Treatment of the Young Adult and their Family

9:15 – 10:45 Session

• Introductions

• Young Adult Programs at Ridgeview Institute

• 9:15 – 10:45 -Who is a young adult? -Developmental stage -Neuroanatomy -Lifestyles of the young adult

• 11:00 – 12:30 -Specific Program Profiles

• 3:00 – 5:00 -How does treatment work?

Young Adult ServicesYoung Adult Psychiatric ProgramYoung Adult Addiction Program

Steven R. Lee, MDProgram Director, Young Adult Servicedrleemd.org

Lori Albert-Walker, MSW Clinical Coordinator, Young Adult Addiction Program

Paul Weaver, LPCCase Manager, Young Adult Psychiatric Program

Specific Programs

Programs – Cottage E Young Adult Addiction Young Adult PsychiatricProgram levels of care - Inpatient – Acute stabilization of Psychosis, suicide risk, mania, detox Partial Hospitalization - 9am to 3pm, M - F Intensive Outpatient - 9am to Noon, M – FResidence – On campus residence available

Who Is a young Adult?• A young adult has a personality that is still in the

process of development. • Much of their personality has already developed but

the narcissism and idealism of the adolescent still needs to be tempered through the realities of the school of life.

• The young adult of 2014 is more so now than in the past, “a professional adolescent”.

• Understanding the developmental stage of the adolescent is critical to understanding the developmental stage of the young adult.

Treatment in Adult or Adolescent Programs do not Work

• Young adults need specialized treatment because of their immaturity and inexperience with life.

• Many young adults are still in the stage of separation and individuation but have one “foot” in adulthood.

• If the YA is approached as an adolescent, they will respond defensively in anger to establish that they are legally an adult.

• Their inadequate and inappropriate responses will need to be explained to them the same way that any adult would want input – with respect.

Acting Out

• Standard adult programs are not designed to provide the structure that can confront “acting out” behavior.

• The young adult is not yet capable of controlling nor verbalizing many feelings.

• Many of these feelings are happening for the first time in their life.

• Feelings are expressed by"acting them out", sometimes in destructive ways, not fully realizing the consequences of what they are doing because of their lack of experiences in life.

2014- The Age of Entitlement

• Most young adults are hybrids of adults and adolescents. Sometimes they are adults and sometimes they are adolescents.

• Oppositional-defiant behavior can be part of a delayed separation and individuation stage.

• They believe they are entitled to free room and board and are not grateful.

• Parents feel disrespected.• Both the young adult and the parent are angry at

each other and want the other to change.

Underneath the Anger and Lack of Motivation

• The mental illness and addiction problems cause the young adult to believe that he is a failure and a burden on his family. He is ashamed.

• Once he begins to see some symptom relief, he sees that what he thought was his personality was actually a treatable medical problem.

• When his self image changes, then the young adult can see his potential and will strive to reach it.

• His motivation returns and he will take responsibility for his life.

Worst candidate for Psychotherapy• He does not verbalize how he feels unless he is

forced to do something that he does not want to do, then, he seems to be able to explain his opinion in no uncertain terms.

• Can be angry and/or apathetic • parents pay for the therapy so no financial

investment in treatment which he does not want to do anyway so he comes late to appointments, if he comes at all.

• You have to call parents almost every session (or they call you) to really know what is going on so sessions can be twice as long as an adult (but you only get paid for one session).

• noncompliant with medication so you do not know if the medical part of the mental illness is being treated.

• Probably using marijuana so traditional psychotherapy is like talking to Carl Jung.

Ridgeview Young Adult Program• After several therapists (or, at least, several

tries to engage the young adult in treatment), both the parents and the young adult feel hopeless and helpless that nothing will work.

• The parent starts the interview with, “According to the Dr. Phil Show and Dr Oz, my child

has Bipolar Illness, ADHD, Lyme Disease, an allergy to gluten, low folic acid, chronic mononucleosis, Beriberi, or chronic Fatigue Syndrome”.

