1. Chestnut Health Systems,
Summary of Clinical Methods used in two of the most common evidenced based practices
Michael Dennis, Ph.D.
Chestnut Health Systems,
Bloomington, IL
Presentation at “Juvenile Justice Conference on Alcohol & Other (AOD) Treatment for Adolescents”, Thursday, April , , Marlborough Massachusetts. The content of this presentations are adapted from materials provided by Drs Mark Godley, Susan Godley & Susan Sampl. The opinions are those of the author and do not reflect official positions of the consortium or government. Available on line at or by contacting Joan Unsicker at West Chestnut, Bloomington, IL , phone () -, fax () -,

2. Normal Adolescent (-) and Young Adult (-) Development
Biological changes in the body, brain, and hormonal systems that continue into mid-to-late s
Shift from concrete to abstract thinking
Improvements in the ability to link causes and consequences (particularly strings of events over time)
Separation from a family-based identity and the development of peer- and individual-based identities
Increased focus on how one is perceived by peers
Increasing rates of sensation seeking/experimenting
Development of impulse control and coping skills
Concerns about avoiding interpersonal emotional or physical violence
Realizing that they are not invincible to environmental risks (which are often less proximate or likely)
From Dennis et al (under review) challenges of adolescent treatment research

3. Conceptual Challenges to Address
Most adolescents do not recognize their substance use as a problem and are being mandated to treatment (and are angry about it)
Co-occurring problems (mental, trauma, legal) are the norm and often predate substance use
Treatment has to take into account the multiple systems (peers, family, school, welfare, criminal justice) involved in their lives
Adolescents have less control of their lives and recovery environment than adults
Need to be creative in dealing with family and peer relationships because they are still central to the adolescent’s self-identity and are not easily changed

4. Family, Peer Groups, and Community
Families often play a pivotal role, but vary in their ability and willingness to help
Peer groups are very powerful – but can have both negative and positive effects
One or two very disruptive people can destroy a group and actually lead to worse outcomes
Need to minimize confrontational approaches unless you have the time and control necessary to do them well and safely
Less availability of aftercare, -step groups and peer based recovery support

5. Adapting Treatment Manuals/Materials
Examples need to be reflect the substances, situations, and triggers relevant to adolescents
Motivational strategies and consequences have to be reflect things of concern to adolescents
Concepts need to be expressed in “concrete” (vs. abstract) terms to match developmental stage
Curricula need to take into account individual differences in severity, co-occurring problems, and development – which often change during the course of treatment
Need for treatment facilities that are physically durable and to have access to recreational facilities

6. Motivational Enhanced Treatment/ Cognitive Behavior Therapy (MET/CBT)
CYT
Sampl, S., & Kadden, R. ()
University of Connecticut Health Center
Farmington, CT USA
Cannabis Youth Treatment
Trials
Treatment Series
Volume

7. Individual MET Sessions & (- min)
Feedback, Rapport-Building, Orientation to Treatment and Review of the Personalized Feedback Report
Peer reference norming
Tell me about…(endorsed symptoms of abuse and dependence)
Review reasons for quitting…ask which they think is most important
Review of Progress, Functional Analysis, Personalized Goal Setting, and Orientation to the Group Sessions

8. Group CBT Sessions - (- Min)
Marijuana Refusal Skills
Increasing Social Support and Pleasant Activities
Coping with Emergencies and Relapse
Plus Random Urines over
six weeks

9. Theoretical Basis of MET/CBT
Roger’s empathic listening and reflection therapy
Prochaska & DiClemente’s The Stages of Change Model
Miller’s Motivational Interviewing
Miller & Rollnick’s Motivational Enhanced Treatment (MET) approach from Project Match
Monti’s Cognitive Behavioral Therapy (CBT) from Project Match
Stephens, R. S., Babor, T. F., Kadden, R., & Miller, M., MET/CBT Approach from the (adult) Marijuana Treatment Project
Therapist style- Research has found marked differences in therapist efficacy. MET is based, in part, on identifying therapist behaviors associated with positive client change.
Respect- Don’t talk down to the client or label them. Be careful that you do not have a lecturing tone.
Brainstorm ways to show interest verbally and nonverbally
Don’t confront- example of how you feel if someone argues for only one side of something that you feel ambivalent about (ending a relationship)
Miller & Sovereign () In a study of treatment for alcohol abuse & dependence, clients were followed up one year after therapy. The more the therapist had confronted the client in treatment, the more the client was drinking one year later! The more the therapist supported and listened, the more the client changed.

