“I didn’t drink every day like a lot of my friends. But when I did drink I always did it to get drunk. Sometimes, I guess I was pretty funny, at least that’s what they told me. Sometimes I didn’t remember, except waking up the next morning with a headache that wouldn’t quit. But then I got the DWI [driving-while-intoxicated violation], and my parents found out. And then about all the other drinking. Who told them, I don’t know—maybe someone minding my business, maybe my friends? My folks had been preaching against my drinking for years, telling me stories about my dad’s brother and my mom’s mom, and all the damage drinking did. I wasn’t paying that much attention. What did they know? Then they pulled me up short. I was still getting some housing and living allowance, but they cut that off. That’s when they offered me this deal. Come back home, get my drinking assessed, and maybe go to treatment, or I would be on my own. So I came home.”
During trial independence, young people have the freedom to live away from home free from what parents can say, see, supervise, and know. But moving out creates a mixed blessing. Living on one’s own often feels lonelier and more disconnected than living at home, and older adolescents can find themselves desperately floundering to become socially established in a new setting. The combination of new freedom and new social urgency are what make trial independence a more impulsive age, the one during which substance use is most widespread and often heaviest of all.
As a parent, then, it is important to understand three challenges that late-stage adolescents face in managing safe substance use in a drug-filled world:
All substance use is about satisfying the desire for freedom—the freedom from negative feelings (escape) or for positive affect (pleasure). The problem is that this chemically induced freedom comes at a cost: freedom from sober caring.
With freedom from caring, as the young person becomes more drug- or alcohol-affected, he or she cares less; acts more careless; and in the extreme (drunk or wasted), feels free to think and feel and act as though he or she doesn’t care at all. The young person operates impulsively, abandoning what he or she would normally, soberly, care about. The rule of reason, principles, cautions, past lessons, and future consequences are of no concern. Only the moment matters. In this altered state, young people can make decisions that they (and maybe others) will later regret. Then, afterward, when the intoxication has long worn off, the young person is left to confront and pay the price of that drug-induced freedom. Like one young woman recalled a week after her drunken adventure: “It was a fraternity party. I was only caring about what felt exciting now. What could happen later never crossed my mind. But later has happened. I guess it always does.”
During trial independence, young people have a lot of opportunity to encounter substances, given the increase in parties that go on during this stage. Away from home, parties provide a social vehicle for hanging out, meeting people, acting more adult, and making new relationships. And this is where “get-to-know-you drugs,” particularly alcohol, come into play, providing the “liquid courage” to loosen up and feel less self-conscious and more confident about how one looks, how one acts, and what one says. It’s no fun partying while anxious. For many young people, substance use on these occasions feels required for the sake of personal comfort and fitting in socially. Partying, in fact, is also a term for situations in which excessive drinking behavior is to be expected. Hence the call to fun: “Let’s party!” For example, at college, excessive drinking can be generally encouraged in alcohol-fueled socializing, and in fraternities or sororities that celebrate pledging and initiations with a lot of drink.
For many young people, it is only toward the end of trial independence, around age twenty-three or so, with more structure and responsibility and maturity in their lives, that impulsive substance use starts to decline and moderate. Until then, the risk of harmful involvement is substantial.
As a parent, you need to be aware of how common substance use is during late adolescence (the high school years.) Some parents don’t consider this because they didn’t know that their child used substances even before leaving home. But in living apart from family during trial independence, young people are an open market for all kinds of illicit drugs or legal drugs illicitly obtained. So if a smart young person does something really stupid and gets into serious difficulty from poor judgment during trial independence, parents should always consider the possibility that substances were involved. Ask your child: “Had you or other people not been drinking (or taking drugs), would the same choices have been made?”
Whether it is before or after young people boomerang home, parents can help them understand substance use and its consequences by explaining the following:
And when it comes to alcohol, the drug that causes the most widespread human harm, parents can share these guidelines for safe drinking:
Freedom is the adolescent drug of choice. Last-stage adolescents want freedom from childhood restraints and for adult behaviors. Substance use is one way for them to achieve a state of freedom in which in the everlasting moment it feels as if nothing were forbidden and everything were permitted. Drugs are not just physically intoxicating; they are psychologically intoxicating. They create an instantaneous sense of limitless possibility for young people, at a time when throwing off and expanding limits is what adolescents most want to do.
But these new freedoms can lead to serious troubles. As a parent, you can listen for trouble signs once your son or daughter has moved away.
