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We Need a Paradigm Shift

We Need a Paradigm Shift

Teen and young adult drug use is a growing epidemic and the way we have thought about teen drug use and when to refer to treatment certainly needs to be rethought. The view from many professionals working in law enforcement, school systems, health systems, and mental health systems is flawed and outdated with regard to understanding the illness of teen drug use. Many of these systems have views that are overly minimizing and hold prejudice about the severity of consequences which occur from one drug to the next. In addition, the magnitude and intensity of drug use that must be exceeded before these systems makes a referral to counseling is held far too high to allow for a more effective intervention. A paradigm shift has to occur.


I remember when one of my mentors talked about educating therapists in the 1980s about how teen drug users needed to be drug tested. He was scorned by the industry, yet had the courage to push on with his clinical truth. He was shifting their paradigm. What David Gust was offering in his talks was not the norm and certainly felt uncomfortable for everyone to even think about. His argument was that teen drug users lie—it is their way to keep the relationship to intoxication undetected and ongoing. Clinicians thought that drug testing would create an injury to the therapeutic relationship and the parent/child relationship. David’s implicit point was that when teens are actively using, their primary relationship is to intoxication and not to therapists and parents. Further, people with a relationship to intoxication lie, con, and manipulate to protect and cover up their relationship to intoxication. However, drug testing does not lie when protocol is conducted properly. While drug testing is the norm today, the practice and implementation of this tool started as an uncomfortable leap in the mindset of many.


In the mid-1990s, when I was working at a psychiatric hospital, a colleague and I spent two years talking to the staff about why drug testing should be a mandatory part of the process when a teen was admitted to the hospital. After two years of discussion, it was finally made (and remains) an automatic practice there, but it started with many false starts and hasty retreats by the doctors and administration.


In the early 90s and prior, it was thought that drug users could not be helped unless they “hit bottom” and wanted to be helped. Many families would call a therapist to get help for their drug-using teen and be told that, “Unless your teenager wants help, I can help him.” Today, it is widely recognized that it goes against the diagnosis for drug users, let alone teen drug users, to see their problem. Most of this is recognized as common practice, though sadly many parents and professionals still subscribe to the old belief. 


So many paradigm shifts have occurred by persistent leaders in the industry, yet we are still seeing a growing epidemic of teen drug use. While many shifts are still needed at the macro levels of understanding this issue, here are two shifts which can occur and need to occur now by anyone working with teens.


Paradigm Shift One 


We have to see the illness as a “pathological relationship to intoxication” and realize that teens are not hooked on marijuana or alcohol or heroin. We are more effective when we understand that the name of the drug teens are using is irrelevant because teens are not at all hooked on marijuana, alcohol, and heroin. Teens are hooked on intoxication and our own bias that one drug is worse than the other significantly gets in the way of anyone being effective when it comes to identifying and helping teens and slowing or reversing the epidemic of teen drug use.


What is getting in the way for parents and professionals working with young people is their own drug bias, which also gets in the way of intervening sooner and more effectively when it is discovered that a young person is using. I do the following exercise with many therapists when I am speaking at trainings and conferences, and I want to do it with you readers now. 


I want you to take a quiet moment and think about your own son or daughter. I want you to connect to your gut. Now I want you to hold that connection and think about how it feels when you get a call from the police and they say your child has just been busted at the park with alcohol. What does that feel like? How driven do you feel in the moment to mobilize and take action? Continue to stay connected. Now you get the same call, but the officer says your child has been busted with ecstasy. What is the reaction now? Your child has been busted with heroin. What is your reaction now? You see the visceral difference, don’t you? That is the drug bias that has to be removed. This is the paradigm shift: we have to see all drugs as harmful. Once a person forms a pathological relationship to intoxication, the symptoms and progression will all play out the same way. Certainly there are differences, but not enough.


Paradigm Shift Two


Referrals to outpatient programs need to happen the very first time it is discovered that a teen has used. When I lecture and train MDs, I am usually asked, “When should I refer a drug using teen to outpatient treatment?” My response is always “The very first time it is discovered they have tried alcohol or other drugs.” When I say this, the crowd usually thinks I am being intellectually tricky because this is a huge paradigm shift for most of them. I tell them that it is easier to prevent symptoms from progressing than it is to reverse them. Wouldn’t you agree?


Nine times out of ten when a teen shows up for outpatient treatment they have already been using for two years longer than the parents knew. You know those moments when a school finds that a teen has drugs on them, makes the referral to treatment, and the kid insists that it was their first use? That is just too statistically unlikely.


So I pose the following issue to MDs and other clinicians, and I’m posing it to you now. Your child has just been busted as having used once. He or she goes to an outpatient program or therapist who specializes in working with teens with these issues. In the outpatient process, your child is evaluated to truly examine their history of use, educated about the effects of the drugs on the developing brain, mind, social group, coping, and how those parts of the developing person become arrested. Your child then explores how use has already created consequences in his or her life with regard to family, school, health, mental health, sports, friendships, money, and other factors. He or she is evaluated to determine if there are any underlying issues as well.


Meanwhile, you are also educated about all of these things and learn to develop a home contract and to implement random drug testing. This process then crescendos to a family session or two where your child shares with you his or her entire drug use history and how it has created consequences in family, school, money, friendships, and other factors. Then you as parents share your perception of how it has created consequences too. Then the home contract is implemented and the family carries it at home from there. What I just described is about eight sessions. This is an investment of time, money, and emotion. Wouldn’t you rather have that for your child or a client? It is easier to prevent symptoms than reverse them, but sadly kids are not being referred to treatment until they are in a later stage of the illness when the referral should have been made at an earlier stage.


Please help me help our youth who are progressing in addiction and dying; whose families and communities are being destroyed by this epidemic. We have to move into at least adopting these simple yet new ways of thinking to be more effective in dealing with this problem. Finally, it is also true that we are either a part of the problem or a part of the solution. Let’s be the latter.