By Terence T. Gorski, Author of
The Adolescent Relapse Prevention Workbook
This article describes the differences between adolescent and adult substance abusers that can lead to relapse and presents practical suggestions for matching the unique needs of adolescent substance abusers to relapse prevention strategies in order to decrease the rate of relapse.
Adolescent chemically dependent patients relapse at a much higher rate than adults. Studies indicate that approximately 42% of adolescents who complete inpatient treatment for chemical dependence maintain total abstinence from alcohol or other drugs during the year following treatment. This is much lower than the 66% abstinence rate reported for adult inpatient programs with similar treatment philosophy and geographic locations.
Seventy-eight per cent of adolescents who relapse (45% of all adolescents treated) do so during the first six months of recovery. The good news is that 77% of those who made it through the first six months of recovery without relapsing maintained their abstinence for the entire year. Of the patients who relapsed during the first six months, 28% were abstinent for the second six months. Of those adolescents who relapse (58% of all adolescents treated), approximately 40% (23% of all adolescents treated) have short-term and low consequence relapses and rapidly return to sobriety. The other 60% (34% of the population) have long-term, high consequence relapses.
Reasons For Adolescent Relapse
There are significant differences between adult and adolescent chemical addictions and the failure to recognize these differences can be an important contributor to adolescent relapse. Most chemically dependent adolescents have three coexisting problems that increase relapse risk:
(1) Chemical Addictions (Adolescent Substance use Disorders)
(2) Normal Problems With Adolescent Development, and
(3) Adolescent Mental Disorders.
Adolescent Substance Disorders
Many chemically dependent adolescents relapse because they fail to recognize that they are chemically dependent and need to abstain from alcohol and drugs. This is especially true for adolescents who are in the early stages of their addiction or lack a long history of alcohol and drug related problems.
Forcing early stage adolescents into harshly confrontational inpatient programs against their will can create high relapse rates after discharge. Many of these adolescents go into compliance and passively resist treatment and, although on the surface many appear to be model patients, after discharge they rapidly return to alcohol and drug use because they have failed to recognize and accept their addiction.
Recovery rates can be improved by using outpatient motivational counseling techniques and substituting intensive outpatient treatment for inpatient treatment.
Some adolescent programs focus exclusively upon the chemical addiction while minimizing or ignoring problems with normal adolescent development or adolescent disorders which can lead to relapse. Many adolescent programs, for example, set behavioral standards that would be appropriate for adults but are inappropriate for adolescents in certain stages of development.
Since the onset of chemical addiction causes many adolescents to stop normal emotional development, treatment centers can overcome this problem by assessing the stage of adolescent development and setting appropriate behavioral expectations and treatment goals.
Normal Problems With Adolescent Development
It can be easy to forget that adolescent substance abusers are children who are not capable of functioning up many adult standards. Normal adolescence is a difficult period of adjustment. Hormones go on-line and start to rage. Social relationships become more complicated. Pressure from peers to conform and pressure from parents and teachers to excel can weigh heavily on many if not most teenagers.
Effective adolescent treatment programs take the stage of adolescent development into account and design treatment plans that are appropriate to the adolescent’s current developmental level. Failure to do so can significantly increase the risk of relapse.
Adding educational approaches to the recovery and relapse prevention process can go a long way to preventing relapse for adolescents in the school environment. 
Coexisting Psychosocial Problems
Typical chemically dependent adolescents have three major life problems in addition to their chemical addiction to contend with when they enter treatment. The most common problems include school problems (58%), dysfunctional relationships with one or both parents (38%), parental substance abuse (35%), physical abuse (30%), sexual abuse (37% of females and 5% of males), depression (29%), and suicide attempts (16%). If left untreated, these other problems can create ongoing pain and dysfunction which lead to relapse.
While treating these other problems, however, it is important to keep an addiction focus. To treat these other problems without helping the adolescent to recognize the role that their alcohol and drug dependence has in creating and maintaining these problems can also contribute to relapse.
An effective relapse prevention approach is to provide balanced treatment for adolescents that focuses upon diagnosing and treating their chemical addiction, the normal tasks of adolescent development that they need to cope with in sobriety, and other major life problems that can jeopardize sobriety.
