A little more than 30 years ago, there was no inpatient treatment for adolescents in trouble with alcohol and drugs.  Those of us working with teens saw the “60’s” drug use trickle down to our adolescent clients and patients. While Greater Cleveland had several excellent adult facilities, none of them could or would take adolescents and rightly so.  We found treatment for them mainly in Baton Rouge, Louisiana or in Minnesota. Often our adolescents spent 6 months to a year in treatment; first primary, then in a halfway facility while attending a local school. Many of them received help for dual disorders during the time after primary treatment. Those of us working with adolescents and their families around the issues of alcohol and other drug use gathered together and decided we needed formalized treatment for substance use disorders geared to the developmental needs of adolescents. New Directions, an adolescent treatment facility, came into being soon thereafter and has flourished under the care of an excellent Board of Trustees, Dr Nikki Babbitt and Mike Matoney.  Other psychiatric facilities began taking our patients focusing on the alcohol and drug use, and treatment in Cleveland for substance using adolescents thrived.  The schools, through Project Care, an initiative of the Greater Cleveland School Superintendents encouraged teachers to recognize teens who were high in school, to know the signs and symptoms and to meet with parents when concerns arose.  Parents were encouraged to attend parent programs giving them the permission and tools to intervene with their children.Over time and, as the result of managed care, residential treatment has been limited and intensive outpatient has taken its place.  Community denial is rampant and children are once again attending school high or getting high at lunch and partying on weekends.  Once more we are seeing an increase in children dying from suicide or auto accidents, going to jail, and dropping out of school as the result of their alcohol and other drug use.According to the US Department of Health and Human Service 2009 information, there were a total of 17,000 substance use disorder treatment admissions in the metropolitan Cleveland area. Approximately 10 % of those were under the age of 18. Marijuana, alcohol and heroin were the substances used by this age group. Approximately 10% of those were admitted to a residential facility and the remainder in outpatient treatment. Approximately half of this number also received services for a mental health diagnosis.Research has shown that the age of first use has decreased markedly since the 1970’s.  Today the average age of first use is 12.6 years. SAMSHA’s 2009 report estimates that two million teens have diagnosable substance use disorders and 145,000 of those have received treatment.All national statistics indicate that the highest risk group for substance use disorders is the age group of 16-25. This then would indicate that the prodromal period of this illness could well span late childhood and early adolescence.  The early onset of use increases the possibility of multiple drug use and the risk of developing a substance use disorder and mental illness.Research conducted by Winter et al in the year 2000, determined that 47% of students returning to their high schools after successful treatment resumed full blown drug use.Since 1987 there has emerged an effort to provide for the special needs of recovering high school students in the form of a separate facility for those students.  A recovery high school can be a charter school, private academy or part of a school system.  Each has its benefits and difficulties.  The major components of such a school are the following:

• A high school curriculum--The high school curriculum is available, but needs to be tailored to the special needs of the population served.  Strong support from both private and public schools is one key to success.
• Family support and participation--Families need to be involved on a very close basis, as they need support in developing parenting styles that avoid enabling their teen and in learning techniques for holding their child accountable.
• Promotion of successful community reintegration--Often community reintegration begins with the students in the Recovery High School providing volunteer help to the local community through service projects.
• Comprehensive care and use of community resources-- Holistic care of mind, body, and spirit are key concepts in recovery.  The school, with the help of counselors, accesses the local community, clinical, social, physical, spiritual and self help services for students.
• Original school collaboration--the goal for students in recovery high schools is to achieve academic competence and recovery.  Coordination with the original high school to determine credits is important in determining graduation status.
• Aftercare--There is nothing more effective than a graduate peer returning to offer a message of hope to recovering students.  It remains helpful to the returning peer, in that he/she will not forget the past, and it will provide him/her with a sense of helping others.

Part of the 2010 National Drug Control Strategy is [to]… foster the expansion of community-based recovery support program, including recovery schools, peer led programs, mutual help groups and recovery support centers.  (NDCS-Chapter 3 p.45)The Monday Morning Forum at the Cleveland Psychoanalytic Center invited me to talk about a Recovery High School.  The response was positive and supportive with excellent questions and comments.   Once more a group of concerned clinicians, parents and educators will gather to examine and develop a new type of facility for the Greater Cleveland teen who has had difficulty with use of alcohol and other drugs.  We are meeting at New Directions in Pepper Pike on October 22, 2010 at 10:30AM.  Please email me at joy.willmott@case.edu if you are interested in attending.Joy G. Willmott