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A Comprehensive Model for

Adolescent Chemical Dependency
Treatment
DOUGLAS L. POLCIN
Chemical dependency among adolescents continues to present significant challenges to helping professionals. This article discusses the
variety of approaches used to treat chemical dependency. An adolescent
program that integrates the strengths of different perspectives and
techniques is described.

lthough publicity about the problem of chemical dependency has increased in recent years, there has not been
enough emphasis on various approaches used to address
it. Counselors, teachers, and the general public need information
about treatment models and resources that are available to them.
Increasingly, masters-level counselors are finding employment
in substance abuse programs (Hosie, West, & Mackey, 1988). To
be effective, they must understand various approaches used in
chemical dependency treatment and be able to integrate them
into their work. Those in the chemical dependency treatment
field itself, however, must first become clearer about when and
how to use various approaches. Unfortunately, chemical dependency professionals have too often engaged in bitter division
about using different approaches rather than joining forces
toward more integrated and comprehensive care (Schonfeld &
Morosko, 1988).
The purpose of this article is first to provide an overview of
different treatment perspectives in the addictions field. I then
argue that combining various approaches in treatment is the most
effective way of addressing the array of needs that chemically
dependent clients present. In particular, the treatment needs of
adolescent clients with addictions are emphasized. Finally, a
comprehensive inpatient program for chemically dependent adolescents that incorporates the strengths of various models is
described.
REVIEW OF TREATMENT MODELS
Shaffer (1986) observed that the addictions field is in preparadigm stage in its development as a discipline. That is, various
treatment models and explanatory mechanisms for addiction
have been put forth by a variety of workers. No single approach
or combination of approaches, however, dominates current research, theory, or treatment. This leaves counselors in the field
without agreed-upon models to guide treatment efforts.
376

Traditional Models
Among the various modalities used to treat chemical dependency are the twelve-step program of Alcoholics Anonymous
(AA), professional counseling and psychiatric care, family systems therapy, and therapeutic community treatment. Historically, these approaches have often been at odds with one another
(Minkoff, 1987; Smith, 1983). Some of the debates have involved
whether chemical dependency is a disease in and of itself
(Jellineck, 1960) or is reflective of some underlying psychopathology (Khantzian, 1975; Rado, 1933). The proponents of the disease
model have included AA (1985) supporters, who have tended to
focus on abstinence as a way of controlling the disease. Adherents to the psychopathology model have mainly been mental
health professionals who have advocated psychiatric and professional counseling treatment. Yeager, DiGiuseppe, Olsen, Lewis,
and Alberti (1988) noted that therapeutic community treatment
has become increasingly popular because traditional and more
individually oriented psychiatric modalities have not been very
effective. They echoed the argument made by Vaillant (1975) that
clients suffering from chemical dependency need milieu and
group involvement with their peers. External control, containment, and structure from milieu-oriented treatment is needed
before meaningful psychotherapy can begin. Stanton and Todd
(1982) agreed that peer influence can play a role in less serious
substance abuse problems but that long-term drug addiction
generally has its origins in adolescence and that serious drug
abuse is predominantly a family phenomenon (p. 8). They
argued that family therapy is therefore the logical treatment of
choice.
The aforementioned models have different theoretical rationales for the different treatment approaches used. A close examination, however, reveals that their approaches are not
necessarily mutually exclusive. Rather, each can be seen as an
examination of different aspects of chemical dependency.
Alcoholics Anonymous. The disease perspective of AA emphasizes the individuals inability to control drug consumption as a
primary symptom (Chatlos, 1989). Willful attempts at stopping
on ones own are seen as futile and counterproductive. Recovery
is largely a spiritual awakening process that is achieved through
working the twelve steps. The twelve-step program begins
with accepting ones powerlessness over drugs and then developing a sense of ones Higher Power. The individuals relation-

