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We’ve Got A Problem

If your child is a smoker, if you’ve caught them drunk more than once, if they’re openly flaunting any type of substance abuse or if they’ve made recreational intoxication a matter of routine, you’re family has a problem. This behavior signals an ambivalence, a recklessness, that is only going to get worse as your child ages into the late teens and young adult years. When kids ‘take the plunge’, by committing themselves to the social cliques, recreational activities and pop-culture values of the party crowd, they take their life on an entirely new track. The ultimate destination is failure. Although it takes some people decades to get there, it is quite common for this long journey to be tattered by disappointment, lost potential, failed relationships, and unnecessary hardships.

Like it or not, you’ll be going along for this ride. So regardless of how they got there, your job will be to help force them away from this dark trajectory. If you believe them when they say that they’ve got it all under control, just consider the lives of Lindsay Lohan, River Phoenix, Heath Ledger, or Brittany Spears. These examples had access to all the help and attention that money could buy, but their defiance and dependence ultimately turned their once dreamy lives into the stuff that nightmares are made of. Your kids need your help. If you don’t realize it now, it may be too late before you do. Ignore those who scoff that you are overreacting. The statistics are too ominous and the stakes are too high. Let the others live in denial.

It goes without saying that your monitoring efforts will have to rise to meet this challenge. The principles and techniques described in Preventing Substance Abuse and Detecting Substance Abuse will help you accomplish that. Simultaneous to installing those measures, however, you will have to present your child for a substance abuse evaluation. A good place to start is with your Medical Insurance Company. Contact them and clarify what coverage is available for substance abuse counseling. If you don’t have medical insurance, it is highly likely that your county government provides financial aid through the Office of Drug and Alcohol Dependency. (This agency may exist under a different name in your state.)

When you present your child for a substance abuse evaluation, the clinician will attempt to determine if patterns of abuse or addiction are present. To do this, they rely upon the Diagnostic and Statistical Manual of Mental Disorders (DSM). We’ve cited the actual manual below, but basically an “addict” is defined as someone who has developed a tolerance for a substance and who would experience withdrawal symptoms upon cessation of use. A “substance abuse problem”, is found to exist if someone continues to use a given substance, despite having knowingly exposed themselves to danger, or having repeatedly suffered negative social or legal consequences for it.

Substance abuse counselors are subject to the same vulnerabilities as those in other professions. You never really know what you are going to get. Most of them are terrific. Some of them are over-extended and under-resourced. If your child has a poly-drug problem, or if they cannot / will not stop using, you would be well advised to push for an inpatient detox and rehabilitation program. Whatever the ultimate prescription, you should also consider family counseling. Very often, substance abuse issues are accompanied by emotional or family structure issues within the home. Group programs like the “Strengthening Families Program” have established a good track record in helping families regroup from problems like this.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). A clinician will review the patient’s past 12-months of behavior, and determine if either of the following two categories of abuse exist:

Alcohol Abuse involves one occurrence of the following:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).
2. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)
3. Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct)
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).

Alcohol addiction involves three or more of the following occurrences:

1. Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance.
2. Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
3. The substance is often taken in larger amounts or over a longer period than intended.
4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
7. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).(1)

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1. American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington D.C.: American Psychiatric Association. (pp. 181-183)