Engaging Adolescents and Families in Treatment

Engaging adolescents in treatment is critical to working effectively with them and the principles are similar to treatment of other chronic disorders in young people.  Establishment of good rapport is required (see section on Assessment in this Chapter). 

Engagement and therapeutic relationships require an understanding of adolescent development and a cognitively and developmentally appropriate approach.  Young people are generally influenced by the ‘here and now’ rather than future benefits of changing current drinking patterns.  It is also important for health professionals to remember that young people are more interested in achieving the goals of adolescence rather than focusing on improving their health.  Given this, treatment goals need to be framed as ‘relevant’ to young people.  Approaches include examination of how alcohol affects their appearance and behaviour (e.g. at a party with peers), peer-reputation, ability to socialise, recreational, educational employment or sporting achievements, or impact on finances.  These discussions need to be delivered by the health professional at a level that is developmentally and cognitively appropriate.  Working with the young person to develop concrete short-term goals (weeks to months) is recommended.  

Encouraging the young person to participate in negotiation of treatment plans facilitates engagement in treatment and empowers change.  In some cases, disengagement with family may have occurred as a result of heavy drinking and other drug use.  Families are an integral part of the adolescent’s world and it is therefore important to try to assist the young person to re-build the connection.  Depending on the individual circumstance this may be through mediation via family counsellors or other health professionals.   

In cases where adolescents are not engaging well with alcohol or drug services, specific outreach and proactive services that cater appropriately for their developmental stage and incorporate a consideration of their cultural background, lifestyle and, in many cases their family, are required.