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Chapter Two

Does Your Daughter Have an Addiction Problem?

“I think parents put on blinders,” confides Amy. A young woman in her early twenties, she has been off drugs for a year and a half. She describes growing up in a loving home in a stable community. Then in high school, feelings of awkwardness about herself led her to try pot, and next the readily available prescription painkillers that were hawked around the school. By the time she graduated she was snorting heroin. Since Amy managed to keep up her work and got into college, her family thought she must be okay, if a bit depressed. It wasn’t until she was arrested for possession of illegal drugs in college and faced significant jail time that they realized they had ignored a lot of troubling signs along the way.

Taking the First Steps toward Change

Will a parent see trouble ahead when they are reassured by signs of achievement, even if their daughter is withdrawn or moody or rebellious in other ways? How can we distinguish between a little experimenting, risky behavior, and abuse of alcohol or other drugs? Isn’t it a rite of passage for kids to “experiment” a little? Isn’t it usually just a phase? Many young people stick to “recreational” use at parties with their friends, and that’s as far as it goes. Some parents who may themselves have indulged in their youth don’t want to be hypocritical. They might even feel a bit nostalgic.

What you need to know: The possibility of a child’s using drugs or alcohol usually begins around puberty. For girls, this age arrives increasingly earlier, and by age thirteen, “more than twice as many girls as boys are depressed, a proportion that persists into adulthood, regardless of race or ethnicity.”¹ And depression increases the risk of addiction. It could be you become concerned about signs of depression in your daughter and seek help for her from a counselor or therapist. But a depressed young woman who is using substances is more likely to hide her substance use and to be treated for depression than for her drug use, whereas a depressed young man who uses substances is more likely to get treatment for his addiction. In fact, women of all ages are less likely to be diagnosed with addiction than are men.² Therefore, if your daughter is depressed, have her checked out by a competent physician for possible drug use. Many parents of young women using drugs I’ve talked to sent their kids to therapists. The girls were sometimes prescribed antidepressants—but their use of substances went undiagnosed.

There are, of course, many factors besides depression that drive girls to use substances. It seems parents have a different view of what motivates their children than the kids do. In one study, when asked to choose from a list of reasons why kids use drugs, most parents picked “peer pressure” or “it feels good.” But their kids mostly chose “stress.”³

Stress for girls and young women can coalesce around their body image. Lifestyle marketing bombards them with sexually charged ads that depict women as thin, thin, thin. Not long ago, the tobacco companies had tremendous power over young people’s decision to smoke. Remember Virginia Slims? That power may have been curtailed, but it’s going strong in the liquor industry. Ads infused with glamour show smiling (thin) young women sipping concoctions like the Skinnygirl Cocktail line. Or have you heard of alcopops, those cocktails on training wheels?

Illegal drugs, in turn, have won a subversive glamour of their own in America in waves of different epidemics over the centuries. I was surprised to learn the first big drug addiction epidemic occurred in the late 1800s, led by legally prescribed opiates such as laudanum, as well as patent or over-the-counter medicines that contained such additives as Coca-Cola syrup, which at that time included cocaine for a pick-you-up, marketed mostly to women to increase energy.

As Thomas Deitzler, Director of the Young Adult Program at the Caron Center for Recovery, put it to me in a conversation in 2010, “Addiction is in epidemic proportions with this generation.” Again, the vast majority of risky users and addicts start when they are teenagers; women get addicted to alcohol and other drugs more quickly than men.⁴ Yet they often hide their use more than young men do. “Boys learn from their earliest days on the playground, jumping at dares, that the willingness to take risks is part of what it means to be a man. For adolescent boys, alcohol and other drug use is the next step in the natural progression of risk taking . . . . Boys who drink may feel invincible, immortal, and beyond the reach of the law.”⁵ More often than girls, boys using substances may also seek negative attention, like being suspended or kicked out of school, getting arrested, driving too fast and having a car accident, until it becomes clear to those around him, sometimes including the criminal justice system, that he has a problem with substances.⁶ Girls tend to be sneakier and more adept at hiding their use, at least at first. The sooner parents identify and respond to a problem-in-the-making with them, the greater the possibility these young women will have a chance to regain healthy lives.

Checklist of Warning Signs of a Possible Substance Use Problem

An eighteen-year-old high school senior, who was taking a variety of painkillers—whatever she could get from friends who mostly cadged them from family medicine cabinets or bought illegally obtained painkillers—describes herself then: “I grew thin and listless, stopped showering, and began sleeping at all hours.” She adds that her parents didn’t suspect drug use until she ended up in the emergency room after an overdose.

