Rabbi Dr. Abraham J. Twerski
Substance Abuse in Adolescents: Detection, Treatment and Prevention
[Editor's note: this article is a follow-up to TorahWeb's event, "Alcohol, Drugs, and Morality Among Orothodx Teens", at which Rav Dr. Twerski and Rav Mayer Twersky addressed these issues. The audio and video of that event are available at http://www.torahweb.org/audio/dtwe_051505_video.html.]
Use of mood-altering chemicals among adolescents is at an all time high. It is important for parents to know that a drug is a drug is a drug. Parents may have a false sense of security, "He's only using alcohol," or "He's only using marijuana, not cocaine." Alcohol is a highly addictive chemical, and whereas mature adults who do not have an alcohol problem may have an occasional l'chaim, a glass of wine with dinner or a beer, adolescents should avoid alcohol, except for a bit of wine for kiddush. Underage drinking is not only a violation of the law, but the developing brain of the adolescent and the impulsivity of many adolescents makes any mood-altering drug potentially dangerous.
Why are so many adolescents using drugs today? Because they emulate adults. For whatever sociologic and psychologic reasons, alcohol and drug use among adults is very prevalent, and the kids are simply following the pattern set by adults.
Today's culture is more hedonistic than in any time in history. Science and technology have provided us with unprecedented comforts and enjoyments. Many people believe that the goal in life is to get as much fun and pleasure as one can. Many kids feel, "Where is my share of the fun and pleasure?' and they find it in drugs.
Which youngsters are at risk of getting into trouble with alcohol or drugs? All of them! Chemicals are an "equal opportunity destroyer." The idea "We are a fine, loving family" or "We are a Torah observant family" should not lull anyone into thinking, "It can't happen in my family." It can and it does. I have treated youngsters from the finest families and from families that were completely Torah observant. We must remove our blinders. Drugs are used by youngsters in yeshivas and in religious girls' schools. Kids are using drugs and are dealing drugs.
No parent wants to suspect a child of drug use, but parents must remain alert. The following warning signs are "red flags." They do not mean that the youngster is using drugs, but they do raise suspicion.
Changes in Behavior
The Role of the Family
One of the most difficult things to accept is that we do not have control of our children. Once we accept that, we can look for ways in which we can help them to avoid self-defeating behaviors. As long as parents think they can bribe the child to not use drugs or control him with threats and punishments, they will not look for what they can do that can be effective.
If parents suspect that their child may be using drugs, they should promptly consult an expert in drug treatment. The warning signs listed above are not evidence that the child is using drugs, and are just things that should heighten the parents' awareness. What to do next should be advised by an expert in the field.
There are many competent psychiatrists, psychologists and rabbis who have not been trained in the understanding and management of substance abuse, and their well-intentioned advice may be misguided. An expert in substance abuse problems can help the parents in their relationship to the child, and tell them what is and what is not effective.
If an adolescent uses drugs, he may still maintain a relationship with his parents, but he may also be very defiant. The parents may be shocked to discover that they cannot exert any authority over him. "Should we insist on urine tests? What if he refuses to go? What can we do when he does not come home until 3AM? Can we lock the door and leave a 15 year old on the street? What can we do when he throws obscenities at us? How do we protect our other children from being harmed by his behavior? If I know he is selling drugs, should I report him to the police?" These and many other questions arise, which obviously are too complex to be addressed in this article. Again, guidance from an expert in substance abuse is crucial.
There are different levels of treatment, and the treatment modality should be determined by a drug counselor who is familiar with adolescents. The treatment for adult substance abusers and adolescent substance abusers may be different.
There are in-patient, residential programs and out-patient programs of varying intensity. Almost invariably, attendance at a drug addiction support group will be recommended. Parental participation in a family support group is very important.
Traditional psychiatric or psychological treatment is ineffective as long as the person is using drugs. The idea of psychotherapy to determine why he is using drugs is erroneous. After abstinence is achieved, therapy with someone trained in drug addiction treatment can be helpful.
The urge to use alcohol and/or drugs is extremely strong, and the resistance to discontinuing their use is formidable. When a person has suffered many setbacks as a result of substance abuse - loss of family, loss of job, imprisonment, health deterioration - he may be ready to throw in the towel. Adolescents generally have not experienced much suffering, and even after treatment, they are likely to use again.
While relapse is certainly unpleasant, it is not necessarily a disaster. Relapse may be the only way a youngster discovers that he cannot control drugs, and sometimes it may take several relapses to get this point across. During this time, the parents need much help in coping with the problem.
It is understandable that parents may flagellate themselves. "What did we do wrong?" This is futile. Youngsters may opt for the high of drugs even if they had the most loving, caring parents. Instead of focusing on the past, the parents should accept expert guidance on what they should do now.
