Pushing Back Against Peer Pressure

In southern New York, one hospital started a program to address a growing social and health concern. The outpatient adolescent substance abuse program at Nyack Hospital came about because of increases in heroin overdoses in the younger population over the past few years.

Nyack Hospital had experience treating adult patients with substance abuse history but the careful considerations of treating teenagers meant they needed a new program with its own approach. Karen Hertz, L.C.S.W, clinical program supervisor, explained, “We saw a need in the community to fill and the hospital saw it too.” In March 2015, they started seeing their first teen patients.

“We’re still getting known as a resource, so we do a lot of outreach,” Hertz said. Referrals to the program come from concerned parents and also from schools. The courts and probation officers will refer teens to treatment as well. “We tend to see the people who have gotten in trouble for it, either legally or academically,” noted Catherine Fliegel, RN, CASAC, although the total population of users may be significantly higher. Other in-patient treatment facilities also refer their clients to the Nyack Hospital program for additional counseling after discharge.

SEE ALSO: Juggling Mental Health and Substance Abuse

Kids Being Kids?
The program addresses the overuse of alcohol and drugs, both illegal and prescription, including the aforementioned heroin abuse. “It’s particularly challenging because so many of their friends are doing it,” said Fliegel, referring to teens using alcohol and marijuana, which have a reputation of not being a big deal.

The CDC’s Youth Behavior Survey from 2013 found that in a 30-day period, 35% of high school students drank alcohol, with 21% binge drinking. An additional 10% admitted to driving after drinking. The same study found that in a 30-day period, 23% of high school students used marijuana. 1

Their parents’ medicine cabinets are another source of illicit highs. ADHD medications, depression medications and opioid pain medications are all trouble spots. 25% of teens admit to using a prescription drug to get high.One area of particular concern is the new wave of synthetic drugs, because they don’t show up in traditional drug tests.

Hertz uses her experience as a social worker and Fliegel uses her combination of experience as a nurse and a credentialed alcoholism and substance abuse counselor to devise successful programs for the teens. Fliegel previously worked in different nursing specialties, but treating adolescents crossed over all of them. She had experience in behavioral health and her CASAC certification gave her the educational background in addiction with co-occurring mental health disorders.

Nurses Lead the Way
“Someone like Catherine really cares about these clients and there’s no judgment,” praised Hertz. The common nursing goal of inspiring hope is appropriate here.

Fliegel meets with every admission for a nursing assessment. A large part of her job is education, on smoking cessation, STI prevention, mental health disorders and eating disorders. “I especially enjoy the educational piece,” she remarked. Other than eating disorders, other common co-occurrences with substance abuse include anxiety, ADHD and cutting. Fliegel explained, “I use all the nursing skills, as far as assessment and interviewing and motivation, and modify them to fit this population.”

With all nursing specialties, treating younger patients requires a different approach, and substance abuse counseling is no different. “Some of them have started using substances around age ten or eleven,” noted Fliegel. “That’s the age at which they arrest their emotional growth.” The level of education needs to be relatable and the program uses an adolescent-geared curriculum. She added, “Their brains are not totally formed yet. Some can’t sit in a group for more than an hour.”

Family Effort
Group, individual and family counseling, with motivational interviewing and cognitive behavioral therapy, make up the bulk of the program. They attend group sessions twice per week and individual counseling once per week. “We use positive peer interaction,” Hertz said. The medical director of the program is a family practice physician and there is also a psychiatrist on staff to provide treatment if needed.

From a physiological standpoint, teens may use different substances than adults, so the treatment approach needs to be tailored to their unique circumstances. They provide education on the disease process and its effects on the developing brain.

Mitigating factors can prevent the adolescents from getting into treatment. The Nyack Hospital program is an outpatient program held after school. Sometimes the kids have trouble physically getting to the center. Parental embarrassment also prevents treatment, as the parents feel they have failed. Other parents may be users themselves or may exhibit a laissez-faire, enabling attitude towards their children’s actions.

Involving the family is an important step on the teens’ road to recovery. Parents sign a contact verifying they will participate in the program. They attend the initial intake assessment. A multi-family group held every other week addresses common social systems that enable and encourage substance abuse and strategies to overcome them. As for the teens, the counselors work with them in treatment to accept parental involvement in their recovery.

A Place for Hope
Hertz admitted, “Some kids need more than we can give them.” They will refer certain patients to specialists for persistent co-occurring disorders. They have also referred teens to inpatient facilities if destructive behavior continues.

“We develop a treatment plan for each client and as they meet their goals, we look towards discharging them,” said Hertz. The counselors may recommend further sessions. “Abstinence itself is not the measure of success. It’s about meeting other goals and re-engaging in healthy relationships,” Fliegel remarked.

Achieving stabilization is the primary goal for the treatment program. Fliegel said, “Providing the right kind of education and support gives them hope.”


1. Centers for Disease Control. Fact Sheets-Underage Drinking. http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htmAccessibility verified August 7, 2015.

2. Partnership for Drug-Free Kids. The Partnership Attitude Tracking Study. http://www.drugfree.org/wp-content/uploads/2014/07/PATS-2013-FULL-REPORT.pdf Accessibility verified August 7, 2015.

Danielle Bullen is on staff at ADVANCE. Contact: [email protected]

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