Selecting The Appropriate Treatment Setting
It is important that adolescents be matched to an appropriate treatment setting. There is the mistaken belief that the preferred treatment setting for all adolescents is a long-term inpatient treatment environment.
Many adolescents, especially those in the earlier stage of addiction with less severe coexisting problems and supportive families, do better in outpatient environments where they can maintain their academic and family lives than in long-term inpatient programs that disrupt the normal course of their lives. For adolescents with late stage chemical addiction with numerous severe, coexisting problems and little or no family support, inpatient treatment may be necessary.
The Role Of Outpatient Treatment In Relapse Prevention
Ongoing outpatient treatment is vitally important in preventing adolescent relapse. The majority of adolescents relapse in the first six months with the second highest risk period being the second six months. Adolescents who are not involved in outpatient treatment that includes family involvement for at least one year following discharge from inpatient are at high risk of relapse.
Failure To Teach Warning Sign Identification & Management
The final factor that contributes to an increased relapse rate among adolescents is the failure of many treatment centers to teach the adolescent patients and their families how to identify and manage relapse warning signs.
Relapse is a process that begins long before adolescents begin drinking and drugging again. There are progressive and predictable warning signs that indicate that the adolescent is getting into trouble with his or her recovery.
The typical sequence of warning signs normally begins when a situational problem triggers the adolescent to react with old addictive ways of thinking. The addictive thinking creates painful and unmanageable feelings. In order to cope with these feelings, the adolescents begin reverting to alcohol and drug seeking behaviors which put them back in contact with other adolescents who are drinking or drugging. Once in this environment, return to use is inevitable.
Teaching adolescents and their families to recognize and intervene upon the early warning signs can prevent unnecessary relapse. Helping the adolescent, the family members, and other concerned persons to intervene as soon as addictive use begins can help assure that adolescents will experience short-term and low consequence relapses.
 Harrison, P.A. and Hoffmann, N. G. (1989), CATOR Report: Adolescent Treatment Completers One Year Later, Ramsey Clinic, St. Paul, MN, pp. 47-48.
 Bell, Tammy, Preventing Adolescent Relapse – A Guide For Parents, Teachers And Counselors, Herald House/Independence Press, Independence, Missouri, 1990
Treatment Completers One Year Later, Ramsey Clinic, St. Paul, Minnesota, p. 40.
 Harrison, P.A. and Hoffmann, N. G. (1989), CATOR Report: Adolescent
 Adding Education to the Relapse Prevention Model: http://www.addictionpro.com/article/adding-education-model
The Adolescent Relapse Prevention Workbook
About the Author
Terence T. Gorski is internationally recognized for his contributions to Relapse Prevention Therapy. The scope of his work, however, extends far beyond this. A skilled cognitive behavioral therapist with extensive training in experiential therapies, Gorski has broad-based experience and expertise in the chemical dependency, behavioral health, and criminal justice fields.
To make his ideas and methods more available, Gorski opened The CENAPS Corporation, a private training and consultation firm of founded in 1982. CENAPS is committed to providing the most advanced training and consultation in the chemical dependency and behavioral health fields.
Gorski has also developed skills training workshops and a series of low-cost book, workbooks, pamphlets, audio and videotapes. He also works with a team of trainers and consultants who can assist individuals and programs to utilize his ideas and methods.
Terry Gorski is available for personal and program consultation, lecturing, and clinical skills training workshops. He also routinely schedules workshops, executive briefings, and personal growth experiences for clinicians, program managers, and policymakers.
Mr. Gorski holds a B.A. degree in psychology and sociology from Northeastern Illinois University and an M.A. degree from Webster’s College in St. Louis, Missouri. He is a Senior Certified Addiction Counselor In Illinois. He is a prolific author who has published numerous books, pamphlets and articles. Mr. Gorski routinely makes himself available for interviews, public presentations, and consultant. He has presented lectures and conducted workshops in the U.S., Canada, and Europe.
The Adolescent Relapse Prevention Workbook