They say aging and death are the great equalizers. They don’t discriminate. Drug addiction should join the list. It is present in all walks of life. It doesn’t care about race, creed, gender, status, or age. Or if you’re the son of a mega-rich hotelier.
Gary Mendell lost his son Brian to opioid abuse disorder in 2011, when Brian died by suicide. Mendell admitted that he hadn’t paid enough attention while his son was still alive. He tried to understand the reasons for the demise by launching his own investigation. Only then did he realize that Brian’s death could have been prevented. He berated himself because with his knowledge and power, he believed he could have done more.
He discovered these important points from his study:
- Current treatment programs in rehabilitation centres, like the ones his son attended, do not use up-to-date, evidence-based research.
- There are no measures in place that eﬀectively monitor doctor prescriptions and drug administration, or penalize oﬀenders.
- Studies with proven methods of resolving addiction are documented and readily available but are not being extensively used.
- Infrastructure exists and systems are in place but are hardly implemented.
- There is no system to measure results.
- Policies governing opioid distribution and addiction treatment inclusions in insurance need to be revamped.
We need tangible results, not just chatter.
Mendell, co-founder of the HEI hotel group, wanted concrete solutions to the addiction problem. So with $5 million, he founded Shatterproof. With this non-proﬁt organisation, he hopes to improve the quality of treatment and focus on what has been proven to work, monitor how doctors prescribe medications, promote early screening and prevention, and change existing policies—especially those of insurance companies and the federal government.
He is pushing for “medication-assisted treatment as the key feature” in the ﬁght against opioid addiction. He cites “methadone, Suboxone, and Vivitrol” for low-level maintenance. He claims that these medications “eliminate the cravings and mitigate the eﬀects of opioids.” He recommends a combination of medication with assisted treatment, behavioural therapy, eradication of the stigma involved, and familial and community support.
One of Shatterproof’s goals is to build a rating system for treatment providers that would force them to step up their standards of care. Another is their push for a uniﬁed prescription database so authorities can monitor and penalize those who abuse the system, for example, patients who go to other districts to buy reﬁlls of prescribed medications so their original doctors or pharmacies won’t know what they’re up to.
In April 2017, Shatterproof co-founded a Substance Use Disorder Treatment Task Force of industry leaders to help accomplish its goals by incorporating specific principles of care. Mendell also speaks publicly, sharing his loss to eradicate the shame and stigma attached to drug and alcohol addiction.
Addiction comes in many forms: watch out for new ones!
According to Shatterproof, “Addiction is America’s most urgent public health crisis. In 2017, drug overdose killed more Americans than car accidents, gun violence, and the Vietnam war. It is the number one cause of accidental death in the United States.”
This disease is not limited to substance abuse. There are also behavioural addictions, such as “eating disorder, gambling disorder, compulsive stealing/buying/sexual behaviour, and problem internet use,” as documented in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classiﬁcation of Disease (ICD).
Parents and guardians now have to be doubly vigilant against a dependency on previously unknown substances, such as bath salts (no, not the ones you use to soak in the tub). Also, don’t take for granted ordinary items in your household, like prescription medication (especially pain killers and inhalants) and cleaning, laundry and automotive chemicals. Inhalants don’t just come in medicine form, either. Spray paint, markers, or cleaning supplies can be abused too.
Many teens think that misusing prescription drugs like sedatives or prescription painkillers is safer than abusing illicit drugs like heroin or Ecstasy, because prescription drugs are used as medicine. But using any substance, including prescription drugs, other than for its intended or prescribed purpose, can cause irreversible damage to the liver and other internal organs, as well as the central nervous system. Drug abuse, whether from prescription or illicit sources, not only severely impairs coordination and mobility, it can also lead to heart disease.
Don’t forget nicotine, which has now gone beyond the usual forms of rolled-up tobacco and ordinary cigarettes. One platform has been in existence for some time now: the vape or e-cigarette, but it hasn’t been properly regulated.
Some companies have shown social responsibility related to nicotine addiction. Juul, an e-cigarette company, posted the dangers of using their products on their website—in capital letters: “WE DON’T WANT ANYONE WHO DOESN’T SMOKE, OR ALREADY USE NICOTINE, TO USE JUUL PRODUCTS. WE CERTAINLY DON’T WANT YOUTH USING THE PRODUCT. IT IS BAD FOR PUBLIC HEALTH, AND IT IS BAD FOR OUR MISSION.”
Part of their campaign to prevent the use of their products by underage youth is through stricter purchasing controls. They took their most enticing ﬂavours oﬀ the retail shelf, only making these available online with age-compliant restrictions.