For young people who are just entering trial independence, combining alcohol or other drugs with more freedom and impulsivity, and with more loneliness and insecurity away from home, can provide a recipe for problematic substance use.
Take the case of a girl who hadn’t gone to many parties in high school and mostly abstained from alcohol, but had been swept up in the party scene when she got to college. (Most colleges do not curb drinking by their underage students.) One nervous night, she drank too much too fast. According to what little she remembered afterward, a resident assistant in the dorm probably saved her life. Hearing her vomit and then seeing the dangerous shape the girl was in, the RA called 911. An ambulance arrived and took her to the hospital, where she was given fluids. Then she was transferred to a detox facility, where she was monitored and kept overnight for observation until her blood alcohol level returned to normal. Hopefully, this was a severe enough wake-up call for the young woman to understand that alcohol can be not only a social lubricant, a stimulant, a depressant, and an intoxicant but also, in sufficient amount, a deadly poison.
On campus or off campus, in school or on the job, the three to five years after high school are a period of extremely heavy and varied use of alcohol and other drugs that disorganizes the lives of many young people. The alcohol- and drug-related problems during this stage are legion.
How largely do substances loom over this age? Think about it this way. There are ten dire risks for adolescents to which parents must be alert:
Eliminate the last of the ten risks, and you dramatically reduce the incidence of the other nine. Adolescence is, by definition, a risky process during which young people are eager to try more “worldly” experiences. Substance use only increases those normal risks. A sober path through the last stage of adolescence is the safest of all.
These risks can be elevated for young people who are already taking prescribed psychoactive medication for anxiety, depression, mood swings, distractibility, or impulsivity. For young people who already rely on mood- and mind-altering drugs to cope, emotionally or otherwise it can seem natural to add recreational substance use to the existing mix to improve functioning, lessen discomfort, or increase pleasure. If your child is in this situation, before he or she leaves home, you need to make sure that the prescribing physician has given your child adequate information about the varieties of harm that additional substance use can do. Of course, parents also want to give their adolescent information about their own history with substance use and what their experience has to teach, explain how they currently manage to moderate or abstain from use, and disclose any cautionary tales about how substance use has affected members of the extended family to whose lives the young person can relate.
Any time parents find out that their last-stage adolescent has had a dangerous experience with substances, they need to make sure that a bad experience has taught a good lesson about avoiding such a dangerous experience again. For example, if your son or daughter is arrested for drunk driving, he or she must face all court-decreed consequences, and you must hold him or her responsible for any legal costs, deny him or her use of a car, obtain a qualified assessment of his or her alcohol use, and ensure that he or she follows recommendations for treatment help. These can be times for parents to impose a time-out from college or living away and bring the young people home to get some help assessing the dangers of their substance use. Serious incidents can be a sign, to quote Alcoholics Anonymous, that “life has become unmanageable.”
So what are some signs of problem substance use parents can look for? Here are some uncharacteristic changes to look for:
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 parental concern. When problem substance use brings a young person home, parents should assess that use to determine whether treatment is needed.
If your son or daughter is in college and encounters substance problems, there are sources of student assistance (advisers, the dean’s office, a health center, a counseling center) to which he or she can turn. Late-stage adolescents working a full-time job do not have ready access to such help, but they do have one protection— they are more anchored in real-world responsibility. Skip a day of class because you’re feeling hung over and you may miss some course content, but skip a day of work and you can lose your job. Having to make a living carries a more sobering weight of reality than does making grades in college. But in either case, young people during trial independence often aren’t good judges of whether they have a problem. Thus, it is very important for parents to help them assess a potential problem and get help if needed.
Before they can convince their son or daughter to get help for substance use, parents have to convince themselves that possibly having a substance problem in the family, though painful to admit, is OK. They need to know that it happens in the “best of families” all the time. So there are two counseling steps that are helpful to take. In both cases, finding a certified alcohol and drug counselor is a good place to start. This type of counselor can help determine where on the continuum of use the young person is:
The further along this continuum of use, the more problematic the use becomes.
To begin addressing a potential substance abuse problem, first parents can get counseling to assess their concern, help direct their efforts, take care of themselves, and learn how not to make the situation worse. Second, parents can have their son or daughter assessed to see whether substances are disorganizing his or her life significantly enough to warrant professional treatment.
Although convincing parents to seek counseling can be difficult (as they are admitting to a family problem they cannot solve alone), taking the step toward getting treatment can be harder still. Feeling defensive, parents may ask themselves: “What does it say about us to have a child enter treatment?” The answer is, “That you care enough about your child and your family to get the help you need.”
