It was nearly 20 years ago that Dr. Robert Schwebel began casting
about for a program to help drug-abusing teens. He’d been asked to
install one at a local treatment center, and he confidently sketched
what he wanted.
“I told them that you have to deal with the underlying issues that
occur with the drug use,” says the Tucson psychologist. “And it has to
be counseling—the role of the counselor isn’t to dictate
behavior, but to help people make their own wise choices. I made these
brash statements about what I thought it should be, and then I thought
I’d go find it and bring it in.
“But what I found was that it didn’t exist.”
Instead, “What was going on in the country,” he says, “was
watered-down (12-step programs) for teens.”
So Schwebel began hammering together his own protocol. He called it
“The Seven Challenges,” and its basic principles—so seemingly
obvious—have since revolutionized teen drug treatment.
“People were looking for an alternative to 12-step,” he says, “for
something with evidence of being effective.”
Follow-up studies by the UA confirmed that his program was getting
results. The Seven Challenges (www.sevenchallenges.com) enjoyed
another boost when the UA tapped it as a comparison model for programs
being submitted for review by the U.S. Center for Substance Abuse
Treatment. “The center was looking for model programs,” says Schwebel,
“because they were dealing with the same problem I had been dealing
with—which was to find a program that was shown to be effective.
And the Seven Challenges had exceptional data.”
That was noted in a paper co-authored by Dr. Sally Stevens, director
of the UA’s Southwest Institute for Research on Women. Stevens
described the program’s success in treating teens at a center operated
by the Tucson-based Providence Service Corporation, writing that “the
three month substance and mental-health outcomes for Seven Challenges
showed significant improvements.”
According to Schwebel, that reflects the decidedly different
approach taken by his program. For instance, Seven Challenges begins
with creating a climate of trust, where teens are encouraged to talk
honestly about their drug use. The second challenge encourages them to
focus on whatever needs the drug is filling in their lives. Next, they
discuss the harm from drug use, ranging from drunk-driving to reckless
sex. Fourth, the self-blame that adolescents often heap on themselves
is diffused by discussing their broader situation, which could include
family problems or drug-using parents.
Then they project the damage that continued drug use might
inflict—and contrast that with how their lives might improve
minus the drugs. At this point, the teen is led into seeing change as a
personal challenge rather than a mandate. Challenge Six involves asking
the youths to make their own decisions about their lives and drug use.
By Challenge Seven, they are monitoring their success—and
returning to master earlier steps when they stumble.
Underlying this entire program is the simple notion that teens
should be given the power to make their own decisions about kicking
drugs. That’s a key difference, because unlike adults, these kids
usually aren’t seeking treatment on their own, but are being dragged to
it by their parents, or forced into counseling under court order. As a
result, they arrive at therapy chafing under imposed pressures.
This program then leads them to the right decision, without
immediately demanding that they simply quit using drugs, or follow what
Schwebel calls “the mad rush toward abstinence.” That rush is
ineffective, he says, “because when kids walk through the door, and you
start bombarding them with how dangerous drugs are—you tell them
they need to quit; you try to coerce them, and coercing doesn’t work
with teens—you get four bad outcomes.
“You get fakers, the kids who tell adults they’re going to quit. You
get fighters—the ones who tell you to shove it, and the
passive-aggressive fighters who play the adults like crazy. They’ll say
something like, ‘Marijuana is harmless; it grows in the earth.’ And
that will drive the adult counselors crazy trying to prove them
wrong.”
Then there are the “players,” who resist anyone telling them to
quit; they just end up leaving therapy, says Schwebel. The fourth type
is the followers. “These are the kids who are swayed by the adults who
care,” he says, “and they try to quit. But in the mad rush to
abstinence, they try to quit and fail.”
The Seven Challenges turns that approach on its head. “We don’t say
it’s OK to use drugs,” he explains. “We say the mad rush is a bad
strategy, and it doesn’t work. It leads to bad outcomes.”
Mike Panico oversees Providence’s substance-abuse program. He says
Seven Challenges is the only treatment program that makes sense for
teens.
“First, they don’t like to be told what to do. And as a clinician,
it’s really not my role to tell people how to live their lives. On the
second hand, teenagers are used to defending themselves and their
actions. The minute they sniff that out that somebody will be critical
or judging of what they do, they immediately take the other side, and
argue to defend their position and behaviors.”
But with The Seven Challenges program, “the theme is that you get to
make your own decisions and decide for yourself,” he says. “There’s
almost something magical that happens when you say, ‘I’m not going to
tell you what to do. You have to make the decision yourself. I’m just
here to help you think it through.'”
Of course, convincing teens of that can take a little elbow grease.
“In the beginning, they’re distrustful,” he says. “They expect that
we’re going to do what every other adult has ever done, so we have to
work really hard at having some personal integrity with the kids, and
really meaning it when we say, ‘No, it is your decision. We want you to
think it through.’
“We find that when kids finally realize that, they say, ‘Oh, you’re
not going to tell me what to do? I guess I have to think it through for
myself.'”
And that’s where The Seven Challenges truly begin.
This article appears in Aug 20-26, 2009.
