Addictions in Children and Adolescents

What Constitutes Addictions in Children and Adolescents?
When we think of addictions, we often think of smoking (tobacco), alcohol, or illegal drugs.  More recently, we are seeing different types of addictions in children and adolescents:  the Internet, gambling, pornography, exercise, shopping, food, and caffeine, to name a few. 

Addiction is considered a chronic disorder that occurs when a person develops an uncontrollable habit of using substances or participating in behaviors despite negative consequences. Many of these behaviors can become physically addictive, which means that the person’s body begins to crave the substance or behavior. More of the substance or behavior may be needed to achieve the desired effect. 

Addictions also have a psychological component that is often even more difficult to overcome. Psychological addiction includes the rituals and emotions that often surround using the substance or the addictive behavior and the addiction may start to feel like it is a major part of who they are as a person. People can become addicted to almost any pleasurable activity and their behaviors become addictive when they lose control and “need” the substance or behavior instead of “want” it. When a behavior becomes an addiction, it always has some negative consequences, which at times may not be noticed immediately. Negative consequences may include failing in school, difficulties with family and friends, getting into legal trouble, (dealing drugs, stealing) and problems with their physical or emotional health. The addicted child or adolescent is so caught up in their own behaviors that it is difficult for them to see how their behavior impacts those around them.

The following are a few of the more common addictions in children and adolescents:

Internet Addiction
Internet Addiction refers to excessive use of the Internet for game playing (gaming) and other purposes, so much so that it interferes with everyday life and decision making ability. Definitions also include the inability to cut back on internet usage, preoccupation with on-line activities, and symptoms of withdrawal such as anxiety, boredom, or irritability after a few days of not going online. Internet addiction in children and adolescents is not necessarily about pornography or gambling; rather, it is about the excessive use of any online activity.  This can also include instant messaging, social networking (like Facebook), or blogging.

Studies indicate a significant association between Internet addiction and depression in adolescents. Internet addiction has also been linked to ADHD, hostility and social phobia.  Some research suggests that 1.4 percent to 17.9 percent of adolescents are addicted to the Internet.

Some studies suggest that boys appear to be at a higher risk of Internet addiction than girls.  In addition, either for boys or girls, those who use the Internet for more than 20 hours a week, every day, or for online gaming, are at higher risk as well.  Children or adolescents with depression, anger issues, or social problems may turn to the Internet as a way to contact other kids similar to them, while staying anonymous.

Since adolescents often have to use the computer or the Internet, the treatment of Internet addiction cannot simply involve abstaining from Internet usage.  Internet usage needs to be monitored by parents, educators and health/mental health professionals to prevent habit-forming, addictive behavior.  The goal should be to incorporate the Internet as part of a healthy part of home life.  Putting the computer in an often used family space within the home, like a family room, can help integrate the Internet into normal family life, and not something that is done in privacy or in secret.

Some symptoms of Internet addiction include: sacrificing sleep for time online; losing track of time while on the Internet; becoming agitated, depressed, irritable or angry when Internet time is interrupted or if the Internet can’t be accessed; sacrificing homework or chores; preferring time on the Internet rather than social time with family or friends; not abiding by Internet usage time limits; sneaking online when no one is around; forming new relationships with people that have been met on the Internet; loses interest in other activities.

Like addiction to drugs and alcohol, the Internet offers children and adolescents a way to escape painful feelings or troubling situations. They sacrifice needed hours of sleep to spend time online and withdraw from family and friends to escape into a comfortable online world that they have created and shaped.

Children who lack rewarding or nurturing relationships or who suffer from poor social and coping skills are at greater risk to developing inappropriate or excessive online habits. Because they feel alone, alienated, and have problems making new friends, they turn to invisible strangers in online chat rooms looking for the attention and companionship missing in their real lives. They may come from families with significant problems, and they cope with their problems by spending time online.

With the use of instant messaging, children and adolescents learn to instant message friends rather than develop face-to-face social relationships, which can impact their way of relating to peers. 

Parents need to be able to comfortably address Internet addiction problems with their children.  These discussions should always come from a place of love and respect for the child, rather than harsh criticism.  Parents need to set proper usage time limits, and discuss this with their children so that they agree on common goals and limits of Internet usage.  Parents need to become computer savvy themselves.  They need to be able to check history folders and Internet logs, learn about monitoring software, and install appropriate filters. It is important for every parent to learn the terms (both technical and popular) and be comfortable with the computer, at least enough to know what your child is doing online.

