Substance Abuse

I. What is substance abuse?

First you take a drink, then the drink takes a drink,
then the drink takes you. – F. Scott Fitzgerald

In a recent study by the University of Michigan, 8th, 10th, and 12th graders across the country are continuing to show a gradual decline in the proportions reporting use of illicit drugs.

“The cumulative declines since recent peak levels of drug involvement in the mid-1990s are quite substantial, especially among the youngest students,” said U-M Distinguished Research Scientist Lloyd Johnston, the principal investigator of the MTF study.

The proportion of 8th graders reporting use of an illicit drug at least once in the 12 months prior to the survey (called annual prevalence) was 24 percent in 1996 but has fallen to 13 percent by 2007, a drop of nearly half. The decline has been less among 10th graders, from 39 percent to 28 percent between 1997 and 2007, and least among 12th graders, a decline from the recent peak of 42 percent in 1997 to 36 percent this year.

Among the substances abused are: alcohol, tobacco, marijuana, cocaine, opiates, “club drugs” (ecstasy, etc.). stimulants, hallucinogens, inhalants, prescription drugs, and steroids.

Drug and substance abuse among teenagers, is substantial. Among youth age 12 to 17, about 1.1 million meet the diagnostic criteria for dependence on drugs, and about 1 million are treated for alcohol dependency.

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From the National Institute of Health:

From 2006 to 2007, the percentage of 8th graders reporting lifetime use of any illicit drug declined from 20.9% to 19.0%.
Reported past year use among 8th graders declined from 14.8% to 13.2%.
Past year prevalence has fallen by 44% among 8th graders since the peak year of 1996.
Past year prevalence has fallen 27% among 10th graders and 15% among 12th graders since the peak year of 1997.

In 2007, 15.4% of 12th graders reported using a prescription drug nonmedically within the past year2. Vicodin continues to be abused at unacceptably high levels. Attitudes toward substance abuse, often seen as harbingers of change in abuse rates, were mostly stable. However, among 8th graders, perceived risk of harm associated with MDMA decreased for the third year in a row. Attitudes towards using LSD also softened among 10th graders this year.

Between 2005 and 2007, past year abuse of MDMA increased among 12th graders from 3.0% to 4.5%; and between 2004 and 2007, past year abuse of MDMA increased among 10th graders from 2.4% to 3.5%.

The remaining statistically significant increases involved teen alcohol use. The percentage of 10th graders who had been drunk in the past year rose from 38.3 in 1998 to 40.9 in 1999. Also, the percentage of 8th graders having 5+ drinks during the 2 weeks prior to being surveyed increased from 13.7 in 1998 to 15.2 in 1999.

Teenagers at risk for substance abuse include those with a family history of substance abuse, who have low self-esteem, who feel hopelessly alienated, as if they don’t fit in, or who are depressed.

II. What are the Symptoms of Teen Substance Abuse?

Symptoms of Teen Substance abuse include the following:

  • Sudden personality changes that include abrupt changes
    in work or school attendance, quality of work, work output, grades, discipline
  • Unusual flare-ups or outbreaks of temper
  • Withdrawal from responsibility
  • General changes in overall attitude
  • Loss of interest in what were once favorite hobbies and pursuits
  • Changes in friends and reluctance to have friends visit or talk about them
  • Difficulty in concentration, paying attention
  • Sudden jitteriness, nervousness, or aggression
  • Increased secretiveness
  • Deterioration of physical appearance and grooming
  • Wearing of sunglasses at inappropriate times
  • Continual wearing of long-sleeved garments particularly in hot weather or reluctance to wear short-sleeved attire when appropriate
  • Association with known substance abusers
  • Unusual borrowing of money from friends, co-workers or parents
  • Stealing small items from employer, home or school
  • Secretive behavior regarding actions and possessions; poorly concealed attempts to avoid attention and suspicion such as frequent trips to storage rooms, restroom, basement, etc.

Different substances lend themselves to different groups of symptoms. The most glaring symptom in all cases is a change, sometimes a radical one, in behavior.

Other physical signs of substance abuse are: slurred speech,
memory impairment, incoordination, and impairment of attention.

III. How is Substance Abuse diagnosed?

It is sometimes difficult for mental health practitioners to arrive at a diagnosis of substance abuse alone. There are a number of practical and empirical methods to determine substance use, among them being urine or blood testing. Another method to determine use is by interviewing parents, teachers, and other caregivers regarding the history of the patient, and the current behavioral aspects that the patient has been presenting.

