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Note to adolescents: Drugs don’t make you cool

Note to adolescents: Drugs don’t make you cool
Boston Medical Center (Photo: Photo: Courtesy Boston Medical Center)

It’s hard to imagine that a 6-foot-5-inch high school basketball player is not fully developed. He might even still have an inch or two to go in height, but the maturation of the brain does not keep pace with the spurt in growth. The part of the brain that’s responsible for assessing situations and making sound decisions is not fully developed, and usually does not mature until the mid-20s, according to a report by the National Institute on Drug Abuse.

“During this critical window of development, [the brain] is particularly susceptible to addiction,” said Dr. Scott E. Hadland, adolescent and addiction medicine specialist at Boston Medical Center, home to the Grayken Center for Addiction Medicine. “Normal development during the teenage and young adult years involves learning impulse control, proper decision-making, coping skills and establishing interpersonal relationships. The fact that this development is not yet complete means youth are at risk for developing addiction, since these developmental processes all protect against risk-taking.”

Almost nine percent of adolescents aged 12 to 17 admitted using illicit drugs, such as marijuana, cocaine and heroin in a 2013 report by SAMHSA. In addition, more than two percent of adolescents were nonmedical users of psychotherapeutic drugs, such as tranquilizers and sedatives. The vast majority used prescription pain relievers, which they often received from a relative or friend.

The reasons an adolescent turns to drugs are varied. Sometimes it is mere curiosity or an attempt to fit in. Peer pressure, physical abuse, exposure to drugs in the home and genetics all play a role. Adolescents suffering from depression and other mental health disorders may use drugs to self-medicate. “For youth, we always consider whether our patients may be experiencing symptoms of attention deficit hyperactivity disorder (ADHD), which can result in some of the impulsiveness or sensation-seeking that we see among youth who use substances, as well as symptoms of anxiety and depression,” explained Hadland. “In short, we never examine substance use in isolation. We always want to know what other mental health or psychosocial difficulties our patients may be living with.”

It can be a bit tricky to detect the signs of substance use disorder because symptoms differ by the drug used. There are some telltale signs, however, regardless of the drug of choice. Dr. Sarah M. Bagley, director of the CATALYST adolescent substance use disorder clinic at BMC, ticked off a number of symptoms: changes in friends, irritability, being withdrawn, changes in appetite, drop in grades or less interest in activities that used to be really important to the teen.

Parents might overlook these symptoms and attribute them to “growing pains” or assume the “not my kid” syndrome. Yet, it is estimated that more than five percent, or 1.3 million individuals aged 12 to 17 have a substance use disorder. The problem extends from the inner city to well-to-do suburbs.

Parents should act as soon as they detect some change in behavior that is concerning, advised Bagley, and take their teen to a professional who can help assess the situation. For successful treatment both parents should be on the same page. “It can be really hard for teens to receive different or mixed messages about their use from their parents,” she said. Chance of recovery is high in adolescents. In fact, early intervention in the development of addiction before it becomes deeply ingrained makes recovery more likely, according to Hadland. “What is critical, however, is to ensure that clinical services for youth are developmentally appropriate and incorporate family members,” he said.

BMC started the CATALYST program, which is one of the first comprehensive substance use treatment programs housed within pediatric primary care in the United States. There, providers offer treatment for addiction just as any other medical complaint that a teen has. It is not uncommon for us to treat teens for their addiction while simultaneously helping them with acne and ensuring their vaccines are up to date so that they can participate in school activities.

Through a $25 million gift from the Grayken family, BMC can continue to make headway in the treatment of adolescents suffering from drug use. The donation is the largest in BMC’s history and the largest private gift in the U.S. in the last decade for addiction treatment and medicine. The Grayken Center will be a leader in the treatment, prevention, research and training in addiction medicine.