August and September can be interesting months in the adolescent substance abuse treatment field. Vacations are wrapping up, school is starting, and many families are trying to navigate the stress and anxiety attached to attempts at motivating teenagers. This is the time of year that parents of substance abusing young people pray their children will go back to school and turn over a new leaf. In fact, numerous young people will make empty promises to their parents that real change is on the horizon. “This school year will be different!” they say. When dealing with a child who is abusing drugs and alcohol, parents must understand that the abuser will say almost anything to not have to stop using. Unfortunately, the commitment to academic excellence is the biggest weapon in a teenagers manipulation arsenal. Parents desperately hope their child will go back to school and be “normal.”
The False Security of School
“He/she must really be bothered by seeing everyone go back to school.” This statement is normal for parents in denial. These parents are desperately clinging to the idea that their child places the same value on school. In reality, it is the parents who feel the blow to their self worth. They believe they have failed as parents. They are convinced that somehow they have done something wrong. For a young person in the midst of addiction, education has zero priority. The motivation to learn will come but it will be later in the recovery process. If the first priority is not abstinence the chances of a young drug abuser staying sober are very slim. One of the primary goals of substance abuse recovery is for the young person to get back on track. However, timing is critical.
Don’t Put the Cart Before The Horse
If a young person is suffering from a substance abuse issue, very little will change until he or she is sober. Once the fog of drugs and alcohol has cleared, the addict will start to think about aspects of life that have been compromised by drug use. Once this happens it may still take a significant amount of time to make progress in these areas of life. It is very important for parents to let go of what others may think or how they will be judged. What matters at this point is the young person’s sobriety and the relationship between the parent and child. There will be plenty of time to resolve education issues and become more “mainstream.”
Substance abuse recovery for young people is not the same as it is for adults. A common misconception is that a program designed for adults can be delivered to young people in an effective manner. There are numerous problems with this belief. People will often assume that a young person has the same sense of urgency as someone who has been drinking or using for several years. This rarely happens. There are several reasons why this is the case.The combination of years of abuse, brain development, and life experience create a much different perspective for adults than for adolescents.
The Adolescent Brain
One significant factor in the difference between adults and young people in recovery is brain development. When a young person starts using drugs or drinking alcohol he or she is at a point in life when the brain is going through significant changes. In his book Sacred Connections, Dr. Steven Jaffe gives a great explanation of how the brain is affected in recovery. Dr. Jaffe explains: “The nucleus accumbens is the pleasure and reward system; it is responsible for drug seeking behaviors. The prefrontal cortex helps to regulate impulses and make informed and smart decisions. Unfortunately, this area of the brain does not fully develop until a person’s mid-twenties.” (Jaffe, 72) This clarifies why an adolescent struggles to make better decisions in recovery, even after abstinence. The drug abuser’s brain has been compromised and it takes time to create better decision making skills.
Healing Takes Time
Recovery doesn’t happen quickly. It is a process. In an enthusiastic sobriety program the combination of fun and engaging activities with strong counseling is key. Twelve step recovery involves physical, emotional, and spiritual healing. This has to be attractive to an adolescent so he or she can maintain motivation. Fear will not inspire long term change in a young person. He or she needs a loving, safe, and fun environment along with supportive relationships. As the addict forms a strong foundation in recovery, he or she will practice better ways of thinking as his or brain develops. All adolescents experience periods of emotional instability. This is exacerbated when a young person is using drugs and drinking. It takes an extended period of sobriety for emotional and mental health to internalize.
No one wants to wake up one day and realize their son or daughter has a serious drug and/or alcohol problem. Most parents would rather be thinking about how to help their child navigate through more “normal” adolescent challenges. Unfortunately many families will run into this problem. An issue some parents struggle with is the recognition that priorities will have to temporarily change. The sooner a parent figures this out the smoother the recovery process will be for everyone.
One Size Does Not Fit All
Substance abuse recovery for young people is not “one size fits all.” Problems with drug and alcohol abuse among adolescents and young adults can range from periodic alcohol and marijuana use to severe opiate addiction. Some young people are relatively functional while others have no direction. What all young people have in common is that early sobriety is extremely difficult. The more a young person is able to focus on recovery in the beginning, the better. It is extremely important for parents to recognize that it may be necessary to temporarily shift priorities. The simplest example is with school.
