The Adolescent Struggle: Here it is

The Adolescent Struggle

Maybe if we are going to invest in drug prevention programs, we need to start with investing in attachment-disorder prevention programs.
-Jon Daily, LCSW, CADC II

Early childhood attachment (social) experiences build our biological (bio) and psychological (psycho) capacity to regulate affective states and turn to others for co-regulation. Attachment researchers have theorized that attunement with a stable, responsive caregiver may facilitate children’s regulation of attention, emotion, and physiological arousal, hence the term, co-regulation.

In recent years, clinicians treating young people, a group that includes adolescents and young adults, with addictive disorders have become increasingly aware that affect dysregulation and an inability to turn to others for emotional soothing and comfort significantly contribute to the onset of drug use, continued use, and relapse. For sustained recovery to occur, affect regulation should be a significant treatment focus. The challenge for recovering users involves learning to recognize and experience their physiological, emotional, and psychological states, along with understanding their need for support. With this understanding, they can build social support and trust. They can then turn to others to help them regulate their affect states rather than turning to drugs, drug dealers, and drug culture for biological, psychological, and social (bio-psycho-social) soothing. We know from current scientific research that healthy relationships build healthy brains, minds, and social capacities in our developing young people; unhealthy dysregulated brains, minds, and people build dysregulated capacities. This information is the focus of this book.

As preteens enter the adolescent phase of life an internal struggle emerges that can powerfully hijack teenagers’ capacity for rational thought and good judgment. Teens in this struggle may have limited ability to use their cortical systems in the brain, i.e., the prefrontal cortex (PFC), which can serve as the braking/inhibitory system. This limitation exists because the PFC is not yet fully developed and myelinated. Moreover, the braking/inhibitory system can be hijacked by the subcoritcal structures of the midbrain, the region regulating social and emotional responses and behavior, which we can think of as the gas pedal/excitatory system.

These years encompass many social and internal changes. Change, whether good or bad, is a common denominator for stress, and change sums up adolescence in one word. The brain and mind are reorganizing during this last period of blooming neurons and the development of the PFC before the early twenties, the time when myelination begins (1) (2) (3) (4). Myelination is the process by which the myelin sheath (insulation/conduit) forms on nerve fibers, typically, around the axon of a neuron. Myelination results in the increased speed of neurotransmission and adds to the stability of the architectural structure of neural networks, making it more difficult to change connections. I often jokingly say: Older people who are set in their opinions are that way because they are fully myelinated, and this means they come to conclusions faster (speed) and their minds are harder to change (neural network stability).

This reorganization and the accompanying new experiences result in a struggle as teenagers consider normal questions that accompany adolescence. These include issues of social and personal acceptance, rejection, sexuality, and appearance. Teens often lack both adequate answers to their questions and someone in whom they can confide. In addition, they may be desperate to ameliorate the associated emotions that are unfamiliar or unpleasant, hence the antecedent to drug use.
We all know that adolescence is a turbulent stage of development. During these years young people expand their social networks and try out new and more sophisticated ways of connecting to others and negotiating their relationships. They explore their identity through a reexamination of their values, beliefs, ideas, and behavior. The questions they ask generally include: Who am I? How Do I see myself? How do others see me? How do I find and enter new social niches? What do I do with these romantic feelings I have for this person? How do I identify, experience, express and regulate the more deeper and broader range of emotions I feel now?

These questions are a normal part of development. Moreover, during the second half of adolescence, teens are supposed to experience anxiety, even if their lives are proceeding normally. During the first half of adolescence, teens generally are not challenged to think about self sufficiency, because their needs are provided for. They are free to focus on activities like talking on the phone, playing video games, keeping up with their online social networking, skateboarding, and so forth.
However, during the second half of adolescence, teens must face the need to be responsible, accountable, and resourceful as they ponder the future. The questions change, too:
Will I pass my drivers exam? Can I afford a car and insurance? Can I get a job? Do I have what it takes to ask a person out on a date? Can I get into college or train for a technical job? Can I get a good enough score on the SAT exam? Which colleges do I apply for? How do I apply? How do I support myself during and after college?

