TAILORING TREATMENTS FOR TEENAGE DRUG USERS

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, Mrs. 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 was soon admitted to
Mountain Manor, an alcohol and drug treatment center for teenagers in
Baltimore. It was, Mrs. Lagana recalls, "the hardest day of my life."

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

Last month, 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 from
1993 to 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 becoming 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 teenage
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 teenagers 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," Dr. Hogue said.

Also, because the brains of teenagers are still developing, many experts
believe they are at greater risk for becoming addicted. A number of studies
have shown that teenagers 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, is among those who have
avoided drugs. "I don't feel I need them to have a good time," she said.

For her, a major deterrent has been seeing other teenagers at school whose
lives became messed up because they were dependent on drugs.

Philip Anderson, a 17-year-old from Ferndale, Md., who began using drugs at
10 and has abstained 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 more treatment programs tailored to teenagers 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
teenagers. 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 teenagers, many addiction experts
say, are different from those that work for adults. Parents and other
family members have to be involved, and treatment has to allow for
continued school work.

Also, because teenagers' 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 have
to be recognized.

Several studies show that illicit drug use is reduced by 50 percent among
teenagers 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 for other chronic, relapsing diseases
like diabetes and asthma, where patients sometimes do not take their medicines.

Another problem is a shortage of treatment programs. The report found that
10 percent of students who needed drug abuse treatment received it, and of
those who did receive it, 25 percent received enough.

Dr. Jeremiah A. Barondess, president of the New York Academy of Medicine, said:

"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."

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 are sent by 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 that use the court system to send juvenile drug offenders into
treatment.

As for Michael Lagana, he is not taking his sobriety for granted. "When I
was using drugs," he said, "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."