Chemical Dependency: How Much is too Much?

Substance use, abuse and addiction falls along a continuum where at one end there is total absinance, the middle consists of experimental chemical use, occasional chemical use and abuse of recreational chemicals and at the other end there is severe dependency. Clinicians do not have a definitive criteria to recognize adolescents with substance use disorders thus there is an urgent need for a diagnostic criteria inorder to identify adolescents who are abusing drugs. One reason being is that adolescents are at a greater risk compared to adults for developing a physical addiction to drugs and alcohol, while adults require chronic abuse of 2-7 years before becoming addicted, adolescents can become addicted within just 12-18 months. There are many signs of probable adolescent alcohol/substance use problem of which include: changes in physical health for instance anorexia,  abrupt failure in work,school or home tasks, legal problems and decline in social relationships. Diagnostic criteria developed for adults are the same standards used for adolescents when in fact may not even apply to the adolescent population. However even after a correct diagnosis in relation to Substance Use Disorder there are not many treatment programs which includes suitable after care programs for adolescents with substance use disorders.

Creating an extensive database about an individual and his/her drug use pattern is one way of improving the precision in assessing an adolescent’s pattern of chemical use, for example if an adolescent uses marijuana once in six months then this is not an immediate sign of a drug use problem but could instead reflect the curiosity about the effects of the drug. There are many models of the stages of adolescent substance use, one of which includes that of Greydanus and Patel who suggested a five-stage model. In stage 0 the adolescent has not used any substance, however is curious about the effect of the drug. Stage 1 is the experimentation stage where the individual engages in substance abuse for the first time but does not suffer any severe consequences. Stage 2 is where the individual actively seeks out the drug and centers his/her life around continued drug abuse. Stage 3 is where the individual has become preoccupied with substance abuse, developing mood swings and acting-out while suffering consequences from the substance use disorder. Stage 4 is where the individual needs the chemical in order to feel “normal”. The progression from stage 0-4 is not automatic. It can take a few months or several years. “social forces and the natural developmental process during adolescence can alter the individual’s path from one stage to another or even block further substance abuse”. Whether or not adolescents become physically addicted to alcohol or drugs is a controversial issue as the signs often seen in adults for alcohol or drug dependence is not always seen in adolescents. Fror instance not all adolescents experience withdrawal symptoms from alcohol dependency  and it is infrequent in adolescents to experience physical health problems in relation to substance abuse.

In many treatment Centres, the administration officers, “claim that the use of chemicals by adolescents automatically means that there is a drug abuse problem present”. They pay more attention to the Centre’s income as opposed to the individual’s need and ignores the fact that the intervention programs could in fact harm the individual. Just because it is illegal for minors to use or buy alcohol or drugs the term drug use is often replaced by drug abuse hence over-diagnosing since majority of adolescents who suffer from a substance use disorder does not go on to become addicts later on in life. There is evidence that health care providers fail to identify a large number of adolescents who abuse chemicals and the results of this are astonishing. For example, substance use disorders are a factor in a significant number of adolescent suicides. Therefore professionals who work with adolescents, “must find the middle ground between under-diagnosis, with all the dangers associated with teenage drug/alcohol abuse, and over-diagnosis, which may leave the individual with a false lifelong diagnosis of chemical dependency”.