When your teenager has a problem with substance abuse, you may think that getting them to attend treatment is the most important part of their recovery. However, participating in a treatment program does not guarantee that your teen will remain sober. Addiction is a chronic condition in which relapses are common, and the best way to ensure ongoing sobriety is to attend aftercare following rehab. Following drug treatment, about 50% of teens relapse within 3 months, and approximately 65% relapse within 6 months. Unlike adults, who often relapse due to psychological difficulties or interpersonal issues, teens relapse most commonly as a result of social and peer pressure.1
Aftercare is a really important component of the recovery process. One study shows that teens who had been through rehab and gone through aftercare were approximately 10% less likely to use alcohol, and about 16% less likely to use marijuana than those teens who had no aftercare following substance abuse treatment2 Further studies had similar findings confirming the efficacy of aftercare.3 Step-down programs offer an opportunity for a teen to continue recovery in a supportive environment; adolescents report aftercare as their top need following treatment.1 These needs may be fulfilled through various aftercare efforts, including progressively less-structured programs, support groups, and individual counseling, all of which this article will explore in greater detail.
What are Step-Down Programs Like?
Step-down programs can help a teenager ease back into their home environment in such a way that the transition from the structure of treatment to “the real world” is not so abrupt. It is relatively easy for your son or daughter to remain sober in a step-down program, which provides intense oversight and does not allow your teen to have free time with friends who may urge them to use drugs or alcohol. Slowly stepping back into the social, educational, and home environment that was present before attending treatment with the support of outpatient treatment gives your child a greater chance of remaining free of substance abuse. The type of step-down program your teen needs depends on the type of initial treatment your teen receives for substance abuse. Some options may include:
• Outpatient treatment. Outpatient programs provide aftercare for teens who have completed a residential or inpatient substance abuse treatment program. Program participants will regularly meet with substance abuse counselors or other treatment professionals and attend groups that reinforce the skills that were learned in residential treatment. One type of outpatient treatment is referred to as an intensive outpatient program (IOP), which usually holds meetings after school hours for a couple of hours, 2–3 days per week.
• Partial hospitalization (PHP). This is a more intensive form of outpatient treatment that may meet 4–5 hours per day, as many as 7 days per week. However, for teens, most programs take place no more than 5 days per week; most attend a few days a week over a period of weeks.
• Other ongoing treatment. After your teenager attends an outpatient program, ongoing treatment is still important to remain sober. The factors that led your teen to abuse substances did not occur overnight, so these issues need to be addressed in ongoing counseling and support groups to help ensure continued recovery. After a formal outpatient program, most teens attend a combination of individual and family counseling. Teens are often strongly encouraged to attend support group meetings, such as those hosted by 12-step fellowships, to remain engaged with longer-term recovery with peers who are going through the same struggle.
Sources for outpatient programs include:
• The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a treatment locator website.
The Importance of Support Groups
Support groups are a vital part of aftercare for anyone in recovery. Many of these programs are based on the 12-step model and are run by members who are themselves in recovery rather than professional counselors. In these groups, members talk about their struggles with addiction, through which they support one another through the recovery process. Typically, a teen entering a 12-step program will find a sponsor, which is someone who has been in recovery for a period of time and can help mentor them as they begin their journey. In many communities, meetings are offered throughout the day with no limit on how often a person can attend.
Other groups, such as SMART Recovery, do not use a 12-step model or sponsors, but do have regularly scheduled group meetings.
Various types of support groups and self-help programs include:
• Narcotics Anonymous (NA).
• Alcoholics Anonymous (AA).
• SMART Recovery.
Is Individual Counseling Right for Your Teen?
In some cases, after a teen completes residential treatment, an outpatient step-down program, and remains fully engaged in a support group, there could still be a need for ongoing individual counseling. This type of aftercare gives your child the opportunity to have personalized care that keeps them accountable to a professional who can objectively evaluate their recovery progress. Individual counseling may also help your child avoid losing the gains made in treatment, work through triggers for relapse, and address the underlying emotional issues that led to drug abuse in the first place.
There are a few forms of individual counseling that are most useful for substance abuse aftercare, including:
• Cognitive behavioral therapy (CBT), which uses interventions that help a teen think differently about stress and other triggers for substance abuse. CBT focuses on changing patterns of emotionally driven thoughts and the actions that follow them, which can help teens avoid drug use and relapse in the future. CBT also helps clients gain an increased sense of self-control.4
• Motivational interviewing tries to help identify a client’s personal motivation to stop using alcohol and drugs. It is a technique that helps your teen think about what they perceive as positives to their substance use, the potential consequences of continued substance use, and the reasons they might want to ultimately stop using drugs and alcohol. The therapist in this process then helps the client work through the barriers that stop them from making the changes needed to reach their goals in treatment. Motivational interviewing is not an actual treatment for drug addiction but is used to motivate teens and adults to get and stay clean.4
• Dialectical behavioral therapy (DBT) is increasingly used to treat substance abuse, because it helps people to better control impulsive or out-of-control behaviors and improves motivation to change. A particular focus of DBT is increasing a person’s ability to tolerate stress, since a teen who struggles with addiction may want to use drugs to cope. DBT typically involves phone calls in between sessions to support the patient.5
If you need help locating a counselor for your teen, a useful service is:
• Therapist Locator – a service provided by the American Association of Marriage and Family Therapists.
1. Acri, M.C., Gogel, L.P., Pollock, M., & Wisdom, J.P. (2012). What Adolescents Need to Prevent Relapse After Treatment for Substance Abuse: A Comparison of Youth, Parent, and Staff Perspectives. Journal of Child & Adolescent Substance Abuse, 21(2), 117–129.
2. Kaminer, Y., Bukstein, O.G. (2008). Adolescent Substance Abuse: Dual Diagnosis and High-Risk Behaviors. New York: Routledge/Francis & Taylor.
3. Kaminer, Y., Burleson, J.A., & Burke, R.H. (2008). Efficacy of Outpatient Aftercare for Adolescents with Alcohol Use Disorders: A Randomized Controlled Study. Journal of the American Academy of Child & Adolescent Psychiatry, 47(12), 1405–1412.
4. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.
5. Dimeff, L.A., & Linehan, M.M. (2008). Dialectical Behavior Therapy for Substance Abusers. Addiction Science & Clinical Practice, 4(2), 39.