Teen Substance Use II

Assessing Level of Use

The more frequently an adolescent uses drugs or alcohol, the more likely school performance will be adversely affected by the non-caring state such substance use creates. Many failing attendance and achievement problems in high school are really substance use problems in disguise.

When parents have evidence that their teenager is using substances, they need to try and estimate the level of use with which they are dealing. What follows is a description of six categories of use for parents to consider, from least to most serious.

Level One: Abstinence

How can abstinence be a substance use problem when by definition no use is involved? First, there is a difference between ignorant abstinence and informed abstinence. Having your teenager not use alcohol or drugs in adolescence is well and good, but what happens after high school when he or she, off in an apartment or at college, enters the period of maximum substance use? Ignorance is no good protection should the young person now choose to use. At worst, suppose you send an ignorant, abstinent adolescent off to college to join a sorority or fraternity, organizations with well-deserved reputations for heavy social drinking? Suppose you've never done your disciplinary job of instructing the young person about strategies for safe drinking should he or she ever choose to use? Informed abstinence means parents, in addition to cautioning against use and appreciating the teenager's compliance, have also been informing their child's understanding about substance risks and safe alcohol use in family discussions since early adolescence.

Second, some teenager's believe they are abstinent, when they are not. When prescribed psychoactive medication for anxiety, despondency, mood swings, or impulse control, for example, they have become prescribed substance users. This means that any additional use of recreational substances is not a good idea because it may adversely interact with, or reduce the helping power, of medication that has been prescribed. Whoever prescribes this medication needs to make very clear to the adolescent what risks are associated with other substance use.

One abstinence question parents commonly ask is: "Is it okay for my abstinent child to be a "designated driver?" No. A "designated driver" is responsible for driving "designated drinkers." It's not safe drinking and driving. It's not safe being driven by a drinking driver. And it's not safe driving around drunken friends. Nor should your child have to assume responsibility for the behavior of intoxicated friends.

Level Two: 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. After all, an early adolescent can try getting drunk on anti-freeze and kill himself.

You can tell your child that experimenting with a substance is really experimenting with her self. 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 Three: Recreational Use

If your teenager is using a substance with regularity, smoking pot or drinking alcohol when hanging out with friends on weekends, 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 Ecstasy where the chemical mix is unknown because it is unregulated, and the dose is often a surprise.

Second, the use is monitored. Monitored use means that sufficient sobriety is maintained so that your teenager maintains awareness of the effects of use on mind and body, thereby knowing when she has had enough and 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 sober reflection will cause them (or others) to later regret. Recreational using means stopping when one has had enough.

Level Four: 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 often have 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 drinking and feels disinclined to drink that much 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, for example, offers. 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. 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.

Level Five: Abuse

Once a teenager descends into substance abuse, discipline problems get more frequent and serious. 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 dependency between the two signs of abuse can now occur. Lack of caring encourages bad decisions, bad decisions are dismissed by lack of caring, and lacking of caring encourages more bad decisions.

At this time, an assessment of use by a certified drug abuse counselor should be sought. 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.

Level Six: Addiction

The most serious level of problem substance use is addiction at which point the teenager has become compulsively 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 will need help to stop.

This is when in-patient or outpatient treatment is advisable. 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, most young people have had experimental, recreational, and occasionally excessive experience with alcohol or drugs. The good news is that most young people do not abuse alcohol or drugs, or become addicted.

Remember, the best way to have drug-free kids 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 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.

One test you can self-administer: if your own alcohol or drug use is not a problem, then you should have no problem giving it up for six months. If you do have a problem living alcohol or drug free, then your substance use may be a problem. When in doubt, cut use out. Which matters to you more: your substance use or your family?

© Carl Pickhardt Ph.D. 2003. For permission to use this article, contact the author.