Twelve-step programs can be extremely helpful for teens who are struggling with addiction or who are on the road to becoming addicted, but they are more useful if they are adapted to the particular needs of adolescents, according to an expert on teenage addiction.

“These programs were developed for adults, and teenagers are not little adults—they are in a totally different developmental stage,” says Steven Jaffe, MD, Professor Emeritus of Psychiatry at Emory University, and Clinical Professor of Psychiatry at Morehouse School of Medicine, in Atlanta.

Dr. Jaffe, who has spent the past 25 years working to modify 12-step programs to make them developmentally meaningful for teenagers, spoke about his work at the recent American Society of Addiction Medicine conference. “These programs are free, they’re everywhere, they provide big brothers and sisters as sponsors, and they offer recovering friends,” he notes. “That’s really important, because if teens go back to their friends who use drugs or alcohol, they will start using again, too.”

Often, teens who are treated for substance use disorders are simply told to go to 12-step meetings. “You can’t just tell them to go, and leave it at that,” Dr. Jaffe says. “They have tremendous anxiety about going, so you need to link them with a sponsor who will take them to a meeting, or else they won’t go.”

Just getting them to the meetings may not be enough, however. Some of the basic concepts of 12-step programs may be troublesome for teenagers, according to Dr. Jaffe. The first step talks about being powerless over drugs and alcohol, but the word “powerless” can be a big turn-off for teens, he observes. “The goal of a teen is to have power, and they think, ‘Who wants to be part of a group that’s powerless?’”

Instead, Dr. Jaffe encourages them to think about getting clean and sober in order to enhance their power. “It’s the same step, but it’s rephrased and reemphasized to make it developmentally appropriate,” he says. “I tell them, flunking out of school, being thrown out of the house and being arrested as a result of drugs or alcohol is not powerful.”

Another concept in 12-step programs that teens can have trouble with is surrender. “Many teens, especially girls, have found themselves in very vulnerable situations when they are drunk or high, and the last thing they want to do is surrender. I tell them if they get clean and sober, they’ll be strong, and never have to put themselves in a position where bad things like that can happen.”

Dr. Jaffe developed two workbooks he uses with teenagers to make 12-step programs more meaningful to them. “So often, teens will tell me the negative consequences of using drugs and alcohol one day, and the next day they’ll deny it. So I have them write down the consequences in the workbook, so they can’t deny it the next day.” It takes one hour to complete the Adolescent Substance Abuse Intervention Workbook, which is then presented to a counselor individually or at a group. The Step Workbook for Adolescent Chemical Dependency structures the working of the first five steps.

Dr. Jaffe can be contacted about his work with teens and 12-step programs at srjaffe@bellsouth.net.