Teenage Substance Abuse: What Parents Need to Know
by Bruce Thomson, Thomson Therapy Center PC
Lots of kids are using drugs and alcohol. Your own adolescent may very likely be using drugs or alcohol. If they are, they are probably lying to you about it, and statistics show you are probably being fooled. In a recent study (2011) at the University of Michigan’s C.S. Mott hospital, 33% of parents listed youth drug abuse as their number top concern, making it tied for #1 on the list along with obesity. In an interesting aside, parents were asked if they thought their child was drinking or using marijuana, and then their children were asked the same question. 10% of parents said yes, their child was drinking, but 52 % of their children said in fact they were. Only 5% said their child was using marijuana, but 28% of the kids said they were. So parents are missing their own children’s use of substances 80-85% of the time!
Drugs and alcohol have become a major factor in human health. The National Drug Research Center in Australia says illicit drugs shave off 13 million years of lifespan worldwide, each year. The World Health Organization (WHO) says there were 241,000 illicit drug deaths in the world in 2000, double the rate in 1990. And in 2011 the WHO announced in its third Report on Alcohol, that alcohol is the #1 killer of men, aged 15 to 59. It kills 2 million people per year – more than all the world’s armed conflicts combined.
The latest scourge is the illicit use of prescription drugs, especially pain medications. The Federal Drug Abuse Warning Network said in 2009 that prescription drug abuse was the second leading cause of accidental death in the U.S., behind auto accidents. Dr. David Koth, from the American Society of Intervention Pain Physicians, says that in 2010, 30,000 people in the U.S. died form prescription drug abuse. Again, this is double the rate from 10 years before.
In Michigan, the numbers are just as alarming. The White House Office of National Drug Control Policy reports 12% of Michigan teens are using drugs recreationally. The Michigan Youth Risk Behavior Survey found 20-28% of teens using marijuana and 45-50% drinking. 3 out of every 1000 patients in Michigan emergency rooms are there for prescription drug overdose. There were 409 reported overdose deaths for youth under 25 from these pills in 2008 alone. By 2009, the toll had risen to 457 – an 11% increase in just 1 year.
In 2005, the U.S. government estimated total cost from substance abuse to be 484 billion dollars. This is more than cancer and diabetes combined. In 2011 the estimate was closer to 600 billion. In Michigan we spend 5 billion dollars each year due to substance abuse. This is second only to K-12 education in total cost. And only 2% of these funds go to prevention, education and treatment. The other 98% go to cleaning up the damage through police, court, prison, parole, hospital and other costs.
Underage alcohol sales in Michigan are an estimated 596 million per year. The industry profit on these sales an estimated 292 million. We only spend about 77 million a year to combat these sales. Michigan does have some positive measures in place, including a graduated drivers license and social host liability for providing alcohol to minors.
When it comes to substance abuse, adolescents are considered to be teens aged 12 to 17. In 2010 there were about 23 million of them in the U.S. The U.S. Department of Health and Human Services does an annual National Survey on Drug Use and Health, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). The data from the 2010 Survey is very sobering (or we could at least hope so): 10.1 % of adolescents are using illicit drugs, up from 9.3 % in 2008. 13.6% (3.1 million) are using alcohol, split equally between male and female. More than half of these drinkers (1.8 million) are bingeing on at least 5 drinks at a setting. And 400,000 are drinking heavily with binges at least 5 times a month.
The study also looks at drinking behaviors for a slightly larger cohort, those aged 12 to 20. 26% of this group is drinking and the use can be broken down by age groups: 49% of 18-20 year-olds drink; 25% of 16-17 year-olds; 12% of 14-15 year-olds and 3% of 12-13 year-olds. 17% are bingeing and 5.7% are heavy drinkers. Men drink more (28% vs. 24%) and binge more (20% vs. 14%). The average age to begin drinking is 17.2 years old. However, this number is skewed by people who don’t take a drink until later in life. There were 4.7 million new drinkers in 2010 and 82% of them were under 21. In fact, 59% (2.8 million) were under 18. That works out to be almost 8000 new adolescent drinkers each day! Most drinking takes place in a friend’s home (55%), or their own home (30%).
