Why Do Young People Begin to Use Mood Altering Drugs?

Working in the field of addiction medicine for the last 35 years and as a practicing pediatrician for the last 20 years has allowed me to draw several conclusions about substance abuse and addiction in adolescents and young adults.  Is adolescent addiction a recent disease of the new millennium? Certainly not. Have the reasons that adolescents begin to abuse drugs changed in the last 50 years? No, the reasons are the same.  Have the substances of abuse morphed over the last decade. Yes, and that is a particular concern for myself and other practicing pediatricians.

Why do young people begin to use mood altering drugs?  Most people assume that young people begin to abuse drugs to feel good.  And that is certainly the case for many.  The young adult goes away to college and joins a fraternity and begins to use alcohol and pot and nicotine and other gateway drugs to feel good and to have a good time.  That’s why they are called mood altering drugs.  What most people do not understand is for the vast majority of young adults who progress to addiction, these individuals more commonly begin to use mood altering drugs to relieve pain. Perhaps as a child they suffered from an undiagnosed and untreated attention deficit disorder or learning disability.  We know that both of these disorders lead to low self-esteem in a young person. If a child doesn’t feel good about himself, doesn’t feel like he fits in or belongs he will invariably gravitate to others in the school with the same low self-esteem. These young people will often begin to look for substances that make them feel better. Children can be physically abused, sexually abused or more commonly emotionally abused. Any type of abuse in childhood will also predictably lead to a feeling of reduced self worth which again frequently results in the child looking for a substance to make him feel whole again.

Other examples might be the child who has an emotionally ill parent.  When a parent is depressed, that parent is unable to be emotionally available to the child.  This lack of emotional attachment will cause the child to feel empty inside, like there is something missing.  This situation will also lead the young adult to look for something to fill that hole.  Im not placing blame here. The parent desperately does not want to be depressed.  But the bottom line is that the parents depression does negatively affect a child. A parent could be addicted to alcohol, drugs, gambling, or work.  A parent who is actively addicted cannot be emotionally available so this child too feels empty and will eventually look for a substance to fill that void.

Young people begin to use mood altering drugs to feel good or more commonly to relieve pain.  They learns the principle “better living through chemistry”.  For a while, the gateway drug will work just fine but as the child develops a tolerance for the drug and the drug becomes less effective he will usually move on to another drug and that drug will work for a while but then quit working.  Eventually the young person will progress to the point that no matter what he uses the drugs do not work anymore. When the drugs quit working, why doesn’t he just stop?  Because as the substance abuse has progressed over months or years many of these children will cross the wall to become chemically dependent.  Chemical dependency is a chronic, progressive, biogenetic disease.  How do we know when a child has crossed this wall?  He’s developed the primary compulsion to use the drug.  He no longer uses the drug to to feel good or to relieve pain.  He uses the drug because he has a compulsion to use.  He will lie, steal, cheat, whatever it takes to get the drug.  He hasn’t suddenly become a sociopath or a bad person.  His compulsion to use the drug causes him to violate his own moral code fuleing his feelings of low self-worth and emptiness.

Different drugs have different addition potentials and variable levels of compulsivity.  Alcohol and pot may take many months or even years to activate addiction.  While cocaine and opiates can activate addiction in a matter of weeks or a few months. The reality is that usually when a young person begins to abuse cocaine and opiates he has already crossed the wall.  The problem with the “harder” drugs in general and the opiates in particular is that the compulsivity is extreme. Every waking moment the young person is thinking about where can I get my next dose.

And that brings me to events I have witnessed over the last 5 years in addiction medicine. Many young people entering treatment for chemical dependency are dependent on opiates.  Up until a couple of years ago the opiate dependency was usually limited to oral narcotics like hydrocodone. More recently, however, I’ve worked with a number of young people addicted to IV heroin.  IV heroin addiction causes the disease to progress at an exponential rate and will frequently lead to death in less than 2 years.

If there is any good news here, it’s that  chemical dependency is a very treatable though not curable disease.  With help and appropriate treatment and support young people can and do recover from this disease.  Recovery is also progressive.  As the young person gets better “one day at a time” he will reach that point that he loses all compulsion to use drugs.  And as long as he has internalized the first step of his recovery program “I am powerless over drugs” and chooses not to use mood altering drugs again he will be forever free of the compulsion to use.

