Assessing level of teenage substance use

When teenage substance use occurs, parents must assess the problem.

Posted Apr 12, 2009

Any use of psychoactive drugs is dangerous because their mood and mind altering effects change normal caring, judgment, and perception. Now the young person's decision making becomes more impulsive, unwise, and potentially harmful.

What kinds of harm? Just consider the Eight "Deadly" Risks of which parents are most afraid for their adolescent: Victimization from violence, Accidental injury, School failure, Illegal activities, Sexual misadventures, Daring risk taking, Suicidal despondency, Drug and alcohol involvement. Eliminate the last of the eight risks, and you dramatically reduce the incidence of the other seven.

Adolescence is by definition a risky process during which young people are eager to try more worldly experiences. Substance use only increases these normal risks. A sober path through adolescence is the safest passage of all.

When parents have evidence that their teenager is using substances, they need to identify the level of use with which they are dealing so they do not overestimate or underestimate the seriousness of the experience. Overestimate the seriousness and they can panic over what was one-time experimental use. Underestimate the seriousness and they can deny troubling signs of increasing dependency. What follows is a description of five levels of use for parents to consider, from least to most serious.

Level One: EXPERIMENTAL USE. Experimental use is about using to satisfy curiosity - to see what taking a substance feels like.  If your teenager explains that she is only a weekend user of marijuana the last three months and is just "experimenting," tell her that such frequency of use is no longer experimental, it is recreational.

Experimental use is limited to one or two times.  Sometimes a teenager will experiment, find out what the drug experience is like, satisfy curiosity and have no further desire to use that substance again.  "I dropped acid once, and that was enough to convince me not to do it any more." 

Of course, experimental use is not necessarily safe use, and the younger the age, the less safe it can be. After all, an early adolescent who tries inhaling household solvents to get high can damage his brain. A "good" experience can have a bad outcome.

You can tell your young person that experimenting with a substance is really experimenting with her self.  She is gambling with her safety because she has no way of knowing how her mind and body will react.  She is literally experimenting with her wellbeing, putting herself at risk of an unknown experience and then, for good or ill, waiting to discover the outcome. No two people react exactly the same way to any psychoactive substance.  So just because it was a "great experience" for a friend does not mean your child will find the same is true for her.

Level Two: RECREATIONAL USE. If your teenager is using a substance with some regularity, smoking pot or drinking alcohol when hanging out with friends on weekends or at parties, for example, then she may be a recreational user if two conditions for recreational use are met.  First, the use is moderate.  Moderate means that use is causing your teenager no problems in her own or in anybody else's eyes, and those eyes include your own. 

Conditions for moderate use include knowing the contents of what you are using and being able to meter out a controlled dose.  This is easier to do with alcohol than a street drug like marijuana where the chemical content is unknown because it is unregulated, and the dose is often a surprise.  Moderate means that use is intentional, not automatic. It is a matter of choice, it is not dictated by habit. And moderate use means that the choice is independently made, and not dependent on socially fitting in, going along, keeping up, or competing for most use. Second, the use is monitored.  Monitored use means going slowly. This way your teenager maintains sufficient awareness of the effects of use on mind and body to judge when she needs to have no more.

Substance use takes the alcohol user, for example, from a caring (sober) to a less caring (high) to a completely care-free (drunken) state. Recreational drinkers draw a line somewhere been a caring and non-caring condition that demarcates when enough has been consumed.  They want to use within the limits of maintaining contact with the values and judgments about personal behavior that normally matter to them.  They don't want to cross over the enough line into a significantly less caring or non-caring state where words can be spoken, decisions made, and actions taken that later sober reflection will cause them (or others) to regret.  Recreational using means maintaining sufficient presence of mind to stop when one has had enough.    

Level Three: EXCESSIVE USE. Sometimes accidentally, sometimes intentionally, a teenager will get "completely wasted" or "extremely drunk." It's important for parents to determine if the excess was accidental or intentional.  Accidental excess comes as a surprise, and the effects can have a cautionary value.  Thus a teenager, who never drank "hard" liquor before, drinks so much so fast he bypasses feeling drunk, passes out, and is rushed to the hospital which pumps his stomach out as part of their intervention to prevent alcoholic poisoning. Coming to, the teenager reflects on the fact that he almost killed himself by accidental excess and, when making the best of a bad situation, feels disinclined to drink that much that fast again.