A major problem in the diagnosis is the consideration of dual diagnoses. A dual diagnosis is given to any person who has both a substance abuse problem and an emotional or psychiatric disorder. In order for the patient to fully recover, they must be treated for both problems. According to statistics, at least thirty-seven percent of substance abusers also have a serious mental illness, and conversely, of all those diagnosed with a mental illness, twenty-nine percent also abuse either drugs or alcohol.

The most common co-occurrences are depressive disorder, anxiety disorder, and psychiatric disorders such as schizophrenia and personality disorders. But any of the emotional disorders: ADHD, Obsessive-Compulsive Disorders, Post Traumatic Stress Syndrome can lead its sufferers down the path of self-medication and substance abuse.

There are three categories of substance abuse:

A. Use: The occasional use of alcohol or other drugs without developing tolerance or withdrawal symptoms when not in use.

B. Abuse: The continued use of alcohol or other drugs even while knowing that the continued use is creating problems socially, physically, or psychologically.

C. Dependence: At least three of the following factors must be present:
a. Substance is taken in larger amounts or over longer periods of time than the person intended.
b. A persistent desire with unsuccessful efforts to
control the use.
c. Large periods of time spent obtaining, taking, or recovering from, the substance.
d. Frequent periods of intoxication or detoxification especially when social and major role obligations are expected (school, social situations, etc.)
e. Continued use even while knowing that the continued use is creating problems socially, physically, and/or psychologically.
f. Increased tolerance
g. Withdrawal symptoms
h. Substance taken to relieve withdrawal symptoms.

IV. How is Teen Substance Abuse Treated?

In cases of dual diagnosis, the recommended method is to primarily treat the symptomatic substance abuse and co-treat the disorder. Once stabilization is established, the full-fledged treatment for the mental disorder begins.

There are various factors that must be taken into account when considering treatment for substance abuse. Among these factors are:

  1. Age, developmental stage, and maturity
  2. Values and culture
  3. Gender
  4. Co-existing mental disorders. Without the correct treatment for the co-existing disorders, treatment for addition may not be effective because these disorders could interfere with the patient’s ability to successfully participate in an addiction treatment program
  5. Family Factors: Family factors that could increase the patient’s risks should be considered: it is considered important that parents and other family members play a large role in their family member’s treatment.

Organic syndromes may be a result of substance abuse, or independent of substance abuse.
A. Medication:
Medication varies with the manner of addiction. If a dual or
co-occurring diagnosis is made, medication is administered according to the co-existing disorder. Medications are given
along with other interventions. Medications that specifically treat substance abuse are:

  1. Naltrexone: alcohol dependency and opiate dependency
  2. Methadone: heroine addiction
  3. Wellbutrin: smoking and marijuana abuse

In order to begin treatment, the first thing the patient must do is detoxify. Detoxification can be done on an outpatient or inpatient basis, depending on the severity of the addiction.

Additional Methods of Substance Abuse Treatment After Detoxification:

  1. Identify underlying co-occurring disorders and treat disorders
  2. Psychotherapy
  3. 12-Step type programs like Alcoholics Anonymous
  4. Group Therapy
  5. Behavior Modification
  6. Cognitive Therapy
  7. Residential Treatment

V. I suspect that my child is abusing substances.
What do I do now?

Professionals to Seek Out

  1. See your physician or pediatrician
  2. Consult with your clergy to assist in spiritual
    and practical guidance
  3. Consult with an educational consultant to help
    you find the right program for your child.
  4. Consult with a therapist or counselor.
  5. Consult with an Educational Advocate to help
    you with your current school situation
  6. Consult with an Educational Consultant to find
    the right program for your child.

Find out more about Educational Consultants


  1. Inpatient: hospitalization
  2. Outpatient Treatment
    Patients must be seen regularly so drug or alcohol abuse
    can be monitored. Some patients combine outpatient treatment with a 12-step type program. Frequent drug testing is done. In addition, outpatient treatment may include outpatient detoxification, and alcohol or drug rehabilitation.
  3. Day Treatment
  4. Residential Treatment Center or Program

a. Therapeutic Boarding School
These schools are usually fully accredited schools with emotional growth programs. They stress holistic education: growth of the person through holding children responsible for their actions. There is no rehabilitation or physicians on staff.
Find out more about Residential Boarding Schools

b. Wilderness Therapy Program
A Therapeutic Wilderness program does not necessarily have academics; their goal can be to introduce the children to a different role. These programs use Outdoor Therapy to help build low self-esteem. They make obtainable goals for them to reach. The programs vary but they are about 6 to 8 weeks long. It is a very structured program with a goal of teaching the children coping skills and raising their self esteem. Children go from this program to mainstream back into their public school or attend a small structured boarding school.
Find out more about Therapeutic Wilderness Programs

