This is the second in a series of articles presented by Chayeinu, a new Baltimore organization dedicated to providing education and guidance to our community to address many facets of substance use disorder. We want to alert readers of WWW that as part of this objective, we have invited Dr. David Pelcovitz to speak to our community about substance use on January 9, 2019, at the Park Heights JCC. Dr. Pelcovitz is the Gwendolyn and Joseph Straus Chair in Psychology and Jewish Education at the Azrieli Graduate School of Jewish Education and Administration at Yeshiva University. We hope you can make it.
Predicting which of our children will develop substance use disorder requires some understanding about risk factors that often precede problematic use of alcohol or drugs. Risk factors increase the likelihood that a child will develop a substance use disorder. Before getting into the details, it is important not to panic. Most children with one risk factor never have a problem, and many children who ultimately develop an addiction do not possess traditional risk factors. However, what seems clear is that as the number of risk factors begins to accumulate, so does the likelihood of problematic substance use. This article will focus on vulnerabilities that lie within the child as the most critical risk factors for addiction.
Children who ultimately develop substance use disorder disproportionately suffer from other pre-existing conditions. These conditions typically precede the substance use disorder by about 10 years. For instance, children with Attention Deficit Hyperactivity Disorder (ADHD) are more than twice as likely to have a substance use disorder than those without ADHD. Children who frequently break established rules (sometimes diagnosed as Conduct Disorder) or initiate arguments with parents and teachers (sometimes diagnosed as Oppositional Defiant Disorder) also possess a strong likelihood for problematic substance use. And children with conditions like depression or anxiety, which often occur with ADHD (or, according to some in the field, are part of the ADHD syndrome), are also at enhanced risk.
An understanding of these vulnerabilities is particularly important when considering the potential dangers of children experimenting with alcohol or drugs. As we have noted in a previous article, national surveys show that alcohol, marijuana, and cigarettes remain quite popular among high school students. Overall rates of use may increase further with expanded access to e-cigarettes and marijuana. While most kids will use e-cigarettes, alcohol, or drugs without long-term problems, some will develop a disorder. Teenagers who are most likely to transition from occasional use to a substance use disorder appear to be those with pre-existing conditions.
We can make the same general point about vulnerabilities when considering other risk factors that often co-occur with problematic substance use. Some of the most important of these risk factors include poverty, family conflict, trauma or violence, academic failure, peer influences, and social alienation. Each of these factors can precede alcohol or drug use. However, these factors become even more powerful predictors of substance use disorder in children with pre-existing conditions.
Does a knowledge of vulnerabilities provide any practical guidance to parents? Our feeling is that whether or not a child has specific vulnerabilities, parents must remain vigilant about a child’s substance use and maximize factors that protect the child from future problems. Reasonable strategies to protect children from developing substance use disorder are to create an engaged and supportive family environment, to support academic achievement, to monitor peer relationships, and to provide opportunities to explore extracurricular interests. It is also important to speak to children about the dangers of substance use, which include but are not limited to the possibility of developing a disorder. As children get older, parents should make their teenagers feel comfortable asking questions about substance use, discussing pressures to use alcohol and drugs, and confiding about their experiences using substances. Perhaps in a future article we can discuss ways to speak to children and teenagers about this difficult topic.
For children who evidence a pre-existing condition, the most important thing a parent can do is to identify a treatment provider and begin treatment. For most disorders, including ADHD, the combination of medication and counseling can offer considerable symptom relief and improve academic achievement, social relationships, and family interactions. There is also growing evidence that treatment of the pre-existing condition provides significant protection to the development of a substance use disorder, though more research is needed in this area.
Research is also quite clear about the importance of seeking treatment as early as possible. Untreated conditions that persist can grow stronger and unnecessarily tax family functioning. Because parents enter a marriage with distinct personalities, they are rarely if ever “on the same page” when trying to manage a child’s vulnerabilities. Children with these types of conditions often require considerably more attention, which means less attention to other family members. Children with untreated or under-treated conditions also have a more difficult time forming healthy social relationships, and become more susceptible to peer pressure. These conditions can also hinder academic achievement and create a sense of alienation from the school culture. As noted earlier, each of these factors has its own pathway to the addictions.
Another reason for seeking treatment early is that treatment often takes time to work. Unfortunately, there is not one type of medicine or therapeutic approach that works for everyone, because every child has unique strengths and needs. The whole enterprise requires a considerable amount of patience from everyone involved. Effective treatment also requires a good collaborative partnership between the treatment provider and the parents. Pediatricians and school counselors are often good resources to discuss treatment options. The good news is that over time, sustained treatment can be very helpful in reducing symptoms and improving overall well-being, and can reduce many of the risk factors that might lead to addiction.
Finally, parents who have a substance use or another psychiatric disorder should seek their own treatment. It is terribly unfortunate that only a small fraction of adults ever seek treatment for their disorder, and that those who pursue treatment often stop taking medications or terminate seeing their therapist before resolution of the problem. Good and affordable treatments are available for most conditions, and can often be identified with the help of the primary care physician. In this complicated world in which our children have easy access to just about any licit or illicit substance, we need to be the best parents that we can be.
Dr. Kidorf is Associate Director of Addiction Treatment Services and Associate Professor, Psychiatry and Behavioral Sciences, at Johns Hopkins University School of Medicine.