• The Young Adult arrives at Ridgeview Institute

What is different at Ridgeview?

• The young adult needs to be with other young adults that have the same problem. They trust each other because they know their peers understand.

• The young adult needs a special structure that will not allow destructive acting out while learning ways to communicate and better coping skills.

• The young adult needs therapists who want to work with young adults.

• And at the risk of sounding altruistic, we are in existence because we care about young adults but we will let you be the judge of that.

Categories of Young Adults1 – Responsible / Age Appropriate / Intact family2 – Irresponsible/ Apathetic3 – Angry / Oppositional–Defiant4 – Immature (Socially / Emotionally)5 – Antisocial / Breaking the Law6 – Chronic Emotional Problems / Hopeless7 – Drugs, Alcohol or Eating Disorder8 – Personality Disorders 9 - Autistic / Problems connecting with others (Asperger’s)10 - ADHD / Learning Disabilities / Problems processing new information11 - No Consistent Parents (orphan, multiple foster homes) / Chronic child abuse 12 - Psychotic

Statistics for 2014• 30% of young adults move to a new residence yearly • 40% move back home with their parents at least

once even though they may have a master’s degree • Have had an average of seven jobs • 66% spend at least some time living with a romantic

partner without being married. • Average age of Marriage in 2009 Female - 26yo and Male - 28 yo• Better educated than parents and the most

knowledgeable group of people in the history of man but they cannot support themselves.

Respect Means Two Different Things

• Young adults expect to be respected but do not understand why they need to give it.

• Parents had more prosperity than they had when they were young adults; their desire to give their children opportunity did not allow the child to work for what was given to them so the YA cannot appreciate what they have.

• Young adults will not have the same prosperity• Unemployment rate in April, 2010 for young adults

was 19.6%, the highest since 1947.

• Ages 18yo to 26 yo, average ~22 yo• 99% have completed high school• 50% are living at home• 99% are dependent on parents & are single• 60% are in college & 90% have some college• Many will have to pay back college loans for

10 to 15 years and do not even have a job.

Not a Ridgeview Young Adult

• A 24 yo, married male, • Evening supervisor at a fast food place • two children, 6 months and 2 yo• returned from a military tour in Iraq 2 years

ago

Neuroanatomy of the Young Adult Brain

Neurological Issues

• NIMH study in 1991 proved that the brain continues to develop after puberty

• The Prefrontal cortex and cerebrum (cortex) does not fully mature until 25 yo.

• The cortex is the location of our higher-order cognitive functioning (problem solving).

• Also, the cortex is the location of memories of potential consequences learned through past behavior as well as what was taught.

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Who Has the Final Word• The limbic system is our more primitive part

of our brain which is essential for survival.• It is responsible for our fight or flight

responses to danger. It has no concern about “collateral”, bad consequences.

• When a young adult is intoxicated, depressed, or overwhelmed, social inhibitions and the risk of dangerous consequences will come secondary to obtaining immediate pleasure or relief of stress.

Nucleus Accumbens• The limbic system is highly interconnected

with the nucleus accumbens, the brain's pleasure center, which plays a role in the "high" derived from "recreational" drugs.

• Its role in pleasure also includes sexual arousal, laughter, reward, and reinforcement learning, as well as fear, aggression and impulsivity.

• Cravings involve dopamine release in the accumbens in anticipation of using.

Car Insurance

• Premiums for car insurance decreases 30 to 40% after the age of 26 especially if that person is married.

• Actuaries are objective facts – Young adults before the age of 26 have more accidents.

• Inexperience, impulsivity, limited financial investment in the car or the insurance premium since they did not work for the money, etc., etc.

Lifestyle Greatly affects Recovery

• Biological rhythms are usually off balance• Sleep – “biological clock” takes 2 weeks to

calibrate• Diet – Appropriate nutrition to minimize carbs

and the use of protein, fruits and vegetables• Exercise – 30 min sustained movement 4

days/week• Nicotine, caffeine, alcohol, and marijuana