Pubdate: Wed, 02 Aug 2006
Source: St. Paul Pioneer Press (MN)
Copyright: 2006 St. Paul Pioneer Press
Contact:  http://www.twincities.com/
Details: http://www.mapinc.org/media/379
Author: Richard Scheinin, Public Access Journalism
Note: Richard Scheinin is a reporter for The San Jose Mercury News.
Bookmark: http://www.mapinc.org/pot.htm (Cannabis)
Bookmark: http://www.mapinc.org/meth.htm (Methamphetamine)
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)
Bookmark: http://www.mapinc.org/youth.htm (Youth)

YOUTH ADDICTION

The Danger Zone: 1.6 Million Addicted Kids Shaping Outside-The-Box 
Treatment Strategies

With her bright pink nail polish, pancake makeup and darting, 
penciled eyes, Sarah looks older than 16. But being too old has never 
been her problem - not since the age of 11, when she sought help from 
a California drug treatment program for adolescents and was turned 
away for being too young.

By then, she had already been smoking crystal meth for at least a 
year. She had been expelled from the sixth grade after 17 
suspensions; run away from five foster homes, and was, in her own 
later estimation, looking "pretty gross" - skinny as a stick, with 
five different hair colors and a face full of self-inflicted scars.

Ineligible for a program "developmentally targeted" for teens, an 
adolescent Sarah fell through the cracks. Although a social worker 
from Child Protective Services, familiar with her case, offered 
alternative counseling, it was years before Sarah quit, and then it 
was on her own terms.

The overwhelming fact is that of the 1.6 million young people between 
the ages of 12 and 18 with serious alcohol and drug problems, fewer 
than one in 10 receive treatment. Of the estimated 175,000 who do, 
only about 25 percent stay in treatment for three months, as 
recommended by the National Institute on Drug Abuse; less than 50 
percent stay for even six weeks, according to the Office of Applied 
Statistics in 2005.

And there is virtually no continuing care for teenagers who struggle 
to stay straight once back in the larger community. A 2002 study in 
the Journal of Substance Abuse Treatment found almost 80 percent of 
teenagers relapse within a year of treatment.

There is an explanation for this public health embarrassment: The 
epidemic of drug and alcohol abuse among young people was until 
recently an invisible problem, either unrecognized, ignored or 
wishfully dismissed as too awful to be true. Until 1997, there were 
only 14 studies published in the field of adolescent drug treatment, 
and those were widely regarded as being of questionable quality.

Today, the field is moving from an uninhabited backwater to a 
state-of-the-art discipline, with dozens of new federal grants, 
hundreds of published studies, promising new interventions and - 
finally - evaluated program outcomes.

One of the most telling developments is the rapid growth of recovery 
high schools and colleges - some with waiting lists - whose main 
focus is abstinence and recovery for students after treatment. At the 
high school level, there are 30 of these schools for abusers around 
the country, each built on a 12-Step model, offering mentorship and 
concrete rules for staying straight, as well as the sort of peer 
bonding that reinforces new patterns of positive behavior, something 
that generally isn't possible in a typical high school.

"To think a teenager is going to go for treatment for 30 days and 
then come back to his old environment - where he bought his drugs, 
where his peers are using and where he was seen as a drug user ... 
that's not realistic for the vast majority of kids," says Andrew 
Finch, executive director of the Association of Recovery Schools, 
which represents the 30 recovery high schools, from Alabama to Alaska.

"For them, school is a danger zone," Finch says. "It's like an adult 
alcoholic being required to go to work in a bar."

Finch says the programs work: Between 20 percent and 30 percent of 
the young participants relapse, but that's a substantial improvement 
over the national norm of 80 percent.

The field is exploding with new knowledge about adolescence and 
substance abuse. It is now understood, for example, that the vast 
majority of teen substance abusers - more than 80 percent of girls, 
according to some recent academic studies - have been sexually, 
physically or emotionally abused. With that in mind, many experts 
have put out a call for routine screening for sexual abuse when young 
drug and alcohol users show up for treatment.

