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Drugs and Child's


Few illnesses bring more fear to a parent than alcoholism and drug abuse. But unlike other disorders that can also be devastating to a child and his or her family, addiction feels particularly confusing - and somehow personal.

Where did we go wrong? How did she use all this time without us knowing? Where did he even get the drugs?

Okay, I’m ready to accept that what happened; so can I help, or am I going to make things even worse?

For other physical and mental illnesses, parents routinely turn to medical specialists for advice and expect guidance and typically follow the experts’ recommendations. The very process of charting a course of action with a doctor has significant therapeutic effects for both the child and the parents. Unfortunately, we have come to expect much less from the medical community when it comes to the prevention, diagnosis, and treatment of substance use disorders.

On one hand, we don’t trust that we know all that much about the illness itself. Both science and popular culture keep shifting their opinion on the “true” cause of addiction. In the 1960s and the 1970s, it was all about parenting; in the 1980 and the 1990s, we woke up to the monumental discoveries of genetics; and during the past decade, we have

been greatly attracted to co-occurring psychiatric disorders including posttraumatic stress disorder, bipolar disorder, attention-deficit hyperactivity disorder, and autism. Recently, family system considerations for both prevention and treatment have resurfaced, bringing us full circle to the world of our parents. Scientists now know that what causes one kid to get drunk and another to stay sober is rather complex. A number of interrelated biological, psychological, and social determinants affect the pleasure, reward, motivation, and memory brain neuronal circuitry leading to impairment in behavioral control, craving, and diminished recognition of significant problems in one’s life.

On the other hand, there are very few medical doctors with the appropriate training to address substance use among children and adolescents. The American Board of Psychiatry and Neurology has certified less than 250 psychiatrists in the subspecialty of addiction psychiatry over the past 10 years. Our texts will be straightforward answers to every parent’s questions about preventing, identifying, and treating substance abuse and dependence.



(16) Drugs & Child’s

The Impact On Children Who Parents Are Alcoholics Or Drug Addicts


What do you mean by tolerance and withdrawal, especially for children?

Withdrawal from drugs, despite chronic use, is rare in adolescents, further supporting the cognitive distortion that a drug is not addictive. Adolescents who have developed a tolerance for a drug will report to me that they have to use more often and usually at increasingly higher amounts to achieve the same high. Many adolescents, however, do not see this as evidence of dependence. In some cases, they will eventually graduate to other drugs to achieve the same effects. Tolerance has some physiologic basis. The body, in particular, the receptors-molecular messengers in the brain-have been modified (such as an increase in numbers) such that the adolescent needs more drugs to occupy those receptors to achieve the same physiologic effects, or that secondary messengers that need to increase in amounts to achieve the same effects have developed.

Also, withdrawal has a physiologic basis in that brain receptors have been occupied long enough that removing drugs from them will cause a change in their configuration, thereby causing characteristic negative physical experiences. Presence of either tolerance or withdrawal, or both, defines what is called a physiologic dependence. This is contrasted from loss of control (obsessive preoccupation) and the need to use without the necessary physiologic change. Known as psychological dependence, this dependence is manifested as craving or loss of sense of control over use. When this occurs, other drug-seeking behaviors are seen, like stealing money from family members, selling family possessions to buy drugs, drug dealing, and worse, prostitution.

 Withdrawal from drugs, despite chronic use, is rare in adolescents, further supporting the cognitive distortion that a drug is not addictive.


Physiologic dependence - Changes in chemical messengers as evidenced by tolerance and withdrawal. Results from longstanding drug use.

Can you explain the 12-month period as part of a diagnosis?

Although a diagnosis of substance abuse or dependence is based on meeting the criteria for 12 months, adolescents can have significant problems even before reaching the 1-year cutoff. In cases where the full criteria are met except for the time criteria, a provisional diagnosis can be made.

Do drugs affect adolescents as they do adults?

What makes drug use in adolescents particularly troublesome is the rapid change and growth that an adolescent’s brain is undergoing. Because of this, the brain of an adolescent is more sensitive to the effects of drug and alcohol use. As mentioned previously, peak prevalence of drug use is from ages 18 to 29 years, making the adolescent stage a critical period of vulnerability. Animal studies involving rats exposed to alcohol levels simulating adolescent alcohol consumption showed alterations in dopamine in the nucleus accumbens, as well as changes in sleep patterns even after only brief exposure to high alcohol levels. The human brain has its own natural cannabinoid receptors. Based on a review of the available data, it is postulated that cannabis exposure during adolescence disrupts this system that affects the release of other chemical brain messengers, causing increased risk of disordered thinking, or psychosis.

