“Teenage Substance Abuse and Impacts on Academic Performance and Relationships”

Introduction

The unobserved complexity of an adolescent and his or her potential severity of substance abuse results in negative consequences. Substance abuse represents a dependence on addictive substances such as alcohol or drugs. The use of tobacco, nicotine, alcohol, and other drugs during adolescent years can interfere with the brain development, reduce academic performance and increases the risk of health complications and increase family issues (NIDA, 2014). In America today, family structures have become more complex than ever. They range from the traditional nuclear family to single-parent families, stepfamilies, foster families, and multigenerational families (Treatment, 2004).

In conjunction, when a family member abuses substance, the effect on the family differs according to the family structure. Family members may experience feelings of abandonment, anxiety, fear, anger, concern, embarrassment, or guilt; they may wish to ignore or cut ties with the person abusing substances (Treatment, 2004). While, some family members may feel the need for legal protection from the person abusing substances. Additionally, the effects on families may continue for generations, which can result in a negative impact on role modeling, trust, and concepts of normative behavior; causing damage to relationships between various generations. Individuals who abuse substances are more likely to find themselves increasingly isolated from their families; associating with others who abuse substances, which supports and reinforces each other’s negative behaviors.

This paper will focus on the negative impact’s teenagers deal with regarding substance use. The impact of substance use disorders (SUDs) on the family and individual family members requires attention. Each family member is uniquely affected by the individual using substances including but not limited to having unmet developmental needs, impaired attachment, economic hardship, legal problems, emotional distress, and sometimes violence being perpetrated against themselves (Lander, et al, 2013). This paper will explain the Stages of the Change Model, and what interventions/techniques can be used to help those individuals who are suffering with substance abuse.

Adolescence and Abusing

According to the Merriam-Webster dictionary, substance abuse is the excessive use of a drug such as alcohol, narcotics, or drugs without any medical justification. Substance abuse is becoming prevalent in our society and there is a growing number of adolescents becoming involved in this aspect of our culture. This can potentially lead to addiction, which then becomes a complex disease of the brain, that is uncontrollable and irrational. The teenage years are a critical window of vulnerability to substance use, because the brain is still developing, and peer pressure is at its highest peak as a teenager. The brain is malleable, and some brain areas are less mature than others. During the teen years the prefrontal cortex is not fully developed. The prefrontal cortex is responsible for assessing situations, making sound decisions, and controlling emotions and impulses; typically, this circuitry is not mature until a person is in his or her mid-20s. Teenagers are highly motivated to pursue pleasurable rewards and avoid pain, but their judgment and decision-making skills are still developing, yet limited (NIDA, 2014).

Substance use affect the brain’s “reward” circuit, which is connected to the limbic system. Normally, the reward circuit responds to feelings of pleasure by releasing the neurotransmitter dopamine, while dopamine creates feelings of pleasure. This then results to drugs taking control, causing substantial amounts of dopamine to flood the system. This flood of dopamine is what causes the “high” or intense excitement and happiness (sometimes called euphoria) linked with drug use (The National, 2014).

After repeated drug use, the brain starts to adjust to the urges of those negative/pleasurable behaviors. Neurons may begin to reduce the number of dopamine receptors or simply make less dopamine. The result is less dopamine signaling in the brain; because some drugs are toxic, some neurons may die. As a result, the ability to feel any pleasure is reduced, causing one to lifeless and depressed. Now the person needs drugs just to bring dopamine levels up to normal, and more of the drug is needed to create a dopamine flood, or “high”, which is considered as “tolerance” (The National, 2014).

Family Impacts

It is important to explore the impact of substance use on the family because genetic and environmental factors contribute to the development of adolescent substance use. The impact varies depending on the role and gender that the individual with the substance use has in the family. For example, if an adolescent child is identified as having a SUD, this will affect the family differently than if a parent has an SUD. The attitudes and beliefs that family members have about SUDs are also of importance as these will influence the individuals as they try to get sober and will influence the efficacy of treatment interventions (Lander et al., 2013). For example, if a parent sees a SUD as a moral failing and thinks his or her adolescent child should just use “will power” to quit, this will be important to know if the treating therapist is working from a disease model of addiction. Education with the family about SUDs, their development, progression, and treatment will be needed.

Family therapy can be a useful intervention where the therapist can assist and support the victim in setting limits with their parent or guardian stating he does not want to drink at all and suggesting alternative non-drinking-related activities. Individuals who grow up in a family where there is a SUD are at significantly higher risk to develop SUDs due to genetic and environmental factors. It is essential to assess for active substance abuse in the immediate and extended family. Knowing that an individual with an SUD grew up in a family with an SUD has significant implications in treatment. Active substance abuse in the family of a client who is trying to get clean will also put that client at risk for relapse (Lander et al., 2013).

