Children in Addiction

One of the things that I find most deplorable about some 12-step programs is that they get poor results due to bad treatment strategies and then say it’s the patient’s fault. These programs have a tendency to say that patients relapse due to a lack of willpower, or a moral failing, or because they didn’t really want to get better. I hate this tactic, as it does nothing to help the patient and just adds guilt and shame to the problems that the patient cannot control.

But just because some programs have a tendency to blame the patient for their own failings, that does not excuse the patient of all responsibility in their treatment. Addiction is a disease with behavioral symptoms, which are under or not under the patient’s control to varying degrees, so assigning responsibility can be tricky. In my practice, I require at the very least that patients follow my instructions and take their medications as directed. This is the minimum level of responsibility required in any medical undertaking, but some patients aren’t willing to give it.

I’m not talking about patients who are weak or immoral. Mostly, I’m talking about patients who are very young. This is a cohort that’s only recently started to be discussed in the treatment community, though they’ve been the focus of public outcry for a long time. Young patients — teenagers and people in their early 20s — are often unwilling to follow the rules of treatment because their addiction doesn’t seem like a problem to them. They often haven’t experienced the negative health effects that come from cumulative use, and they don’t have a stable family or career that they might lose, the way many established adults too. For most young patients, their addiction provides their peer group and entertainment, and it defines their goals — losing it is a terrifying prospect.

In my experience, these patients are usually young, and many are being supported to some degree by their parents. Even those without any parental support seem content to live a life of homelessness; moving from shelter to shelter, or half way house to half way house, or rehab to rehab, or from one friend’s couch to another. Their life is filled with using and getting high when they can, and scraping by when they are not high. Perhaps they see no future for themselves due to the economy or their upbringing or due to real barriers to success — no education, no job, no income, no permanent  address, no transportation. They have literally become an invisible population that lives amongst us content for nothing more than an opportunity to get high another day. When one of them dies, it is almost as if that death is memorialized as a brave soldier who has died in pursuit of a lofty cause: “He lived his life hard and fast, on his terms, and he died young. Let us drink or shoot up to his memory.” 

I don’t know how we can go about changing this culture of idolization and romanticizing of drugs among the younger patient population. Current youth drug education is full of problems, and needs to get much more factual and comprehensive before it will start to do any real good. The parents of these patients are moving in the right direction when they bring their children in for treatment, but they often seem powerless to direct or control their child’s behavior. In the long run, probably only widespread educational and economic change will be able to rescue these children from lives of addiction and poverty, and the sooner we begin that change, the better.