Karen R Rapaport, Ph.D, ABPP


Adolescents, by nature, struggle with many internal conflicts and often act impulsively, at least in one area of their lives. Their central conflict is their attachment to their parents versus their loyalty to peer-group codes. As a group, they are particularly vulnerable to group mores, yet usually unaware of their own high state of suggestibility. Some teens indulge much more than peers in risk-taking, flouting safety and health care and, often, legal regulations. These are the lead-teens, and they typically have followers who are even more highly suggestible than the lead-teens tend to be.

It is essential to define two central factors in understanding adolescents and addiction:

1) Abuse of drugs, which is an isolated event(s) of drug use, vs. drug dependence, which is characterized by continued abuse of a drug or alcohol, despite development of cognitive, behavioral, and physiological signs and symptoms. The dependence pattern leads to increased tolerance for the drug, withdrawals, and compulsive drug taking.

2) Psychological dependence: The motives of adolescents who begin to use drugs are typically:
a) To cope with anxiety,
b) Ease social interactions
c) Join networks of teens and adults where they can obtain alcohol and drugs.

Encountering the life-long struggle with the authority problem, adolescents tend to be especially vulnerable to the contagion of belief that other teens are expressing. Apathy and sometimes outright combative antipathy are typical stances toward adults. Within this context, it is not uncommon for adolescent chemical dependency to develop. Most teens have some incidents of chemical abuse, e.g. alcohol, or pills, yet the teens that develop chemical dependency begin to experience hallmark signs of chemical tolerance and withdrawal symptoms.

It is helpful for parents to view their teen’s chemical dependency within the context of adolescence, a developmental period characterized by identity diffusion. Teens, under the best circumstances, have a wavering sense of self and some difficulties with relying on their own strengths. Thus, they are particularly vulnerable to substance abuse or addiction. Like its adult counterpart, teen addiction is a progressive disorder which distorts and destroys healthy development of the adolescent and his/her family.

As adolescents tend to recover from acute toxic insults following ingestion of alcohol and/or drugs, they are much less aware of complications that may result from such intoxication, including physical, e.g. pancreatitis and other medical disorders, and psychological disorders, e.g. depression. Parents must be aware that many teens also engage in poly-substance abuse. Thus, it becomes more difficult to predict the course of the problem. However, most addicted teens lean on a “drug of choice.” In recent years, teen abuse and dependence on prescription drugs has risen, while use of marijuana, related to daily consumption, has not.

Trends over recent decades reflect that 18-25 year-olds are still the target group for the highest use rates of drugs. It is also estimated that 10-15% of teens under 18 years old have a definable problem with at least one incident of drug/alcohol abuse. Yet, less than 1% are “chemically dependent.” Also, over the decades, there has been an increase for young female adolescents to begin using drugs, and to develop drug dependence. Teens still tend to fall into groups of those who are drug “experimenters,” vs. those who are exhibiting transition-marking behavior, e.g. potential dependence on drugs.

Risk- factors for teen drug abuse dependence are genetic predisposition for depression, the style of parenting in the family-of-origin, behavioral patterns of the family, which may reinforce “family myths,” peer relationship problems, physical/medical disorders, school and legal problems. Families who suspect drug abuse/dependence in their teens will benefit most by psychotherapy, if not for the entire family, then for parents alone and teen separately, if they will attend sessions. Often, teens may require treatment in a treatment recovery facility, if the problem cannot be handled well on an outpatient basis.

In daily family experience, parents will benefit from developing skills in: reframing the adolescents behavior/drug abuse problem, developing an action plan, seeking support of other parents, maintaining and communicating positive expectations of the addicted teen, assertiveness with teens, and understanding the problems with co-addiction.

Teens who are using alcohol or drugs often present themselves to adults as free of problems or as falsely accused, yet truly blameless. Individual and/or group psychotherapy is warranted, outpatient or inpatient, in addition to work with parent(s). The orientation of treatment needs to be addictionology/traumatology, as there are patterns of addictive behavior that the clinician must be able to predict. They also need access to meeting lists of Alateen, AA, NA, and Al-Anon. Finally, within any therapeutic context, teens need to learn interoceptive awareness, or consciousness of a spectrum of internal sensory and affective states that may precipitate slips or relapse.

Karen R. Rapaport, Ph.D, ABPP is a Fellow of the Academy of Clinical Psychology (FACLINP), and Board Certified in Clinical Psychology, American Board of Professional Psychology.

She has been in private practice in Palm Beach County at
CME Psychology Consultants for over 25 years, specializing in Psychotherapy and EMDR for the treatment of trauma, addiction and mood/anxiety disorder.