After noticing that teens from bedroom communities in the Dallas-Fort Worth area were frequently showing up in hospital intensive care units suffering from drug overdoses and other substance use-related problems, leaders at one Texas health system decided to try something different.
Children’s Health in Dallas recently launched its new Teen Recovery Program, which officials say is the first outpatient program in northern Texas to treat substance use disorders in the adolescent population. Teens who are misusing drugs or alcohol often have multiple comorbidities, such as attention deficit hyperactivity disorder or depression, says David Atkinson, M.D., the program's medical director. That’s why Children's Health believes it is important to treat the whole person, including behavioral and emotional issues, he says.
The spark to create the program came about four years ago amid a spike in teen opioid overdose victims admitted to the ICU. “Leadership at Children’s said, rather than sit around and mope and complain about how there's so many drugs in the community, why don't we take responsibility for the health of this whole population? And why don't we take responsibility for the health of our patients regarding their substance use behaviors?” says Atkinson, who is also an assistant professor of psychiatry at UT Southwestern Medical Center. “I think that was the real shift. This idea of, if we don't address this, there is going to be no magical entity that comes in and takes care of adolescent substance use.”
Doing so has proven difficult, as the three-hospital system looked to gather the necessary staff and seek out other programs to emulate. While Children's Health leaders drew inspiration from a similar offering at Boston Children’s Hospital, they had to “blaze a little bit of our own trail” in creating a program that is specific to the needs of Dallas, Atkinson says.
Atkinson — who is board certified in both child psychiatry and addiction psychiatry — has brought aboard a team of specially trained therapists who have years of experience treating behavioral health and substance misuse, according to the organization’s website. Doctors can refer teens aged 13 to 17 to the program, or patients can refer themselves. Evidence-based treatments are offered in three phases:
- Individual and family therapy sessions that last two to four weeks, based on the teenager’s readiness to begin addressing his or her substance use and behavioral concerns.
- Intensive outpatient therapy, which takes the form of group sessions, focused on learning how to manage anger and express emotions, cope with difficult situations in the absence of drugs and alcohol and act “socially appropriate” with peers while sober. These sessions take place three times a week for a duration of five weeks.
- After a patient shows progress with the first two phases, plans are crafted for any follow-up care after the patient's discharge from the program.
The Teen Recovery Program makes use of motivational enhancement therapy that is focused on engaging patients in self-driven change, along with cognitive behavioral therapy that’s goal-oriented and helps to replace old negative behaviors. Where necessary, in consultation with the teens' parents, medications are prescribed to treat behavioral health problems, such as ADHD or bipolar disorder. But Atkinson emphasizes that substance misuse is treated as a primary condition rather than being secondary to depression or other behavioral health issues.
Atkinson believes it is crucial, with both teens and their parents, to emphasize positivity and goal-setting rather than the kind of punitive measures that may have characterized approaches to intervention in the past. For instance, program participants can earn vouchers or gift cards as rewards when their drug screens indicate they have not used drugs or alcohol. “Sometimes teens become a little bit immune to negative consequences after a while,” Atkinson says. “Your parents yell at you, so what? They've been yelling at me since I was 6. So, one of the things that we're trying to do is give a positive reason [not to use].”
Tailoring therapies to the individual is also crucial, he says. Children’s Health has found that teens treated by the program come from all walks of life and reflect a range of ethnic, socioeconomic and geographical backgrounds. Addressing the opioid epidemic in the teen population won’t be easy, but Atkinson urges hospital leaders not to shy away from this work.
“Just get that idea out of your head that it’s too hard. It can be done,” he says. “It’s impossible to do perfectly, but it's not too hard to make a significant difference. We have to get better at treating this disorder, and the only way we’re going to get better is by trying models, developing them and communicating with each other on what's working and what isn’t.”