Young people need support during this tumultuous time, but they may have grown up with family issues, relational traumas, poor self-esteem, insecurity, and other mental health issues. The arduous challenge for these teens and young adults is to regulate their emotional state and push to build various competencies and healthy relationships, despite their circumstances and issues.

When does Adulthood Begin?
We often hear that in our society, we have extended adolescence from the late teen years well into the twenties. This has had implications for our society in general, but it is also relevant in a discussion of addiction, because those who become addicted in their teenage years have a difficult time transitioning to young adulthood. For the purposes of this book, we use the term “young people” to include both adolescents and those in their early twenties.

According to Clark, sociologists, psychologists, and others recognize adulthood as starting at age 25, a time when young people typically have graduated from college, entered the military, or are working and can financially support themselves (5). The transition from adolescence to full adulthood means that young adults must assume new social roles and face more complex intellectual and social challenges. However, they face these sophisticated challenges regardless of how well they have worked through previous adolescent challenges, such as identity development, along with physical, social, intellectual, and emotional development. Many young adults face these new challenges while still trying to work through previous social and emotional struggles.

While these young adults are experiencing emerging levels of sophistication in thinking, conflict, tension and emotional regulation challenges, their brains are simultaneously undergoing changes in the regions associated with these necessary capacities for regulation. For example, the prefrontal cortex (PFC) is associated with the ability to plan and anticipate ramifications of decisions, along with the complex concept of morality, authority, civic law, natural law, divine law, and so forth. The PFC is an inhibitory-braking region of the brain that serves to counter the lower subcortical structures of the brain that typically are impulsive-excitatory (limbic and hedonic regions). Translation, a young person who longs for belonging, emotional and social connection, mixed with sexual desire and peer pressure to sneak out of the house while his parents are asleep to satisfy these desires is experiencing impulsive-excitatory drive from the mid and lower regions of the brain (subcortical structures). In this tension filled and primed impulsive state of excitation, the firing of dopamine and other neurotransmitters ascend from the lower regions of the brain up to the PFC; here, the PFC can send descending signals back to counter this as the young person ponders the morality taught by his parents, culture, and society, thus serving as a inhibitory-braking system. If the PFC dominates in this “tug of war,” then he has made the decision to stay home and no risky behaviors or negative consequences occur. If he sneaks out, has sex, and possibly even uses drugs, then he has experienced “bottom up hijacking” whereby the lower regions of the brain have hijacked the top regions. This is the old cartoon depicting the devil on one shoulder, saying, “Come on, it will be fun and your parents will never know.” Meanwhile, the angel on the other shoulder says, “You know better than this and when your parents find out they will be hurt and having sex and doing drugs can be harmful.”

During the young adult years, we see insulation form around nerve fibers and neural networks, which allows the brain to transmit signals more efficiently. In addition, extra neurons and networks are pruned, which enables those neurons and networks currently used to send signals more efficiently (6) (7). Research has shown that substance use and mental health problems tend to be highest among persons in their late adolescent and young adult years, with substance use generally being higher among males and mental health problems generally being higher among females (8).

We have seen attachment theory research grow over the past sixty years, particularly in the last decade with the advent of research in the field of interpersonal neurobiology. This research demonstrates that children raised by parents who are warm, reflective, consistent, and attuned to their children’s needs build the affect regulation system both psychologically and biologically (9) (10). The field of interpersonal neurobiology has deepened our understanding of development by elegantly linking bio-psycho-social variables. In other words, during the last decade, to study attachment theory is to study biology, psychology, and sociology.

In addition, during the last decade, researchers have discovered that systems of the brain and neural networks are developed or stunted as a result of secure or insecure attachment. The development of a child’s brain, mind, and affect regulation system is “experience dependent.” Specifically, the brain is built and organized from the experiences a child has with caregivers during the early, formative years of life.
Biologically, the opiate and dopamine system fire and develop during the attuned experience between parent and child. A later chapter delves into this neurobiology in greater detail, but briefly, the opiate system helps us manage stress and emotional and physical pain, experience pleasure, and reinforce behavior. Perhaps most significantly, the opiate system is a neurological core component of “secure” human attachment to caregivers in our early childhood experience. As attunement occurs, the system is activated, developing and reinforcing the bond with the caregiver and the associated behaviors involved in approach, such as calling out, walking to, asking for, and so on.

