American teen-agers have shown an increase in substance abuse since 1992. In a 1997 report by the National Institute on Drug Abuse (NIDA), 22 percent of eighth-graders, 39 percent of tenth-graders and 42 percent of 12th graders reported using an illicit drug in the past year. Adolescent drug abuse does not just affect the individual.Social and economic effects can be severe, especially when the abuse is started early and the disorder doesn’t remit.
Other consequences associated with youth drug abuse include; psychiatric co-morbidity, suicide, mortality from drug related accidents, risky sexual practices and increased health care costs.Drug use continues to show increases in arrests among juveniles. According to the National Institute for Justice, reports from 12 major cities indicate that nearly half of all juvenile arrests include some recent drug use, most commonly marijuana.Studies have shown drug use by young people to have a connection to violence and delinquency.
A syndrome of general deviance characterizes some adolescents who abuse alcohol and other drugs.Delinquency is common among adolescents treated for a substance abuse disorder.In fact, manifestations of delinquency often precede the onset of drug use. A study of Colorado students found that the same behaviors associated with general deviance (i.
e. rebellion, rejection of conventional values, illegal behaviors) were associated with drug use during high school and could be indicative of problem drinking seven years later. (Winters, 1998)Further, these studies indicated that the progression of substance use is affected by the seriousness of the conduct problems. The most common sequence of behaviors is minor delinquency, followed by alcohol use, more serious delinquency behaviors, followed by marijuana and other drugs.Drug AddictionDrug use among children and adolescents is widespread. Young people appear to take drugs because they wish to escape their own reality and to experience a new level of functioning, out of curiosity, a desire to be one of the crowd, and to solve or dissolve emotional problems.
Understanding the drug use and the definition of drug addiction is critical to resolve the issue. Misuse is the frequent use of drugs or the exercise of bad judgment in their use. Abuse is the use of drugs in ways that result in physical or psychological harm to the user. Dependence is the need to take a drug regardless of the consequences and the inability to give up the drug even if they wish to do so. (Copel, 1973)Drug addiction in adolescents differs in several ways from that of adults.
Adolescents lack adult coping skills and most have not yet separated completely from their parents. Some adolescents feel sexually insecure and may not have yet had their first sexual experience, although drug-abusing adolescents tend to be sexually promiscuous.Many have not yet experienced meaningful, loving, bonding relationships. Most still live at home and are not responsible for their financial support or for the financial support of others. Parents seldom withdraw food and shelter, so adolescents do not suffer the same consequences as adults.
Most drug-addicted adolescents exhibit denial. It causes them to be unable to perceive themselves or others as they really are. Because of this self-deception, they begin to deceive others. Drug-addicted adolescents lie about their behaviors and feelings and hide them from those who might confront them about their drug use.
They lie about their substance abuse, guard their supply of drugs, and appear in public in altered states of consciousness. They hide drugs for future use, are preoccupied with drugs, and continue to use drugs despite punishment, warnings, or advice. They have dysfunctional emotional involvements with others and feel anger, rage, and defensiveness about their drug use.They blame others for their problems, pity themselves, and attempt to control others.
They intellectualize about their drug use, withdraw from people who care about them, and are chronically irresponsible. Development of the drug addicted adolescent can be delayed up to two years.Epidemiology of Drug Use in Children and AdolescentsAmphetamines are often the first drugs used by adolescents. They may be prescribed for medical conditions, such as ADHD, or gotten from a parent’s medicine cabinet. Approximately one fifth of teenagers will use amphetamines for studying and then later for entertainment. Dependence on amphetamines is usually short-lived as the user develops tolerance to the medication.
Barbiturates are not often used unless in combination with alcohol or another drug. Marijuana is the drug of choice for adolescents. Studies in high school populations suggest that about 30 percent of students have smoked marijuana. Many drugs provide adolescents with exactly what they want and because the drugs magnify experiences, the user often feels as though they are more creative. (Copel, 1973)Young people who use drugs for pleasure tend to give up alternative ways of seeking pleasure. They become outgoing and feel accepted by others when they are high.
But this does not solve the problems that make them feel socially isolated or anxious when they are not high. Drugs are used as a substitute for solving the problems they face.Individual Assessment & TreatmentEach drug problem must be considered individually, however, there are some general principles that should be part of any rehabilitation plan. In each case, an analysis of the relationship of the drug user to his environment is critical.