10. The Stages of Change Model
Permanent Exit?
Relapse?   
Pre-contemplation
Maintenance
MET
Action
Contemplation
Another critical assumption within MET is that motivation is not seen as a trait, but a state of readiness to change, which fluctuates across times and situations. Most importantly, this state can be influenced, and clients can be helped to go through the different STAGES OF CHANGE, a transtheoretical model conceptualized by Prochaska and DiClemente. These stages don’t just come in one linear order, but instead are circular. Clients can go around the circle many times before they achieve a stable change (for ex. P&D found that smokers go around the circle in average times before quitting for good). An important implication of this paradigm is that different stages of change require different behaviors from the therapist.
Review material in handout
Determination
CBT

11. Assumptions of MET
Therapist style is a powerful determinant of client motivation and change
Change is more likely when the motivation comes from adolescent, rather than being imposed by the therapist, family, school, or court
Need to show respect for the client and demonstrate understanding (vs. confrontation)
Ambivalence about change is normal
Change involves a process
Therapist style- Research has found marked differences in therapist efficacy. MET is based, in part, on identifying therapist behaviors associated with positive client change.
Respect- Don’t talk down to the client or label them. Be careful that you do not have a lecturing tone.
Brainstorm ways to show interest verbally and nonverbally
Don’t confront- example of how you feel if someone argues for only one side of something that you feel ambivalent about (ending a relationship)
Miller & Sovereign () In a study of treatment for alcohol abuse & dependence, clients were followed up one year after therapy. The more the therapist had confronted the client in treatment, the more the client was drinking one year later! The more the therapist supported and listened, the more the client changed.

12. Five Strategies of MET . Express Empathy . Develop Discrepancy
. Avoid Argumentation
. Roll with Resistance
. Support Self-Efficacy
Refer to handout.
Express Empathy- Do Forming Reflections Exercise #.
Play early part of video with adolescent after describing Avoid Arg. And Roll w. Res.
It illustrates Building Rapport, Rolling w/ Res., Avoid Arg., Supporting the client’s feelings of efficacy.

13. . Express Empathy Conveyed Non-verbally: eye contact body position
facial expression
Conveyed Verbally
through reflections
Refer to handout.
Express Empathy- Do Forming Reflections Exercise #.
Play early part of video with adolescent after describing Avoid Arg. And Roll w. Res.
It illustrates Building Rapport, Rolling w/ Res., Avoid Arg., Supporting the client’s feelings of efficacy.

14. Reflective Listening Open vs. Closed Ended questions…
“How often did you xxx…” vs. “Tell me about when you xxx...”
“How many of your friends use drugs?” vs. “How have your friends reacted to your going into treatment?”
“Have you had problems with xxx..?” vs. “Tell me about the problem you mentioned with xxx…?”
Demonstrating understanding of what the client is communicating
“It sounds like you”
“So you”
“It seems to you that”
“It sounds like you’re feeling”
Avoid labeling, lecturing, preaching, shaming, ridiculing, warning, arguing, or threatening

15. . Develop Discrepancy
Discrepancy is thought to be the engine that drives change
Help the client describe the discrepancy between how their life is when abusing substances and how it was/could be without
Often need help seeing the pattern of similar situations and drawing the link to consequences
Refer to handout.
Express Empathy- Do Forming Reflections Exercise #.
Play early part of video with adolescent after describing Avoid Arg. And Roll w. Res.
It illustrates Building Rapport, Rolling w/ Res., Avoid Arg., Supporting the client’s feelings of efficacy.