The following checklist can help you decide if your daughter may be either at risk for addiction or already addicted. No one can predict which kids will go down the road of addiction. Early intervention saves lives. For young people whose brains are still developing in the teen years and until about the age of twenty-five, some of these warning signs may seem to be the “normal” moodiness of a young person navigating the rocky passage to adulthood. However, if you recognize more than a few of them in your daughter there is cause for concern.

Physical signs

• Smoking (Does this surprise you? It did me. But, research consistently links smoking to depression—and depressed young people are more likely to turn to alcohol or other drugs.)

• Red, watery eyes, heavy use of eye drops

• Shaking hands, feet, or head, lack of coordination, clumsiness, stumbling, lack of balance

• Puffy face

• Paleness

• Vomiting

• Nausea

• Hacking cough

• Runny nose (not from a cold or allergies)

• Frequent nosebleeds

• Dilated pupils

• Alcohol on the breath, smoke on the breath, bad breath

• Rapid heartbeat

• Sores that don’t heal

• Spots around the mouth

• Needle or track marks

• Excessive talking (motor mouth), hyperactivity, clenched teeth, slurred speech

• Marked increase or decrease in appetite, sudden loss or weight gain

• Burns or soot on fingers or lips

• Messy, careless appearance

• Avoidance of family dinners

• Sleep problems (too little or too much)

• Passing out, seizures

Behavioral signs

• Lower grades, skipping classes, lack of participation, loss of interest in extracurricular activities, hobbies, sports; complaints from teachers

• Many (or more) arguments with family or friends

• Emotional meltdowns: irrational and inexplicable mood swings—such as being friendly, then angry, sometimes violently so—ADHD, rebelliousness, inability to control impulses, paranoid thoughts, panic attacks

• Depression, anxiety, conduct disorders

• Stealing money; unexplained need for money; disappearance of valuables

• Lying, including asking others to cover for her

• Sudden use of air fresheners, incense

• Car accidents

• Marked withdrawal from family and friends

• Different friends—usually older; avoids introducing them to you

• Paraphernalia such as pipes, razor blades, vials, baggies, straws, rolling papers, rolled-up money, pill or alcohol bottles hidden in her room, purse, or car

• Overheard conversations that raise suspicions

• General lack of responsibility—failure to do schoolwork or chores, flimsy excuses for missed curfews or obligations

• Chronic defensiveness

• Trouble with the law for any reason

• Someone (siblings, neighbors, school officials) trying to tell you she is using drugs or drinking too much

• Thinking that drinking and/or using drugs isn’t that harmful

Effective Conversations with Your Daughter Early On

If nothing on this list resonates for you, you may still be concerned about preventing a problem before it starts. Or maybe you still have that lingering gut instinct that something is off. There may have been an “incident” or two that doesn’t sit right. Perhaps emotions have escalated between you and your daughter. No matter what the reason, parents can play a vital role in helping her make good decisions about using substances. Even if she’s not using now, you can’t assume

• she’s not interested in drinking or drugging—the majority of high school students will try something before they graduate, and binge drinking and drug taking is rife on college campuses;

• she’s already learned about it at school—with certain exceptions, schools aren’t effectively teaching about today’s reality;

• she won’t listen to you—parents are known to be the number one source kids turn to for important information.⁷

As a starting point, when and how you talk to your daughter can make a big difference. You’ll be more effective when you’re prepared and focused on avoiding a confrontation. Kids are much more approachable when they are not tired, such as at the end of a school day or after a sporting event. Choose a time when you both are more receptive. It may be going together somewhere in the car, at a coffee shop, or at home if that’s a comfortable place. Remember all kids are generally resistant to “the talk.” You need to be caring, respectful and, as my daughter’s kindergarten teacher used to say, “put on your listening ears.” How you talk to her can mean the difference between her shutting down or opening up. Showing concern and respect for her are bouquets.

Many experienced counselors suggest opening up the conversation by asking about other kids she knows. If you begin with general concern instead of zeroing in on her, it will probably be easier for her to open up, or at least not shut down, than if she feels she’s being scrutinized or judged. Is she worried about any of her friends? Ask her how so-and-so is doing. Let her know you understand some kids struggle with substance use, and that you are genuinely concerned for their welfare. If you do ask your daughter about her own use, you may not get a truthful answer, but you have set a tone and reminded her of your positive role. By doing so, you have opened up a new pathway that you can revisit.

