Are some adolescents at greater risk for serious alcohol problems? And, if so, how can they be identified and protected? These are central questions guiding assessment, diagnosis, treatment and alcohol prevention programs.
According to the DSM-IV (www.psychiatryonline.com), Alcohol Abuse Disorder is diagnosed when an individual indulges repeatedly in an alcoholic substance that impairs their occupational or social functioning. The key word here is "impairs." To be considered a psychological disorder, alcohol use must result in clinically significant impairment of social or occupational functioning. Right away we run into problems with this definition for teens. What is their occupation? What is expected of them socially?
Many problems arise trying to use the DSM-IV, the bible of the mental health community, to diagnose teenagers. First, the DSM-IV is designed on, written for, and clinically tested on adults. And, adolescents are different from adults in important ways. To begin with, adolescents are not fully grown. The very root of the Latin word, adolescere, means still growing. Adolescent brains and neurology are not fully developed. Teens are more impulsive and have less self-control than adults. They are curious and like to experiment.
For years, adolescent disorders have been assessed by using psychological instruments developed and normed on adults. These tools tend to "overpathologize" for teens. When I compared the same 18 year olds on the adult version of the MMPI, Minnesota Multiphasic Personality Inventory, to their profiles on the adolescent version, their adult profiles looked schizophrenic but the adolescent profiles were normal (Gumbiner, 1997). This is because different questions were asked for teenagers and different norms were developed. For example, it is normal for teens to seek out excitement, to like loud fun, and to experiment. This is important because for decades, teenagers have been diagnosed as having more serious problems than they actually did. Because the DSM-IV is based on adults, because adult psychological tools tend to overpathologize for teens, and because experimenting is normal for teens, it is extremely difficult to accurately diagnose adolescent alcohol use disorders.
Adolescents are different than adults. They are impulsive. They lack self-control. They like to experiment and all of these characteristics are normal in teens. Not surprisingly, teenage drinking patterns differ from adult ones. Teenagers typically drink less often than adults but will drink in heavy quantities, or binge drink (www.teens.drugabuse.gov). Their histories of alcohol use are shorter. And, many of them mature out of drinking on their own. So, understanding adolescent drinking requires understanding the maturational level (or lack of it) of each individual teen and adolescent development in general.
The course of adolescent drinking may take several directions. Probably, the most serious direction is an alcohol related injury. Accidents are the leading cause of death in teens. An intoxicated teen can cause a car accident and kill themselves or someone else. Also, due to their youth and short history with alcohol, they are not very judges of their degree of intoxication. Furthermore, due to lack of self-control, teens are more likely to get into alcohol related fights or date rape situations. Some teens will simply mature out of drinking but some will have life-long struggles with drinking. Is it possible to identify this group and intervene before the problem becomes overwhelming? This is the question, I plan to address in my next post.
Gumbiner, J. (1997). Comparison of scores on the MMPI-A and MMPI-2 for young adults. Psychological Reports, 81, 787-794.
