Last month I ventured into the non-clinical realm and discussed sports psychology and the, if you will, lighter side of the profession. This month I am plunging into the depths of what appears to have been, or may still be, an epidemic of heroin and opiate abuse among high school and college students. In my clinical practice in southern California, the problem appears to be lessening over the past year, but in certain areas of the country, such as the Midwest, the problem appears to be growing.
Traditionally, heroin and opiate abuse has been considered an “inner city” problem, and those who are reading this blog may wonder what is going on here. The news is that heroin and opiate abuse has become a suburban problem, perhaps best exemplified by the recent death via heroin overdose of a 17-year-old Caucasian boy from the Chicago suburb of Franklin Park. The 17-year-old’s father was a Deputy Police Chief, who claimed that he had moved the family to the suburbs to insure that his children were not exposed to such problems as heroin abuse. It appears that no one, nor any community, is immune from the current epidemic.
Googling “youth overdosing on heroin” gives one pause. See, for example, the website of the Pioneer Press (twincities.com) in Minnesota, where they discuss the struggles of teens in Hastings, one of the city’s suburbs. Numerous problems are quickly identified in all areas of the country, and the problem is clearly not limited to California.
In short, heroin use among our youth is a problem, and it is no longer confined to the inner-city area.
What makes heroin so inviting? In terms of basic neurology, the human brain contains receptor sites for the opiates (opium, heroin, and morphine). A discovery was made at Johns Hopkins University in 1972, only forty short years ago, that the brain contains these specific receptor sites for opiates. These receptor sites for those who do not take opiates are usually there to receive the messages of endorphins. Endorphins, a shortened form of the chemically correct words, endogenous morphines, are the usual occupiers of these receptor sites. So, for those of us who do not use opiates, our endorphins have room to land when we are exercising or enjoying ourselves. However, when we are low in those traditional ways of stimulating these receptors and choose to use opiates instead, the brain is chemically equipped to receive them. This is probably why one becomes “hooked” so quickly on the opiates.
When endorphins are effective, we feel good, high, or euphoric, such as after a great workout or having accomplished something after a great deal of hard work. Endorphin levels have also been reported to increase during labor, or in response to stressors, in general. Endorphins can both relieve pain or negative stimuli, or just make us feel good, whether or not we felt bad prior to their increase.
Much has been written and theorized lately about the brains of those who become addicted to alcohol and other substances. It appears that many who become addicted are possibly victims of lower levels of dopamine in the brain, and the drug-taking behavior is a maladaptive attempt to artificially increase the levels of dopamine or other “pleasurable” chemicals in the body, such as the endorphins. These issues are beyond the scope of this article, but the reader is referred to a great blog, Neuroscience for Kids, which is a product of Washington University.
Since much of what I have learned has been first-hand with suburban heroin addicts in a substance abuse recovery program for teens in Southern California, Teensavers, I will report the path that many of my former patients have told me is what led them to the opiates.
First and foremost, there is no one direction. Some of my patients told me that they started by taking a pain pill, usually Vicodin, enjoying the high, and then realizing that they could get heroin easier and cheaper than having to go through the legal means of getting prescription medication, which was usually either by stealing it from their parents or having contacts who had such prescriptions and were willing to sell them. Others began by smoking marijuana or drinking alcohol, learned that the euphoria produced by heroin greatly exceeded alcohol and marijuana, and graduated to same accordingly. Either way, the time from first use to a drastic problem with the opiates is generally very short. As opposed to alcohol or marijuana, which may take months or years to develop into a problem, opiates are more likely to take days or weeks. Therefore, “just say no” to opiate abuse is probably the only effective strategy in dealing with same.
I have also been surprised by how, for lack of a better word, “nice” the young heroin addicts with whom I have worked have been. They are often kind, considerate, have a boyfriend or girlfriend, have generally done relatively well in school before the problem started, and have been known more for their conformity than for their pushing the rules and getting into a great deal of trouble. I often tell many of them that we will not let them out of the program until they prove to us that they have the ability to “be mean” and stand up for themselves.
One key to parenting in these troubled times is to make sure that you have access to the child’s room and belongings. Do not be afraid to search the room, if and when you have suspicions. Do not be afraid to ask if your child knows how to get heroin, or if they know someone who is currently using heroin. Also, tell them that they have a social obligation to tell those in authority, such as teachers or their friend’s parents, about their friends who are using. Many an adolescent patient has told me that they might have been deterred from using initially, if their parents or friends had intervened earlier.
You can also set an example for your children by living a lifestyle in which alcohol or drugs are not used to solve problems. Model for your children the idea that effective communication and problem-solving are the roads to long-term emotional and behavioral success, not the quick fixes of drinking and drugs. If you take pain medication, be scrupulous about exactly how many pills you take and how many pills should be remaining in the bottle. Almost all of my adolescent and young adult/college student patients in the above-mentioned substance abuse recovery program have told me that they stole pain pills from their parents’ medication at some point early in their addiction. If you do have pain, you might also profit from looking into behavioral or other non-medication means of dealing with the pain (see, for example, Dr. David Bresler’s, Free Yourself From Pain).
Finally, let me elaborate on the above-mentioned surprise finding that most of the young heroin addicts whom I have met are nice, well-behaved, and mannerly. Most of my work with youth who abuse substances in the past has been with those who are more “in your face” and outwardly angry. They often have trouble early in school, get into trouble with authority figures early in life, and have problems controlling their anger and impulses. I am very accustomed to this kind of patient, and it still surprises me when I find a nice, quiet teenager who also happens to be a heroin addict. Many of these addicts’ parents are unaware of big differences in the child’s behavior because their child has always been quiet, and now they just seem even quieter once the heroin abuse starts. Depression and anxiety also play a large role in the development of substance abuse problems, in general, and with this type of adolescent and young adult, in specific. Ironically, heroin is a nervous system depressant, and thus it often makes these types of mood disorders worse in the long run.
Look for things like sleep differences, frequent trips to the bathroom, nausea, and, according to some reports, constipation. Watch the money that is going out as well. Do not give anything other than what is necessary, as sometimes heroin addicts borrow money from their friends, who do not even know that the heroin addict is using. Thus, even if your child is not using, they may be inadvertently financing their friend’s use, if they have extra money to lend or give to their friend. Most of the suburban areas that are currently showing increases of heroin abuse and overdoses are financially well-off, and the children’s extra money, cell phones, and other signs of a suburban lifestyle may actually make it easier for them to gain access to the world of heroin.
Finally, do not ignore any of the major signs of abuse, such as your child’s having a hypodermic needle, actually finding heroin In their room, or their request for help because they realize they are in trouble and cannot stop using. Ignoring heroin abuse will not make it go away. Due to the serious nature of opioid addiction, out-of-home placement may be the only alternative to get help for your child. A good resource if you are sure you have a problem is Teensavers.com, and they will give you a free telephone consultation and answer your questions confidentially.
George H. Tucker, Ph.D., ABPP | Clinical Psychologist II | CYBH/CCPU