 

Gardening, Endorphins and Dishes

I like weeding. There, I’ve said it. That feeling of satisfaction when a dandelion pulls right out, roots and all and leaves my beloved Shooting Star intact, is hard to match. I know there are others of you out there that know what I mean. Gardening has a way of leaving me with a sense of satisfaction and calmness that few other things do. Watching my garden evolve though the seasons always brings a smile to my face. An empty bed is just sleeping waiting on the warmth of spring to inspire the plants there to bring on their show. A freshly weeded bed will actually stay nice and neat for weeks, unlike my house. Dishes and clothes propagate in my house just like the weeds in my garden but seem to reappear in a matter of minutes instead of weeks after they are cleared. I just read an article that says natural endorphins are
released when you dig in the dirt. Maybe that is part of it.

Planned Home Births

Planned home births have increased during the past several years. Of all births, the incidence of home births is still below 1% and is not well supported in the United States. If a home birth is considered, I cannot stress enough the importance of subsequent newborn care that includes erythromycin eye ointment and intramuscular vitamin K. I recommend reading the American Academy of Pediatrics’ policy statement regarding home births.  http://pediatrics.aappublications.org/content/131/5/1016

 

FluMist Shortage

Get your flu shot! The CDC and AAP recommend that everyone 6 months and older get the flu vaccine. There is currently a production delay of FluMist (nasal spray flu vaccine), making the timing of the availability to both schools and doctor’s offices uncertain. If you are waiting for FluMist to become available, consider getting the injectable flu vaccine instead! A Vanderbilt pediatrician explains more about the FluMist delay.

http://www.wsmv.com/story/30331311/vanderbilt-doctor-explains-nationwide-flumist-shortage

Dental Care for Infants and Toddlers

Did you know that the American Dental Association recommends the use of fluoride containing toothpaste for dental care beginning with the eruption of the first tooth? A child from 6 months to 3 years should use a “smear” or an amount the size of a grain of rice. A child from 3 to 6 years requires a pea sized amount. These amounts are considered safe twice a day even if the child is unable to spit it out.

http://jada.ada.org/article/S0002-8177(14)60226-9/fulltext

 

Kids and the Flu Shot: 11 Things Every Parent Needs to Know about the 2015-2016 Influenza Vaccine

A St. Louis pediatrician has written a very informative article discussing the flu vaccine.  Parents often ask these very questions.  All your doctors at KPA strongly recommend the flu vaccine.  This article should those of you that have real questions about the vaccine make a good decision.

http://childrensmd.org/browse-by-age-group/toddler-pre-school/kids-flu-shot-11-things-every-parent-needs-know-2015-2016-influenza-vaccine/

Backpack complaints are a matter of perception

We blessed the backpacks at church last week but some of our kids seemed more interested in a ceremony called “cursing of the backpacks”. It does seem that in this age of IPads and Kindles that backpacks would have already been relegated to the dustbin of history. But if your child’s pack exceeds 20% of body weight and she has chronic neck, shoulder or back pain, we can help medically but also help persuade teachers to decrease the weight of packs.

Click here to read full article.

Immunization

Part of young parents’ reticence to immunize their kids is due to the fact that they have lived in a golden age of medicine; they have never witnessed the ravages of measles, chickenpox or polio so the natural fear that they should have is largely absent. August is National Immunization Awareness Month. Elder pediatricians, including myself, have been asked to provide anecdotes about some of our patients who had vaccine preventable diseases before vaccines were available.

I vividly remember a nine year old boy with leukemia who developed chickenpox. He had blisters over his entire body and inside his mouth, esophagus and trachea. We could not start IVs because there were no veins visible. We treated him as we would treat a severe burn patient. There were no drugs to combat the virus. He died a miserable death from chickenpox pneumonia, severe dehydration and skin superinfection.

I also remember with great fondness our senior partner Dr. Hammond Pride, who, with Dr. Dick Willingham established Knoxville Pediatric Group, the predecessor of KPA. Ham had polio as a child but survived with only a minor limp. However, as he grew older, he developed a huge belly but he didn’t seem particularly fat anywhere else. His doctors finally came to the realization, when he was 53 years old, that Ham’s bladder had been partially paralyzed by the polio. It was as big as a large pumpkin! He had many urinary infections later in life along with increasing weakness from his childhood bout with polio. But polio never suppressed his indefatigable spirit or his good humor. He is missed.

It is truly heartbreaking to witness parents withholding these life saving vaccines.