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ship with his or her Higher Power, honesty, openness, communication, and willingness to learn and grow are central to the
twelve-step recovery process (Ehrlich, 1987). It is important to
emphasize that the twelve-step recovery process does not take
place in isolation and that within the context of a fellowship with
others, one finds hope and support (Ehrlich, 1987).
Counseling. Rather than viewing chemical dependency as a
disease in and of itself, traditional psychiatric and counseling
approaches have tended to emphasize a host of emotional disorders as causal factors (Khantzian, 1975). Therefore, treatment has
focused on understanding and resolving the emotional problems
that underlie drug use. This may involve the use of psychiatric
medications in addition to psychotherapy. Unlike recovery in the
AA program, abstinence per se is not necessarily the primary
objective.
Therapeutic community. The therapeutic community model of
treatment strongly emphasizes both abstaining from alcohol consumption and addressing emotional factors associated with drug
use (DeLeon, 1989). Emotional issues, however, are addressed
primarily in terms of how they are reflected in behaviors and
attitudes in the milieu environment. There is less emphasis on
resolving past developmental or family-of-origin issues. At the
center of therapeutic community philosophy is the critical importance of involvement with ones peer group (Yeager et al.,
1988). Through involvement with each other, clients learn how
to manage emotional issues effectively; practice new, more
adaptable behaviors; confront and support each other appropriately; and take responsibility for their behaviors. The tools used
to achieve these goals include a wide variety of groups and
program systems. Clients are involved in process groups, confrontation groups, support groups, and community meeting
groups. A client government of chain of command delegates
specific responsibilities to clients with specific job positions. A
discipline system that involves clients and staff ensures that
clients receive consequences for rule violations and reinforcement for progress in treatment. As DeLeon (1989) has stated, the
therapeutic community perspective views drug abuse as a disorder of the whole person, reflecting problems in conduct,
attitudes, values, moods, and emotional management (p. 179).
Family therapy. Stanton and Todd (1982) focused on family-oforigin conflicts and issues as central in developing and maintaining chemical dependency. They pointed out that drug abuse
usually begins in adolescence and is the result of intense fears of
separation. Both the adolescent and his or her family fear the
adolescents process of beginning to separate from the family
because the stability of the existing system is upset. Drug-using
behavior by the addict then serves to maintain the stability of the
existing family system and helps the family avoid going through
the adolescents separation phase. Stanton and Todd (1982) suggested the use of a structural-strategic family therapy approach
to help families address separation issues and to help the system
adapt more effectively as the addict gives up drug-using behavior. A central goal is to help parents address conflicts between
each other that may have been ignored because of their focusing
on the addicts drug-using and antisocial behavior.
Multimodal approaches. Although the aforementioned treatment approaches have often been at odds with one another, the
drug treatment field seems to be moving in the direction of using
multimodal approaches that incorporate several different models simultaneously (Chatlos, 1989; Francis, 1988). This shift may
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reflect the increasing recognition that chemically dependent clients require a broad-based approach because of the various needs
presented by them. For example, chemically dependent clients
who also show signs of significant psychiatric problems have not
done well in therapeutic communities (McLellan, 1986; OBrien,
Woody, & McLellan, 1984; Rounsaville & Kleber, 1984). These
dual diagnosis clients seem to require psychiatric care in addition to treatment for chemical dependency. De Leon (1989), however, has argued that some therapeutic communities have been
effective in treating emotional disorders and that others could
better treat dual diagnosis clients if their methodologies were
adapted to address individual differences and individual presenting problems.
The term biopsychosocial is being used to describe approaches
that recognize and address biological, psychological, and social
aspects of addictions (Frances, 1988). Data supporting this view
of chemical dependency treatment have been provided by Adelman and Weiss (1989). In their study of inpatient alcoholism
treatment programs, they found that factors related to successful
outcome included the following: (a) a group-oriented, milieu
approach to treatment; (b) interdisciplinary assessment and treatment; (c) a focus on psychiatric disorders in addition to alcoholism; (d) judicious use of medications; (e) thorough medical evaluation; (f) involvement of clients in AA meetings; and (g) a strong
focus on aftercare treatment.
Klein (1988) made recommendations along these lines for the
treatment of clients with other chemical dependencies. He, however, more forcefully emphasized the disease model perspective
that abstinence is the critical goal of treatment and that the
chemical dependency must be treated as primary and not reflective of underlying psychopathology. He suggested an interdisciplinary approach that involved individualized treatment, education about chemical dependency, the development of social skills,
enhancement of the clients abilities to cope with stress, and
occupational therapy.
A somewhat different multimodal approach has been described by Brown, Peterson, and Cunningham (1988), who emphasized cognitive behavioral techniques along with a strong
focus on the spirituality found in the twelve-step program of AA.
The growing recognition that twelve-step approaches are a critical part of recovery for many clients can be seen in data cited by
Frances (1988), who reported that more than 90% of psychiatrists
interested in addictive disorders work closely with the twelvestep model in addition to providing professional care.
Treatment for Adolescents
Planning treatment approaches for chemically dependent adolescents in particular continues to be a major challenge for helping professionals. Compared with adults, teens have an especially high incidence of substance abuse that presents very
serious health risks (Chatlos, 1989). Some of the dangers include
the effects of the substances themselves on teens while others
involve engaging in risky activities such as driving while under
the influence of alcohol. Adolescents also require special treatment considerations because their developmental needs are different from those of adults (Ehrlich, 1987; Golden & Schwartz,
1988; Schiff & Cavaeola, 1988).
Ehrlich (1987) has described many critical differences between
treating adolescents and adults. He pointed out that unlike adolescents, adults generally have a well formed identity prior to

