three years. Has little respect for authority figures. Has been expelled from school due to keying teacher's car.
What would you do?

No matter how great your triumphs or how tragic your defeats---approximately one billion Chinese couldn't care less.
--Lazlo's Chinese Relativity Axiom:

[Troll Control]

Geez, you coulda thrown a softball question first for warmups...

Well, I'll give you an "armchair" analysis of this scenario with the qualification that we'd need to know more than this to set up a treatment plan.

First and foremost, we would require a full battery of psychometric testing to assess any mental health issues.  I'll proceed under the assumption that this testing shows no pathology.

Since outpatient therapy hasn't abated the substance abuse issue, it would be appropriate to recommend a higher level of care.  Personally I would consider a thirty day inpatient treatment option followed by structured outpatient aftercare including individual (CBT) and family therapy (FFT).

Once the child is stablized and is functioning more-or-less normally and is free of intoxicating substances, work can be done towards settling the issues that cause her to act out against authority and to perform poorly at school.  It is entirely possible, however, that there is "spontaneous recovery" from these issues when the child is no longer abusing alcohol and drugs and is in therapy with her family.  That is, if the root problem is addressed, these symptoms may just "go away."

I think many people fall into the logical trap that the drug and alcohol use are "the" problem, when, in my experience, the drinking and drugging are usually ancillary to other psychosocial issues.  Simply put, the child medicates herself because she is singularly unable to address the underlying problems that spur the substance abuse.

So, my approach would be to stablize the child and get her drug-free by short term inpatient treatment, then family and individual therapy.  After an assessment of the measurable effectiveness of this trial, we would reevaluate the behavior and school problems to see if they meet any clinical threshold.

See, Odie, the problem with these programs are manifold.  

One, the child rarely, if ever, meets the clinical threshold for residential treatment.  This threshold is met in LESS THAN ONE PERCENT of clinical cases.  

Two, if this threshold is met, these facilities are WOEFULLY INADEQUATE to provide requisite care.  They simply don't follow accepted practice to address the problems with which their patients present.  They use a one-size-fits-all approach and anyone who has even a scintilla of knowledge about mental health treatment KNOWS FOR SURE that this approach WIL NOT and CAN NOT work for the vast majority of the patients in their care.  

This is why these TBS's or EG "schools" typically have a recidivism rate identical to the penal system (65-75%) - no surprise considering they are both one-size-fits-all approaches.

[odie]

Thanks DJ I knew you'd get the right answer...lol.I was going to put some more spice to the case but I figured I'd keep it real simple for now. I just wanted to hear some opinions on how to treat any kid because of all the negativity on here. Anybody can rant and rave how bad various programs are or how research shows how a modality doesn't work but if all we do is complain how will we ever know what does work? Well I haven't been on here much because I'm researching the new "miracle" drug Suboxone which doctors in my area are being a wee bit overanxious to prescribe to "cure" drug addiction.
Funny how the medical field comes up with these magic pills every so often thinking it has to be the drug that is the problem. :wave:

Janis, Jimi, Gery, Timothy... Did you HAVE to get so close to the edge to get a really good view?
-- Anonymous

[Troll Control]

Well, you call it "negativity," but maybe it can be framed differently.  

Suppose we call it "what we KNOW DOESN'T WORK."  There are only really two sides to this issue:  "What Works" and "What Doesn't."

Fortunately, through years of experience and clinical research there are a few things that DO WORK.  Unfortunately, it is almost impossible to profiteer from "What Works," and, therefore "What Doesn't Work" has become the most popular method of dealing with problems because "What Doesn't Work" does work for profiteering.

The people who get sucked into the treatment scam are sold by highly motivated people willing to say WHATEVER IT TAKES to get the dollars, er, patients through the door even though they ALREADY KNOW FULL WELL that they aren't going to help anyone.  Unless, of course, you consider separating a fool from his money "help."

