How to help your child with addiction
People become addicted to experiences that protect them from life challenges they can’t deal with. It is not possible to say that any one thing causes addiction.
Most kids who use drugs and alcohol don’t become addicted to them. On the other hand, they can get addicted to very typical, common activities—such as eating, the Internet, other media, games, even medications they are prescribed for other problems.
The core of an addiction is that people become enmeshed in an activity that interferes with their functioning and, for children, thwarts their growth. If your children avoid regular involvements and experiences, if they can’t cope with their lives, and if you fear that, left to their own devices, they will either collapse or go haywire, your children face addictive problems.
Disagreements about the nature of addiction make for vast differences in how we go about combating it. I do not ﬁnd it helpful to regard addiction as a disease, which is the prevalent view these days. Although many people, including scientists, now believe that a wide range of things can be addictive, they wrongly persist in seeing addiction as a biological phenomenon beyond people’s control.
By contrast, I was one of the ﬁrst proponents of the view that addiction is not limited to drugs. But its very universality makes it clear that addiction can’t be traced to a speciﬁc neurological mechanism. If sex or gambling addictions are deﬁned by changes in the brain, why do so many people who ﬁnd these involvements alluring for a moment, or even enthralling for some time, then simply move on to other activities? As we shall see, the exact same thing is true of “addictive” drugs.
Addiction can be especially debilitating for the young, but young people are more likely than not to outgrow it. The way out of addiction is to develop a range of skills and engage fully in life. The disease mythology is particularly unhelpful for young people. Telling adolescents that they have inherited addiction as part of their biological makeup encourages them to get stuck in the problem, rather than motivating them to overcome it.
Although my view of addiction is not the conventional one, my way of thinking has been adopted by many and is gaining inﬂuence in the ﬁeld. My approach includes recognizing that addiction is not limited to drugs, that people overcome addiction when they are motivated and when their lives improve, and that successful therapy for addiction builds on people’s own motivation to change while teaching them better ways of coping.
At the same time that not all drug use is addictive, addiction does not have to involve drugs. People can become addicted to powerful experiences such as sex, love, gambling, shopping, food—indeed, any experience that can absorb their feelings and consciousness. Addiction to the Internet is now in the spotlight, and before that came addiction to television and then video games.
Addictions provide quick, sure, easy-to-obtain gratiﬁcations, and advances in the electronic age such as the Internet, cell phone, iPod, and BlackBerry bring more addictive possibilities. Two addictions intertwined with the Internet are pornography and gambling. People become enmeshed in these experiences in isolation, rejecting everything else in their lives. A typical Internet pornography addiction case reads like this:
My son is addicted to pornography. He can’t stop looking at porn. He stays up on his computer all night. In the morning he can’t stay awake, and he often doesn’t go to school. I’m at my wits’ end.
Likewise, we frequently hear of people who cannot stop gambling or shopping, often going deeply in debt. Such addicts, as adults, may steal, go to prison, and lose their families as a result.
To come to grips with how widespread addictive experiences can be, consider that love relationships can become addictive. We are all aware of this phenomenon, which is captured in popular song lyrics such as “Why must I be a teenager in love?” But these cases can be remarkably debilitating:
About a year ago I fell in love with someone I believed was “The One.” Ever since then my whole life has been about him—and, as time went by, I’ve become more and more depressed.
I have always been easily addicted. But before this whole thing started I was a very happy and energetic person with a lot of interests who enjoyed living and loved talking to people. During the time we were together I threw all of my life away: my friends, my schooling, my dreams. He became the only thing that mattered to me. I continued to feel this way even when I realized that he didn’t really accept me.
At some stage we decided it would be best if we stopped dating and tried to be friends, but after a short time I realized I couldn’t do that.
Now, I am depressed all the time. I’ve thought about him every second of my life for the past year. I can hardly sleep, I can hardly get out of bed in the morning. I feel like being alone most of the time. I have no energy, I nearly always feel sick. I find it hard to enjoy anything at all. I can’t get him out of my head.
I described addictive love in 1975 in my book Love and Addiction. But because this idea is so shocking, it keeps resurfacing as though it were new. A woman wrote in the New York Times in 2006: “This is what love addiction did to my life: I dropped out of college, quit my job, stopped talking to my family and friends. There was no booze to blame for my blackouts, vomiting and bed-wetting.”