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becoming dysfunctional. They can refer back to this identity in
treatment and work toward regaining losses that resulted from
their addiction. Adolescents, however, can refer back only to the
identity of a much younger person in a very different developmental stage. Chemically dependent teens have developed an
integral sense of who they are that is centered on the use of alcohol
and other drugs. Through drug intoxication, they have attempted
to have fun, relieve stress, heal emotional pain, and develop peer
relationships. It must be recognized in treatment, then, that chemically dependent adolescents are to a large extent being asked to
give up their identities and develop new ones.
Ehrlich (1987) argued that teens in treatment must learn to
change their sense of identity by finding new ways of having fun,
managing emotions, and relating to their peers. The treatment
model he described very strongly emphasizes the twelve-step
model of recovery along with psychodynamic groups, educational groups, and wilderness experiences.
The peer cluster theory of Oetting and Beauvais (1986)
similarly suggests that treatment efforts with teens must focus on
clients peer involvement. In treatment, special attention needs to
be paid to the beliefs, values, and behaviors of adolescents because these factors dictate patterns of use. Although Stanton and
Todd (1982) agreed that peer influences can play a minor role in
the development of chemical dependency among adolescents,
they argued that peer influence is a much more significant influence on adult addicts. They believe that the central contributing influence for adolescent chemical dependency is the adolescents family. Accordingly, they recommended family therapy
as the most important component of treatment.
Golden and Schwartz (1988) suggested that in treating adolescents with chemical dependency, counselors need to pay attention to several specific stages of adolescent development. Adolescent development is not perceived as one phenomenon to be
contrasted with adult maturity but is broken down into three
distinct phases. Counselors must recognize that chemical dependency in early adolescence disrupts the development of the
clients ability to tolerate emotions. Among adolescents in the
middle-age phase, the critical issues shift to avoidance of conflict
and a sense of false intimacy with drug-abusing peers. Older
adolescents with chemical dependency tend to have difficulty
with individuation and are overly dependent on family and
peers. To be effective, treatment interventions must consider
which of the aforementioned developmental stages applies to
each client, and therapeutic efforts must address the issues that
are relevant to that stage. Golden and Schwartz (1988) stressed
the critical importance of programs being flexible enough to
adapt to the treatment needs of different developmental stages
of adolescence.
The high incidence of chemically dependent adolescents with
concurrent psychiatric disorders is another factor that programs
must address (Chatlos, 1989; Schiff & Cavaeola, 1988). These dual
diagnosis clients have significant problems with depression as
well as high rates of attention deficit, sexual abuse, and physical
abuse disorders (Schiff & Cavaeola, 1988). To be effective, treatment approaches must incorporate assessment procedures that
will recognize these coexisting diagnoses and develop appropriate plans to treat them.
Chatlos (1989) described a program specifically geared to the
needs of adolescent dual diagnosis clients. The model described
begins with a thorough neuro-psychiatric evaluation that as378

