On the Search for Spirituality in the Substance-abusing Adolescent
| 2011 - June |
Kevin M. Large
Adolescence is a time of development – growing up, making friends, dealing with schoolwork, dealing with family stressors, and developing a social identity. Some teens are looking at completing high school, some are dropping out of high school, some are looking at college, and some are working and pursuing a trade. It has been said that alcoholism and drug addiction progresses more rapidly in the body of the adolescent as the individual is still developing in terms of normal physiological development. So, you take this developing adolescent, and add the factor of an addictive substance such as alcohol or drugs, and you have the recipe for arrested development and the tragic end to a life as it was about to unfold.
Individual stories will vary, some adolescents may have been doing well and appeared successful in every way, while others may have been leading quiet lives of desperation with little hope for their future. Yet, when the drugs and alcohol are entered into the equation, there is a very real possibility that the normal development of that adolescent will become derailed, disrupted, and may possibly lead to death.
In our work our clients, both young and older, over the years, how many times have we used the phrase to describe the three places that addiction will take you – jails, institutions, and death.
In the movie "twelve – is there really life after rehab in recovery?" one young man states this in a similar fashion, citing that there are three places where an alcoholic or addict may end up – "Locked up, covered up, or sobered up." So, it is clearly an existential crisis when an otherwise healthy individual engages in this self-destructive behavior of drinking and drugging to excess, which leads to any number of problems caused by, or made worse by, the use of alcohol and/ or drugs, with the potential end result of an early death.
I recall a quote from Edith Weisskopf- Joelson that still stands out in my memory after reading it over twenty years ago. In Viktor Frankl's Man's Search for Meaning, Frankl quotes Edith Weisskopf-Joelson's paper on logotherapy: "Our current mental hygiene philosophy stresses the idea that people ought to be happy, that unhappiness is a symptom of mal-adjustment. Such a value system might be responsible for the fact that the burden of unavoidable unhappiness is increased by unhappiness about being unhappy."
Weisskopf-Joelson wrote that logotherapy "may help counteract certain unhealthy trends in the present-day culture of the United States, where the incurable sufferer is given very little opportunity to be proud of his suffering and to consider it ennobling rather than degrading."
I appreciate the sentiment shared by Weisskopf-Joelson as an explanation of how – for some individuals suffering from unbearable conditions, such as cancer, addiction, and other afflictions of the body and spirit – the suffering can seem to be insurmountable, with no way out, no end in sight. While the suffering is apt to be extremely painful and emotionally exhausting, viewing the suffering as ennobling offers a way of bearing the burden as a survivor rather than viewing the suffering as intolerable.
[Author's Note: Frankl was a survivor of Auschwitz, and Weisskopf-Joelson was a Jewish refugee from Austria who taught at Purdue, Duke and the University of Georgia.]
Treatment Implications
Treatment programs have been advised (for some time now) to address spirituality in their assessment process with the incoming client, but how often does that signal the end of the discussion of spirituality? For those programs that utilize a workbook or worksheet to address the Twelve Steps, there is the opportunity for discussion of some concepts relating to spirituality, including references to God, a Higher Power, and connection with others.
It has been my experience that some addiction counselors, social workers, and other treatment providers DO address spiritual issues with their clients. For the sake of discussion, I would imagine that this issue could be addressed with more of the clients that come into treatment or counseling. I believe that dealing with spiritual issues has a significant impact on the potential for the individual to achieve sustained recovery.
As is commonly known, the founders of A.A. incorporated spiritual principles into the program for recovery as found in The Big Book and the Twelve Steps. I think that, all too often, some individuals dismiss A.A. and going to A.A. meetings because of their belief that A.A. is about God and religion. There is a distinction that is commonly drawn between the notion that A.A. is about religion, but instead focuses on more precisely spiritual issues and spiritual principles – A.A. and specifically the "twelve steps" are based upon spiritual principles.
By increasing our understanding of how spirituality plays an important role in the recovery process, we can more fully realize how, by addressing spiritual issues, we are actually able to more fully appreciate the impact of addiction on the life of the suffering addict. By exploring how an individual has been wounded by their addiction, the individual in recovery can begin to address some of these issues with the help of their counselor, their sponsor, and by reaching out to others in the program.
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One question would be to clarify the need, that is, whether there are residents who are chemically dependent or not? So, a substance abuse assessment would be in order.
And a programmatic question as to what level of service would be provided: (A) substance abuse prevention educational groups for residents who may have abused drugs and/or alcohol, but are NOT diagnosed as chemically dependent; and/or (B) substance abuse treatment groups for residents who ARE diagnosed as chemically dependent.
For residents who are addicted, in addition to treatment groups, provide step work, linkage with 12-step meetings, and encourage them to find a temporary sponsor at a meeting.
In working with clients in a residential setting, you have the opportunity to do some long-term work with them. While we are familiar with the sense of providing “rehabilitation”, there are those times and those individuals that could benefit from “habilitation.” In the long-term residential treatment setting, the therapist and treatment team have an opportunity to help the client to make some deeper longer-lasting changes to how they relate to the world and how they function as an individual. The residential treatment setting provides a crucible where the client typically recreates on the “inside” what their world has been like for them, in terms of interpersonal relationships and behaviors, “on the outside,” life prior to residential treatment.
I know some residential programs have experiential components, which would be excellent -- such as a ropes course, the wilderness programs, etc. For a typical "housed" residential program, I would think that it would be helpful for some creative programming to provide something akin to a team-building approach, safe and appropriate "trust" exercises, to work towards increasing interpersonal cooperation and interdependence, teamwork, enhancing personal self-efficacy and enhancing self-esteem.
Depending upon the length of time in residential treatment, anticipate the need for discharge planning, that is, follow up with a substance abuse treatment provider. Upon discharge, possibly some period of time in IOP as a step-down, and, at the very least, some referral to a provider for aftercare, plus recommendation for ongoing 12-step meetings.
A further consideration, depending upon the presenting issues of the individual resident(s), would be to address any process addictions. This may be beyond the scope of the typical residential treatment program, however it may bear mentioning -- at least for the purposes of assessment and potential referral following residential treatment. For example, if there is a "co-occurring" process addiction such as gambling or sex addiction. With the Internet, I suspect that teens may be just as susceptible to these problems ~ as one might typically consider that it would be "adults" that would have a problem with gambling, or sex addiction....
Hope this is helpful.