If we want to understand all kinds of self-destructive behaviors, we need a broader conception of addiction than the simple idea that some drugs are addictive: Child Addiction is a way of relating to the world. It is a response to an experience young people get from some activity or object. They become absorbed in this experience because it provides them with essential emotional rewards, but it progressively limits and harms their lives. Six criteria deﬁne an addictive experience:
- It is powerful and absorbs people’s feelings and thoughts.
- It can be predictably and reliably produced.
- It provides people with essential sensations and emotions (such as feeling good about themselves, or the absence of worry or pain).
- It produces these feelings only temporarily, for the duration of the experience.
- It ultimately degrades other involvements and satisfactions.
- Finally, since they are getting less from their lives when away from the addiction, people are forced increasingly to return to the addictive experience as their only source of satisfaction.
Addiction Versus Normal Experience
Watching television every night, drinking daily (for an adult), and having an active social life are not necessarily addictions. Broadening the deﬁnition of addiction does not mean that everybody is addicted to something. The word is now often used casually, even humorously: a friend says he is addicted to crossword puzzles, a baby is addicted to his paciﬁer, a teenager to her cell phone.
Addictions are harmful, perhaps overwhelmingly so—as in the cases of pornography and love addiction described above. People may joke that they are addicted to exercise or coffee or work, and they can be. But it is only when these things seriously detract from their ability to function that people are genuinely addicted—for example, they can’t stop exercising after they have suffered an injury, or they drink coffee throughout the day even though it prevents them from sleeping, or they are so preoccupied with work that they neglect their families.
Here’s a case in which being well-balanced saved a man’s life:
Peter was in the south tower of the World Trade Center when the north tower was struck. His floor was evacuated down a stairwell. But after going down several flights, a security officer told the evacuees they should return to their offices. A number of people who were in the stairwell with Peter did so.
Peter—who was well paid and worked long hours—thought about returning. The instruction by an official to do so reinforced his conscientiousness and dedication to work.
But Peter also thought about his wife and children, and decided to proceed down the stairs. Soon after he left the building, the second plane hit below the floor on which Peter worked.
After September 11, Peter’s wife couldn’t stop hugging him. “Every time I see him, I feel such love and gratitude that he was spared,” she explained.
Peter was a person who might have been at risk for being caught up in mindless, compulsive working, irrespective of any damage it caused him. Instead, his independent thinking and commitment to his family saved him from addiction. For young people, too, the more connections to life they have, the better able they are to resist addiction. When people give up much of their lives for their addictions, as we saw in the cases of love addiction, it is because their other involvements are superﬁcial or somehow unsatisfactory.
We all rely on ﬁxed elements in our lives, and children especially do. It is essential to your children’s security and psychological wellbeing that you provide them with consistent limits, acceptance, and love. You should also recognize that children and adolescents will often ﬁxate on an object or activity—their stuffed animal or a recording artist, playing with dolls or video games, wearing certain clothes or going to particular places. These fads are normal phases in growing up, and you should accept them as such.
What makes for addiction is when young people cannot extricate themselves from an activity in order to do the things required of them—things that they in some sense would prefer to be doing. Instead, they persist in behavior that is consistently harmful, or that is disapproved of by society, or that damages their health, their future, or their relationships with other people.
One of the thorniest problems for parents is deciding whether children are addicted when they use a substance (such as marijuana) regularly but otherwise function successfully. One possibility is that their drug use is normal. A landmark study found that moderate experimentation with drugs characterized the most psychologically healthy adolescents, while heavier use and abstinence were both signs of poorer adjustment.
You need to key in on how well your children are coping with the demands made on them to ascertain whether or not they are abusing a substance. But even when they are abusing a substance, it may be wrong to call the problem an addiction or unhelpful to put them in drug treatment. I deal with these dilemmas in Chapter 10.
Addiction in Adolescence
Some adolescents do become so involved with drugs or alcohol that it completely dominates their lives. Consider these cases:
Alice grew up in a family that had many problems. Her parents repeatedly separated, then got back together. Her father was violent, and screaming and crying were typical in the home.
Alice quickly got used to going out with friends as a way of escaping the turmoil and pain at home. When she was fourteen, she began drinking with these other teenagers, many with backgrounds similar to her own. The first time she drank she became falling-down drunk—“wasted,” as she described it. Alice soon became sexually active when she was intoxicated.
