ADOLESCENCE  BEHAVIOUR  PROBLEMS & SUBSTANCE ABUSE

-Dr Bhaskar Gupta

1. What are the general problems that one notices during adolescence? Are these problems interlinked.

-- Adolescence is period of  rapid physical, emotional and mental growth and abilities. This is a period of  risk taking  behavior and impulsiveness giving rise to a variety of problems.  As you know that adolescence constitutes around 18-20% of  population which is the biggest golden asset for any community. Also this is a group which does not like to visit a physician or counselor resulting in masking of the adolescence problems.  Carefree and irresponsible  behavior may result in variety of  problems in this age group.

The most frequently observed  problems during this period are psychological disorders like Anxiety and depression, Violent  behaviors, Eating disorders, Sexually transmitted diseases and Substance abuse. All these could be interlinked as the adolescent who wants to overcome with one of these disorder tries another modality resulting in much worse outcome.

 

2. What is the cause for emotional instability among adolescents?

Excitement is felt gushing through the veins of adolescents during this period of rapid growth. A sense of independence and risk taking behavior takes place during this period where there are physical changes in body as a result of interplay of various hormonal changes in the body. 

With parents being regarded as greatest foes who object and give their opinion in all matters, friends become the soul mates.  This period  is marked with  increase emotional labiality, hypothetical thinking and distraction can result in variety of disorders.  Also excessive competition  brilliant  academic achievements  and over expectation  by parents and lack of  family support may contribute towards emotional instability.

 

3 How can parents recognize anxiety in their children and where should they seek help in Kuwait.

Anxiety is a natural and important emotion that every individual experiences throughout his life. When anxiety becomes severe in a adolescence affecting his social interactions, academic performance and his everyday activities then this needs treatment. The initial  features may be excessive worries and fear, nervousness, restlessness ,extreme stress, overanxious disorder where there is constant worry and dreams about  bad future.  Anxious teenagers may appear dependant,  withdrawn or uneasy.

They may complain of  physical symptoms like muscle tension, headaches, stomachaches, fatigue, hyperventilation and tremors.   When the parents notice any of these unusual features in their teenagers which is repetitive and progressive they should seek medical and psychological help.  In Kuwait there are lots of good facilities for counseling and treatment in the Government run Psychological medicine department as well as fully equipped private centers with Psychiatrists  and behavior therapists. These disorders can be very well treated with Cognitive  behavioral therapy, relaxation techniques, family support and anti anxiety medications.

 

4. You mentioned that adolescents can be treated with ant anxiety  drugs - is it right to give such drugs to young people? Won't they be hooked for life?

Ant anxiety  drugs are to be used only in severe cases where the basic treatment of behavioral and biofeedback techniques do not work and anxiety symptoms start taking a toll on the teenager. These medications are to be used under strict supervision  by a Psychiatrist and are used as monotherapy or in combinations. When medications are used the physician will closely monitor for side effects and would be used for a minimal time as needed. Most of the commonly used drugs are safe in adolescents and are not habit forming. Thus when used strictly under supervision they are much more beneficial for adolescents and along with cognitive and psychotherapy can ameliorate the symptoms.

 

5.  Is substance abuse also related to mental health disorder? Can depression lead to substance abuse among the young people? How do we recognize symptoms of depression among the young and how do we help them?

Substance abuse is a very serious threat to the adolescent population and is a result of variety of stressful factors including various mental health disorders.  Depression is one of these disorder resulting in substance abuse as a means to escape from the reality.  The symptoms of depression may be loss of interest and pleasure in usual activities, decreased food intake, inability to sleep or oversleeping, fatigue, feeling of hopelessness  and thought of death. Depression may lead to falling school grades, school absenteeism, trying alcohol and drugs and suicidal tendencies.  Depression is most noticeable by parents and close friends and develops over period of  weeks to months and need treatment. Counseling, psychotherapy, family therapy and medications can help such adolescents.

 

6.  How big is the threat of substance abuse among adolescents in Kuwait? 

The threat is significant in adolescents in Kuwait given the fact the economical prosperity of the country resulting in much illegal availability of these commonly used drugs in the country. As per WHO estimates, tobacco, alcohol and illicit drugs together contributed to about 12.4% of all deaths worldwide.  An earlier study here observed  almost 14%  of  college going students had  tried these at some stage of their college life. Adolescence is the stage when experimentation and later dependence  on these begins, so definitely the threat is significant.

