Sue Scheff: Teenage Depression and Drug Abuse

As a Parent Advocate, this article is a very important for parents with teens and tweens that you suspect may be using drugs. Summer is here, many kids have extra time on their hands, and experimentation can be common. Learn some warning signs and parenting insights.

Teenage Depression and Drug Abuse

by Partnership Editorial Staff

Teenage depression and drug addiction are often linked, but new advances in science may be able to help treat both.

By Joanne Nicholas for Partnership for a Drug Free America

“There’s ample evidence that many children use drugs to self-medicate for depression, not to mention a host of mental-health disorders. The drugs they take may become the focal point for both kids and their parents, but they may be masking deeper problems. How can a parent know? Many symptoms of these disorders appear to be identical to some of the symptoms of drug abuse. Also, by the time experts finally figure out there’s a problem, drug addiction may have exacerbated the underlying ailment and fused with it. It becomes impossible to know where one leaves off and the other begins.” --David Sheff, Beautiful Boy

On any given day in America, as many as 5 million adolescents suffer from clinical depression. But according to a 2009 study, an estimated 70 percent are undiagnosed and do not receive any form of treatment. The statistics for drug and alcohol abuse are even worse. Only 10 percent of the estimated 1.4 million American teens with substance abuse problems receive treatment.

“From the outside, Nic looked fine.” That’s what author David Sheff says when he talks of his son’s high-school experience. “With an almost perfect GPA, a varsity athlete, you wouldn’t know that he started smoking pot at twelve or thirteen and used drugs throughout his teenage years.”

Sheff poignantly chronicled Nic’s battle with depression and drug dependence in his best-selling 2008 book Beautiful Boy — A Father's Journey Through His Son's Addiction. The author now continues to spread awareness by publicly discussing and blogging about the countless hardships that come with drug addiction; however, Sheff’s biggest frustration of all appears to be with the medical establishment that failed to diagnose his son’s underlying mental health issues until Nic’s condition was out of control.

“Why is it so hard for parents and even doctors to identify these problems?” Sheff asks, referring to brain diseases such as clinical depression and bipolar disorder. “If it was possible for someone to have diagnosed the problem early, would it have stopped [Nic’s] falling into heroin, cocaine, and addiction to crystal meth?” Sheff believes his son’s life would have been completely different had his depression and other mental illnesses been pinpointed and treated early on in his youth.

Nic Sheff is not alone – many people struggle with the dual diagnosis of an addiction and a mental health issue (also known as a co-occurring disorder or co-morbidity). But thanks to heightened understanding and advances in the medical field, we can now better comprehend the relationship between depression, addiction and other psychiatric disorders.

Two Illnesses, One Major Problem

Not everyone who battles depression will develop a substance abuse problem, and not every drug-addicted teen is also depressed. Each illness can occur individually, and when both exist together, each must be treated separately, preferably by an expert who specializes in both addiction and depression. Still, it is important to recognize the strong links between these two diseases – especially because they often exacerbate one another.

According to Thomas G. DeWitt, M.D., of the Children's Hospital Medical Center in Cincinnati, “Six percent of all adolescents at any time are depressed and twenty percent will at some time have a major depressive disorder." Depression in teens is often triggered by a traumatic event in the family or an episode that causes the teen to feel unstable or insecure. But although most are aware of the dangers and damaging effects depression can have, pediatricians and other health care professionals routinely ignore or are at a loss as to how to treat the problems of depression, anxiety, and attention disorders, even when brought to their attention by a parent. Therefore, “people with depression will use drugs to self-medicate,” explains Dr. DeWitt.

David Sheff agrees. “The drugs [Nic used] were really an attempt to self-medicate. The requirement to get drugs was not to feel good, but to feel normal. By seventeen, the addiction to methamphetamine kicked in pretty quickly.”

“Depression can play a significant role in developing an addiction in adolescence,” agrees Adam C. Brooks, PhD., a research scientist at Treatment Research Institute in Philadelphia. He notes that teens today have a different relationship with prescription drugs than did teens in the past. “They are more prone to see them as a utility and less likely to see them as something dangerous."

Yet this is a dangerous – and possibly deadly – belief. Even though the trend of teenage drug abuse in the United States has declined in general, nearly half of American students have tried an illegal drug by the time they reach high school graduation, according to the 2008 Monitoring the Future Survey conducted by researchers at the University of Michigan. Prescription drug abuse in particular is on the rise; 12- to 17-year-olds abuse Rx drugs more than they abuse ecstasy, crack/cocaine, heroin, and methamphetamine combined. Many teens with depression will look not to the streets but to their families’ medicine cabinets to find a substance that will compensate for their psychiatric problems.

