Adolescent Substance Abuse Articles

Insight-Oriented Therapy for Adolescent Substance Abuse

By Meghan Vivo

“Know thy self” is an ancient Greek aphorism that has been used since the days of Socrates, but applies equally to modern life. The more you know yourself, the happier you will be – this is a basic tenet of insight-oriented therapy, which has helped thousands of adults and adolescents overcome problems like substance abuse, trauma, depression, and other psychological and behavioral issues.

Insight-oriented therapy, or insight therapy, encourages people to break free from old habits and behavior patterns by looking inward and assessing one’s own emotions, motivations, and self-talk. Through enhanced self-awareness, patients are better equipped to challenge negative thoughts and work through difficult emotions in healthy ways.

An Insightful Approach to Teen Addiction

At no time could understanding oneself be more important than during adolescence, when young people are first establishing their identity. This is no easy task – at the same time they’re learning who they are as individuals, they must find a way to fit in with friends, peers, and family.

If adolescents realize they can proactively create whatever they want in their lives, the transition into adolescence will be smooth, says Jeff Nalin, Psy.D., co-founder and executive director of Echo Malibu, a residential drug rehab program for adolescents in Malibu, California. But if they lack confidence and support, they will be more susceptible to other people’s judgments and will be reactive, trying to fit in anywhere they can.

In other words, says Dr. Nalin, “Youth function best when they aren’t working from a place of fear. When they’re scared, they make bad decisions and end up in a place where they’re not being themselves.”

Historically, adolescent substance abuse treatment programs have focused on behavior modification, seeking to reduce negative behaviors rather than treating the underlying issues. In recent years, there has been a shift toward inquiring more deeply into what the negative behaviors point to.

“When you’re dealing with chemical dependency in teens, there are usually dual diagnosis issues,” says Dr. Nalin. “The substance abuse is often a symptom of a deeper issue like depression, anxiety, or trauma.”

Dr. Nalin, who has worked with struggling youth throughout his career, has observed teens in various rehab programs complying with treatment and telling the therapists what they want to hear, but returning to their old behavior patterns just a few weeks after going home. “They were holding their breath for weeks rather than dealing with the real issues,” Dr. Nalin notes.

Echo Malibu is unique in its approach to teen substance abuse treatment, which may explain its impressive success rates. The staff seeks to genuinely understand the adolescents’ world, meet them where they are, and accept them for who they are without any pretense. Because the environment is open and accepting, teens begin to buy into the program and then they start buying into themselves, says Dr. Nalin.

“We don’t want our clients to come here and behave. We want them to be themselves,” he says. “We don’t coerce or scare teens into behaving because we want to see what’s really going on. In this way, we are an ideal match – teens want to be heard and we want to listen.”

Writing Their Own Story: The Shift from Reactive to Proactive

Insight-oriented therapy permeates every aspect of substance abuse treatment at Echo Malibu. Among other approaches, the staff at Echo Malibu uses depth psychology and narrative work to help teens address the issues underlying their substance abuse.

“The teens at Echo are involved in their treatment in the truest sense of the word,” explains Dr. Nalin. “We are upfront with our clients about what we’re trying to do. They know we want to build trust and a sense of competence in them, and we are clear about our intent from day one.”

On an ongoing basis, the staff works with each adolescent to gain insight into themselves and how they fit into their family system in an effort to help them improve their lives. “They have all the answers they need inside themselves,” says Dr. Nalin. “They just need a safe place to start to openly explore who they are.”

As part of its therapeutic approach, Echo Malibu asks clients to take a close look at the story they’re telling themselves about who they are. “So many teens think they’re stupid, ugly, or fat and outcast themselves in some way. Some of these views are self-created, some are thrust upon them by others, and some have been adopted as survival mechanisms to fit in with a specific group of peers.”

For most teens, it’s a relief to learn they are not defined by their self-limiting beliefs and that those beliefs can be altered. The staff at Echo Malibu helps each teen understand the developmental stage he is in and how his experience of life will change over time. Once teens understand that their story isn’t finished, they begin to shift from reactive (acting out) to proactive (writing a new life story for themselves).

In the Echo Malibu model, the “e” in “Echo” stands for empowerment. When teens feel empowered, they are better able to deal with drug cravings and triggers to use at home and change any negative patterns with the significant people in their lives. Because they will inevitably be faced with drugs, parties, and old friends and lifestyles when they go home, adequate preparation is essential.
 
“When young people feel empowered, they act out less because there is nothing to act out against,” explains Dr. Nalin. “They feel in control and confident about who they are – both characteristics that support long-term sobriety.”

Families Benefit from Added Insight

Insight-oriented therapy is effective not only with teens, but also their parents. Family relationships are a focal point at Echo Malibu, where therapists work with parents and teens to understand their place in the family system, how those roles are working, and which patterns should be modified.

It is rare that substance abuse treatment is exclusively about “fixing” the adolescent. More commonly, there is dysfunction in the family system that must be addressed for change to translate to the home environment. Through insight-oriented family therapy, parents and teens start to appreciate each other’s strengths and challenges rather than blaming one another for the discord at home.

Figuring out what’s happening in the family is an important aspect of adolescent drug treatment. “Some teens act out because they have no power or have internalized the emotional drama of the family. Others have assumed all of the power and are running the household,” notes Dr. Nalin. “In both cases, we work with families on drawing boundaries, providing emotional support, and improving communication by using insight and understanding the underlying processes at work in the family.”

A Better Way to Live

Effective treatment for teen substance abuse requires more than addressing the drug or alcohol abuse itself. One of the primary goals of treatment also has to be learning how to live better. Although other therapeutic approaches are helpful to address risky behaviors and help teens avoid negative peers, therapies aimed at shifting internal belief systems set a firm foundation for long-term change.

Teens who abuse drugs or alcohol often have negative world views, constantly reminding themselves that “life is hard” and “the world is bad.” “I’ve never met a happy, well-adjusted person that needed to numb themselves with drugs and alcohol,” says Dr. Nalin. “Our goal is to teach teens how to maneuver through life better by checking in with themselves and asking for the support they need. Eventually, they find that they are in control of their lives and don’t need drugs or alcohol to feel good.”

When recovery is based on genuine internal change, you see significant, life-shifting moments, says Dr. Nalin. “That’s why it’s nice to work with young people – if they change their trajectory even a little bit, you will see a dramatic change later on.”