Addiction to drugs and alcohol is leading teens to the E.R. at a skyrocketing rate. How you can prevent disaster
(Credit: Photographer: B-d-s)
I know a 23-year-old NYU graduate—I’ll call her Sophia—who had an arrangement with her dad when she was in high school: he would buy her booze if she would buy him pot. Since many folks don’t think either pot or alcohol are “hard” drugs, some adults—including Sophia’s dad—don’t have a problem with such boundary-crossing bartering. For my friend, however, it created a number of conflicts: for one thing, it meant Sophia was dealing in illegal drugs, and exposing herself to prosecution for felony crimes. For another, it meant she got a clear message from her father that teenage drinking isn’t harmful.
So began Sophia’s drinking career as a young teenager. In high school she drank hard and hung out with likeminded kids. Her grades dropped, and her parents switched her school and put her in therapy—perhaps her father couldn’t imagine what might be leading his daughter to “act out.”
In college she continued to drink, picked up weed, popped Xanax and got wasted regularly. Finally she realized that if she were going to have any chance at a normal life, she’d have to get sober. So she did, at age 21, in the Manhattan 12-step community. To this day, her dad doesn’t get how much weight his lax attitude about drugs and alcohol carried.
This scenario is more common than you might think. “Sometimes we’ll see a situation where one parent smokes pot,” says Nicole Kurash, LSW, director of inpatient adolescent programs at Gateway Rehabilitation in Pittsburgh. “It hasn’t been a problem—they can hold a job, they’re successful, so they don’t think their kid smoking pot is a problem either. A lot of times what we see is, ‘If I let my kid drink at the house, it’s OK. At least it’s in my home.’”
Sophia’s situation might sound beyond the ordinary—her dad buying her booze if she buys him pot. But it’s how ordinary it came to seem to Sophia that’s so significant an illustrator of the teenage epidemic of drinking. “I was like, ‘Who am I trying to hide this from if it’s my dad who’s buying it for me?’” Sophia recalls. “My therapist told me I was totally crying out for rules.”
The federal Centers for Disease Control and Prevention (CDC) classify underage drinking as a public health crisis. Alcohol is the most commonly abused drug among America’s youth, more than nicotine and illegal drugs, and people aged 12 to 20 drink 11% of all the booze consumed in the US. Most of this alcohol—more than 90%, in fact—is consumed in binges. In 2008, underage drinkers made 190,000 emergency department visits for alcohol-related reasons.
“We see kids coming in on alcohol and marijuana, and also prescription opioids—first it’s Percocets and Vicodins, then Oxys, then heroin,” says Patricia Schram, MD, an instructor in pediatrics at Harvard Medical School and faculty at the Children’s Hospital Boston Center for Adolescent Substance Abuse Research.
“People are dying from this,” says Kurash. “It’s not this horrible homeless person living under a bridge using IV heroin—that’s not the total reality of who loses their lives. It is also the wealthy suburban kids who are mixing their prescription drugs. It’s the beautiful 19-year-old girl who goes off to college to be a teacher and gets pressured into drinking too much and overdoses and dies.”
Gateway’s adolescent program serves kids between 13 and 21, and most of the kids they see come from “privileged suburban neighborhoods,” not the inner city, says Kurash. “They have access and money, and sometimes they’re held less accountable. We always have kids who use alcohol and marijuana, and we’re seeing plenty of kids who are using prescription pills—opiates and benzos like Ativan and Xanax.”
“I’m seeing kids who get addicted on their first time” trying prescription drugs like oxycodone, Schram says. “Their prefrontal lobes are not fully developed, they don’t have brakes on their impulses. That’s why they engage in high-risk behaviors—not only drugs, but other high-risk behaviors.”
What happens in the brains of kids at risk for alcoholism and addiction? “We see that even prior to use themselves, they have some abnormalities in the cognitive control circuitry in the brain,” says Bonnie J. Nagel, PhD, who runs the developmental brain imaging lab at Oregon Health Sciences University in Portland. Nagel’s five-year, $1.6 million ongoing study underwritten by the National Institute on Alcohol Abuse and Alcoholism is looking at the effects of substances on adolescent brains. She enrolls kids ages 12 to 15 before they’ve started to drink or use and follows them throughout time.
“We know that family history of alcoholism increases one’s likelihood of going on to develop alcoholism,” Nagel says, “but we don’t understand the neurobiology of that. When we bring in kids and throw them in the scanner and say they have a predisposition to alcoholism, we don’t know how much is genetic and how much is environment.” But her initial findings suggest, she says, that “there are abnormalities in the circuitry of the brain during decision-making that would suggest atypical kind of control.” Which means that when kids are placed in a heated situation, unlike adults—whose wiring has had a chance to develop by years of experience making good decisions—kids’ fragile circuitry might break down.
Most experts agree that genes don’t make a person an addict or alcoholic. Instead, as Canadian addictions expert Gabor Maté notes in his book about addiction, “In the Realm of Hungry Ghosts,” addiction is one result of “an infinitely complex and moment-by-moment interaction between genetic and environmental effects.” The way parents model—or don’t model—healthy ways of negotiating feelings has a profound influence on kids ability to deal with their own emotions.
“In addicts—and you see this in adolescents—there’s an inability to self-soothe or manage emotions,” says Michael Clemmens, PhD, a gestalt therapist and author specializing in addiction who lectures internationally and who for many years worked with teens with addiction. How do parents read the signs of addiction?—kids who are headed for trouble are quick to anger and show discomfort with feelings, Clemmens says.
