Case 3 (Leigh). To illustrate the concept of treatment settings, let us extend Case 3 and imagine Leigh, a 16-year-old marijuana and alcohol user who has run into trouble with her substance use. Her problems intensified one evening when she and her friends were brought into custody for questioning by police. Leigh was partying with some new friends in a wooded area close to the high school she attends. Police, responding to a complaint initiated by neighbors in the area, confronted the adolescents and found alcohol and marijuana. Officials were concerned about the underage drinking, illegal use of marijuana, and in particular Leigh’s emotional state, which was hostile, disoriented, and apparently intoxicated. Police contacted Leigh’s mother and discussed the possibility of charging Leigh with possession of marijuana and disorderly conduct. After several unsuccessful attempts by police to persuade Leigh to seek immediate medical care, she was evaluated to be at risk to herself and was involuntarily admitted to medical detoxification. She spent several days in detoxification and getting “clear headed,” and then she voluntarily agreed to attend a re-habilitation program. When she had 28 days of successful treatment, her counselors recommended an intensive outpatient program to continue her recovery. This scenario illustrates that treatment settings are not stagnant environments but integrative opportunities to move clients to-ward recovery and health. The reverse is also possible. Leigh might have a relapse (or slip) and need a temporary, more restrictive set-ting to regain her hard-won progress. Moving up and down this continuum of care provides a multitude of treatment ser-vices designed to fit the client’s unique needs. The effectiveness of treatment settings comes from their flexibility, adaptability, and responsiveness to the client’s current recovery needs.

Let us return to the case of our 17-year-old, polysubstance-abusing client Leigh. After her arrest and detoxification, she was admitted to a 30-day chemical dependency rehabilitation program. Her biopsychosocial assessment revealed a history of using alcohol and marijuana at parties and sometimes during school hours. She has had some moderate school-related problems (e.g., lateness) and a shoplifting charge. She described a new, well-defined group of peers who “I like to hang out with and party with.” Some potential problem domains related to Leigh’s situation might be as follows: Relationship factors: gravitates toward unhealthy, drug-using peers Home environment: disengaged relationship with father, financial stressors, and feelings of having to choose be-tween parents Medical treatment: potential dietary problems, disheveled appearance, and poor hygiene It is important to have an accurate, reliable, and detailed assessment to identify problem areas and match them to the most fitting problem domain. Each problem domain al-though often conducted separately, is considered part of the full treatment plan that is both time-consuming and inclusive.