Clean: Overcoming Addiction and Ending America’s Greatest Tragedy
By David Sheff
David Sheff is the author of Beautiful Boy and his son is the author of Tweaked. David was also a Drake parent. His son has been an addict since his days as a student at Branson, and is currently five years sober. It has been a long and difficult struggle, but father and son are now working on a book together.
Drugs now kill more people than any other non-natural cause. (Throughout this book, when the author speaks of drugs, he includes alcohol.) Drugs are involved in from one-half to three-quarters of all incidences of violence, including child abuse, spousal abuse, homicides, rape and close to 100 percent of date rapes.
Whole families and whole peer groups have been devastated by drug addiction. Kathleen Kelly, professor at Colorado State University, sent David a photo of her son and his two friends. All three boys are dead of overdoses (by the age of 24).
Much of the prevention and treatment efforts have tailed because they focus on drugs themselves, as opposed to the root causes of drug use – stress, trauma, mental illness or some combination of these factors. Addiction is looked at in the book through the lens of disease, prevention and treatment.
When kids use drugs, their brain chemistry makes them more susceptible to using, and drugs impede the maturation of the prefrontal cortex, further slowing the development of the brain.
A University of Pittsburgh study, cited in the NYT, noted, “The average adolescent is exposed to approximately 84 references to illicit substance use per day and 591 references per week, or 20,732 references per year … studies have long shown that media messages have a pronounced impact on childhood risk behaviors. Generally, drug and alcohol use in media is associated with wealth or luxury. The more kids see drinking in movies, the more likely they are to binge drink. The message kids get is that smoking is cool and drinking alcohol is normative behavior. They feel that everyone is doing it.
A major issue with dealing with addiction is that no one in the medical community likes addicts. The stigma associated with addiction – that bad kids use, good kids don’t, and those with full-blown addiction are weak – has contributed to the escalation of use and hampered treatment more than any single other factor.
Teenagers are far more likely to engage in risky behaviors when surrounded by other teens, and far less likely to do so when an adult is present. Many are using less as a form of rebellion and more as a way to chill out and manage the increased stress and demands that teens face today compared to teens 20-30 years ago. For the socially awkward, drugs serve as a social lubricant. For the lonely, drugs provide an avenue into a social group.
While drugs can cause impotence and other problems related to sex, many users associate drugs with sex and rely on them to lift their inhibitions. (At Drake, many students engage in sexual activity only while under the influence of drugs.)
A 2012 study conducted by National Institute on Alcohol Abuse and Alcoholism found a high rate of childhood trauma in adult alcoholics in residential treatment. Of those studied, the prevalence of emotional abuse was @ 21%, physical abuse @ 31%, sexual abuse @ 24%, emotional neglect @ 20% and physical neglect @20%. If one parent is a drinker the child’s chances of becoming a heavy drinker increase 2-3 times.
Children with ADHD and/or other mental illnesses are far more likely and susceptible to use marijuana and cocaine as kids without ADHD or other mental illnesses. Research at the University of New South Wales explained that smoking pot not only increases the risk of mental illness but also brings the illness on earlier. Cannabis users with psychosis say they smoke for the same reasons as nonpsychotic people; and the more you smoke, the greater the risk, and the earlier you smoke the greater the risk. The link between using pot and developing serious mental illness is strongest in the youngest smokers – 12-15 year olds. Although the vast majority of people who use pot never develop psychosis, some lives are devastated by it, as drugs are used both to self-medicate and to escape the mental anguish.
Offsetting risk factors: the suggestion is a network of approaches; family-based, school-based, and community-based prevention. The combination of programs has been shown to be more effective than one along. FAMILY DINNERS are once again cited (as in all research on any effective parenting for any adolescent problem) as an effective strategy in combating use and addiction. Teen who don’t eat dinner with their families five to seven times a week are twice as likely to have used alcohol; 2-1/2 times likelier to have used marijuana; twice as likely to have friends who use illegal s substances, prescription drugs without a prescription or over the counter meds to get high.
9 out of 10 people who become addicted began using before they were 18; a person who gets to age 21 without using is virtually certain never to do so (and only one in 20 of those who start using after the age of 21 become addicted). The goal of prevention strategies should be preventing all use, but it’s also valuable to delay use as long as possible.
Ask these questions and then listen, listen, listen:
· Why might you decide not to drink or use drugs?
· What kind of things are important to you?
· What kind of person do you want to be?
· How could using drugs keep you from doing those things or becoming the person you want to be?
Drugs compromise kids’ social and emotional development – those who haven’t used by the time they reach college age are more likely to have learned how to handle stress, failure and disappointment. Kids need to be taught healthy ways to cope with stress, channel their impulsivity, navigate challenging social situations, and get high in healthy, rather than destructive, ways.