A parent with a SUD is 3 times more likely to physically or sexually abuse their child. Children who have experienced abuse are more likely to have the externalizing disorders such as anger, aggression, conduct, and behavioral problems whereas children who experience neglect are more likely to have internalizing disorders (depression, anxiety, social withdrawal) Incest has a very high association with parental substance abuse; averaging about two thirds of incest perpetrators report using alcohol directly before the offending incident (Lander et al., 2013).

Academic Impacts

Academic problems are related to substance usage, resulting in the adolescent acting out or skipping class. When students are not behaviorally or psychologically engaged in the classroom, they tend to cut class, fail to complete their schoolwork, and otherwise misbehave. This misbehavior may transfer to other settings and provide adolescents with more opportunities to use substances. Research suggests that White adolescents may be more vulnerable than African American adolescents to the impact of school-related risk factors on substance use. In general, girls report higher grades than boys, and low achievement seems to affect girls more negatively than boys. However, girls with low levels of academic achievement are more at risk than boys with low levels for psychological distress and low academic self-concept, suggesting that school failure may put girls at more risk than boys for problem behaviors such as substance use (Bryant, et al, 2003).

Substance Abuse Statistics

In the United States, one in four individuals between the ages of 12 and 20 drinks alcohol monthly, and specifically 12th graders consume five or more drinks in a row at least once every two weeks (Balsa, Giuliano, & French, 2011). Several studies have reported that alcohol use during adolescence affects educational attainment by decreasing the number of years of schooling and the likelihood of completing school. Underage drinkers are vulnerable to the immediate consequences of alcohol use, including blackouts, hangovers, and alcohol poisoning, and are at elevated risk of functional brain activity, and neurocognitive defects. Cigarette, alcohol, and marijuana are among the most commonly used drugs by adolescents between the ages 12 and 17 (SAMHSA, 2012). Recent national surveys indicate that among high school students, 39% used alcohol in the past month, 18% smoked cigarettes, and 23% used marijuana (Hill & Mrug, 2015).

The 2011 Monitoring the Future (MTF) data reveal current predominant issues regarding adolescent substance use. The use of tobacco products remains high, with 2.4% of 8th graders, 5.5% of 10th graders, and 10.3% of 12th graders smoking every day (Whitesell, et al, 2013). Similarly, binge drinking was reported by 6.4% of 8th graders, 14.7% of 10th graders, and 21.6% of high school seniors (Whitesell, et al, 2013). Another key area of concern is use of prescription and over-the-counter (OTC) drugs for nonmedical purposes NIDA reports that prescription and OTC drugs are the most commonly abused illicit substances among 12th graders (Whitesell, et al, 2013).

Risk Factors

There are an extensive number of risk factors that may contribute to the onset of substance use among adolescents. Familial risk factors include childhood maltreatment (including abuse and neglect), parental or familial substance abuse, marital status of parents, level of parental education, parent-child relationships, familial socioeconomic status, and child perception that parents approve of their substance use. Males are more likely to be physically abused, whereas females are generally more likely to be sexually abused (Whitesell, et al, 2013).

Research shows that experiencing emotional abuse can lead to increased risk for adolescent substance use, though it does not have as much influence as experiencing physical or sexual abuse (Whitesell, et al, 2013). It has also been found that witnessing violence can increase an adolescent’s risk for developing a substance use disorder with alcohol, cigarettes, marijuana, or hard drugs by as much as two to three times (Whitesell, et al, 2013). This is likely because witnessing violence creates great stress, especially in the case of a child witnessing domestic violence. Therefore, substance use becomes a coping mechanism.

Research has revealed that playing the role of the bully has been positively associated with increased alcohol use (Whitesell, et al, 2013). Interestingly, being a victim of bullying has an inverse association with alcohol use. However, those studies also indicate that victimization is positively associated with other forms of substance use, including marijuana, inhalant, and hard drug use. Adolescents who fill the role of both the perpetrator and victim tend to have the highest exposure to mental disorders, such as depression and anxiety (Whitesell, et al, 2013). The effects of bullying on mental health of participants have shown to be similar among males and females.

Similarly, peer pressure and perceived popularity have been shown to be associated with increased risk for adolescent substance use. Specifically, when adolescents believe their popularity increases with the use of substances, they are more likely to participate in such substance use (Whitesell, et al, 2013). Adolescents who self-identify as popular have shown to have increased prevalence of substance use when compared to adolescents who do not identify this way. This goes back to living life based on societal expectations. Boys may also be more likely to engage in smoking to improve their social image, whereas girls more often do so as a form of stress relief (Whitesell, et al, 2013).

Case Study

John Anderson is seventeen-year old African-American male, who lives in the deep streets of Harlem, New York. John was a senior at the Harlem Heights High School, and his past 2 years of life have been particularly stressful due to life’s mishaps and lack of motivation. John constantly was suspended from school due to police officials constantly picking him up from skipping school. He has received two DUI’s in the past year and a half. He was recently caught cheating on his SOL’s test. John bribed another classmate to take the test for him, in return for free marijuana. John lost his license due to his bad decisions. John just recently found out he is going to be a father, but believes he is not good enough. He starts cutting on himself. John was a gifted child, who was never afraid to express himself. John was well known in his neighborhood and school as the “Dope King (KG)”. John was a heavy drug dealer, but he always focused on family. John was the oldest of four. John was always the class clown, when he was in school. He always the family’s entertainer. John wanted to practice stand-up comedy as a mean to learn to cope with his anger, guilt and, regret. He felt if he laughed it off, it would hopefully bring joy to his life and numb the pain internally. John wanted to be perceived as the cool kid, but inside he was truly hurting.

