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.
Term:
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.