The dopamine system can be thought of as the system of both desire and reward. Dopamine is the central neurochemical in what Panksepp called the seeking system (11). It provides the initial stimulation and excitement for activity and can be thought to set the tone for intensity.
The pleasurable experience of attunement, both biologically and psychologically, reinforces the social attachment between the children and their caregivers. During infancy these systems develop and fire to create a pleasurable experience when the caregiver attunes to the child’s needs. As the dopaminergic system and opiate systems are built and firing, the experience of attunement—hedonic—becomes the seeking (desire) and reinforcing (reward) systems. This plays out in the attachment relationship as the child’s neurochemistry (bio) reinforces the idea of turning to others (social) for support, affect regulation (psychological), and so forth.

In addition, the attunement experience also builds the child’s belief, or Internal Working Model (IWM), that “I can trust others,” or conversely, “I can’t trust others.” (The IWM is explained in detail in a later chapter.) If a child turns to others to be soothed, only to be left alone emotionally, this creates shame (12) (13) or more pain, which thwarts the development of the previously mentioned desire and reward systems, and builds an IWM that represents mistrust and inadequacy of self and others. When this occurs, the IWM reinforces the tendency to turn away from others for support, affect regulation, and so forth. The mistrust of others builds when the act of turning away occurs more frequently than turning to others in search of soothing. Ultimately, unless they can discover relational experiences, mistrusting children are stuck with limited capacity for affect regulation and the ability to build healthy and secure relationships in adolescence and adulthood.

This early bio-psycho-social dynamic underpins and drives addictive disorders. When teenagers are unable to self-soothe, or trust others to help them soothe, then they are at risk for relying on drugs, food, sex, gangs, and so forth, for comfort, and they carry this risk into young adulthood. (These concepts are further developed throughout the book.)
Biologically, almost all addictive drugs activate the dopamine and the opiate system, the same system operating during parent-child bonding in the early years of life. Therefore, drugs become the substitute for healthy regulation and co-regulation from others. Furthermore, young people who mistrust others often quickly discover that drug dealers, and the drug culture in general, respond to their need for closeness, belonging, warmth, and soothing. Drug culture is accepting, not judging; drugs feel intoxicating, not depressing. Currently, many young people play out these struggles in self-destructive attempts to resolve their emotional and social conflicts. When unresolved, these conflicts show up as significant problems in all areas of an adolescent’s life and later, in adult life when they attempt to fit in as a member of society.

The Problem of Teen Drug Use
In the office J’s mom talks nervously. His dad sits next to her on the couch in a tense silence. Fifteen-year-old J slouches in a plushy chair, almost falling asleep. His mom talks about how she found marijuana in his room six months ago, how they spoke to him and he promised to stop, but his grades continued to deteriorate , his friends changed, he was away from home more, and when he was home they fought constantly. Then J went to outpatient counseling briefly, then to a month-long program for teen substance abusers. But he came back and the same behaviors started again. Now they discovered he is using Vicodin. She and her husband are scared and do not know what to do. J and his parents are not alone.

Most of us would agree that the number of adolescents using alcohol and illicit drugs is a great concern and many variables contribute to the epidemic. In 2008, the benchmark index, Monitoring the Future, an annual survey used by clinicians and researchers to track trends in adolescent drug use, found that 19.6% of eighth graders and 47.4% of high school seniors have used illicit drugs. More specifically, the teens were asked about their near-term use, and within the past 30 days: More than 25% of alcohol-dependent adults, age 21 and older in 2003 first used before age 14. Over 80% first used before age 18, and 96% used before age 21!

