Adolescent Addiction: What Every Parent Should Know

Worrying is a standard part of parenthood, especially as children grow older and become more independent. In the wake of a current opioid epidemic, parents are adding a substantial concern to their roster of fears: substance use disorders.

The increase in people living with addiction is staggering. More than 20 million people in the United States struggle with drug addiction, and this creates an expenditure of $400 billion in health-related costs each year. In 2015, more than 33,000 people in the United States died from accidental overdose. Of that number 1,526 deaths occurred in Massachusetts alone—nearly four people per day statewide. This issue is even more alarming for adolescents and young adults age 15-24, with a death occurring almost every three days accounting for one-quarter of all deaths.

What was once thought of as something only experienced by people living troubled lives, the reality is anyone can fit the profile of someone with a substance use disorder—even young teens. Substance use can stem from seemingly harmless situations typical of adolescence—a prescription from a doctor for a high school sports injury or routine dental procedure—and quickly snowball into dependency, where the person using may not even realize there is a problem. The avenues in which youth are exposed to substances may be worrisome, but there are ways to spot use and stop it in its early stages.

Those at risk for substance use …
If today’s epidemic has taught us anything, it is that substance use knows no geographic or demographic boundaries—it is affecting girls and boys, and men and women of all ages from both urban and suburban communities. Michael Botticelli, executive director of the Grayken Center for Addiction Medicine at Boston Medical Center (BMC), says, “Part of what we’ve learned from the opioid epidemic particularly is that this can really affect anyone.”

As with many diseases, there are other traits aside from access that can impact whether someone will develop a problem with addiction later in life, including genetic, environmental and social factors. Adolescents in particular are at the greatest risk for developing substance use disorders, especially those who started using drugs early and/or have a family history of substance use disorders, an underlying mental health disorder or who have experienced trauma.

Sarah Bagley, founder and director of the CATALYST Clinic (Center for Addiction Treatment for AdoLescent/Young adults who use SubsTances) at BMC and associate professor of medicine and pediatrics at Boston University, says adolescents are more vulnerable to peer pressure, boredom and the influence of social media, which can put them at higher risk.

Knowing the warning signs of addiction disorder …
Knowing the warning signs of addiction can save lives, and ensuring it is addressed through every possible channel is key—even at a yearly doctor’s appointment. Scott Hadland, MD, MPH, adolescent and addiction medicine specialist at Boston Medical Center, says, “Doctors are trained to confidentially ask all teens about substance use at their annual physical exam, and a thoughtful pediatrician can ask the right questions and find out about early opioid use.”
Here are some signals:

• Changes in mood
• Becoming more withdrawn
• Changes in grades
• Lack of interest in activities that used to be exciting to them
• Problems at school or work
• Changes in friends, hanging out with a different crowd
• Being unable to keep a commitment to stay away from drugs
• Suffering withdrawal symptoms, including shaking, seizures, anger, personality changes
• Denying that there is an issue and becoming defensive
• Hiding drug use and using substances in private

“It’s important to point out, though, that some of these signs can also be signs of a mental health disorder,” Bagley says. “If there are any behaviors or signs that are concerning to a parent about a child’s well-being, they should have a direct conversation with the child and raise their concerns.”

What to do about substance use disorders …
If signs of substance use are spotted, it is important that teens feel supported and comfortable talking about what is going on. This will help keep him or her from feeling alienated, which can hinder timely recovery and prolong use. “Given the overdose deaths associated with opioid addiction, we can’t have people delaying asking for help because we know the consequences can be really significant,” Botticelli says.

Bagley suggests supportive dialogue. “Make it clear that no matter what happens, the parent is there to listen and be a support,” she says. This is even helpful talking to younger children, as a preventive measure. “With younger children, you don’t have to explicitly talk about alcohol or drugs but can focus on the importance of putting food in your body that makes you healthy and that we only take medications if we are sick.”

With a combination of knowing how to identify signs of addiction and how to bring it up with the person, it can help ensure timely access to high-quality, respectful care. Although these tips are helpful for parents of teens, it is critical to be on the lookout for signs among any friend or family member. “The more we create an atmosphere where it’s supported and embraced that people can talk about these struggles openly, the better off we’ll be,” says Botticelli.

Where BMC’s expertise comes in …
No matter the age or stage of substance use, there is help available. BMC is committed to fighting the opioid crisis and continues to pioneer the most sought after substance use treatment services in the area, including a myriad of coordinated substance use and pain management programs modeled across the country. Boston Medical Center’s newly launched Grayken Center for Addiction Medicine will provide a platform to greatly improve the nation’s ability to treat, detect, prevent and learn more about addiction—a disease that increasingly touches almost everyone in one way or another.

“Years ago I was the director of substance abuse services for the Massachusetts Department of Public Health, and most recently ended my tenure as director of the White House Office of National Drug Control Policy under the Obama administration—in all my time in this field, Boston Medical Center has always stood as a leader and innovator in addiction medicine,” says Botticelli. “When I was given the opportunity to work for Boston Medical Center, it was an easy decision. There is no other medical institution in this country as well prepared to fight this epidemic.”