Tailoring Treatments for Teenage Drug Users

Tailoring Treatments for Teenage Drug Users
Posted by CN Staff on January 06, 2003 at 23:13:33 PT
By Howard Markel
Source: New York Times 
In many respects, Michael Lagana is a typical 17-year-old. A junior at Dundalk High School in Maryland, he carries a full load of courses, loves playing football, and works after school selling newspaper subscriptions.He began smoking marijuana at 14. At 16, he was smoking three fat marijuana cigarettes a day or drinking a couple of 40-ounce bottles of malt liquor.
Donna Lagana, Michael's mother, began to worry last June when she discovered some marijuana among Michael's things. He assured her then that it was "not a problem."But Michael's drug and alcohol use only escalated. In September, after he drank a fifth of brandy in less than an hour, he passed out and was taken to the emergency room for acute alcohol poisoning.Although Michael steadfastly refused to see a drug abuse counselor, his parents worried that he might pose a threat to himself or others. As a result, Mrs. Lagana petitioned the Baltimore County Circuit Court to order him to undergo a substance abuse evaluation. The court agreed, and within a few hours, Michael was picked up from school and taken to a local hospital.There he was examined by an addiction specialist and was soon admitted to Mountain Manor, an alcohol and drug treatment center for teenagers in Baltimore. It was, Mrs. Lagana recalls, "the hardest day of my life.""How could I have not noticed it before?" she asked.Last month, researchers at the University of Michigan reported that the use of alcohol, nicotine and marijuana among high school students across the nation was declining. Nevertheless, levels of teenage drinking and drug use remain stubbornly high.At least 53 percent of all American adolescents have tried an illicit drug by the time they have finished high school, according to the Michigan researchers.The Centers for Disease Control and Prevention reported last week that from 1993 to 2001 the rate of binge drinking episodes among drinkers 18 to 20 increased by 56 percent, compared with an increase of 35 percent for all American adults. Binge drinking was defined as five or more drinks at a sitting, with the intention of becoming drunk.To highlight the continuing problems, a number of doctors who treat substance abuse among adolescents will give a report to all members of Congress and every state governor on Thursday. The report, by a group called the Physician Leadership on National Drug Policy, describes teenage alcohol and drug abuse as a national public health problem.Dr. Aaron Hogue, a psychologist and a researcher at Columbia University's National Center on Addiction and Substance Abuse, said that last year's reported decline in drug use by teenagers did not mean the problem was going away."I am not sure that these general trends, as important as they are, speak directly to those kids who have the most severe substance abuse problems and are in the greatest need of treatment services," Dr. Hogue said.Also, because the brains of teenagers are still developing, many experts believe they are at greater risk for becoming addicted. A number of studies have shown that teenagers who begin using illicit drugs before they are 15 are eight times as likely to develop substance abuse problems as those who start at 18 or later.Anna Joseph, a 15-year-old who lives in Ann Arbor, is among those who have avoided drugs. "I don't feel I need them to have a good time," she said.For her, a major deterrent has been seeing other teenagers at school whose lives became messed up because they were dependent on drugs.Philip Anderson, a 17-year-old from Ferndale, Md., who began using drugs at 10 and has abstained for over a year, explains that young people try drugs for a lot of reasons. "I got into drugs because I thought it was fun," he said. "Some kids see their parents using them. Others see their friends using them and feel pressured to do the same. Some are just curious."Dr. Marc Fishman, a psychiatrist at Mountain Manor and a faculty member at Johns Hopkins, said: "Many adults trivialize how bad these drugs really are. They say it's just pot or booze, what's the big deal? But it is a big deal when it involves children."Still, many experts say more treatment programs tailored to teenagers are needed.Dr. David Lewis, a physician at Brown University and the lead author of the physician group's report said: "You can't just apply the adult model to teenagers. We need a new investment for what we know works for children."The physician group wants more money devoted to prevention and treatment and less money spent on incarcerating juvenile drug offenders.Effective drug treatment programs for teenagers, many addiction experts say, are different from those that work for adults. Parents and other family members have to be involved, and treatment has to allow for continued school work.Also, because teenagers' thought processes often differ from those of adults, different approaches to psychological counseling are required. More than half the adolescents enrolled in drug rehabilitation programs also have some other psychiatric problems  including attention deficit disorder, depression and trauma from sexual or physical abuse  that have to be recognized.Several studies show that illicit drug use is reduced by 50 percent among teenagers one year after completing substance abuse treatment, although fewer than half are still abstaining five years later.The physicians' report says that these rates of relapses and compliance are similar to those seen in programs for other chronic, relapsing diseases like diabetes and asthma, where patients sometimes do not take their medicines.Another problem is a shortage of treatment programs. The report found that 10 percent of students who needed drug abuse treatment received it, and of those who did receive it, 25 percent received enough.Dr. Jeremiah A. Barondess, president of the New York Academy of Medicine, said: "If we had less than the needed facilities to treat diabetes, we would be labeled as heartless and accused of practicing medicine that is immoral if not criminal. I can think of no other disease that is deliberately underfunded in such a manner." What is more, the report says that many pediatricians feel uncomfortable treating addiction problems and that financial reimbursement in the form of Medicaid or third-party health insurance is limited. About 44 percent of all referrals for substance abuse treatment are sent by the juvenile court system, compared with 22 percent from schools, 17 percent from themselves or family and 5 percent from health care professionals.The rest of the referrals come from a variety of sources.The physicians' report calls for training judges and criminal justice workers to collaborate with health care professionals in proceedings called drug courts that use the court system to send juvenile drug offenders into treatment.As for Michael Lagana, he is not taking his sobriety for granted. "When I was using drugs," he said, "I just didn't think it was such a big deal. Since I began treatment four months ago, I've realized that I almost lost my life."Source: New York Times (NY)Author: Howard MarkelPublished: January 7, 2003Copyright: 2003 The New York Times Company Contact: letters Website: Related Articles:Teen Drug Use Declining, Study Shows Drug Use Drops to an 8-Year Low
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Comment #4 posted by FoM on January 07, 2003 at 09:26:46 PT
I posted it and named you Newshawk.
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Comment #3 posted by WolfgangWylde on January 07, 2003 at 08:14:06 PT
Notice that the title...
..talks about Teen Drug Users, and the first case study is about a kid who's biggest problem is alcohol.  But hey, that's legal, and Mom and Dad certainly enjoy a stiff drink now and again, so it must be ok.
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Comment #2 posted by JSM on January 07, 2003 at 06:44:24 PT
Fat, forty, and facing death are doing nothing but following example of parents and those around them. It is unfortunate, but this is not a perfect world and people will always turn to whatever might provide a little relief; however, prohibition is not the answer and in fact makes things much worse. It is time we dispose of this puritan mindset and find realistic solutions to these problems.
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Comment #1 posted by CorvallisEric on January 07, 2003 at 05:28:00 PT
Ran into something good, and right on-topic
Posted on Slate last Friday, don't remember seeing it mentioned here but I could be wrong. Trick or Treatment - Teen drug programs turn curious teens into crackheads. - By Maia Szalavitz (link to discussion forum at bottom of page): only good, but recommended by addiction-policy specialist Mark Kleiman, only a lukewarm reformer. He says: Coerced treatment is always a tricky proposition. But it's worse when people are forced to be treated for diseases they don't actually have, and not considered "cured" until they admit to having them. That's Maia Szalavitz's rather grim take on the burgeoning teen-drug-treatment industry. She knows what she's talking about. ... Kleiman's page: http://markarkleiman.blogspot.comSearch for Szalavitz on CNews turns up intersting stuff including a debate on CNN about Noelle Bush:
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