Using science and positive engagement to help young people get sober.
Frank Couch, Executive Director for the Science and Management of Addictions (SAMA), has studied alcohol and drug use among young people for more than a decade. Every spring, his organization hosts the Knowledge is Power Luncheon to inform Seattleites about the various alcohol and drug treatment programs in the area, as well as recent trends that impact youth everywhere. We recently spoke about this upcoming event, as well as the chemistry of addiction, some of the misconceptions people have about treatment, and resources for at-risk young people and their loved ones.
How do you define the term addiction?
I define addiction as a brain disease. There are neurochemical imbalances – or, more accurately, misfirings – that can develop biologically, as well as through the environment. The core factor is that it’s chronically progressive, and that it isn’t a matter of choice or willpower. It’s a chemical dysfunction.
How has addiction treatment evolved in recent years?
There was a time when the ’12-Step’ model was the one most widely used, and it is still engrained in the addiction treatment system – but it’s not the only model. I also believe that, historically, we used modified adult models for adolescents; today, we are slowly building on protocols designed specifically for youth. I think that’s a great direction for us to be headed.
We talk about addiction as a brain disease, and we know the brain isn’t fully developed until around the age of 25. So when we treat adolescents, we’re essentially shooting at a moving target. We need more modalities and research focused on the development of the adolescent brain and how drugs affect young people, as well as the appropriate treatment for these individuals.
We also don’t want to discount the impact of culture, because not everyone adheres to the same treatments in the same way. We definitely don’t want to advocate for a ‘cookie-cutter’ approach; however, we want the approaches we use to have proven outcomes.
Prior to your time at SAMA, you served as a treatment director and adolescent case manager at Lakeside Milam Recovery Center. What did you learn about childhood addiction during your time there?
I learned that adult addiction starts in adolescence, and all the adolescents I worked with had systems attached to them. It’s also really important to not only treat the identified person, but also educate and treat the individual’s family – parents, siblings, grandparents, and other people affected by the situation.
You joined SAMA in 2006. What programs have you spearheaded during your time with SAMA, and are there any new projects in the works?
When I first joined SAMA I worked on the Family Navigator phone line, which addresses people who might have an addicted person in their family. My job was to crisis manage, provide referrals and resources, and help callers figure out how to connect with loved ones. From there, we began to provide information to the public about addiction being a brain disease and where people can go for help. We also started a skill-building group to help parents shape their language for young people who are treatment-resistant, or those who have just come out of inpatient or primary treatment programs.
Two years ago, we started to offer intensive outpatient treatment and continuing care; we also provide assessments and Community Reinforcement and Family Training (CRAFT). In addition, we decided it would be to our advantage and our client’s advantage to offer marriage and family therapy, as well as individual therapy. The thing about addiction is that it destroys communications in a family in a way that is long reaching and long lasting. We can treat the addiction piece, but we also need to bring the family back together and heal the lines of communication between different family members. When it comes to people who have been addicted for a number of years, we need to show them how to improve their quality of life in a comprehensive way that goes way beyond chemical dependency treatment.
Is this comprehensive strategy a new approach to addiction management, or is it based on older models you’ve encountered in the past?
I’ve been fortunate enough to work at a number of places – Lakeside Milam, Washington Asian Pacific Islander Families Against Substance Abuse (WAPIFASA), Juvenile Drug Court – that have focused on the family, the comprehensive piece. There are a lot of folks out there doing it like this, and it’s absolutely the right way.
What approach do you take with new clients?
We try to meet new clients where they’re at. We might not be the best fit for everyone; some folks need inpatient, and we don’t have that. We try to figure out what they’re willing to do, and then get them the appropriate level of treatment for what’s going on in their life. Sometimes it’s just about having a positive engagement until they’re willing to get treatment. We try to engage them in that way, as well.
In your experience, what are some of the major factors that contribute to childhood substance abuse and addiction?
Research indicates that trauma, abuse, lack of funds, living in high crime areas, and dropping out of school all contribute to addiction. However, all of those risk factors are individualized. There are also pre-dispositions to consider. If you have addiction on either side of your family, then the propensity for you to become an addict or alcoholic is higher. This doesn’t necessarily mean that you will become an addict – but it might mean that when you decide to use alcohol or drugs for the first time, your body will react differently on a cellular level. Addiction can also develop out of experimentation; we see that with opiates all the time. The thing is, addiction is an equal opportunity destroyer. It doesn’t matter where you come from, or who you are. Anyone can be afflicted by this disease.
In terms of addiction and substance abuse, how does the media influence young people?
If you turn on the television, you’ll see semi-young folks in liquor commercials. The bartender shakes the canister, music is playing, and everyone is dancing. As soon as the bartender stops shaking the canister, the music stops and everything is dead. That’s the media world our children live in.
