Adolescent Substance Use and the Problem of Denial

Neither teenager nor parents want to admit substance use should be a concern.

Posted Dec 11, 2017

Carl Pickhardt Ph. D.
Source: Carl Pickhardt Ph. D.

No matter how disorganized their lives have become, young people who regularly rely on substances to their costs do not usually self-refer for help.

Instead, they appear brazenly untroubled by their destructive use. Why? The answer is because of that “enemy in hiding,” denial.  Just listen to some of what such a young person might say to parents.

“I’m not acting any different than before.”

“You’re just imagining things.”

“I don’t have a problem.”

“It’s no big deal.”

“I can handle it.”

“I can quit any time I want to.”

“It’s not affecting how I’m leading my life.”

“If it makes me feel good, how can that be bad?”

“All my friends are doing it and they’re okay, so I am too.”

In response, parents can itemize eight dire threats in adolescence: of serious accidents, social violence, school failure, emotional impulsivity, sexual misadventures, daring risk taking, law-breaking, and suicidal despondency. And they can explain how all of these experiences are more likely to occur with substance use that alters mood and judgment and reactivity. For example, I believe many regretted first sexual experiences have been enabled by the use of alcohol or other drugs.

Explain how the safest path through adolescence is substance-free. “This is why you do not have our blessing to use substances.”

Denial is the intellectual act by which people discount or block out the evidence of their experience: the existence of a past hurt, of a current problem, or of a potential danger in their lives. As substance use becomes more serious, denial just gets more powerful with the young person stubbornly refusing to acknowledge how the need for, and effect of substance use is altering their life.   

In addition to lying to oneself (an example of denial), there can be lying to others to escape being found out. “The drugs you found snooping around my room aren’t mine. I didn’t know what they were. I was just keeping them for a friend.”  

So consider some quotes from a high school newspaper story I saw years ago about binge drinking. Some of the students interviewed were unwittingly open about their denial.

“I’m going to drink no matter what. We just have more fun when we drink.”

“I drove drunk because I needed to get home. It’s really not as hard as everyone thinks. I mean it doesn’t take a miracle to get you home.”

“Everyone’s done it at least once. After the first bad experience, I’ll quit. Besides, 16-year-olds don’t die. It just doesn’t happen.”

“I don’t think drinking is a big deal. Sure everybody does it every weekend, but it’s not out of control.”

“It would suck if something bad happened, but I’m not worried.”   

So, if the adolescent is denying a problem with substance use, what person is going to seek the help that is needed? Parents seem like the logical choice, except they are often in denial too. For example, they may decide to decide to ignore a dangerous accumulation of common warning signs that are often expressed through uncharacteristic changes in youthful behavior. For example:

  • When smart kids make stupid decisions,
  • When good kids act bad,
  • When truthful kids lie,
  • When mindful kids can’t remember,
  • When interested kids become indifferent,
  • When kids with little money have a lot to spend,
  • When capable kids fail,
  • When communicative kids shut up,
  • When open kids become secretive,
  • When nice kids act mean,
  • When considerate kids act exploitively,
  • When conscientious kids act carelessly,
  • When reliable kids default on their agreements,
  • When motivated kids start not to care,
  • When careful kids act careless,
  • When obedient kids break rules and laws,
  • When focused kids have accidents,
  • When honest kids steal,
  • When healthy kids become run down,
  • When responsible kids deny responsibility.

None of these changes individually is a guarantee of problem substance use, but over time a pattern combining a number of these behaviors should be cause for increased parental concern and attention.

In the words of one sorry parent, “We were part of a conspiracy of silence. We had our suspicions, but neither one of us wanted to speak up. We treated the problem like it would just go away, or like we hoped it would.” Why? The unhappy answer is admission can feel threatening “What parent wants to admit their kid is in trouble with drugs?” Parental denial can be based on fear.

They may fear helplessness: “How can we stop our teenager from using?”

They may fear personal responsibility: “Where has our parenting failed?”

They may fear social censure: “What will friends and family think of us?”

They may fear repetition: “How can I face having a substance-abusing teenager after living with a substance abusing parent?”

They may fear self-confrontation: “Suppose I have to question my own substance use?”