sesses physical, psychiatric, and chemical dependency problems,

If there is a medical condition that is contributing to the clients
problems, provisions for appropriate treatment are made. Psychiatric medications that are needed to address specific diagnoses
are prescribed at the onset of treatment. Central to the treatment
approach is addressing the addiction as primary rather than
viewing it merely as a reflection of underlying psychopathology.
Generating a commitment to abstinence from clients becomes a
critically important first goal. Clients must also commit to abstaining from other dysfunctional behaviors related to psychiatric problems (e.g., engaging in self-mutilating acts, attempting
suicide, binging and purging, and destructive dieting).
The viewpoint taken by Chatlos (1989) is that only after dysfunctional behaviors cease can meaningful counseling begin. The
counseling approach described emphasizes a close examination
of structures from the past that emerge after the commitment
to abstinence is achieved. These structures are described as
patterns of behavior that can then be addressed from various
theoretical viewpoints (e.g., psychodynamic, cognitive, behavioral). This approach allows for examination of individual client
issues within a group-oriented, milieu environment. The program also emphasizes the use of twelve-step meetings and integrates twelve-step assignments into the treatment planning process. Clients are expected to know and apply the first 5 steps to
the problems and difficulties they are dealing with in treatment
on a daily basis. A major strength of the model is that it helps to
foster communication between professionals of different disciplines and the development of an integration of various approaches.
Although many treatment programs similar to those described earlier are taking steps in the right direction for developing more comprehensive, integrated treatment approaches, important elements are still lacking in them. The models described
by Chatlos (1989) and Ehrlich (1987) incorporate twelve-step
principles into treatment along with professional counseling in a
group-oriented, milieu environment. They, however, do not describe in any detail how clients family members are involved in
treatment or how family work is integrated and coordinated with
other modalities. Furthermore, therapeutic community philosophy and techniques per se are not mentioned. Lacking in the
earlier models are the following elements of therapeutic community treatment: (a) an emphasis on the critical importance of peer
group involvement within a strongly bonded milieu community,
(b) a description of a client government or chain of command to
help monitor and enforce clients compliance with their job responsibilities and program expectations, (c) the use of confrontation and support groups to help involve clients in one
anothers treatment, and (d) a behavior modification system that
involves staff supervision of clients giving each other consequences for rule violations and reinforcements for compliance
and progress in treatment.
Many programs that explicitly identify themselves as therapeutic communities and incorporate the aforementioned elements of therapeutic community treatment into their programs
ignore other important components of chemical dependency
treatment. For example, the therapeutic community model described by Yeager, DiGiuseppe, Olsen, Lewis, and Alberti (1988)
does not mention the use of any twelve-step principles or AA