  • 11% of 8th graders and 25% of seniors tried marijuana
  • 16% of 8th graders and 10% of seniors tried inhalants
  • 16% of 8th graders and 43% of seniors used alcohol

This survey also showed that from 1991 to 1999 illicit drug use has nearly doubled (14).
Because of neurological research, we now have a greater understanding of the relationship between early first-use of intoxicants and brain development, along with the subsequent increased risk of addiction. Consider these facts:

(Testimony by Charles Curie, M.A. A.C.S.W, April 26, 2005) (15)

Taken as whole, we can see that on any given day, “100 million Americans are taking some stimulant, antidepressant, tranquillizer, or painkiller; smoking; inhaling from aerosol cans or glue bottles; or self-medicating with alcohol or illegal substances like marijuana, cocaine, heroin, methamphetamines, hallucinogens, Ecstasy, and other designer drugs” (16).
Those of us working in the field also see an additional alarming trend. The total number of drug-using teenagers has increased over the years, and first intoxication occurs at increasingly younger ages. In clinical practice we have seen the average age of first intoxication go from age 15 in the 1980s to age 12 in the late 1990s, an age holding stable in this new century. The decrease in age alarms us because the younger the age at first use, the more likely the individual will go on to develop alcohol or other drug dependency. A study conducted by Dawson and Dawson found that those starting to use drugs at age 13 or younger had a 42% chance of having substance dependence; if they also have a genetic family history of addiction the chance increased by 15% (17).

J’s parents are reasonably alarmed. J and other youth are using illicit drugs earlier, experimenting with a wider range of intoxicants, and their repeated use is seriously affecting their social, emotional, and biological growth, which not only disrupts their immediate functioning, but puts them at much higher risk for long-term substance dependence and long-term dysfunction as adults.
More Varied and Potent
Not only have young people begun using alcohol and drugs at an earlier age, we have seen an increase in the variety, potency, and availability of the drugs they typically use. For example, marijuana potency doubled from 1997 to 2008. Is it likely to decrease in potency in the future? I doubt it. Today we see technology that enables dealers, growers, and users to produce more potent marijuana in the comfort of their own homes, so to speak. They genetically clone plants and use the latest types of elaborate grow-lighting, technologies that continue to advance. A glance at the chart below reveals the steady rise of marijuana potency.

The Rise in Varied Use
According to a study conducted by Columbia University’s Center on Addiction and Substance Abuse, children who smoke marijuana are eighty-five times more likely to use cocaine than their peers who never tried marijuana (19). At our offices in northern California, we routinely take a drug use history from our clients. Many years ago, the typical history gathered at an initial interview consisted of nicotine, alcohol, and marijuana. Currently, it is increasingly common that these histories list nicotine, alcohol, marijuana, Ecstasy, mushrooms, nitrous oxide, Vicodin, hydrocodone, Adderall, and dextromethorphan. Some of our young clients also report using cocaine, oxycontin, methamphetamine, salvia, K-2/spice and so forth.
Looking at these lists, it is clear that since the mid 1990s young people have developed an open mind about what creates intoxication. This “creativity” takes them beyond the well-publicized drugs their parents look out for, i.e., cocaine, marijuana, and a few others. Now they search through their parents’ medicine cabinet for both psychiatric and over-the-counter medicines. Who would have thought that adolescents would abuse Nyquil, “the sniffling, sneezing, coughing, aching, rest medicine?”
J reported stealing Vicodin from his grandparents’ home. He admitted to drinking Robitussin with a friend. He said he had been offered to use cocaine and heroin intravenously, but denied using them. He was familiar with Ritalin, Adderal, Xanax, and Klonopin, though he had never been prescribed any of them. He had tried Ecstacy once, had heard of “G,” a designer street drug that reportedly enhances somatic sensations and visual distortions and he states that he wants to try Opana, a strong pain killer.
Emotional turmoil, social pressures, and other issues contribute to drug use, but several common beliefs also play a role. Adolescents often acknowledge negative consequences of using any drug, but then they use false beliefs to justify their use: It won’t happen to me…I can control it… I’ll just do it once… I won’t use the harder drugs… I can stop any time I want to, and so on. Logically, negative consequences from drug use occur, and they become the next common denominator for the problems in their lives. In other words, the negative effects of the drugs and drug culture combine with the already present bio-social- psycho issues.
As their relationship to intoxication becomes stronger, their relationship to other areas of life becomes more fragile. Students with a history of good grades begin to fail; they may not graduate, let alone go on to trade school, college or job training or qualify for military service. Some young people gradually reorganize their groups of friends and end up associating only with other drug users. They abandon sports, families, jobs, and other extracurricular activities.
Beyond these consequences, many teens are convicted of serious crimes. We know that the families of young addicts lose many thousands of dollars in attorneys’ fees and/or medical bills. Parents often lose time at work while dealing with the consequences of their child’s drug issues, and many suffer the demoralizing experience of having their child literally “rip them off.” Frankly, many families have lost their children to addiction. Every day, drugs and alcohol drive young people to run away, often disappearing into a community of addicts living on the streets; even worse, drugs and alcohol are a major cause of death of our young people. In recent years, research has illuminated the severity of these consequences.