On the other side of the coin are people who practice "What Does Work."  There is not a lot of money in it and there is a code of ethics.  This is why they charge standard rates and offer treatment that really does work.  There are no shiny brochures, no pitchmen, no hucksters or shysters roping in the desperate, because they AREN'T IN IT FOR THE MONEY, period.

So, what reaches "the masses"?  "What Doesn't Work" does.  Unfortunately, there's a sucker born every minute and plenty of programs to take advantage of their weakness.

[69]

On 2006-02-16 06:20:00, odie wrote:

"I figured its about time I asked this question. I've seen all the negative responses to the different treatment modalities but nothing said of anything that works. Let me give an example of a ficticious case and I'd like to hear what people think is the best way to handle the person.

14 yo girl that has been drinking a six pack of beer on weekends and 4 or 5 joints with it since she was 12 years old. Has been to outpatient counseling for a year but continues to use. Grades have been falling for three years. Has little respect for authority figures. Has been expelled from school due to keying teacher's car.

What would you do?

No matter how great your triumphs or how tragic your defeats---approximately one billion Chinese couldn't care less.
--Lazlo's Chinese Relativity Axiom:

"

Hmmm... well, first I want to know why the person explaining their daughters issues completely leaves out the family situation at home. Is the girl having problems with her father? Her mother? Perhaps she does not get a long with her new step-parent? Was she recently told she was adopted? What is the family situation like? Is there abuse going on in the household?

These are the first questions I would ask, having a twin sister my exact same age, who acted out just as much as me, we can now easily discuss the reasons why. It was our family situation, we were acting out as a tool to cover our pain and get attention from anyone willing to give it to us.

So first, I would delve into the family situation, since the out-patient therapy had little effect, it's obvious drug use and alcohol use itself are not the problem, just symptoms of the greater disease, whatever that might be.

After that, I would figure out how she is getting alcohol and marijuana. Someone over 21 must be buying it for her? Where is she getting the money for that much alcohol and weed? Am I, as a parent enabling her by giving her the money, or is she stealing it, or worse using guys to get it for her and giving god-knows what in return? Once I figured that out, I would solve the problem. If it were older guys, I as a father would confront them, in no uncertain terms, and warn them to back off. If they continued supplying a minor with illegal substances I would call the police and have them arrested.

Then I would make her write an apology letter to the teacher. I would make her research how pathetically low paid our teachers are, and require her to pay for the repairs to the car. I would not call the police on this one, only make her take responsibility for her actions by both apologizing and paying for the damages. If she is too young to get a 'normal' job outisde the house, I will let her do work around the house for me, or the neighbors, or family members.

Most importantly though, I would try and figure out why she would rather escape into drunkeness and highness than live life sober. There is always a reason. I would not use the AA/NA approach, I think that is a ridiculous method, and only sets someone up for failure. She is 14, she will slip up again, that's part of life. The fact she is smoking weed and drinking alcohol is better than her snorting meth and shooting heroin. I would want to step in and help her overcome whatever problems she was having, to prevent the drug and alcohol use from getting worse and moving into harder drugs.

Like DJ said, I would have her see a psychiatrist, see if there are any psychological disorders going on. If she wanted, and the doctor agreed, perhaps try an anti-depressant or anti-anxiety medication, although I am not really overly impressed by medicating teens, I think that is just covering up the problem too in some cases.

Lastly, I would involve myself more in her life in a positive way. I think it's important the child is not scared of the parent, but feels comfortable telling them the truth, even if it might get them in trouble. I was always afraid to approach my dad, so I hid everything from him. Finally, one day he found out everything I had been doing, and it was a great shock. I don't want my relationship with my child to be this way.

I believe in the philosophy of helping someone, even if they continue down a path you do not desire. All you can do is try your best to steer them back in the right direction, but I do not believe in forcing teens into behavior mod schools like WWASPS or PROVO. I was mistreated at SCL, a WWASPS school, and because of that, of course I would never seek treatment for my teen in that type of environment. ESPECIALLY if they were only 14.

