The Opiate Crisis Starts, and Ends, With Our Children

By Jeanette Friedman, MS, LCSW, PLLC and Harold S. Koplewicz, MD

The increasing numbers of youth succumbing to opiate overdoses has provoked a long-needed reevaluation of what many professionals now consider a developmental disorder, grossly misunderstood for decades. From this point of view, if we want to arrest the deadly crisis gripping our nation, we must begin with childhood where the earliest of signs appear.

Based on our decades of experience in child and adolescent psychiatry and addiction treatment, it is our strong belief that deaths due to opiates and other addictive drugs are largely preventable -- if we begin to identify signs in childhood and we are willing to take action.

It feels unseemly to consider a seven year old's actual risk for later opiate abuse -- but there are signs even then that can help us protect our most vulnerable and the families that are destroyed when addiction is allowed to develop. Families of the opiate crisis will report that there was usually a long and painful struggle on many fronts including disbelief and shame over how this could possibly happen to their children. Unfortunately, these fearful, close-minded attitudes we have allowed to develop are deadly and get in the way of lifesaving treatment. 

Addiction, simply put, is the result of a process set in motion in childhood. We now understand it to have myriad biological, psychological and family roots, which is why it is so difficult to treat and has been misunderstood and stigmatized as a moral failing. It is subtle, mysterious, and cunning; many recovered addicts will say it's a disease that tells you you don't have a disease. By the time we actually see it in an adolescent, intervention can be very difficult to initiate.

Waiting until adolescence is reached and we learn of a daily marijuana habit, or weekend alcohol binges, or the self-medicating child with depression or ADHD, we have missed an important developmental period when we could have intervened. Personality and environment have already influenced attitudes, relationships and lifestyle patterns that enable addiction to continue.

Compounding the problem, chronic drug use in adolescence is often neglected as a public health problem that has long term effects on the community, and trivialized as a rite of passage. The reality is that most youth who use drugs or alcohol chronically suffer from untreated psychiatric illness. When they socialize with a like-minded peer group, their choices are normalized.

So what can we do?

For many years the "gateway hypothesis" suggested that early use of alcohol, tobacco and marijuana led to more addictive drugs over time.  Today, we think the progression to more addictive and lethal drugs is less about a "gateway drug" and more about risk factors and biological response to any addictive substance. Understanding which children are at risk and preventing them from initiating drug use is paramount.

Families and schools can become more skilled at recognizing early personality features that influence behavior as a child develops:

1. extreme dependency and the need to control

2. "here-and-now" thinking characterized by impatience and instant gratification

3. self-involvement that leads to poor social connections and empathy

4. difficulty with mood management and frustration tolerance

5. resistance to change leading to chronic arguing or debating

On a national scale, cultural attitudes have an impact. The attitude within our culture that avoids conflict at a high cost, that values and promotes escape, pleasure, avoidance, and distraction, that encourages intolerance for waiting, frustration, discomfort and uncertainty -- contributes to a mentality that is primed for addiction.

We must be realistic in our quest for solutions. Even as we develop more comprehensive and sophisticated approaches to prevention and treatment, they are bound to fall short for some. Dysfunction that thrives on the complexities of our home lives, our neighborhoods, the media, Big Pharma and an international illicit economy cannot be eradicated.

In the final analysis, we are all responsible for the drug addiction in our communities. There is plenty of blame to go around - from our policies on incarceration to how we avoid treatment protocols to how uneducated we remain as a nation when it comes to keeping our children -- and their brains -- healthy and safe. Yet, treatment works -- as long as we are willing to make it a priority, to accept setbacks and imperfect results, and to agree that it matters.