It is not possible to accurately determine if a young adult or adolescent who is engaging in “self-destructive behavior to the point of absurdity” has an addiction, and it is vital to understand why. Young adults and adolescents are very different from fully matured adults in many ways but especially in their neurobiology. These differences demand that we adjust our treatment approaches to fit this age group.
I was at a luncheon at the annual NAATP (National Association of Addiction Treatment Providers) Conference in 2009 in which there was a panel of five people, each representing his or her treatment program – top-notch people respected and knowledgeable, each representing top-notch programs. Collectively, they had worked with thousands of teens and young adults over many years. The leader of the group would pull out a card, read the question, let the panel discuss it, and then open it up to the audience. One question was particularly significant to me. “Can we as an industry tell an adolescent or young adult that they are an addict?” I was expecting a yes from each person but got the opposite.
Every single member of the panel said no. All five. Their consensus was that we cannot accurately determine if any young adult or adolescent has an addiction because all of us have seen teens and young adults who were using so many drugs and/or alcohol that if they were older, we would say that they were severe addicts, full-blown addiction, or what I call the “body-rot” phase of addiction, Jelinek’s chronic phase. However, they abuse like this for a few years, and then something changes – they heal their trauma, get into a safe and supportive group of friends and family, finish high school or college, move to a new location, or are removed from an overwhelming situation of distress – and they stop abusing and, instead, control use in a healthy way, such as a glass of wine at night or a beer at the barbecue on Saturday. (Not that I am for either; I’m a teetotaler by choice.) The maturing of the prefrontal cortex (PFC) is often the neurobiological change that goes along with these positive changes. To find out more about the neurobiology of young adults and adolescents, click here.
The neuroplasticity, or pliability, of the young adult / adolescent brain is remarkable. It is sort of like a new can of Play-Doh that you’ve just opened; you can mold it and make it into any form that you want. These young brains imprint neuropathways quickly. They can also “unimprint,” if you will, relatively quickly. The PFC, the executive-function area of the brain, is not fully developed until the late 20s. A person that was considered a “mature adult” in the ’60s and ’70s was around the age of 20-21. Today, that age is much later due to the delayed maturation of the PFC.
Dr. Andrea Barthwell says that it is rare to find a 19- to 20-year-old who has a mature PFC, and when we do, it is most often a female who is the oldest child, with younger siblings, and with absent, uninvolved and/or non-nurturing parents; so she has had to be responsible for food, shelter, clothing, safety and much more since she was a small child. Our culture has changed dramatically in the last two to three generations, and children are growing up without the responsibilities that build the “muscles” of the PFC. Part of the function of the PFC is making decisions about choices and their consequences, navigating quality relationships, reading social situations and more. Take a minute to watch this 60-second video on YouTube, and it will help you understand.
Caution! Not only can we not accurately determine who has an addiction; we also CANNOT determine who DOESN’T have one, so trying to control use after being a compulsive abuser of chemicals or behaviors is like playing Russian roulette. Abstinence is always the best plan once a person has had an abuse problem that might be an addiction or might become an addiction, simply because it could. Please hear what I am saying, not what I am not saying. Pain, hurt, emptiness and consequences don’t just start once an official addiction or compulsion starts. They’ve been going on for some time; they sort of lie on a continuum. Both the hurt that the abuser is trying to medicate and the hurt the abusing causes to the individual abuser and his or her family and inner circle are in all these phases: abuse, dependency, compulsivity and addiction. What does all this mean for your loved one?
You must be careful when thinking about diagnosing anyone with any diagnosis. As stated previously, the assessment lens through which you look at a problem takes you to the diagnosis, which usually is a label. When young adults and adolescents get officially labeled, they tend to live out a self-fulfilling prophecy, which is why we at Capstone don’t label them. That diagnosis determines the treatment plan, which in turn determines the outcome. Using the wrong assessment lens means you made the wrong diagnosis, which in turn means you developed the wrong treatment plan, and that will produce failed outcomes.
Capstone does not just treat the compulsive/addictive behavior by itself because to do so means any gains will be short-lived because of the other two core systems: the core and the context. We must work on all three simultaneously because you don’t get lasting change in one without change in the other two – thus, the Core-Systems Model.
How you see it is how you treat it.
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