If for some reason, I did feel removing the child from their environment was necessary, as many program parents do, I would do one of two things. First option, move the entire family. Second option, take my teen traveling with myself.

Sounds crazy, but hear me out. WWASPS school cost my dad about $3500/month to keep me there. If he had he kept that money instead, and we traveled around together by ourselves, talking things out -- it would have been money much better spent. The best time I ever had with him was the roadtrip up to SCL (as ironic as that sounds). I was finally able to open up to him, and we started being more open with eachother. But then he dropped me off at SCL... and things went downhill from there, once seperated our relationship drifted apart and never recovered. WWASPS was a big mistake, believe me -- for our entire family. With the amount of money he spent on WWASPS we could have traveled around the entire country, Europe and then some. It might have been difficult for him job-wise, but even if he cut the amount of months in half, the extra money spent on WWASPS was more than the pay he would have missed.

All we ever needed was some good, inclusive family therapy, and to remove all the fear and tension so we could communicate. We didn't really even need the 'therapy' other than the fact, the therapist made a good mediator. It got to the point we couldn't talk to each other, but being out of the normal environment, traveling around just me and him, it was great and would have helped me a lot more than WWASPS ever did. Obviously this doesn't apply to every situation, but in my own situation back then, it would have worked. Things would be a lot different with my family.

And reading about a 14 year old girl with those behaviors, it sounds like family issues, and maybe time spent together in a fun, positive and different environment can open up the lines of communication to a healthy level. I'm no expert though, that's for sure! :wave:

It is the mark of an educated mind to be able to entertain a thought without accepting it.
-- Aristotle

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[Anonymous]

Much thanks to Dysfunction Junction and Exit Plan.  As a survivor of the Academy at Swift River I can say without at doubt that the treatment options described by them would've been immensely more helpful than ASR, to say the least.  First of all, the psychological testing bears mentioning again.  This is absolutely imperative.  You can't treat your child unless you have the best available knowledge on what they need treatment for, if they even need it.  In my case, my parents and the schools stated reasons for my being there were the following: My grades had gone down from B's to C's.  I was suffering from clinical depression, and/or bi-polar disorder, and anger management issues.  I was getting involved with the "wrong crowd" (which had more to do with the way they dressed than anything else), and my personal belief system (religious and political) was at odds with what my parents believed in.  (They thought that reading anarchist and socialist philosophy would ruin my life, and that I desperately needed more Judaism).
When I finally saw a qualified mental health professional years later, it was an immense relief to be given a diagnosis that didn't involve placing blame on me.  I didn't have bi-polar, I have ADD, which explains why previous medications had only exacerbated my mood swings and led to severe insomnia.  This in and of itself would've eliminated so many of the issues I had at the time, but the only licensed medical professionals at ASR were psychiatrists who saw kids once a week and doled out Wellbutrin and Aderall based on snap judgments of the kids and the reports counselors gave them.
Anyway, the family issues that needed to be dealt with involved severe depression on the part of my parents.  My mother would sleep for 16-plus hours at a time, struggled with balancing her mental problems with excessive prescriptions from her doctor that only made her sleep more, and turned her into a zombie when she was awake.  My father criticized me unmercifully and predict horrible futures for me.  I didn't get straight A's, so college wasn't going to be possible, I was obese, so I was headed for a heart attack at 30, things like that.  This is when I was 12 years old, mind you.  My father and stepmother used to forget to introduce me to people, often when I was in the same room as my little sister, whom they had just finished bragging about and showing off.  This disproportionate treatment was so obvious, that even years later, people who work for my father still express their sympathy for what I had to go through.  My father had me start working in his warehouse at 13, 40 hours a week in the summer, (a job that full grown adults find to be manageable, but quite hard) "so I could see what it's like to not go to college".  Full time manual labor at 13.  My little sister gets whatever she asks for.  I'm not complaining, I'm saying that this disparity is bad for the both of us.  She never gets to develop a work ethic, and the favoritism is obviously not good.
My stepmother is an emotionally abusive and manipulative woman who controls my father and sister by playing control games and frequently exploding and showering verbal abuse upon them, or using the possibility of these outbursts as a threat.   SHE was the driving force behind my going to ASR, pressuring my father and my mother to send me away.  She shouldn't have had a say in it in the first place, having no custody over me, but at ASR, they recognized her as more of a parent than my mother, who despite her faults was still my legal guardian, and a better parent than my stepmother ever was.
So to apply what was said about what works to my own situation, obviously a full psych assessment as a prerequisite.  And then full family counseling in addition to seeing a psychiatrist and/or psychologist on my own.  Depending on recommendations, perhaps a 30 day inpatient program might've been a good start, simply to defuse some of the tensions and allow me a chance to think objectively about my situation without constantly having to deal with it being in my face.  I think that this would work a lot better than punishing me for acting out, blaming me for faulty family dynamics, and cutting me off from all contact with "undesirables", and medicating me excessively with anti-psychotics, which was the next step after forcing Wellbutrin on me wasn't enough for those scumbags at ASR.
My whole point is very simple.  Had any of the issues of my childhood and adolescence been addressed by a neutral, qualified mental health professional, one familiar with the issues at hand, and available treatment options, I could've still had those 14 months of my life, gone to a high school where my teachers had degrees in the subjects they taught, and the issues with my family might've been resolved, rather than swept under the rug after I was forced to accept the blame for almost all of it, never to be discussed again post-ASR.  This is the alternative to locking up your kids without even a trial or an appeal, which ASR likes to believe is the only way to save them from the proverbial dead/insane/in jail fate that all prospective students and their parents are told awaits those who don't go into the program.  Sounds just a bit like a cult to me.  "We're the only ones who possess the truth on this issue, we know the only way, only we can help you, and only if you put complete faith in us, put a lot of money in our pockets, and do everything we tell you."

