As perhaps you have heard, the Becket Family of Services, working with the Family Support Collaborative, has been asked to create a new vision for the former Penikese Island School. This new program, Penikese, will be a small, non-profit, residential treatment program for young men (ages 14 to17) with substance abuse issues – and will be located on Penikese Island in Massachusetts’s Buzzards Bay. We plan to open on July 1.
The following is the profile of whom we serve.
Penikese is designed to address the specific, co-occurring treatment needs of older adolsecents and young men, ages 14-17, suffering from Substance Use Disorders and “internalizing” mental health conditions (i.e., disorders of anxiety, mood, attachment and trauma).
Substance Use Disorders at Penikese
Substance Use Disorders range across a spectrum of severity. One common assumption about a SUD is that one must hit rock bottom in order to be ready for treatment. At Penikese we believe quite the opposite. Our goal is to catch a young person at the earliest possible recognition of a SUD and to simultaneously treat the underlying internalizing mental health condition. We seek to prevent problematic use that is recurrent and already resulting in significant adverse consequences from becoming chronic, habitual and compulsive.
While there are a range of SUDs, the most common ones associated with the young me we serve include:
- Cannabis Abuse Cannabis Dependence
- Alcohol Abuse; Alcohol Intoxication
- Inhalant Related Abuse
- Sedative and Anxiolytic Abuse (Sleep Medication and Anti-Anxiety Medication)
- Amphetamine Abuse (ADHD stimulant Medication Misuse and Abuse)
Treatment is possibly indicated and Penikese may be an appropriate setting when parents, teachers and friends of the young person begin to observe and witness substance abuse and some the following significant adverse behavioral changes:
- Sudden personality changes that include abrupt changes in work or school attendance, quality of work, work output, grades, discipline
- Unusual flare-ups or outbreaks of temper
- Withdrawal from responsibility
- General changes in overall attitude
- Loss of interest in what were once favorite hobbies and pursuits
- Changes in friends and reluctance to have friends visit or talk about them
- Greater difficulty in concentration, paying attention
- Sudden jitteriness, nervousness, or aggression
- Increased secretiveness
- Deterioration of physical appearance and grooming
- Association with known substance abusers
- Unusual borrowing of money from friends, co-workers or parents
- Secretive behavior regarding actions and possessions; poorly concealed attempts to avoid attention and suspicion.
Penikese Focuses on Internalizing Mental Health Conditions
Mental health conditions are often characterized as being externalized or internalized. Words commonly associated with young persons with externalized behavior include extroverted, under-controlled and acting out. Conversely, those with internalized conditions are often characterized as being introverted, depressed and disinterested. Persons suffering from internalized conditions often experience a diminished or lost interest in their previous patterns of activities of life, including social activities, work, school and activities of daily living.
Based on our focus on treating SUDs and co-occurring internalizing mental health conditions, we typically work with young persons diagnosed with one or more of the following diagnosis:
- The Mood Disorders: Major Depressive Disorder, Bi-Polar Disorders, Dysthymic Disorder.
- The Anxiety Disorders: Generalized Anxiety Disorder, Social Anxiety Disorders, Panic Disorder, Separation Anxiety, Obsessive Compulsive Disorder, PTSD, and Specific Phobias.
- Autistic spectrum disorders: Aspergers Disorder, Non Verbal Learning Disorder, Childhood disintegrative disorder, Pervasive developmental disorder not otherwise specified.
Whom We Do Not Serve
At Penikese, we do not seek to focus on the entire spectrum of co-occurring mental health conditions. Penikese is a small and highly integrated community. We do not have the ability to “divide and conquer” populations that research indicates should either not be mixed during treatment or could require a different treatment regimen that is not available at Penikese. In addition, severe addictions are best treated in alternative environments where symptoms of withdrawal can be better monitored and addressed. Accordingly, Penikese has developed exclusionary criteria that include the following:
- Primary diagnosis of Oppositional Defiant Disorder, ADHD or Conduct Disorder
- Need for medical detoxification
- Requirement for opiate replacement therapy
- Current or recent history of suicidal ideation
- History of requiring a highly restrictive setting as the result of acting out or anti-social behaviors.
Most adolescents who present with a SUD also suffer from another mental health disorder. In order to maximize the likelihood of recovery both disorders should be treated at the same time. Adolescents with co-occurring disorders are less likely to recover from SUD when the mental health condition is left untreated. They are also more likely to be treatment resistant and more greatly inclined to drop out of treatment.
Many adolescents presenting with SUD begin using and drinking as a way to self-medicate untreated mental health disorders. In some cases mental health symptoms do not appear until the young person begins to use and drink. This may point to the fact that the drugs and alcohol either accelerate or cause the mental illness to manifest. In any event, the research points to the fact that if one of the co-occurring disorders is not treated there is a high risk that they will both get worse and even open the possibility for further complications to surface.
Over the past several decades there have been many studies highlighting the prevalence of both internalized (e.g., anxiety and mood) and externalized (e.g., conduct or oppositional defiance) disorders co-occurring with SUD. Adolescents presenting with SUD and co-occurring externalizing behaviors have received significant attention and much of the resources allocated for co-occurring disorders. Perhaps because of the internalized nature of the behaviors, there has been less focus on the treatment of internalizing disorders and SUD. Penikese seeks to respond to this need.
Of further note, adolescents with mood disorders, anxiety disorders and disorders related to trauma and attachment have particularly poor outcomes when their SUD is not treated simultaneously with their mental health disorder. A 2007 study (Buckner, et al.) found that Social Anxiety Disorder serves as a unique risk factor for the onset of cannabis and alcohol dependence. The prevalence of co-occurrence of SUD and internalizing disorders has been suggested by the empirical data as being as high as 47.9% (O’Neil, et al. 2011). The relationship between these disorders relative to which came first is unclear. What is clear is that early intervention in treating both disorders simultaneously gives the greatest chance that the adolescent will avoid the devastating implications of a bottom and begin to develop skills and discover strengths that will help protect him from relapse.
Penikese stands alone in its commitment to treating co-occurring internalizing disorders (disorders of mood, anxiety and trauma) simultaneously with SUD.