Adolescent substance abuse recovery: next steps

This fall, the Community Practice is launching a new service aimed at providing comprehensive recovery support for adolescents following substance abuse. Theresa Henry, MSOT, OTR/L, a clinical specialist for the practice and 1991 Program alumna, will serve as lead clinician. This new service line is more than just a professional passion for Henry – it’s a personal one, too.

After watching her son struggle with the daily challenges of occupational performance throughout his recovery from substance abuse, and listening to the shared concerns of countless other families facing similar circumstances, she committed her personal and professional experience to developing a comprehensive program. We sat down with Henry to discuss the clinic’s new services.

Tell us a little bit about yourself and your background.

I have 25 years of experience working in a variety of settings, including acute rehabilitation, long-term pediatric rehabilitation, school-based therapy and in-home services. Before coming to WashU, I served as a related services administrator at Special School District of St. Louis County, where I coordinated occupational therapy (OT), physical therapy (PT), adapted physical education and assistive technology services.

I’m a Missouri Substance Abuse Prevention associate, I serve on the executive board of the Alliance for Healthy Communities and also participate in the St. Louis Coalition for Addictions.

Let’s talk about this program. What impact have you observed in adolescents who are
in this high risk population?

Adolescent substance abuse affects all aspects of a person’s well-being, including relationships with others and the ability to engage in the activities and tasks that individuals want and need to do. Many life skills may be impacted following substance abuse, such as attention to basic self-care (including sleep and nutrition), learning the tasks and skills necessary to live independently, acquiring the skills to prepare for success in work or school, managing moods and emotions, social interactions, executive functioning skills (memory, organization, problem-solving, planning), stress management and relationships with friends and family.

So many adolescents in recovery find it hard to regain some of these life skills on their own, due to limited self-confidence or knowledge they missed out learning as a result of the addiction. I see a very clear role for occupational therapy to support adolescents, young adults and their families, and am passionate about sharing my experience to provide them with the personalized assistance and coaching they need to take their next steps.

Where did your inspiration for this idea come from?

Addiction impacts everyone differently. I witnessed the overwhelming interruption to life functioning that my son experienced, as well as other adolescents I encountered during the treatment and recovery process. I would hear the distress in parents’ stories, as they would describe the persistent stagnation in life skills, despite their young person’s current sobriety. It was painfully disappointing to see the gap in community resources to support newly sober teens as they attempt to transition into productive living.

What kind of gap?

Becoming sober is only the beginning of the recovery journey for anyone struggling with substance abuse. Individuals involved in substance use typically have a variety of co-existing or underlying (physical, mental health, social/emotional) issues that complicated their disease process. They miss out on so many of life’s skill development opportunities while they are “mentally unavailable.” There is often a lot of shame, uncertainty, fear and anxiety when they become sober and realize the many things they don’t know how to do in order to live independently, particularly as compared to same-age peers who have moved forward in their lives. Many recovery programs are designed primarily to address sobriety needs. While they may offer after-care recommendations, treatment programs have very limited resources to provide comprehensive transition support.

What makes this program unique?

There’s nothing like it available. Inpatient and intensive outpatient substance treatment programs are designed to address sobriety, within a limited timeframe, which may be quite short. The staff members in substance rehab settings are not normally equipped to address the broad range of occupational performance deficits that we see in this population. Occupational therapists have unique expertise in life skills training, task analysis and adaptation, and environmental assessment. At Washington University Community Practice, we are able to work with the client directly in their community settings, where they most need to implement learning and practice strategies. OT has the opportunity to come alongside the client and serve as a “coach” as the young person explores and develops necessary life skills needed to live productively on their own. OT is also a covered service on most insurance plans.

How are you spreading the word about these services?

The goal is to reach individuals in the places/environments where they need to function. I continue to connect with agencies and service providers who are currently “holding the baton” and seeking to find resources to “bridge the gap” following substance use intervention. The ultimate goal of the program is to provide supports that will best prepare individuals to maintain sustained recovery in the environments where they need to function. For adolescents, that includes high school or college. For young adults that includes a variety of places in the community where “life occurs.” Typically, the adults and administrators in community settings are overwhelmed with their own objectives they need to meet, and are in need of partnering support. I want them to know how this program can make their jobs easier, and how I can partner with them in order to help these young people successfully reintegrate into their settings.

Every client is unique, but tell me about some of the things you work on with a client as part of the treatment plan.

This program is designed to offer a comprehensive assessment of occupational performance needs, as well as underlying factors that may be impacting functioning. We discuss current strengths and barriers to success, and develop a targeted action plan. Initial focus is on self-awareness, and implementation of instructional strategies to meet client-determined goals. Specific intervention modules are designed to address gaps in skills related to health/wellness, self-regulation, emotional resiliency, instrumental activities of daily living (home management, budget/finance, community access), leisure activities, educational supports, pre-vocational training, interpersonal relationship dynamics (social perceptions), resource identification and self-management tools and strategies.

What are your hopes for this program?

As the client population grows, I will add targeted group experiences to help adolescents further grow in skill development, alongside peers who are faced with similar challenges. These groups may include specific life skills of interest, such as cooking, vocational exploration or technology/study skills. In addition to supporting young people in recovery, and the community partners that support their daily needs, I work with the entire family. Our story started with the pain of parents in distress. I remember all too clearly how the stresses of early recovery impact entire family dynamics. I offer groups that support parents and/or siblings in their understanding of recovery dynamics and reestablishing healthy family relationships.

What do you most want people to know about this program?

Sobriety is the first step in the recovery process. When an individual is ready for their next step, community-based occupational therapy is positioned to be a comprehensive wrap-around support to meet each client right where they are at in their recovery journey. The service gives these young people the very best opportunity to feel confident and competent in their ability to take care of themselves and remain sober.

For more information about this program, visit ot.wustl.edu/substanceabusenextsteps.