When the Levee Breaks: Treating Adolescents and Families in the Aftermath of Hurricane Katrina

Article excerpt

Hurricane Katrina brought to the surface serious questions about the capacity of the public health system to respond to community-wide disaster. The storm and its aftermath severed developmentally protective family and community ties; thus its consequences are expected to be particularly acute for vulnerable adolescents. Research confirms that teens are at risk for a range of negative outcomes under conditions of life stress and family disorganization. Specifically, the multiple interacting risk factors for substance abuse in adolescence may be compounded when families and communities have experienced a major trauma. Further, existing service structures and treatments for working with young disaster victims may not address their risk for co-occurring substance abuse and traumatic stress reactions because they tend to be individually or peer group focused, and fail to consider the multi-systemic aspects of disaster recovery. This article proposes an innovative family-based intervention for young disaster victims, based on an empirically supported model for adolescent substance abuse, Multidimensional Family Therapy (MDFT; Liddle, 2002). Outcomes and mechanisms of the model's effects are being investigated in a randomized clinical trial with clinically referred substance-abusing teens in a New Orleans area community impacted by Hurricane Katrina.

The core experiences of psychological trauma are disempowerment and disconnection from others. Recovery, therefore, is based upon the empowerment of the survivor and the creation of new connections. Recovery can take place only within the context of relationships; it cannot occur in isolation. (Herman, 1997, p. 133)

Images and stories of Hurricane Katrina's young victims were captured on television news reports and magazine covers around the world for weeks after the storm and subsequent flooding. Experts predicted high rates of posttraumatic stress disorder (PTSD), depression, behavior problems, and substance abuse among Katrina's young victims in the months and years to come. While dire prognoses have been easy to generate, solutions to the overwhelming problems brought on (or perhaps brought to light) by the hurricane have not. Addressing the needs of children and families in the post-Katrina period requires sustained focus on certain key questions. There is considerable evidence to suggest that disasters create vulnerability to PTSD among children. Yet for youth directly affected by Hurricane Katrina, the pervasive and longlasting life disruption and cumulative stress may trigger a host of other problems. Premorbid conditions may be complicated among those at risk before the storm, and youth may use substances to cope with stress and traumatic loss. The result may be an urgent need for effective integrated services in an area depleted of resources and funds. Yet little is known about how to effectively intervene with youth and families after community-wide disaster. With few notable exceptions (Boss, Beaulieu, Wileing, Turner, & LaCruz, 2003; Landau & Saul, 2004; Sargent, 2007), typical services for disaster victims and trauma survivors do not include the family. A new era dawned on August 30, 2005, when New Orleans' levees broke. It is time for answers to Katrina's questions, and for new models that empower families through life's most unspeakable tragedies.

This article addresses a number of gaps in the current evidence base related to understanding substance abuse and other problems that may potentially surface or become exacerbated among teens in the wake of disasters such as Hurricane Katrina. While recent research has established direct links between trauma and substance abuse among teens (Dennis & Stevens, 2003), little is known about these associations in the aftermath of catastrophic events. Additionally, while cognitive behavioral therapy (CBT) interventions have shown positive effects on trauma symptoms with young disaster victims, rigorous postdisaster intervention research is rare, and few empirically based clinical guidelines exist. …