Consequences: Health
Alcohol, tobacco, and drug abuse is the number one health problem in the U.S., and as such, it places an enormous burden on the country. More deaths, illnesses, and disabilities result from substance abuse than from any other preventable health condition (20). This situation strains the healthcare system and contributes to the death and ill health of millions of Americans every year.
Parents and clinicians working with young drug abusers have witnessed heath issues ranging from things like quitting sports and not getting physical exercise all the way to contracting sexually transmitted disease (STDs), alcohol poisoning and drug overdoses, strokes, and death. In my career thus far, I am aware of far too many adolescents and young adults who have died of addiction-related causes, and many more who have suffered serious injuries from auto accidents, unwanted pregnancies, and violence. In most cases, the fights and other violence would not have occurred outside the presence and use of alcohol or drugs.
In 2006, hospitals in the U.S. delivered patient care in a total of 113 million Emergency Department (ED) visits. The Drug Abuse Warning Network (DAWN) (21) estimates that 1,742,887 ED visits were associated with drug misuse or abuse. Of those ED visits:

  • 31% involved illicit drugs only
  • 28% involved pharmaceuticals only
  • 7% involved alcohol only in patients under the age of 21
  • 13% involved illicit drugs with alcohol
  • 10% involved alcohol with pharmaceuticals
  • 8% involved illicit drugs with pharmaceuticals
  • 3% involved illicit drugs with pharmaceuticals and alcohol

In patients under age 21, DAWN estimates:

  • 76,760 alcohol-related ED visits for patients aged 12 to 17
  • 105,675 alcohol-related ED visits for patients aged 18 to 20

Alcohol is an illegal drug for both of these age groups. Further:

  • About two thirds (69%) of the alcohol-related ED visits for minors involved alcohol and no other drug
  • The rate of alcohol-only ED visits for patients aged 18 to 20 (581 visits per 100,000 population) was 2.8 times that for patients aged 12 to 17 (204 per 100,000)
  • Males and females had similar rates

Cost to Society
The health and social costs to society of illicit drug use are staggering. Drug-related illness, death, and crime cost the nation approximately $66.9 billion. Every man, woman, and child in America pay nearly $1000 annually to cover the expense of unnecessary health care, extra law enforcement, auto accidents, crime, and lost productivity resulting from substance abuse (22).
A 2009 study showed that drug abuse remains one of the top five costliest health problems in the United States. According to a recent report from the National Center for Addiction and Substance Abuse (CASA) at Columbia University (23), most of the money invested in combating alcohol and drug abuse is spent responding to the consequences of these societal problems. Only a minimal 2% percent goes to prevention. The study also found that 96 percent of the $467.7 billion that federal, state and local governments spend on substance abuse is used to deal with the public effects, including crime and homelessness. Healthcare costs associated with substance abuse receive the largest percentage (58.0). Governments spend the second largest percentage (13.1) on the costs of prosecuting and jailing offenders. In a related study from the United States Office of Drug Control Policy, over 50% of men arrested in nine selected cities tested positive for drugs.
As stated earlier, we can all agree that adolescent drug use is of great concern. The open question for parents and therapists is why they use. Parents in our program routinely ask, “What are the underlying issues that make my child want to use?” Meanwhile, researchers are trying to answer the same question.
Clinicians usually conclude that as many reasons exist for drug use among young people as there are young people using drugs. For years, researchers have explored this question, and their data shed light on some specific factors. For example, in a study of more than 4,700 teenagers, researchers found that parents’ drinking habits appeared to influence their children in both direct and indirect ways. Teenagers seemed to directly follow the example of a parent who drank excessively, or they indirectly viewed their parents’ drinking as a sign of lax parenting, which, in turn, affected their likelihood to drink.
Past and current studies have found that parents can be a strong influence on their children’s odds of drinking and shed light on how the influence plays out among adolescents (24). Other research shows that a close parent-child relationship, one in which teenagers can turn to parents to discuss their feelings, delays the age of first intoxication.
The Partnership for a Drug-Free America reveals troubling new insights into the reasons teens use drugs. According to the 2007 Partnership Attitude Tracking Study of 6,511 teens (PATS Teens) (25), the number one reason teenagers list for drug use is to deal with the pressures and stress of school. In this nationally projectable study (margin of error +/- 1.6 percent), 73% of teens reported school stress as the primary reason for drug use. This indicates that teenagers’ perceptions of motivating factors for using drugs are dramatically different than past research has indicated.