It is important for parents to become knowledgeable about drugs. What are the dangers of marijuana? What is Ecstasy? What is Oxycontin? When and how should I discuss alcohol and drugs with my children?
There is much reading material that can help parents become more knowledgeable about alcohol and drugs. The following books and pamphlets are available from The Hazelden Foundation.
Eight administrations have declared "War on Drugs," but drug addiction continues to rage in epidemic proportions. Billions of dollars have been spent on prevention, but at this point in time, no one can point to any single program as being effective in deterring use of alcohol or drugs. The best we can hope for at this point is early case identification and early intervention.
There may, however, be something that can be done to lessen the incidence of adolescent substance abuse. The problem is that there may be great reluctance to implement this method.
It has been suggested, inasmuch as the 12-step program is effective in the treatment of alcoholism and drug addiction, why not institute it as a preventive method? Why not have schools teach young people the 12-step program?
The answer is twofold. First, the primary teaching of a healthy life style should be in the home rather than the school. Teaching proper attitudes and behavior in the school may be adjunctive, but cannot replace the home.
Second, it is evident that the 12-step program requires change in life style, and perhaps even a radical change. Human beings are creatures of habit, and there is always resistance to change. The only reason an alcoholic or drug addict is willing to change is because he has reached a "rock-bottom." Things have become so painful and so intolerable that he has no choice other than to make the necessary changes to save his life. Prevention, by definition, means that nothing terribly upsetting has yet occurred. The only reason one should change is to avoid trouble in the future. This is not an adequate motivation. Many cigarette smokers are well aware that they are courting lung cancer, emphysema and heart disease, but inasmuch as they are symptom free at the moment, even the awareness of the most serious and deadly problems of the future does not deter them from smoking. Furthermore, immature adolescents are interested in the pleasure of the moment, and do not think about the future.
If children learned true spirituality at an early age, it is possible that they would be less likely to become addicted to alcohol, or drugs. Children do not respond to lecturing. They are much more likely to emulate their parents. If the home was truly spiritual, the children might absorb this in their development.
Spirituality in the home would require implementation, in daily life, of all the elements of a spiritual life. As important as religion is, if it is primarily ritual observance without spirituality, it will not be a deterrent to substance abuse. To model a spiritual life, parents would have to live their lives directed toward an ultimate goal and purpose. For a Torah-observant Jew, living a spiritual life means that everything one does, including all the daily activities of life, should be dedicated to the will of Hashem.
To have a truly spiritual home, parents would have to constantly be trying to refine their characters and eliminate character defects. Behaving disrespectfully to one's spouse or losing one's temper toward anyone are character defects which parents would have to eliminate. One parent asked, "Is it proper to apologize to a child? Doesn't that undermine the parents' authority?" If we want our children to admit a mistake and apologize, we must show them how it is done. If a parent lost his/her temper, it is appropriate to say, "I'm sorry I lost my cool. I'm going to try to control myself better when I get angry about something."
Children would have to see that their parents are uncompromising in honesty, and that they are truthful even when it is to their own hurt. Parents would have to manifest delay of gratification and a willingness to defy and resist desires when the latter are not of the highest morality and ethics. Children would have to observe prayer that is more than perfunctory, and is really a sincere devotion to G-d. Parents would have to show a willingness to sacrifice their own comforts for the benefits of others. The home would have to defy the hedonism of modern society and demonstrate that the family is dedicated to higher values.
Would such a home guarantee that the children would not become addicted? There is no guarantee. However, children raised in a truly spiritual home would be less likely to engage in self-destructive behavior.
Just as the addict does not make changes until he hits "rock-bottom," so do the community and family not make changes until they hit "rock-bottom." We can only hope that the awareness of the danger confronting our children should constitute adequate motivation to live a lifestyle that will lessen the likelihood of children turning to self-destructive habits.
Parents! There is no quick fix and there are no simple answers to the following commonly asked questions.
How can I tell if my child is drinking excessively or using drugs? If some warning signs are present, consult an expert in substance abuse treatment. Read the material recommended earlier in this essay.
What constitutes effective treatment? This varies. It will depend on the evaluation by a competent addiction therapist.
What can parents do to be helpful in a child's recovery? Attend family support groups, get competent counseling, and read the recommended material
What can parents do to prevent their child from abusing drugs/alcohol? Read up on effective parenting techniques. Make the home a truly spiritual home.
Modern society has diluted and even eliminated traditional values. The parenting techniques of previous generations may not be strong enough to enable children to withstand the temptations of modern society. If we realize the dangers to which our children are exposed, we can adopt techniques that will strengthen them so that they will be able to cope with today's challenges.