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meetings in their treatment approach. They also fail to mention
how, if at all, family members are involved in treatment.
In the remainder of this article, I describe a more comprehensive inpatient program that serves chemically dependent adolescents and their families. The model incorporates the strengths of
therapeutic community treatment, the twelve-step program of
AA, individual counseling, and multifamily group therapy approaches. The major advantage of the model is that the variety of
needs that chemically dependent adolescents present can be
better accommodated. The model is based on the premise that
chemical dependency involves social, familial, behavioral, medical, psychological, and spiritual factors and that to be effective
treatment must recognize and address each of these.
PROGRAM DESCRIPTION
Thunder Road, Adolescent Treatment Centers, Inc., is a 50-bed
hospital for chemically dependent teens located in Oakland,
California. The program includes a short-term component for
clients with private insurances, usually 45 to 60 days, as well as
a longer-term program for clients referred through county juvenile probation departments, usually 7 to 12 months. Upon completion of the inpatient program, clients begin a 6-month outpatient program in continuing care to coordinate a smooth
transition back to the community and to support continued
sobriety. In addition to a clinical focus for chemical dependency,
the program provides a fully accredited school and medical
department to address the variety of special health and academic
problems that chemically dependent teens develop.
Assessment
Treatment at Thunder Road begins with a comprehensive drug,
social, medical, psychiatric, behavioral, spiritual, academic, and
family assessment. Upon intake, primary counselors conduct
interviews to generate data about clients drug use, social background, behavioral problems, and family situation. The programs pediatrician conducts a physical examination and makes
provisions to address any medical problems in need of attention.
Within several days the client is also evaluated by one of the
programs two psychiatrists for a complete psychiatric evaluation. This includes assessment for specific psychiatric disorders
in addition to chemical dependency along with a complete mental status examination. The programs pastor is responsible for
interviewing clients and making a spiritual assessment, and the
school assesses clients academic needs.
Treatment plans are geared toward addressing problems in
each of the aforementioned areas. Although the medical department addresses any physical problems clients may have and the
school staff work on clients academic needs, the clinical staff
address other needs through the integration of several different
treatment approaches: professional psychiatry and counseling,
therapeutic community treatment, multifamily group therapy,
and the twelve-step program of AA.
Although each of the aforementioned modalities tends to
emphasize different areas in need of attention, the modalities are
not exclusive in their focus and, in fact, are interrelated. For
example, whereas professional psychiatry and counseling are
primarily designed to address the psychiatric disorders and emotional issues clients present, many other issues are necessarily
addressed, including how emotional issues are relevant to family
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concerns, peer relationships, communication skills, dysfunctional behaviors in the milieu, and concepts relevant to twelvestep principles.
Phases of Treatment
The treatment modalities are implemented throughout three
distinct phases of treatment. Phase 1 can best be characterized as
orientation and education. Clients and their families are introduced to basic chemical dependency recovery concepts such as
the twelve-step program, therapeutic community tools and philosophy, the roles of family dysfunction in chemical dependency,
and the emotional and behavioral aspects of chemical dependency. The goal here is to engage clients and their families in the
treatment process and orient them for what to expect in later
stages of treatment and in continuing care. Treatment in phase 1
is geared toward helping clients learn to comply with basic
behavioral expectations, integrate into the community, and deal
with resistance and denial. A full description of how the different
treatment approaches are used to achieve these goals is provided
later in this article.
Once clients have adapted to the milieu and demonstrated an
understanding of basic chemical dependency and treatment concepts, they move into phase 2. Here they begin work on their
core issues that are related to their chemical dependency. They
are expected to address emotional issues in counseling and multifamily groups and examine how their behavior reflects emotional
issues on a day-by-day basis in the treatment milieu. It is understood that core emotional issues will not be completely resolved
but will be identified, appropriately managed in the milieu, and
worked on throughout the remainder of treatment and in continuing care. Clients are expected to have a good understanding of
the twelve-step program by now and to actively work their own
steps on a day-to-day basis. Clients are also more involved in
helping new clients adapt to the milieu and learn treatment
concepts.
Phase 3 concerns preparing to leave Thunder Road and reentering the community. Clients are now going home on passes in
the community, attending outside AA meetings, practicing the
tools they have learned in treatment, becoming more acutely
aware of relapse triggers, and processing separation issues. A
continuing care agreement is developed by the client, parents,
inpatient counselor, and the counselor who will be working with
the client in continuing care. The purpose of the agreement is to
help clients and families identify specific plans for working,
going to school, managing conflicts, dealing with relapse triggers, and building positive social support systems. By now it is
critical that clients have AA sponsors and be actively working on
developing healthy support systems in the twelve-step community outside of the program.
These stages are somewhat different for short-term and longterm clients. The model, however, has been found to be entirely
workable and effective for both short-term and long-term clients.
The central difference is that short-term work is more intensively
geared toward identifying and preparing for the work to be done
in continuing care. In many respects, for both long- and shortterm clients, the heart of what happens in treatment manifests
itself in the continuing care program. It is here that clients are
given the opportunity to practice the skills they have learned in
treatment. Following is a more specific description of the treat-

