Substance Abuse & Trauma

The Problem | Rationale

The road through adolescence can be bumpy. During this stage of life, girls and boys face a variety of developmental tasks and challenges as they transition from the roles and responsibilities of childhood to those of adulthood. As adolescents build more independence and autonomy in their lives, they must also face a wide range of dramatic physical (puberty), social (peers, family), sexual, and emotional changes all while navigating their obligations at home, school, and in the community.

The way the brain develops throughout adolescence predisposes many teens to seek novel, exciting, “high reward” experiences while brain regions responsible for self-regulation, inhibition, and problem-solving are not fully matured. This is often a recipe for impulsive, potentially unsafe behaviors, particularly when combined with risky environmental factors like spending time with delinquent peers or low parental monitoring. Given this situation, it is perhaps not surprising that adolescence is also a time when many young people begin to experiment with alcohol, other drugs, and sex. The majority of U.S. youth engage in some form of substance use by age 18 and approximately 40-65% have had sexual intercourse by the time they graduate high school.  For some adolescents, experimentation can cascade into serious problems.

Exposure to interpersonal violence and other traumatic events is one of the strongest and most consistent predictors of adolescent behavioral and emotional health problems, including substance abuse and posttraumatic stress disorder (PTSD). Unfortunately, trauma exposure is quite common. By age 18, approximately 1 in 2 youth will experience interpersonal violence, such as child sexual abuse, child physical abuse, domestic violence, community violence, and dating violence.

Teens who have experienced interpersonal violence and other types of traumatic events are highly vulnerable to the development of PTSD and other trauma-related mental health problems (PTSD, depression), risk behaviors (substance use/abuse, risky sexual behavior, non-suicidal self-injury [NSSI]), and re-victimization. Most behavioral treatment models are untested or unsuitable to address these diverse problems concurrently, or have not been designed with sensitivity to the unique developmental needs and challenges faced by adolescents. RRFT was developed to fill this gap.

RRFT | Description

Risk Reduction through Family Therapy (RRFT) is an integrative, ecologically informed approach to addressing co-occurring symptoms of PTSD, substance use, depression, and other health risk behaviors often experienced by trauma-exposed adolescents. RRFT is novel in its integration of these components given that standard care for trauma-exposed youth often entails treatment of substance use problems separately from treatment of other trauma-related emotional and behavioral health problems.

Kristi House therapists were trained and guided in RRFT by its developer, Dr. Carla Danielson of Medical University of South Carolina. The intervention is offered by Kristi House to those adolescents and families who would benefit from RRFT.

Integrative: RRFT integrates components, skills, and principles from existing, empirically supported treatments, including Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Multi-systemic Therapy (MST), Dialectical Behavior Therapy (DBT), Motivational Interviewing (MI), Contingency Management (CM) and psycho-educational risk-reduction and prevention programs.

Ecologically Informed: A variety of risk and resiliency (or protective) factors contribute to one’s health and behavior. These factors—or drivers—vary from person to person, and can be classified across several “levels” of one’s ecology. For adolescents, some key levels include (a) individual, (b) family, (c) peers, (d) school, and (e) community. By focusing on drivers of trauma-related mental health, substance use, and risk behaviors across these levels of ecology for each adolescent, RRFT is highly tailored and can be adapted for a wide variety of trauma types and presenting clinical problems.

RRFT is individualized to the needs, strengths, developmental factors, and cultural background of each adolescent and family. This tailored approach is incorporated throughout all components of treatment. RRFT involves seven intervention components: Psychoeducation, Coping, Family Communication, Substance Abuse, Posttraumatic Stress Disorder (PTSD), Healthy Dating & Sexual Decision Making, and Revictimization Risk Reduction.

The pacing and ordering of RRFT intervention components is flexible and is determined by the needs and priorities of each family, as well as the intensity or severity of symptoms in each domain. Symptoms are monitored throughout RRFT using standardized assessment tools to help track treatment progress and guide clinical decision-making. The average frequency and duration of RRFT depends on the symptom level of each youth, but typically involves 16-20, weekly, 60-90 minute sessions with periodic check-ins between scheduled appointments.

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