Research shows that computer time can hurt. Facebooking teens are more likely to use, according to a CASA study of 1000 teens between 12-17. Banning social media may seem draconian, but experts say that it’s reasonable and advisable to limit time spent online and playing video games. Kids who were heavy gamers (30 hours or more per week) were shown to be more likely to use drugs than moderate players, more likely to be depressed, anxious and have social phobias (all of which contribute to drug use).
Schools can maintain a higher number of PE and art teachers, and counselors, as exercise, creative expression and emotional support are more important to kids’ well-being than AP courses. Schools can evaluate their priorities and put programs in place to protect kids. The SFUSD survey reported that students who participated in wellness programs used fewer drugs and drank less alcohol. Other programs, like early childhood centers and programs focused on health, healthy behavior and substance prevention have likewise been shown to lower use.
Escalation of Use: experimenting means you try something two or three times. More than that is using. After that, there is no clear demarcation between using and abusing. Casual users can easily become abusers or addicts. The fifth edition of the DSM essentially eliminates drug abuse as a stage separate from addiction. Anyone who uses drugs in spite of harmful consequences has a substance-abuse disorder and is an addict, on a scale from mild to moderate to severe.
Common signs of abuse and addiction: kids become sullen, withdrawn, depressed, unusually tired, silent, uncommunicative, hostile, or deceitful. They are usually less motivated and more lethargic. Or hyperactive. They frequently break curfew, drain money and avoid eye contact. They’re often sneaky, locking doors, hiding conversations or being vague about where they spend their time. They may experience sleeplessness or sleeping way too much; unexplained disappearances; loss of interest in things they used to enjoy or care about; complaints from teachers or coworkers, frequent sickness; sudden or dramatic weight loss or gain; and the disappearance of prescription or over the counter pills, alcohol, money or valuables. Pay attention to these warning signs. If you think your kids are using, they probably are.
Good grades, athletic achievement and participation in school activities is not a guarantee that teens will not become addicts or enjoy the thrill of drugs use. Becoming a drug addict tends to sneak up on teens. They don’t think it’s coming, they don’t see it coming, and they are certain they can handle it. They are wrong, more often than not.
Addicts Aren’t Weak, Selfish, or Amoral – They’re Ill
Illness is something that requires treatment. If you feared your child had cancer, you would get her/him immediate treatment. Drug use is an illness and requires immediate treatment. There are long-lasting and measurable changes in the brain from drug use. Heavy drinkers and pot smokers are altering their brains without an awareness of the long term damage being done. Many addicts don’t understand that they are ill because the same part of the brain that’s damaged by the disease is the part that’s responsible for self-awareness and self-analysis.
Don’t Deny Addiction, Don’t Enable It, and Don’t Wait for an Addict to Hit Bottom – He Could Die
By allowing kids to continue using, parents enable it and unwittingly encourage it to advance. But getting clean is traumatic, because then you have to deal with all the issues that led to use in the first place. Inpatient programs are generally more helpful than outpatient because it is difficult for users to be the friends, neighborhood, and pressures that led them to use in the first place. Parents are only allowed to force their children into rehab until they turn 18. It is a small window of opportunity, especially if you have waited and waited while your child uses. Relapse prevention is addressed, but relapse is also accepted as a part of the process of sobriety.
There is evidence that pot can trigger depression, schizophrenia and other serious mental illness; and impede emotional and physical brain development in children at precisely the time they’re supposed to be maturing.
Appendix: Just Say Know – this chapter is really the best one in the book in my mind, as there is so much good information. Everyone – especially teens and their parents – should read it.
Alcohol use (over 60% beginning prior to the age of 18) is addressed. Binge drinking as a rite of passage during high school is addressed. Alcohol is suspected in half of teen suicides. There is a large body of evidence that shows that when people are high, they can’t concentrate well, don’t learn well, they can’t remember well, and have slowed reaction times. And those who start when they are younger consistently have poorer outcomes in the long term than those who start later, or not at all. Teenagers with drug problems will not be ready for the adult roles … they will chronologically mature while remaining emotional adolescents.
When David Sheff was at Hazelden Adolescent Center, he was informed that 90 percent of patients from 15 to 19 years of age who were pot smokers had been diagnosed with co-occurring psychological disorders. Regardless of physical or psychological addiction, more adults and adolescents are now admitted to treatment for primary marijuana addictions, than heroin, cocaine or hallucinogens, according to the Substance Abuse and Mental Health Services Administration.
Posted by Sheila Souder on 3/6/2017