"The issue of traumatic victimization is an unspoken elephant in the 
counseling rooms," writes Michael L. Dennis, a research psychologist 
at Chestnut Systems, a research and treatment center in Bloomington, 
Ill., and author of well-regarded drug assessment tests. "Physical, 
sexual and emotional abuse is the norm."

Many adolescent substance abusers - federal estimates say 70 percent 
- - also have a mental health issue, such as attention deficit 
disorder, bipolar disorder or post-traumatic stress disorder. In a 
Catch-22 scenario, mentally ill youths and adults are routinely 
turned away from drug and alcohol treatment centers, told, typically, 
that they have to get their depression under control before being 
treated for their addictions. The consensus among experts today is to 
treat it all.

Slowly, local public agencies across the country are responding, some 
even consolidating mental health and substance abuse agencies into 
single entities, its counselors expected to be trained to deal with 
both. Multi-tiered programs are becoming the new norm: A teen meets 
regularly with counselors, parents, clergy, probation officers; every 
one is around the same table, considering the teen's interests. This 
sort of wraparound approach is partly a response to the growing body 
of research that unmasks the effects of alcohol and marijuana on the 
adolescent brain.

Among the findings on alcohol's effects: A teen with a family history 
of alcoholism has a 50 percent risk of becoming an alcoholic. When a 
teenager drinks large amounts of alcohol, his brain is changed; 
researchers suspect that specific proteins are activated, increasing 
the susceptibility to alcohol throughout life. Adolescents who begin 
drinking before age 15 are four times more likely to become 
alcohol-dependent later in life.

"And when youth drink, they tend to drink heavily," notes a recent 
report from the American Psychological Association. "Underage 
drinkers consume on average four to five drinks per occasion about 
five times a month. By comparison, adult drinkers age 26 and older 
consume on average two to three drinks per occasion about nine times a month."

Among kids who move from one high to another, a taste for alcohol can 
easily escalate to one for drugs - and there are more choices out 
there now than ever.

Since 1992, a new kind of drug abuse has tripled in popularity among 
teenagers: the mixing of controlled prescription drugs like opiate 
painkillers, tranquilizers and stimulants. Among adolescents, they're 
known as "farming" or "trail-mix" parties, now constituting the 
fastest growing type of drug abuse in the United States, outpacing 
marijuana by a factor of two.

The most recent Monitoring the Future report, the continuing study of 
teenage drug use conducted by the University of Michigan and the 
National Institutes of Drug Abuse, found that 5.5 percent of 
12th-graders have abused the prescription drug Oxycontin, up 4 
percent since 2002.

In the past five years, methamphetamine has become a severe problem 
throughout the West and Midwest. In a recent survey, 70 percent of 
county and regional hospitals in the Midwest attributed 10 percent of 
all emergency room visits to methamphetamine. "We're really in an 
epidemic," says Brent Kelsey, assistant director of the Utah Division 
of Substance Abuse and Mental Health. "Methamphetamine is now the No. 
1 drug of choice for people between 26 and 35, and the public health 
consequences are enormous."

While treatment for meth addiction has been shown to work, it is 
typically more intensive than that for other drugs; experts often 
liken the damage from meth to a brain injury requiring unique and 
long-term treatment needs. In fact, meth addicts' needs have begun to 
crowd out treatment for alcoholism.

"In Utah, the number of alcoholics entering treatment is much smaller 
and I don't think it's because there are fewer alcoholics," Kelsey 
says. "What's happening is that - because of the criminalization of 
drugs - it's become harder and harder for the alcoholic to get 
services in our system. Methamphetamine and other drug users are 
really squeezing them out."

