In Balance Ranch is a therapeutic boarding school for boys who struggle with substance abuse and co-occurring mental health issues. Open for only three years, In-Balance has already garnered acceptance from educational consultants and families. The program is located outside of Tucson, Arizona.

My interest in this program is to understand the man and staff who operate this program. Patrick Barrasso, the founder, is a 47 year old former cowboy who worked in Buffalo, Wyoming, prior to getting involved in substance abuse treatment. He moved to Tucson in 1979 to work on an undergraduate degree in family relations with plans to earn a law degree in order to help reform the juvenile justice system with changes he felt were needed after having volunteered as a big brother in the juvenile court system. He was disappointed in the "lock them up" attitude and punitive approaches to the treatment of youth within the court system. Influenced by a graduate school professor, Patrick was encouraged to obtain a clinical license instead of a law degree. Patrick graduated with an MSW degree from Arizona State University in 1989 and later was licensed as a clinical social worker. Patrick learned early on that he "fell in love" with working with substance abusing teens.

In 1991, he began working on the concept of a holistic residential treatment program that would not use the "break them down and build them back up" approaches that were so prevalent in the 60's through the better part of the 1980's. Parallel to designing In Balance, Patrick began a strength based outpatient treatment program for adolescents. It soon became clear that the vast majority of his patients were abusing alcohol and drugs. Through this experience, his direction was set.

In 1996, Patrick began to refine his thinking of what an adolescent needs to overcome this debilitating and life threatening behavior. In 1996, he opened In Balance out patient program with three boys in treatment. The first In Balance approach included the 12-step model, cognitive behavioral therapy, and other theories. By 1998, Patrick had two outpatient programs operating, including both adults and adolescents. 40 adults and adolescents participated in these programs.

Patrick's dream of developing a holistic therapeutic boarding school for boys was solidified after giving the eulogy at a former patient's funeral. After excessive drinking, the boy died in a car accident. Patrick was encouraged by the boy's mother to live out his dream and help others who are facing the same fate. After this experience, Patrick talked with his wife and son, who was ready to graduate from high school. He knew the work would require a lot of his time, and the family joined in and told him to "go for it." The involvement of his family on the decision seems to be typical of Patrick's management style. Patrick and his highly experienced staff encourage and support each other, with all contributing to the dream Patrick initiated. It was obvious to me that the entire team has a unique feeling of ownership of the program.

Six months prior to opening, Patrick and many of the In Balance staff held a think tank and worked together designing a program designed specifically for adolescents. Patrick operates a program that has included input and guidance from his family and key staff. He personally was influenced by research as well as Albert Ellis, Larry Bentro, Arnold Goldstein, Carl Rogers, Terence Gorski and others. The program uses cognitive behavioral approaches, many developed by Ellis. Goldstein's influence impressed upon Patrick that adolescents need skills that serve to displace destructive behaviors with constructive pro-social behaviors. Goldstein also influenced Patrick with tools to identify and more appropriately recognize triggers for anger and other destructive activities. Moral reasoning is included in his work, addressing the egocentric nature of drug using teens and their delayed and limited thinking process. Rogers contributions are best known for the underlying belief that all of us, if given the opportunity, are capable of drawing out of ourselves the right choices in our lives. Bentro, the positive peer culture guru, has been instrumental in In Balance Ranch's core foundation. I asked Patrick whether In Balance ran a "pure" positive peer culture program. Patrick laughed and told me that Bentro told him that in reality, as long as there are kids needing help, the attainment of a "pure" positive peer culture will never exist! Gorski's primary contribution was centered around relapse prevention. Patrick is trained in the Gorski Relapse Prevention Model.

By design, the program includes many therapies that address adolescent issues. These include family involvement, equine therapy, adventure therapies, positive peer approaches, community service, physical fitness, sweat lodges, 12- step approaches, therapists who effectively deal with co-occurring issues and a strong academic program. Many, including this writer, would be skeptical of covering so many bases in a program, let alone developing these components during start-up. I first visited the program over a year ago, and the program included these components from the beginning. Today they are solidified and all contribute to the program's content. Nevertheless, it is expensive to operate a program with all of the services that In Balance provides. In Balance, unlike so many programs, has set a limit of 44 students even though they could easily move to over 100 students within a year. Patrick has consistently vowed that the program will avoid the temptation to increase its number of boys.

I asked Patrick how he saw the 12-step model since many think that it has little influence on teenagers. Patrick agreed this is true, if the 12-step concepts are used alone. However, in combination of the various other program components, 12-step approaches are critical to long term sobriety. Furthermore, 12-step meetings can be found all over the country, enabling the boys to attend and be supported wherever they live in and out of the country. He went on to say that the use of 12- steps is an integral component of programming and its use after the program is one of the best indicators of post treatment success. I also asked him if he thought that relapse is a normal part of adolescent recovery. He said that because relapse can end up being fatal, In Balance stresses the importance of relapse prevention efforts.

We discussed the numerous program models around the country as I was interested in his point of view on length of stay and intensity. Patrick's point of view was that a typical 30-day program can realistically be expected to be able to introduce a few concepts and be used as a diagnostic tool. He believes that research and his experience indicates a minimum of one year is necessary for success.

Group and educational components are part of the program to address the myriad of problems adolescents face and experience today, including such issues as trauma, the disease model, divorce recovery, depression, anxiety, medications, family issues, and other co-occurring issues.

In a clinical meeting I attended, Patrick talked of helping the boys experience healthy activities to replace drinking and drug use. He believes that the program needs to continually find ways to make sobriety fun. I had fun with the In Balance staff and can understand why there has been no turnover with the key original staff members.

I learned that over the coming weekend, Patrick was to be a key speaker in Las Vegas at the U.S. Journal's 5th Las Vegas Conference on Adolescents. Patrick speaks nationally on a variety of adolescent topics including the challenges of overcoming the culture of adolescent substance abuse. At this conference, Patrick was presenting three different topics on adolescents. Patrick has come a long way from the cowboy country of Wyoming.