Thursday, December 12, 2013

Meredith Fowler Tweet

Meredith Fowler, a young adult in recovery, expressed the above sentiment when asked during our National Recovery Month behavioral health chat on Twitter (#bhchat) about the most rewarding aspect of her recovery. Her recovery—a recovery she owns—came about because of supportive people in her life who effectively engaged her in the recovery process using structures that were already in place. Her family recognized her need for help, she engaged with a supportive treatment provider in a recovery environment, and she received the necessary recovery supports to ensure a productive life in her community of choice. Although her path to recovery may not have been as cut-and-dried as described, she was not a victim of “missed opportunities,” that disreputable phrase that echoes following a tragic event when everyone collectively realizes in hindsight that signs, cues, and opportunities to intervene presented themselves.

Let’s begin with a few drug use statistics and trends. The use of narcotic drugs (mostly prescription analgesics) other than heroin has increased sharply among youth in recent years. Among college students, 61.8 percent were offered prescription stimulants during college and 31 percent used them, primarily in an effort to keep up with studying. Most students got their stimulants from a friend who had a prescription. The use of stimulants without a doctor’s prescription is also increasing among students in the 9th through 12th grades. (1)

Youth often put themselves at further risk by combining prescription drugs with illicit drugs or alcohol without realizing the danger. In 2013, the National Institute on Drug Abuse reported that of teens who take prescription opioids nonmedically, 24 percent usually or always combine them with marijuana. Moreover, teens who mix prescription opioids with other drugs are four times as likely to get drunk frequently and eight times as likely to use marijuana. (2)

Evidence is strong that youth with emotional disorders are at risk of developing substance use disorders. Among adolescents who enter treatment for substance use, 83 percent of females and 62 percent of males have emotional disorders, including behavioral disorders. (3)

What are the implications for treatment and recovery? While 1.5 million U.S. teenagers meet the clinical criteria for substance use disorders, only about seven percent receive treatment because of inadequate insurance, low motivation, a lack of youth-focused treatment programs, and inconsistent quality of youth treatment. Those who have worked with young people who have substance use disorders or who are at risk for developing them agree: Imposing adult standards on youth and young adults does not work. These individuals are not being stubborn; they just do not have the capacity to operate as adults.

When it comes to our youth and young adults who are experiencing substance use challenges, we can avoid “missed opportunities” by meeting them where they are. Opportunities can effectively and authentically engage them in services that support their recovery and help them reach their greatest potential.

Here are considerations that have proven effective for preventing substance use among youth and young adults or that meet the needs of those who are already battling substance use problems. Remember, these are broad considerations; tailored approaches should reflect the unique needs of the individual.

  • Interventions must integrate an understanding of youth culture. SAMHSA and other federal agencies have collaborated in and funded the development and testing of a number of interventions for the treatment of youth with substance use disorders. Implementing these interventions can lead to successful treatment and recovery outcomes. However, there is no one-size-fits-all method to recovery; interventions must be adapted to each youth’s age and level of need.
  • Harm-reduction approaches may be appropriate. The prevailing model in U.S. drug and alcohol treatment modalities is total abstinence. Given the increased risk for later problems associated with the use of drugs or alcohol at an early age, prevention is the best possible approach. For those who started using drugs or alcohol at an early age, preventing further damage almost seems to require abstinence. However, one-third to one-half of treated youth will return to some drug use during the first 12 months after completing therapy,[1] suggesting that a “harm-reduction” model might be worth considering. A harm-reduction program for youth means giving them the space and support to make their own positive decisions toward their recovery and follow through with them.
  • Emphasize goal setting and age-appropriate recovery support needs. When working with older youth and young adults in recovery, goal setting is essential. They need help identifying where they want to go and how to get there. Recovery supports are as important for youth and young adults as they are for adults, but the supports are typically much different. Most teenagers, for example, do not have children and therefore do not need child-care services. While most youth or young adults may still be in school, help with finding a job may be needed, particularly if the individual is living on their own or must offer financial support to a household. Transportation services also are helpful so that youth can get to meetings and structured activities. Help with homework and opportunities to interact with peers in drug- and alcohol-free activities have been found to be effective recovery support services for youth and young adults.
  • Integrate thoughtful use of social media. Social media is popular among youth and young adults, so it seems to be ideal for reaching out to them. When using social media, however, it is important to remember to exercise confidentiality and professional boundaries. “Friending” program participants on Facebook, for example, is inappropriate because one of the friends is in a position of authority. A program can use social media effectively to advertise its services or provide information. Young people will find them and can decide whether to respond.

Ideally, we want to prevent addiction before it grabs hold of any of our loved ones. However, with these considerations in mind, strong recovery support structures, and a foundation of steadfast (and supportive) family and friends, we can provide the best care for youth and young adults who are traveling along their recovery path. Together, we can support these individuals in achieving recovery from substance use disorders to give them a fresh start to their lives so that we have more people like Meredith and fewer missed opportunities.


  1. Garnier-Dykstra, L. M., Caldeira, K. M., Vincent, K. B., O’Grady, K. E., & Arria, A. M. (2012). Nonmedical use of prescription stimulants during college: Four-year trends in exposure opportunity, use, motives, and sources. Journal of American College Health, 60, 226–234.
  2. National Institute on Drug Abuse. (2013). Teens mix prescription opioids with other substances. From (accessed April 19, 2013).
  3. Winters, K. C., Botzet, A. M., & Fahnhorst, T. (2011). Advances in adolescent substance abuse treatment. Current Psychiatry Reports, 13, 416–421. Retrieved April 23, 2013, from

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