Adolescents who use drugs regularly suffer impairments in psychosocial and academic functioning because they have very limited coping skills to fall back onto. The sequelae of drug use is what we see when they become adults as they continue to present with these problems.

How is a drug abuse or dependence diagnosis made?

The psychiatric interview remains the cornerstone of diagnosis and evaluation and has implications in treatment planning. The immediate goal is to determine whether the adolescent has used a single psychoactive substance or a combination, and whether abuse or dependence exists. A comprehensive evaluation also addresses the presence of coexisting psychiatric conditions and establishes whether psychiatric symptoms are direct results of psychoactive substances or exist in combination with other psychiatric disorders. This entails a robust knowledge of epidemiology, phenomenology (descriptions of illnesses), and course of psychiatric disorders. To illustrate this by looking at ADHD and substance use disorder, a differentiation is based on establishing symptoms of inattention, hyperactivity, and impulsivity before onset of substance use. ADHD typically begins before the age of 7, and symptoms can be seen as early as kindergarten. In some cases, children are observed to be very hyper even during preschool, and I have encountered some who have been denied admission to day care. It is likewise important to establish a synthesized history from multiple sources. Information should be obtained about the student’s functioning in school, relationships with peers and friends, and how he or she manages his or her leisure time.

Be patient and plan for these psychiatric evaluations to take a long time so that you can have a better hold on what is happening with your child.


(17) Drugs & Child’s

Causes of Substance Abuse & Addiction


Are any other tests involved in the drug abuse diagnosis process?

Use of structured and semi structured interviews helps further describe the extent and severity of substance use and its impact in multiple domains. Remember the CRAFFT and CAGE questions? There are also more extensive questionnaires that have been used both in physicians’ offices and in research. For individuals who have complaints other than substance use, routine questions surrounding substance use and use of screening questionnaires avoid omitting an otherwise important coexisting condition. Once one is screened and drug abuse is found to be significant, a more thorough evaluation can be made. A drug use screening inventory screens multiple domains and identifies youth in need of further assessment. Self-reported and self-administered instruments are available in paper-and-pencil or computer-assisted versions. The Addiction Severity Index was used to create adolescent screens such as the Adolescent Problem Severity Index, the Adolescent Drug Abuse Diagnosis Instrument, and the Teen Addiction Severity Index. Other measures include the Adolescent Drug Abuse Diagnosis (ADAD), Adolescent Diagnostic Interview (ADI), and Diagnostic Interview Schedule for Children (DISC), and Teen Addiction Severity Index (TASI). Self-administered tests include the Minnesota Multiphasic Personality Inventory-A (MMPI), Personal Experience Inventory (PEI), Personal Experience Inventory (PEI), Personal Experience Screening Questionnaire (PESQ), Problem Oriented Screening Instrument for Teenagers (POSIT), Drug Use Screening Inventory-Revised (DUSI-R), and Substance Abuse Subtle Screening Inventory (SASSI).

These questionnaires may not be routinely used by practitioners because they rely more on a clinical interview. These inventories increase reliability of subsequent psychiatric interviews. In addition, some of these scales can be read ministered to determine improvements or positive response to treatment over time.

 It is true that brain images (through CT scans and MRIs) can detect damage from drug use?

Although brain images can be used to detect brain conditions where there are structural changes, like masses or tumors, these tests are not used primarily to arrive at a psychiatric diagnosis. They are, however, extensively used to advance research in substance abuse. In fact, the use of functional imaging (seeing how the brain works in real time) among live volunteers has given us a better understanding of which parts of the brain are involved in addiction. The part of the brain that is strongly implicated in drug abuse involves the same circuitry (connections) that also underlies the things that make us feel good or drive us to feel better. These are the nucleus accumbens and ventral tegmental area.

 Is drug abuse or dependence considered to be a brain disorder?

Yes, but saying this is in no way minimizing the contributions of family and social factors that interplay with the biology of addiction. Advances in the way we image the brain and even look at how the brain works among live research participants have opened up remarkable theories and postulates on how addiction works. The studies done through the National Institute of Mental Health established functional and chemical changes in the brain resulting from drug use.

