When is intensive drug treatment necessary for a teenager?
A parent, let’s call her Ms. Jones, called the Montclair Counseling Center a few months back seeking help in making a difficult decision regarding her teenage son. She recently discovered that he, a high school junior, has been smoking marijuana. He has also been presenting some problems in school, including skipping classes, and his marijuana use came to the attention of his school counselor. The school counselor arranged an interview at an intensive outpatient treatment program and the recommendation of the professionals there was that he begin attending daily outpatient services.
His parents do not want to minimize the seriousness of their son’s drug use and they are determined to respond appropriately. However this young man was planning to begin the spring athletic season as a starter on a varsity team. Daily attendance at the treatment program would require withdrawing from the team as well as missing a piece of his school day. Their son responded angrily to this recommendation, feeling it was out of proportion to the level of his drug involvement.
Ms. Jones, naturally, felt torn. Confronted with a child’s drug use, and the resulting broken trust, our thoughts as parents often turn to the dire possibilities, such as an arrest, or derailed college plans. A less than sufficient intervention at this point could be a major mistake.
So, what is a reasonable course of action with this situation? We can, of course, only scratch the surface here, with some questions and points for consideration. Have this young man’s grades declined sharply? Has he suddenly changed his circle of friends or style of dress? Is he moody, lethargic, uncharacteristically defiant or unmotivated? And let’s not forget to consider the protective factors in this case, including an alert, concerned family, and the sports team participation.
Some help can be found with a review of the screening instruments that have been developed, and adapted for adolescents, to estimate the severity of an individual’s problem with drugs. Many of these indices include well over 100 questions designed to tease out information on a range of problem tendencies. However one commonly used screen is the 6 question CRAFFT, which is a acronym for Car, Relax, Alone, Forget, Friends, and Trouble. The questions are:
- Have you ever ridden in a Car with a driver, including yourself, who had been using alcohol or drugs?
- Do you ever use alcohol or drugs to Relax, feel better about yourself, or fit in?
- Do you ever use alcohol or drugs while you are by yourself, Alone?
- Do you ever Forget things you did while using alcohol or drugs?
- Do your Friends ever tell you that you should cut down on your drinking or drug use?
- Have you ever gotten into Trouble while you were using alcohol or drugs?
The scoring guideline for this is that 2 or more positive items indicate the need for further assessment. It is also useful as a platform for parent and adolescent discussion of the purpose and extent of drug use for a particular adolescent. This would ideally lead to a discussion of the prospects for, and a commitment to, discontinuing use.
In this case, after serious consideration and discussion, the Jones family decided to start with a treatment option less intensive than the 5 day a week program. The option to move up if necessary to a more intensive level of treatment remains open.
If you think your teenager might be using drugs and you would like an evaluation, feel free to call me at 973 783 6977 x33