16. Facilitating the Risk/Reward Analysis
Normalize ambivalence to encourage contemplation
Help “tip the decisional balance scales” by:
Eliciting pros and cons of use and change
Emphasizing client choice and responsibility
Elicit self-motivational statements, and summarize them

17. . Avoid Argumentation Resistance is a cue to modify your approach
Treat ambivalence (mixed feelings) as normal
Use double-sided reflections
Refer to handout.
Express Empathy- Do Forming Reflections Exercise #.
Play early part of video with adolescent after describing Avoid Arg. And Roll w. Res.
It illustrates Building Rapport, Rolling w/ Res., Avoid Arg., Supporting the client’s feelings of efficacy.

18. Strategies for Gentle Encouragement
Establish rapport and build trust
Raise doubts by:
Eliciting the client’s perceptions of the problem
Providing feedback
Facilitating feedback of a significant other
Avoid premature prescriptive advice
Express concern, back off if necessary and keep the door open

19. ROLLING WITH RESISTANCE.
Don’t get rattled when the client says something against change
Best response is empathy, plus slightly hopeful comment
May need to use small steps (such as relapse sampling instead of lifetime commitment)
Refer to handout.
Express Empathy- Do Forming Reflections Exercise #.
Play early part of video with adolescent after describing Avoid Arg. And Roll w. Res.
It illustrates Building Rapport, Rolling w/ Res., Avoid Arg., Supporting the client’s feelings of efficacy.

20. . Support Self-Efficacy
Reinforce any willingness:
to hear information
to acknowledge the problem
to take steps toward change
Make the connection between previous successful change and potential to change the current problem
Refer to handout.
Express Empathy- Do Forming Reflections Exercise #.
Play early part of video with adolescent after describing Avoid Arg. And Roll w. Res.
It illustrates Building Rapport, Rolling w/ Res., Avoid Arg., Supporting the client’s feelings of efficacy.

21. Assumptions of CBT
Substance use is a learned behavior in which use becomes triggered by environmental stimuli, thoughts and feelings and is maintained by reinforcing effects.
Individuals who wish to stop or reduce substance use need skills to cope with these triggers, as an alternative to drug and alcohol use.
Effective learning of these new coping skills requires repetition and practice with feedback.
*Reinforce small steps in the recovery process
* Therapists help the adolescent realize that long term drug use is incompatible with other short and long term goals
* Work to increase alternative positive, non-drug related social/recreation activities, while teaching social skills (e.g. problem solving, drug refusal, etc)
* Helps the adolescent maximize family/peer/community resources and activities to reward non-drug using behavior.

22. Structure of CBT Group Sessions
Introduction and Rapport Building
Review of Progress
Introduction and Teaching Coping Skills
In-Session Practice Exercise
Assign Real-Life Practice Exercise
Closing

23. CBT Session Drug/Alcohol Refusal Skills
Review Rationale:
Narrowing of Social Circle
Best to avoid high risk people
Need for refusal skills
Teach Styles of Refusal
Provide Rehearsal through Role-Play
Describe Real-Life Practice exercise
Page -

24. CBT Session Increasing Pleasant Activities
Review Rationalea positive alternative to smoking marijuana
DiscussFun if not high?
Brainstorm activities
Ask them to commit to do one before the next session
Page
Steve to do demo.

25. CBT Session Planning for Emergencies and Coping with Relapse
RationalePreparation for high-risk situations increases likelihood of effective coping
Brainstorm potential high-risk/emergency situations
Give introduction to problem-solving skills
Review that relapse is not uncommon and provides an important opportunity for learning
Develop Emergency Plan for coping with lapse or full relapse
Page , page- Emergency plan

26. Assumptions Behind CBT Group Therapy
Breaks through isolation
Skill deficits are inter-personal in nature and need to be practiced to work
Group is realistic yet “safe” setting in which to practice
Provides additional opportunity to recognize problem and its link to consequences
Provides therapists the opportunity to observe and provide feedback on inter-personal behavior
More time in treatment is better