But has it gotten worse over the years? I can’t say for sure, but I’d say pieces of it have gotten worse. If we look at our healthy youth surveys, ‘first use’ has gotten younger in terms of prescription drug abuse. A lot of young kids are dying of this disease – and in this sense, I’d say things have definitely gotten worse. But the way we message it in our media is crucial to how our youth view the seriousness of this disease – if they even view it as a disease at all. Look at folks like Charlie Sheen or Lindsay Lohan, who sensationalize being out of control. Who wants to raise their hand and say, ‘I think I might have a problem’, when they could live like these people instead? It’s just insane.
We need to treat addiction and alcoholism as a long-term disease. Addicts and alcoholics might be the people in the alley shooting drugs into their arms, but they’re also the people getting dressed up and going to work every morning.
Where does Washington stand in terms of nationwide addiction statistics?
Nationwide, it looks as if prescription drug abuse is going down; however, Oregon and Washington are ranked among the top four states in the nation with the most prescription drug abuse. Washington was also one of nine states in where the number of deaths by accidental overdose of prescription drugs is higher than the number of automobile fatalities.
Thanks to the passage of I-502, marijuana has gotten a lot of local press lately. What is your professional opinion of marijuana, as well as the recent legislation to decriminalize it?
I think that there are probably medicinal properties in marijuana and other definite benefits. But for adolescents and adults, we know addiction can occur, and have long-lasting and harmful effects. That’s undisputed.
I-502 set aside money for treatment and prevention, and the bill focuses on making sure the young adult population is considered and that we’re not marketing to them. Now it’s time to make sure the monies that have been allotted to these programs don’t get diverted into something else, because we’re going to need it now more than ever. When there are 21-year-olds legally buying and smoking marijuana, that means the underclassmen will be smoking it as well. And at 18, anyone can get a ‘Green Card’ – that’s another major conflict.
Alcohol is legal, but there are still people who are addicted to alcohol and require treatment. It’s the same with marijuana. But people are going to think the drug is less harmful, and this might mean they take longer to get treatment.
If parents are concerned about their child’s drug and alcohol abuse, what are some key first steps toward addressing the problem?
Parents don’t have control over the youth – they never have – but what they do have is influence. They should set boundaries and reinforce them. And whether there are one or two parents present, the key is figuring out what the bottom line is and then sticking to it. When I say bottom line, I don’t mean that parents should necessarily kick out their kid for smoking marijuana – I don’t endorse that. But whatever your bottom line is, it needs to be consistent: “I don’t appreciate your abuse, and there needs to be consequences for that”.
If the use continues, then the best thing a parent can do is initiate treatment, and it all starts with an assessment of the extent of the problem to make sure he or she gets the right treatment the first time.
What is ‘Young People in Recovery Night’, and how can local youth get involved?
We created that event because there are a lot of activities and resources for adult clients in recovery, but there is very little in the local community for youth in recovery. People in recovery deal with a certain set of circumstances that people who aren’t in recovery can’t really understand, so environments that are labeled as ‘drug-free zones’ – such as Boys & Girls Clubs or the YMCA – aren’t necessarily the best places for youth in recovery. So we wanted to create a social activity that showed young people can have fun and be sober.
So we teamed up with the Recovery Café; they provide the space and we host the event. Artists, comedians, and musicians come in to entertain the kids, and we also feature movies, video games, raffles, and other things like that. I think it’s a great alternative for these kids. They can be anywhere they want on a Friday night, but our room is packed most of the time. Young People in Recovery Night is held on the third Friday or every month.
What are some of the obstacles that hinder effective addiction treatment and counseling?
For youth that are street-involved, they may not have a cohesive family unit – how do we build a family system for them when they don’t have any natural support? Here’s one thing I can absolutely tell you: lower income folks will usually see the inside of a jail cell or get kicked out of school before they receive treatment. At that point, many of them are already too far down the scale. Early intervention means that the line they have to cross is a little higher up, and they don’t have to be involved in the criminal justice system. Schools can be providing prevention and treatment to these students, rather than kicking them out. They need instruction, and school is the best place for that.
What can you tell us about the ‘Knowledge is Power Luncheon’, which will be held at the Seattle Sheraton on April 18 from 12 to 1 p.m.?
Jean Enersen from King 5 is our emcee; she’s graciously been able to support us in that way for a number of years. Dr. Linda Becker will also be there to discuss recent trends in the latest Healthy Youth Survey, as well as I-502 an I-1183 and how these legislative changes have impacted Washington State. After the educational piece, we will have some success stories identifying how treatment works. People can register online; they can also become ‘table captains’ and fill an entire table by recruiting others.
‘Knowledge is Power’ is our annual fundraiser, but it costs nothing to attend. The suggested donation is $150, but we recognize that not everyone can afford that. We just want folks in the room so that they can get the information.
In September, SAMA will host the annual Recovery Summit (also free to the public). The summit will feature a presentations from local agencies and projects that have a positive impact on youth and families in our community. For more information about the Knowledge is Power Luncheon, Recovery Summit, and other SAMA-related events and programs, please visit the foundation’s official website.