Susan B.* heard a knock on her door Tuesday, November 19th, 2002, that every parent dreads. It was the news that her 22-year-old son had been shot to death by their neighbor because he had entered their premises while high on Psychedelic Mushrooms and Marijuana. John B.* was your “typical teenager.” He was active in sports through high school, a high academic achiever, was social, and was a talented artist. Susan admits that her son might have “experimented” with drugs through his teen years, but she in no way thought that his use could have lead to this. When asked if she thought he was an addict, she replied that she just didn’t know.

          The story of John B.* was told to me by his best friend. The boys grew up together in South Florida, attending private school, family barbecues, and weekend camping trips. They also used drugs together. Their parents knew little of what the boys were doing through the years. Today, drug use, misuse, and addiction in adolescents throughout South Florida and nationwide is rampant, as represented by the ever increasing population at Inspirations for Youth and Families, a teenage rehab in Fort Lauderdale, Florida. I teach English to the residential teens seeking treatment for substance abuse and behavioral problems. Currently we have teens from as far away as Tacoma, Washington to our own backyard. The ages are as varied as the geography.

          In this article, I interview a 13-year-old male who abuses marijuana regularly and a 17-year-old female who has been here twice for poly-substance abuse. Poly-substance is a fancy term that is used to describe what my teens call “garbage heads” or “drug dumpsters.” These are the children using anything they can get their hands on: Heroin, Methamphetamine, Opiates, Benzodiazepines, Ecstasy, LSD, Marijuana, Alcohol and other drugs. There are more male teens here, but in the last two years that I have taught we have had at least a dozen females in treatment as well. There are several areas of concern when evaluating teen drug use.

          For parents like Susan B.* it is too late to address and understand what her son John B* was going through. Primarily, parents and teens need to actively engage in conversations about the types of drugs teens are using, why teens use these drugs, telltale signs of use, relapse and relapse prevention, and finally, why teens stay sober. The goal of Inspirations for Youth and Families is to help parents never say, “I didn’t know” again. Why does my teen want to use drugs and what kinds of drugs are they using? On July 17, 2013 I asked 42 teenagers in treatment for substance abuse and behavioral issues why they used drugs. The survey was random and anonymous and the answers were quite revealing. They said that they used for many reasons but some things stuck out.

          Many of our teens said they used drugs because they wanted to escape, enjoyed the feeling, wanted to have fun/be social or were curious and bored. Some, however, used for all together different reasons. Chad S.* said he uses to lose weight, another admitted his use was because he was angry with his father, and another because she thought her mother was never there for her and didn’t want her. Family problems came up again and again. Others said that they used the drugs to self-medicate for depression and anxiety or because they couldn’t handle reality. Three separate teens said they used because they were bullied.

          I interviewed Clinical Director Marlene Rodriguez, LCSW, and Primary Therapist Michele NeSmith, LMFT, with one question on my mind: what kinds of drugs are teens using today? Rodriguez responded quickly with one steadfast word: Marijuana. “Marijuana,” she stated, “is used by teens because it is both accessible and acceptable. Teens think that it is ‘not a big deal.’” Turning to NeSmith I asked which drugs they are seeing more of this year than last. She also had a singular answer for me: pills. Pills, however, encompasses a grosser area of drug use and abuse. Both NeSmith and Rodriguez agreed that the majority of teens they treated were using MDMA (3,4-methylenedioxy-N-methylamphetamine) or Ecstasy, but that prescription drugs are equally prevalent. NeSmith said that, “medicine cabinet drugs like Benzodiazepines, Hydrocodone and other Opiate derivatives, and even cold medicine have become a big problem for teenagers.” The teens echoed NeSmith’s statement adding that they still are using alcohol but that it is much easier for them to take pills from their parents than liquor. Alcohol, NeSmith told me, had “lost the appeal – there were more fun drugs to do.”

How do I know if my teen is using drugs or headed towards a relapse?

          Lying, manipulation and change in behavior are ubiquitous behaviors when I asked this very important question of the teens and clinicians of Inspirations. Primary Therapist Lisa Cohen, LMHC said that, “they like to lie and manipulate their parents into making them think that their drug use is their fault…they will say things like ‘how dare you.’” She added that blaming, anger and defensive behavior is very common with teens that are abusing drugs. Primary Therapist Hernaldo Morales, M.S., MFTI, agreed with Cohen and added that inconsistent behavior or changes in behavior are significant indicators that a teen is using or headed towards a relapse. He said, “There are two things that come to mind (when thinking about relapse and signs of drug use), first, the teen shows inconsistent behavior and second, there is no motivation or interest in previous goals or activities.” He added that things in their life just, “stop!” I asked the teens to tell me some sure signs that they are using drugs and their answers ranged from the obvious to the obscure.