Alice would sometimes quit drinking, only to return to it with a vengeance. This became a pattern for her throughout high school. As a junior she attended meetings of Alcoholics Anonymous and entered a six-month period of abstinence. But soon she returned to drinking and began using drugs as well. At first it was marijuana. In her senior year, however, she also used cocaine and took LSD.
Alice was smart and attractive, but her academic performance was lackluster. She decided not to go to college. Instead, she became a waitress at a local restaurant, where other young employees joined her in drinking and using drugs following work.
In adolescence and early adulthood, Alice’s life was devoted to intoxication and the activities that surrounded it—which she called “getting rowdy.” Since her life centered around drinking and drugs in a way that limited her opportunities, her friends, and her future, Alice was addicted during this phase of her life. But Alice, as typically happens, quit drinking and drugs when she reached her late twenties. Unfortunately, her addictive phase hampered Alice, because of the opportunities she lost, even after she stopped abusing substances.
While Alice’s background is common for youthful addicts, hers is certainly not the only path to drug and alcohol excess and addiction.
John’s family was stable—his older sister did well in school and went on to become a doctor. His father made an excellent living in the financial industry. His parents got along well together.
But John began abusing drugs early in life. In fact, he had already used heroin by the time he was sixteen. To do so, he associated with other kids who engaged in the most negative behaviors. It was as though—as his father put it—John was “following the loser.”
John certainly had ability and enjoyed successes as an adolescent. He was a very good runner, for example, and made the county championships in the quarter mile. His parents devoted themselves to taking him to track meets and getting him additional training—such as a summer track camp—to further this skill.
After he became addicted, John’s parents placed him in a series of treatment programs. After each, he returned home seemingly prepared to resume a typical high school existence. But within a matter of weeks or months he was back with his old crowd, abusing drugs and heading to his next treatment episode.
Eventually, John’s family felt they had to expel him from the household— he went into treatment, then a halfway house in a different state. His father told him he would continue to help John financially and stay in touch only if John could prove that he was clean.
For a time, John became a pariah to his parents, who felt it was best for their family to expel him from their home. I consulted with John’s father and helped him to reach a better resolution with John. Although he didn’t quit drinking and continued to use recreational drugs occasionally, John stopped using heroin and started to take his schooling seriously. I describe this harm reduction therapy in Chapter 9.
Both Alice and John began to abuse drugs and alcohol in early adolescence, and the abuse quickly become the focus of their lives. People like Alice—from fragmented, violent, or emotionally disturbed families and from families facing economic hardships—are more likely to abuse drugs and alcohol. But children from stable and prosperous backgrounds also do so. When children from well-off backgrounds abuse substances, they are failing to buy in to their family’s values. The pressures placed on them to achieve may then saddle them with emotional problems and bad feelings about themselves.
From an early age John and Alice could not ﬁnd a positive role for themselves. As a result, both of them developed alternative lifestyles and self-images around drugs and alcohol that locked them out of what society has to offer—at least for a time.
Adolescent Addiction is not Limited to Drugs and Alcohol
Broadening our concept of addiction to include electronic devices, gambling, destructive relationships, and even eating and therapeutically prescribed drugs helps us to understand the troubling behavior of some children and adolescents.
Alex was a normal, if quiet, child. He didn’t have many friends, and from a young age preferred to spend time with electronic gadgets of various sorts. He would sit playing video games or listening to his iPod, making motions in rhythm with the music, for hours at a time.
Alex did well in some school subjects—he got good grades in mathematics—and showed talent in music, which his parents encouraged. Although his father was shy and somewhat withdrawn, his mother was active and verbal and his parents’ relationship was stable. Yet Alex never found a group of peers who interested him more than his electronic devices.
When Alex decided not to go to college, his parents were at first shocked. But they came to accept their son’s decision—not everyone is suited for college, they thought, and this might be a better path for Alex. Instead of getting out in the world, though, Alex retreated more from it. He spent all of his time alone in his room playing on his computer, listening to music, or watching television.
Alex was addicted to interacting with electronic media and entertainments. Only predictable experiences such as these made him feel safe and in control of his life. Alex was already isolated, and his immersion in the Internet further limited his possibility of developing a social network and outside involvements.
Alex’s story suggests something remarkable—that while we are emphasizing the danger of illicit drugs and alcohol, addiction frequently emerges from ordinary aspects of children’s lives. In fact, addiction may be encouraged by standard childhood and adolescent experiences—creating questions and concerns for anybody raising children today.