As previously stated, the nature of adolescence itself means that young people go through many internal and social struggles. In his formulation of the human hierarchy of needs, Abraham Maslow pointed out attachment is important for both young children and teenagers. However, the kinds of attachments change by adolescence, usually shifting away from caregivers, though the Internal Working Model (IWM) remains, and moves toward peers in the form of the “need to belong.” This developmental stage exerts powerful influence and leaves many teens vulnerable to attachments that can lead them down a destructive path and makes it more important that kids go into the high school years with healthy people and resources in their lives, along with, a strong capacity and skill set for coping. The reality is that the teenage and college years will be stressful. That is normal and okay. In fact, more time could be spent by parents and clinicians explaining the normality of it and how to work with and through it. It is a developmental milestone in life.

We know that many stressed and struggling young people feel inadequate in their relationship with themselves, while simultaneously feeling scrutinized by their peers. They will do whatever it takes to be “good enough to belong.” Referring to the survey above, you can see that items 1, 3, 4, 5, 9, 10, 12, and 14 are linked to the need to fit in and belong with peers. The powerful drive to keep people close and belong is very real.

Adolescence is a natural time of change and conflict. Teens are discovering their capacity for self-direction. Peter Blos, an eminent specialist in adolescent analysis, once said that teenagers change personalities the way they change clothes. They are trying out new ways to be themselves, new possibilities for who they are and “how they are going to be in the world.” This involves a natural amount of self-absorption, risk-taking, and experimentation. Intoxication is often seen as a means to self-exploration, new friends, new perceptions and emotions, and new ways of thinking. The risk of this experimentation is minimized.

Adolescents often acknowledge negative consequences of using drugs and alcohol, but then they use false beliefs and minimization to justify their use: It won’t happen to me…I can control it… I’ll just do it once… I won’t use the harder drugs… I can stop any time I want to, and so on. But this new excitement about self-direction and self-control is youthfully naive. Adolescents are largely unaware of the trajectory of their emotional development and how who they have been as young children and as school-age children significantly contribute to their strengths and vulnerabilities and who they can actually become as adults. Logically, negative consequences from drug use occur. And inevitably they interact with and often compound the already existing problems in teens’ lives. Then their minimization becomes denial. Experimentation becomes compulsion. A venture into new friends and new feelings becomes a new identity.

Raising adolescents can be challenging and exhausting for parents, too, which often makes it difficult to be emotionally attuned to and supportive of their children’s developmental struggles. An accompanying Partnership for a Drug-free America study of parents’ attitudes about teen drug use (released in June 2007) showed that parents severely underestimate and are disconnected from the impact of stress on their teens’ decision to use drugs. Only 7% of parents believe that teens might use drugs to cope with stress, despite 73% of teens making that attribution.

Teenagers struggle and need emotional support and guidance. Affect regulation, a person’s ability to manage positive and negative emotional states, is experience dependent. It is not automatic; it is built in the early relationship the child has with its caregiver (26).
Teenagers struggle and need emotional support and guidance. Insecurity in their relationships is going to drive them to soothe unpleasant emotions on their own. Unfortunately, many teenagers discover that drugs can change the way they feel. Drugs can give them the experience of feeling soothed, calm, euphoric, stimulated, and so forth. When it comes to the need to belong, teens have learned that drug culture is responsive to their calls, nonjudgmental, and accepting. In the survey mentioned, nearly all the 16 reasons teenagers give for using drugs can be attributed to managing painful emotions and to the all important need to be accepted in a peer group.