The adolescent brain and substance abuse
The brain continues to develop until the mid-20s. The teenage brain is highly sensitive to being shaped by environmental stimuli and experiences. Drug and alcohol abuse can adversely aﬀect brain development, possibly aﬀecting both its structure and information-processing capability.
Many addictive substances, such as marijuana and heroin, increase levels of a naturally occurring chemical in the brain called dopamine. This encourages users to take more drugs. Repetitive drug use interferes with the brain’s ability to produce its own dopamine, so that without the drug, users are unable to function normally or go about their daily activities. The adolescent brain is more vulnerable to alcohol and drug use than the adult brain. So long-term eﬀects would be more intense in young people.
Why does teenage addiction happen?
The reasons are varied and include the following:
- They may be dependent on their medications, especially those with a high potential for addiction. This is common with adolescents diagnosed with attention-deﬁcit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and bipolar disorder. If stimulants, such as Adderall or Ritalin—often prescribed for ADHD—are used in the wrong way, they can lead to addiction and overdose. Teens on painkillers (taken for sports or automobile accidents, for example) are also susceptible.
- They’re curious and want to know what the fuss is about.
- They want to ﬁt in. Peer pressure and the desire to make friends can lead teenagers into alcohol abuse or a dependency on amphetamines, prescription drugs and other substances. Most young people have not developed a strong foundation of conﬁdence. They need approval from peers, and if these young adults are popping drugs and/or engaging in underage drinking, those who want to be accepted in the group would participate in these activities too, even if they know the dangers.
- They’re bored. This is especially true for idle teenagers because they lack outside interests. But not all adolescents who engage in illicit substance use are rebellious. Encouraging them to participate in extracurricular activities would help keep their mind oﬀ dangerous pursuits.
- They’re depressed or anxious. They resort to drug or alcohol use to deal with stressful situations and raise their spirits.
- They use substances, especially nicotine, to lose weight. This practice is prevalent among ballet dancers, gymnasts, and ramp models who are constantly under extreme pressure to be thin. Be on high alert if you notice your teens being obsessed with food, weight, and appearance. They may have eating disorders.
- They’re stressed out and use drugs to chill. Teach teens healthier methods of relaxation, like sports, exercise, chess, yoga, and meditation. These are beneficial for optimum mental health as well.
- They have inferiority complex. Drug and/or alcohol use gives them artificial temporary conﬁdence or helps them bury unpleasant emotions.
- They need help in social situations. Liquor is the main choice in overcoming shyness and shedding inhibitions. This usually sets the stage for future alcohol problems.
- They need help staying awake and performing better. Stimulants like the methamphetamine group provide bursts of energy, albeit short-term and minimal. Young adults need to know this limitation, plus the terrible consequences of their use.
- They see family members, neighbours, or older ‘cool’ friends using these substances. They want to emulate people they look up to. This is why adults shouldn’t forget their responsibility as role models.
- Athletes and those involved in high-level competitions sometimes use illicit substances, including legal steroids and energy drinks to amp their academic performance and physical abilities. Research from the National Institute on Drug Abuse (NIDA) shows that college students who regularly consume energy drinks may be more susceptible to prescription and substance use disorders.
- They don’t want to miss out and be an outcast. They think everyone is doing it. Tell them this is false. The good news is, “over one quarter of high school seniors have never used any alcohol, marijuana, cigarettes, or other drugs,” according to the 2018 survey by Monitoring the Future (MTF)—an annual survey of 8th, 10th, and 12th graders by researchers at the University of Michigan, Ann Arbor. The MTF survey is made possible by a grant from NIDA, which is part of the National Institutes of Health (NIH). Dr. Geetha Subramaniam, Deputy Director, NIDA Center for Clinical Trials Network, conﬁrms: “One of the processes of engaging an individual into changing their use behaviours is to help them understand how infrequent substance abuse is in that age group. Because most teenagers who are using substances are of the opinion that everybody in their class is using drugs. That is really not the case.”
- It’s all in the family. Genetics is something beyond our control (though scientists are trying to change this). This is hard to accept, especially in cases of mental illness. But you can head it oﬀ. Inform your teen about your family’s medical history. Explain that since your family members are predisposed to addiction, everyone within the circle should take extra precautions.
Prevention of teen drug abuse: start early
The first step is to remember what it was like when you were a teenager. When you put yourself in young people’s shoes, you’re on your way to understanding them. Some steps you can take in your family include the following:
- Monitor your children’s friends and others they hang out with. If you’re not able to know their whereabouts after school due to work commitments, ask help from relatives, friends, and neighbours.