John continued to battle with low self-esteem and the hardships of life. He found himself continuously running around in the same hamster ball, never finding an outlet. John never saw the good in any situation and was convinced everyone was out to get him. John was concerned about possibly not graduating high school. John was facing a court mandated appearance for possible expulsion from Harlem High School District. John was caught with 1LB of marijuana on school grounds. Prior to this incident, John received his 2nd DUI. His thought process has been negatively impacted by his history of bad decisions, consequently convincing him he has no willpower now.

John has silently disappeared! John maybe physically there, but mentally and emotionally he has disappeared from every situation. John’s parents have been complaining about the lack of care and motivation they have observed from John. John has been losing his focus in school; he is constantly becoming fidgety, disruptive and rude. He never stays in class for a whole class period. He does not complete homework, he has this pre-conception that schoolwork is only to be done at school. Anything outside of that should be pleasurable. He does not engage is school assignments, or school activities outside of school, such as homework. His reading and comprehension skills are beginning to negatively impact his academic performance, resulting in a referral for a remedial program. John’s parents are worried his isolation and mood changes will reflect onto his younger siblings. They are wishing and working towards forcing John out of their house by signing him up for the army. They believe the quicker they can get him out the house, the quicker they can fix the wrong behaviors their smaller children have picked up on from John. John constantly hears his parents encouraging and praising his younger siblings, while always feeling like a red headed step child.

Theory Chosen

I have taken a different approach to handle this case study. Based off of my experience from Couples, Marital and Family Counseling class, I have learned there is no right or wrong theory to use when counseling families. I have learned it is important to research the theory and interventions, while correlating them to the family’s dynamics and culture. I have combined both experiential and solution focus therapy to represent this case study. I have learned the importance of meeting the client where they are, while providing a holistic approach to meet multiple needs at once.

I have chosen both theories because I wanted to address what John’s current needs were, while addressing the family’s need on a larger scope. John is currently feeling powerless. His cognitive thinking has diminished, and it is being clogged by the constant drinking and using of marijuana. Although John is the IP, there is still a family issue at hand. They have all given up on John. As the family counselor my responsibility is to help build back up the trust and communication within the family, while educating and encouraging along the way.

I think incorporating solution focus therapy will help direct results to John and his addiction. It will also help the family set attainable goals within the family system to see better communication and trust patterns. Solution focus therapy focuses on fixing the problem, which forces the family to be in the working stage of change. Since family issues are horizontal stressors, not focusing on where the problem came from, will help focus on the here and now, while eliminating excuses for the problem. This theory will help with self-empowerment, holding family members accountable for problem solving rather than the counselor.

Utilizing experiential family theory in addition to solution focus, puts greater emphasis on each family member experiences/feeling. This approach helps everyone seek emotional responses and correlate them to their decision-making skills. This type of theory helps the family not directly talk about the issue, but gives the opportunity try something new, while learning to solve an issue from a new perspective. Techniques such as role playing, arts therapy and psychodrama could be incorporated in the family’s treatment plan. This theory also will help relive experiences, which will allow family members to process and discuss their current and past feelings, while moving into the solution focus part of treatment to find a resolution to feel and maintain.

As the Family Counselor responsible for this case, I would approach each issue with the experiential/solution focused theory. I think addressing feelings/emotions of targeted solutions help the client process internally the who, what, where, when and how variables of the situation. Transitioning into the solution focus theory, forces the client to think on a creative scale to solve the issue, while still feeling empowered over the situation. This also helps with independency and self-esteem boost. In relating this theory to the IP, it will address what John is currently feeling. It will bring light to his feelings of lack of support, feeling lonely, powerless, addiction, depression, not feeling valued and being heard. This will open eyes to the family on ways they can better support their son/brother, while looking at ways to resolve the dismissive attitudes amongst each other. Lastly, this approach will help the family find creative solutions to help keep John on track in school, while addressing his feelings of why he decides to use and looking at the decision-making process.

Conclusion

After extensive research, a common theme presents itself that there is a need to bring about awareness regarding substance use by adolescents. There may be a lack of prevention services due to the geographical area of where adolescent lives. Addiction is an uncontrollable need or want that can result in negative academic performances and negative family relationships amongst family members. It is prevalent to address and engage family members as a whole in the treatment process of abstinence to help create an environment that challenges the victim to eliminate drug use. The responsibility to help keep adolescents’ safe falls to all of us. Acting now and educating students about the dangers of substance usage is the first step among many to eliminating this increasingly negative epidemic."

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