[Goodtobefree]

Above post was mine.

[Antigen]

Ok, leme throw in my ¢2 here. The very first thing I'd look at w/ a kid who just keyed a teacher's car is the teacher. Does this kid do mean things to all of them, or just this one? Then I'd look at the overal culture and attitude toward kids present in the school. Maybe the problem is not that the kid is mentally ill or somehow disordered, but that she's out-classed in this contest of wills. Quite possibly, she's responding predictably and understandably, though not effecively or in an advisable way, to mindfucking tin gods who like to torment vulnerable kids.

Sometimes, getting the kid out of that situation and onto something better (admitting they've got a point and never did deserve to be treated badly by those in authority) can be a good start. Even if getting out of school, switching schools or changing teachers is not an option, just having one or a few understanding adults to give good avice about how to deal w/ unfair, cruel authority figures can help a LOT!

Next I'd see if the kid has other interests and look into how she can pursue them. Maybe the standard curriculum is just too damned boring and redundant to captivate her attention. How about a job earning money w/ the sound advice to keep the partying to a minimum, if not cut it out entirely, in order to be able to function in the workplace? Just that alone can bring a fair amount of peace and confidence to a kid. See, maybe the parents are too strict, too critical, too stingy w/ praise or too generous w/ false praise... any number of things. But you get out there w/ a boss and customers and co-workers who are not so investid in you personally, who just want the job done and reasonably decent, respectful treatment and, suddenly, the 'problem child' finds she's not so bad or needs to improve in some ways. It's just good for confidence and, sometimes, a much needed reality check.

But this is far from demonstrating that the authorities must interpose to suppress these vices by commercial prohibitions, nor is it by any means evident that such intervention on the part of the government is really capable of suppressing them or that, even if this end could be attained, it might not therewith open up a Pandora's box of other dangers, no less mischievous than alcoholism and morphinism.
http://www.mises.org/liberal/ch1sec11.asp' target='_new'>Ludwig Von Mises