Part 13 Substance abuse treatment for young people in the countryside

In the course of my field period, I went to the Mäkirinne youth home to meet the manager, Kalle Pakarinen.

I sat in a chair in Pakarinen’s room and we started our discussion. At one point we had lunch in the kitchen, connected to the living room, and had coffee with two young people who had newly arrived at the youth home.

A house in the country

The youth home is situated in the countryside, amidst fields and forests. It is a few kilometres away from the nearest public bus stop, and a fifteen minute ride from the railway station. It resembles an ordinary house built on slightly sloping ground.

There are seven places at the youth home, and one crisis place for young people aged 13-17, coming from regions across southern Finland. The young people are mainly placed in this youth home as urgent placements or after having been taken into care. An urgent placement lasts for 30 days, and it can be continued for another 30 days. The period can be extended even further if preparations for taking the young person into care are ongoing.  There is no time limit for a care order, the decision is reviewed periodically, and it ends at latest when the young person turns 18, or earlier if the criteria for continuation are no longer met. At the youth home, the staff consists of eight care workers and the unit manager. Without a framework agreement, the cost of care at the unit is 394 € per day, which adds up to 11.800 € per month.

At the youth home, physical holding is not in use, and it does not favour strict limitations. The young people are tested for drugs, and their clothing and room may be checked. If a young person comes to the youth home inebriated, they may be placed to sleep in an empty, bare room next to the entrance, to sober up overnight in order to guard their safety, as well as others’. Movement and contact with people may be restricted when necessary, within the boundaries set by child welfare legislation.

Substance abuse among the residents

The young people who come to the youth home have long histories of abusing a variety of substances. The most commonly used drug is cannabis, followed by alcohol, amphetamine and other substances.

The community’s functioning is based on abstinence. No substance use is allowed at the youth home. The community strives to find out the reasons behind each young person’s substance abuse. If the young person finds a way to connect with these causes, and finds things that can replace the addictive substance in their life, it becomes possible for them to quit using. The young person no longer needs addictive substances to ease the tangles in their life. If this does not happen, the youth may continue the substance abuse.

Pakarinen considers substance abuse among youth to be partly a matter or attachment relationship issues. The young person has not received enough adult support and care in their life, and has been left with a care deficiency.

Among these young people, one can observe substance abuse, crimes and debt and broken relationships. The meager finances of young families show, as well, but there are some clients who are not from families with limited means.

Understanding of substance addiction

Pakarinen considers substance addiction to be an illness when it is uncontrollable and accompanied by physical symptoms, from which the person seeks relief.

He feels that addiction is also a mental disorder, and that addictive substances are used to numb negative feelings.  How the addiction progresses, or how the person copes with it later on, is highly individual.

Pakarinen feels that substance abuse is linked to the young people having suppressed their feelings with the addictive substances.

The treatment period

Pakarinen describes how the placements have kept getting shorter.

For the most part, the young people come to the unit from home, when it has turned out to be impossible to support or secure their home environment. They may also come straight from jail to the youth home.

Pakarinen estimates that a little more than half of their clients are taken into care, and the other half either go home to their parents or move to their own flat. They aim to support the youths to finish elementary school and possibly to have started vocational education.

The statutory monthly allowance for the youths is 52 € per month. They may also receive a bonus for good behaviour and for remaining substance-free, about 22 € per month. In addition, the youths can maintain the yard or clear the snow for the benefit of the community, and for this they can receive payments of 7 € per hour.

The youths have the option of being home-schooled at the community, or they can be transported to the train and attend a school.

Pakarinen is of the opinion that the young people at the community are not yet quite ready to decide about their own affairs while they are under 18 years of age and under the guardianship of their parents. The youths function at the community according to their abilities. They proceed through their treatment stage by stage.

The youths have two personal coaches each, and to these they have the opportunity to talk about their issues. Each coach has two youths to coach. Part of the coach’s job is family work, focused on assessment and transition. Assessment-oriented work means that the young person’s situation is assessed, and transition-oriented work means that the focus is on bringing about change in the young person’s life situation.

As part of assessment-oriented work during the community treatment, each young person’s network is mapped with regard to resources and problems. For example, the workers consider if grandparents could support the youth, and whether the youth could contact other relatives. Part of assessment-oriented work is also considering where the youth will move to live after the treatment period.

In transition-oriented family work, discussions are conducted with the youths and their guardians. Efforts are made to open the situation and make it visible so that both parties understand it from the other’s viewpoint, as well. In the discussions, no attempts are made to name guilty parties, but instead the goal is to jointly agree on the changes to be made. It is possible to make efforts to change things in situations where a family member has mistreated the youth, or where the youth has to face seeing their parents inebriated.

The principles of community treatment

 The youth home has its own principles of community treatment. Their treatment differs from traditional community treatment in that each young person’s personal issues are processed privately, not in the community.

Communality means that the workers aim to have open dialogue with the youths. The purpose is to establish a connection. In addition, they try to bring the parents and youths into an open discussion with each other.

The coach and the young person try to have at least one hour of discussion once a week. The aim is to get to discuss why the youth uses addictive substances. This would be, in a way, getting to the core of the matter, according to Pakarinen.

Usually the things that come up in discussions with a young person have to do with bullying at school, physical abuse, or sexual abuse. When the youths have good networks close to them, Pakarinen considers their chances of recovery to be good.

Pakarinen feels that important aspects of the encounters between youths and coaches are especially equality, empathy and the right kind of presence, as well as setting clear and consistent boundaries, which signal caring. He feels that an adult can also admit to being wrong in some situations.

The youths can be told that there are alternative ways to act in their lives. Because some of the staff members have personal experiences of recovery, they can function as positive examples of recovery for the clients.

Everyday togetherness

At the youth home, community treatment largely consists of being together in the activities of everyday life, including various groups. On Monday evenings, the community members have a community meeting where they plan the programme for the next week. Each client makes their own plan. The youths each clean their own room, and they prepare food together.  At the substance abuse group they discuss issues related to addictive substances, under worker guidance. At the activity group the workers engage in hobby activities with the youths.

The coaches support the youths to find a hobby, unless they already have one. The workers want to offer the youths something meaningful to do, and alongside the activity they can have in-depth discussions, depending on the youths’ willingness and capacity. The youths can also participate in NA/AA groups, if they wish.

In the community, each young person prepares their own folder with a coach, and in this they collect a variety of memories from their time in the community.

In the spring, the community has a “get-together day”, with previous residents and coaches attending. At this occasion, everyone gets to hear how the previous clients are doing. Half a year after the treatment ends, the aim is that the youth home staff members make a phone call to the youth and ask about their situation.

Transition with monitoring

Pakarinen says that he likes the concept of transitioning with monitoring in place, because he sees that this approach is based on a plan where out-of-home carers are in connection with aftercare.

In his view, forward-thinking separation processing is sorely needed, and this would mean that all parties would go through what it means to start living independently, and what the relevant responsibilities are. Pakarinen feels that support for the transition stage could be started earlier than it is currently started.

Coaches can visit for example the Social Insurance Institution or aftercare services with clients, so the young person knows who will continue managing their affairs. The youth is entitled to aftercare once they accumulate transition funding from an out-of-home care placement lasting a minimum of six months. Aftercare services could also provide follow-up that would prevent the youth from being left to manage on their own.