Don’t Dance with Her Denial

Let’s say after one or more of these kinds of conversations with your child and a look at the checklist of warning signs you do suspect there may be more going on with her than the ups and downs of adolescence. Or that, again, you have that sense something else is wrong. Respect your parental intuition. But now what? It is a huge step to confront your child’s risky substance use. Minimizing a suspected problem by making excuses for her drinking and/or drug use changes nothing, but a full-on confrontation usually does not work either. Demanding the truth from her can backfire. As one mother of an addicted daughter writes, “In my experience, denial, dishonesty, and manipulation are the behaviors most fundamental to addiction . . . . These behaviors become like second nature, helping the addiction take root and blossom.”⁸

The operative word being denial—hers and yes, yours: an inability or refusal to face the truth because it is so painful and frightening, whether for the person who is addicted or her loved ones. The user becomes incapable of being truthful to herself about what she’s doing. This is the aspect of addiction that may be the hardest to understand. When I was at the worst phase of my addiction, the need for the substance and the neurological distortions caused by the substance, degraded my ability to see reality to such an extent that using logic with me was pointless. My daughter, for her part, would explain away a slew of symptoms associated with addiction—irresponsibility in every area, extreme messiness, poor hygiene, high irritability, and deceitfulness—as being due to “teenage hormones” and “PMSing.” (Ironically, she was partly right, as we do know sex hormones play a vital role in the emotional lives of young adult women.) Kim also played the moral outrage card: I was “invading her privacy.” I was “a snoop.” And my favorite: I was “bipolar.” Like many other parents of addicted daughters I’ve met, she used lies and anger as weapons to fend off the truth. She lied because she was on the defensive and had to protect her addiction. For a while, it was effective.

When confronted about her use, a young woman is likely to minimize the problem or just lie about it. In scientific terms, the intake of booze or drugs increases the experience of pleasure and reward in the user’s brain because more dopamine is being produced. Anyone who has a drink knows this feeling. But for the habitual user, there is a hazard: Over-stimulated by all those calls for dopamine, the brain of the heavy substance-user in time slows the process down by decreasing nerve cell proteins that function as dopamine receptors. It is then that the alcoholic or addict experiences a deficit of pleasure, tries to recapture that pleasurable sensation by drinking or using more in compensation. In short, a user needs more and more of the drug to recapture a sense of normalcy and, in short order, to avoid a mental crash since alcohol and other drugs drastically change the normal brain circuitry. In time, to feel just “okay” she has to get the next fix, which becomes a constantly diminishing okay, and in-between the lows get lower and lower. When backed into a corner, an addict guards her addiction as ferociously as a mama bear protects her cub. She’ll view confrontation as an attack. This is the tough reality we have to face to be helpful.

Things kids who use drugs may say to protect their drug use:

“You don’t understand.”

“I’m just having a tough time right now.”

“I’ve cut back.”

“I can cut back.”

“I will cut back.”

“I can stop whenever I want.”

“I’ll deal with it when I find the right person/get the right job,” etc.

But the truth may be quite different: She physically craves the pleasure—the “high”—and the escape the drug provides. Soon she needs the substance(s) she began using to feel more relaxed or to boost her energy or to forget her problems or just to avoid feeling terrible. Her brain-body chemistry now screams to avoid the physical pain of withdrawal.

During the initial period of my daughter’s increasing use of drugs and alcohol I clung to the fiction that “things” weren’t out of control. I kept hoping I’d overreacted and that with the right combination of discipline, activities, and friends, Kim would be alright. Following are comments from parents who, like me, got caught up in their own denial. Do you identify with any of the following?

“I wanted to believe her so much.”

“Drinking with friends at that age was normal, as long as she wasn’t driving drunk.”⁹

“It was just marijuana.”¹⁰

“It wasn’t that bad.”

“I allowed her to manipulate me.”

“I covered up for her.”

“I gave her money.”

“I couldn’t let her sit in jail.”

“I should have set stricter limits.”

“We let the problems in our marriage ruin our child’s life.”

“I kept trying to fix her problems.”

“I sat at home worrying.”

“The harder I tried to make her see the problem, the more she resisted.”

“I was overwhelmed with everything because of what was going on in her life.”

“I didn’t talk to anyone about the problem.”

“I didn’t want anyone outside the family knowing about our problems.”

“We kept giving her one more chance.”

“I would know if my kid was using.”

I said each of the above at one time or another. As parents, we want to protect ourselves from what is painful to accept in our children. As Kim’s addiction worsened, I learned a vital lesson: By evading the evidence of my child’s drug use, I was actually delaying the process of her getting well because there were no serious consequences to her actions.

We needed to have a different kind of conversation. We needed to communicate about consequences—positive as well as negative—for the choices she was going to have to make.

