Cohesive Narrative on Robert

¶ … Cohesive Narrative Using a Fictional or Real Character to Build Story

Nineteen-year-old Robert was a perfectly 'normal' child for the majority of his life; he anticipated zoo outings with his mother and he was a part of his school's swim team. With three older siblings, Robert was the youngest in the family, and was good friends with his high school classmates. He enjoyed French and art classes. He never faced any problems with alcohol or drugs; he neither drank nor smoked pot, or anything of that sort. But his girlfriend was a different case entirely. Addicted to heroin, Robert's girlfriend tempted him to have a go at it; unfortunately however, Robert didn't resist. She injected him with heroin in 2009. Robert later began to find himself craving the drug, and before long, he became a quasi-addict as well, consuming the drug once every two weeks.

It is said that 'peer pressure' plays a persuasive role in initiating teens into drug use. Whether to fit into their peer group, to appear 'cool' or simply to assuage their curiosity, teenagers are more prone to drug-use if they find their friends using or showing favorable attitudes to drug-use. Teenagers whose friends consume marijuana and other drugs are themselves at nearly three times the probability of consuming marijuana on a regular basis, as discovered in research conducted by experts from the National Institute on Drug Abuse and Cardiff University (Sack, 2012). Robert progressively became more frequent in his drug-use, beginning to consume it on a daily basis.

His parents were both active addicts anyway, so his mother egged him on. Acting like a teen herself, Robert's mom was more of a pal than a responsible parent, giving him his first drug pills. Back then, Robert was residing with her, and he began to consistently use drugs - downing pills, drinking excessively, and smoking weed (marijuana). His main obsession was pills - Vicodin, Percocet, and many other downers. He began struggling with depression, which when added to his parents' verbal and physical abuse made him increasingly unhappy. Thus, Robert began abusing himself - using excessive drugs, being anorexic and bulimia, 'cutting', and having a string of girls passing through his life.

Robert began acting like the 'typical' teen drug - addict, sneaking out at nights and stealing, hoping for attention from his parents. This was all, however, pointless, since his mother was always high and never noticed. Robert informed his parents of his substance abuse, and tried his best to quit. He could not, however, and by March 2009, he went back to daily drug-consumption. Together with one of his acquaintances, Robert brought needles and drugs, planning a three-day long 'senior retreat'. However, the school staff found out their plans; Robert's parents were summoned to the school and asked to take him away. Robert found himself expelled from high school, only two months short of graduating.

Risks and protective factors associated with drug abuse

Factors for risk and protection can influence teenagers during different life stages. At every stage, risks arise that, through timely prevention and/or intervention, could be altered. Risks in early childhood, such as aggressive actions, can be controlled or prevented through intervention by family, educational institutions and community. These interventions focus on aiding teenagers to develop appropriate positive behaviors. Negative behaviors, if not properly addressed (and addressed in a timely manner), can result in greater risks. These greater risks include social difficulties and academic failure, both of which put children at a further risk for drug abuse in later life.

There are several ways in which risk factors contribute to drug abuse. It is known that the more often children are exposed to risks; the more likely they are to resort to substance abuse. Certain risk factors are stronger than others in particular life stages, such as peer pressure in the teenage stage. Similarly, certain protective factors, such as a strong bond between parent and child, can greatly enhance risk reduction during a child's early years. A crucial preventive goal is to change the balance between protective and risk factors, such that the former outweighs the latter.

One among the many risk factors most consistently responsible for teenage drinking is perceived parental approval (Donovan, 2004). The reported perception of maternal care was significantly lower among those who consumed alcohol and multiple drugs. Association with peers, who use drugs, as well as rejection by peers, possibly creates problem behavior and shapes norms and attitudes related to substance abuse. Being exposed to problem behavior from peer groups is linked to increased consumption of alcohol and drugs. As well, teenagers who testify to low levels of parental monitoring significantly prove to be more liable to substance use. Close parental monitoring and positive parenting styles are established factors that protect against teenage alcohol and drug use (Shillington et al., 2005; Stewart, 2002).