One striking example of how common addiction has become is the meteoric rise in childhood obesity. Overweight in adolescence has tripled in the last three decades while it has almost quintupled for children ages six to eleven. Ironically, one reaction young people can have to their fear of being overweight is to circle all the way around to anorexia or bulimia, another alarming trend among the young. Both obesity and anorexia reﬂect an all-or-nothing approach people take when they are incapable of controlling an involvement, and both are forms of addictive behavior.
Children are unable to match their appetites with their nutritional needs if they aren’t equipped with a sound approach to eating and physical activity. Francine Kaufman, a diabetes specialist at Children’s Hospital in Los Angeles, describes the problem as getting “people back in energy balance.” She adds, “Yet nothing is fundamentally harder to do” because of a “ ‘toxic environment’ created by modern living, which promotes overeating sugary and fatty junk foods, reinforces inactive lifestyles and focuses on ‘disease care’ instead of preventative health care.”
Can children be addicted to psychiatric drugs?
One important source of addiction is people’s emotional problems and bad feelings about themselves, including anxiety, depression, and low self-esteem. Children and adolescents are more likely than ever before to be diagnosed with psychiatric problems such as depression, bipolar (manic-depressive) disorder, and ADHD (attention deﬁcit hyperactivity disorder).
If your children have serious emotional problems, you need to address them. Contemporary psychiatric treatment for young people typically involves giving them drugs. There has been considerable debate about the use of psychiatric medications for childhood emotional problems. Although this book is not a general mental health manual, the potential addictive impact of the drug therapies increasingly administered to children and adolescents is a serious consideration, as we discuss in Chapter 8.
How can drugs prescribed to help children be harmful addictions? Neither I nor the American Psychiatric Association recognizes positive varieties of addiction. When people come to deﬁne themselves in terms of substances they use, even if prescribed for them, this dependence on chemicals is in danger of becoming an addiction.
Society has not yet had time to determine the effects of the large-scale psychiatric medication of children, which concerns many experts in childhood development and emotional problems. At the same time, adolescents and college students regularly take pharmaceutical drugs without prescriptions to study, sleep, be calm, stay awake, and party. The recreational use of prescription medications is so widespread among the young nowadays that one anti-drug organization calls them Generation Rx.
What causes addiction?
Some people are more prone than others to pursue satisfaction through an external ﬁx. “I have always been easily addicted,” admitted the young woman we saw earlier who sacriﬁced her life for a transitory love affair. Some young people turn to addictions because they can’t seem to get the satisfaction they crave from their regular lives.
This susceptibility—and its opposite, resistance to addiction— stems from children’s lived experiences, including their homes, neighborhoods, and school environments.
Addiction-proof children have:
- Skills to gain real rewards, and the patience to learn and deploy these skills
- Values that sustain moderation and reject addiction
- Conﬁdence that they can achieve the goals and gain the rewards they desire
Addiction-prone children are saddled with:
- Chronic bad feelings, including fear, depression, and anxiety
- Environments that deny opportunities for fulﬁllment and satisfaction
- Histories of dependence, including on their parents
These personal assets don’t guarantee immunity from addiction, and these deﬁciencies don’t guarantee addiction will occur. But these addiction-preventing and -causing factors are the ones over which you have the most control. In the second part of this book I concentrate on teaching you how to exert your inﬂuence to produce non-addicted children.
How do people recover from addiction?
Although it can be hard work to help your children gain what they need to avoid addiction, there is no alternative. On the other hand, these conditions often change naturally as adolescents mature, develop skills and interests they care about, and become more conﬁdent, enabling them to free themselves of youthful addictions. Most people—and particularly young people—leave addiction behind somewhere along their life’s path. This process often involves common elements.
Young people overcome addiction when they:
- Develop the skills to gain life rewards
- Reafﬁrm values they have that oppose addiction
- Resolve emotional problems and become less anxious, depressed, and afraid
- Acquire assets—such as a family, work, status, security—they don’t want to lose
- Mature, so that their focus shifts beyond their own needs
- Feel that they control their lives and can get what they want in the world
The easy way to overcome substance abuse is to outgrow it, as most young people do. Koren Zailckas stopped the decade-long dependence on alcohol she described in her memoir Smashed when she found someone she cared about more than she did about drinking and became serious about developing her skills as a writer. Zailckas’ is the typical path out of alcohol and drug abuse.
But Zailckas has been forced to defend her account of her life, since so many experts say that she couldn’t do what she says she did—simply outgrow alcoholism.