c. Residential Treatment School
A Residential Treatment Program or School provides a full professional staff that includes therapists, psychologists, and psychiatrists. They also have a small academic program. Many of the children in the program have been recommended there by mental health agencies that make the placements. It is a highly structured environment whose emphasis is on treatment and learning coping skills and independent living. Chemical dependence education and rehabilitation is also provided. Outdoor therapy is sometimes used to facilitate building social skills and self-esteem. Recovery programs are also available. Residential Treatment schools are secure schools.

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Be safe: Have an alcohol-free pregnancy

What is FASD?

Fetal Alcohol Spectrum Disorder (FASD) is a term that describes the full range of harm that is caused by alcohol use in pregnancy. If a pregnant woman drinks alcohol, her baby may have:

  • brain damage
  • vision and hearing difficulties
  • bones, limbs and fingers that are not properly formed
  • heart, kidney, liver and other organ damage
  • slow growth.

Brain damage means that a child may have serious difficulties with:

  • learning and remembering
  • thinking things through
  • getting along with others.

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Is there a safe time to drink alcohol?

There is no safe time to drink alcohol during pregnancy. Your baby’s brain is developing throughout pregnancy. The safest choice during pregnancy is no alcohol at all. In fact it is best to stop drinking before you get pregnant.

Is there a safe amount?

There is no known safe level of alcohol use during pregnancy. It is best not to drink any alcohol during your pregnancy.

Are some types of alcohol less harmful than others?

Any type of alcohol can harm your baby (beer, coolers, wine or liquor). Binge drinking and heavy drinking are particularly harmful to an unborn baby.

What might happen if I drink alcohol while pregnant?

Drinking alcohol during pregnancy can cause permanent birth defects and brain damage to your baby. Many pregnancies are not planned. Having a small amount of alcohol before you knew you were pregnant is not likely to harm your baby. You can help your baby by stopping drinking.

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Do children with FASD grow out of their problems?

There are many things teachers and parents can do to help children with FASD. However, FASD is a life-long problem. Teens or adults with FASD may have:

  • depression
  • trouble with the law
  • drug or alcohol problems
  • difficulty living on their own
  • trouble keeping a job

What if the father drinks alcohol?

If the father drinks alcohol, it will not cause FASD. However, fathers should also try to be as healthy as possible before and during pregnancy.

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How can others help?

Partners, family and friends can help pregnant women to stop drinking by being supportive and encouraging.

Where can I go for help?

If you are pregnant or planning a pregnancy, choose not to drink any alcohol. If you are worried about your baby or want more information about FASD, call:

  • Motherisk 1-877-FAS-INFO (1-877-327-4636)
  • Your Young Parent Outreach Worker
  • Your health care provider
  • Your local health unit
  • Your local Friendship Centre
  • The INFOline for facts about Ministry of Health programs and services, 1-866-821-7770

You can also get more information by visiting these websites:

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Tattoos During Pregnancy

Once thought of as something only for bikers, rebellious teenagers or servicemen, tattoos have become quite fashionable and more accepted in all ages and sexes. Men, women, moms, dads, teens and grandmas can all be found sporting butterflies, barbed wire bracelets, inspirational sayings, their children’s names and other artsy designs from their ankles to their necks – and anywhere in between!

But what about pregnant women? If you’ve always wanted a tattoo, or want to add one to commemorate this special time in your life, is now the best time to do it?

A Risky Behavior? “There are not any more risks when getting a tattoo when pregnant than getting a tattoo when not,” says Myrna L. Armstrong, professor and regional dean at Texas Tech University Health Sciences Center School of Nursing. “Currently, there is not any information or research that shows the tattoo pigment interferes with a pregnancy, yet there is very little research to support either side.”

While there is not much research on the subject, Dr. Joel Schlessinger, a dermatologist, general cosmetic surgeon, past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery and president of, does not feel pregnant women should consider getting a tattoo. “Even in the best of situations, obtaining a tattoo is a mixed bag of risks, but when you add a pregnancy, the cons far outweigh any potential benefits,” he says. “Tattoos are essentially nanoparticles that are unregulated and may contain foreign substances of dubious purity.”

Even in the best of situations, obtaining a tattoo is a mixed bag of risks.