Drug abuse risks greatly increase during stages of transition. For adults, divorces or job losses can potentially cause drug abuse; likewise, for teenagers, risky phases include moving or changing of schools. In the early adolescence stage, when children move from elementary to middle school, new and challenging academic and social situations are to be met. Often, at this stage, children are, for the very first time, exposed to cigarettes, alcohol and other 'abusable' substances. On entering high school, teenagers may find greater access to drugs, substance use by senior students, and social activities wherein drug-use is seen. Concurrently, several behaviors that are normal aspects of development, like the yearning to take more risks and try out new things, may increase the tendency of teenagers to try out drugs. Some teenagers may yield to the encouragement provided by their drug-using peers to share in the experience, while others may (wrongly) perceive that drug-use (such as steroids) will enhance their athletic performance or their appearance, or that substances like MDMA ("Molly" or ecstasy) or alcohol will alleviate anxiety when it comes to social situations. A large number of teenagers abuse prescription ADHD drugs such as Adderall to assist them with losing weight or studying (NIDA, 2014).

After expulsion from school, to keep him occupied, Robert was hired into his father's business; in the meantime, his parents searched for ways by which they could help him out of his condition. In their search, they came across Hope Academy, which is a high-school for recovery at Fairbanks. Robert once again quit drug-use, and was optimistic about being enrolled at Hope Academy, immediately 'clicking' with the school staff. However, the expectations here were different than what Robert was accustomed to. Focus was not just on his academic performance (i.e. grades), but on his sobriety as well. Robert continued struggling with drug-addiction and relapsed in the year. The academy's staff convinced Robert to taking a tour of the Fairbanks Treatment Center, and he stayed there, in the adolescent section, for the following six weeks.

Prevention programs

Robert participated in two targeted prevention programs while at the Hope Academy School, Project TND and Project SUCCESS. Project SUCCESS (Schools Using Coordinated Community Efforts to Strengthen Students) is a targeted interference, designed specifically for youth with high-risk factors. This program employs specialized experts in schools to provide a series of early intervention and substance abuse prevention services. The program claims both prevention and reduction of substance abuse in multi-problem, high-risk high-school children. The program operates by forging partnerships between prevention agencies and alternative schools. Trained individuals, specialized in counseling substance-use teenagers are employed in alternative schools in the form of Project SUCCESS Counselors (PSCs). These individuals offer early intervention and prevention services to reduce risk factors, while at the same time, boost protective factors concerning substance abuse. The program works effectively for both adolescent boys and girls, across 9th to 12th graders, and students belonging to different ethnic groups (National Crime Prevention Centre, 2009).

Another interactive targeted intervention program is the Project Toward No Drug Abuse (TND), aimed at helping youths in high schools (14- to 19-years-old) to resist substance abuse. A school-based technique, this program involves a dozen lessons of duration 40-50 minutes (including social skills education, decision-making elements, and motivational activities) delivered by means of role-playing activities, games, group discussions, student worksheets, and videos over a period of four weeks. Originally intended to assist high-risk adolescents in alternative schools, this program was made up of 9 lessons, developed by means of a motivation-skills -- decision-making model. Topics such as active listening and efficient communicative skills, coping skills, self-control, tobacco-stopping techniques, and stress management are addressed in order to counter drug-use risk factors for older teenagers. The program has been carefully evaluated, with results proving that significant alcohol-and-drug abuse reductions were successfully achieved by TND. Carried out on typical high-school youth, this study also depicted a significant decrease in alcohol and hard drug use in intervention students, during follow-up after a year (National Crime Prevention Centre, 2009).

In the course of his stay at Hope Academy and Fairbanks, Robert went through multiple relapses, with the worst taking place over Christmas vacation. Typically, when Robert relapsed, his drug-use would be limited to just one or two times. This time, however, he consumed drugs on a daily basis during the Christmas break. Yet, rather than hide his condition, Robert informed the staff at Hope about his relapse, knowing that it was the thing to do. It began to work well; for once, he had done what was right. From that point on, Robert found it all the more easy to maintain sobriety. The perfect environment is provided to high-school students for drug-and-alcohol-addiction recovery by Hope Academy, and this promotes academic success as well as life-time recovery. Furthermore, Hope Academy provides support to students pursuing higher education or careers by extending college planning facilities.

