Deciding to Say No

A groundbreaking program, developed locally, helps teens kick drugs

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 ( 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.

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