Young people's substance abuse and recovery in television intervention programs

¶ … addiction and recovery are powerful, showing how young people use drugs and alcohol to cope. At times, the experience of watching the videos can be heart wrenching. My feelings ranged from shock and disgust to sadness and fear. I recognized bits of myself in the people, and they also reminded me of people I know. Many of the young people depicted in the videos, like Joey, Paige, and Casey, sabotage their careers and do not live up to their fullest potential. In A&E's Intervention, Joey and his family talks about the success he "could have been," just as Paige in MTV's "I'm Addicted to Molly" discusses the way she threw away a career as a professional dancer because she was doing too many drugs. In MTV's "I'm an Alcoholic," Casey likewise loses friends as well as job opportunities due to her substance abuse issue. All of them knew they had a problem, but only Ally in "I'm Addicted to Molly" finds the strength and willingness to envision herself having a rich and fulfilling life sober.

I found it interesting that not all the people the shows followed ended up clean and sober. Some, like Casey, fail to find the courage to go clean, and others, like Joey, experience a series of setbacks and relapses on their journeys. The producers were willing to reveal the realities of drug and alcohol abuse. Not all people who go to rehab succeed in staying sober, and it is important to remind viewers that even the greatest efforts at maintaining sobriety can fail. Moreover, each person has a different set of emotional and psychological issues. Deep, unconscious psychological mechanisms cause them to either continue using or to find sober living intolerable. Ally realizes that she does not need Molly or even alcohol to have fun with friends, but her counterpart in the show, Paige, never reaches that point even when she knows that "dance is the best high there is."

What is particularly striking is the high level of self-awareness the people seem to have about how the addiction is ruining their lives, while they also feel powerless to stop. Their identities are wrapped up in the using of the drug, which is part of their problem. They have trouble envisioning themselves as being sober, and without fail, all note that the drug staves away depression. Joey, Paige, Ally, and Casey all claim that when they first did their drug of choice, they felt happy and they used the drug to chase that happiness. Another factor all of the young people shared in common was their admission that they had no idea how to stop. They found it hard to imagine a life without drugs/alcohol, and knew that when they stopped the feelings of depression would surface. The drug was clearly used as a coping mechanism, which suggests that their problems were much deeper than simply affection for that substance. Psychiatric medications and the use of counseling was not addressed in any of the documentaries.

2. Some of the videos reveal much about the different reactions of friends and family members, too, showing that addiction impacts more than just the addict. Joey's little brother cried a few times throughout the show. He loved and looked up to his older brother, and never once lost faith in him, which was touching. Joey was estranged from his dad, but his dad loved him regardless. Joey's mother took on the "tough love" approach by sending her son to jail but never gave up on him either, and always believed that he had a lot of potential. Interestingly, the producers, and therefore the television viewers, actually knew more about Joey's dad's feelings than Joey himself because Joey refuses to talk to him. Yet Joey's dad cried and felt like he might have done something wrong. Ally's mother was highly supportive, whereas Paige had moved away from home and her family was not featured at all in the show. However, Paige does have a lot of friends who care enough about her to try to get her to become sober.

I appreciated the fact that many friends and family members in the shows were overtly supportive but they showed their support in different ways. For example, Joey's mother sends her own son to jail on more than one occasion. She does not necessarily make the right choice in doing so, but she believes that jail might help her son wake up and get sober. Using the criminal justice system as a substitute for proper mental health care is not a good idea, but Joey's mother did not want to be an enabler. A more balanced approach was taken by Ally's mother, who encourages her daughter to go to rehab on the grounds that, "We want to see you happy." Providing a positive motivation for her daughter does help Ally to achieve her goals. Ally's mother also bought her a new wardrobe for rehab, as a symbol of her starting her new life. This supportive approach seems constructive and helpful. Paige's friends likewise offer good advice, even when Paige refuses to listen. Their willingness to go out of their way to help Paige proves they are true friends, rather than people who are afraid to be honest. One of them purposely withholds money from Paige so that she does not spend it all on drugs.

3. Each person has a unique pathway to recovery. However, recovery must be defined specifically as sobriety or abstinence. None of the young people featured in the videos is capable of "having their cake and eating it too," in the sense that they cannot manage recreational use. Paige, for example, frequently mentions her desire to do Molly less often but is never really able to manage her addiction. She does not want to stop completely, but given she has yet to achieve inner peace, it is clear that she might eventually have to give it up entirely. All of the other people whose lives I watched did have to make the choice between total sobriety or a downward spiral. Joey knew he had to go cold turkey. Even though he did end up relapsing a few times, it seemed as if he maintained a sober life. Likewise, Ally's success story comes from her choosing a path of total sobriety. Even drugs that were not their primary drug of choice are verboten because sobriety itself is the goal.

It also seems as if the addicts do need a period of detox, in which they are removed totally from their normal life and are physically prevented from using. After the detox period, they engage in a more concentrated rehabilitation program involving therapy. These programs are usually on an in-patient basis, which prevents the addict from cheating and protects them from the triggers or outside influences. The length of the programs varies. Joey's lasted a week for detox followed by several months of both inpatient and outpatient follow-up, and then life in a sober living home. Ally's rehabilitation program was much shorter. After just two weeks, she became determined to live a sober life and returned home.