Add onto that the potential for getting infected with hepatitis and HIV while getting a tattoo, and Dr. Schlessinger says you have a very serious problem on your hands, all while you are trying to keep your baby safe. “Doctors such as myself are absolutely scrupulous to avoid any potential procedure and/or medication while pregnant in order to make sure the baby has every chance to be safe,” he says. “Why mess with luck and have a procedure that is clearly not for the baby, but all about the mother and pass on any risk (however small or large) to the unborn baby? Not a good choice, in my opinion.”

Mario Barth, world-renowned celebrity tattoo artist and CEO and founder of Starlight Tattoo, would never consider tattooing an expecting mom. “When you’re pregnant your body is undergoing so many changes,” says Barth, who has Lenny Kravitz and Nikki Sixx of Motley Crue on his clientele list. “When you get tattooed you are putting a foreign object into your body and therefore your bloodstream, which goes directly to your baby and could cause potential harm. Excess ink will get distributed to your organs and blood, and as with any foreign object your body will try to fight it off. Your baby is so small – why would you cause it potential distress?”

John Reardon, author The Complete Idiot’s Guide to Getting a Tattoo (Alpha, 2008), says while he has not found any evidence that getting a tattoo while expecting can affect the pregnancy, he also would not tattoo a mom-to-be. “The main reason women should not get tattooed while pregnant is that there is a possibility of either infection or an allergic reaction,” he says. “It is rare, but does happen. Also, if the woman went to a tattoo shop that wasn’t clean, there is a risk of transmitting HIV or hepatitis. It is really hard to transmit these diseases with modern preparation techniques.”

Reardon also points out that certain people may be allergic to some colors, especially red. “This can cause a rash, which can spread through the body,” he says. “Many people are allergic to petroleum-based products such as Vaseline, Bacitracin or A&D ointment. This reaction is characterized by lots of little pimples, which usually itch, around the tattooed area. It can also spread to other parts of the body.”

Another consideration is possible problems during labor with anesthesia. “A pregnant woman with a tattoo on the lower back should be aware that some physicians might not administer anesthesia via an epidural through the lower back if there is a tattoo,” Armstrong says. One theory behind this is that there’s a possibility particles of ink could travel through the epidural needle into the spine during the procedure; another suggests there is an increased risk of infection. There is, however, no conclusive evidence that tattoos and epidurals are a dangerous combination.

Selecting a TattooistThe pros and cons have been weighed, research done and you have decided that a tattoo is something you want to do during your pregnancy. The next step is to put safety first and foremost, and find the right tattoo shop and tattooist.

“A pregnant woman should take the usual safety precautions of getting a tattoo,” Armstrong says. She says to make sure of the following:

1. The studio is clean and uses the proper precautions and procedures in dealing with blood-borne contaminations.
2. The artist has knowledge about skin care, sterilization and anatomy.
3. That the needles have been sterilized properly or that disposable needles are new (with the old ones disposed of appropriately).
4. The artist wears gloves, uses a single unit of pigment with the excess pigment being disposed and uses pigment and dressings that are sterile.

Reardon suggests looking online for a reputable tattoo shop. “Myspace has thousands of tattooists with full portfolios and all the artist’s information,” he says. “You really need to see the work of the tattooist to be sure you won’t regret your tattoo. Ask someone you know who has a tattoo or knows someone who has lots of tattoos. The best way to be able to judge a tattooist’s ability is to see the work firsthand and fully healed. You will want to see if the lines are relatively straight and smooth (many customers jump or squirm while getting tattooed so it’s not always up to the artist); the shading or coloring will be strong and full, not spotty or faded; and the design will be drawn well. There shouldn’t be any scarring, where the tattoo will be raised up and lumpy. Also the tattoo shop should be clean.”

Armstrong recommends using word of mouth. “I would recommend that women talk to others about getting and having a tattoo, seek referrals for an artist, shop around for techniques and do their research,” she says.

Barth agrees. “Research on the Internet and check with the Better Business Bureau and local Health Department,” he says. “Also, ask a lot of questions and go with your gut. If it doesn’t feel right, then wait. A tattoo is for the rest of your life, so you can afford to wait.”

Tattoos 101 What is a tattoo, really? “A tattoo is pigment placed in the skin,” says Reardon. “If a tattoo is done correctly, the pigment will rest in the upper part of the dermis just below the epidermis. Some form of sharp object will be used to implant the pigment. Modern tattooing is done with sterilized needles and an electric tattoo machine. Many people still practice the traditional ways of tattooing from the South Pacific and Japan, which is done by hand.”

