November 1st, 2010

Introspection, respect, heals youth drug addiction at CASTLE

Self respect, and the respect we elicit from family and peers, is often the common missing denominator among kids who use drugs to salve pain. A program in Brockton, Mass., with a regal-sounding name is teaching patients to restore the missing tenet of respect as the first step toward healing from drug addiction.

CASTLE stands for “Clean and Sober Teens Living Empowered,” and its foundation is based on a model that combines neuroscience with familial therapeutic practices to build the self esteem adolescents typically fill with drugs’ euphoria. Two years ago, this short-term residential rehab program opened for patients ages 13-17 (in some cases, 18) under the umbrella of the High Point Treatment Center.

CASTLE’s curriculum was designed by Medical Director Joseph Shrand, M.D. At its core is Shrand’s Imax theory, a concept he developed in 1982 around the idea that people, at all times, are operating at their maximum potential, and that by restoring the self value and esteem of youth by showing them the respect they deserve, we can help reverse their need to seek artificial highs and instead, tap into them from within.

“When was the last time you got angry with someone who was treating you with respect?” he asked. “We see people simply doing the best they can, from moment to moment,” he says of his Imax theory, which itself is an acronym and contraction, of sorts, of the phrase “I’m doing my maximum.”

“When we begin to look at people as doing the best they can, there is an enormously different view,” says Shrand. “I don’t have to condone someone’s behavior, but I have to respect that this is the best that they can do.”

And this perspective, he says, is often what’s missing from kids with addiction. Addiction is a disease; but when kids are treated like they’re sick and broken, they can resist treatment and recoil deeper into addiction. Shrand’s Imax theory says if we respect teens – anyone, for that matter – enough to believe they’re doing all they can in any given moment, we send the message that they’re valuable enough for us to keep leading them toward healing.

“This is not lip service,” says Shrand. “It’s letting kids know they’re valuable.”

The program can accommodate up to 26 patients at once and has a staff of 24-hour nurses and recovery specialists and social workers, pediatricians and a psychologist who are on site up to seven days per week.

Through group and individual therapy, CASTLE’s biopsychosocial model delves into four domains that interact and have the greatest impact on why adolescents turn to drugs: their home environment, their social domain, their current perception of self and their biology.

Although CASTLE provides services for addictions from alcohol to heroin, Strand says it was a rash of youth deaths in Brockton, associated with overdoses of drugs like Oxycontin that also prompted the program’s start.

Joanne Peterson has seen the program in action. The founder of the grassroots parent organization Learn to Cope, also in Brockton (see related story), she says CASTLE and Shrand’s approach have helped where others haven’t. “Before CASTLE opened, many adolescents were going to adult treatment programs or psychiatric hospitals, which was not always a good place for them,” she says. “Dr. Shrand speaks of keeping in touch with these kids post treatment so they have a place to get support should they need assistance in their future. That is one of the most important aspects to recovery for these kids and their families: once they leave treatment they still need support going back to the real world.”

Shrand is an instructor of psychiatry at Harvard Medical School and an assistant child psychiatrist on staff at Massachusetts General Hospital in Boston, Mass., and among countless posts that keep him engaged in the child psychology community, he was an original cast member of the PBS children’s series Zoom, which was produced by Boston’s WGBH and aired from 1972-1978.

CASTLE is located in a former-factory town in New England, in a building that was once a pump house boasting brick and – ironically – white-trimmed turrets reminiscent of the dwellings of regality. Its welcoming rooms are more home than hospital, more comfort than clinical and where Shrand says kids are helped to feel safe, and valuable.

By Jennifer E Chase

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