Ten years ago, on the acute unit of an inpatient hospital, I worked with a 15-year-old young man named Scott. He was a tall, skinny boy with slightly unkempt blonde curls, green eyes that sparkled with amber, and the kind of golden sun-kissed skin typically seen on California surfers.

I remember him raging at his misfortune for having the kind of parents who messed up their kid enough to make him need to be in a psychiatric hospital. To make things even worse, they stuck him in the hospital in the middle of his summer holiday. The girls on the unit, thrilled by his constant anger and rages and his good looks thought he was “so cute.” They agreed with him. How could any parent be so stupid as to admit their child to a hospital for something as silly as smoking marijuana?

Scott saw his parents as outsiders interfering in his life. He had stopped doing his homework, had a whole new set of friends whom neither parent knew, he seemed to think he should come and go as he pleased, and when confronted by his bewildered parents, he cursed and swore so much that sometimes they were frightened by their own son — sullen, moody, isolative, unpredictable. He had never been this way before. About five weeks into his stay, I sat in a group with Scott and I can still remember the look of amazement on his face. It was as if he had stumbled suddenly on a profound Truth.

“I didn’t realize how smoking pot had changed me. I had no idea. I can’t believe I ever threatened to hit my mother. I’m back to myself now, but I still can’t figure out how all this happened.” ‘Myself’ meant his moods were stable now and he was no longer irritable and raging. ‘Myself’ meant he was interested in the world again. ‘Myself’ meant he wanted to go back to school, was interested in learning, could focus and concentrate again. ‘Myself’ also meant he was back to being shy, socially awkward, and tongue-tied around girls.

If I knew then what I know now...
Before becoming a psychiatrist, I had worked in a large city hospital. Back then, I thought I could identify drug users and addicts ... the coarse skin, dilated pupils (look for people who wear sunglasses all the time), the track marks on the arms (look for people who wear long sleeves in summer), fingers and arms and legs swollen from circulatory damage. Urban. Black. Hispanic. Violent. Deadly.

Scott’s parents also held this point of view. Their son met none of these stereotypes. He was a middle-class white teenager from a semi-suburban, semi-rural part of the state. He’d bought his marijuana from dealers who were students at his high school.

“Everyone knows who they are,” he told me. “They can get you anything you want ... weed (another name for marijuana), heroin, cocaine, Xanax® (a prescription anti-anxiety medication), Vicodin® (a pain medication), anything you want.”

Scott’s friends, all of them from surrounding counties, got their drugs from suppliers at their respective schools. I never would have identified one of them had I seen them on the street. My experience with Scott went a long way toward teaching me the dangers of stereotypes, which serve, I think, as a way to keep most of us, especially parents, thinking the problem is elsewhere.

I used to be rather judgmental about drug use, thinking that addicts were just weak-willed losers. I am embarrassed to say that I thought this even when I finished my adult psychiatry training. I think I used to feel that if a person made a choice to start then that person could make a choice to stop. It was, to my mind, just that simple. How could you call addiction a disease when the afflicted had made a clear choice to start using in the first place? But if you look at how people like Scott change with drug use, you have to ask yourself questions. If it was that easy to stop, why would a person lose their job, home, family and still keep drinking or using cocaine? Why would an adolescent who has been raped multiple times in a crack house not stop using, but instead keep going back to that same crack house to get drugs? Why didn’t Scott stop using when he realized he was failing all his classes, arguing with his parents every day, stealing from them to support his use? Why do people keep using when it is obvious both to them and to everyone else that they are playing a losing game?

Why don’t they stop?
From almost every addict I have spoken with the answer is clear: they don’t stop because they can’t. It should be an obvious thing for us to grasp, but most of us do not consciously link our personality, behavior, and thoughts to our brain, a powerful but delicate organ. Alterations in the brain change who we are and how we behave. Drugs and alcohol alter our brains and change who we are. No one is exempt. Not even our own kids.

Acquiescing to stereotypes and being judgmental engender a false sense of security for parents and clinicians. But such attitudes are highly dangerous because they encourage us to believe that the problem is anywhere else other than right in front of us.

Substance abuse treatment does work. It is long-term. It is hard. But it can be successful. Our attitudes and beliefs can prevent parents and clinicians from seeing the problem and from supporting the treatment so desperately needed to change lives. Scott’s parents woke up in time. I’d like to think I did too.

Norma Clarke, MD, a child psychiatrist, is medical director of The Menninger Clinic’s Adolescent Treatment Program in Houston, Texas.

This article is published in Counselor,The Magazine for Addiction Professionals, October 2004, v.5, n.5, pp. 56-57.

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