Remember the scare tactics associated with drugs of abuse potential a few years ago? “Just say no to drugs,” “This is your brain on drugs,” – which depicted an egg frying in a pan? The obvious point: Don’t be foolhardy and try these substances because you’ll get hooked on them, just like everyone who used them before you did. These messages failed miserably, because trying to dissuade people through sensationalism, only encouraged many of them to try these drugs all the more.
Children, and even more so adolescents, are particularly susceptible to racy influences such as the display of drug use in pop culture via music concerts, videos and film, spring boarding young people toward drugs as the cool thing to try – and even continue to do.
When a substance use disorder is suspected in children and adolescents, it’s usually because of school suspension or an encounter with the legal system that has mandated they be professionally evaluated. Particularly with older adolescents, abuse issues can be subtle because severity is written off as “they’re just partying,” when it’s really an impairment issue. And adolescents can be hard to work with because they’ve been either mildly or forcefully coerced into treatment that they aren’t motivated to accept, and don’t want.
What’s Trending in 2020
- Alcohol; cannabis; psychostimulants; vaping; opioids; and energy drinks are the most prevalent
- Marijuana use among high school seniors is currently the highest since 1979-1981.
- Over-the-counter (OTC) and prescription drugs are responsible for a growing number of overdoses
- OTC products are increasingly becoming the launching pad toward more dangerous and abusable substances
- “Mixing” substances such as alcohol and energy drinks has become a dangerous trendsetter
Screening and Assessment Preliminaries
The CRAFFT screening test (craft.org) is a short assessment tool used to determine substance use disorders in those ages 12-21. It is endorsed by the American Academy of Pediatrics. CRAFFT is a mnemonic representing the key words of the six items in the second section of the assessment: Car; Relax; Alone; Forget; Friends; Trouble. Each “yes” response scores 1 point. A total score of 2 or higher is considered a positive screen, indicating a need for additional assessment.
When initiating the screening process, keep “first things first.” Kids tend not to talk until they trust people, so consider beginning a discussion with neutral topics, such as hobbies, favorite films, or music videos. Adolescents in particular, have a finely tuned “B.S. meter,” so it’s unwise to try to act cool when it’s unlikely you’ll be perceived that way – particularly in my age range! Also don’t be the parent or detective, avoid getting caught up in the countertransference trap that can lead to emotional entanglements.
Motivational Interviewing
Regardless of age, I’ve never met a substance abuser who wants to become an addict; nevertheless most are ready to give up the consequences, but not the drug(s). At its most basic, motivational interviewing is a conversation using a narrative style, whereby you’re trying to help the young person deal with the ambivalence that’s keeping them from acting on a problematic behavior. It’s about helping him or her sort through the circumstances to reach a decision that makes sense within their personal framework. Motivational interviewing is empathic – not confrontational or argumentative. Instead of telling them what to do, explore what they think they need to change, and how they believe they can go about doing it. Young people with a SUD do want to be heard; however you can’t solve it for them and you may not be able to improve their condition either. Also, they do care about what their parents think, they care about what’s important to them, but they’re wired to resist as a way to maintain and protect their autonomy. Hear their stories and you’ll be providing important value.
Questions for Child and Adolescent Users
Employ a conversational, non-judgmental style when asking questions. This helps reinforce “change” talk. Ask about nicotine products and what they may be using in their vape. For prescription medications, ask whether they’re taking more than prescribed. Then go a bit deeper by asking how often they think about using, whether they’re buying from friends and possibly not getting as “high” as they used to. These questions are important to determine what role drug use is playing in their lives, and whether there is a concurrent anxiety or untreated mood disorder present.
Talking To Parents
Constant and consistent parental involvement is vital. Before meeting with the child or adolescent, schedule a meeting with their parents first. Psychoeducation is essential – comorbidity and suicide risk must be discussed. Communicate to parents that medication in the home needs to be secured in a lock box or even a mini-safe that can only be accessed by responsible parties. And by all means, parents should exercise their power over the car keys or anything else the adolescent values because of impairment.
Stepwise Treatment
Deciding on the appropriate treatment course is contingent upon the severity of use. Is it mild, moderate or severe? Are there legal consequences? Unsurprisingly, when you ask most young people what they think about their use, you’ll hear, “I don’t think it’s a problem.” Upon hearing that, I’ll then ask, “Do you think you could quit for a period of say, 2 weeks?” If this fails, then an intensive outpatient setting (IOP) or a partial program would be the next step. These programs would focus not only on the substance use component, but also on co-occurring disorders which are all too common in adolescents, in particular. If use is severe, then detox and residential care should be considered.
Final Points
Sixty percent of adolescents relapse within the first 3 months after treatment completion, so plan on a long treatment course with ongoing assessments.
Simply – the earlier in life someone begins using potentially problematic substances, the higher the risk of developing a substance use disorder as an adult.
Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.