SEPTEMBER2002

Are youth with severe emotional and behavioral problems at greater risk for abusing drugs?

Several studies have documented that youth with severe emotional and behavioral problems are at increased risk for abusing legal and illegal substances (another term used for drugs). In a system of care brief (Holden & Santiago, 2002), 10th graders with a DSMIV diagnosis were significantly more likely to use drugs than their non-diagnosed peers. Youth with diagnoses of conduct disorder, depression, and impulse disorders have higher rates of comorbidity with substance abuse than those with other disorders. Other risk factors for substance abuse-besides diagnoses-include physical and sexual abuse, witnessing violence, and a family history of substance abuse.

The substances most apt to be abused by all youth are cigarettes, alcohol, and marijuana (64%, 55%, and 45%, respectively). Hallucinogens (LSD) and inhalants were used by 21% and 14% of youth who used an illegal substance besides marijuana. There seems to be a strong correlation between certain diagnoses and an increased risk for the abuse of certain substances: 

• Posttraumatic stress disorder and marijuana/ hard drugs (cocaine, LSD)

• Conduct disorder and alcohol/cigarettes/marijuana

•  Impulse control and marijuana

Gender, age, and race/ethnicity are significant factors in whether youth with a diagnosis abuse substances and what kind of substance they are most likely to use.

The Diagnostic Criteria (DSM IV) for Substance Abuse 

A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following occurring within a 12-month period: 

1. recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household) 

2. recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) 

3. recurrent substance-related legal problems (e.g., 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 (e.g., arguments with spouse or parents about consequences of intoxication, physical fights)

The Diagnostic Criteria (DSM IV) Substance Dependence

A. A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: 

1. tolerance, as defined by either of the following: 
a. a need for markedly increased amounts of the substance to achieve intoxication or desired effect b. markedly diminished effect with continued use of the same amount of substance 

2. withdrawal, as manifested by either of the following: 
a. the characteristic withdrawal syndrome for the substance b. the same (or a 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 was 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 (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), 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 or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance 

8. current cocaine use despite recognition of cocaine-induced depression, or continued drinking 

9. despite recognition that an ulcer was made worse by alcohol consumption.

Source: DSM-IV

Early Signs of Substance Abuse in Teens: 
Among teens, the evidence of substance abuse can be nonspecific and very subtle. For this reason, parents should be alert to new trends in their behaviors, such as these: 

• Fatigue

• Headaches

• Edginess

• Impatience

• Falling grades

• Loss of interest in school and other activities

• Changing friends

• Deterioration in honesty levels

• Red or dilated eyes

• Excessive use of eye drops

• Extraordinary aspirin consumption

• Burning incense

Symptoms Indicating the Possibility of Serious Substance Abuse:

• School deterioration (grades, attendance, or conduct)

• Hangover

• Passing out

• Vomiting

• Social or sexual regrets

• Blackouts or memory problems

• Mood swings

• Personality changes

• Having passion in their defense of a habit

• Driving under the influence

• Any legal consequence for alcohol or other drug use

• Continued usage despite negative consequences

Steps That Parents/Families Can Take If Substance Abuse Is Suspected:

• If your child comes home drunk, don't argue; don't threaten. Discuss the issues calmly in the morning. Do not avoid the issue. 

• Be intrusive. Always contact the school for grades and attendance records. Try to access a school counselor as an ally. Usually teens will hide at home what is obvious at school. Look into rooms and cars or insist on a urine analysis

• Even if you only suspect that your teenager might have a drug problem, arrange for him or her to undergo a professional evaluation with your family doctor or a pediatrician. The evaluation should include a complete physical exam including blood and urine tests. Urine drug screens will show use of many illicit drugs, but a blood test is necessary to detect alcohol use.

• A mental status exam by a psychiatrist is also an important part of the assessment because all physical findings may be negative for many years of abuse.

• Be certain that your teen takes responsibility for facing the natural consequences of his or her actions, such as paying traffic tickets, appearing in court, losing a driver's license, sentencing to a diversion program or community service, or working to earn the money for increased insurance premiums.

Source: Substance Abuse-Health Education Consultants/American Academy of Child and Adolescent Psychiatry

Evidenced-Based Mental Health Interventions

• Cognitive Behavioral Therapy

• Multi-Systemic Therapy

• Relapse Prevention Therapy

• Voucher-Based Contingency Managemen