ADDICTION, RECOVERY AND A PATH TO PREVENTION: STEMMING THE TIDE ON YOUTH SUBSTANCE USE

Stephen Gray Wallace, M.S. Ed.

YOUTH Drug

Lawrence Steinberg, Ph.D., author Age of Opportunity – Lessons From the New Science of Adolescence, warns us that “When
a country’s adolescents trail much of the world on school achievement, but are among the world leaders in violence, unwanted pregnancy, STDs, abortion, binge drinking, marijuana use, obesity, and unhappiness, it is time to admit there is something wrong with the way that country is raising its young people”.

That country, he says, is the United States.

While there is a lot of bad news contained in Dr. Steinberg’s assessment of modern-day adolescence, the note of binge drinking and marijuana use strikes a special chord for those of us working in the addiction, recovery and – maybe most important – prevention spaces.

A case in point can be found in the story of Nic Sheff, as described by his father David in the New York Times bestseller Beautiful Boy – A Father’s Journey Through His Son’s Addiction. The book details Nic’s journey from alcohol addiction at age 16 to marijuana, ecstasy, LSD, mushrooms and crystal meth addiction by his late teens.

In turn, that book inspired my September 2014 Camping Magazine article “Beautiful Boys,” which I co-authored with some of my former campers, each of whom had found his way to addiction during his teens. One of them told a tale similar to Nic’s: escalation from alcohol and marijuana to LSD, mescaline, cocaine, MDMA, and amphetamines.

I knew “Michael” (not his real name) as a friendly, sensitive, somewhat rambunctious, rising 9th grader. What I would come to learn, years later, is that during his first year at boarding school, Michael got into a fight with an upperclassman, which resulted in a broken ankle. That scuffle, along with a questionable academic record, short-circuited his career there. He then bounced around from school to school and began drinking heavily and smoking marijuana – which led, as it so often does, to the abuse of a spate of other drugs.

Michael revealed a highly dysfunctional relationship with an authoritarian dad whose expectations for him were wildly oversized. His relationship with his mother, while better, was distant as she was consumed with her career.

He said he craved structure, order, guidance and direction but found very little. He turned away those who tried to help him because of his “conflict” in understanding, let alone accepting, unconditional love. Regardless, Michael was a resilient kid and found what he needed to make his way through six or seven years of addiction. He is in recovery to this day.

As Nic and Michael’s stories reveal, adolescence represents a critical intersection of personal growth and personal behavior.

Indeed, Nora D. Volkow, M.D., Director of the National Institute on Drug Abuse (NIDA), stated in Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide, “The adolescent years are a key window for both substance use and the development of substance use disorders. Brain systems governing emotion and reward-seeking are fully developed by this time, but circuits governing judgment and self-inhibition are still maturing, causing teenagers to act on impulse, seek new sensations, and be easily swayed by peers – all of which may draw them to take risks such as trying drugs of abuse”.

Volkow goes on to explain that, given the fluid nature of adolescent brain development, substance use during this critical time may actually modify brain functioning, possibly making the development of a substance use disorder significantly more likely.

Youth drug use can be hard to measure, though measure it we do. And as preventative strategies emerge from the data, we see almost cyclical drops in the popularity of certain types of drugs, only to see rises in use of others. As I illustrated in my book, Reality Gap: Alcohol, Drugs and Sex – What Parents Don’t Know and Teens Aren’t Telling, “In many ways, trends in negative behaviors act much like a balloon: Squeeze it smaller here, and it gets bigger over there.”
What does that mean? That hyperfocus on lowering the impact of any particular drug at any given time, say heroin, may be successful but simultaneously other drugs may gain new users.

A solution to that conundrum may lie in a new approach being pro-moted by the Institute for Behavior and Health. Its president, Robert L. DuPont, M.D., reflected on declining youth drug use in many ar-eas and asserted, “This finding has the potential to reshape all pre-vention strategies away from substance-specific health-promoting campaigns to a single focus that promotes no use by adolescents of any addicting substances”.

In “Beautiful Boys” I detailed Monitoring the Future (MTF) data from 2013. MTF is an ongoing study of the behaviors, attitudes and val-ues of American secondary school students, college students and young adults conducted by researchers from University of Michigan and reported out by NIDA, among others.

The data included the following.