Intentional excess is another matter.  It can be a very alluring state to adolescents because of the total freedom from normal care (freedom from restraint, freedom for acting crazy) that getting really drunk or wasted offers. For adolescents particularly, the sense of liberation, of complete letting go, can be a state much to be desired.  "Nothing matters and anything goes" as one college fraternity member described it, who wore his hangover the next day like a badge of honor, accepting jokes from his fraternity brothers about his drunken exploits the night before, some of which he remembered and some of which he didn't. Mostly he remembers competition drinking, drinking to keep up with his companions, drinking more thany anybody else.

Anytime you have a teenager who likes to drink to get drunk, you have a problem drinker on your hands. If he or she is running with a "drink to get drunk" crowd, do what you can to discourage that socializing. Using or drinking to deliberate excess is a common bridge to the next level, substance abuse.

Level four: ABUSE. Once a teenager descends into substance abuse, discipline problems get more frequent and serious at home, and academic motivation and performance typically decline at school.  The first sign of substance abuse is a significant loss of caring about performance, values, reputation, and relationships that previously mattered.  Now freedom from not caring has taken hold.  And now the second sign of substance abuse appears. Increasingly bad decisions - educational, familial, and social - begin to be made.  For example, school may be skipped, lies may be more frequently told to parents, and problems with police may happen as laws are broken out in the community.  

Unfortunately, a connection between the two signs of abuse can now occur. Lack of caring encourages bad decisions,and bad decisions are dismissed by lack of caring. Now lack of caring encourages more bad decisions.  Most teenagers who reach the level of abuse do not self-correct without some outside help.  Most parents cannot effectively play a role in this assistance without getting some outside help for themselves as well. Continued substance abuse can lead to addiction.

Level five: ADDICTION. The most serious level of problem substance use is addiction at which point the teenager has become dependent on a self-destructive substance to survive.  The number one priority for the young person at this point is doing whatever it takes to maintain the destructive habit that feels life sustaining. 

Two kinds of dependencies have now become established.  There is psychological dependence, some signs of which are denial, compulsion, and escape.  And there is physical dependence, some signs of which are tolerance, craving, and (should use be suddenly stopped) withdrawal.     

Sometimes parents misunderstand the power of addiction.  "If you could start using, why can't you just stop?"  The answer is because the decision to start using in the first place was mostly under the teenager's self-control, but by the time he has descended into addiction, power of dependency has taken the decision to stop "on his own" mostly out of his self-control.  Now he has become compulsively wed to the habit and will need help to stop. 

This is when self-help, twelve-step groups like Alcoholics Anonymous and Narcotics Anonymous usually have a role in supporting sobriety and guiding recovery into a healthier drug-free life.  This is when parental support from another twelve-step group, Al-Anon (for those living with an addicted member of the family) can be invaluable, helping them maintain emotional sobriety so they can support their child in constructive, and not enabling, ways.

The bad news is that by the end of adolescence,in the early to mid twenties, most young people have had experimental, recreational, and accidental excessive experience with alcohol or other drugs like marijuana.  The good news is that most young people do not abuse alcohol or other drugs, or become addicted.

In general, where experimental, recreational, and accidental excess occurs, parents must insist on adequate two-way communication with their teenager to determine circumstances of use, choices made, effects experienced, risks taken, and what parents need to have happen now. Where intentional excess occurs, parents should get their teenager to a certified drug or alcohol counselor to assess risk of more serious substance involvement. Where abuse or addiction is evident, drug counseling or treatment is probably in order.

Remember, one of the best ways to help kids remain drug-free is to have drug-free parents - parents who either don't use, or if they do, do so in a moderate and responsible fashion. The worst enablers of substance-abusing children I have seen are substance-abusing parents who don't want to take any stand against their child's use for fear of exposing and endangering their own.

Should you have some concern about your own or the other parent's use (of alcohol, for example) and are sometimes in doubt when one of you goes over the "enough line," there is a test you can self-administer to make sure. If your alcohol or drug use is not a problem, then you should have no problem giving it up for six months.  If you are unable to live alcohol or drug free for this period of abstinence, then your substance use may be a problem.  

What to do? When your substance use is an intermittent or ongoing problem for you or members of the family, get it checked out. After all, which matters to you more: your substance use or your loved ones?

For more anout parenting adolescents, see my book, "SURVIVING YOUR CHILD'S ADOLESCENCE" (Wiley, 2013.) Information at: www.carlpickhardt.com

Next week's entry: TALKING TO YOUR TEENAGER ABOUT SUBSTANCE USE.