 What parts of the brain are affected?

There are a number of brain areas that are implicated in drug use. Two brain regions are most commonly associated with the reinforcing effects of drugs: the nucleus accumbens and the ventral tegmental area. Neurons made up of dopamine project from the ventral tegmental area to the nucleus accumbens, forming the central mesocorticolimbic dopamine system. They then project into the deeper areas of the brain (limbic system) to the amygdala and hippocampus. These areas are responsible for memory stores of emotionally laden stimuli. They also project into more superficial surfaces (the cortex) of the brain, which are responsible for how certain stimuli in the environment become more prominent. This explains the phenomenon of craving. Expectedly, these are also the same areas that are involved when we talk about the things that normally make us feel happy-when we get satisfied from food or eating chocolates, when being greeted by friends or families, or when watching our favorite programs on TV, listening to music, or having downtime with our families.

What changes for drug addicts is the way these usual sources of happiness become less reassuring, and drugs take a predominant role in these individuals. Addictive behavior is very much a part of the context of drug-seeking behavior. This is illustrated by cues in the environment that remind one of drugs to the extent of causing craving with psychological and bodily manifestations. Relapse has already started even before the resumption of use; that is, when individuals have experienced craving, they have relapsed

 Relapse has already started even before the resumption of use; that is, when individuals have experienced craving, they have relapsed.

 Guia’s comment:

I now know that addiction really causes brain changes. I grew up in a family where responsibility and choices were important. It is a matter of strong will and character, so if you are weak, you are more likely to use drugs. I realize now that it is not that simple. Having read and seen brain images with drug effects, I know that drugs affect the brain not only in how it functions but also in how the chemical messengers are altered. I am more realistic in dealing with my son’s cravings.

 Is there any brain messengers involved in drug use?

Yes. The most commonly implicated brain chemical messenger (neurotransmitter) is dopamine. This is the same chemical that lights up the brain when we eat chocolates, when we get praise, or feel happy being with friends. This is also involved with sexual satisfaction. Other chemical messengers and receptors (where the chemical messengers bind to exert their effects) include gamma hydroxybutyric acid, serotonin, nicotinic and cholinergic receptors, and the N-methyl-D-aspartate systems.

 How is drug testing done?

Monitoring of body fluids for the presence of substances is an important adjunct to treatment. Blood samples or gastric contents are tested during acute intoxication and in emergency room settings. Urine toxicology is more practical and is widely used to monitor response to treatment. Immunoassay techniques are useful screening tests, followed by gas chromatography/mass spectrometry for confirmation. Quantitative assay is useful to track reuse within a defined period of time. Immunoassay is a biochemical test that involves measuring a property of the drug to be identified, called the analyte, to determine its presence or concentration. Assays are based on the ability of a substance to bind to the analyte, and an immunoassay can be qualitative or quantitative. A qualitative measurement consists of a sample without the analyte and one with the lowest concentration detectable, and a quantitative measurement requires references of known quantities. Positive screening tests are then confirmed by gas chromatography/ mass spectrometry. This procedure is considered the gold standard as it is a very specific test for the presence of a particular drug. They work synergistically to identify the substance compared to when either used separately.

Gas chromatograph utilizes very fine columns through which different substances (drugs) pass through. Based on their intrinsic properties, these substances will travel along these tubes at varying elapsed times. The mass spectrometer will then capture these molecules and break them into charged (ionized) fragments which are then quantified. Because “dirty” urines have far-reaching implications, sample collection is important. The following are suggested:

1. Removal of access to articles that promote adulteration (removal of articles of clothing used for concealment, water fountains, etc.)

2. Minimum of 60 milliliters (2 oz.) to prevent short sampling

3. Proper labeling and identification of sample

4. Proper documentation of the chain of custody

 Random serial drug testing gives an objective measure of the individual’s attempt at his or her sobriety. In addition the testing serves as a deterrent to relapse. The aim is for the adolescent to eventually incorporate this sense of control as his or her own personal tool.

Hair sampling is not commonly used, but it is more sensitive and can detect drug use as far back as 3 months. Saliva and sweat can also be sampled.