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Confronting the Myths of Single Parenting

The stigma attached to being a single parent is rising anew. Many media commentators blame America’s up-trend in violence and other social problems on family breakdown: on single parents. This stigma is based on myths and stereotypes that have been promoted by half-truths and often prejudiced viewpoints.

These myths can be confronted successfully and new strength can be found in the truth. As with so many aspects of single parenting, we rise to the challenge and become better people because of it. The myths are sometimes subtle and subconscious, but the more we examine them, the more clearly we take responsibility for our lives and the lives of our children.

Myth : Predominance of the traditional nuclear family.

Our cultural mythology has it that single parents are an aberration, not the norm. Single parents often feel isolated, alone, and different.

In the past twenty-five years, the number of single parent families has more than doubled. According to U.S. Census Bureau estimates, 59% of United States children will live in a single parent home at least once during their minor years. That is a majority.

Over 16 million children currently live in single parent homes. More and more of these families can be defined as “binuclear” families, with both parents actively involved in parenting and creating two separate homes for their children. Divorce and remarriage, rather than the exception or aberration, are more and more common in families today.

Myth : Children in single-parent families always have deficits, do poorly in school, and suffer emotionally and behaviorally.

Limited data fueled Dan Quayle’s attack on Murphy Brown, mainly sourced from sociologist Barbara Whitehead. Her negative conclusions about the outcomes of children from single-parent families selectively ignored all the data that contradicted her position, according to several other researchers. (Richards and Smiege, 1993.)

The oft-quoted ten-year study of Judith S. Wallerstein used tainted search subjects “… drawn largely from children in treatment for psychological disorders or from the wards of the criminal justice system.” (Olsen and Haynes, 1993.) No wonder the outcomes were dismal ten years later.

Of course, statistical studies are never appropriate to predict outcomes:  single parent children are not doomed or reprieved from doom. Somehow we have this mythology, of their inherent disadvantage. This disadvantage does not exist.

Myth : Single parent families are “broken homes.”

In the television series, “Grace Under Fire,” a recent episode showed Grace, a single mom, protesting hotly, “My home is not a broken home. When I got a divorce, I fixed it!”Many single parents who divorced or didn’t marry made the healthiest choice in creating a peaceful and stable home for their family. Many well-researched studies document positive outcomes in single parent families. “Single parenting develops the parent’s independence and ability to handle a variety of situations.” (Shaw, 1991.) “Children benefit from increased levels of responsibility.” (Amata, 1987) “Parental and child health outcomes were related to larger networks of social support and good communication within the single parent family.” (Hanson, 1986.) A study by University of Michigan of over 6,000 adults had surprisingly positive conclusions for children of divorce.

Statistically it turned out that adult children of divorce were just as likely (43%) to be happily married as someone who grew up in a two-parent home. Perhaps confronting the reality of the fragility of marriage the adult children of divorce were more than twice as likely to be worried about the health of their marriage.

Myth: Children from single parent families have lower self-esteem.

A carefully controlled study (Nelson, 1993) found income level to be the deciding factor related to children’s self -esteem. Because single parent families aree often also a low income household, children’s self-esteem is likely to lower, just as in low income two-parent homes.

Parents need to be especially careful to emphasize to their children that who you are is not based on what you have. Modeling this unconditional self-esteem through self-respect and self-nurturance is the best way our children can absorb the self-esteem skills necessary to be resilient and successful citizens of the 21st century.

Myth : We should strive to be entirely self-sufficient.

The western myth of self-sufficiency has perpetuated much needless shame and guilt among the emotionally and financially challenged, single parents among them. Being able to give and receive are both necessary skills to bring the wider resources of the world to our families.

We live in an interdependent world. Being responsible for ourselves means getting healthy support and even professional help when we need it. We cannot depend on our children for social and psychological support; it is their place to receive our support.A support group of other single parents can serve your needs for emotional support, a social outlet, childcare, and fun. Volunteering as a family within the community can also create deep satisfaction.

Being aware of the balance between nurturing and being nurtured, independence and support creates for ourselves the middle ground where family takes place. Through this each family member is nurtured towards increasing maturity and independence.

By confronting the truth of our situation, assessing the true risks and opportunities, single parents can go beyond the cultural mythologies and reap great rewards. Being proactive with the truth wherever we find the myths surfacing will help transform the negativity out there to optimism about the future.

Loanda Cullen is a psychotherapist in Colorado. She leads workshops for single parents; teaches parenting classes; and single parents her fifteen year old son, Sean.

This article was reprinted with permission from Single Parenting in the Nineties. Copyright 1995 by Pilot Publishing. All rights reserved.