27. Tips for Using CBT in your Clinical Work with Adolescents
Individualize with adolescent’s concerns and avoid a cookbook feeling
Monitor for boasting about antisocial behaviors, or excluding some participants
Try to make it lively and interesting
Tell them what my involvement with using CBT has been
Find out what clinical population and type of programs they are working with/at.
Avoid cookbook-
Use examples from their experience
Don’t make the agenda more important than having room to hear about their current concerns.
Lively and Interesting
Vary styles of presentation-
Written materials
Posters
Get up and move about
Prizes for homework completion
Clapping
Don’t read verbatim
Role play pp -
Ok to use humor (not sarcastic)
Let clients help teach others
Game show host

28. Supplemental CBT Sessions (Webb et al )
A five stage problem-solving model is presented consisting of (a) general orientation, (b) problem identification, (c) generating alternatives, (d) decision-making, and (e) verification.
Anger awareness skills, highlighting both internal and external cues and triggers.
Anger management skills, including the use of calm-down phrases and anger reducing thoughts.

29. Supplemental CBT Sessions (cont.)
Communication skills, including active listening, assertiveness and positive ways of responding to criticism
Menu of coping options for cravings and urges for marijuana combined with a log exercise
Awareness of depressed feeling and their management through techniques like substituting positive for negative thoughts
Managing thoughts about marijuana, the most common excuses for relapse and discussing termination.

30. Most Common Modification
Currently being replicated in over dozen agencies around the country with consistent outcomes
Most Common Modifications:
Addition of family session at beginning and end
Addition of mental health component
Better linkage to continuing care
Modification to meet cultural, racial or other special population needs

31. Assertive Continuing Care (ACC) Experiment
The Assertive Continuing Care (ACC) Protocol: A Case Manager's Manual for Working with Adolescents After Residential Treatment of Alcohol and Other Substance Use Disorders
Assertive Continuing Care (ACC) Experiment
Godley, S. H., Godley, M. D., Karvinen, T., & Slown, L.L (2001).
Chestnut Health Systems
Bloomington, IL USA

32. Continuing Care—Defined
The provision of a treatment plan and organizational structure that will ensure that a patient receives whatever kind of care he or she needs at the time. The treatment program thus is flexible and tailored to the shifting needs of the patient and his or her level of readiness to change. (p. , ASAM Placement Criteria-nd edition; Mee-Lee et al., )

33. General Models of Continuing Care
Step up or lateral transfer, e.g., OP -> Res
Relapse/poor response to treatment
Step down transfer, e.g., Res ->OP
Successfully completed index treatment
Decrease frequency/intensity
Tx progress results in decreased OP freq and/or intensity
Attend step meetings
Advice frequently given upon tx discharge
Non AOD Tx referrals
E.g., family counseling; psych medication monitoring
Explain in terms of ASAM levels of care L-Outpatient; L IOP; L Residential

34. Linkage to Continuing Care within days Following Residential Treatment for Adolescents
Most clients do not receive any CC within days of discharge
Those who do link tend to go to residential or op
We cannot tell step attendance, MH tx. Or other services outside of AOD tx.
Source Illinois Statewide DARTs

35. Why do so many clients fail to link to continuing care?
May never get a referral – why?
Referral advice to see another provider (medical model) is “hit or miss” at best
Even transferring to another counselor within agency can be a problem.
Low Motivation/Treatment Fatigue- clients ready to be finished
Financial disincentives
. Read and discuss each of the bullet points
. For the past several years our research group at Chestnut has been studying assertive approaches to continuing care in an effort to improve linkage, retention, and outcomes
. Financial disincentives can arise in two ways ) group treatment may be the only way the provider can meet expenses; or ) client waiting lists may be sufficient that they just jump to the next client if an intake appt no shows.

36. Time to Enter Continuing Care and First Use after Residential Treatment% % %
First Use % %
Percent of Adolescents % %
Entered CC % % % %
Days after Residential (capped at )
Source DARTS and Godley et al

37. Who Links to Continuing Care?% % %
Dischargedtransfer
within agency % %
Percent of Clients Linked % %
DischargedReferred to
other agency %
The green and red curves represent planned discharges, while the red curve represents unplanned discharges. Again you see that if clients are going to link—it is most likely to happen in the first - weeks out of residential
These data illustrate the problems in linkage when multiple agencies must coordinate services
Those with unplanned discharges (ASA/ASR’s) had almost no possibility of receiving continuing care
Also, the pairwise comparisons between the lines are each significantly different from the other, p <. % %
Unplanned Discharge %
Days from Residential Discharge
Source CSAT ART Grantees Wilcoxon (Gehen) statistic (df=)=., p <.