This assessment should be based on the knowledge of the interaction between the user and his/her family, school situation, and social environment. The drug user must be considered the primary focus but all members of his/her family must be considered significant elements of the users life and drug use.A determination should be made as to the family’s willingness or ability to support the assessment and treatment of the user. Do the parents have drug addictions of their own that make them less likely to take an interest in the child? Is the family so overprotective that the child is completely dependent upon them and drug use is their way of showing rebellion and autonomy?Drug use may be a cry for help.
Drug use may represent a conflict between the child and a parent, a conflict of values between the parents and children, or a result of sibling rivalry.(Copel, 1973)Assessment and treatment should indicate whether a child needs inpatient treatment or outpatient treatment. Inpatient treatment will include a medical, psychological and social assessment to aid in developing a treatment plan.The medical assessment will evaluate if there are presenting physical conditions that indicate that a detoxification plan is necessary. The medical or physical assessment will also indicate if there are any underlying physical conditions that contribute to or are a result of the drug abuse.The psychological assessment will help in indicating the child’s ability to think and reason.
Additionally, it will assist in determining if there is any loss of brain functioning due to drug use or other environmental factors.This involves collecting data from the patient, family members, friends, teachers, and employers on the patient's level of social functioning. It includes his educational level, history of childhood abuse, legal history, childhood role models, family life, and a detailed life-long drug history.Finally, a treatment plan is developed based on medical, psychological, and social assessments. Physicians and counselors list identified problems on a master problem list.Individual problems may be dealt with in treatment, may be noted and merely monitored, may bedealt with after treatment, or may require no action.
For each problem that is to be dealt with in treatment, a treatment plan that sets forth specific goals and objectives for resolving the problem is developed; it includes a projected time frame for the resolution of a problem.Parent-Adolescent Problem-SolvingThe relationship of the family and the adolescent’s drug use has been recognized for decades. The majority of adolescents drink alcohol for the first time with their parents. Adolescent use of marijuana is directly associated with a parent’s use of other psychoactive drugs. Other family variables that may have indirect effects include socioeconomic status, parental attitudes, and parent-child relationships. Previously, studies involving adolescent drug use focused on the importance of the peer group.
Current practice recognizes the family and peer group as part of an extended social system, with each having impact on the other. The child learns skills within the family structure and implements them in the peer group.The child’s growing autonomy is practiced in the peer group and implemented in the family. Conflict is often defined as the adolescent implements behaviors contrived as a result of his own experience and peers.
This conflict has been shown to be a predictor of adolescent drinking.Conflict within the family may occur because of a lack of problem solving skills or an inability to cope with stressful life events. Deficits in problem-solving skills is often associated with adjustment difficulties and psychiatric disorders. Distressed families are more likely to report problems that require change. Studies indicate a clear connection between greater family conflict and illicit drug use among adolescents. (Hops, 1990)Psychosocial Correlates of Adolescent Drug UseSubstance abuse has the same characteristics of other major diseases: it is primary, chronic, treatable, and can be fatal if not treated.
The range of influences on adolescent drug use are representative of three sociological theories: social control theory, social learning theory, and sub cultural theories.Indicators common in these theories is the belief that outside forces affect the adolescent’s behavioral patters. If the child is sufficiently influenced by persons that adhere to normal expectations, the child will adhere to socially acceptable behavior. If the child is influenced more to those that do not exhibit normal expectations, they may exhibit criminal or aberrant behavior such as illicit drug use.Parental attitudes also influence the adolescent’s use of illicit drugs. If adolescent’s perceive that their parents’ attitude toward substance abuse is favorable, they are likely to use substances at a higher rate.
Among significant risk factors for narcotic addiction were parental alcoholism and parental absence. Children who reported strong, positive relationships with their parents had lower levels of substance abuse.Internalized emotions that affect behavioral choices are addressed by containment theory and consistency theory. Containment theory emphasizes that behavioral choices are made based on external limitations (i.e, rules, laws, and consequences) for those individuals who are externally contained.
Those who demonstrate internal control mechanisms (inner containment) make choices or decisions based on personal beliefs, values, attitudes, and self-identity. Studies indicate that those who scored higher on external controls, often had lower self-esteem. Further, those individuals may use drugs as a way to deal with life’s challenges. Those who scored higher on the internal controls had higher levels of self-esteem and consequently lower drug use.
