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Part II: Genuinely Serious Teen Problems v. Those Most Likely to Be Outgrown and What to Do About Them

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Several massive industries and government agencies collaborate to terrorize parents about the prospects of their adolescent offspring. The Office of National Drug Control Policy, for example, wants you to believe, contrary to the scientific evidence, that marijuana is a gateway drug that will lead to heroin, that it is "not your father's reefer" and is now highly addictive and that it can cause mental illness.

When reporting on youth issues, the media focuses largely on sex, drugs and violence--using statistics selectively to obscure the fact that by all available measures (drug use surveys, teen pregnancy rates, overall death rates, suicide and homicide rates,) today's kids are doing better than their parents did.

Educational consultants, drug prevention and treatment experts, teen residential treatment providers all tend to stress to parents that their children are at great risk if they do not receive immediate residential care.

Fortunately, this is rarely true. So how's a parent to tell whether a child genuinely does have an addiction or behavioral problem that warrants residential treatment? The following summarizes what I've learned in nearly two decades covering addiction and mental illness and the research on the best treatments.

The first thing to consider is how long the problem has gone on. Difficult behavior that begins in adolescence is far more likely to be outgrown, with or without treatment, than disturbing behavior that starts in early childhood. With heavy drinking and other drug use, the vast majority of teen users stop or moderate by their mid-20s, whether or not they get help. The earlier heavy drug use starts, however, the more likely it is to be a serious problem. Most kids who start drug use before puberty or in very early adolescence have serious mental health problems and often have suffered trauma or abuse.

Two situations can call for some period of residential care for teens: daily use of substances that cause physical dependence like heroin and Oxycontin and any injection drug use. Daily cocaine or methamphetamine use--especially if the drugs are smoked or injected--also calls for serious consideration of residential treatment.

Parents should note, however, that less than 2% of high school seniors ever try heroin; less than 5% report trying methamphetamine, 13% report trying a prescription narcotic (and most of this seems to be teens getting left-over dental codeine once or twice) and 7% report ever using cocaine. The percentages reporting daily use of all of these substances are so low as not to be reliably measurable in surveys of tens of thousands of high school seniors. Even daily use of alcohol and marijuana is rare: just 5% of high school seniors report daily pot-smoking and 3% are daily drinkers.

Daily use of marijuana or alcohol--unless the drinking is so heavy that the teen will suffer withdrawal if suddenly stopped, which is extremely rare in adolescents-- is not sufficient to automatically require residential care. For less than daily substance use of any type without injections, outpatient family therapy and outpatient one-on-one counseling should be given repeated tries before residential care--or even outpatient drug treatment--is considered.

In fact, even with more serious drug use, if at all possible, it's best to start with the least intensive measures. One doesn't treat chest pain with an immediate heart transplant because the treatment might be riskier than the disease.

Teen behavioral treatment carries risks because concentrating misbehaving teens together, in and of itself, can do harm. Several studies have shown that grouping troubled kids together magnifies deviant behavior. Even short of the heroin injectors telling the pot-smokers where to buy hard drugs (and this does happen), the culture of both inpatient and outpatient rehab programs (see James Frey!) often glamorizes bad behavior and makes the "worst" kids into role models, no matter how much the program itself tries to minimize such problems.

Before doing anything else then, if at all possible, the first step parents should take is to get a full, independent psychiatric evaluation of the teen. More than half of adolescents with drug problems have another mental illness--often depression, attention-deficit disorder (ADD) or anxiety disorders--and if these go untreated, they are very unlikely to stop using drugs. Also, symptoms of mental illness like extreme mood swings or aggressive behavior are often mistaken by parents (and sadly, some treatment centers) for drug problems and obviously, addiction treatment will not help in such cases.

Parents often fear that treating conditions like ADD with medication might increase the risk for addiction, but the best studies suggest that just the opposite is true: treating ADD cuts the risk of addiction by 50%. Teens with untreated ADD are far more likely to self-medicate with illegal drugs than those who are given appropriate medication for the disorder.

To get your child evaluated, find the absolute best child and adolescent psychiatrist that you can: someone who is not affiliated with any residential programs, who has an excellent reputation and most importantly, who has a good rapport with teenagers. This is absolutely not the place to economize or choose someone in whom you don't have confidence because he or she is covered by your insurance.

Before you broach the subject with your teenager, try to find a moment when you are not in conflict with each other and really talk about what's going on with him. Say that you are concerned, that you want the best for him, express your love and affection. Then say that you'd like him to go in for what is essentially a mental health and behavior check-up and ask what his concerns about that might be.

Teens commonly fear two things: being considered "crazy" and stigmatized and being put on medications which will "control" them and make them robotic and compliant. If your teen has these fears, stress that you don't yet know whether or not there is any real problem--and that if there is one, treatment will give him greater control over his behavior, not less.

Also, emphasize that many people take illegal drugs to deal with mental and emotional problems--and that medications and talk therapies actually work better for those purposes. The goal of treatment is to make the teen feel better, not worse. If a treatment doesn't improve the teen's misery, reassure her that you'll keep searching until you find one that does.

What you want the teen to understand is that you are not trying to take away his or her fun or deny the things that make life bearable, but trying to offer ways of feeling good that are ultimately much more effective than the drugs or "acting out" behavior. The more you can ally yourself with the teen and see things from her perspective, the easier it will be to cope with the problem.

Part Three: Questions to Ask if Your Teen Does Need Residential Care