38. Do adolescents attend step meetings after residential discharge?% % * % % % % . * % % % %
Both the adult and adolescent residential programs at Chestnut emphasize participation in step meetings. These data come from two different follow-up studies of adults and adolescents and their utilization of step meetings during the first days after residential discharge.
You can see that about out of adolescents attended a step meeting compared to . out of adults
On average, adults attend nearly times as many step meetings as adolescents . vs. . respectively. % % . %
Attended One or More Meetings
Median No. Meetings Attended
Adults
Adolescents
Significant chi-square for enrollment and Mann-Whitney U for meeting attendance, p<..

39. Outpatient Continuing Care Criteria% % % % % % % % % % % % % % % % % % % % % %
Weekly Tx
Actual UCC
Weekly step meetings
Relapse prevention
Communication skills training
Problem solving training
Regular urine tests
Meet with parents -x month
Weekly telephone contact
Explain that we surveyed Outpatient Providers (n=) to determine these critieria for clients returning to the community following residential care
Explain that the poor rate of adherence on individual and total items but that this is applied to an intent to treat sample rather than just those who connected to treatment
Explain that later we’ll see that adherence matters with respect to outcome
Contact w/ probation/school
Referrals to other services
Follow up on referrals
Discuss probation/school compliance
AdherenceMeets + Criteria
Expected
Expected UCC

40. What Makes Assertive Approaches … Assertive?
Shifts linkage/retention responsibility from the adolescent/parent to the clinician
All admitted adolescents are eligible - not just graduates or “as planned” discharges
Understands the “clock is ticking” from the date of discharge and initiates continuing care within first-second week out of treatment
No confrontation, sessions are positive and reinforce progress toward goals

41. What Makes Assertive Approaches … Assertive? (Continued)
Sessions are usually held in the community (home, school, after work, restaurant, park) or by phone
Clinician may drop by unannounced if missed sessions
Case Mgmt and transportation assistance to access needed services
Telephone calls between sessions to check “homework” progress and provide support

42. Assertive Continuing Care (ACC) Enhancements
Case Management based on ACC manual (Godley et al, ) to assist with other issues (e.g., accessing needed services, job finding, monitoring, support)
Individual sessions for adolescent, parents, and together based on ACRA manual (Godley, Meyers et al., )
ACRA is a behaviorally based intervention to increase prosocial day to day activities for youth. It is based on the straightforward premise that teaching and encourgaing youth to participate in prosocial activities and goals reduces the liklihood of relapse. ACRA uses functional analysis of using behaviors and social behaviors as well as pt. Self assessment to generate GOC. Techniques include prosocial activity priming and sampling problem solving, and communication skills training with pt and caregiver. CM srvcs include transportation, linkage to other services such as GED, alternative school, or psychiatric services, and priming prosocial activities with patients.

43. ACC Case Management Services
Goal Provide assistance linking to needed services & regularly accessing prosocial & recreational activities
Critical Procedures:
Home based
Linkage
Monitoring lapse cues & attendance at services including step and other mutual support meetings
Advocacy to receive services
Social support

44. Main Case Management Activities
Meet with client in home and other community settings
Do some activities with client that are fun
Assess needs and help client link to other needed services
Serve as an advocate for the client to get needed services
Discuss/coordinate services with other providers, schools, etc
Job finding assistance
Limited transportation assistance
The measures used in this study included:
The GAIN -I at assessment - this is a biopsychosocial assessment tool used for clinical and research assessments covering substance use and a host of related life-health domains.
We are also using Alcosensors to assess breath alcohol content and accusign urinetests for cannabis and cocaine as well a collateral interview. All of theses measures are to assess the validity of the clients self report. Results to date suggest that caregivers underestimate patients self-reports much more so at intake than at follow up In addition, there is no sign. Difference in agreement between the two groups on self-report and biological measures of substance use.
Supplemental asssessment forms are included to assess family environment and coping and service contact logs are included to track AAP model fidelity and utilization.

