Helping A Teen Who Just Can't Say No

Few things are more heartbreaking for parents than seeing a child swept up in the drug tide. While substance abuse among teenagers is gradually declining, the government estimates that 4.9 million adolescents drink, more than a million smoke marijuana, and thousands more use stimulants or tranquilizers. As many as half of these kids may be chemically dependent.

Fortunately, treatment has grown increasingly sophisticated, with many programs tailored to teenagers. But finding the right one for your child takes research. Public programs often have waiting lists of up to six months, especially for inpatient care, and they tend to be in poor urban areas. Private facilities are very expensive, and insurers generally limit coverage for substance-abuse treatment.

HOTLINE. If your company has an employee-assistance program, find out what kind of covered treatment is available for your dependents. Or, you can call the National Institute of Drug Abuse's hotline (800 662-HELP) for a referral that matches your location, income, and specific problem. A few private inpatient facilities have "scholarship beds" based on need, taking one or two patients a month for free.

Treatment can take the form of intensive detoxification and rehabilitation in a hospital or other accredited institution, usually over one to two months. Such programs average $9,000 for a 28-day stay. The alternative is an outpatient plan involving therapy and support sessions for as long as two years. These programs usually cost $1,000 to $2,000 a month, and some health professionals say they do a better job of reeducating an adolescent to live happily without getting high.

A responsible program will conduct a pre-admission assessment that includes tests for physical diseases, psychiatric disorders, and learning disabilities. That's because some children--just like adults--use drugs as a way of self-medicating manic depression, for example.

The evaluating team should also include trained family counselors. Kids often learn substance abuse at home, even if parents use nothing more potent than cigarettes and beer. "Usually, one or both parents have a drug or alcohol problem," says Dr. James Cocores, medical director of outpatient recovery at Fair Oaks Hospital in Summit, N. J. In such cases, the whole family needs to learn to live without chemicals. Fair Oaks operates two adolescent outpatient programs--one with a strong educational focus for young "experimenters" and another for habitual drug users--in addition to an inpatient plan.

HEALTHY HABITS. Most programs are loosely based on the 12-step system of Alcoholics Anonymous, which stresses abstinence and strong peer support. But "it's very different from adult treatment," says Cathy Seward, head clinician at Pioneer House, a unit of Minneapolis' Hazelden clinic that specializes in 14- to 25-year-olds. Because adolescence is such an intense learning phase, kids who drink or use drugs risk a degree of developmental retardation, according to Seward. "Part of their recovery is learning how to catch up," she says. As part of this process, Pioneer House may have nutritionists or exercise trainers help kids learn healthy habits.

Straight, an unusual long-term outpatient program with 18 facilities throughout the country, separates troubled teenagers from their parents in the first phase of rehabilitation. The kids live with a family whose teenager is in a more advanced stage of recovery. Teens go home when they're ready to begin building a new life and repairing family ties. They continue outpatient therapy for up to a year, and the program also offers "aftercare" support.

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