          Some of the obvious indicators included moodiness, missing money, lighters and eye-drops, consuming large amounts of food and staying up late at night. More atypical indicators were reported by Chad S. * who said: “Almost everyone who uses drugs in the adolescent phase is usually a compulsive liar. They lie about very basic things. It could be as simple as the shoes they wore last Tuesday or the color of their hair a month ago…some use drugs to lose weight and might have eating disorders.” Many of the other teens echoed Chad’s* admission. Adolescent male anorexia is on the rise and often co-occurs with drug abuse.

          The female teens agreed that weight loss and lying or change in appearance were key indicators. I spoke to a few parents who admitted using incense to cover up the smell of Marijuana when they were teens but were surprised by the admission of their own son who used the same devise (with the addition of towels against the door, excessive perfume, and air freshener) to cover the smell of him smoking crack. The same teen admitted that he preferred to wear only white t-shirts while smoking crack and often didn’t change his clothes for days, a habit he called, “going hamster.”

          Primary Therapist LisetteLacosta, M.S. RMHCI, said that there are also several not so obvious signs that a teen is using drugs or has relapsed. She pointed out that what can be seen as typical moodiness or shyness is often isolation. She said that if a parent is to catch the teen in the “emotional-phase” of relapse that they may deter it. Here, the teen says things like, “I’m fine,” or “that like a switch they are no longer interested in talking about emotional issues with a parent at all.” This emotional phase is, “when things are starting to get out of control,” or “unmanageable.” Lack of support could lead to the next two stages: mental and physical relapse.

What makes my teen want to stay sober and how do I prevent relapse?

          The quintessential question then, is how do we keep teens sober? There is no easy answer to this question. I queried both teens and clinicians, and have been engaged in the research process myself as a Masters in Social Work (MSW) student at Florida Atlantic University. The research is varied and the longitudinal studies are limited. Inspirations for Youth and Families employ solutions based and 12-step methods of recovery for treatment of teens. Primary Therapist Damien McKnight, MED, said that a multi-dimensional approach is best. He stated that, “having a support system, going to NA (Narcotics Anonymous) and AA (Alcoholics Anonymous) Meetings, staying humble and not believing that they are cured, as well as open and honest communication about the possibility of relapse” are key to keeping teens sober. A 16-year-old male teen in his second rehab stint said that the best way to stay sober is to change friends. He said that he thought he could hang out with the same people and watch them use drugs and not participate but was clearly wrong. Another teen emphasized the need for a rigid schedule. She said that free time was not good for her because she always wanted to use drugs when she was bored. Still another teen emphasized developing a “moral conscious” and connecting to a “higher power.” He also said that finally starting to enjoy the “other things in life” are important to staying sober.

If my teen is abusing drugs, what can I expect them to get out of a rehabilitation facility?

          I hurried past the office of Clinical Director Sam Glenn, LCSW expecting to see a closed door. Glenn’s door is often closed because he is rarely disengaged from teen interventions, parent interviews, staff reviews or other crises of the moment. I seized the opportunity and I asked what might be the singularly most important thing for a parent or teen to know when they leave Inspirations. I asked Glenn, What is the most valuable skill that a teen will acquire when they have completed treatment? Glenn paused for quite some time before answering this question. I could see the years of slogans flying though his mind, ‘let go and let God,’ ‘people, places and things,’ ‘coping skills,’ ‘relapse prevention,’ and ‘go to meetings.’ I had often heard these sayings and ideas myself around the treatment center. He began to speak about one of them then shook his head, no. “When a teen leaves Inspirations,” he looked up and said with his hands folded in a prayer like position, “they will know without a doubt the necessity of actively practicing recovery as a lifelong process.” I have no doubt that when the teens leave Inspirations they understand this, and many other valuable things about substance use, misuse and most importantly addiction. The thing that I have learned from watching them, their families, and all those who love them is that maybe, just maybe, if Susan B. * had said something besides I didn’t know, her son might be alive today. My favorite moment is when a teenager leaves Inspirations. I watch them hug their parents. I watch them both cry. Finally, I hear a relieved mom and dad say, “Thank you for giving me my son back.”