Leader Blues

Tuesday, October 14, 2008

TOP STORY > >Drugs are easy to obtain

Leader staff writer

As many as one in five teens have abused prescription drugs at some point in their lives, according to national studies.

The drugs are easy to obtain – as easy as opening the family medicine cabinet or meeting up with a friend who has a supply.

Teens say illicit medications are as easy to get their hands on as beer.

Kids don’t realize the dangers in using prescription drugs recreationally; they think the substances are safe to use because they are medications, something that comes from doctors and drugstores. They don’t see the future risks of addiction, of damaged health and broken dreams.

Helping kids overcome a problem with drugs is not as simple as enacting consequences for bad behavior, such as grounding or taking away the car keys. When a kid breaks rules or violates accepted standards of behavior, the common parental response is punishment: you mess up, you suffer the consequences. The same punitive approach is society’s way of dealing with drug addiction, because criminal behavior is often involved. For most individuals incarcerated in U.S. prisons, drugs were involved in the crimes that got them there. Most remain addicts on the inside.

But now research into the behavioral whys of substanceabuse is leading to an approach that uses the appeal of immediate reward to help both adult and teen addicts stay drug-free, so that they never wind up before a judge.

Psychologists at the Center for Addiction Researcher at University of Arkansas for Medical Sciences are applying some old – and new insights – about human behavior into therapies to help individuals with substance abuse problems. The approach is called contingency management.

Contingency management is based on the premise that a behavior is more likely to be repeated if reinforced positively – whether it’s with a pat on the back, money, praise, or other tangible reward. That is nothing new. Psychologists and the rest of us, ordinary folk, have known that for eons.

The newer insight is that individuals with addiction problems tend to live more in the present than the majority. So preaching to them about the horrors and harms of continued addiction – to one’s health, happiness, and finances – may have little impact. The future seems just too far away to matter, when compared to the powerful allure of a high.

In the past 20 years, researchers have been testing out this premise; many studies have shown its effectiveness in helping break addiction for cocaine, marijuana, alcohol, benzodiazephines, opiods, and other drugs.

Those in the business of helping addicts “are beginning to recognize that people involved with drugs extensively are not very good about thinking into the future,” Warren Bickel, director of the UAMS Center for Addiction Research, said. “Immediate reinforcement is often the only thing they can deal with.”

In successful research trials, patients are required to undergo frequent urine samples – several in a week. Clean tests result are rewarded with payments of a few dollars or gift certificates and coupons for goodies such as movie tickets, eating out or store purchases for clothing, electronics, or sporting equipment.

“This is something that works; it has been replicated time and time again,” Bickel said.

When it comes to helping kids with addiction problems, the “in the moment” mindset of the typical adolescent adds to the challenge. As any parent knows, teenagers are notorious for not thinking far into the future and believing they are invincible, beyond harm.

That is why some public health warnings about long-term deleterious health effects of drugs, drinking and tobacco are not effective with this age group.

“The older, classic treatment models for adults – which is very confrontational – don’t work as well with kids,” says Chris Rule, instructor in the Department of Psychiatry, University of Arkansas for Medical Sciences. “The kids don’t buy into it. It doesn’t faze them in the same way as adults. They don’t see their problem. They say, ‘I know tons and tons of people who do it lots more than I do. I just got caught.’ They don’t see their problem as the start down of path to serious addiction problems.”

The UAMS Substance Abuse Services Program for Adolescents offers assessment and treatment at no cost to youth, ages 12 to 18, who qualify, as part of on-going research into effective programs to prevent and treat substance abuse problems. The research is supported by the National Institutes of Health, the city of Little Rock, and state tobacco settlement funding.

Parental involvement and positive incentives for desired behavior change are two cornerstones of the UAMS research trials.

“Family-based treatments have the most research support to date, and parents are required to participate with their teen in our clinic,” says Catherine Stanger, who with Alan Budney, direct the UAMS Substance Abuse Services for Adolescents. “Also, the use of incentives has been demonstrated to improve outcomes, and all of our research treatment programs use some form of incentives, either for participation or for abstinence.”

Teens accepted in the program receive 14 weeks of counseling and 12 weeks of follow-up services. They are expected to undergo drug testing while in the program and during follow-up. Parental involvement is required.

Parents are encouraged to not delay seeking help for a teen suspected of drug or alcohol abuse.

“Generally, the more severe the teen’s problem is at the time they enter treatment, the worse their outcome,” Stanger says.

“This is why we encourage families to seek treatment early in the development of a substance use problem. We generally tell families that if they have any concerns about their teen’s substance use, it is a good idea to seek an assessment to determine if treatment is appropriate. Don’t wait to see if things get better on their own.”

Tony Thurman, superintendent of Cabot public schools, concurs that “parental involvement is absolutely the key if a teen is to overcome the addiction.” An other essential, he says, is the child getting away from the crowd that is promoting the drug use.

“Typically, unless the student totally changes their peer group, it is almost, impossible for the student to overcome the addiction.”

“Think of drug addiction like an infection – if your defenses are down, you are susceptible – you’ve got to work on keeping your defenses up,” Bickel pointed out. For the teen in treatment for substance abuse – or to prevent one from ever occurring – that means parents need to work on creating the kind of life and environment that makes the youngster less vulnerable to drug use.

“Kids can’t be left alone for long periods to time, which can be a hard thing for parents to think through if both are working,” Bickel continued. “Kids need to be involved in community groups – scouting, museums, libraries, things that are pro-social, with people who are thinking of the best interests of the kids. Parents need to stay connected with their kids, sit down to dinner, hear about their day.”

Overcoming substance abuse is not necessarily a quick process. As anyone who has tried to stick to a diet knows, behavior change is tough. For the adult who has abused drugs or alcohol for years, staying clean involves in the whole person – engrained patterns and habits of life style, job skills and work ethic, friendship and family relationships, and finances.

“Addiction is a chronically relapsing disorder; learning how to be abstinent takes a lot of times trying … it involves learning how to manage how you think,” Bickel noted.

All the more reason to get help for a teen who has a substance abuse problem. Don’t wait for them to outgrow it. They may not.

For information about UAMS Substance Abuse Services for Adolescents, call (501)526-8446.