Talbott Recovery: Young Adult Addiction Treatment
Age Specific, Longer Term Treatment Imperative for Young Adults
Michael L. Fishman, M.D.
Program Director, Talbott Recovery Young Adult Program
Achieving and maintaining sobriety is a daunting struggle at any age, but for young adults (ages 18-26 years old) it is statistically proven to be even more so. Issues such as newfound independence, peer pressure, and collegiate “expectations” make staying sober an exceptional process for them in comparison to adults. Taking these and other issues into account is detrimental to a successful recovery. In general young adults need more time, and more exclusive treatment than others. In turn, this will lead to a better result for all involved. Long term, age specific treatment is imperative to the young adult recovery process.
Treating young adults over the past 22 ½ years has offered me a lot of experience in their typical drugs of abuse, behavioral patterns, family dynamics, and tendency to avoid feelings at all cost. I spent many years directing a young adult program that generally lasted four weeks in a partial hospitalization level of care (day treatment). This was generally followed by two weeks in an intensive outpatient level of care (2-3 hours a day) while living in a ¾ way house.
Many young adults arrive to treatment cognitively impaired due to long standing use of drugs and/or alcohol. Marijuana alone causes significant cognitive inefficiencies. In my experience, it takes a minimum of 2 to 4 weeks to detox and/or see cognitive clearing in the young adult. Drugs such as marijuana, alcohol, Roxycodone®, heroin, benzodiazepines (Xanax®, Klonopin®), cocaine, and methamphetamine, Spice, and bath salts have a profound negative impact on the young person’s cognition as well as behavior.
It is also common to see these patients attempting to maneuver their way out of treatment over their first 1 to 3 weeks of treatment. They “work” on their parents in an attempt to undermine their treatment. They have rarely, if ever, followed rules and are used to having their way with their parents. Extensive work is needed with patients and their parents in regard to detox, healthy boundaries, and consistent messages.
It is not until after the 3rd or 4th week of treatment that the young adult settles into treatment and becomes more willing to do the difficult work ahead. I have seen significant work done with both patients and their families during weeks 4-10. Individual and group therapy is much more effective as consistent boundaries develop. During that period of time, healthy coping mechanisms are discussed as well as overt and covert craving management techniques. Weekly family therapy is a must. Oppositional defiant behaviors have to be dealt with.
At Talbott Recovery Campus, we find the level system especially important during this time of emotional and behavioral growth. As the young adult continues through weeks 10-12, he/she is able to formulate a significant aftercare plan of structured support including random, witnessed urine drug screens.
In my experience, it is a minimum of 90 days before a young adult patient is ready for an intensive outpatient level of care. This too can be completed at Talbott Recovery Campus through our Mirror Image phase of treatment, or through intensive outpatient programs such as those at Talbott Recovery Dunwoody. The young adult patient is much more appropriate for ¾ way house level of structure at that point. Any significant mood disorders have been addressed and treated by this time. I strongly believe a minimum of 90 days of treatment for the young adult is mandatory.
In addition to the specified length of a successful recovery program, I also believe that young adults should be treated in an age specific setting. Historically, young adult treatment was combined with that of older adults (26 and older). Over the years, we repeatedly heard feedback from adult patients that the young adults were disruptive, creating distractions in groups. Experts in addiction treatment generally recognize that young adults find achieving sobriety more difficult than their adult counterparts. Some of the age-specific challenges have been identified in recent studies which indicate that young adults with addictive disorders are seldom addicted to just one substance or behavior. Additionally, they are experiencing significant life changes and are subject to intense peer pressure. Talbott Recovery’s Young Adult Program was designed to address these difficulties and tailored to the therapeutic needs of our young adult patients, as they are learning to navigate their constantly changing social environment.
While living in Talbott Recovery’s structured patient community, young adults begin to experience a life free from active addiction. As they progress through the levels of care, each comprising a broad spectrum of specialty groups and services, patients also actively participate in 12-Step recovery programs, weekly sessions with their physician, and a weekly group facilitated by me. These treatment elements help each patient unearth their own therapeutic issues that fuel substance use problems. These insights provide individual, patient-specific direction to develop new behaviors necessary to halt the addictive response.
We have found it mutually beneficial for our young adult and adult patients to participate in some activities together. Weekly community dining experiences with combined age groups, followed by a 12-Step meeting and specialty group sessions, provide a meaningful therapeutic environment for the two groups to support and learn from each other.
Family therapy is critical in the treatment of young adults. Patients and their families participate in weekly family sessions, as well as psychoeducational and psychotherapeutic groups designed to help them explore addiction and co-occurring psychiatric disorders and the impact these diseases have on the entire family. Periodic dinners for individual patients and their family members, followed by groups combining all patients and families, furthers the process of patients identifying the underlying issues that tend to drive the disease of substance use and/or addiction.
As young adults begin to recover from the shame that permeates the disease of addiction, they can learn how to relate to self and others in a more healthy and meaningful way. This process gives patients an opportunity to develop and practice newly-learned, healthy coping mechanisms and socialization skills necessary to maintain abstinence. Upon completion of the Young Adult Program at Talbott Recovery, patients are more prepared to face life’s challenges substance free.
Michael L. Fishman, M.D. is a nationally recognized leader in the treatment of young adults suffering from addictive diseases. He specializes in addiction medicine and the treatment of nicotine dependence. After graduating magna cum laude in biology from the University of Georgia, Dr. Fishman received his medical degree from the Medical College of Georgia where he also did an internship and residency training. He is the Director of the Young Adult Program at Talbott Recovery Campus in Atlanta, GA and holds the following certifications: Board Certified in Addiction Medicine, Diplomat of the National Board of Medical Examiners, MRO Certification, and the American Society of Addiction Medicine (ASAM).
For more information about Talbott Recovery’s Young Adult Program, visit: https://www.talbottcampus.com/index.php/addiction-rehab-programs/young-adult-program/