(18) Drugs & Child’s

Drug Addicted Children- Documentary


When someone becomes dependent on drugs or alcohol, the whole family is affected. Whether it's relationships, trust, money, marriage or children, drug or alcohol addiction touches every part of an individual's life.

I heard that kids could do something to make the sample read negative. Is this true? How is this detected?

You’ve probably heard that adolescents drink a lot of water to dilute the urine thinking that the drug test will then be negative. For the most part, what can more likely adulterate urine samples and render false positive results is what is added to it at the time of collection. Adulteration of urine samples generally fall into three categories:

 (1) Urine substitution;

(2) Ingestion of fluids to dilute the sample or interfere with the testing process; and

(3) Direct adulteration of the sample itself. A pragmatic approach is to time urine sampling with random collections.

A number of drugs are pH dependent, with excretion hastened when pH is lowered. Thus, consumption of cranberry or vinegar produces more of the drugs in the urine. Ingestion of large amounts of vitamins C, B, niacin, and goldenseal has been shown to be completely ineffective by various studies. Addition of sodium chloride, sodium bicarbonate, hydrogen peroxide, bleach, alcohol, blood, and soaps has been shown to produce false positive and false negative results. Obtaining samples can be stringent, and there are certain protocols that are followed to include one-on-one monitoring. Colorants may be placed in toilet bowls to make sure that samples are not adulterated by toilet water. Samples tested for legal purposes follow a chain of command that must be adhered to.

There are means to detect adulteration in the laboratory, including the following:

1. Urine appearance and color-Alcohol, soaps, and bleach are readily identified by odor. Soaps cause excessive bubbling. Solid adulterants are seen as residues in the container.

2. Creatinine level-The creatinine level is normally greater than 40 mg/dL; less than 20 mg/dL is abnormally diluted; this leads to false negative results.

3. Specific gravity-The level of specific gravity is normally between 1.002 and 1.030 g/ml. Extremely low specific gravity suggests dilution whereas a high specific gravity indicates dissolved solids.

4. pH level-The pH level is normally between 4.8 and 7.8. Low pH suggests acidic substances like cranberry juice and vinegar were ingested. Elevated pH suggests basic compounds like sodium bicarbonate and bleach were added to the urine.

5. Detection of temperature-Within 4 minutes of collection, the sample normally yields a temperature of 32.5 to 37.7°C. If it doesn’t, it has probably been altered.

How long do drugs stay in the body? Is it true that marijuana stays in the body for about a month?

Cutoff levels for different drugs are established by individual laboratories to match analytical and client needs. For a test to be reported as positive, drugs must meet the threshold concentration, which is greater than the limit of detection, also known as sensitivity, and usually greater than the limit of quantization, the lowest level of accurate quantization. Results are not reported as “negative,” as this implies absence of drug being tested.

Laboratories do not test down to a level of zero. “None detected” means that no drug is present or the drug is present but below the threshold concentration. Detection of drugs in the urine is dependent on a number of factors including variability of urine specimens, drug metabolism and half-life, patient’s physical condition, fluid intake, and method and frequency of ingestion.

Marijuana can stay in your body for about a month if you are a regular user. A single use of marijuana may only persist for 4 days, such that urine testing after that time can have a negative result. It is customary to have urine samples tested up to a maximum of 4 days of interval in between tests to reliably detect use. Adolescents often comment that they have only smoked marijuana once but that it will stay in their bodies for weeks. Marijuana gets stored in body fat, and prolonged storage is only through repeated use over longer periods of time. In addition, quantification gives a good time line of use and estimate of use in the last 30 days.

 Rachelle’s comments:

Kids would tell me that weed stays in the body for thirty days. Even for someone who had smoked a blunt only once, he or she will not stay positive for longer than a week. Persistence of the drug for at least thirty days with cessation of use indicates a pattern of regular use. The level of the drug that is present gives a good estimate of last use. This helps me to determine whether my son is forthcoming about his use or not.


Threshold concentration - The level of drug in a sample that meets or exceeds a preestablished cutoff level. A sample with a level above this concentration is said to be positive.

Limit of detection - The lowest level of drug at which an instrument is able to determine its presence.

Sensitivity - The proportion with which the presence of a drug is correctly identified in drug testing.

Limit of quantitation - The lowest level of drug at which its presence cannot be reliably determined

 What are the usual drugs for which one is tested?

 The usual toxicology test includes tests for opioids, cocaine, and cannabis.