Samantha’s Story

“Trauma,” says Stephanie Covington, a leading expert on women and addiction, may be “any stressor that occurs in a sudden and forceful way and is experienced as overwhelming.” She adds “Trauma also impacts how the brain functions. People under extreme stress often process and organize information differently.” ¹¹

Pam and Neal have two daughters, ages eighteen and twenty-two, and live in a pleasant suburb of New York City. Pam, who recently retired because of a medical condition, worked as a Credentialed Alcohol and Substance Abuse Counselor (CASAC), both in outpatient and inpatient programs at a rehabilitation center. “I was shocked by the lovely young women getting into opiates,” she says. “Many of them came from the courts. With the repeal of the Rockefeller drug laws, they could get treatment the first time instead of jail.” These drug laws in New York State had been among the toughest in the nation. Repealed in 2009, they had required mandatory prison sentences for lower-level felons. “I remember one young girl especially. She had a very strict, loving family and she was a full-blown heroin addict by eighteen. The parents were overwhelmed. They couldn’t believe it. And that was my story too.”

Pam’s older daughter Samantha was diagnosed with ADHD in the third grade. “She couldn’t sit down or sleep. We tried everything else first before she finally went on Ritalin. It really helped: her behavior markedly changed. She still takes Ritalin. As a child, Samantha always wanted to get out and experience life. She had to be with the cool kids, she’d put up with them because status was so important. She’s had big problems since she was a little girl, going to extremes sometimes. My younger daughter is not like that.”

Pam and Neal started finding pot in her room when Samantha was around twelve or thirteen. “We’d find glass pipes, paraphernalia. The third time we found pot, she started going to a therapist once a week—someone I knew who worked at a recovery center. She was negative about it at first, but ended up enjoying speaking to her. And I didn’t see more evidence of pot use. But then, at fifteen, she was arrested for shoplifting in Manhattan. She had to sit in a jail cell at a local precinct until we showed up. My husband wanted to hire an attorney so she’d get off, but I wanted her to face the judge and tell the truth. Well, she was given community service and had to work at a local library and at an arts program there on Saturdays, which was very good for her. She also went to an adolescent outpatient group program—where she was drug-tested—with a family group that met once a week. And she did well. After the group program, she continued to meet with a therapist one-on-one, then graduated to group peer counseling with a social worker and other adolescents—all of this for about eighteen months. In her senior year in high school, she went to an alternative program and got into the college she wanted at eighteen—a studio arts program.

“In college, she was in a dorm her first semester and did great. In the spring, she met a guy at a party who was about five years older than her and fell in love. First love. By the summer they decided he’d live with her in a student house at college. I always wanted to have an open relationship with her, so I was glad she was open with me about it. And he did keep her on point, academically. But as they started living together, I noticed Samantha was becoming very thin. I was worried about her, and I asked if she was eating enough. Looking back, she was probably doing heroin then. The boyfriend was smart, but I knew he’d had a tough childhood. And then I found out he used to have a heroin problem, which he’d kicked. Well, that’s what he said. It was probably BS. Meanwhile, he was buying her beautiful things: clothes, jewelry, and so on; I would see her modeling them on Facebook. And he didn’t have a job. But she had been doing well in school, so . . .

“She stayed at the college after her sophomore year for summer school. But she wasn’t answering my phone calls. When there was no bill from the college, I confronted her and she made some illogical excuse about why she wasn’t going to school. In my gut, I knew something was wrong. Her dad was angry because she lied. We told her, ‘You’ll have to get a job for the summer if you are not going to school,’ and she went and got one at a yogurt store. She would come home occasionally and she’d sleep in late, way into the afternoon. I didn’t realize why: she was using heroin. My misconception about heroin was that you could not function because you would shoot up, go on the nod, then shoot up again, and continue the cycle. But, she was probably using it all the time just to be normal. I don’t know if she shot up or snorted it because she still won’t talk about that, but I found syringes in her room and in a car she and her boyfriend borrowed. They made excuses about it. I found three syringes in the spare bedroom from when Samantha, her boyfriend, and another friend visited. Again, there were the excuses. So I knew there was something wrong but I didn’t know what it was.

“Samantha went back to her apartment at college in late August and one morning she calls me, absolutely hysterical: the police had come and taken her boyfriend away. He had become weird and paranoid—I later found out he had been doing all kinds of drugs. He started yelling at her, throwing stuff, and then he threw her against a wall and started choking her. Her roommate called the police. It was an automatic domestic violence charge. As the police were taking him away he assaults them. They took him to the ER, he was hospitalized, and then released to his mother.

“Now she’s on the phone with me, out of her mind, so I stay on the phone with her and talk her down while Dad makes the three-hour drive to get her and bring her home. On the phone, she only raves about being assaulted. Nothing about the drugs. She keeps playing the part of the abused woman who needs help. We arrange for her to see a counselor and she gives the counselor permission to say only that ‘Samantha’s in over her head and needs support to open up to you.’ We go with her to the next session and Samantha tells us: ‘I’ve been using heroin and I need help.’ She said later, ‘If the assault hadn’t happened, I would have gone on using.’