Dr. Paula Riggs dropped her shoulders, lowered her voice and planted her feet apart a little wider as she assumed the character of a surfer dude who wanted to get clean but couldn't imagine not being with his stoner friends.
The teen-age character was real patient and soon, she told a group of professional counselors and social workers last Wednesday, a doctor and the dude were brainstorming ideas about how he might hang with his still-using buddies who he'd been close to since third grade.
"Maybe you can fix them?" was the dude's totally serious suggestion.
Riggs' delivery and the quirky suggestion got a laugh from the assembled adults. Yet, she said, together they talked through the suggestion and soon his friends started picking him up and dropping him off for treatment, some. A few actually joined Riggs' research program. Last she heard, at least the dude and one friend were still clean.
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Actively listening, being willing to innovate, strategically guiding teens to discover their own solutions were among the many suggestions Riggs, a national recognized expert in addiction, shared with 45 social workers, counselors and others already working in substance abuse this week in Kentucky. "We know from experience you can't lecture or give advice," said Riggs, director of the division of substance abuse at the University of Colorado Anschutz School of Medicine.
Riggs provided a series of trainings in Lexington, Bowling Green and Prestonsburg which are funded as part of a $1.5 million grant announced in May by Attorney General Jack Conway and University of Kentucky officials. The money comes from two settlements totalling $32 million the state received from pharmaceutical companies.
Riggs' training is the foundation of a grassroots network that will span across the state. All 45 trainers, through a series of reviews of their work, including video taping actual sessions with patients for critique, will get ongoing supervision from experts who work with Riggs to insure they are delivering treatment accurately. Nine participants will be trained as lead supervisors and certified to be able to train others, said Dr. Catherine Martin, the principal investigator for the program known as Adolescent Health and Recovery Treatment and Training.
Eventually, the names of those who have completed the training will be available to the public, said Martin. The program is targeted at ages 12 to 18 and includes kids who are addicted to or abusing tobacco as well as drugs and alcohol.
According to the most recent statistics from the Centers for Disease Control and Prevention, 66 percent of Kentucky kids have used alcohol, 37 percent have used marijuana, 19 percent have abused prescription drugs and 24 percent of Kentucky teens smoke.
From coping with cravings to creating a strategy for teens to say "no" to using alcohol, drugs or tobacco, to saying goodbye to the patient when the treatment ends, Riggs and her students in Lexington shared real-world examples as they worked through a thick manual that laid out everything from a descriptive range of feelings to positive activities to replace addictive behavior.
After the research project is complete, the state will be able to show measurable progress, Martin said.
"That is what is beautiful about this grant and this program," said Riggs. "There is a very systematic series of clinical supervision in place."
Health officials from other states are already reaching out to UK officials to learn how they can implement similar programs, Martin said.
Some of those trained will be available to provide telemedicine consultations so even the most remote parts of the state can have access to the most up-to-date techniques and information, Martin said.
"In the end," Riggs said, "it focuses on teaching the kids the skills that they need to stay abstinent" from drugs, alcohol or tobacco.
An important part of the treatment is providing a space for teens where it is "safe for them to tell the truth," Riggs said.
Addiction is a chronic relapsing disease with a biological base just like diabetes. Where some old-school practitioners may have a zero tolerance policy for relapse, she encouraged her students to focus on the overall reduction of use while encouraging the ultimate goal of total abstinence.
"You don't kick a diabetic out of treatment if their sugars are high," she said.
People also think of "graduating" from substance abuse treatment, she said, but people don't graduate from treatment for heart disease or diabetes. The care is ongoing.
Many people still look at addiction treatment about something that you graduate from and "that's the wrong model," she said.