 

7.Why do adolescents experiment with drugs and alcohol? Is it because they are curious and want to experiment with the unknown  and they do not realize the potential threat?  Do they do it for pleasure or peer pressure?

Adolescents abuse drug and alcohol due to many reasons like they want to fit in with friends or certain groups, they believe it makes them more grown up or they like the way it makes them feel relaxed and euphoric. Curiosity, risk taking, escaping from reality, split and poor supporting families  are some of the risk factors for this behavior. Peer pressure forms an important factor in such experimentation.  Adolescents with poor self esteem, emotional and mental health problems are at increased  risk for substance abuse. Some teens try these substance only few times and then stop but there are others who cannot control the urge and cravings and land up with drug dependence. 

 

8. Is substance abuse associated with violent disorders among adolescent or is violent disorder normal with most adolescents.

Substance abuse appears to be a major determinant of  violence as it was found that 70% of  crimes of violence were associated with substance abuse. Normally boys are more aggressive as teenagers, but when  violence results in indulging with dangerous activities, then it indicates serious underlying problem. Antisocial problems, property destruction, cruelty to animals,  rape, armed robbery, use of weapons and fire setting are some of the violent disorders commonly found among adolescents.  None of these violent disorders can be labeled as normal for any community worldwide.

 

9. Is sexual disease also common among adolescents? Why is this so?

Yes sexual diseases are also common in adolescents due to variety of reasons like sexual experimentation, failure to use contraception, peer pressure, denial and not reporting to the physician any such illness. Diseases like Gonorrhea, syphilis, Chancaroid, Herpes, Warts and HIV may result due to such behavior. Self treatment, peer group advices and improper medical care results in progression of  such diseases.  Strong association between , psychological disorders substance abuse and sexual disease exists as one condition leads to another.

 

10. Do Schools have a role to play in this?

Yes schools have a significant role to play in this as school  is the most important time where the adolescent spends a lot of his time and where the peer pressure behavior  may expose him to the risk of substance abuse .  Monitoring for groups of  adolescents with abnormal behavior, violent and aggressive disorder, poor scholastic performance are the earlier indicators of  substance abuse. Schools can check the nearby areas for any abnormal activities in making the availability of illegal drugs.  Involving the Governmental and Non governmental organizations would help to stop the spread of this nuisance. Also moral education,  awareness programs, counseling, more stress on family time and social activities would reduce this menace.

 

11, You are a Pediatrician- what made you take special interest in this issue?

From my time when I was teaching medical students as lecturer and Associate professor  in Pediatrics, I had observed this growing problem in the community which made me take special interest in this issue. Pediatricians are keenly involved with the care of adolescent and have the responsibility of delivering complete care from birth to adulthood to deliver the society a healthy progressive adult who would be the greatest asset to the community and the nation. 

 

12.  How did you go about spreading awareness? Did it help?

I read extensively and observe  keenly the growing trend about adolescents problems and how sensitively this should be tackled.  I have been giving presentations to most of the schools here and also creating awareness for parents in various  workshops  organized  by socials groups and NGO's . Also I have been counseling this group of  population in my clinic by various sessions and giving them leaflets to understand.  This has resulted in much better understanding and more monitoring of the adolescents by parents.

 

13.  Kuwait has such strict laws on substance abuse - how can young people get access to such stuff in Kuwait?

Yes the Kuwait laws are very strict which may include death sentence to dealer of such substances and this has been implemented on variety of occasions.  Kuwait has National committee for drug prevention, Drug control general department and various Narcotics control regulations and laws. International day against Drug abuse and illicit trafficking  by United Nations is held on June 26th every year in which Kuwait also takes a lead role during the conferences and public awareness on this day. But still the fact exists that wherever there is a demand, there are traffickers ready to take any risk for making this available as it involves huge financial earnings.   Due to such unscrupulous elements which are a threat to the society, substance abuse is on rise.

