Adolescent dual diagnosis: a 12-step transformational model

A structured model inpatient treatment program for multiple-diagnosed treatment-resistant adolescents is described. The chemical dependence disease model of Predisposition+Drug+Enabling System=Disease provides the fundamental theoretical approach. This model is elaborated and used similarly for psychiatric disorders, with examples presented. The role of psychiatric evaluation for pharmacological interventions is outlined. The psychotherapeutic treatment focuses on a commitment to abstinence as the goal. A "psychology of commitment" is described using a reframing of traditional psychotherapeutic approaches. This approach is used in conjunction with the first five steps of Alcoholics Anonymous as an empowering therapeutic model. The role of defenses, denial, confrontation, and cognitive distortions is described. The value of this approach as a neutral ground for discussion using concepts from traditional Freudian therapy, self-psychology, cognitive and learning therapies, and rational emotive therapy is elaborated.