Adolescent Addiction: An Ongoing Challenge
Drs. Richard Frances & Avram Mack
use, abuse and treatment of substance abuse in children and adolescents
has been a major focus of attention for parents, school personnel,
law enforcement officers and mental health professions. The prevalence
of Substance Use Disorder in this age group is rising, the age
of first usage is dropping, and the progression of the disease
and the mortality rate is increasing. Substance abuse can interfere
with natural growth and normal interaction and development: relationships
with peers, academic performance, attitudes toward law and authority
and acute, chronic organic effects. Drug abuse by 12 to 17 year
olds has climbed from a low of 5.3 percent in l992 to a fluctuation
from 9 and 11 percent since l995. Furthermore, the age of first
usage of drugs or alcohol has dropped. More than 50% of 6th
graders have tried alcohol or other illicit substances.
Warning signs of adolescent drug use include a drop in school
performance, irritability, apathy, mood change (including depression),
poor self-care, weight loss, over-sensitivity to questions about
drinking or drugs, and sudden changes in friends. Screening devices
should include routine medical examinations and the use of urine
analysis to confirm a diagnosis when necessary.
Peer group, school environment, age, geography, race, values,
family attitudes, risk-seeking temperament and biological predisposition
all contribute to adolescent substance abuse. Whereas non-users
are more likely to describe close relationships with parents,
users more frequently indicate they do not want to be like their
parents and do not need their approval or affection. Frequently
there is a positive family history of chemical dependency. Children
of divorce have a greater risk of substance abuse.
In the treatment of substance use disorders, the role of the family
is more important to adolescents than to adults. Inpatient or
residential treatment is recommended for adolescents whose drug
problem has interfered with functioning in school, work and home
environments, and those who could not maintain abstinence through
outpatient treatment. Depression and suicide inclinations, hyperactivity,
chemical dependence and drug overdoses all indicate need for inpatient
Intoxication with drugs and alcohol in adolescents or children
may lead to a lack of inhibition, violence and medical complications.
Most adolescents entering inpatient drug and alcohol treatment
programs have additional mental health problems, such as attention-deficit
disorder, anxiety disorder and eating disorders. Treating attention-deficit
disorder in adolescents significantly reduces risk of developing
substance abuse patterns in later life.
Suicide ideation and behavior is common in adolescents with substance
use disorders and if there is family history of suicide or depression,
the risk is increased. Increased alcohol and drug abuse in adolescents
is often associated with risk-taking behavior linked to the spread
of HIV infection.
The treatment of adolescents requires both structure and flexibility.
Most programs rely heavily on a therapeutic environment with individualized
treatment planning. Programs that are most successful are structured,
encourage openness, peer support, spontaneous expression of feelings,
allow patients to engage in independent decision making and use
cognitive and behavioral approaches. Relapse prevention for adolescents
is often more difficult than for adults, and the goal of total
abstinence becomes more difficult to achieve. A patient should
not be rejected.#
Hill Hospital is a nationally recognized psychiatric and substance
abuse treatment center providing a full range of services for
adults and adolescents, from inpatient to partial hospital, halfway
houses and outpatient programs. For further information, call
(203) 966-3561, Extension 2509.
Dr. Richard Frances is President and Medical Director of Silver
Hill Hospital. Dr. Avram Mack is a Child Psychiatry Fellow at
Columbia Presbyterian Hospital.
Update, Inc., P.O. Box 20005, New York, NY 10001.
Tel: (212) 481-5519. Fax: (212) 481-3919.Email: email@example.com.
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