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ment components, with an emphasis on how each reinforces the
other.
Treatment Components
Counseling and psychiatric care. A major advantage of including
counseling and psychiatric care in the treatment model is that it
ensures that clients with dual diagnoses will be appropriately
assessed and treated. Peer-oriented models such as AA used
alone are generally unable to address the needs of most dual
diagnosis clients (Minkoff, 1987). Furthermore, professional care
allows for the appropriate assessment and treatment of specific
developmental needs of adolescents of different ages.
Psychiatric care and counseling begin with a complete psychiatric, social, and family assessment. Assessment includes DSMIII-R (American Psychiatric Association, 1987) diagnosis for psychoactive substance abuse as well as other psychiatric disorders.
These assessments ensure that only appropriate clients are admitted to treatment and that inappropriate clients are referred
elsewhere. Medications are used very judiciously and are prescribed only when clearly indicated in the treatment of dual
diagnosis clients. Most of these cases involve prescribing antidepressants for affective or eating disorders. All clients are involved
in two psychotherapy groups per week that are conducted by
staff counselors and psychiatrists. The developmental needs and
emotional issues of clients are assessed and treated throughout
clients participation in these groups. Information about individual clients is also disseminated to other staff to help them in their
work with clients on a day-to-day basis in the milieu. Groups are
divided by phases to help focus on the specific goals and objectives of each phase.
Phase 1 psychotherapy groups tend to focus primarily on
helping clients adapt to the milieu setting and deal with denial
of their addiction. It is also a way of helping clients identify and
begin to examine core issues that they will work on in phase 2.
Clients core issues include self-esteem, shame, and family and
peer relationships. Some clients have additional concerns, such
as impulse control, sexual or physical abuse, eating disorders, or
depression. Phase 2 groups allow for the emergence of these
issues and help clients manage them in healthy ways that substitute for the abuse of chemicals. Clients are given the opportunity
to practice new coping mechanisms within the safety of the
milieu before going out into the community.
Phase 3 groups attempt to monitor how well clients are able
to practice what they have learned in treatment while out on
passes in the community. Often, family issues come to the fore
because clients are spending increased time with family members
and have fears about returning home. Parting is a necessary task
of phase 3 as well. It is extremely difficult for adolescents to leave
the caring structured environment that the therapeutic community milieu provides. Learning how to terminate appropriately,
however, is a critical part of the recovery process, and issues of
unresolved loss and grief are often precipitant to chemical dependency relapse.
The therapeutic community. George Vaillant (1975) convincingly argued that the path out of drug addiction is similar to the
path out of adolescence; it comes through healthy connections
with ones peers. Therefore, work with drug-addicted adolescents necessitates a very strong emphasis on facilitating healthy
relationships among clients. Here lies the strength of the therapeutic community approach. Over the years, however, thera380

peutic community has come to mean different things to different

people and has not often involved a consistent, clearly thoughtthrough treatment rationale or approach.
At Thunder Road, the therapeutic community approach refers
to a variety of techniques used to help clients form supportive,
responsible relationships with each other. A strong emphasis is
placed on examining clients behaviors in the milieu. Attempts
are made to help them to learn adaptive, functional ways of
coping with interpersonal relationships and stress. A commitment to abstinence from alcohol and other drugs is mandatory
throughout treatment, and compliance is monitored by urinalysis. Clients also learn how to have fun while being clean and sober
by engaging in recreational activities and outings. The resulting
emotional bonding of clients into a cohesive community becomes
a potent therapeutic force. Through learning new ways of relating with their peers, new ways of coping with stress, and new
ways of having fun without alcohol or other drugs, clients begin
to form new identities for themselves as clean and sober persons
in recovery.
Some of the elements of the therapeutic community approach
include setting up a consistent daily structure, developing a
system to administer consequences for program rule violations,
empowering clients through establishing a client government or
chain of command, and engaging clients in forums to confront
and support each other. Interpersonal skills are taught on a
day-to-day basis as clients interact with each other in groups and
in more informal situations in the milieu. Clients are taught how
to express their feelings to each other rather than act them out
and how to manage emotions effectively when feeling overwhelmed. Attempts are made to foster the values of openness,
honesty, and humility in interpersonal relationships. Behavioral
expectations for clients are in part influenced by the phases of
treatment that they progress through.
Upon entering treatment in phase 1, clients focus on learning the community rules and structure. Toward the middle of
phase 1, clients may be given a position in the chain of command
(e.g., monitoring room checks for cleanliness or making sure
clients complete discipline assignments). By the time clients are
in phase 2, they are expected to have a more potent positive
influence on newer clients. They should be giving pull-ups or
reminders to clients when they forget or rebel against program
expectations. They provide leadership in all groups and activities
in terms of confronting and supporting other clients. As clients
approach the end of phase 2, they begin to take on higher level
positions in the chain as a way of learning responsibility and
contributing to the community. Higher level positions in the
chain are essentially supervisory positions that involve monitoring whether clients below them are completing their assigned
duties.
Day-to-day activities in the chain provide clients with great
opportunities to deal with many of their core issues and practice
interpersonal skills. Inevitably, self-esteem, assertiveness, manipulation, and other issues are played out in these interactions.
If monitored appropriately by staff, these activities offer invaluable growth opportunities.
As clients move into phase 3, they are considered senior
peers and are expected to provide role-modeling behavior for
newer clients and to help newer clients deal with difficult situations in adjusting to the milieu. Examples include helping clients
remain in treatment or deal with difficult issues that they them-

