For many years, the treatment of substance abuse has followed a traditional "illness" or "disease" model. The "disease model" has its roots in the traditional, twelve-step approach and has long been considered the only successful medium for the treatment of addictive disorders. Indeed, this traditional model has been successful in treating alcohol and other drug (AOD) problems, but it has failed to show success in the development of drug resistance skills, according to a study conducted by Dr. Sally Stevens and the University of Arizona.

The University of Arizona study did, however, identify a model that has been empirically significant in treating substance abuse among adolescent populations.

It is a cognitive based approach developed by psychologist Robert Schwebel, PH.D., knows as the "Seven Challenges". The research was conducted with an aftercare population. This significance of this is that the pressure on youth who were the focus of the study, to "get high" and the availability of substances were much more prevalent and significant than would have been the case in a residential treatment setting where access to the outside world is carefully controlled. This factor alone makes the success of Schwebel's approach more statistically significant.

The sample was conducted with 83 males and females (48% Hispanic and African-American), with a median age of 15 years. The instrument utilized was the POSIT (Problem Oriented Screening Instrument for Teenagers). The results showed a decrease in the number of adolescents using marijuana by 42%, cocaine by 23% and alcohol by 11%. Also noted was a 23% decrease in drug selling activity, a 20% decrease in retail theft and a 15% decrease in the theft of cigarettes. The study also showed a dramatic increase in the skills associated with the building of relationships and the communication skills of substance abusing adolescents. It also revealed an increase in honesty, awareness, concentration, hopefulness and direction. The fact that this research was conducted in an outpatient or aftercare setting is even more impressive because abstinence occurred while the youth was "on the street".

• Treatment should be based on lifestyle.
• Treatment should be based on research.
• Treatment should be culturally appropriate.
• Treatment should be holistic.
• Effective treatment is relationship based.
• Effective treatment is based on mutual respect.
• Effective treatment utilizes education, respectful confrontation and finesse instead of locking horns and intimidation.
• Relapse prevention occurs through raising consciousness and internal motivation to change.
• Effective treatment is individualized.

 Traditional Model

The traditional twelve-step model is based on viewing the use of substance abuse as an illness. In order to stay clean, one must abstain from the use of all substances that intentionally alter one's conscious state. As a result, the drug or alcohol dependent person is taught that their "recovery" from dependency and addiction is a life-long process that is approached "one day at the time". (Adolescents have a difficult time embracing the concept that they suffer from a disease from which they will never fully recover.)

The primary caregiver is typically a person who is also in "recovery". The model is predicated on the belief that only another addict or alcoholic can understand. The treatment model demands that clients "surrender" themselves to a higher power and seek to "make amends" for all those they have wronged as a result of their behavior. Spirituality is a strong component of the twelve-step approach and one on which life-long "recovery" is predicated.

The process of twelve-step treatment involves support groups of users and ex-users. Members only use first names and they introduce themselves as alcoholics and/or drug addicts. Discussions are based on self-disclosure and group support. Anonymity is the bulwark of the twelve-step approach. As a result there is little empirical evidence of the long-term efficacy of this approach. Outside of formal residential treatment settings that employ the twelve-step approach to recovery, no records are maintained and no long-term longitudinal studies are performed. Abstinence and recovery are measured only by self-report.

 Seven Challenges

The twelve-step model has been used as the preferred approach for adults. However, just as young women need to be approached through a female, gender-specific "lens", the same should be done for adolescents and substance abuse.

The Seven Challenges is based on the Philosophy of Change. It is consistent with the substance abuse treatment model used effectively in Canada predicted on the research of the Correctional Services of Canada. It advocates utilizing a cognitive-behavioral approach to develop skills such as assertiveness training, problem solving, coping skills and structured relapse prevention.

The Seven Challenges is based on "reduction of harm rather than illness". It also identifies the use of substances as a life choice that has meaning to the adolescent. Treatment is geared towards recognizing the meaning of usage and building cognitive and behavioral skills to cope with issues without using substances.

The process also uses a support group, which focuses on social skill building and education.

Each "challenge" identified has a workbook that requires the youth to reflect on life situations, to explore feelings and beliefs and to complete exercises designed to build coping skills.

The first three challenges are based on cognitive processing and exploration. The last four challenges put in to place, an action plan including structured relapse prevention, social skills training, rehearsals of situations in which alcohol or other drugs were used, problem solving and vocational training (as articulated by Correctional Services of Canada research).