 Can I use an over-the-counter screening kit?

 Parents have reported using these kits and find them helpful. The kits will test for the following: marijuana, cocaine/crack, amphetamine (Ritalin, Dexedrine), methamphetamine (crystal meth), and morphine/opiates (heroin, codeine).

 My son said he uses weed but he also tested positive for opioids and PCP. He insists he is not using them. Could he be telling the truth?

Occasionally, urine drug tests will be positive for both cannabis and opioids. During an interview, adolescents may repetitively deny that they are abusing heroin or opioids. This can also be attributed to cannabis laced with opioids, which is not their drug of choice. Sometimes, adolescents report heightened aggression or paranoia with cannabis intoxication. This can be attributed to cannabis laced with PCP. As PCP is not routinely tested, this is not regularly documented in reports unless there are strong reasons to also screen for it.

 How will I know if the drug test results are accurate?

 Screenings depend on the cutoff for each particular drug tested, which is determined by federal standards. Once a specimen has been declared positive, it can be subjected to further confirmatory tests, which are at least 99% accurate. Thin-layer chromatography is highly specific for a particular drug being tested.

You may have heard adolescents who had tested positive say that they were with a group of kids who were using and that they did not smoke but inhaled the others’ smoke second hand. There is no evidence that this would result in a positive urine test. Studies have simulated a situation where individuals who did not smoke but were placed in a closed car with other individuals who smoked marijuana were tested, and they were found to have negative urine drug tests. I often hear this from adolescents as an excuse for positive test results while in treatment. It is simply not the case.

 Once a specimen has been declared positive, it can be subjected to further confirmatory tests, which are at least 99% accurate.

 What are other drug tests?

Serum toxicology (blood samples) is also used, especially in emergency room settings. Other tests include breathalyzer tests used by law enforcers, and less commonly used tests involving hair and saliva. The U.S. National Highway Traffic Safety Administration has considered breath alcohol devices approved for evidentiary use with results admissible in court. A word of caution: These tests are used in conjunction with other physical evidence like being able to walk on a straight line and good coordination.

I remember taking this test with my supervisor and a recent mouthwash gargle made my test positive!

 What about alcohol strips? Can these be useful?

Parents of individuals in a day program who use no drugs other than alcohol have found alcohol strips helpful as a deterrent for relapse. As alcohol is not routinely tested, some individuals will even change their drug of choice from marijuana to alcohol to escape detection of drug use. Alcohol strips use saliva to detect presence of alcohol. Concentration of alcohol in saliva compared to blood is almost 1:1. A vendor has claimed sensitivity is up to 0.02% (



(19) Drugs & Child’s

BBC: Addiction - Afghanistan's Secret Shame


Does drug treatment really work?

It is encouraging that most interventions are effective. Large-scale studies demonstrated efficacy in terms of drug use reduction, criminality, and improved overall functioning. A very important aspect of treatment is the attitude of treating clinicians. Dealing with adolescents who have abused drugs creates special challenges and strong reactions even from treating providers, which can make treatment difficult at the outset. For the adolescent, this is particularly difficult, as engagement in treatment is significantly more erratic and dictated by outside forces.

The Cannabis Youth Treatment study evaluated then effectiveness and cost-effectiveness of five short-term outpatient interventions for adolescents who used cannabis.

Treatment included Motivational Enhancement Therapy, Cognitive Behavioral Therapy (see Question 86), family education and therapy components (Family Support Network), an adolescent community reinforcement approach, and Multidimensional Family Therapy. Six hundred cannabis users also had other substance use, legal issues, and family issues. All five interventions demonstrated significant effects by decreasing drug use. The most cost-effective interventions were Motivational Enhancement Therapy, Cognitive Behavioral Therapy, and the adolescent community reinforcement approach.

In 2009, another study large study demonstrated efficacy of treatment of substance abuse among adolescents with ADHD. This is very encouraging, as the study involved screening of 1334 youngsters, of whom 300 were included in the study. The study covered 11 sites across the country.

To make the study as authentic as possible, it addressed the need to include as many individuals who are usually in community settings as possible in addition to those individuals who were only seen in hospital and study settings. As parents know, it is particularly challenging for adolescents to get engaged and be retained in treatment. Compliance of individuals in this study proved to be excellent-even better than those in the Cannabis Youth Treatment study. Because parents have expressed concern that stimulants can be abused, the Osmotic Release Oral System (OROS) methylphenidate (Concerta) was chosen to be used in this study because it is proven to have a good safety profile with a low abuse potential. Emergent side effects are usually mild and transient.

