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TEEN ALCOHOLISM-TEEN DRUG ABUSE-TEEN GAMBLING Teen drug treatment or teen alcohol treatment must be different. You cannot use the same program for adolescents that you use for adults. Teenagers have not developed the skills that adults have. They are not socially and emotionally mature. Adults have a stable identity. Adolescents are just developing an identity. Adolescence is the age where tremendous physiological changes occur in the body. The patient’s emotional and physical structure is in transition from childhood to adulthood. Teen drug treatment sets the addicted person free from the slavery to addiction. THE NORMAL ADOLESCENT Studies have shown that most adolescents are well adjusted. They get along well with their peers, teachers, and families (Douvan and Adelson 1966; Westley and Epstein 1969; Offer and Offer 1975; Offer et al., 1981; Csikszentmihalyi and Larson 1984; Vaillant 1977; Block 1971). Adolescence should be understood as a transitional stage that allows the adolescent to gradually adjust to growth, development, and change. Each cycle of life brings new challenges and opportunities, but all of the changes will be incorporated into the basic personality structure. At the end of high school, the majority of American adolescents enter a new phase of life, called young adulthood (Offer 1986). Normal adolescents do not feel inferior to others. They do not feel that other people treat them badly. They feel relaxed. They believe that they can control themselves and they have confidence that they can handle novel situations. They feel proud of their body image and physical development. They feel strong and healthy. They have embraced the work ethic. They feel good when they do a good job. They are not afraid of their sexuality and they like the recent changes in their bodies. They do not perceive any major problems between themselves and their parents. They are hopeful about the future and they feel like they will be a success. They do not feel like they have major problems (Offer 1986). There are three alternative routes through normal adolescence. Twenty three percent of adolescents develop continuously through adolescence, thirty-five percent show developmental spirts, alternating between periods of some conflict and turmoil, and twenty-one percent experience more severe turmoil (Offer 1975). These three groups have been labeled the continuous growth group, the surgent growth group, and the tumultuous growth group. The continuous group is characterized by excellent genetic and environmental backgrounds. They have strong egos, and are able to cope well with internal and external stimuli. They have mastered previous developmental stages without serious problems. They accept social norms and feel comfortable in society at large. The adolescents in the surgent growth group are different in that their genetic and environmental backgrounds are not as free of problems and traumas. Both of these groups are free of adolescent turmoil and they comprise eighty percent of the adolescent population (Offer 1986). Ages 13 to 16 The age of 13 to 16 brings an enormous change in physical and psychological development. Throughout adolescence, girls remain about two years ahead of boys in their level of maturity. Some adolescents bloom early, and some bloom late, each having a different psychological challenge. Early bloomers may be expected to perform with individuals of their size, where late bloomers suffer from the problems of self-esteem that result from looking more immature than their peers. Adolescents of this age group experience a great deal of ambivalence and conflict and they often blame outside world for their discomfort. As they struggle to develop their own identity, dependence upon parents gives way to a new dependence upon peers. The adolescent struggles to avoid dependence and may disparage parents devaluing past attachments. These early teens often find a new ego ideal that leads to idealization of sports figures or entertainers. Adolescents at this state are particularly vulnerable to people they would love to emulate. The development of a self-concept is crucial at this stage. The adolescent must explore his own morals and values, questioning the accepted way of society and family in order to gain a sense of self. They make up their own mind about who they are and what they believe in. They must reassess the facts that were accepted during childhood, and accept, reject, or modify these societal norms as their own. The here and now thinking of earlier childhood gives way to a new capacity for abstract thought. These adolescents may spend long periods abstractly contemplating the "meaning of life" and "who am I." Ages 16-19 In our culture, we expect a gradual development of independence and self-identity by the age of nineteen. The physical manifestations of approaching adulthood require numerous psychological adjustments, in particular the development of how one views self in relation to others. The vast majority of adolescents attain their adult size and physical characteristics by the age of eighteen and the earlier differences between early and late bloomers are no longer evident. The process of abstract thinking changes along with physical development, becoming more complex and refined. Late adolescents are less bound by concrete thinking. A sense of time emerges where the individual can recognize the difference between past, present and future. They can adopt a future orientation that leads to the capacity to delay gratification. The individual develops a sense of equality with adults. Self-certainty and an internal structure develop while teens experiment with different roles. By age nineteen, most adolescents are considering occupational choices and have begun to develop intimate relationships (Weedman, 1992). THE CHEMICALLY DEPENDENT ADOLESCENT The tumultuous group of adolescents consists of twenty percent of the population. These adolescents