Headlines
As reported by the Connecticut Jewish Ledger, May 15, 2007.
Conversation With…Dr. Yifrah Kaminer
Teen Substance ‘Use’ Is Often More Deadly Than ‘Abuse,’ Says Expert
By Judie Jacobson
FARMINGTON - Dr. Yifrah Kaminer is professor of psychiatry in the Department of Psychiatry & Alcohol Research Center at the University of Connecticut Health Center in Farmington, where he also serves as co-director of the research division of Child & Adolescent Psychiatry.
Born in Israel, where received his M.D. from the Sackler School of Medicine at Tel Aviv University, Kaminer’s primary interest has focused on clinical research of assessment and treatment of high-risk behaviors, particularly substance abuse, gambling behavior and suicidal behavior in youth with psychiatric disorders. Currently, he is conducting research into the different treatment approaches for adolescent substance abuse.
A member elect of the board of the International Society for Addiction Medicine, Kaminer, who lives in West Hartford, is widely published and the author of “Adolescent Substance Abuse: A Comprehensive Guide to Theory and Practice.”
Recently, the Ledger spoke with Dr. Kaminer about the phenomenon of alcohol and drug use and abuse in adolescents.
Q: How serious a problem is the use of alcohol and drugs among teens in Connecticut?
A: Very serious. The three most prevalent reasons for deaths among adolescents in the U.S. are (1) car accidents; (2) homicides; (3) suicides. In all of them there is a significant co-occurrence of being under the influence.
We try to differentiate between substance use, substance abuse and substance dependence. Substance use is definitely very high. The percentage of kids who have not been diagnosed as abusers and dependents and who nevertheless use alcohol and drugs on a regular basis is extremely high. In this area, in my estimation, it amounts to 25%-30% of high school students.
In general, Connecticut is considered to be the state with the highest rate of teen substance abuse in New England. The rate of abuse is higher even than neighboring states such as New York.
Q: You draw a distinction between use and abuse. Can you explain?
A: Use is basically when kids use alcohol and drugs but not to the point where they are identified as having a dysfunction in domains such as school, family, legal or psychiatric. If you have identified dysfunctions, usually you meet criteria for abuse or dependence.
Nevertheless, use is not something that you should not take seriously, because most of the cases of morbidity and mortality are associated with use and not abuse. All those kids who drive while high or intoxicated during the weekend and hit another car or hit a tree are not necessarily diagnosed as substance abuse or substance dependent. They just use chemicals that alter their function.
Q: Many parents believe that it’s okay for teens who fall into the “user” category to drink at least sometimes. Do you agree?
A: Absolutely not. First of all, legally in the U.S. you are not allowed to drink any alcoholic beverage until the age of 21. And drugs, of course, are illegal at any age.
Secondly, adolescents can get involved in all sorts of things, besides the three incidents I mentioned earlier n road accidents, homicide and suicide. There is unprotected sex. There is violence and aggression. There is date rape. Even drowning is associated with alcohol and drug use. A lot of things can happen when your judgment is impaired when you drink and use drugs. And adolescents have this aura that they are invincible n bad things happen to other people and not them. That’s one of the problems.
Q: Besides alcohol, what is the drug of choice among teens these days?
A: Marijuana is still the most common drug used, but a growing problem in Connecticut is the use of prescription opiates, such as OxyContin, that people can get through family members or funnel through other sources. Kids take all kinds of over the counter drugs, such as cough medication like Robitussin that have some active ingredients that are definitely addictive.
Q: Why is it that parents seem to be the last to realize that their teens have a problem?
A: Parents are the last to know that their kids are using drugs because of a lack of knowledge and a lack of understanding of the adolescent culture. Even if they know about it, sometimes they hope that it will go away because there is a shame factor and it usually takes them a long time until the kid gets in trouble n either a complaint from school or a call from the police for driving under the influence or for being in possession of drugs or alcohol. At that point, parents are focused on getting their kid out of trouble. Sometimes parents just want the child to go to treatment in order to avoid legal trouble n but they aren’t really investing in treatment per se to stop the teen’s drug use.
Q: What are some of the telltale signs that should lead a parent to suspect a teen is using drugs?
A: There are all kinds of signs. Teens come home later and later and are very secretive. They develop friendships with kids whose behavior you don’t really support. They have difficulty getting up in the morning n although that’s always an issue with adolescents, this would be more than usual. They have red eyes or use eye drops such as Visine to disguise the fact that they’re using marijuana. They are more edgy than usual. You see changes in their grades and complaints from school. There are a lot of telltale signs that accumulate.
Q: What should parents do if they suspect that their teen is involved in alcohol or drug use?
A: It all depends on the relationship of the parents with the teen. They can definitely discuss the issue with the child and find out whether he or she admits to using it. They also need to use contingencies. For example, they can develop a set of rules in the house that are contingent upon the child’s behavior. Whether it’s a curfew, or being grounded, or not getting keys to the car, or not providing the teen with some other thing which the teen feels entitled to get. They should try to reach some agreement, some contract, with the teen. If this doesn’t work, than most probably they need to get some professional advice and help.
Parents need to understand that there is a lot of unfinished business in the brains of their adolescents that makes their children impulsive, unpredictable, and not using their insight very much. They can be great in math, in computers, etc….but when it comes to managing their personal lives they are a mess. Why? Because they’re not done yet. And parents have no idea how unprepared adolescents are for life. Teens are able to get what they want from us either by cajoling or by misbehaving n they exhaust us and therefore we let them do what they do and we justify it by saying, “everyone else does it, so let it be…” That’s not the way to do it.