This Is Not Forever
We are all conditioned to believe that if a certain level of education hasn’t been attained by a specified age that somehow the child and the parent have failed. Think about that for a minute. There are many things wrong with that perspective. That is not to say that education isn’t important. Obviously, it is critical to gain a worthwhile education. However, if a young person isn’t functioning emotionally it will be extremely difficult to learn, excel, or care. In fact there are some drug abusers who are able to do well in school primarily to keep people off their back. The point is that while a young person is learning to stay sober, his or her focus will not be on school. Once the newly sober person is stable his or her ability to care about work, school, and other aspects of a healthy life will change. It is vital to trust the recovery process. A couple of points to remember:
- early recovery is difficult for everyone involved
- once an addict is thinking clearly his/her priorities will change
- this is temporary
Patience is difficult but in this case it is vital. Remember that building a strong foundation in early recovery sets the addict up for success in life.
There has been some recent interest in the use of smoking marijuana as a harm-reduction strategy to treat opiate/heroin addicts. To further evaluate this issue, we conducted clinical interviews with 10 opiate/heroin severe substance abuse use disorder patients being treated in an Enthusiastic Sobriety Intensive Outpatient Program.
Ten patients between the ages 14 to 19 years were interviewed; eight males and two females; all met DSM 5 criteria for severe substance use disorder, opiates/heroin. They had been sober between five days to nine months when they relapsed by smoking marijuana. All ten were motivated by the belief that smoking marijuana would help them not to return to opiate use; however, within the range of a few days up to six months, each resumed opiate use.
Patients described the following: “marijuana use was not enough-made me want to use heroin;” “smoking weed make me not care and I went back to opiates;” “the weed made me want more;” “each time I relapsed on weed, I would immediately think heroin is so much better;” “weed just didn’t cut it. I’m smoking weed to get high, but heroin is so much better;” “The weed was just not enough and accelerated my need for a better high.”
All of these patients relapsed by smoking marijuana, which they thought would help them not to return to opiate use. In each case smoking marijuana was not sufficient, and they all returned to heavy opiate/heroin use. Since they all smoked marijuana which contains THC, these case reports are not helpful as to whether just CBD would have a beneficial effect.
In summary, 10 young opiate/heroin severe substance use disorder patients tried to smoke marijuana as a way not to return to opiates/heroin use. In each case this failed.
Steven L Jaffe, MD
Professor Emeritus of Psychiatry, Emory University, Clinical Professor of Psychiatry, Morehouse school of Medicine
Enabling is a word that has been used in drug and alcohol recovery circles for decades. It can be a term that is very misunderstood and misused. No loved one of an addict or alcoholic wants to be thought of as an “enabler.” To enable literally means to make something possible or easy. It can also mean to permit. An enabler is often believed to be complicit in the drug abuser’s self-destruction. The most common forms of enabling include: providing money to an active user, allowing an active addict/alcoholic to remain at home, paying for an addict/alcoholic’s legal costs, and other actions. Sometimes providing help in these ways is not enabling. How can one determine the difference?
Demonstrations of Love
The enabler will say that he or she is “just trying to help” or “what am I supposed to do, let him go broke or die?” It is never a question as to whether or not a parent or significant other loves the addict or alcoholic. The issue is always the demonstration of love. When most people think about “love” they are actually referring to sentiment. Love, as an action, is not always the easiest path to take. Sometimes love is best demonstrated through not accepting behavior that is harmful to one’s self or other people. When an active addict or alcoholic is allowed to avoid consequences of his or her behavior he or she is not being “loved.” This sounds harsh but consider the alternative. Someone actively using is not rational. His or her decisions are not made based on concern for self or others. The addict only wants to be left alone so he or she can continue to use. People are either a means to this end or are in the way. Until he or she is abstinent this way of thinking will not change.
Consider the Motives
There are some simple questions a loved one can ask when confused about whether or not a pattern of enabling is taking place:
- is this going to help my loved one find sobriety?
- am I doing this/providing this help because I feel guilty?
- am I worried about what others will think?
- am I doing this because it helps my loved one or because it will make me feel better?
These are not the only questions to ask but it is a beginning. Not every situation is the same. What one person does may be enabling while someone else does the exact same thing and it is not. There is no exact formula. Always seek the guidance of someone who is objective and has experience in this area. No loved one ever has to face these difficult decisions alone.
