I know my mother worried about it, though when she broached the subject – none too subtly – I’m not certain she believed me when I said simply, “I know better.”
I didn’t drink. I didn’t do drugs. I didn’t screw around.
But now that I’m a parent, and having dealt with adolescents for many years, I get it.
I get the incessant worry, even if you basically do trust your teenager. I get the bigger picture view. I get the breadth of appalling possibilities that flash through your mind when you worry about kids and substance abuse – drugs, alcohol, cigarettes, and more.
Kids and Drugs
But we don’t seem to anticipate the extent of the problem – or potential problem. (Shall we revisit the issue of students, prescription drugs, and SATs?)
We don’t imagine how easy it is for kids (in nice suburban schools) to get their hands on whatever they want – at least – to hear some of them talk.
Thinking back to my own adolescence, plenty of my friends drank, though more smoked pot. What else were they up to? I didn’t pay attention. The girls in my circle weren’t those who “disappeared” for a year to get through a pregnancy, we were all very academically focused, and drugs and alcohol weren’t my thing.
Sex, drugs, and rock ‘n roll? I loved the rock ‘n roll, like every other teenager, but as for the rest – I knew myself well at the time – what I wanted and did not, what risks I was willing to take, and those I would walk away from.
But times, they are-a-changing. Or have changed, as drugs are more accessible than ever – not only in the high schools, but middle schools and elementary schools – and that includes legal drugs.
And it isn’t just drugs we worry about. It’s self-destructive behaviors that may slide into compulsion.
Do Definitions Matter? Abuse, by Any Other Name?
I came across an interesting article yesterday at The Fix, a site that specializes in dealing with the addiction community from all angles, including policy changes and treatment attitudes.
Yesterday’s feature is an article on the all important DSM.
For those of you who may not be familiar with this reference, the DSM is the Diagnostic and Statistical Manual of Mental Disorders. In short, it is what it sounds like – the Bible to those professionals who deal with mental health conditions. And as you might imagine, the definitions included in the DSM have sweeping impacts on treatment options, insurance, not to mention what Big Pharma is up to.
I quote from the article by Dr. Richard Juman, as he assesses the proposed revisions to the DSM, first by situating the difficulty of these definitions:
Since psychiatric disorders don’t announce themselves with biological diagnostic data, the coherent organization of a huge number of complex disorders into a “manual” to be used by researchers, healthcare professionals and third-party payers is daunting. How do you capture, in a few pages, illnesses and patterns of suffering that manifest uniquely in every new patient?
A gargantuan task, indeed.
He goes on to explain the three main areas of change as:
Adding “craving or a strong desire to use” as a criterion; replacing the separate categories of substance “abuse” and “dependence” with a unified “Substance Use Disorder” rated for severity (Alcohol Use Disorder, say, or Severe Cocaine Use Disorder); adding Gambling Disorder to the Addictive Disorders, where previously Pathological Gambling was listed as an Impulse Control Disorder. (This change likely paves the way for other Addictive Disorders in future editions, such as sex addiction and internet addiction.)
I am not a psychologist, psychiatrist, or other health care professional, but I can easily put two and two together and see the potentially slippery slope. Might any (destructive) behavior be deemed a “syndrome” and distract us from dealing with our societal ills by turning to Big Pharma?
Does inclusion in the DSM always mean less stigma and more legitimacy to problem behaviors, so this may be a positive step?
Will these changes cause us to shortchange the very real assistance to be gained through talk therapy, or at least, some combined effort when it comes to treatment for these “disorders?”
The article references issues of binge drinking in college, legitimate worries about “false epidemics,” and other implications. (Read the article – it’s fascinating, even for a layman.)
Dr. Juman states:
Along with the fear of unnecessary diagnoses comes the fear of unnecessary pharmacologic treatments. Critics argue that the changes in the diagnostic criteria and the availability of psychotropic medications for cravings may lead to an increase in the use of prescription drugs for the disorders. They also complain about the financial ties to the pharmaceutical industry among some of the clinicians responsible for drafting the revision.
I would agree with Dr. Juman’s perspective that pharmacological solutions alone may not be the best call. Pressure, depression, self-esteem issues, family issues – all may trigger emotions we are hard-pressed to deal with alone, and so we turn to whatever eases the pain or numbs it. Talk therapy could be the differentiator, but then again, there is less stigma to a pill than a shrink, not to mention less cost.
And isn’t that a considerable problem, whatever condition we’re trying to treat?
A Parent’s Job: Worry?
I can only comment on these proposed DSM changes as a parent, and a member of the greater community of Americans who are directly and indirectly touched by addictions of all sorts. And we are all touched in some way, aren’t we? Ethically, economically, emotionally?
Think about our health care system.
Think about our crime rates.
Think about our tax dollars.
Think about our growing isolation, our kids, our neighbors, our schools, our city streets.
Think about the waste of lives.
Yet my greatest worry is for the issues in society that we aren’t addressing – or addressing sufficiently which I see as root causes for at least a portion of our substance abuse ills.
- What’s your take on considering extreme (dependent) Internet usage as an addiction?
- What about sex? What about food abuse?
- Do you worry about labeling certain destructive behaviors as “disorders?”
- How do we keep the pharmaceutical industry from pushing more pills down our throats (with an assist from certain physicians?), rather than dealing with root causes?
- Do you see these changes as a step in the right direction toward access to solutions?
Note: Salon.com offers commentary on Dr. Juman’s article in The Fix as well.