What is “treatment”? Substance abuse, and particularly substance addiction, can adversely affect all areas of young people’s lives:
To combat such pervasive and deeply habituated self-destructive behavior is usually more than most parents, even with the aid of counseling, are able to accomplish. They are not up against a problem with a single cause, but one that has many contributing factors:
To effectively deal with extreme substance abuse or addiction, a more powerful mode of help is required, and the name given to that help is treatment. The purpose of treatment is to provide a group therapeutic program designed to help young people do the following:
Types of treatment vary. The most intensive and expensive is inpatient care—in a hospital or residential program. The least intensive and expensive is day or evening outpatient care. Somewhere between these two types of treatment strategies are therapeutic communities and halfway houses. Choice of treatment will depend partly on the severity of the young person’s need and partly on what parents are able to afford.
Upon what does a successful outcome of treatment most depend? Probably the most important variable affecting how well a program works is how hard the young person works at the program being offered.
The advantages of inpatient hospital treatment include the following:
If medical attention is not required, however, then residential treatment may be a good choice. Inpatient hospital and residential care programs have the following advantages:
This last component can be very important, because young people’s behavior while abusing substances can seriously strain their relationships with family members. A treatment program that addresses these strains can help restore the family to healthy functioning.
A major advantage of outpatient care is that programs do not remove young people from their social and family worlds while working on recovery; patients remain actively engaged with those daily demands. There is no problem of reentry into social reality, which goes with the return from inpatient care, and young people can bring the challenges of coping with the daily stresses and temptations of normal life into treatment and resolved them there.
With all types of treatment, having realistic expectations is important. Here there is both good news and bad. The good news is that most substance abuse problems can be significantly helped. The bad news is that most problems on the level of substance addiction are more intractable, with a far higher likelihood of relapse, or returning to use after having given it up.
For addicted young people, treatment is neither a quick fix nor a sure cure. No responsible program guarantees an end to addiction. “Once addicted, always addicted” is the reality that young people must come to accept and understand. For addiction, treatment can be the beginning of a slow, long process of recovery, as young people are given a chance to stop and consider and learn and change their addictive ways. Then, with ongoing support and continuous effort, they can come to live a full and satisfying drug-free life.
When treatment, aftercare, or halfway-house time is over, the question is, Will the chemically dependent young person remain substance-free on his or her own? In too many cases, the answer is no. Going it alone can risk relapsing to substance use, because the power of old habits and the lure of old companions can prove too strong to resist. What young people need, to translate treatment into lifelong change, is ongoing support to continue recovery.
Fortunately, that support is widely available at no cost, thanks to Alcoholics Anonymous (AA) and other self-help groups modeled on the AA program, such as Al-Anon (for family members of an alcoholic or drug-addicted family member), Cocaine Anonymous, and Narcotics Anonymous (for other drug use). (To locate any of these groups in your own community or nearby, consult a telephone or Internet directory.)
These self-help groups for various kinds of addictions create a fellowship of people, from all walks of life and with varying years of sobriety, who are trying to live healthy and rewarding drugfree lives one day at a time. By studying group literature, attending meetings, following a twelve-step recovery program, and having and being a sponsor, members come to help themselves by helping one another, as everyone learns from the exchange about the ups and downs of recovery. Because addiction is so cunningly self-defeating and psychologically complex, most affected individuals need experienced guidance to recover. The twelve-step group can provide a source of invaluable understanding and support, reinforcing the principles of collaboration to cope with human problems: “None of us is as smart as all of us,” or “Times of trouble are no time to walk alone.”
The AA program has worked well for many people and has helped them abstain from alcohol and recover a drug-free life by helping them in the following ways:
Al-Anon, a twelve-step recovery program originally for spouses of alcoholics, provides a forum in which parents and other family members can get necessary support and understanding to cope with their substance-addicted child or other family member and to free themselves from four fateful errors:
Twelve-step programs do not work for everyone, nor are they the only self-help groups available to provide support. As of this writing, however, Alcoholics Anonymous and other twelve-step programs are the most widely available and time-tested. Which kind of support group should you use? The answer is whichever one works best for you.
What is clear is that if a substance-abusing or addicted young person comes home having created unmanageable circumstances out in the world, parents should insist that to stay in the home, he or she must do the following:
As for themselves, parents usually benefit by going to Al-Anon to get the support and understanding they need to provide healthy, nonenabling parenting during what can be a very difficult return.
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