“The substance becomes a remedy for normal emotional struggles,” he says. “How do you ask a girl to to dance? Is anybody going to like me? I feel my body going in a thousand different directions.—All these things are managed by the substance. Emotional, moral and cognitive development is slowed because you don’t get to move through those problems on your own. What you’ve learned is, ‘I don’t have to feel that.’”
The desire not to feel, not to face reality, comes out in kids’ behavior: their grades may drop; they may change friends; they may isolate themselves in their rooms; their tempers may snap for no reason; they may swipe cash or possessions. Worst of all, they may begin to be secretive or deceptive. “I can’t get the kid to engage in treatment if they see I’m pointing out they’re lying to me,” says Harvard’s Schram.
It’s important for parents to keep in touch with their kids’ social networks. “If your kid is hanging with other kids who are using,” says Gateway’s Kurash, “you can bet your kid is also using.”
As in my the case of my friend, the NYU grad, parents see the acting-out—the changes in friends, dropping grades, skipped classes, failure to communicate—and often miss the underlying addiction. So how should parents go about learning how to identify addiction in their kids, and how to talk to them about it?
Parents may be tempted to go through kids’ rooms and backpacks, but most experts agree that, without hard evidence, that’s likely to exacerbate the problem. “If you go in there without any evidence, it communicates mistrust big-time,” says Clemmens. “If there’s an incident, or a pattern of using, that’s one of the options. If it’s just because they’re an adolescent, it creates an atmosphere of mistrust.” If parents have evidence, he said, it’s a good idea to have a third party conduct the search so the parent can continue to be the good cop.
“Searching rooms, notebooks, journals—I come down kind of hard on parents who do that,” says Heidi Van Doeren, a Pittsburgh-based private-practice therapist who has worked with teens with addiction since 1994. When parents search their kids’ stuff, Van Doeren says, “they’re trying to manage their own anxiety—which is an impossible phenomenon—by controlling an external circumstance.
“Look,” she says, “we’re trying to raise confident individuals. So if you find drugs, what are you doing to do with it? If you read the journal, what do you do with that information? It’s not like that information leads to a more empowered stance. Do you really think it’s going to get the kid to stop smoking pot?”
Instead, parents should learn how to talk with kids about addiction and drug-use, and most of all learn how to demonstrate the behaviors they want kids to adopt. Instead of just talking a good talk, parents need to walk the walk.
“I believe you hook the kid—I believe you ask them, ‘What does this behavior cause for you? What is it in your life that you are interested in that this could jeopardize? Whether it’s getting into college, getting that girl, having your parents finally respect you—you inquire into what they’re most interested in.”
“I think the first thing to do is to ask them, ‘Where are you going? How are you doing?’ Keep communication open, and model talking about feelings,” says Clemmens. “And that’s tough with adolescents because they don’t want to talk about that shit with us.”
Clemmens noted that kids are often smarter and more perceptive than parents give them credit for. “If we talk about drug-use in condemning, prohibitionary ways, or in joking ways—those are things adolescents can pick up on,” he says. “Parents need to be communicating, ‘My concern is not about the drug, it’s about you. You have to be aware of the impact of these drugs on you.’”
Experts said parents need to be firm about setting limits on drinking early in kids’ lives. Kurash says Gateway emphasizes that parents are legally responsible for their kids’ decision to drink, and for any consequences. “Number one, it’s against the law,” she says. “Number two, a child can overdose from alcohol, especially young kids who don’t know their tolerance level, and then you have that on your hands.”
Clemmens grew up in rural eastern Pennsylvania, in Amish country, and went to Catholic men’s college where, he says, all the students and even the priests smoked pot. Clemmens himself began getting drunk at 14, then progressed to cannabis, meth and cocaine; he has been sober since 1975. He urges parents to set limits by helping their kids understand the physiological consequences of excess drinking in teen years: it disrupts brain development. “It’s different from having a glass of wine with dinner as an adult,” he says. “To get drunk behind the barn with a bunch of your friends as an adolescent—that’s just plain too early.”
Clemmens and others also agreed that it’s impossible to talk about preventing teen addiction without talking about the health of the entire family. The CDC’s long-running Adverse Childhood Experiences study shows that risks of addiction and alcoholism increase with the number of traumas kids endure during childhood. These include physical, emotional and sexual abuse; physical and emotional neglect; living with substance abuser, a convicted offender, and/or a family member with mental illness; and seeing domestic violence.
“When you have family environments that do not teach affect regulation—learning how to soothe yourself—and you have the biochemistry that’s already a potential time-bomb, there’s the tendency to move in the direction of addiction,” Clemmens says.
In order for parents to teach kids how to regulate their feelings, the parents themselves may have to start with their own emotions. Van Doeren urges parents to confront their own feelings of insecurity and inability to control their kids. “I ask the parents, ‘So what’s it like for you that your 15-year-old son is moving away from you? What kind of support do you need from your system?’ I would encourage Al-Anon.
“I encourage parents to talk about their own experience with their kids: ‘I’m worried; I love you so much and maybe this worry is all mine, but I want to talk with you about this,’” she says. “If you can do this without unbridled emotional out-of-control-ness, which is never helpful—if you can keep from saying, ‘You need to quit the football team, you need to do this or that or the other thing’—then it can work out well.’”