Academic journal article Indian Journal of Psychiatry

Psychosocial Interventions among Children and Adolescents

Academic journal article Indian Journal of Psychiatry

Psychosocial Interventions among Children and Adolescents

Article excerpt

Byline: Deepak. Jayarajan, Preeti. Jacob

Substance use disorders in children and adolescents are a significant cause of concern as they can have long term implications in practically every sphere. The etiological factors that contribute to substance use disorders are complex and the formulation must amalgamate and synthesize all the different factors including the predisposing, perpetuating, precipitating and protective factors in order to plan management. Interventions must stem from this comprehensive formulation and must be child-focused, multidisciplinary, multisystemic, with strong family participation and community involvement. The treating team must actively collaborate with the young person and help him/her understand the rationale for treatment in order for them to engage in it. Assessment and treatment of comorbidities are an important part of intervention package. Skill training for problem solving, emotional regulation, social skills, and communication are an essential part of the treatment for substance use disorders in adolescents. Relapse prevention strategies, including how to seek help when there is a lapse must be part and parcel of the interventions delivered to the young person. Substance use disorder interventions must be part of a larger plan that addresses other areas of concern in the young person's life. While there are few studies, and so a relatively weak and preliminary evidence base for pharmacotherapeutic interventions, early evidence shows that their combination with psychosocial interventions may have a synergistic effect on substance use reduction. Substance use disorders affect the entire family and the community at large and thus must be treated holistically, but by individualising the treatment to suit the needs of that particular child and family.

Introduction

Interventions for substance use disorders (SUD) in children and adolescents are often complex as the child/adolescent rarely seeks treatment or help on his/her own. More often than not they are brought by the family with requests from them for the most restrictive kind of treatment available. Due to this coercion, during the initial process of treatment seeking, there is a certain degree of hostility and mistrust, especially from the child/adolescent towards the treating team, right at the beginning of treatment. In order to counter the hostility associated with treatment against their will or without their expressed consent, the treating team must have an empathetic, understanding, respectful, and non-judgmental stance. Apart from this, another aspect that is difficult to navigate is the child's and parents' distinct goals and requirements for treatment. This again is complex, as while the child/adolescent is the primary client, the parent is the guardian and ultimately gives consent for various aspects of treatment. Herein lie issues of confidentiality and the limits of confidentiality that the child/adolescent must be told about at the beginning of treatment such that treatment can be as transparent a process as possible. Ensuring the transparency, confidentiality, and allowing for participatory decision making often times reassures the child/adolescent and they may be more willing to take part in the treatment process. Rapport and relationship building with the child/adolescent and their family is another important area that the clinician needs to keep in mind as the subsequent success of treatment depends on the strength of the therapeutic alliance.[1],[2]

There is no doubt in anyone's mind that adolescents cannot receive the same treatment as adults. The benefit of including the family in the treatment process is also well established.[3] Given that the risk factors for substance use disorders are varied and multi-factorial, any intervention can begin only with a good understanding of the problem behaviour, which includes the substance use history. History must be obtained from the child/adolescent at first in order to foster trust. …

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