Tag Archives: Thunder Road

Saving Thunder Road

In a recent article in the Contra Costa Times, journalist Malaika Fraley writes that Thunder Road Adolescent Treatment Center in Oakland is scrambling to stay open. She reports that TR’s longtime operator, Summit Medical Center, has been planning to sever ties with the program for two years, due to annual running costs of the residential drug rehab and plus facility in excess of $6 million, yearly deficits of $800,000, and declining admissions. Well, I think that conversation’s been happening for much longer, actually.

I worked at Thunder Road for fifteen years, between 1996 and 2011. I chronicled my time, what I observed, what I think treatment for substance abuse and teens entails, both from a research and personal perspective, in a book I published in 2013, entitled Working Through Rehab. Among other things, I remember that threats to the program’s viability started around 2004, and continued periodically thereafter. When I left TR in 2011, I’d worked most clinical positions in the program, seen various changes to program structure, tweaks of philosophy and methods, etcetera, and held the view that TR had been “scrambling” for some time. I am sympathetic to its latest bid for survival, and for the prospect of retaining “the only program of its kind” for Bay Area, and especially East Bay, Alameda residents.

But what is the meaning of this latest, perhaps most threatening of crises? If the community wants drug treatment for youth; if it believes that drug abuse, gang violence, physical and sexual abuse, child abandonment, are ills damaging the community, where is the ongoing support for programs like Thunder Road? Why were admissions declining? Where is the city leadership, the rally of business sponsorship that would spare a thirty year old institution from this desperate position? At the risk of disparaging efforts that may yet come to fruition, I wonder if there is enough conviction to save Thunder Road; if there exists a muted rejection of drug treatment in the community as a whole.

An overview survey from 2014 by the National Institute on Drug Abuse (NIDA) reveals some interesting trends. Use of illicit drugs has generally declined over the past two decades: decreasing use of alcohol, cigarettes, the misuse of prescription pain relievers; stable rates of marijuana use among teens, but perhaps more importantly, changing attitudes about the perceived risk of harm associated with marijuana use. 36% of adolescents say that regular use puts users at great risk compared to 52% just five years ago. In other words, a majority of teens no longer think marijuana use is significantly harmful, which begs the question: what becomes the pretext for treatment, especially a residential admission, if this attitude prevails? Aundrea Brown, who runs Alameda County’s public defender’s juvenile division, states that Thunder Road is an essential placement alternative to juvenile hall (according to the Times article). The Save Thunder Road petition site says something similar. But I suspect many citizens of Alameda, the county that TR now dominantly serves, might reject the implied dichotomy. They’d surely rebut that neither alternative should exist; that a society moving towards legalization of currently illicit drugs, and that deems K2/spice, painkillers, e-cigarettes (according to NIDA, the only major substance whose use is on the rise) as effective, acceptable mood-altering substances, should leave well enough alone.

I hope the county is able to broker financing for a provider (or coalition of providers) to take over care of Thunder Road from Sutter. On balance, I believe what the program brings is a valuable service to the community, though it undoubtedly needs reform. But a broader question needs to be aimed at the community, in schools, churches, within board meetings and without: what do you really want to do about drug use?

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Adolescents and brain development: “Naming an emotion can calm it”

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Putting aside for now questions confidentiality and containment, matters of how to confront or otherwise engage kids about addictive use of substances, let’s turn to some research about human development which helps us understand child development and the implications for drug treatment. Last year, Daniel Siegel, renowned psychiatrist and neurobiologist at UCLA, published Brainstorm: The Power and Purpose of the Teenage Brain, a book seemingly aimed at an adolescent readership.
Siegel’s book touches on many subjects which affirm assertions I make in my own book, entitled Working Through Rehab: An Inside Look at Adolescent Drug Treatment. Firstly, Siegel explains the adolescent’s susceptibility to such things as novelty seeking, risk taking, the seeming observance of positive outcomes of behavior, coupled with the seeming disregard of negative consequences—all of which are characteristics of an addictive personality. He points out that during adolescence there is an increase in the activity of the neural circuits utilizing dopamine, a neurotransmitter central in creating drive for reward. A drug, alcohol for example, can lead to release of dopamine, and users may later feel compelled to drink further so as to re-trigger a dopamine release (the addictive cycle). When alcohol wears off, dopamine levels decrease, and those who become addicted experience withdrawal symptoms, and are then driven to use more of the substance that spiked the dopamine circuits (tolerance). Through phenomena such as pruning and myelination, humans are able to integrate functions of various areas of the brain—the cortex, limbic system, and brainstem—render it more efficient, and in particular consolidate skills around that which is repeatedly experienced.
And therein exists the problem for many who become addicted or otherwise troubled. Alluding to problems of attachment in early childhood, as well as social conditions that exacerbate feelings of disillusionment and disconnection, Siegel observes that many seem to become arrested in survival modes of thought and behavior, and therefore strain to develop skills that serve collaboration: so-called pro-social behaviors, reflective thought, and above all, empathy. They become prone to what psychoanalysts call psychic equivalence—the inner sense of conviction as to what others are thinking, leading to impulsive action. For the individual lacking what Peter Fonagy calls mentalizing skills (the ability to reflect upon another’s mind), even another person’s neutral responses are filled with hostility. Therefore, not only must those individuals not be trusted, they must be defended against, at all costs.
These were among the qualities that I observed repeatedly over my fifteen years working in adolescent drug treatment, in kids and sometimes parents; especially at Thunder Road, the Oakland facility wherein I worked until 2011. There were distinctive patterns of thought, feeling expression, and behavior that I observed, and which I depict and chronicle in my book. Siegel writes about many of these phenomena from a largely theoretical point of view. He describes the tendency for troubled kids to avoid their feeling states, to feel anxious but “get rid of the feeling”, rather than being open to learning about those feelings. In the dynamic between parent and child, he reminds us of feedback loops: the cycle wherein kids act out in some manner, producing negative consequences; adults react severely, exacting consequences that further stifle adolescents, who in turn rebel against the restrictions with further, perhaps even more egregious behaviors (BTW: I see this playing out with adult couples, also). Implicitly, Siegel affirms the premises of both drug treatment and psychotherapy (sometimes compatible entities, believe it or not) by indicating that in the brain, naming an emotion can help calm it. Here the psychiatrist is encouraging something that many resist. Indeed, hardly a week goes by without someone in my practice asserting that the problem is not so much “not talking about it”, but rather “talking about it.” The solution, according to the addict not in recovery, is not a sustained emotional release, but rather the opposite: silence and isolation.
Dan Siegel’s book, Brainstorm, is a useful affirmation of several ideas promoted in Working Through Rehab, though don’t get me wrong. I’m hardly claiming originality. In keeping with my sense of being a droplet in huge reservoir of information, my book contains well over a hundred references and endnotes. In the fourth of these articles devoted to adolescent drug treatment, I shall explore the territorial battle between theories of psychotherapy, and in particular, upbraid the narrow-minded, cynical, and even corrupt disregard of long-term, psychodynamic models of psychotherapy. As a preview, I’ll return again Siegel’s thoughts. In Brainstorm, he challenges the adolescent reader to reflect upon his or her past—the early attachment experiences—which are a staple of long-term, psychodynamic (as in psychoanalytically-derived) practice: “It makes sense for you as an adolescent to make sense of your life history so you can be as fully present as possible in your relationships. What this means is reflecting on your relationships in the past in your own family life and asking yourself how those experiences influenced your development.”

 

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