Furthermore, in 2009, a study by the American Psychological Association (APA) was referenced on a blog at the New York Time’s website about teen stress (27). The blog specifically focused on the disparity between what teens report about the stress they experience, versus what parents believe about their teenagers experience of stress. As author Lisa Belkin says, “Not only are our kids feeling it [stress], we parents aren’t noticing.”

As another example, almost half of children (ages 8 and up) believe school is stressful, but only one-third of parents see school as stressful to their children. Consistently, parents underestimate the source and intensity of their children’s stress. Unbeknownst to many parents, 30% of teens are concerned about the family finances, but only 18% of parents believe this is a source of stress for their teens. Further, both teens (and “tweens,” those who are between late childhood and adolescence) report difficulty sleeping and experience headaches in numbers only slightly lower than their parents, yet their parents do not see it.

This is important, because parents tend to underestimate the stresses experienced by their tweens and teens to about the same degree as they under-report their teens’ risky behavior, including drug use and sexual activity. Parents also underestimate depression in their children. Past and current studies have found that parents can be a strong influence on their children’s odds of drinking and shed light on how the influence plays out among adolescents (23).

Other research shows that a close parent-child relationship, one in which teenagers can turn to parents to discuss their feelings, delays the age of first intoxication. “Lack of attunement,” a parent not knowing how their child is feeling or what their child is doing, is a significant disruption to healthy emotional and social development. Teens that have not been attuned to do not develop the necessary skills to manage their emotions, to control their behaviors, to negotiate relationships, to handle stress, to ask for help. These are major factors in teens turning to intoxication and the pseudo-social world of users as a resource to feel better.

However, when kids are attuned to, they experience the reassuring feeling that “my parents get me.” Adolescent experimentation then is grounded in the safe, reassuring relationship with the parents. An attuned relationship is encouraging, tolerant, and limiting, all of which provides a supportive safety net for youth to explore but feel supported and contained.
Parents own use of substances is an important factor in teen substance abuse. As shown earlier, the drinking habit of parents has an influence on their children in both direct and indirect ways. An intoxicated parent cannot be an attuned parent, and as such, gives a child a double dose of risks by modeling addictive behavior and by not providing an emotional safety net.

Co-morbid psychiatric disorders significantly increase a teen’s vulnerability to substance dependence. Depression, anxiety disorders, early childhood trauma, attention-deficit disorder, learning disabilities and school failure often lead to seeking substances as a source of relief, escape, and a way to fit in. Substance abuse is a bad illness that can happen to good kids and well-meaning families. Clinicians specializing in the treatment of young people with addictive disorders see many wonderfully bright, talented, sensitive, ambitious kids who through a convergence of risk factors have developed a serious drug problem. The consequences permeate all areas of their lives: family, friends, school, money, sports, physical and mental health, and so forth. In addition, some otherwise law abiding young people have their first brush with the legal system because of their drug use.