Depression, Drugs and the Teen Brain

Why are teenagers with depression so susceptible to drug use and addiction? And why are drug-using teens so much more likely than others to be depressed? The answers to these questions can be found in science. Studies have shown that untreated depression and substance abuse can actually interfere with normal development of the brain.

"Although we are still at the early stage of knowledge, we have learned the brain undergoes dynamic changes during adolescence, a process that is not completed for many features until the mid-twenties and not until middle adulthood for some others," says adolescent brain expert Bradley S. Peterson, M.D., of New York-Presbyterian Morgan Stanley Children's Hospital.

"The teenage brain is plastic, which means that it changes its structure and function in response to experiences and need. It prunes out and develops new connections constantly to create the adult brain," continues Dr. Peterson. He explains that the process can be negatively affected by a teen's poor mental health. “Depression interferes with learning and the processing of emotional stimuli. It isolates the adolescent in their own emotional world.

“Depression is a common antecedent of adolescent drug abuse, occurring at a time of heightened vulnerability for the developing brain.” But when teens begin to self-medicate, a vicious cycle begins. “Drug abuse interferes with the brain's normal pruning and growth processes, hijacking them to create a brain that seeks out more of the drug," Dr. Peterson continues. In other words, depression causes the brain to want to try drugs, and drugs in turn mutate the brain so it constantly craves more chemicals.

End the Trend

A report from the independent United States Preventive Services Task Force released in April 2009 recommended that all pediatricians routinely screen children aged 12 to 18 for depression. This can be done by having them answer a few routine questions that indicate symptoms of depression, such as mood, anxiety, appetite, or substance abuse, as part of their check-up.

Dr. DeWitt, who is also a member of the Preventive Services Task Force, says the panel created the recommendations because “there is now evidence that we can effectively screen for depression and effectively treat depression with therapy and certain medications if appropriate follow-up is part of the treatment program.” He says the guidelines “recognize that depression [is a] major health problem for teenagers” and aim to identify adolescent depression before it turns into an even greater issue – addiction, or in too many unfortunate cases, death. Drug or alcohol abuse is responsible for more than half of all deaths of adolescents aged 15 to 24. Suicide is the third leading cause of death for children aged 10 to 19.

Dr. Peterson fully endorses the task force's recommendation to screen teenagers for depression. "There are lots and lots of reasons why we should prevent and treat early depression and all of the terrible functional and psychosocial consequences that depression brings," he says. "We need to create greater public awareness of those consequences and the availability of treatments, and to develop more robustly effective treatments. Perhaps most importantly, we need to prevent and treat both depression and drug abuse so that we target the greatest known risk factors for suicide and thereby prevent adolescents from tragically taking their own lives.”

Learn, Connect, Share, Get HelpPlease visit our online communities and resources to help teens & young adults stay drug-free. Learn more.

So what should parents do if they observe a change in their child? Dr. DeWitt recommends that parents contact their pediatrician if they notice their teen has "feelings of sadness, irritability, loss of pleasure, social isolation, change in school performance, a change in sleep patterns or change in appetite that last more than two weeks." Because a significant number of teens purposely hide their depression, like Nic Sheff did, parents should also encourage their children to share their feelings, seek help when they need it, and feel comfortable opening up to a guidance counselor or school nurse.

When selecting treatment for a child with depression, Dr. Brooks recommends finding a practitioner in the community that offers a robust mental health assessment where family members can also be brought in regularly. He cautions that drastic, so-called “boot camps” “have not shown evidence of superior results” in helping teens.

The hopeful news? A majority of adolescents treated for depression respond to therapy and maintain improvements over nine months, according to a 2009 study in the Journal of the American Academy of Child and Adolescent Medicine. Furthermore, diagnosing depression and co-occurring disorders in an addict can be the gateway to successfully treating the addiction itself. In the epilogue to Beautiful Boy, David Sheff phones a sober Nic a year after treatment. “We talk awhile,” writes Sheff. “He sounds – he sounds like Nic, my son, back.”

What Should Parents Do?

What should parents do if they observe warning signs in their teens, like a change in friends or social groups, or anti-social behavior? Our experts weigh in:

• Contact your pediatrician if you notice your teen has feelings of sadness, irritability, loss of pleasure, social isolation, change in school performance, a change in sleep patterns or change in appetite that last more than two weeks.

• When selecting treatment for a child with depression, find a practitioner in the community that offers a robust mental health assessment where family members can also be brought in regularly.

• Be cautious of drastic, so-called “boot camps.” They have not shown evidence of superior results in helping teens.

• If your child is on medication for any mental health disorder, monitor his medicine bottle to assure he's taking the correct dosage and be sure he is routinely seen by his doctor.

• Because a significant number of teens purposely hide their depression, encourage your child to share her feelings, seek help when she needs it and feel comfortable opening up to a guidance counselor or school nurse.
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