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selves worked through in their own treatment. The overall philosophy is that clients in phase 3 have received valuable tools and
experiences from the community and they now have a responsibility to give back some of what they have learned to newer
clients.
Multifamily groups. Thunder Road takes the position that
chemical dependency is a family disease and as such requires
family involvement in treatment. Throughout the adolescents
treatment, at least one parent or guardian is expected to attend a
multifamily group meeting once a week. The major advantage of
bringing many families together in a multifamily group is that
various families can mirror, support, and confront each other.
This allows for greater variety of interactions, and thus a possibly
richer experience than family therapy. In individual family work,
adolescents and parents are unable to receive the benefits of
support and confrontation from their peers as well as the learning
that can take place from watching other families work. Important
interactions can also be orchestrated between clients and the
parents of other teens in the group. Clients then learn how to
develop supportive relationships with adults other than their
parents.
Families progress with their adolescents through three phases
of multifamily group treatment. In phase 1 families learn about
how disease concepts of chemical dependency apply to their
family and about the various supports that are available to them.
The pervasive tendency of parents and adolescents to blame each
other for family difficulties can usually be addressed in terms of
problems being symptoms of the family disease. The family can
then begin to learn constructive ways to confront each other
rather than blame.
It is expected that other family members may be dealing with
their own addictions and will need to be confronted about this
and given referrals where they can find their own help. All family
members are strongly encouraged to attend Alanon meetings, a
twelve-step program of recovery for families with chemically
dependent members. The steps are geared toward helping family
members learn to cope effectively with the impact that the chemically addicted members drug use has had on them. Involvement
in Alanon helps family members recognize that recovery is for
every member of the family, not just the addicted adolescent.
Attendance at Alanon meetings can also help families deal
with boundary issues in several ways. For family members who
are enmeshed with the client, Alanon provides a way of detaching by putting an emphasis on taking care of oneself and recognizing ones powerlessness over the addicted family members
behavior. For family members who are too detached from the
client, Alanon can provide a way of learning something about the
twelve-step program and the process of recovery that the client
is going through. Whether family members work on these boundary issues through the Alanon program, they are consistently
addressed in the multifamily groups.
As families take in new information and learn basic skills
about how to communicate with each other in phase 1, they are
preparing for phase 2 family work on core issues. This may
involve more actively confronting an addicted family member
who is still in denial or is disclosing family secrets such as
physical or sexual abuse. Phase 2 family work is where central
family conflicts, past grievances, and new ways of handling these
are addressed.
When family members move into phase 3, they focus primarJOURNAL OF COUNSELING & DEVELOPMENT