 Melissa’s comment:

I am more hopeful for my child. It’s been difficult to even find help for my daughter. I don’t know anything about drugs, or at least I didn’t before we all got help. The professionals gave me options and, of course, I have done my own reading.

There are treatments that specifically address the needs of my child and at the same time, help us to cope with her problems.

A very important aspect of treatment is the attitude of treating clinicians.

What is the goal of treating my son?

 The goal is achieving and maintaining abstinence from drug use. Risk factors are identified, and areas of concern in psychopathology, social skills, family functioning, academic and school functioning, and involvement in prosocial activities stress the multidimensional approach to treatment. Treatment is therefore aimed at improving overall psychosocial functioning in addition to resolution of symptoms. It is important to assist him in fulfilling his developmental roles and expectations. As treatment can be on a longer term, his needs have to be met in the least restrictive level based on need.

What are the features of treatment facilities that I should look for?

Characteristics of treatment facilities should be intensive and sufficient enough to achieve changes in attitude and behavior; the duration of treatment depends on the severity of problems. There are ways to engage adolescents and retain them in treatment. Aftercare follow-up should be provided; this serves as a means to further help adolescents in applying learned skills once they are back in the real world. This also allows for extending the duration of treatment to support longer term sobriety. The program should be as comprehensive as possible and target psychosocial dysfunction in multiple areas. This includes treating coexisting psychiatric disorders; addressing vocational and educational needs; and providing recreational/leisure time activities, birth control services, and information about substance use/medical issues, particularly HIV/AIDS. In a number of situations, this may initially be the reason to hook youths into treatment. Facilities should also be sensitive to cultural issues; there are certain challenges that are particularly important to certain groups (Hispanics, Asian, African Americans, people from the Caribbean, those with issues of religion and spirituality, Anglo Saxons, etc.). They must encourage family involvement, which is a key component, especially with adolescents. I emphasize that parents need to be involved and know what is going on with their children’s treatment, as not knowing what is happening can be used to undermine the treatment.

Parents should form part of the individualized Relapse Prevention Plan that will be developed during treatment. Parents should feel at ease so that monitoring and checking their kids should come as naturally as possible. Lastly, facilities should have access to social link to additional services, especially during the aftercare planning.

Once an addict, always an addict. Is there any truth to this statement?

There is truth to this, which can be viewed as a double-edged sword. Some can view this in a negative way such that no recovery is possible. In order to be helpful in maintaining sobriety, one must believe recovery is possible. This is a reminder that individuals need to be vigilant and always on guard for any early relapse signs so that use or a full-blown relapse can be avoided. It is also important that following treatment, parents continue to be part of their child’s sobriety through constant monitoring for any recurrence or early warning signs, which parents should have learned during their child’s treatment.


Are there other things issues that should be addressed?


While medication has a role in treatment, it must be combined with counseling and skill building. This is particularly important as your child starts to hang out with his or her friends again, especially when it comes to learning to assert oneself. It is likely that he or she will have difficulty avoiding those who smoke weed or use drugs. Adolescents will need to be able to refuse drugs if offered, and even assert themselves to their friends and asking them to respect their sobriety by not using in their presence. Lack of problem solving, communication and interpersonal skills, and self esteem are, by themselves, identified as triggers for drug use that can be improved to lessen the likelihood of relapse. Ways to improve some of these skills are described in manuals or how-to books, though of course, improving these skills is facilitated by trained counselors. High-risk situations (situations that increase the likelihood of drug use) can be rehearsed in role plays so that ways to deal with these situations can be anticipated.


(20) Drugs & Child’s

 Drug Abuse Education - It's a Fact!


How do I know how much treatment my child needs?

Interventions need to be responsive to your child’s needs. Levels of care depend on intensity of treatment services and supervision. These include inpatient treatment, residential treatment (group homes, therapeutic communities), partial hospitalization, or day treatment and outpatient treatment with or without community treatment (self-help groups or self-support groups). The American Society of Addiction Medicine has placement criteria for adolescents that take these variables into account during a comprehensive evaluation.

