Contributing factors often start in the home

Question: What factors put a child or adolescent at risk for developing substance use disorders?

Answer: The teen years are a time of great change. Body and brain changes occur at a quick pace. A healthy, growing teen’s behavior can include sometimes worrisome mood swings, emotional outbursts and demands for privacy. The better you know your child, the better you can detect any warning signs of alcohol or other drug problem.

It’s important to remember that the parents set the tone of the home and that they need to be alert to changes such as those described by the Hazelden Betty Ford Foundation. These signs include heightened secrecy, difficulty keeping focus, withdrawing from classroom participation, resistance to discipline or feedback, increased tardiness or absence, paranoia, irritability, anxiety, fidgeting, changes in mood or attitude, significant weight loss or gain, loss of interest in hobbies or activities, decline in school performance, and abandonment of the long-time peer group.

Family. When someone in a child’s family has a history of substance use, that child may have a predisposition to addiction, and will, therefore, be at a greater risk of a substance problem than a child without a family history. As an example of this vulnerability, the Yale University School of Medicine says that first-degree relatives (children, siblings and parents) of alcoholics are roughly eight times more likely to develop alcohol use disorder than those without the family history.

Age. Age is another crucial risk factor for substance abuse issues. The younger a person is when they start using alcohol or other drugs, the more likely they are to develop an addiction. Current research by the National Institute of Mental Health suggests that the human brain does not complete its primary development until a person is in their 20s. Several factors in brain development lead to this heightened risk:

A generalization that can be made about the developing brain is its gradual evolution throughout childhood and adolescence into adulthood toward increased emotional and behavioral equilibrium. Compare the tantrums and “meltdowns” of toddlers when they don’t get their way to the reasoned reaction and restraint of adults, who, although disappointed, retain the will and the power to conduct themselves in an age-appropriate manner. This gradual development of selfcontrol is made possible by the growth of reliable connections involving executive function in the frontal cortex. Although under ideal circumstances, many of these functions are developed during the teenage years, they are still under ongoing development and strengthening until the mid-20s.

It’s folly to expect the developing brain to be able to cope effectively with the intense reward and emotional and cognitive shifts associated with substance use, even at a low level. The brains of youth are no more able to process such signals effectively than their vocal apparatus would be able to withstand the rigors of singing grand opera.

Cravings and Tolerance: The “rush” of emotional stimulation and pleasurable experience overwhelms the areas of the brain that are meant to moderate that experience with clear thinking. Due to the power of the ecstatic response, the childhood need for instant gratification quickly becomes ingrained, with little or no nuance of the pleasureful impulse. If you also factor in the reality that the child/adolescent may be experiencing a painful, even traumatic home environment (e.g., an abusive parent or the trauma of witnessing violence in the home), which is, in itself, warping the brain’s development of executive function behavioral self-control, you have a recipe for disaster. The youth hyper-learns that using alcohol or some other mood alterer soothes the rage and terror they’re experiencing daily.

Surroundings. Unstable, chaotic (and even abusive) parental behavior is a markedly obvious warning sign of substance use. Exposure to the use of alcohol and other drugs, whether it be within a family or a peer group, “normalizes” use so that it is perceived as “the thing to do.” It also increases access to substances, making a person more vulnerable to first-time and ongoing use opportunities.

It’s like being raised in a fun house with distorting mirrors. If that’s all children see, they never realize that the mirrors aren’t presenting a normal picture of themselves and their world: “What’s normal is what you’re used to.” Only later do they begin to notice the discrepancy between what they’ve always experienced and how things are outside the “fun house.” Out of this improvised coping with events that are, as often as not, traumatic, come inevitable distortions of interaction among family members.

Remember, parents set the tone of the home. Where there is validation, involvement in enriching and inspiring activities, consistent, loving expectations clearly presented and enforced are powerful protective factors in the life of any child and adolescent!

Kent Dean is the director of clinical development at CADA (the Council on Alcoholism & Drug Abuse of NWLA) and director of the School of Addiction and Behavioral Health. For more information about substance use disorders or about classes at the school, contact Kent at kent.dean@cadanwla.org or visit CADA’s website at www.cadanwla.org.