6 February 2019

Treating Addiction for Adolescents

Almost 75% of 12-17 year olds have tried alcohol and approximately 15% have tried drugs including cannabis, inhalants and other recreational drugs. 65% of Australians are regular gamers and 93% of households own at least one gaming device. Concerns have increased regarding internet gaming addiction with a current focus on the game fortnite.

Motivational Enhancement Therapy (MET) combined with CBT is an effective treatment approach to managing addiction with adolescents and research demonstrates the effectiveness of school prevention programs including education and other CBT strategies such as problem solving and social support for reducing risk and substance use.

MET involves 5 key strategies for increasing motivation for change.

Express Empathy and Acceptance: communicating respect for the client and avoiding an experience of client inferiority is important. MET does not involve confrontation and does not seek to convince clients to give up their substance/gaming use. Empathetic listening and accurate reflection are key to facilitating change and if the adolescent feels understood and accepted they will be more open to the possibility of change.

Example: So you’re saying you really enjoy the feeling that you get from smoking pot, but you’re worried that it might be hurting your mind.

Develop Discrepancy: Clients are more motivated for change when they can see a discrepancy between where they are and where they want to be.

Example: On one hand, you want to keep getting high, but you’d also like to get your mum off your back

Avoid Argument: avoid any direct argument as it triggers resistance. If a client becomes hostile or resistant there is a good chance that the therapist has said something to cause this and needs to return to the motivational interviewing style. Treat ambivalence as normal and this helps the client feel understood and reduces argument.

Roll with Resistance: don’t meet resistance head on- roll with it. Don’t provide a counter argument to the clients resistance. Empathetically reflect the client’s ambivalence or avoidance and let the client know that it is up to them to decide to change.

Support Self-Efficacy: work with your client to help develop and support their belief that he/she can change. The client needs to feel hopeful that there is a chance of success. The following questions regarding previous self efficacy can help the client’s self-efficacy.

a.Previous periods of abstinence
b.Earlier success in quitting
c.Part accomplishment in gaining control over another problematic habit
d.Attainment of a previous goal that was facilitated once they set their mind to it

The subsequent use of strategies is dependent on the client’s readiness to change. With less motivated clients, the primary therapy tasks are to help the client recognize possible negative impacts of substance/gaming/alcohol and identify and work through ambivalence.

Highly motivated clients work on strengthening their decision/motivation for change and then working through cognitive behavioural strategies. Thought challenging, problem solving, assertiveness training, activity scheduling, social support and behavioural strategies to manage urges are all helpful.

Written by Dr Michelle Pritchard Clinical Psychologist