come from family backgrounds that are not stable. There is often a history of mental illness in the family; the parents have marital conflicts; and the families have more economic difficulties. The moods of these adolescents are not stable and they are more prone to depression. They have significantly more psychiatric disturbances, and they only do well with the aid of intense psychotherapy. They do not grow out of it. (Masterson 1980; Offer 1986). These figures parallel the percentage of mental illness found in adult populations (Freedman 1984). It is in the tumultuous growth group that chemical dependency often develops. In this country the average first use of mood altering chemicals for boys is 11.9 years; for girls, 12.7 years (U.S. Department of Justice 1983). Adolescents almost always use alcohol or drugs the first time under peer pressure. They want to be accepted and be a part of the group. Children are likely to model after the chemical use of their parents. Children with alcoholic parents are at greater risk of becoming chemically dependent (Spalt 1979). The adolescent who continues to use will increase drinking to a regular pattern (usually weekends). They may experiment with other drugs. They begin to use drugs to communicate, to relate, to belong. With regular drinking, tolerance develops. The adolescent needs more of the drug to get intoxicated. The family may first notice emotional changes here. The adolescent may become irritable and more non-communicative. They may begin to spend more time in their room. They may begin not caring for themselves or others. Polarization of parents and children begins to occur. (Morrison and Smith 1990). As chemical dependency further develops the adolescents can no longer trust themselves when using chemicals. The choice to use the drug is no longer available to them; they have to use to feel normal. The continued use of chemicals eliminates the ability to think logically and rationally. Rationalization, minimization, and denial cut the adolescent off from reality (Soujanen 1983). Chemically dependent adolescents gradually change their peer group to include drinking and drug using friends. They begin to use chemicals to block out the pain. They longer use for the euphoric effect. They drink to escape pain. Blackouts and drinking alone are strong indicators of chemical dependency in the adolescent population. With the progression of the disease, family conflicts increase. The adolescent may run away, withdraw, or act out at home and at school. They withdraw from family and community activities. Problems with the police and school officials increase and become serious. The adolescent may become verbally abusive to parents and more rebellious to authority figures. Life begins to center around alcohol or drugs. Daily use begins and the patient begins to use to maintain rather than to escape. The adolescent makes attempts to cut back or quit but they are unable to stay clean and sober. Physical deterioration begins. Hiding and lying about drugs becomes more common. The adolescent feels more intensely isolated and alone. Parents, teachers, and even peers now openly express concern. Gradually the adolescent loses all self-esteem and depression begins. Persistent chemical use leads to incarceration, institutionalization, or death (Morrison and Smith 1990; Chatlos and Jaffe 1994). Chemical dependency halts emotional development. To develop normally, a person must learn to use their feelings to give them energy and direction for problem solving. When alcohol or drugs consistently alter feelings, this is no longer possible. The major coping skill of the chemically dependent person is chemical use. Adolescent chemical dependency can occur extremely quickly, within weeks, because the child's emotional development is immature. Adolescents don't have the internal structure to bring themselves and their lives under control. They cannot delay the onset of chemical dependency for years like adults can. Red Flags for Adolescent Alcohol/Drug Abuse 1. Physical injuries; MVA, gunshot/knife wound, unexplained or repeated injuries. 2. Evidence of current use, e.g. dilated/pinpoint pupils, tremors, perspiring, tachycardia, slurred/rapid speech. 3. Persistent cough (cigarette smoking is a risk factor) 4. Engages in risky behavior, e.g. unprotected sex. 5. Marked fall in academic/extracurricular performance. 6. Suicide talk/attempt; depression. 7. Inflamed, eroded nasal septum. 8. Track marks, injection sites. 9. Sexually transmitted diseases. 10. Staph infection on face, arms, legs. 11. Unexplained weight loss. 12. Pregnancy (screen all)
Laboratory Red Flags for Adolescent Alcohol/Drug Abuse 1. Positive UA for alcohol illicit drugs. 2. Hepatitis A-B-C. 3. GGT-High 4. SGOT-High 5. Bilirubin-High.
Questions to ask the Adolescent Patient: 1. When did you first use alcohol/drugs on your own, away from family/caregivers? 2. How often to you use alcohol/drugs? Last use? 3. How often have you been drunk or high? 4. Has your alcohol/drug use caused you problems with: your friendships, family, school, community? Have your grades slipped? 5. Have you had problems with the law? 6. Have you ever tried to quit/cut down? What happened? 7. Are you concerned about your alcohol or drug use?
Questions to ask the Parent/Caregiver: 1. Do you know/suspect your child is using alcohol/other drugs? 2. Has your child’s behavior changed significantly in the past six months: sneaky, secretive, isolated, assaultive, aggressive, hostile? 3. Has school, community or legal system talked to you about your child? 4. Has there been a marked fall in academic/extracurricular performance? 5. Do you believe an alcohol/other drug assessment might be helpful?
Click here for a page full of facts about teen alcohol and drug use. Call 1-800-992-1921 if you or someone you know has an teen alcoholism, teen drug abuse or teen gambling problem. Click here to search for books on addiction:
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