 

14 Do these young people suffering from substance abuse belong to one particular community  or social class?

This disease is universal and does not differ amongst communities. But it has been noted that availability , social practices and economical prosperity are linked to increased incidence of substance abuse. For example almost 50% of all high school seniors in United states of America have used alcohol or an illegal drug. Substance abuse is noted amongst all the social classes- the substance used may differ from one class to other depending upon the economic conditions and its availability. 

 

15  What facilities are available for adolescents with substance abuse in Kuwait.

Kuwait is fortunate to have excellent infrastructure and facilities  which have been highly successful to combat this problem.  Detoxification  programmes, psychotherapy, behavioral therapy, medications and support groups are available here.  There are many centers like Fawzia Sultan Rehabilitation Institute, Kuwait Finance house Addiction treatment center, Bashayer Al Khair organization  and   Kuwait Psychological Medicine hospital. 

 

15 What is the common stuff that young people have  here in Kuwait?  Is it true that apart from illegal drugs young people are also abusing prescription drugs and inhalants?

Marijuana or cannabis is one of the commonly used illicit substance. Other drugs like Cocaine, Heroin, Ecstasy are also used.  Yes it is true that young people do abuse prescription drugs mainly codeine, Dexamphetamine, Ephedrine,  Diazepam and barbiturates may be misused.  Also Glue, cleaning fluids and aerosols may be abused.

 

16  What kind of effect can alcohol and drug abuse have on the minds and bodies of young people. Can it scar them for life.?

There are certain chemicals in the brain called neurotransmitters which control our emotions.  Drugs and alcohol modify these neurotransmitters and  create a euphoric state.  Over a period of time they create dependence. Drugs and alcohol have been harmful to each and every organ of  the body. Not only they have ruined the adolescent physically, emotionally, economically, they have resulted in deaths in many cases of overdoses  about which you do get reports in the newspapers frequently.  A drug addict has poor academic performance, loss of  job and has risk of accidents.  For the sake of  this habit they can engage in robbery, burglary, drug dealing and prostitution. This is a huge loss to self and the community, endangering  his life and of  others. Thus it scars for the entire life for self, family as well as the entire community.

 

17. Can you share some case studies with us.

There have been cases with these adolescent problems during my clinical practice. A parent came with his teenage son who complained of repeated headache and abdominal pain and had falling school grades with violent behavior. On examination he did not have any physical illness, but looked detached and avoided eye contact and direct answering.  On taking him in confidence with counseling I found that the group of senior students with whom he was and wanted to be like them had been indulging in substance abuse that was available in the  shop near to the school.  Also I encountered a violent behavior child who enjoyed killing the cats near to his house. His parents were shocked when they noted that he also had a tendency of fire setting  behavior. I had to refer him to the Psychiatrist for behavior modification therapies.

 

18 How can parents keep themselves aware of what's happening with their children without imposing on their social activities.

Parents are the most keen observers for their children. If they are fully involved with their children and are just like their close friends in whom the adolescents can confide, these problems would be reduced to a great extent.

Parents should be very vigilant on the group of  friends his child is associated with, frequent visit to the school , monitoring the academic grades and watch for any abnormal signs in his child. Loss of interest in school, stealing money, skipping classes, or any signs of using drugs should alert serious problems. With modern gadgets of mobile, internet etc being used freely by adolescents, it is vital for parents to monitor these for any abnormal group or their discussions.  

 

19 Studies have shown that the lack of parent-children interaction is one of the major reasons blamed for the rise in early drug use. We have to combat drugs as a family, as a peer group, as an educational institution and as a social organization- you need a many sided approach to fight this problem - do you agree.

Yes this is an issue that is of serious concern and need multidimensional approach - social, emotional, legal and medical.  Parent child interaction and family discipline with moral values are essential to avoid the adolescence  ever think of entering this dark world of substance abuse. Keeping the adolescent busy with sports activity, religious teaching, family support and praise for good achievements would help these adolescents.

 Every diamond is a stone that is cut, polished  and sharpened to make it a beautiful piece.  Similarly childhood is like stone in rough stage which when progressing to adolescence has to be processed which is painful and mandatory - only then it becomes a gem of an adult.  Thus parents have the major role to play in order to have a worthy and fruitful adolescent useful to the society. 

-Courtesy:Arab Times