NEW GUIDELINES PROVIDE TOOLS FOR DETECTING TEEN DRUG ABUSE

The recent news stories seemed to be in direct contrast. In Virginia, a
worried mother told of being so concerned that her teenage son was using
illegal drugs that she placed a wiretap on his phone to confirm it. In
Pennsylvania, the parents of five high school girls killed in a recent car
accident were stunned to learn that their children had been inhaling
dangerous chemical solvents, which played a role in the deaths.

Both anecdotes point to the need for new ways for parents, doctors, teachers
and mental health professionals to detect adolescent substance abuse early,
before parental wiretaps are necessary and fatal accidents occur.

That is the goal of guidelines just released by the federal Substance Abuse
and Mental Health Services Administration (SAMHSA).

"The new guidelines bring some rigor to the field," suggesting whom and how
best to treat, said Alain Joffe, head of adolescent medicine at the Johns
Hopkins Medical Institutions.

A key recommendation: shift from confrontational, heavy-handed methods of
tackling suspected drug and alcohol use in teens to a more subtle,
"motivational" approach.

Signs a child should be screened include: psychological difficulties,
substantial behavior changes, hospital emergency room visits for trauma
injuries as well as for gastrointestinal disturbances, sudden changes in
grades, unexplained school absences and a general tendency toward being
accident-prone.

While there are indications that drug use among adolescents may be leveling
off, drug and alcohol use remains high.

An estimated 77,000 teens under the age of 18 were in substance abuse
treatment in 1996 - nearly double the 44,000 adolescents having such
treatment in 1991, according to SAMHSA.

The majority of teens enter substance abuse treatment only after they have
gotten into trouble with the juvenile justice authorities.

Studies show that teens who drink alcohol and use drugs are more likely to
engage in other risky behaviors that increase the odds of early pregnancy,
contracting sexually transmitted diseases, and exposure to violence or
involvement in car accidents.

In advocating away from confronting teens, Ken Winters, chairman of the
panel that wrote the guidelines, said: "Strong-arm tactics have a high
potential to backfire. They can likely start to create a larger gap between
parents and kids (rather) than building bridges."

Adults are encouraged not to yell or use accusatory tones, threats and
inflammatory labels such as alcoholic or drug addict when they confront a
teen about substance abuse. A more effective approach, the guidelines
suggest, is simply to talk honestly and openly about parental concerns.

"Kids don't mind being asked about possible drug or alcoholic use," said H.
Westley Clark, director of the Center for Substance Abuse Treatment, which
issued the guidelines for SAMHSA. "They just don't want to be accused or
browbeaten. . . . And if we fail to ask them questions to screen for
substance abuse, then we fail the kids."

One of the most difficult moments for parents is when children, once
confronted, challenge parents by pointing to the adults' use of alcohol or
cigarettes, and "parents often feel paralyzed", Clark said.

All too often, he explained, that frustration leads to a breakdown in
communication and may result in ultimatums to the child that rarely work and
simply escalate the situation.

To overcome a child's denial that often occurs with substance abuse, the
guidelines suggest helping teens focus on the way that alcohol and drug use
may be interfering with their life - causing problems in school, missed work
or getting kicked off a team.

When adolescents argue that their drug and alcohol use "is not a problem,"
then "parents might respond that if you don't really have a problem, then
you have nothing to fear about going for an assessment with a professional,"
Winters said.

Once substance use is confirmed in teens, the next step is treatment with a
mental health professional.

The guidelines underscore that teens require special treatment and often
don't do well in programs designed for adults. For example, traditional
12-step addiction recovery programs usually are revised for teens to focus
on the first five steps, which are more developmentally appropriate for
adolescents, according to the guidelines. Residential treatment programs
need to be less confrontational for teens than for adults, and some teens
may need treatment longer than the standard 28 days.

Family therapy for teen substance abuse should deal not only with the teen's
relationships within the family and with peers, but also: how parents
monitor their children in age-appropriate ways; quality of family life; and
potential of sexual or physical abuse of the adolescents within the home.

The guidelines point out that adolescents are entitled to privacy and
suggest that professionals honor confidential conversations to keep open the
lines of communication.

The new guidelines are available at http://www.samhsa.gov/csat/csat.htm (go
to TIPs, No. 31) or by calling the National Clearinghouse for Alcohol and
Drug Information at 800-729-6686; TDD (for hearing impaired) at
800-487-4889.