The total numbers for marijuana and other drugs are smaller, but the pattern is the same. 57% of all new drug users were 12-17 years old. This includes 1.4 million new marijuana users, 540,000 new inhalant users, 380,000 new ecstasy users, and others who began using cocaine, methamphetamine, hallucinogens, heroin and prescription drugs. These prescription drugs include stimulants like Adderall, depressants such as Xanax, and narcotics such as Vicodin and Oxycontin. Keep in mind that all of these figures, for both alcohol and drugs, are missing those who start using even earlier, before age 12.
Are these kids getting in trouble? Unfortunately, the answer is clearly yes. SAMHSA says over 7% of all adolescents now meet the criteria for substance abuse or dependence and need treatment. These criteria include the following characteristics: tolerance, withdrawal, increasing use, inability to cut down use, lots of time spent on drug-related activities, important activities given up because of use and continued use despite negative consequences. Of the 1.8 million adolescents who needed treatment in 2010, only 138,000 received it. The other 1.7 million did not. Over 1 million teens are in trouble with alcohol but only 6% (70,000) of them got treatment. 1.2 million have a problem with drugs but only 8% (100,000) of them got help. The numbers total more than 138,000 because some received treatment for both alcohol and drugs. It may surprise you to note that for this age group, there are actually more girls in trouble than boys (7.7% vs. 6.9%).
The data also shows a dramatic impact for the early use of substances. The SAMHSA study shows that 16% those who drink before age 15 become dependent on alcohol, but only 4% of those who wait until age 18 or later become dependent. Another study, the National Longitudinal Alcohol Epidemiological Study in 2000, showed a 40% chance of substance dependency if you first drink by age 14, and a much-reduced 10% chance if you wait until at least age 20. Both studies indicate you are 400% more likely to need treatment if you start drinking early in your teen years. According to Dr. Mark Menestrena, at Brighton Hospital, early users are also 7 times more likely to have a car accident, 11 times more likely to get in a fight, 12 times more likely to be injured, 3 times more likely to commit suicide and much more likely to misuse prescription drugs.
The illicit use of prescription drugs is the new gateway to addiction. Teens have access to a full spectrum of stimulants, depressants and narcotics simply by going through their home medicine cabinets. The legal market for opioids such as Vicodin (hydrocodone mixed with acetaminophen), and Oxycontin, Percoset, Percodan (all made from oxycodone), is over 10 billion dollars per year. There were over 128 million Vicodin prescriptions alone written in 2009. Hydrocodone inspired 86,000 ER visits in 2009. Oxycodone is now the most-abused medicine in the U.S., and soon to hit the market is Zohydro, a super-strong hydrocodone formulation designed to compete with it. In 2005, 470,000 people in Michigan reported using painkillers illicitly. These “legal” opioids have one big drawback for the teen user: when you cannot get them free from your home or friends, they are very expensive to buy illicitly ($10-$80 per pill). The solution for the addict who runs low on money is to sell their belongings, steal from family and friends, or turn to a lower cost narcotic –namely Heroin. Heroin is more powerful and less costly than ever before. A new generation of teens is naively thinking they can use it safely if they avoid injecting. The reality is heroin overdose deaths are skyrocketing. Pinckney has had over 15 overdoses in the last 4 years alone.
So what can parents do? The first step is to notice the problem. Talk to your kids about drugs and drinking. Be curious and interested in what they have to tell you. Talk very little and listen a lot. Listen in the car when driving the carpool to school. Listen when they have friends over. Pay attention to what they wear, how they smell, their eyes, skin and hair. If things just don’t seem right, trust your intuition and investigate further. Look for dramatic changes in how they spend their time and who their friends are. The classic indicator of a problem with marijuana is that everything becomes too much bother for the teen. Sports, band, drama, exercise and homework/grades all become not worth the effort. Where then does all their time, money and interest go? Take a guess. The ultimate outcome of a love affair with marijuana is the death of motivation. If you truly believe there is a problem then purchase a drug test kit and use it.
