Safety for Girls – Pipher and others contend that the lack of viable options for girls to express their true selves leads them to act in ways that appear self-destructive but are often logical, adaptive responses to the world in which they live. Their behavioral actions and symptoms, reconditioned in this way, can be understood as acts of resistance and strength against a society that ignores and damages them. Running away, truancy, suicidal gestures, depression, excessive dieting, weight gain, prostitution, early pregnancy, drug and alcohol use may be signs that a girl is trying to protect herself from the messages she receives on a daily basis that she is bad, wrong, manipulative, frigid, unlovable, and weak. Lack of safety is cause for depression and anxiety. In order to feel safe, the child must experience predictability, constancy, and activity.
Assessment for Adolescent Girls with Substance Abuse and Depression – Adolescent girls who abuse substances are prone to other emotional and behavioral problems, including depression. The major challenge facing therapists is differentiating problems related to substance use from issues that are not drug-related.
Substance symptoms such as depression, serious familial conflict, and school truancy are also common mental health issues for adolescents.
Adolescent substance abuse is best viewed on a continuum of drug use progression. Differentiating drug experimentation from substance abuse is a critical issue in conducting assessments.
Assessments for co-morbidity, i.e., substance abuse and depression, should rule out other disorders or include features of other disorders. Feelings of depression, anxiety, and peer rejection have been found to be general predictors of drug disorders among adolescent girls. Special attention should be given to suicidality.
This is important when assessing marijuana users, as their rate of suicidal ideation is three times as high as that of non-users.
For purposes of establishing treatment intervention, it is important to examine the motivation for adolescent substance use:
1) a peer motive—wanting to be accepted or dealing with rejection; 2) a coping motive—addressing feelings of anger, anxiety, fear, depression about school or home life, or lack of safety or predictability; 3) a drug experience motive—a desire to know the experience of the drug, often prompted by peer use. It may benefit the diagnosis/treatment plan to inquire directly what purposes her drug use serves.
Interventions for Adolescent Girls with Substance Abuse and Depression
Clinicians who successfully treat adolescent girls who present with substance abuse and depression must understand the differing alcohol and drug use of girls and boys, their respective risk factors, and the ways in which depression manifests differently in girls and boys. A major report issued by the National Center on Addiction and Substance Abuse at Columbia University entitled, “The Formative Years: Pathways to Substance Abuse Among Girls and Young Women Ages 8-22” outlined the following risks and consequences of smoking, drinking, and drug use unique to girls and young women:
• Girls experiencing early puberty are at higher risk of using substances sooner, more often, and in greater quantities than later maturing peers; puberty is a time of higher risk for girls than for boys.
• Girls are more likely than boys to be depressed, have eating disorders, or be sexually or physically abused—all of which increase the risk for substance abuse.
• Girls are likelier than boys to abuse prescription painkillers, stimulants, and tranquilizers.
• Substance use can sink into abuse and addiction more quickly for girls and young women than for boys and young men.
• Girls and young women are likelier than boys and young men to experience more adverse health consequences, such as greater smoking-related lung damage. Women are more susceptible to alcohol-induced brain damage, cardiac problems and liver disease, which occur more quickly and with lower levels of alcohol consumption than with males.
• Girls using alcohol and drugs are likelier to attempt suicide.
• Girls who move frequently are at greater risk of using substances than boys who move frequently.
• Transitions from grades of school are times of increasing risk for girls. Girls making the transition from high school to college show the largest increases in smoking, drinking, and marijuana use.
• Girls are more likely to be offered substances by female acquaintances, a female relative, or a boyfriend and to receive offers in private settings, while boys are more likely to be offered drugs by male acquaintances, male relatives, parents, or strangers, and to receive these offers in public settings.
• Religion is more protective for girls than for boys.
The CASA report offers an invaluable tool for clinicians to effectively work with adolescent girls. It supports a collaborative effort by every system in the lives of adolescent girls. In the area of prevention, CASA’s formative year’s survey showed that most girls (61.6 percent) who discussed substance use with their parents were less likely to smoke, drink, or use drugs. The report concluded that prevention programs should target girls at times of highest risk and be sensitive to the reasons why girls use drugs, how they get them, and contributing factors that increase their risk. Health professionals should screen young female patients for substance use, depression, sexual and physical abuse, poor school performance, eating disorders, and stress and provide appropriate referrals. Government should invest resources in research, prevention, and treatment that focus on the special needs of girls and women. Lastly, media should refrain from presenting glamorous images of women smoking and drinking that make positive associations between these activities and thinness and sex appeal.
CASA has conducted a national survey of 1,220 girls and young women passing from elementary to middle school, from middle to high school, from high school to college, and from college into the world beyond. They coordinated focus groups with preadolescent girls and their parents to understand their attitudes, beliefs, and behaviors regarding smoking, drinking, and drug use. Those interested in their findings can visit their website at www.casacolumbia.org.
In working with adolescents, there is the principle that says, “If you take something away from a kid, you must be willing to replace it with something else. It is this author’s hypothesis that rather than clinicians, parents, and teachers being so quick to say no to kids, we must give them some things to say yes to—other possibilities for their lives, that they can recover from alcohol and drugs and depression and live normal lives; that their lives are worth living; that dreams do come true; and that they have value and worth. Adolescents and girls in particular need to hear yes more often than no.
Fred Dyer, Ph.D, CADC, is a nationally recognized trainer and consultant who services social service, juvenile justice, and mental health organizations and systems, as well as school districts and juvenile detention centers. Dr. Dyer has provided trainings and consultations in the United States, Canada, and Europe and has published numerous articles on children, adolescents, and adults with substance use and psychiatric disorders. He can be reached at firstname.lastname@example.org or 773/322-8425.