Twelve step recovery can be very challenging for young people because so much of it is based on concepts that are usually associated with an adult perspective. A realization of powerlessness, any admission of wrong doing, reliance on a Higher Power, and a willingness to face people who have been hurt is difficult. This is particularly a challenge for adolescents and young adults. Adults in recovery have a difficult time taking responsibility for their actions, much less a young person. In the mind of a young drug and/or alcohol abuser there is nothing wrong with what he/she is doing. In his or her mind if everyone would just back off, there wouldn’t be a problem. This has always been a challenge for young people who need help but is especially difficult today.
Drug and alcohol treatment is not immune to the current climate of identity separation. If you look around, there are 12-Step meetings available to almost every imaginable classification of people. Many of these group distinctions are unnecessary and can water down the message of recovery. It is generally dangerous for a person with drug and alcohol problems to be “terminally unique.” However, young people are at a different stage of development. Not only are they working through a dangerous drug and alcohol problem they are experiencing normal brain development along with hormonal changes. This can be a lot to deal with. These factors don’t excuse poor behavior but must be understood when treating young people. An 18 year old with an opiate or marijuana addiction is not going to experience early recovery the same way a 45 year old alcoholic does. (Yes, I am aware that I wrote marijuana addiction)
Sobriety: The Great Equalizer
Any recovering addict or alcoholic learns the importance of “living life of life’s terms.” The sober man or woman recognizes the value in being a productive member of society. The same is true for a young person. Although some of the definitions may differ, a person in recovery needs to mend broken relationships, become responsible, and learn to adapt to changing circumstances. These characteristics are essential to long term recovery. The twelve steps provide a simple framework to achieve these goals. Change may not happen immediately but with patience and perseverance these turnarounds can be permanent.
Another year is coming to an end. For many people 2017 was an emotional rollercoaster. If you happened to enter into a recovery program this year you certainly know what I mean. Drug and alcohol abuse tears families apart with unrelenting voracity. The healing process can be unpredictable and painful. However, as sobriety takes hold emotions start to calm and a new perspective takes shape. Finally, those who have experienced tremendous fear, anger, and anxiety can begin to be grateful for a new lease on life.
Gratitude Is An Attitude
In recovery programs it is common to hear people talk about “an attitude of gratitude.” This generally
means that those who are affected by addictions of any kind tend to have a pessimistic and hopeless outlook. A change in thinking can begin to
melt away the negativity that keeps people stuck in destructive patterns. When someone is a
ble to take a step back and be grateful for a new opportunity to change,hope is reinforced. A family in crisis desperately needs to see the possibility for life to improve. There are simple ways to begin to shift into an attitude of gratitude.
A Simple Exercise
One way to begin to shift into gratitude is to start focusing on it. For example, take five minutes every day to write five aspects of life for which to be grateful. This gratitude list can be something to look forward to each day that can have a significant impact on someone’s way of thinking. The person focused on gratitude will seek more situations to build the list. It certainly accomplishes more to think about what is good rather than to obsess over all that is wrong. Granted, we need to be aware of problems in order to find solutions. Denial is never healthy. But think about how much easier it is to remember what is wrong. Coming up with a list of items that elicit a feeling of gratitude may require some effort but it is certainly worth it.
On behalf of the entire staff at Insight I would like to wish you and your family a blessed 2018! Merry Christmas and have a wonderful New Year.
It has become common for young people with substance abuse problems to go through multiple treatment programs. Sometimes this is due to a parent not knowing what else to do. In other cases it is because another round in treatment may be necessary to save a young person‘s life. A young person’s motivation to enter drug rehabilitation is usually different than an adult’s. In most instances a young person enters rehab because of outside influences; parents, school, or the law. Adults often enter treatment because of similar factors but can usually see more clearly the responsibility they have for the problem’s existence. What adults and young people have in common is that without significant lifestyle and attitudinal change, long term recovery will not take hold.
Addiction Treatment and Approaches
A philosophy that is gaining momentum in treatment is MAT. MAT stands for medication assisted treatment. This approach is in response to the increasing rates of opiate addiction and is built on the premise that addiction is a brain disease. In other words, the addict is a victim of brain dysfunction. His or her behavior is as the result of something being “organically” wrong. Yet again, we are at the place of treating drug issues with more drugs. Although it seems easier to accept that someone is suffering from a brain disease, the fact remains that if an individual is to achieve long term recovery he or she must address all areas of life. Harm reduction methods, MAT, or any other alternative substance abuse treatment may provide temporary relief and may open the door to long term recovery but the addict must change his or her behavior.
