Sobriety Grows in Trees: Wilderness Therapy Continues to Gain Credibility

By Kevin Riley LCSW, CADC – Clinical Director, Catherine Freer Wilderness Therapy Expeditions

The staff and kids who spend weeks in beautiful wild places working together and sharing themselves have long known the power of substance abuse treatment in the wilderness. Parents who meet their children with dirty clothes and sparkling eyes can attest to its effectiveness. Nevertheless, some addiction professionals and funding bodies have been skeptical about treatment that takes place under open skies.

Wilderness therapy is often confused with recreation or leadership focused “Outward Bound” type programs that do not directly treat substance abuse. Also, some people may be worried about harsh, military style “boot camps” that bully kids into superficial compliance.

There is a growing awareness that the better wilderness programs use much of the same clinically sound and evidenced based practices as traditional “bricks and mortar” treatment facilities. They have master’s level and state certified counselors who create detailed and individualized treatment plans. These counselors provide psychological-educational groups and process groups for the clients along with intensive individual sessions. Also, family involvement is made a priority. A couple of programs have even gone through the rigorous process to become accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

The difference in an outdoor program is that the groups take place under a star filled sky huddled around a glowing campfire. The adolescents spend the days challenging their minds and bodies by hiking or whitewater rafting. And they are far from the familiar scenes that keep them in familiar mindsets.

In a wilderness therapy program, clients spend the majority of their time outside, in a natural area, far from urban or suburban life. They are given the equipment and taught the skills that they need to flourish in that environment and then held accountable for putting in the effort. Usually clients carry all their belongings in their backpacks and hike with the group to a new campsite each day. They cook over an open fire that they have built without matches or lighters. Therapy groups usually take place at lunch or after dinner but individual sessions are happening all day long. The counselors are talking to the kids as they hike beside or while helping to cook dinner. This type of informal process helps to reduce typical teen defensiveness about walking into an office to be “therapized.”

In 2003, a national non-profit organization, Drug Strategies, that studies and promotes “more effective approaches to the nation's drug problems,” released a publication that surveyed and assessed adolescent drug treatment programs across the country and identified nine key elements of effective adolescent drug treatment. These elements are:

• Assessment and treatment matching

• Comprehensive, integrated treatment approach

• Family involvement in treatment

• Developmentally appropriate program

• Engage and retain teens in treatment

• Qualified staff

• Gender and cultural competence

• Continuing care

• Treatment outcomes

Among the organizations assessed, a wilderness therapy program was chosen as a “promising” program, identified as having strengths in all nine elements.

Specifically, Drug Strategies said that this wilderness therapy program managed to engage and retain clients by providing “strong therapeutic alliances with most participants by having the field staff live with teens throughout the three weeks of a trek.”

Also, the program was identified as being “developmentally appropriate” in that it uses the wilderness to provide lessons in a “hands-on” fashion and uses nature to provide natural consequences. Furthermore, the program offers a “comprehensive, integrated approach” to treatment by incorporating nature, which “provides an inspiring background” for discussions about the spiritual aspects of the 12-Step approach (Drug Strategies, 2003).

More importantly, clinical research has been published that confirms the efficacy of the wilderness treatment modality. The Outdoor Behavioral Healthcare Industry Council (OBHIC) was formed in 1997 and to date includes ten programs that provide wilderness-based treatment to adolescents. Its purpose is to develop and promote standards for these types of programs.

OBHIC teamed up with Dr. Keith Russell, an assistant professor and researcher now at the University of New Hampshire, to conduct an outcome study of clients at the programs and determine the effectiveness of the treatment.

The 2001 24-month study questioned clients and parents at admission, discharge, and at 12-months and 24-months following discharge. The assessments found:

• On the Youth Outcome Questionnaire, which considers behavioral, emotional and substance abuse issues, clients admitted to wilderness treatment programs score near to those admitted to psychiatric hospitals. At discharge, they score just outside the normal range for community adolescents, and at 12 months, they maintain those gains.

• 80 percent of parents and 95 percent of youths perceived the treatment as effective.

• 24 months after discharge from the wilderness program 83 percent were doing “better” and 58 percent of the youths were rated as doing “well” or “very well” by their parents

• While 62 percent of youths had used some substance in the 24-month period following discharge (a percentage similar to more traditional adolescent treatment facilities), most of the youths were reported to be doing “well” in school and to have improved communication with their families.

• About 85 percent of the clients were treated for significant substance abuse issues. Of those, 27 percent reported being abstinent since treatment (at 24 months) while 15 percent continued to have a “significant struggle” with substance abuse.

The results from a second major study assessing the degree to which wilderness therapy influences motivation to change are expected in the coming year.

You cannot quantify the power of a red-tailed hawk soaring and shrieking above an afternoon group. It is difficult to develop an outcome study to measure the confidence boost of climbing to the top of a windswept ridge. However, as wilderness therapy continues to become more recognized and as more evidence lends more credibility to this therapy as a proven effective adolescent substance abuse treatment option, hopefully addiction professionals, insurance companies, and other decision-makers will help make it possible for more teenagers to experience this unique healing option.

Resources

Russell, Keith. (2004). Two Years Later: A Qualitative Assessment of Youth Well-Being and the Role of Aftercare in Outdoor Behavioral Healthcare Treatment. University of New Hampshire

Russell, Keith. (2001). Assessment of Treatment Outcomes in Outdoor Behavioral Healthcare. University of Idaho – Wilderness Research Center

Drug Strategies (2003). Treating Teens: A Guide to Adolescent Drug Programs. Washington, DC.