I wanted to use this space to once again encourage parents to consider the benefits of early intervention for their kids who have started to drink or use other drugs. We already know that substances like nicotine, cannabis, and alcohol are used by too many adolescents in our community. We also know that some of these kids who begin to use drugs will develop a more serious problem that will become a disorder.
It
is no small thing to have a substance use disorder, no matter what the drug. It
is one of the worst things that can happen to a person (and a family). The
diagnostic manual used by most health practitioners (DSM-V) describes 11
criteria for substance use disorder. These criteria include:
·
symptoms that fall into the categories of poor control
of use (e.g., using more than intended)
·
risky use (e.g., driving under the influence)
·
impaired social functioning (e.g., neglect of
schoolwork or other obligations)
·
physical dependence (e.g., tolerance or withdrawal)
* * *
Substance
use disorder is currently diagnosed according to severity. The severity of the
disorder is based on how many symptoms the adolescent experiences. Kids who
experience two to five symptoms are diagnosed with mild to moderate substance
use disorder, while those with six or more symptoms are diagnosed with severe
substance use disorder.
The
progression from mild to severe substance use disorder varies from adolescent
to adolescent; no two teenagers are alike. Some kids never progress to severe
problems and stop (or reduce) drinking or drug use once they mature and take on
more responsibilities. Others will progress from mild to severe substance use
disorder over the course of months or years. The point is that there is an
opportunity to address substance use problems before they get worse.
We
know a little about which teenagers are more likely to progress from mild to
severe forms of the disorder. These are kids who have a family history of
substance use problems. Adolescents who have experienced trauma or have
co-occurring ADHD or mental health concerns are also at high risk to accelerate
drug use because drugs can help manage uncomfortable feelings, at least short term.
We also know that earlier initiation of substance use is associated with more
severe forms of the disorder. These risks are relevant to boys and girls and to
the rich and poor, though kids from poor families, who have less access to
resources, remain particularly vulnerable.
* * *
What
all this suggests is the importance of intervening as soon as your adolescent
experiences mild problems (that is, two or more symptoms), especially if he or
she has one or more of the vulnerabilities listed above. In most cases, it is
the safer option to be careful and seek treatment for your child rather than
hope that the problem will go away on its own.
Dr.
Thomas McLellan, former U.S. “drug czar” and a senior researcher, recently
advocated in the Journal of the American Medical Association (JAMA) to use the
term “pre-addiction” for people experiencing mild problems that might increase
to major problems. He considered this language based on efforts in the medical
field over two decades ago to coin the term pre-diabetes to identify people at
high risk for developing Type 2 diabetes.
At
that time, the American Diabetes Association proposed to classify people with
pre-diabetes when they demonstrated higher than normal blood sugar levels. The
term quickly led to increased public awareness and to the development of
medical and even psychosocial interventions (directed at lifestyle changes) to
halt progression to Type 2 diabetes. While the language of “pre-addiction” will
likely not make it into our vocabulary because it is potentially stigmatizing
in a way that “pre-diabetes” may not be, the idea to address small problems
before they become big problems remains important.
Unfortunately,
we do not have similar biological markers in the addiction field to denote when
a person is at risk for substance use disorder. In the meantime, substance use
disorder criteria provide a useful guide to when intervention is needed.
* * *
What
would early intervention look like? It starts with parents recognizing the
signs of substance use because children usually do not want to share this
information with adults. Parents are generally pretty good at noting when their
kids are acting out of the ordinary, even after factoring in the “out of the
ordinariness” of routine adolescence.
Teenagers
will unintentionally leave clues here and there about their substance use:
entering home with red eyes or the smell of weed or alcohol, leaving vaping
products in their clothing that are found in the laundry, increasing moodiness
and apathy, decline in academic interest and performance, or changes in their
usual friends. While none of theses is the end of the world, it should trigger
in parents the importance of helping the child seek care, complicated primarily
by the substance user’s denial of problems and disinterest in therapy.
It
is often helpful to speak with the family pediatrician, who can provide
education to our kids about the dangers of substance use and help parents
consider a therapist who has a specialty in addiction. Referral to a
psychiatrist, psychologist, or licensed therapist experienced in managing
addiction and co-occurring psychiatric conditions or ADHD may often be
necessary. Many pediatricians feel comfortable prescribing medications for ADHD
and mental health concerns. They are also often good at “normalizing” treatment
and helping adolescents feel good about taking care of themselves.
Another
benefit of early intervention is that treatment for teenagers can take some
time to work its magic. We are getting better at treating psychiatric and
substance use disorders in adolescents, but it is often complicated, and the
treatment plan and medications are often altered over time to fit the specific
needs of children and their families. There are times when family therapy is
indicated because having even one child with a substance use disorder can
seriously alter and impair the dynamics of the entire family.
We
must keep in mind that companies are working harder than ever to market new
ways to reach adolescents and get them involved in substance use. We live in a
new world of marijuana legalization, nicotine pouches, edible cannabis, and
home alcohol delivery. No matter how companies explain their products, the
clear intent is to get more people to use their drug, which includes our
children. When we suspect that our kids have a problem related to substance
use, even a minor one, it is good to get the support of professionals to help
carry the burden of teenage substance use and help our children reach their
potential.