However, rehab is a struggle for most of the young people. The pathway to recovery is often long, and none of the young people is able to instantly turn their lives around. All who tried rehab had to try it more than once, and their failures can be discouraging. Joey had spent time in prison and had been in and out of rehab several times. Paige had spent six weeks in rehab, and during that time, lost her lucrative job as a dancer. After that, she became less willing to return to rehab. Ally initially enrolled in a thirty-day program but left after two weeks because she was committed to sobriety. Casey's story was less promising, as she never was able to reap the benefits of rehab.

Their different pathways to recovery yield differential results, and there are no sure things. The biggest factor seems to be the level of commitment of the person. Ally became fully committed to sobriety. Moreover, she found it within herself to feel good in social situations without drugs. She also had supportive friends and family. Not all the young people are strong on the inside, and able to envision their lives sober. Ally and Joey, as well as Casey, verbalized their inability to see themselves living a sober life. It seems important that no matter what the chosen path to recovery, that a mental commitment and social supports are the two most important factors to ensure success. None of the documentaries discussed pathways to recovery in a specific way, such as discussing cognitive-behavioral therapy, family therapy, or pharmacological treatments for depression.

4. None of the documentaries I watched depicted the young people in program meetings, and it is uncertain as to whether Ally, Paige, Joey, or Casey attended Twelve Step meetings. However, it is highly likely that people like Ally, Joey, and Paige, all of whom went to an in-patient facility, were at some point exposed to the Twelve Step model. It is widely used in treatment centers, including those that focus on an adolescent population (Kassel & Jackson, 2001). Whether or not the Twelve Step model works depends on a number of different variables. Research is inconclusive because of several methodological limitations (Kassel & Jackson, 2001). There are not enough studies on adolescent populations, and few that conduct follow-up research or use reliable experimental research designs. Nevertheless, enough adolescents have shown some improvement using the model for the Twelve Steps to remain a viable option in treatment centers. The Twelve Step model can provide a semblance of structure and a tenuous social support system. Although not necessarily evidence-based practice, the Twelve Step model may nevertheless be helpful for people like Ally or Joey.

The Twelve Step model may present serious limitations and potentially even inhibit recovery in some cases, and therefore may not be developmentally appropriate for adolescents and young adults. For example, the Twelve Step "disease" model is based on the belief that addiction is a lifelong issue. As Kassel & Jackson (2001) point out, labeling oneself as an addict or alcoholic prematurely might not be fruitful for many young people. Furthermore, the criteria used to diagnose adults as addicts or substance abusers cannot necessarily be used for adolescents because many of them eventually outgrow the need to use drugs or alcohol as crutches (Kassel & Jackson, 2001). There is as of yet a paucity of evidence concerning the effectiveness of Twelve Step meetings on long-term sobriety among young people, and the existing research remains flawed (Winters, Botzet & Farnhorst, 2011).

Labeling adolescents while they are forming their identities might be detrimental to their recovery, as it is more important for the young people to cultivate a strong and positive sense of self. The story of Ally proves this may indeed be the case with some young adults. Ally's mother encourages her daughter to focus on being happy and on seeing herself as a capable person, rather than telling her daughter that she has a "disease." Identity formation is a cornerstone of recovery, as the addict needs to recreate a sense of self as a sober person. Adolescents who use from a young age, as did all the teens profiled in these three documentaries, "develop their sense of identity around the addiction, and thus possess no established, integrated sense of self prior to the onset of their drug use," (Kassel & Jackson, 2001, p. 344). Their addiction problems are usually comorbid with other mental health issues like depression, which is not addressed in the NA/AA meeting. Supplementary treatment will be required anyway. Recovery for young people may need to be more proactive than the Twelve Step model currently allows. Finally, the Twelve Step model is based on total abstinence, something that might not be realistic for many adolescents. Perhaps a more developmentally appropriate treatment intervention takes into account the possibility that not all adolescents who abuse drugs will need to be fully sober and abstain from all substances throughout the rest of their lives. As Williams et al. (2000) points out, substance use reduction may be a more effective and reliable measure of the effectiveness of a treatment.

5. Improving on AA/NA meetings might be difficult, given the predilection for tradition. However, different groups do have different meeting models and it is possible to interject teachings and points-of-view without compromising the Twelve Step framework. One of the first things that may be helpful is framing the first few steps in as neutral a way possible, to appeal to adolescents and young adults who may be agnostic or atheistic. Some Twelve Step meetings avoid using the word "God," for example, and this may be helpful. It may be especially useful to have meetings that are specifically designed for young people, perhaps with no one over the age of thirty in attendance. This would ensure that the stories and experiences being shared are appropriate for the age group and generation. Research by Kelly & Urbanoski (2012) supports the use of youth-specific Twelve Step meetings, which would help retain more young people.