I don’t identify myself as an alcoholic. That identity didn’t feel true to me, so I didn’t write it. I also think the brand “alcoholic” prevents a lot of people, especially young people, from seeking help or even reevaluating their relationship with alcohol. In my mind, the whole point of Smashed is to say, you don’t have to be a quote-unquote alcoholic in order to examine the underlying reasons why you’re drinking.
Some of those who have spent their youthful lives getting drunk and stoned suffer from deep-seated deﬁciencies. Some will have to learn basic skills in order to overcome the life problems that come along with their addiction, making addiction treatment more complicated and difﬁcult. This is the hard (though far from impossible) way to overcome addiction—to build a life, sometimes on top of a pile of rubble.
In the United States, we often attempt to remedy substance abuse by pressing young people into substance abuse (or “chemical dependence”) treatment, including Alcoholics Anonymous and similar self-help groups. Does treatment work? It may, but success—as Alice’s and John’s parents and most of us recognize—is far from guaranteed. And being involved in treatment can have its own drawbacks.
Sadly, unhelpful treatments for substance abuse are the rule. The worst danger is that the treatment can cause people to “take their eyes off the prize”—that is, preoccupy child and parent with tangential issues while overlooking the essential things the young person needs in order to lead a satisfying life. Instead of teaching life skills and engaging young people in regular life activities, the treatment can make addiction the focus of their lives, even after they are abstaining. Thus, even when it “succeeds,” this kind of treatment fails to address the underlying causes of addiction in children’s lives.
AA and twelve-step treatment are particularly inappropriate for young people, and can be limiting in ways that are themselves addictive. This occurs because such treatment demands that they adopt an identity built around their recovery status, which is everlasting.
Lana was an artist who entered AA as an adolescent; it became the center of her existence for crucial years of her life. Lana’s social life revolved around her AA friends. But in her twenties, when the boyfriend she met in the group died of an overdose (Lana didn’t know he was using), that world became alien and repulsive to her.
Finally, I chose to leave AA but continued to stay sober. I didn’t know what I believed—I felt continual fear and doubt for the rest of that year. AA, of course, says that you will always be an alcoholic. My ex-AA friends reinforced and encouraged my self-doubt, telling me I would never make it on my own.
It was a slow process integrating into the outside world. I was so used to relating to people with the AA language, I often felt awkward talking to non-AAers.
But I got involved with a martial arts group, reconnected with a loving relative, began working with other artists, and came to feel I was part of that community. In therapy, I learned to accept my feelings and still go out and live.
My life is full now, but it was a long, bumpy road to find the strength to be independent. Now so many things bring me pleasure, fulfillment, and challenge that getting drunk doesn’t interest me.
Where do we Turn?
You’re probably concerned about the many ways your children can go wrong, and perhaps this chapter has made you more anxious. The aim of this book is not to scare you but to make you aware of the nature, danger, and signs of addiction, and then provide you with the tools to combat and overcome it with your children. My purpose is to empower parents.
Although there is no question that there are more opportunities for addiction than ever, and that more young people enter periods of addiction, I want you to remember that most children don’t become addicted permanently.
In the next chapter, we see that the challenges you confront include the likelihood that your children will use drugs at one time or another, just as they are overwhelmingly likely to drink. I didn’t say the job of parenting is easy. But you can manage it, just as your parents did.
The skills and experiences you and your children bring to this task are the best antidotes to addiction. You need to learn and teach your children such skills—and feel conﬁdent that your children can progress through relying on their own abilities—in order to help your children grow into adulthood.
- R. Yoder, “Strung Out on Love and Checked In for Treatment,” New York Times, June 11, 2006.
- J. Shedler and J. Block, “Adolescent Drug Use and Psychological Health: A Longitudinal Inquiry,” American Psychologist 45 (1990): 612–30.
- Institute of Medicine, Progress in Preventing Childhood Obesity(Washington, DC: Institute of Medicine, 2006).
- G. M. Vogel, “Defying Diabesity,” USC Trojan Family Magazine, autumn 2005.
- Wikipedia, “Koren Zailckas: Alcoholism,” Ãhttp://en.wikipedia.org/wiki/Koren_Zailckas, accessed September 6, 2006.
- R. W. Hingson, T. Heeren, and M. R. Winter, “Age of Alcohol-Dependence Onset: Associations with Severity of Dependence and Seeking Treatment,”Pediatrics 118 (2006): 6755–63.