Denial doesn’t prevent problems, denial protects and protracts problems. It's best for parents to keep an open mind: “In a drug-filled world, problems with alcohol or other substances can happen to any teenager, including my own.”

The power of denial goes beyond initial blocking out. Denial by the teenager or parent, or by the collusion of both, can delay early recognition of the problem and the timely seeking of help. Admission takes time because denial must be overcome. And when the problem is finally confronted, denial can still delay full discovery because the teenager often understates the scope of what has actually been going on, while parents often underestimate the damage substance abuse has done. “Only the mattering of schoolwork was affected.”

What allows parents to overcome their denial? As more and more evidence of problem use accumulates, through a process of painful elimination of lesser possibilities, parents reluctantly become convinced that what they have long dreaded and rejected is actually true. How else to explain why all their well-intended speeches and strategies have failed to stem the flow of adolescent misadventures? The lies have continued, the promises have kept being broken, the troubles have mounted, the continuing crises have created constant stress, and at last one more misadventure becomes more than parents are willing to ignore.

They “bottom out.” They’ve had enough. They add up all the evidence again and reach the inescapable conclusion: their adolescent daughter or son is harmfully involved with alcohol or other drugs. Perhaps, with what they know, they have informally assessed the level of use going on:

  • Experimental use: trying a substance out of curiosity and deciding not to use it again.
  • Recreational use: repeatedly socially using for pleasure, doing so in moderation and not at the expense of normal responsibility.
  • Accidental excess: unknowingly using too much and suffering from the unexpected and unwanted consequences.
  • Intentional excess: intentionally seeking dissipation for the mood and mind-altering freedom (getting drunk or wasted) that overindulgence can bring.
  • Abusive use: regular and excessive consumption now lead to self-defeating, self-endangering, or socially harmful behavior, but the user does not care.
  • Addictive use: craving for use now couples with the compulsion to rely on habitual self-destructive substance use to survive. 

The bad news is that by the end of high school most teenagers have at least tried cigarettes, alcohol, and pot. The good news is that most use has been of the experimental and recreational kinds. However, parents must remain vigilant.

In the struggle between parental denial and admission, honesty born of desperation can win out. Seeking outside consultation, they might be told that while talking about experimental and recreational use with their teenager may provide sufficient self-management safeguards for the young person, from now on they must stay alert. And they need to have a teenager who remains open and comfortable discussing her or his use.

If, however, their interest is met with denial, and if the data they have suggests accidental excess, intentional excess, abusive use, or addictive use, parents should seek a qualified substance use assessment to determine whether counseling, out-patient, or inpatient treatment is advised.  

Because most denial is based on fear, their admission is an act of courage. But now another struggle is typically begun. Still in denial, the teenager resists what steps the parents are now prepared to take, and what help they are prepared to seek. Pleading contrition and promising reform, the young person begs for one final chance to get their life together.

“You’ve run out of all your second chances,” parents firmly explain. “We love you enough to see you get the help that you need, and that we need as well. After all, while choosing to use has been your responsibility, choosing to enable that use by looking the other way and hoping for the best has been ours.”

To keep their own emotional sobriety through a demanding parenting time, they may seek no-cost support like attending Al-Anon meetings for people who are striving to maintain adequate connection and detachment with a family member whose behavior is being substance-affected. (See your local community directory to find places and times of meetings.)

Parental delay is denial in a drawn-out form that can have a damaging effect. Like the young person admitted in so many words: “The longer they waited, the worse I got.”

Teenage substance use to the point of addiction, just like eating disorders to the point of addiction, can lead to life-threatening problems. Therefore, if as a parent you have curiosity or specific cause to want to know how complicated your decision-making can become and what to do, for starters this is what I recommend.

Read the recent book, “A Parent’s Guide to Teen Addiction” by Laurence M. Westreich, MD. “Love is a battlefield,” he says, when teenage substance use takes addictive hold. He tells you how to lovingly fight the good fight: “Always remember that substance use—not your teenager—is your adversary.”  

For more information about parenting teenagers, see my book, Surviving Your Child's Adolescence, (Wiley, 2013). 

Next week’s entry: Adolescence and Missing Childhood