Treatment programs

Robert participates in two treatment programs: life skills and counseling. With the help of counselors, teenagers and adolescents deal with relationship problems, coping skills development, and other concerns as they strive to comprehend the tools needed to stay sober. Counseling motivates teens and adolescents to incorporate healthy changes into their lifestyles to continue with recovery upon leaving the treatment unit. Adolescents also engage in life-skills education such as completion of college applications, resume writing, building sober support systems, and participation in domestic chores. Each of these encourages practical, usable skills, and leads to enhancement of self-esteem. Additionally, students are assigned simple tasks during their stay in the treatment center, to increase the sense of accomplishment and community (South Oaks Hospital, n.d). The Adolescent Partial Hospitalization Program was implemented to achieve this. The program is devised for 13- to 18-years-old who need intensive psychiatric therapy; however they are still able to attend school and live among society. Participation eases transition back to society after a stay at the treatment facility. This program is founded on the basis that it is possible for youths to positively change their lives. The goals of the program are to produce a caring, therapeutic, supervised environment. In this environment, individuals can make the most of their capability to manage symptoms, be trained to assume personal responsibility, and develop support systems essential for promoting ideal growth, development and functioning in their families, institutions, and community. This program for teens, children and adults aims to bridge the divide between critical in-patient and out-patient facilities; it serves as a substitute to hospitalization as well as a transition to community, from in-patient support. A therapeutically intensive, structured setting is provided by the program to students who require high-level therapeutic support, despite not needing round-the-clock supervision. The program also comes with various specialized treatments for those suffering substance abuse, self-destructive activities, and mood disorders. A Transitional Youth track included with the program facilitates transition of mentally-ill teens into an independent life of adulthood. Finally, the interdisciplinary staff employed for this program, comprising of psychologists, psychiatrists, expressive therapists, nurses and social workers, provides an array of treatment approaches that are group-based. These approaches include psycho-dynamic, activity and psycho-educational group therapy (Adventist healthcare, n.d).

The Intensive Outpatient Treatment Program is another program employed for treating teens and adults. It creates a therapeutic, structured environment for treating individuals suffering substance abuse. Utilized often by individuals to phase out of in-patient psychiatric treatment, this program offers facilities for evening treatment(s), so that students can attend school during daytime. Directly concentrating on the contribution of drugs to negative behaviors and feelings, the program includes teen and adult education on alcohol addiction disorder. Other aspects of the program include: determining the degree of addiction/abuse of alcohol by patients; recognizing psycho-social stressors causing substance abuse; provision of alcohol and drug education; employing the 12-stage model for treatment; and offering treatment and education for relapse prevention (Adventist healthcare, n.d).

All too often, individuals who require drug or alcohol treatment do not receive proper care, as this would entail extended time taken away from family or work. With Hope Academy's flexible out-patient drug therapy program, teens and adults can get over substance use without putting their lives on hold. It is perfect for individuals who have strong support systems, stable living conditions and the inner drive to change. The Intensive Outpatient Treatment Program represents a 12-stage rehabilitation process located in neighboring communities, and is designed for those who need no medical supervision in their detoxification therapy, as well as those who have supportive and stable work and home environments. The program is intended for self-motivated individuals who have varying schedules and needs. The programs are of different lengths, depending upon the requirements of individual patients, and chiefly serves adults aged 18 years and above. Hope Academy provides an individualized, tailor-made plan for every patient, with the main objective being lifelong recovery. Flexibility is offered in treatment, in accordance with patients' schedules; the institution's staff is experienced with implementing comprehensive education on addiction. As well, the staff understands the hurdles to recovery and approaches it by way of individual and group therapy, specialized therapy for families, and twelve-step meetings (Louise, n.d).

