EXPERTS ZERO IN ON TEEN SUBSTANCE ABUSE

In many respects, Michael Lagana is a typical 17-year-old. A junior at
Dundalk High School in Maryland, he carries a full load of courses, loves
playing football, and works after school selling newspaper subscriptions.

He began smoking marijuana at 14. At 16, he was smoking three fat marijuana
cigarettes a day or drinking a couple of 40-ounce bottles of malt liquor.

Donna Lagana, Michael's mother, began to worry last June when she
discovered some marijuana among Michael's things. He assured her then that
it was "not a problem."

But Michael's drug and alcohol use only escalated. In September, after he
drank a fifth of brandy in less than an hour, he passed out and was taken
to the emergency room for acute alcohol poisoning.

Although Michael steadfastly refused to see a drug abuse counselor, his
parents worried that he might pose a threat to himself or others.

As a result, Donna Lagana petitioned the Baltimore County Circuit Court to
order him to undergo a substance abuse evaluation. The court agreed and
within a few hours, Michael was picked up from school and taken to a local
hospital.

There he was examined by an addiction specialist and soon was admitted to
Mountain Manor, an alcohol and drug treatment center for teen-agers in
Baltimore. It was, the mother recalls, "the hardest day of my life."

"How could I have not noticed it before?" she asked.

In December, researchers at the University of Michigan reported that the
use of alcohol, nicotine and marijuana among high school students across
the nation was declining. Nevertheless, levels of teenage drinking and drug
use remain stubbornly high.

At least 53 percent of all American adolescents have tried an illicit drug
by the time they have finished high school, according to the Michigan
researchers.

The Centers for Disease Control and Prevention reported last week that
between 1993 and 2001 the rate of binge drinking episodes among drinkers 18
to 20 increased by 56 percent, compared with an increase of 35 percent for
all American adults. Binge drinking was defined as five or more drinks at a
sitting, with the intention of getting drunk.

To highlight the continuing problems, a number of doctors who treat
substance abuse among adolescents will give a report to all members of
Congress and every state governor on Thursday. The report, by a group
called the Physician Leadership on National Drug Policy, describes teen-age
alcohol and drug abuse as a national public health problem.

Dr. Aaron Hogue, a psychologist and a researcher at Columbia University's
National Center on Addiction and Substance Abuse, said that last year's
reported decline in drug use by teen-agers did not mean the problem was
going away.

"I am not sure that these general trends, as important as they are, speak
directly to those kids who have the most severe substance abuse problems
and are in the greatest need of treatment services," Hogue said.

Also, because the brains of teen-agers are still developing, many experts
believe they are at greater risk for becoming addicted. A number of studies
have shown that teen-agers who begin using illicit drugs before they are 15
are eight times as likely to develop substance abuse problems as those who
start at 18 or later.

Anna Joseph, a 15-year-old who lives in Ann Arbor, Mich., is among those
who have avoided drugs. "I don't feel I need them to have a good time," she
said.

For her, one of the major deterrents has been seeing other teen-agers at
school whose lives got messed up because they became dependent on drugs.
Philip Anderson, a 17-year-old from Ferndale, Md., who began using drugs at
10 and has abstained now for over a year, explains that young people try
drugs for a lot of reasons.

"I got into drugs because I thought it was fun," he said. "Some kids see
their parents using them, others see their friends using them and feel
pressured to do the same. Some are just curious."

Dr. Marc Fishman, a psychiatrist at Mountain Manor and a faculty member at
Johns Hopkins, said: "Many adults trivialize how bad these drugs really
are. They say it's just pot or booze, what's the big deal? But it is a big
deal when it involves children."

Still, many experts say that more treatment programs tailored to teen-agers
are needed.

Dr. David Lewis, a physician at Brown University and the lead author of the
physician group's report, said: "You can't just apply the adult model to
teen-agers. We need a new investment for what we know works for children."

The physician group wants more money devoted to prevention and treatment
and less money spent on incarcerating juvenile drug offenders.

Effective drug treatment programs for teen-agers, many addiction experts
say, are different from those that work for adults. Parents and other
family members must be involved, and treatment must allow for continued
school work.

Also, because teen-agers' thought processes often differ from those of
adults, different approaches to psychological counseling are required. More
than half the adolescents enrolled in drug rehabilitation programs also
have some other psychiatric problems - including attention deficit
disorder, depression and trauma from sexual or physical abuse - that must
be recognized.

Several studies show that illicit drug use is reduced by 50 percent among
teen-agers one year after completing substance abuse treatment, although
fewer than half are still abstaining five years later.

The physicians' report says that these rates of relapses and compliance are
similar to those seen in programs designed for other chronic, relapsing
diseases like diabetes and asthma, where patients sometimes do not take
their medicine.

(STORY CAN END HERE. OPTIONAL MATERIAL FOLLOWS) Another problem is a
shortage of treatment programs. The report found that 10 percent of
students who need drug abuse treatment receive it, and of those who do
receive it, only 25 percent receive enough.

Dr. Jeremiah A. Barondess, president of the New York Academy of Medicine,
says that "if we had less than the needed facilities to treat diabetes, we
would be labeled as heartless and accused of practicing medicine that is
immoral if not criminal."

"I can think of no other disease that is deliberately underfunded in such a
manner," Barondess added.

What is more, the report says that many pediatricians feel uncomfortable
treating addiction problems and that financial reimbursement in the form of
Medicaid or third-party health insurance is limited. About 44 percent of
all referrals for substance abuse treatment now come from the juvenile
court system, compared with 22 percent from schools, 17 percent from
themselves or family and 5 percent from health care professionals.

The rest of the referrals come from a variety of sources.

The physicians' report calls for training judges and criminal justice
workers to collaborate with health care professionals in proceedings called
drug courts, which use the court system to get juvenile drug offenders into
treatment.

As for Michael Lagana, he is not taking his sobriety for granted: "When I
was using drugs I just didn't think it was such a big deal. Since I began
treatment four months ago, I've realized that I almost lost my life."