What can you do to help stack the deck in favor of sobriety and help keep your child from experimenting early with drugs and alcohol? Strong family bonds and parental involvement help. This means support, oversight and control. Teens crave boundaries (although they would die before admitting it). Limit their time with friends on school nights. Check on their homework and help where you can. Limit their T.V., internet and video game time. Require help with chores. The SAMHSA study credits these parental behaviors with reducing drug use and alcohol bingeing by 2/3.
Clear expectations and consequences, both in general and around substance use, are important. Establish strong norms for the family regarding substances. Studies have shown that when parents strongly disapprove of marijuana use, even once or twice, use drops by 75-85% compared to families where parents only somewhat disapprove of use. Most teens (81-88%) say they disapprove of their friends smoking marijuana or drinking daily. And yet, they themselves are often using. Peer pressure and fitting in is a dominant social reality for teens. They need strong family and social bonds with firm, clear, non-using norms to offset the pressure from using friends. Contrary to what they think, and what they tell you, not everyone is using. It just seems that way to your teen.
Religious or spiritual affiliation is also a preventative factor in early substance use. Encourage a sense of awe and humility about the universe and the child’s place in it. It is never to early to teach the reality that everyone needs help sometime and we do best when we can ask for it. SAMHSA results show a 25% drop in drug use and bingeing when a teen strongly agrees that religious beliefs are an important part of life.
Drug and alcohol prevention messages at school are often met with disdain by teens. Even so, the information is important for them to have and it will filter through over time. SAMHSA results show students who receive these messages lower drug use, including marijuana, by 25%. Teens are bombarded with “facts” about drugs from their friends and dealers. Much of it is completely inaccurate, so it is important to supply them with alternative, factual information.
Perceived risk is critical. Human beings respond to the threat of negative consequences. Only 5% of adolescents who perceive great risk of physical or other harm from drinking show binge drinking in the last month. Those who perceive moderate, slight or no risk show double the binge rate at 10%. The results for marijuana are even more dramatic: 1.3% of those who perceive great risk have smoked in the last month but 10% of the others have smoked. Of course, it is not easy to convince a teen of risk in anything. They are immortal and invulnerable, which is why they are such easy prey for drug dealers. When I lecture in the high schools, I make sure to emphasize all of the possible consequences of use in graphic detail - from memory loss to organ damage. The one fact that seems to really get their attention is when I explain to boys that heavy marijuana smokers have exactly double the risk of testicular cancer.
Your teen is going to be exposed to drugs. Over 14% of all adolescents reported being approached by a drug dealer in the 2010 study. 49% of teens say it is fairly easy or very easy to get marijuana. Even 20% of 12-13 year-olds say this. By 14-15 it reaches 52% and for 16-17 year-olds 70% say no problem. 19% of adolescents can easily get cocaine. Even LSD and heroin are easy to find for 12% of teens. Your challenge is to provide a solid foundation, clear expectations and lots of information to balance the scales. If you can do this with a hug and a smile, even better. The approach you are looking for is firm but loving. Zero tolerance for abuse coupled with a lot of goodwill for your child. As we all remember, it is no easy task being a teenager.
In another column I will write about treatment options if your teen does have a problem. There are medications, facilities, programs, therapy, sobriety coaches and 12-step support groups. All can play a role in recovery. SMAHSA studies show an important role for therapy. The best outcomes occur with treatment for the entire family system, not just the client. And longer treatment shows better outcomes for adolescents in recovery. This can be challenging since insurance companies are increasingly pushing for short-term care to save money, even though the longer, more complex treatment is the best care.