This is the third of a three-part series by @DrewHorowitz, a recovery coach and interventionist who specializes in working with young adults and their families to work through addiction, treatment and recovery. Thank you, Drew, for sharing your professional insights to help families confronting substance use.
A young adult is a hybrid of an adolescent and an adult. I consider most young adults that I work with to be professional adolescents since they have not yet taken on the responsibilities of an adult and have been in graduate studies in adolescent behavior. The oppositional-defiant behavior coupled with the feeling that they are entitled to free room and board eventually causes parents to feel disrespected, resulting in anger. This cycle creates chaos between the young adult and parents, and the untreated addiction coupled with immaturity continues to dominate all parties involved.
A new study shows that nearly 7 million American’s aged 18-25 (more than one in five young adults) needed treatment for drug or alcohol use in the last year. The study, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) also shows that 95 percent of these young adults did not receive the help they needed at a treatment facility. These levels have remained fairly stable since 2002. In addition, 96 percent of the young adults needing help did not believe they needed the help. Even among the 4 percent who thought they needed treatment in the last year but did not receive it, less than on third made any attempt to get treatment.
Why is it so hard?
Deemed the most challenging age group to treat, the young adult population has flooded drug and alcohol treatment centers throughout the country. Many treatment centers have developed specific tracks, while others have devoted their entire program to this population.
Why? Because young adults do not easily fit into an adolescent group or an adult addiction group. Usually the young adult is the only 24-year old in a group of adults with the average age of 38. The young adult will quickly use this fact as a reason why an addiction program is not what they really need. This patient cannot relate to the adult stressors of childcare, marriage nor the pressure and responsibility of paying bills (which he has never experienced).
Further, this same population cannot identify with the adolescent group either. Adolescents face different stressors and challenges with sobriety when compared to the young adult. Part of this confusion stems from the young adult believing that they are grown men, mature and no longer need “babysitting,” which sometimes occurs in adolescent treatment programming.
For this reason, the combination of young adults with adolescents can be extremely counterproductive, causing patients to leave against medical advice or “checking out” for most of treatment.
How to Treat Young Adults with Addiction
Recognizing the unique needs of this population is imperative for successful recovery. Any addiction treatment program that treats this age group must have the experience, the ability and the interest to deal with this population.
The onset of chemical dependency in the adolescent or young adult stage of human development can result in arrested development preventing the sufferer from maturing into healthy adulthood. For this reason, many young adults arrive at treatment with many childish like tendencies.
For example, the young adult may become argumentative with his or her counselor, push the rules of the program and potentially get them removed from the program for breaking rules. It is common for addiction counselors to create behavioral plans, threaten to involve law enforcement and family, while confronting the young person on their acting out.
This is one of the greatest mistakes that a counselor can make. Confrontation generally makes the situation much worse. Young adults are naturally oppositional and respond poorly to demands and threats. Therefore, when counselors become agitated and frustrated with their client, it amplifies the situation.
The young adult is accustomed to being spoken down to and told that they are out of line or misbehaving. By re-enforcing this pattern, it essentially tells the patient that they are “bad” or “misunderstood”, which pushes them further away and leaving them to cope by using substances.
Changing Our Approach to Treatment for Young Adults
The solution lies in taking a more empathetic, compassionate and caring role to validate frustrations and provide support. Taking a client-centered position and changing the cycle will ultimately create greater outcomes.
The key: to not become part of the dangerous downward cycle that this population creates. By engaging in arguments it fuels the addiction and leads to poor outcomes and early discharges from treatment. However, when validated, recognized and heard, the young person is almost left speechless and in awe by the counselors attitude. It is this understanding and rapport that sets the young adult up for success.
In my experience, this population suffers tremendously from low self-esteem and self-worth. At the basis of their illness rests strong feelings of inadequacy and failure. It is these emotions that fuel the addiction and keeps the young person caught in a cycle of anger and helplessness. For that reason, the foundation of treatment must be built on trust, empathy, support and unconditional positive regard. Additionally, it is crucial that they play a strong role in their recovery. Asking them to assist in writing their treatment plans, allowing involvement in aftercare planning and validating frustrations and concerns goes a very long way with this group.
I recently asked one of my clients, “How can I help you in your recovery?” His response, “Just treat me like a person.” This young man has been through several rigorous treatment programs and all have failed him. The treatment center is not entirely at fault, however many have not set the stage for their recovery.
It is imperative that prior to treating young-adult clients that counselors must first build a strong alliance where the patient and his or her counselor can walk with them through their recovery as opposed to dictating their recovery.
About Drew Horowitz, MA, LADC, RAS, CIP
Drew Horowitz, MA, LADC, RAS, has a vast range of experiences working with addiction and mental health. He gained a wealth of knowledge through his own recovery coupled with extensive training: a master’s level education from the Hazelden Graduate School of Addiction and an undergraduate degree in psychology and human development from Hofstra University. Following a career with several substance abuse and mental health organizations, he formed Drew Horowitz & Associates, LLC, an organization designed to assist young men who struggle to overcome addiction and mental health.