Frontline Initiative Self-Determination

Breaking the Bonds of Substance Abuse:
Renewed Self-Determination


  Amy Brandhuber is a patient community facilitator for Cottonwood de Tucson in Arizona

As a Direct Support Professional (DSP) in the field of adolescent substance abuse treatment, I have found restoring self-determination to be a key concept which is important for me to understand and implement. For adolescents to be successful in the outside world, they need to feel they have the ability to control their lives. Instilling this belief in an adolescent who has or is struggling with a dependence on alcohol and/or drugs can be an important step to his or her future success.

Adolescence is a period of development when individuals separate from their parents and create their own identity. When adolescents start to abuse substances, they stop the normal emotional developmental process. Consequently, when they stop using drugs there is a gap between where they should be developmentally and where they are chronologically. They often lack the confidence in themselves to believe that they can determine their own future.

There are several different ways to treat adolescent substance abuse. One way is a short-term residential program which usually lasts from 28 to 40 days and offers a chance to remove adolescents from their everyday setting and place them in a safe, drug-free environment. For many in the program, it will be the first time they have not had access to drugs on a regular basis in years. Residential treatment takes away many of the day-to-day decisions that the person has to make because it is structured and most decisions are made for the adolescent by the staff. There are disadvantages to this when the goal is to promote self-determination among the youth because there are not many opportunities to make decisions and face consequences either positive or negative.

The DSP must work hard to help nurture as much choice making as possible given the setting. Another option is having the adolescent attend three to five hours of counseling three to five nights a week. Self-determination is much easier for DSP to promote with this option because adolescents stay in their homes and school settings and continue to make decisions but there is structured time to address the issues around their drug use. This enables the youth to test out new skills they have learned and receive support from peers and staff in doing so. The DSP plays a crucial role in helping adolescents gain confidence in themselves to make decisions that will have a positive effect on their futures. As an adolescent begins to practice self-determination, usually several observable changes occur. Many times the youth will begin to discuss his or her future and what he or she wants to do. For many adolescents, drugs have taken away their hopes and dreams and left them without plans or aspirations. Believing in themselves again, they begin to consider their futures. Another sign that an adolescent is beginning to practice self-determination is when he or she begins to discuss breaking away from drug-using friends; for most teens, their friends are critical to them and the thought of leaving them is overwhelming. When adolescents begin to see that staying away from drugs is about more than just saying “no” and they realize their drug-using friends are linked to their chances at sobriety, they are starting to take control of their lives and recover. As the adolescents take these steps, it is crucial that DSPs around them support their decisions. They cannot be forced into these decisions because adolescents will not follow through if they do not believe it is necessary for their sobriety.

The DSP must strive to create an atmosphere where adolescents are given enough choices so that they can see how these choices will affect their future, but not too many choices too soon so that they are not overwhelmed. Most adolescents want to have self-determination and the confidence in themselves that they can make the right choices. Often it is the DSP that needs to give that encouragement to the youth so that they may start down the road to self-determination.