The advantages of the Outpatient Substance Abuse Treatment include the ability to continue work or school, affordability, confidentiality and support access. The Intensive Outpatient Program ideally works for individuals needing employment to support their families, or students aiming for graduation. Normally more affordable as compared with residential care, the program still offers high-quality treatment for persons suffering alcohol or drug-abuse disorders. It allows patients to be in close proximity with their families and friends, and their support network during the process of receiving treatment. Hope Academy's Outpatient Substance Abuse Treatment promises confidentiality and offers privacy, removing the necessity to give explanations for extended time spent away from school or workplace (Louise, n.d).

Recommendation

The program recommended for Robert is in-home treatment for addiction. This process provides alcohol and drug treatment to teens struggling from drug-abuse, in their home environment, involving the teenager's family in every stage of the treatment process. The proven intervention that can be received by Robert from home comprises 3 main parts: (1) Drug abuse therapy, family therapy, and skill building for parents. Tailored for teenagers aged from 13 to 17 years of age, with moderate drug addiction, or initial stages of life-disrupting drug-use, this intensive treatment, administered to teens after enrolling, addresses their drug abuse directly, along with the skills required to get over it. In the out-patient drug and alcohol abuse treatment, therapists come home to meet patients (instead of their offices), and observe families in a natural setting, thereby providing greater privacy, decreasing resistance to therapy and reducing transportation challenges faced by families in the locality. The treatment comprises Structural, Multidimensional Family Therapy, Motivational Enhancement Therapy, and Systems Theory practices for improving family communication, resolving existent conflicts, and teaching coping and drug refusal skills to the teen. Teens and their parents, then, get additional education, including exercises in-session as well as homework, to increase the rate of success of the treatment. Every family member can access the therapist during the course of the treatment, to answer queries, offer support, and address arising issues. On completion of the program, opportunities for continuing these in-home therapy services may be available; as well, opportunities include switching to a different treatment or terminating services, depending upon the teen's clinical assessment as well as that of his/her family. Those who qualify and get enrolled into this program reap the advantages of continued family support in their own home setting, and can continue with the positive parts of their life, while undergoing treatment.

A thorough approach is utilized by the out-patient treatment program, for assisting 13- to 17-years-old individuals in the initial phases of recovery. It offers support in keeping with the problems faced by teenagers with low substance abuse levels, or those already making headway in recovery and requiring only additional counseling. Many challenges are to be faced by adolescents who struggle with drug abuse. The program's objective is providing youngsters the tools with which to handle the everyday challenges, in addition to the opportunity of learning to enjoy being sober. Drug-abuse disorders of teenagers create massive hurdles for the youth's parents as well. Therefore, the out-patient therapy strongly emphasizes family recovery. Along with the teenager, parents also receive counseling, support and education. This program applies basic treatment standards in an attractive manner, catering to the whole family's needs. Consisting of a 1.5-hour group session once a week for nine weeks, and individual 12-stage counseling for the same duration, this program only takes in voluntary admissions, with clients willing to take part in the program. Each client needs to attend a 12-stage support meeting every week, in addition to a social function every weekend (if scheduled). Clients discharged from the program successfully can obtain aftercare services for up to 4 weeks. Insight support group during treatment and for about two years after successful discharge can also be obtained by clients, if it is deemed essential by the Academy's staff. The Intensive Outpatient Treatment Program deals with issues such as: dealing with peer pressure; resolving life sabotage resulting from alcohol and drug use; improving self-worth; enjoying life while staying sober; learning to clarify matters related to trust with parents as well as other members of the family; learning the long-term outcomes of alcohol and drug abuse; and relapse prevention and relapse triggers. Individual work is carried out by the staff with each patient to formulate treatment plans in keeping with the patient's needs. Before discharge, an all-inclusive after-care plan is developed by the staff, in consultation with the patient and family members, to ensure that treatment does not stop after discharge. The plan applies recovery tools to all areas of life, and teaches teens how to implement tools acquired throughout the treatment. Aftercare plans are long-term; they may last for about 2 years (The insight program, 2013).