Trick or treatment

Making government work better.
Jan. 3 2003 1:38 PM

Trick or Treatment

Teen drug programs turn curious teens into crackheads.

Illustration by Mark Alan Stamaty

America loves its quick fixes. Think your child might be on drugs? Test him. Think your child's school is full of addicts? Test them all. Institute a policy of zero tolerance: One strike and it's off to a drug treatment program. Get those rotten apples out and clean them up before they can poison the whole batch. Last year's Supreme Court decision in Board of Education v. Earls allowed for a massive expansion of drug testing in schools. And increases in drug testing increase the numbers of offenders. As a result, schools and juvenile courts are increasingly turning to both "zero tolerance" and "treatment, not punishment" as a remedy.

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The number of teenagers in drug treatment as a result of court coercion and school diversion increased by nearly 50 percent between 1993 and 1998 according to the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration, and the number of teen admissions to treatment programs in general rose from 95,000 in 1993 to 135,000 in 1999. But what if drug "treatment" doesn't work for teens? What if, rather than decreasing drug use, teen treatment actually encourages it by labeling experimenting kids as lifelong addicts? What if it creates the worst sorts of peer groups by mixing kids with mild problems with serious drug users who are ready and willing to teach them to be junkies? What if suggestible kids respond poorly to the philosophies that have made Alcoholics Anonymous and Narcotics Anonymous successful for many adults? Then we'd be using "treatment" to turn ordinary adolescents into problem drug abusers.

That's precisely what we're doing. A 1998 study of nearly 150 teenagers treated in dozens of centers across the country found that there was 202 percent more crack abuse following treatment and a 13 percent increase in alcohol abuse. In other words, recent research suggests that parents and schools may be sending binge-drinking/social marijuana smokers off to treatment and getting back crackheads in their stead.

Michael's case illustrates some of the dangers inherent in shipping youngsters off to treatment programs. An 18-year-old marijuana smoker and cocaine user I interviewed regarding drug treatment, Michael was recently sent by his parents for drug treatment at the respected Caron Foundation. But his $11,000 one-month treatment program degenerated into a fruitless debate when his counselor wanted him to admit that he was "powerless" over drugs. Michael, who didn't use daily, wouldn't accept that. What teenager would admit to being "powerless" over anything? Michael used again within four hours of leaving treatment.

Michael's reaction may be the rule for teenagers, not the exception. For an adult who has lost his wife, his job, his health, and his home, admitting to a loss of control might help him recognize that quitting drugs is the only way to solve his problems. But a teenager may not be "in denial" when he says he can control his intake. Most teenagers can. Conversely, forcing a teen to assert that they have no control may do more harm than good, if they have only been experimenting with drugs but are convinced, via treatment, that they are serious addicts. If a teenager has been persuaded that she's powerless and has a 90 percent chance of relapse, she's far less likely to exercise self-control when confronted with a drink or drugs. In fact, a 1996 study published by Bill Miller, professor of psychology at the University of New Mexico, found that those adults who most accepted the idea of personal powerlessness had the most severe and dangerous relapses. Since teenage identities are fluid anyway, encouraging them to view themselves as powerless addicts may cement an anti-social identity that a teen was just trying on for size.

The core problem with teen treatment programs is that most teen drug or alcohol users are just not out-of-control addicts. More than one teen in six who's forced into treatment does not even fit the criteria for a "substance abuse disorder" (the less serious diagnosis for an abuser), and most also don't have substance dependence (the psychiatric term for addiction) at all, according to SAMHSA. More troubling, SAMHSA statistics also show that about three-quarters of the U.S. teens now being sent to treatment programs are diverted there by courts or schools, rather than being referred by professionals. In other words, many have problems no more serious than those of their friends who've escaped detection.

In addition to labeling kids as addicts, drug programs may also surround them with the worst possible influences. Studies show that teens are more subject to peer pressure than adults—and more influenced by the people around them. Teen treatment programs remove teens from a healthy peer group and surround them with other problem kids, virtually guaranteeing that their role models will be negative. Group therapy during such treatment invariably involves discussions of their drug experiences—which only makes the hard-drug users seem "cooler" because their stories are so much more exciting. Worse, aside from providing a way for relatively inexperienced kids to learn about different ways of getting high and obtaining drugs, these programs frequently offer kids new connections. One 17-year-old girl from Florida told me that she hadn't used cocaine until after treatment—her new best friend from rehab scored it for her.

There are treatments for teens that don't reinforce the labeling or peer problems inherent in most drug programs. Research presented at a spring conference held by the National Institute on Drug Abuse compared teens who'd been sent to traditional group sessions with peers to teens who received family therapy, with a third group who had both kinds of care combined. The kids in the peer-group sessions used 50 percent more marijuana after treatment, while the kids in the combined treatment used 11 percent more pot. The teenagers treated with their parents, however, decreased their marijuana use by 71 percent.

The greatest irony in the current well-intentioned treatment efforts is that they ignore the few things we do know to be effective in helping teens stop getting high, and chief among them is finishing their education. The better educated someone is, the less likely he is to become an addict or to have a lengthy course of addiction if he does. So removing kids from school and placing them with a more deviant peer group in an unproven therapy is madness—and not much smarter than simply expelling them and tossing them on the street. Not only is the education provided in treatment programs often inferior to that in ordinary school, but having a drug-related disciplinary record diminishes the chances of admission to a decent college.

Ultimately, it's clear that the vast majority of teenagers (even those with the very worst problems) simply "mature out" of drug use. This natural recovery process is seen in statistics from the annual federal household survey of drug use, which, for example, find that while 18.4 percent of the population ages 18-24 in 2001 qualified for a diagnosis of alcohol or other drug abuse or dependence, only 5.4 percent of those over 26 meet these criteria. Since less than 2 percent of the total population annually receives treatment (including self-help), most of these young people are clearly recovering on their own.