- Teach adolescents (especially high school students) not to be inﬂuenced by peer pressure by saying no to experimentation invites and suchlike.
- Lay down the rules early on. Follow these yourself. Be a model to your child.
- Avoid entertainment platforms (TV shows, movies, gaming media, music genres) that glamourize substance use.
- The best way to build up your child’s conﬁdence is from an early age. Low self-esteem plays a big role in addiction.
- Arrange to have regular family activities. Remind them of enjoyable moments in recent years. Recreate them or make new memories.
- Encourage your kid to participate in school organisations, hobbies, sports, and other team activities.
- Establish open communication with teens. Tell them it’s okay to ask embarrassing questions.
- If you notice obvious signs of behaviour change, investigate counselling options. If you can’t aﬀord paid counsellors, consult the one at your teen’s school, your pastor, or community leader. Individual, family or group therapy can help your teenager deal with issues that could lead to prescription drug abuse or other kinds of addictive behaviour.
- Prevent or restrict access to prescription medicine (especially inhalants), household chemicals, alcoholic drinks, and any substance that may be addictive.
- Talk about the dangers of substance abuse and compulsive behaviour starting from middle school or earlier, when children have not yet started using drugs, alcohol, or nicotine.
- Teenagers are notoriously difficult to please. They have short attention spans, are easily bored, and do not respond favorably to lectures and ‘sermons’. So meet them at their game. Use platforms they enjoy. Enlist their peers to deliver messages. They are more likely to listen to them than to adults.
Treatment centres, medical facilities, and other organisations dealing with addiction oﬀer educational resources on the subject. Drugs + Your Body: It Isn’t Pretty is a science based online program for grades 6-12 that uses interactive descriptions, images, and videos to show how drug use can adversely aﬀect the body. The site is the result of collaboration by Scholastic and the scientists of NIDA and NIH, and the US Department of Health and Human Services. This can be accessed at: http://www.scholastic.com/drugs-and-your-body.
A helpful, easy-to-understand video on how illicit drugs aﬀect the developing brain can be found at https://www.youtube.com/watch?v=EpfnDijz2d8. The teenage host uses the analogy of computer programming to explain the process of brain development.
The following websites feature games and quizzes for teens that inform them about substance abuse and what happens to the body and parts of the brain when a person uses drugs:
What to do if your teenager has an addiction
Wear the oxygen mask ﬁrst. Take care of yourself and make sure your foundation is intact before you help your kids.
- Difficult as it is after they have done seemingly irreparable damage, let your teens know that you have their back and that you will love them, no matter what, even in the event of a relapse.
- Be cool. Refrain from showing outrage when you ﬁnd out. Teen addicts will expect you to be angry. Putting them oﬀ-guard will give you an advantage. Patience is an important ﬁrst step to surviving the turbulent teenage years.
- Sympathize, listen, be supportive. Adolescents will open up more if you oﬀer a safe space without judgement.
- Stage an intervention, especially in cases of relapse or difficulty maintaining sobriety.
- Stop activities (yours and theirs) that will enable them to continue the addictive behaviour. Mostly, this involves giving teens money, letting them borrow family cars, being lenient with curfews, or taking back punishment.
- Parents and guardians should be consistent with discipline. Spouses shouldn’t contradict themselves. Otherwise, their children will play them against each other.
- Ask for professional help, such as addiction specialists, pediatricians, the mental health services administration, and support groups. If outpatient rehab or a residential treatment program are necessary, do not delay. Your child may need medical detox to safely manage withdrawal symptoms. Behavioural therapy, group therapy, substance abuse treatments, substance replacement remedies, and other medications are some eﬀective treatment options for addiction.
Crises can be averted
There are many circumstances beyond the control of parents and guardians of young people. But with vigilance, preparation, communication, education, unconditional love, and unwavering support, tragedies can be prevented. Prepare them for the challenges of adulthood by setting the foundation earlier.
National Institute on Drug Abuse for Teens. 2019. Accessed at: https://teens.drugabuse.gov/national-drug-alcohol-facts-week/chat-withscientists/chat-day-fast-facts/2019
Kim Harris, Sion (Associate Professor of Pediatrics, Harvard Medical School). Webinar: “The State of Science: Teen Brain Development and the Impact of Marijuana Use.” School-based Health Alliance. Accessed at: http://www.sbh4all.org/webinars
Photo credit: Cia De Foto. This picture has a Creative Commons attribution license.