Recovery Doesn’t Always Feel Good
Today it is popular to avoid feelings of discomfort. Who likes to feel any kind of pain? Unfortunately this has led to an increased desire to make sure addicts “feel ok” rather than work through issues. Referring to an addict as an addict is not shaming or demeaning. It gives an individual the opportunity to acknowledge and address the problem. Whether there is an issue in the brain or not the door needs to be open to the recovering substance abuser to own his or her behavior. This can be uncomfortable but with the appropriate level of support the person in recovery will not feel lost or alone. Substance abuse affects a person physically, emotionally, and spiritually. For recovery to be effective all areas need to be addressed.
Substance abuse treatment for young people is full of different philosophies. New innovations come up on a regular basis. In spite of this constant pursuit of a better way, effective substance abusetreatment for young people usually comes back to some simple techniques. Problems surrounding substance abuse treatment for adolescents include:
- a misunderstanding of the pressure young people feel
- a lack of alternatives to the drug and alcohol subculture
- failure to address the whole family
- a lack of follow-up and aftercare
- There is no perfect approach for all young people but there are some key elements a parent can look at regarding a program under consideration.
1. Who Is Being Served?
One issue often forgotten is that an adolescent does not think like an adult. An adult who has been abusing drugs and/or alcohol for several years has suffered a number of consequences . This person has to realize in a clear way the gravity of the problem and must have a depth of willingness to change that an adolescent isn’t capable of reaching. A young person needs to simply recognize the aspects of his life that have been directly harmed by drug/alcohol abuse.
2. What Is the Motivation
When reaching young people the carrot is almost always a better motivator than the stick. This isn’t to say that one must be permissive when counseling a teenager but a young person needs something to look forward to. Adults are often tricked into believing a substance abusing adolescent can be “scared straight.” Any young person abusing drugs and alcohol is desensitized to this kind of tactic. It never works.
3. It Better Be Real
One of the keys to helping teenagers with drug problems is to meet them where they are. When an adult tries to act like a teenager it comes off as non-authentic and condescending. Talk to a young person as a first class citizen. When seeking help make sure the counselor or therapist really understands adolescent substance abuse. It is very easy to mistake a drug and alcohol problem for a serious psychological disorder. If a young person is abusing drugs and alcohol the substance abuse issue has to be dealt with first.
Substance abuse allows a young person to feel accepted, provides a social outlet, and provides a coping mechanism. If recovery doesn’t involve an element of peer support, real social options, and better tools to deal with feelings the chances of it working are slim. Beware of anyone who promises quick vocational, educational, or disciplinarian solutions. Horses will not help a young person stay sober nor will massages, yoga, or diets. Recovery is not fast and easy.It takes time for an individual and a family to heal.
Teen drug abuse continues to be a tremendous problem in our country. Although the substances young people abuse change, the plague of addiction is the same as it has been for decades. No matter how people try to solve this issue it continues to grow. There is no simple answer as to why this scourge remains but there are some simple steps people can take to provide young people with some alternatives.
Remember The Angst Of Adolescence
Most young people can’t wait to become adults. In the mind of a teenager this is the time in life when there are no longer any restrictions. Unfortunately, in society today many teens are expected to act as adults before they are truly capable. Rather than adolescence being a time in life when a person can make mistakes and learn from them, in the age of “zero tolerance” and increased isolation, young people are often left to fend for themselves. At some point almost every teenager will have to face the temptation of drugs and alcohol. It is impossible to predict who will wind up with a serious problem but there are certain factors that increase the odds.
Be Available And Listen
Most of how a person views the world starts at home. Throughout childhood and adolescence other factors start to influence how someone thinks but the foundation is laid early on. In substance abuse treatment the person with a strong emotional footing is more likely to grasp a program of recovery quickly. People that grew up around a lot of dysfunction, instability, or spent very little time with positive family members will have a more difficult time connecting with basic concepts common in treatment. At this point figuring out “why” a teenager has a drug problem is far less important than having a stable and secure environment in which to heal. Most teenagers thrive on friendship, security, and (most importantly) fun. Often what they need more than anything else is to be listened to. An easy response to adolescent substance abuse doesn’t exist but society can make a difference with a shift in attitude.