When one Duke University student entered his freshman year, he was unprepared for how different his life was going to be from high school. He faced an elevated level of academic expectations, vast social pressures, and unexpected freedom. Instead of being excited, he found himself feeling overwhelmed—and he turned to substances to cope.
However, he soon realized he needed help. That’s when he found the Duke Center for Adolescent and Young Adult Substance Use Treatment (CAST). It’s a program dedicated to identifying the root causes behind substance use and helping young people surmount those hurdles to overcome addiction.
“Being able to talk with a counselor at the center turned my life around. I’m very grateful,” he says. “Looking back, it feels like I walked into the right place at the right time. It saved my life.”
Now, years after graduating from Duke, he wants to make sure every young person who seeks help for substance use-related difficulties has easy access to the services they need. That’s why he donated $250,000 to CAST. His goal is to ensure the program has the necessary resources to deliver care.
“It’s important to maintain the right infrastructure behind the counseling and to support the providers who forge the relationships with young adults who need help. At the end of the day, those counselors make the difference for someone who’s teetering on whether to seek intensive treatment,” he says. “To me, it’s vital that infrastructure remains intact and remains supported.”
“At the end of the day, those counselors make the difference for someone who’s teetering on whether to seek intensive treatment. To me, it’s vital that infrastructure remains intact and remains supported.”
— Donor
Youth Substance Use & Programs in North Carolina
According to the North Carolina Department of Health and Human Services, substance use disorders are not uncommon among young people across the state. As of July 2023, 7.7% of youths between ages 12 and 17 and more than 24% of young adults between ages 18 and 25 had a diagnosed substance use disorder.
But alcohol and substance use disorders don’t exist in a vacuum, says clinical psychologist David Goldston, PhD, a professor of psychiatry and behavioral sciences who leads CAST. They’re frequently linked to additional problems, including trauma exposure or other mental health difficulties. Unfortunately, few outpatient programs across the state are equipped to address multiple issues simultaneously, particularly in adolescents.
This is where CAST shines, Goldston says.
“Our program stands out in the community because it is integrated,” he says. “We frequently serve individuals who have co-occurring mental health conditions. In contrast, most programs in the community focus singularly on substance use issues without addressing the underlying problems, like anxiety, ADHD, depression, or trauma, that can contribute to addiction.”
The CAST Approach to Combatting Substance Use
For 30 years, CAST has been dedicated to helping young people and their families address substance use and its impact on their lives. Initially, its intensive outpatient program offered at least nine hours of weekly counseling to all participants.
In response to the COVID-19 pandemic, CAST pivoted to a new model that could meet the needs of more people, Goldston says. Today, the fully outpatient program takes a patient-centered, family-focused approach. Program clinicians provide ongoing evaluations, as well as 12 weeks of individual, group, and family therapy.
All patients have access to the same therapy services, says clinical psychologist and assistant professor Angela Tunno, PhD, MS, a CAST team member who has vast experience with trauma-informed care. But, because each young person’s needs and experiences are different, delivering care isn’t a one-size-fits-all endeavor.
“Our program varies by person,” she says. “We meet each young person for an initial evaluation and then design a personalized care plan that is dependent upon their needs and level of willingness to receive care. We do our best to embrace the opportunity when someone is willing to enter that journey to recovery.”
Drawing on Evidence-Based Treatment Techniques
To reduce current and prevent future substance use, CAST takes an evidence-based approach to care, says Shayna Cheek, PhD, a clinical psychologist who works with CAST.
“We tailor our treatment plans to the specific challenges that each youth comes in with,” she says. “We try to focus on practices that can target substance use and behavior change.”
Trauma-informed cognitive behavioral therapy that is designed to prevent relapse is the overarching treatment approach that guides the CAST program. Elements of dialectical behavior therapy (DBT) also inform program therapies, she notes. With this DBT-informed approach, patients keep a written record of their feelings. Then, every week, during one-hour sessions, therapists talk about those urges with patients to help them learn to manage those emotions and form positive social relationships.
“By using DBT-based skills, we work to help youths understand why they’re using a substance and provide them with strategies for managing those emotions,” says Cheek, an assistant professor of psychiatry and behavioral sciences. “We’ll teach them emotion regulation skills and distress tolerance. We also discuss ‘urge surfing’ to help them identify their urges and mindfully and intentionally watch them until they pass.”
To help program participants reduce their substance use and adopt healthier behaviors, CAST providers also use motivational interviewing, a technique that helps patients explore and resolve ambivalence to encourage behavior change. Contingency management is another approach the team uses, in which a therapist and patient agree to rewards that the patient will receive when they exhibit positive behaviors or reach specific goals.
If a participant needs additional intervention or resources, the CAST team connects patients with more intensive resources or programs that are appropriate to their needs.
The CAST team uses the same contingency management and DBT techniques to educate parents, says clinical psychologist Jeremy Grove, PhD, an assistant professor and member of the team who also specializes in DBT. Through weekly parenting groups and family sessions—led by a different provider than a participant’s individual therapist—counselors teach parents how to engage their child and respond to them during the recovery process.
“Parents have their own struggles when they have a child struggling with substance misuse,” he says. “These therapy sessions are meant to foster better communication and openness within the family and help parents discover ways they can support their child.”
“Parents have their own struggles when they have a child struggling with substance misuse. These therapy sessions are meant to foster better communication and openness within the family and help parents discover ways they can support their child.”
— Jeremy Grove, PhD
Training the Next Generation of Substance Use Clinicians
In addition to providing care directly to program participants, CAST also addresses the need for more substance use providers for teens and young adults through its training program. This program gives graduate students, psychiatry fellows and pre-doctoral psychology interns—students in their final year of their PhD program—the opportunity to shadow CAST providers, as well as deliver care directly to young people, Tunno says.
“Our trainees are part of our consult teams and conduct hour-long sessions with several patients under close supervision,” she says. “In our training program, we focus on the intersection of trauma and substance use, giving them the skill set to treat substance use through a trauma-informed lens.”
As CAST faculty, Goldston, Grove, and Cheek also provide training opportunities within their specific areas of focus.
Treating the Whole Person
Ultimately, Goldston says, when a youth or young adult comes to CAST for care, they receive compassionate treatment that looks beyond their substance use. They receive holistic care designed to put them on a path for long-term recovery and success.
“In our program, we try to look at the young individuals who come in not just as people who have problems with substance use. Instead, we look at them as a whole person,” he says. “We assess their interests and consider their aspirations. What’s most important is the direction they’d like to see themselves going in. We’re here to help them get there.”
It’s that philosophy that inspired the Duke alumnus who completed the CAST program. He says he hopes his gift will help other young people reach their full potential.
“I look at this in terms of lives impacted, lives saved. Substance use is always going to be a problem, and there will always be kids who will need this type of treatment,” he says. “Giving to this program contributes to the war against substance use. It’s a way to make sure the experts who help people have the support they need.”
“I look at this in terms of lives impacted, lives saved. Substance use is always going to be a problem, and there will always be kids who will need this type of treatment. Giving to this program contributes to the war against substance use. It’s a way to make sure the experts who help people have the support they need.”
— Donor
Learn more about supporting Duke Psychiatry & Behavioral Sciences.