Amid all the discussion of addiction in the past few years, I have noticed that there has been little public discourse about what I consider the ultimate form of prevention: the education of children.
Conveying full and sound information about addictive substances to children and parents is crucial because of the core nature of addiction — that it is a near absolute inability to control one’s relation with the substance.
That is the essence of the problem, but we still are burdened with the feeling that those who fall to addiction have made choices. The truth is that, once dependence arrives, the victim has virtually no choice at all. There may be periods of abstinence, but they are exquisitely difficult to sustain. This is entirely consistent with our understanding that the addict is not depraved but suffers an illness.
Remarkably, our medical understanding of addictions reveals that some young adolescents are biologically destined for addiction, even to a particular substance. The important concept is susceptibility, that a particular child’s genetic constitution and social experience may render him at extreme risk. It is not a matter of nature versus nurture; it is both.
The genetic endowment is profoundly important but cannot be measured for prediction by medical studies. In my office parents will often tell me that, “There is alcoholism in our family!” I explain that this is true of most families, because the general population risk is about 1 in 15 for the disease of alcoholism. The probabilities are additive, so that the risks for cocaine, stimulants, opiates and cannabis each add to the overall risk for the child to develop an addiction.
All of this means that first contact with a substance to which a child is susceptible is a pivotal fulcrum in time. It is like the turnstile in a subway station; one can pass through but not turn around. All of the phenomena of addiction can bloom rapidly after first exposure: finding the drug more valuable than anything else in life, developing complex means for sustaining access to it and neglecting all other important aspects of sustaining progress in life.
Early education about addictive drugs also has to do with culture. Adolescents value the respect and esteem of their peers more than those of their parents. Their parents belong to a different but related world. In the past 20 years, the use of alcohol and cannabis in high school has become the cultural norm. Children believe their parents would not understand and should not know they are trying these substances. This occurs in families of the strongest moral reasoning and caring ties. Research in the past decade has demonstrated that adolescents are eclectic and promiscuous with addictive substances. They try many or all — there is no “gateway drug.”
I am routinely astonished how little young adolescents and their parents know about addictive drugs, even in highly educated families. The most astonishing is cannabis. Few of the parents of my patients are aware that, while cannabis may increase creativity, it becomes addictive for the low number of adolescents who are susceptible. We now have reputable research demonstrating that daily cannabis use in adolescents yields a predictable decline in measured intelligence. Cannabis can hasten or precipitate schizophrenia or bipolar disorder, for which about 2 out of 100 adolescents are at risk.
Cannabis use is catastrophic for some drivers. When I was a new intern in the hospital, I pronounced two young women dead who were bowled down by a stoned driver. There are several clear medical conditions in which cannabis is highly effective, but the Maine Medical Use of Marijuana program has become a free-for-all, available to anyone who wishes.
The challenge of how to provide education about addictions to children and parents is confounding.
My daughters had excellent drug and alcohol education programs, but this fine work historically has had inadequate impact on the culture of substance experimentation. Providing education in schools makes the most sense from a public health perspective, but schools and teachers have been burdened with external directives and requirements to a devastating degree in the past decade.
We do have methods that are well understood by mental health professionals. Rather than providing one course of education at a period in time, such education is best rendered in many briefer episodes over years, which allow for questions, repetition, review, pondering and evolution of understanding as the child’s mind develops.
Like adults, children learn about addictions best in small groups that allow for discussion. It is not a coincidence that group treatment has long been the most successful medium for treating those who have fallen ill with addictions. These methods would make it possible for children and young adolescents to acquire complex, detailed, scientific understanding of addictive drugs. That might endow them with the ability to avoid the turnstile.
David R. Hawkins Jr. is a child and adolescent psychiatrist in private practice in Bangor.