Despite the flood of information pouring in from academia, families 
and adolescents with problems all too often face questionable 
practices and scant alternatives. Parents can go broke looking for 
help, since private insurers don't cover the cost of treatment. Even 
for the few who can afford to pay the typical $20,000 cover charge of 
a 30-day private residential treatment program, there are few 
effective programs available and no guarantees from those that do exist.

In 2004, an expert panel evaluated 144 of the "most highly regarded" 
drug programs for adolescents and concluded that most of them failed 
to address the key elements of successful treatment: individual 
assessment at the start of treatment; tailored therapy for teens with 
psychiatric disorders; gender and cultural differences; continuity of 
care; staff evaluation and treatment outcomes.

What the study neglected to mention is that there are, in fact, no 
licensing standards for adolescent drug counselors. A handful of 
states, including California, Washington and Colorado, are now 
working to establish them.

"If I were a parent trying to navigate something for my child, even I 
- - knowing everything I do - would have a very hard time trying to 
figure it out," admits Yolanda Perez-Logan, project director of the 
Reclaiming Futures program in Santa Cruz, Calif.

Introduced in 10 cities, Reclaiming Futures is a five-year initiative 
funded by the Robert Wood Johnson Foundation in response to the 
"treatment gap" that occurs when an increasingly drug-dependent teen 
winds up in trouble with the law. The gap is more like a canyon: Four 
out of five teen arrests involve the use of drugs or alcohol, while 
80 percent receive no treatment for the problem that got them there.

The juvenile justice system serves as a kind of laboratory for what 
works, since most young drug and alcohol abusers first enter 
treatment through its doors. Which means they don't come willingly. 
By far, the majority of youths in residential treatment are sent 
there through the criminal justice system. Even then, parents have to 
shoulder a huge part of the financial burden.

In California, for example, the cost for court-ordered residential 
treatment is nearly $6,000 a month. Individual counties then bill 
families for about 60 percent of that cost. At that rate, a six-month 
stay can easily cost a family - one already likely living on a 
financial precipice - more than $20,000.

For those who can get to private treatment, many youth programs are 
now moving away from the classic 12-Step model, as embodied by 
Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). A 
philosophical split has emerged in the treatment community, with some 
on-the-ground programs endorsing alternatives to 12-Step and its 
insistence on total abstinence.

"Many treatment programs are using new evidence-based practices that 
meet youth where they are with their current substance abuse and help 
them make a decision what they're going to do about it," says Randy 
Muck, lead public health advisor for Adolescent Treatment Programs at 
the federal Substance Abuse & Mental Health Services Administration.

Many experts argue that the language of 12-Step programs, with their 
starting point of sobriety, grew out of a therapeutic model aimed at 
adult males. Its requisite call to a "higher power" is often a major 
sticking point with teens who, in the words of one probation officer, 
often "think they are the higher authority."

"For years, the problem we've encountered is that treatment for kids 
is basically treatment for adults repackaged," says Scott Reiner, 
program development manager in the Virginia Department of Juvenile 
Justice. "They changed a couple words, perhaps, but never addressed 
the developmental needs of kids."

Small wonder, then, that an 11-year-old girl like Sarah could be told 
to come back for treatment when she turned 14.

Sarah now takes classes at The New School, an alternative high school 
largely comprised of former gang members and drug addicts in 
Watsonville, Calif., that offers some services you won't find at your 
typical high school - including rides to nearby AA and NA meetings, 
after-school 12-Step classes, routine urine testing and a dog that 
comes in to sniff backpacks a few times a year.

Like many of her peers at the school, Sarah claims she had to find a 
way to get clean on her own, without professional treatment. She says 
it happened like this:

"I'd run away from a group home and no one knew where I was for a 
month. One day I came home and my niece asked me, 'Are you going back 
to jail?' That made me feel really bad because she was only 6 years old.

"I saw my niece going through the same exact thing I went through. 
Fighting with her mom, her mom always hitting her," Sarah says. "And 
I thought, how am I going to help her if I don't stop?"
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MAP posted-by: Beth Wehrman