45. Case Manager Do’s
At intake explain office and home or other community visits
Stress need to meet at least weekly
Keep sessions positive, search for the positive to build upon
If they have a telephone, call in between sessions (support, reminders, etc)
Spend time with youth doing some fun activities that they want to do either to build rapport or to celebrate accomplishments
If two or more consecutive missed sessions—be in the neighborhood and drop by
Talk to supervisor about difficulties with any procedures as well as client-specific issues.
ACRA is a behaviorally based intervention to increase prosocial day to day activities for youth. It is based on the straightforward premise that teaching and encourgaing youth to participate in prosocial activities and goals reduces the liklihood of relapse. ACRA uses functional analysis of using behaviors and social behaviors as well as pt. Self assessment to generate GOC. Techniques include prosocial activity priming and sampling problem solving, and communication skills training with pt and caregiver. CM srvcs include transportation, linkage to other services such as GED, alternative school, or psychiatric services, and priming prosocial activities with patients.

46. Case Manager Don’t’s Can’t take parental responsibility
Know the code of professional practice for your agency and respect those boundaries
Avoid giving, loaning, or accepting money or gifts
Maintain friendly, but professional relationship
The measures used in this study included:
The GAIN -I at assessment - this is a biopsychosocial assessment tool used for clinical and research assessments covering substance use and a host of related life-health domains.
We are also using Alcosensors to assess breath alcohol content and accusign urinetests for cannabis and cocaine as well a collateral interview. All of theses measures are to assess the validity of the clients self report. Results to date suggest that caregivers underestimate patients self-reports much more so at intake than at follow up In addition, there is no sign. Difference in agreement between the two groups on self-report and biological measures of substance use.
Supplemental asssessment forms are included to assess family environment and coping and service contact logs are included to track AAP model fidelity and utilization.

47. Safety Issues
Is this home safe? Read the Client’s case record from residential tx to help determine safety.
Pay attention to your instincts when you visit
Preferable if adolescent is not home alone
Know where exits are; keep a clear pathway to exit
Stay in living areas of the home.
If concerned you may suggest a coworker accompany you
May go with adolescent to other community location for session
Always carry a Cell Phone—call office at home
Situations we have encountered
The measures used in this study included:
The GAIN -I at assessment - this is a biopsychosocial assessment tool used for clinical and research assessments covering substance use and a host of related life-health domains.
We are also using Alcosensors to assess breath alcohol content and accusign urinetests for cannabis and cocaine as well a collateral interview. All of theses measures are to assess the validity of the clients self report. Results to date suggest that caregivers underestimate patients self-reports much more so at intake than at follow up In addition, there is no sign. Difference in agreement between the two groups on self-report and biological measures of substance use.
Supplemental asssessment forms are included to assess family environment and coping and service contact logs are included to track AAP model fidelity and utilization.

48. Adolescent Community Reinforcement Approach (ACRA)
CYT
Godley, S. H., Meyers*, R. J., Smith*, J. E., Godley, M. D., Titus, J. M., Karvinen, T., Dent, G., Passetti, L., & Kelberg, P. ().
Chestnut Health Systems
Bloomington, IL USA, and
*University of New Mexico
Albuquerque, NM USA
Cannabis Youth Treatment
Trials
Treatment Series
Volume

49. ACRA Treatment Structure
Individual sessions with the adolescent
sessions with the caregiver
individual sessions with the caregiver
sessions with the caregiver and the adolescent
ACRA is based, not session based

