When Does Just Having Fun Become a Bigger Problem?

11/09/2017

When Just Having Fun Becomes a Bigger ProblemIs “just having fun” a phase?

As a specialist in substance use disorders one of the most frequent questions I receive is “How do you know if an adolescent has a drug/alcohol problem?” Most often this question emerges in the context of adolescent development; is this a problem or is this just a phase?

Despite what some may think, this can be an extremely difficult question to answer. One reason in particular, is that it is important not to answer this question in an overly simplistic or complicated fashion. Simplifying the issue causes us to lose the sensitivity needed to guard against jumping to conclusions. Alternatively, if in our efforts to answer this question we become entangled in complexity, we are apt be blinded to the reality that a true substance abuse problem is at hand. We must be cautious to not label a teenager as an addict and send them off to “rehab” prematurely (being too simplistic). Additionally, we must not accept excuses or exhibit enabling behavior when a teenager exhibits a bona fide substance abuse problem; e.g. “He’s just self-medicating because he can’t get along with his father” (complicating the process).

A second reason for the difficulty in answering this question is that it is a tremendously personal issue. All of us have our own ways of defining a problem. Within the field of addictions, there is a variety of criteria that can be used to identify substance abuse and/or dependence. So, prior to answering this question we first need to work with the adolescent to determine what his-her definition of a problem is.

Rather than continue to harp on what makes answering these questions so difficult, let me offer some thoughts on specific ways to assess if a substance abuse problem exists.

To start, let’s borrow a slogan from Alcoholics Anonymous, “If you’re having problems because of your drinking than you have a drinking problem.” This important slogan does well to keep us grounded in remembering that the use of alcohol and/or drugs can warrant an intervention, well before it reaches the level of abuse or addiction.

5 Core Indicators of a Substance Abuse Problem

I have found through my work that there are numerous domains that must be considered to truly understand the level of abuse or addiction. Below are 5 core indicators we look at to determine risk for a potential substance use disorder, or confirmation of a substance use disorder:

  1. Family history—genetics increase risk for a substance use disorder as well as favorable or ambivalent parental attitudes.
  2. Adverse Experiences—the more stressors over the course of the life span the more at risk the individual is independent of how long ago they happened.  Examples of an adverse experience include family conflict, divorce, social stress, isolation, bullying, loss, and mental health disorders.  If someone has 2 adverse experiences they are more at risk level for developing a substance use disorder, if someone as 4 the risk level is dramatically increased.
  3. Impaired control—Has the individual tried to cut down or stop and not been successful?  Alternatively, has he/she desired to cut down or stop use for a prolonged period, but never taken steps towards change?  Does the individual accurately predict what happens once they start using; if they set a limit with themselves such as 4 beers, do they stick to that or go past this limit? Questions such as these clarify how much an individual’s control over his-her use has been compromised.
  4. Age of initiation—the younger you start using the more your risk increases for being diagnosed with a substance use disorder.  Someone who started at 13 is much more at risk than someone who started at 16
  5. Readiness to change—If none of the other risk factors are in place and the client feels there isn’t a problem, then in fact there may not be.  However, when the above risk factors are present, they are magnified present when the individual is not ready to change. 

How do you define “problem?”

There is solid research behind each of these variables that help us to differentiate if an adolescent is experiencing a substance use disorder, or is at risk for developing a substance use disorder. When we consider indicators such as these we can start to get a greater degree of clarity and sensitivity as we consider whether we’re encountering a challenge to development or a primary substance use disorder.

Only through careful assessment of these variables can we determine if a problem exists. A thorough assessment phase is crucial in setting the stage for our future work with each adolescent. It is an important tool that provides the foundation necessary to work closely with each client towards positive change. Presentations are available on the assessment and intervention of adolescent substance abuse and we would be happy to discuss providing this service to you.

By: Andy Buccaro, LCSW, LADC