MET/CBT: Treatment of Adolescent Substance Abuse

1. Teen Substance Abuse
2. Motivational Enhancement Therapy and Cognitive Behavioral Therapy (MET/CBT)
3. Evidence for MET/CBT
4. Accessing MET/CBT Services

Statistics on Teenage Drug Abuse

One of the most significant factors in predicting the development of a substance use disorder later in life is the age at which a person first uses a substance.² For those who begin using substances in their early teenage years, the likelihood of developing a substance use disorder is increased exponentially.²

An example given by the National Institute on Drug Abuse reports that:

• 15.2% of people who begin drinking by the age of 14 will go on to develop a substance use disorder.
• In comparison, only 2.1% of those who wait until they are 21 years or older will develop a substance use disorder.²
  

In addition, similar data from 2012 found that:

• 13% of people who have been diagnosed with a substance use disorder began using marijuana by the time they were 14 years of age.²

While the numbers may be concerning, it is even more concerning to know that of the adolescents between the ages of 12-17 who are abusing substances, only 10% receive the services that they need in order to learn how to change the cognitive and behavioral patterns associated with substance use.²

One such treatment that has been shown to be effective in treating adolescents between the age of 12 and 18 is Motivational Enhancement Therapy in combination with Cognitive Behavioral Therapy (MET/CBT). These two modalities, when used together, target both the motivation to change the substance use behavior and the underlying thoughts and feelings that may be triggering the maladaptive substance use behaviors.

Teen Substance Abuse

A study conducted between 2012 and 2014 by the National Institute on Drug Abuse surveyed the use of substances each year by adolescents between the ages of 12 and 17.¹ This study revealed that on average¹:

Many factors contribute to whether or not an adolescent will engage in the use of alcohol, tobacco or illicit drugs. Developmentally speaking, it is normal for teenagers to seek thrilling and new experiences and to engage in activities that are risky.² The choice to engage in what is developmentally appropriate versus what is maladaptive often includes factors such as the presence of other mental health issues, the availability of substances in the school, community, and home, whether or not peers are engaged in substance use, and what the environment in the teenager's home has been throughout their life.²

Motivational Enhancement Therapy and Cognitive Behavioral Therapy (MET/CBT)

• 
  Motivational Enhancement Therapy (MET) is a therapeutic modality that places the responsibility and decision to change on the client.^{3, p. vii} The therapist's role in MET is to encourage the client to tap into their innate capacity to change, which the therapist facilitates by using a non-confrontational, person centered approach that utilizes active listening and empathy to help the client build and strengthen their motivation to change.^{3, p.13}

  • In its standardized form, MET is a brief therapy that consists of 5 sessions.^{3, p. 1} A client can expect that the initial session, which requires a complete assessment battery to be completed, will take up to 8 hours to complete.^{3, p. 1}
  • The 4 sessions following the initial assessment are 60-75 minutes long, and the first 2 sessions of the 4 can be done alone or with family members who play a significant role in the adolescent's life.^{3, p. 1}

• 
  Cognitive Behavioral Therapy (CBT), on the other hand, is based on social learning theory, which views substance use within the context of other significant issues and problems in a person's environment.^{3, p. ix} In CBT, the therapist's role is to help the client overcome skill deficits and enhance their coping mechanisms so that they are better able to face high risk situations that could trigger a relapse.^{3, p. ix}

  • The focus of CBT is to build cognitive and behavioral skills that will replace the outdated and maladaptive coping skills that lead to substance use and abuse.
  • This is done by helping the client understand how their thoughts, feelings, and behaviors are all related to one another.^{3, p. ix}

Evidence for MET/CBT

Treatment outcome research has shown MET, alone, to be effective as a short term treatment option for adolescents between the ages of 12 and 18 years old who are being treated for alcohol and marijuana use disorders. MET draws on motivational interviewing principles that have been empirically shown to be effective in the treatment of substance use disorders. CBT, alone, is also an effective treatment for adolescent substance abuse.⁵ CBT may help address co-occurring mental health and conduct issues associated with substance abuse in adolescents.⁶

Accessing MET/CBT Services

In order to receive the benefits from MET/CBT as described in this article, it is crucial to find a therapist who is trained and certified in this modality. Training and certification ensure that the quality and approach to treatment is the same no matter what provider you see. Below is a list of resources from organizations in the field of addiction:

• ASAM Member Search.
• SAMHSA Treatment Finder.
• AAAP Patient Resources.
• AACAP Treatment Finder.
• Inpatient and outpatient treatment resources.
• Contact your insurance company representative for a list of providers in your area.
• Call 1-888-993-3112Who Answers? to talk about inpatient options.
• Other similar programs:
  • Adolescent Community Reinforcement Approach (A-CRA).
  • Relapse Prevention Therapy (RPT).
  • Family approaches:
    • Multidimensional Family Therapy (MDFT).
    • Brief Strategic Family Therapy (BSFT).
    • Multisystemic Therapy (MST).

References:

1. National Institute on Drug Abuse, National survey on drug use and health. 2014. Available at http://www.drugabuse.gov/national-survey-drug-use-health. Accessed January 6, 2016.
2. National Institute on Drug Abuse, Principles of adolescent substance use disorder treatment: a research based guide. 2014; Available at http://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/introduction. Accessed January 6, 2016.
3. Miller W.R. Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence. National institute of alcohol abuse and alcoholism: project MATCH monograph series. 1995; http://pubs.niaaa.nih.gov/publications/ProjectMatch/match02.pdf
4. Dennis ML, Godley SH, Diamond GS, Babor T, Donaldson J, Liddle H, et al. The Cannabis Youth Treatment (CYT) Study: Main findings from two randomized trials. Journal of Substance Abuse Treatment. 2004;27:197-213
5. Deas, D., & Thomas, S. E. (2001). An overview of controlled studies of adolescent substance abuse treatment. The American Journal on Addictions,10(2), 178-189.
6. Riggs, P. D., Mikulich-Gilbertson, S. K., Davies, R. D., Lohman, M., Klein, C., & Stover, S. K. (2007). A randomized controlled trial of fluoxetine and cognitive behavioral therapy in adolescents with major depression, behavior problems, and substance use disorders. Archives of pediatrics & adolescent medicine, 161(11), 1026-1034.
7. Ramchand, R., Griffin, B. A., Suttorp, M., Harris, K. M., & Morral, A. (2011). Using a cross-study design to assess the efficacy of motivational enhancement therapy-cognitive behavioral therapy 5 (MET/CBT5) in treating adolescents with cannabis-related disorders. Journal of studies on alcohol and drugs, 72(3), 380.
8. Hunter, S. B., Ramchand, R., Griffin, B. A., Suttorp, M. J., McCaffrey, D., & Morral, A. (2012). The effectiveness of community-based delivery of an evidence-based treatment for adolescent substance use. Journal of substance abuse treatment, 43(2), 211-220.