Notes: Chapter 1

  1. Giedd, J.N., et al. 1996. Quantitative magnetic resonance imaging of human brain development ages 4-18. Cereb. Cortex 6:551- 560.
  2. Pefeferbaum, A., et al. 1994. A quantitative magnetic resonance imaging study of changes in the brain morphology from infancy to late adulthood. Arch. Neurol. 51:874-887.
  3. Spear, L.P. 2000. The adolescent brain and age-related behavioral manifestations. Neurosci. Biobev. Rev 24: 417-463.
  4. Yurgelun-Todd, D. et al. 2002. Sex differences in cerebral tissue volume and cognitive performance during adolescence. Psych. Rep. 91: 743-757.
  5. Clark, C. Hurt: Inside the World of Today’s Teenagers. (Baker Book House 2005).
  6. Donald, M., A mind so rare: The evolution of human consciousness. (New York, Norton 2001) and Giedd, J. N. (1999). “Development of the human corpus callosum during childhood and adolescence: A longitudinal MRI study.” Progress in Neuro-Psychopharmacology & Biological Psychiatry 23: 571-588.
  7. Giedd, J. N., J. Blumenthal, et al. (1999). “Brain development during childhood and adolescence: A longitudinal MRI study.” Nature Neuroscience 2(10): 861-863.
  8. Office of Applied Studies. (2005). Results from the 2004 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 05-4062, NSDUH Series H-28). Rockville, MD: Substance Abuse and Mental Health Services Administration.
  9. Schore, A.N. Affect Dysregulation and Disorders of the Self. (New York: W.W. Norton, 2003).
  10. Siegel, D. J. The Developing Mind (The Guilford Press, 1999).
  11. Panksepp, J. Affective neuroscience: the foundations of human and animal emotions. (Oxford University Press, 2004).
  12. Schore, A. N. Affect Dysregulation and Disorders of the Self. (New York, W.W. Norton, 2003).
  13. Siegel, D. J. The Developing Mind (The Guilford Press, 1999).
  14. Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2009). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2008 (NIH Publication No. 09-7401). Bethesda, MD: National Institute on Drug Abuse.
  15. Testimony by Charles Curie, M.A., A.C.S.W, April 26, 2005. Substance Abuse and Mental Health Service Administration U.S. Department of Health and Human Services on Substance Abuse Prevention Programs of the Substance Abuse and Mental Health Services Administration before Subcommittee on Criminal Justice, Drug Policy and Human Resources Committee on Government Reform United States House of Representatives
  16. Califano, Joseph. A., Jr. High Society: How Substance Abuse Ravages America and What to Do About It (Public Affairs, New York, 2007).
  17. Grant BF, Dawson DA (1998): Age of onset of drug use and its association with DSM-IV drug abuse and dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey. J Subst Abuse 10:163-173.
  18. University of Mississippi Marijuana Potency Monitoring Project, Report 95, Jan 9 2007;
  19. J.C. Merrill, K. Fox, S.R. Lewis, and G.E. Pulver, Cigarettes, Alcohol, Marijuana: Gateways to Illicit Drug Use (New York, N.Y.: Center on Addiction and Substance Abuse at Columbia University, 1994).
  20. The Schneider Institute for Health Policy, Brandeis University for the Robert Wood Johnson Foundation, Princeton, New Jersey. Substance Abuse: The Nation’s Number One Health Problem. Key Indicators for Policy (update) Feb. 2001.
  21. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Drug Abuse Warning Network, 2006: National Estimates of Drug-Related Emergency Department Visits. DAWN Series D-30, DHHS Publication No. (SMA) 08-4339, Rockville, MD 2008).
  22. Dorothy P. Rice, Sander Kelman, Leonard S. Miller, and Sarah Dunmeyer. The Economic Costs of Alcohol and Drug Abuse and Mental Illness: 1985, report submitted to the Office of Financing and Coverage Policy of the Alcohol, Drug Abuse, and Mental Health Administration (San Francisco, Calif.: Institute for Health & Aging, University of California, U.S. Department of Health and Human Services, 1990).
  23. J.C. Merrill, K. Fox, S.R. Lewis, and G.E. Pulver, Cigarettes, Alcohol, Marijuana: Gateways to Illicit Drug Use, (New York, N.Y.: Center on Addiction and Substance Abuse at Columbia University, 1994).
  24. Alcoholism: Clinical & Experimental Research. Parental Drinking and Parenting Practices Influence Adolescent Drinking. ScienceDaily 4 February 2008. 11 June 2009­/releases/2008/02/080203174447.htm.
  25. The Partnership Attitude Tracking Survey (PATS). Teens 2007 Report; Released August 4, 2008;
  26. Schore, A.N. Affect Dysregulation and Disorders of the Self. (New York: W.W. Norton, 2003).
  27. Belkin, Lisa:, 2009, 12:46 pm.
  28. Blos, P. in The Fragile Alliance: An Orientation to Psychotherapy of the Adolescent, J. Meeks, W. Bennett (Krieger Pub Co; 5th ed., 2001).

(2014) By Jon Daily, LCSW, CADC II
Founder & Clinical Director for Recovery Happens Counseling Services, graduate school instructor for USF and author of (2012) Adolescent and Young Adult Addiction: The Pathological Relationship to Intoxication and the Interpersonal Neurobiology Underpinnings. (Most of the information in this article is from chapter 1)

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