Duration of treatment is determined by likelihood of a successful transition to a lesser restrictive setting. Outpatient treatment is the least restrictive level whose treatment is time limited and focused. This usually involves a single or limited combination of treatment modalities.

Community treatment includes school-based programs and self-help groups such as Narcotics Anonymous (NA) or Alcoholics Anonymous (AA), which are important adjuncts to treatment. Self-help groups are available for families and friends (Al-Anon, Parents of Teenage Alcohol and Drug Abusers), which provide support, psycho education, and modeling to reduce maladaptive enabling behaviors of parents, families, and friends.

 Lito’s comment:

 For my son, Stanley, being in a residential program stopped his drug use. He was using a lot of cough medications and got involved with legal problems. It was difficult for me to even consider that he had to go to a drug program. He was away from us and his siblings missed him. I believe now that he needed his own time alone to grow up and mature. He is now more confident and looks forward to going home, and I also feel more confident in helping him keep his sobriety.

 What is a day program?

A day program is an outpatient program that is usually considered when your child’s needs cannot be met by simply attending weekly individual or group counseling.

A day program consists of providing milieu treatment (the setting becomes a driving force of treatment, with a built-in behavior plan), in addition to a number of group, family, and individual therapies. Certain programs also provide psychiatric treatment, with medication monitoring in particular. Day programs may either be after school or for a full day, depending on how intensive the needs are or how compromised the adolescent’s functioning has been. For example, if the adolescent has been missing classes, has had multiple suspensions, or is failing in school, a full-day program is justified.

Parental involvement is key to the success of this program.

Parents have to make use of the behavior modification to effect positive changes in their child’s behavior.

This is an expectation that I always discuss with parents at the outset. Due to mounting frustration, parentshave the tendency to expect providers to treat their child without the parents being involved, and this is a limiting problem that has to be addressed.

 When should I hospitalize my child?

 The American Society of Addiction Medicine criteria have been modified to meet the needs of adolescents for placement purposes. Criteria for receiving inpatient treatment include:

 1. Controlled environment for persistent running away

2. Separation from a problematic family environment so that crisis stabilization can be made in an inpatient setting

3. Increasing intensity of treatment when lower levels of care are not sufficient

4. Severe and clinically significant psychiatric conditions involving psychosis, suicidal or homicidal behavior, or acutely dangerous behavior

5. Risk of withdrawal problems Adolescents with severe personality maladaptive patterns, inadequate psychosocial supports, and history of treatment failures are appropriate candidates for residential treatment.


 Day program - An intensive outpatient treatment program that relies heavily on milieu as its defining treatment, combined with behavior interventions, and group, individual, and family therapies

 Parental involvement is key to the success of this program

 How many adolescents have been treated in hospitals?

 In 2006, there were 2.1 million youths aged 12–17 (8.2% of this population) who needed treatment for an illicit drug or alcohol use problem. From this, only 181,000 youths received treatment at a specialty facility (approximately 8.7% of youths who needed treatment), leaving 1.9 million youths who needed treatment for a substance use problem but did not receive it at a specialty facility.

Specialty treatment is defined as treatment received at any of the following types of facilities: hospitals (inpatient only), drug/alcohol rehabilitation facilities (inpatient or outpatient), or mental health centers. It does not include treatment at an emergency room, private doctor’s office, self-help group, prison, or jail.

In 2006, approximately 7.7% of the drug/alcohol admissions to treatment facilities in the United States involved individuals ages 17 and younger. Significantly, marijuana abuse ranks as the highest reason for admission at 61% of those admitted younger than 15 years and 65% of those admitted between 15 and 17 years. Alcohol abuse and alcohol abuse with secondary drug abuse is responsible for 7–12% of those admitted. Two to four percent of admission was accounted for by methamphetamine use.

Edwin’s comments:

I realize that sometimes, hospitalization is necessary. My son Bobby was depressed and using drugs and I didn’t know which one was driving the other. He was so depressed that

he could not take care of himself, but he continued to use. The doctor recommended hospitalization to stabilize him, and I would have lost him without it. The hospital staff has been helpful. After that, he came back to the day program and continued to move on.


 Specialty treatment - Treatment received at any of the following types of facilities: hospitals (inpatient only), drug/alcohol rehabilitation facilities (inpatient or outpatient), or mental health centers.







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