  • Five-year trends are showing significant increases in past-year and past-month marijuana use across three grades: 8th, 10th, and 12th.
  • The percentage of 12th graders reporting past-year nonmedical use of amphetamines rose from 6.8 percent in 2008 to 8.7 percent in 2013.
  • In 2013, perceived risk of harm of trying Vicodin occasionally declined in 8th graders, from 29.4 percent to 26.2 percent, and in 10th graders, from 40.3 percent to 36 percent in 2013. This drop in perception of risk might indicate that use could begin to rise again in future years.

In the same article, I made connections from Vicodin use to heroin use and from use to addiction – something that seems to happen in a surprisingly, alarmingly short amount of time.

By last year, predictably, the data had changed, with NIDA stating, “2014’s Monitoring the Future survey of drug use and attitudes among American 8th, 10th, and 12th graders continued to show encouraging news about youth drug use, including decreasing use of alcohol, cigarettes, and prescription pain relievers; no increase in use of marijuana; decreasing use of inhalants and synthetic drugs, including K2/Spice and bath salts; and a general decline over the last two decades in the use of illicit drugs. However, the survey highlighted growing concerns over the high rate of e-cigarette use and softening of attitudes around some types of drug use, particularly decreases in perceived harm and disapproval of marijuana use”.

Despite the decreasing use of alcohol and a stagnant rate of marijuana use, the numbers remain depressingly real: 9 percent of 8th graders, 23.5 percent of 10th graders, and 37.4 percent of 12th graders noted past-month use of alcohol. In terms of binge, or high-risk, drinking nearly 20 percent of seniors (19.4 percent) reported engaging in that behavior in 2014.

With marijuana use, there are also many reasons for concern. MTF notes “past month” use of marijuana among 6.5 percent of 8th graders, 16.6 percent of 10th graders and 21.2 of 12th graders. Perhaps more concerning, 6 percent of 12th graders reported using marijuana every day and a whopping 81 percent said that it is easy to get.

While some young people and some adults may view alcohol and marijuana use among adolescents as “no big deal,” the truth is that both can be gateways to other, potentially more lethal drugs. Or they may become the addictions themselves. Indeed, according to a 2014 report from the Substance Abuse and Mental Health Services Administration (SAMHSA), alcohol and marijuana accounted for the top two categories of treatment for those ages 12 and older during the past year.

For his part, Ken, also a co-author of the Camping Magazine article, spoke of his alcohol addiction: “It was an experience of being divided against myself and distracted by feelings of inadequacy, resentment and despair. I felt alienated from others and overwhelmingly tired.” After he quit drinking, Ken said, he made amends to the people he had hurt and learned to deal with his feelings of fear, resentment and shame. He also revealed that with his recovery came a desire to connect to, love and be useful to others. Ken is now an ordained minister, and his congregation hosts addiction and recovery expos for those in or seeking recovery.

Not everyone is so successful.

Rates of illicit drug use are epidemic. So, too, is addiction. But what is driving young people into drug use in the first place? According to NIDA, the reasons include a desire to fit in, to feel good, to feel better, to do better and to experiment.

No surprises there.

Some good news for teens can also be found in the NIDA guide. It states, “Adolescents can benefit from a drug abuse intervention even if they are not addicted to a drug. Substance use disorders range from problematic use to addiction and can be treated successfully at any stage, and at any age. For young people, any drug use (even if it seems like only ‘experimentation’) is cause for concern, as it exposes them to dangers from the drug and associated risky behaviors and may lead to more drug use in the future. Parents and other adults should monitor young people and not underestimate the significance of what may appear as isolated instances of drug taking.”

What does that intervention look like? According to NIDA, it can take many forms, including partial hospitalization, behavioral approaches, cognitive-behavioral therapy, motivational enhancement therapy and family-based work.

Regardless of the mode of treatment, it is important to note that addiction can, in fact, end in sustained recovery – as we saw with Michael and Ken – which, on its own, lights a pathway to prevention.

References provided upon Request

Stephen Gray Wallace is President and Director of the Center for Adolescent Research and Education (CARE), a national collaborative of institutions and organizations committed to increasing positive youth outcomes and reducing negative risk behaviors. He has broad experience as a school psychologist and adolescent/family counselor and serves as senior advisor to SADD, director of counseling and counselor training at Cape Cod Sea Camps, a member of the professional development faculty at the American Academy of Family Physicians and American Camp Association, an expert partner at RANE (Risk Assistance Network & Exchange) and a parenting expert at kidsinthehouse.com and NBCUniversal’s parenttoolkit.com. He is also the author of the critically acclaimed book Reality Gap: Alcohol, Drugs and Sex – What Parents Don’t Know and Teens Aren’t Telling. For more information about Stephen’s work, please visit

StephenGrayWallace.com.
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