ily on issues arising during clients weekend passes home. There

is usually a great deal of anxiety around the prospect of the
adolescent returning home, and the family group is a forum to
address these concerns and monitor how well the family is able
to practice at home what they are learning in treatment. If only
the adolescent has taken recovery seriously, the chances of continuing sobriety and having a supportive family system are low.
Ideally, every family member will be involved in a recovery
program of his or her own that he or she can share with other
family members.
Alcoholics Anonymous. Active involvement in the twelve-step
program of AA is an integral part of treatment for clients. This
approach not only helps clients achieve sobriety during inpatient
treatment but is also critically important for continuing sobriety
in the community after discharge. AA meetings provide both a
supportive community of recovering persons that reinforces continuing sobriety as well as specific steps and direction for how
to go about maintaining sobriety. The program addresses both
social and spiritual needs that clients present by emphasizing a
fellowship of recovering people and a relationship with ones
Higher Power.
The power of the twelve-step program lies in its providing
clear direction about what to actually do to work on recovery.
Clients work on and practice the steps in many ways. These
include assigned writing exercises that are part of their treatment
plan, attending in-house and outside AA meetings, discussing
the steps in groups and in one-to-one contact, and practicing the
steps in their lives on a day-to-day basis to deal with difficulties
and conflicts that arise in the treatment milieu. By phase 3 clients
should be solidifying their AA connections in the community by
attending outside meetings regularly and having an AA sponsor.
This is a kind of mentor who has been involved in the twelve-step
program for some time who can provide the client with support,
guidance, and information. This is an important transitional
person who can help support a client from inpatient treatment
into recovery in the community.
The steps described are entirely consistent with other approaches used in treatment. Step 1 work dealing with the clients
powerlessness is consistent with psychotherapy group work on
denial and resistance, as well as family denial and resistances that
are seen in multifamily groups. Steps 1 through 5 help facilitate
counseling work by emphasizing the ability to see and trust
sources of help, the development of self-examination, and the
sharing of ones self-reflections with others. The nature of the
therapeutic community milieu facilitates the working of all steps
through peer modeling and peer pressure. Clients also learn how
to integrate the steps into their day-to-day life by practicing the
steps in the milieu daily.
CONCLUSION
Although the problem of chemical dependency has received
widespread attention in the media and in the helping professions,
there remains tremendous ignorance about various approaches
used to address this problem. Hosie, West, and Mackey (1988)
have suggested that masters-level counselors will continue to
play key roles in the treatment of chemically addicted clients. For
them to be successful, they must have a good understanding of
various approaches and models used in chemical dependency
treatment as well as how to use and integrate these models
effectively. The chemical dependency field itself, however, has

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too often been divided into supporters of different approaches
rather than seeking ways of joining forces toward more comprehensive treatment. Workers in the chemical dependency field
are increasingly recognizing that addiction is a complex phenomenon and, as such, requires a broad-based approach in treatment.
Aspects of chemical dependency are social, behavioral, familial,
biological, psychological, and spiritual. Treatment models must
be broad enough in scope to accommodate approaches that
recognize and address each of these.
A comprehensive model for adolescent chemical dependency
treatment has been described here that incorporates the strengths
of professional counseling and psychiatry, therapeutic community, Alcoholics Anonymous, and multifamily group approaches. How these approaches combine and reinforce each
other through three discreet phases of treatment has been reviewed. The model is broad enough in scope to address the wide
variety of needs that chemically dependent adolescents present
and represents a step toward a joining of forces (Schonfeld &
Morosko, 1988) in chemical dependency treatment.
A possible criticism of the model described is the cost involved
in funding comprehensive, multidisciplinary treatment. Models
that incorporate fewer approaches would undoubtedly cost less.
Counselors, however, have an ethical responsibility to help develop and describe state-of-the-art treatments and advocate their
use. Furthermore, if the war on drugs is to be anything more
than a convenient slogan for politicians, funding from private
and government sources must become available for the highest
quality of treatment possible. Funding treatment for adolescents
in the beginning stages of their addictions would also deter costs
accrued from years of addiction that these adolescents would
develop as adults.
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Douglas L. Polcin is a recent graduate of the doctoral program in counseling
psychology, rehabilitation, and special education at Northeastern University,
Boston, Massachusetts. He is currently program director at Thunder Road,
Adolescent Treatment Centers, Inc., Oakland, CA, and he maintains a part-time
private practice. Correspondence regarding this article should be sent to Douglas
L. Polcin, 3459 Piedmont Avenue, #1, Oakland, CA 94611.

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