A System's Inept Protocol


Social boundaries seem almost non-existent. Teenagers feel it is their right to try and do whatever they want. There is a new permissiveness afoot that implies there are few or no social boundaries. A growing ...

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Social boundaries seem almost non-existent. Teenagers feel it is their right to try and do whatever they want. There is a new permissiveness afoot that implies there are few or no social boundaries. A growing number of high school teenagers believe they should come and go as they please. They feel they should have exclusive decision making over the use and practice of drugs, alcohol and sex.

Recently, in a local North Shore high school newspaper, there appeared a fairly well written article by a high school coed supporting a high school student's right to drink and use illegal drugs. The author took an interesting position. The article suggested that if a student is parent friendly, reasonably compliant in school, a good student and acting responsibly, why should a student not be free to use drugs and alcohol socially.

Clearly that is an interesting perspective. However, I don't know how blatant breaking of the law with potentially risky behavior is acting responsibly. Unfortunately, after the article's appearance, the hoped for debate on this issue never happened.

The student writer raised a perspective that sounds outrageous to many adults but is becoming more mainstream with a growing number of responsible, fairly successful students. Why? As a society, we endorse that kind of thinking by our silence, by our indifference and by our example. We repeatedly give young people an assorted bag of mixed messages. I am not an advocate of prohibition, censorship or restricted freedom, but I am a proponent of consistency and accountability. We need to practice what we preach. We need to implement what we legislate and hold everyone, without prejudice, accountable for the choices they make.

If we accept the premise that more and more students are experimenting with drug and alcohol use at an earlier age, then we need to also face that a growing number of teenagers are developing addictive behaviors across the board in the areas of drugs, alcohol, food, sex and gambling.

Addictive behaviors wear many faces. One of the more troubling faces of this disorder is its' impulsive and compulsive manifestation. It is paralyzing, disabling and oftentimes very lethal.

You are a parent and you notice your high school student is acting out recklessly with drugs and alcohol. In addition to his or her reckless behavior, you observe some troubling compulsive and impulsive behaviors. What do you do?

One's first response would be to bring one's son or daughter to a counselor. More often than not, the recommendation would be to urge either in-patient or outpatient treatment.

That sounds simple. However, now your nightmare begins. First you must deal with your teenager or young adult's resistance, denial or blatant refusal to get help. Your second challenge is to find the appropriate venue and person for effective treatment.

In Suffolk County, where do you turn? There are a variety of outpatient programs that provide an assorted variety of treatment possibilities. How do you pay for this? How do you get your son or daughter there? Is outpatient treatment for non-motivated teenagers effective?

The nightmare continues. Even if you have insurance, most insurance companies are pathetic in their coverage of any kind of treatment for addiction. They, who are least competent to judge, design structures that set people up for failure and in some cases to die.

The scandal of drug and alcohol treatment is that it is no longer focused around the needs of the patient, but rather around the politics of the insurance company.

What happens if outpatient treatment fails? (In most cases of hard-core teenage addiction, it does.) Parents should turn to a residential possibility. Unfortunately, that turn only furthers the nightmare. There are few residential possibilities that have an effective track record for teenagers and young adults.

The three programs that have not caved in to the insurance disaster, deal with Medicaid, which is another horror story. However, at least their design offers some hope of recovery if the patient completes the residential component and has a comprehensive, "do-able" after-care plan.

My experience, after twenty years of professional and informal training, indicates that a hard-core teenage (or person of any age) addict needs an extensive residential component to treatment that is longer than fifteen days. Too many people are discharged from treatment when their insurance runs out, whether they are ready to be discharged or not. That practice is reprehensible and unconscionable. It is even more troubling that the larger community is not more outraged. The recovery community are unfortunately among the voiceless. Maybe when someone among the rich and famous is victimized, the system will sit up, take note and reform this god-awful approach to human suffering and addiction.

TJ is twenty-five. He has battled addiction since the age of sixteen. Throughout most of his teen years, he hid his obsessive-compulsive behavior around his drug and alcohol use. He managed to graduate high school and steer clear of the law, even though when he was most out of control, he was thieving and stealing everything in sight to support his crack/cocaine habit.

Over the last number of years, TJ has been reaching out for help. Because of insurance and personal finance, he never really took the appropriate steps that would have helped him to enter recovery.

TJ is a brilliant carpenter and tradesman. He has, at times, made a great living for a young man. Recently, he had his longest stretch without using crack/cocaine. His hard work, even though he was still drinking, allowed him to buy all kinds of toys and live very comfortably this past year.

Unfortunately, he reconnected with old friends and they all picked up. He lost everything, including his brand new truck. He was reduced to begging for food on the street.

One night after binging, he passed out on the street. A friend brought him to a shelter. After he came down from his high, he admitted that he was broken, that he couldn't fight anymore. He was ready to face his demons and do whatever he needed to do to enter healthy recovery. The consensus, because of his history, is that long-term treatment is needed. He applied for Medicaid. He was sanctioned for thirty days because he quit his job! He might not last the thirty days he needs to wait before he can reapply.

How many other TJs are being pushed to the edge of existence because of a system's inept protocol?

I hope TJ makes it, despite the bureaucracy.