50. Theoretical Basis for ACRA
Operant Conditioning Model
Skills Training
Social Systems Approach
Azrin, Sisson, Meyer & Godley Community Reinforcement Approach with alcoholics
Meyers & Smith CRA adaptation for individuals concerned about the drinking of significant others
Smith, Meyers, & Delaney adaptation of CRA for homeless people dependent on alcohol
Higgins et al. combination of CRA with contingency management for treatment of cocaine addiction
Azrin et al. adaptation of CRA to adolescents
Catalano, Hops, & Bry’s work on parenting practices
Human Services of Franklin-Williamson County collaborated in developing the model where Mark Godley, Bob Meyers, and Wendy Bailie worked

51. Assumptions for ACRA
For many adolescent marijuana users, their social environment encourages marijuana use
The therapist needs to help the adolescent
recognize that their drug use is incompatible with other short- or long-term reinforcers (e.g., parental approval, staying out of criminal justice system, having a girl/boy friend)
maximize family/peer/community resources and activities to reward non-drug using behavior
increase alternative positive, non-drug related social/recreational activities
developing social skills (e.g., problem solving, drug refusal, etc.) will increase the likelihood of success in these endeavors.

52. Key Concepts Positive and enthusiastic approach Uses lay language
Keeps it simple
Flexible
Uses role-playing
Uses homework

53. Key Procedures Goals of Counseling ACRA Triangle Functional Analysis
* The handouts need to include copies of each of these forms and I can talk about them briefly
Key therapeutic approach:
Positive & enthusiastic approach
Uses lay language
Keeps it simple
Flexible
Uses role-playing
Uses homework
Functional Analysis
Happiness Scale

54. Treatment Mechanisms
Functional Analysis of Substance Use to identify the internal and external triggers that lead to substance use, document these behaviors and identify consequences of these behaviors.
Functional analysis of pro-social behaviors that compete with substance use
Skills training in relapse prevention, communication, problem solving, etc.
Incorporation of above into a treatment plan
Monitoring progress with the “Happiness” scale

55. Primary Goals Goals for Adolescents Goals for Caregivers
Promote abstinence
Participation in pro-social activities
Positive relationships with family
Positive relationships with peers
Goals for Caregivers
Motivate participation in ACRA
Promote adolescent’s abstinence
Positive communication and problem-solving skills
Promote critical parenting practices

56. Goals of Counseling
(Simplified Treatment Plan)

57. Critical Parenting Practices
Good modeling
Increase positive communication
Monitor the adolescent’s whereabouts
Involvement in adolescent's life outside the home

58. An important component of this intervention is to work with the adolescent on developing pro-social behaviors that do not involve drug use. So another funcitonal analysis is conducted to examine what leads to current pro-social behaviors, the consequences of those, and plans are discussed to increase them.

59. ACRA “Happiness” scale

60. Detailed List of Procedures from Manual
Functional Analysis of Substance Use Behavior
Functional Analysis of Prosocial Behaviors
The Happiness Scale and the Goals of Counseling
Increasing Prosocial Recreation
Relapse Prevention Skills
Communication Skills
Problem-Solving Skills Training
Urine Testing
Caregiver Overview, Rapport Building,
and Motivation
Caregiver Communication Skills Training
Caregiver–Adolescent Relationship Skills
Treatment Closure

61. Optional Procedures from Manual
Dealing With Failure To Attend
Job-Seeking Skills
Anger Management

62. Other Recommendations for Post-residential Continuing Care
Consent to participate in CC should be obtained within the first week of residential treatment
Linkage after residential discharge should be accomplished in the first week following discharge
Using an assertive approach, nearly all clients can be linked to CC—regardless of discharge type.
Maybe half of the “As Planned” discharges do not need the extra effort required of assertive approaches….but which half?

63. Other Recommendations (Continued)
Strive for high adherence to CC criteria (+criteria) with every client
For the most resistant clients consider motivational approaches such as contingency management to increase attendance, prosocial activities, and abstinence
Facilitate linkage to needed services (medical, psychiatric, school, legal/probation, -step, etc)
Develop local and community-wide recovery support activities to improve clients’ recovery environment

64. Contact and Additional Information
Michael L. Dennis, Ph.D., CYT Coordinating Center PI
Lighthouse Institute, Chestnut Health Systems
West Chestnut, Bloomington, IL
Phone () -, Fax () -
Manuals and Additional Information are Available at