Often parents will get angry if they fear that their child is becoming addicted to the Internet.  They may take away the computer as a punishment or demand that the child stop all Internet activity immediately.  Both of these approaches may not be helpful and may make things worse.  Children will internalize that they are “bad” kids and will not see you necessarily as someone who is loving and trying to help them.  A much healthier approach is to work with your child or adolescent and establish clear and reasonable boundaries for healthy and limited Internet use.  For example, parents can allow one hour per night after homework, with a few extra weekend hours. It is important to remain firm and consistent with the rules you establish.  Remember, you are not trying to be controlling; rather, your goal is to insure that your children do not become psychologically dependent on the Internet.  

Parents can also help cut down Internet time by helping their children develop other enjoyable activities that are not computer related, such as sports or other outside activities.  If needed, Parents can seek help from outside sources, such as addiction treatment programs, to help address this problem. Family therapy may also provide help in addressing the family conflict around Internet usage.

Tobacco (Smoking) or Alcohol Addiction
Tobacco (Smoking) or Alcohol Addiction are perhaps the two most significant drug addictions in children and adolescents.  Smoking and alcohol, though “legal”, are often considered “gateway” drugs; both can lead to other illegal drug usage, such as marijuana and other illegal drugs. Research indicates that children and adolescents who smoke or drink alcohol are many times more likely to use marijuana than those who abstain.  In addition, the younger the age the smoking or drinking begins, the greater the risk of a serious health problem.  Cigarette smoking and alcohol consumption are also related to a higher risk of engaging in dangerous behaviors. 

Smoking (Tobacco) in children and teens has decreased since the 1990s.  However, the rates of cigarette smoking among high school juniors and seniors are still higher than those of adults.  Almost all long-term smokers start when they are young: 90% by age 18 and 99% by age 26.  The younger the smoking begins, the more likely it is that the child or teen will smoke as an adult, and the harder it will be for them to quit.

Other forms of tobacco favored by teens include clove cigarettes (kreteks), flavored cigarettes, (bidis), cigars, and hookahs (contrary to the claim that hookahs are a safe alternative, it’s not) 

Cigarette smoking puts children and teens at risk of serious medical problems, including respiratory ailments, gum disease, poor lung growth and overall poorer physical health and fitness.  

Smoking cigarettes has also been linked to harmful behaviors such alcohol and substance abuse, aggressive behavior, carrying weapons, attempted suicide, depression and hi-risk sexual behaviors. Children of parents who smoke are much more likely to smoke themselves.

What Can parents do to Prevent Cigarette Smoking in their Children and Teens?

One of the most important things that parents can do is to keep their children from starting to smoke.  Parents need to talk with their children about the harmful effects of smoking.  Let them know about the serious health problems that can arise from smoking, such as cardiac, lung, gum, respiratory or other medical illness.  Perhaps there is a loved in the family who unfortunately is ill or who died of a cigarette related disease, such as lung cancer. Talk to your children and teens about this sad event in relation to the negative effects of cigarette smoking. 

Parents can also mention what it can do to the way the teen looks and smells: smoking makes hair and clothes stink, causes bad breath, and stains teeth and fingernails.

Even a parent who smokes can make a difference.  Try to never use tobacco in front of your children, and don’t leave it where they can easily get to it.  Talk about ways to say “no” to tobacco use, even if the child/teen has a friend who is already smoking.  

If the parent discovers that the child is already using tobacco, try to avoid threats and ultimatums. Find out why your child is smoking or using other forms of tobacco. Is smoking an attention seeking device or a way to fit in with peers?  Show an interest in understanding your child/teens motivation for smoking and find ways to help them quit.  If they are trying to stop, be supportive and offer some tips, such as deep breathing, drinking water, talking about the craving and looking for alternative, healthy activities.

Helping a child/teen to quit tobacco use is one of the best parenting activities a parent can do for their child. And if you are a smoker, the second best thing may be quitting yourself.

For more information on tips on how to stop smoking, go to www.tobaccofreekids.org 

Alcohol Addiction
Alcohol is the most frequently used drug in the United States.  There are many dangerous effects of alcohol use in teens, including the following:  difficulty with attention and concentration, memory loss, the use of other substances, most notably marijuana, a higher rate of suicide attempts in teenage girls who drink as opposed to the same age range who do not, and the tendency for male teens to not pursue more years of education. Studies indicate that the younger the person is when they start drinking, the more likely they will develop a problem with alcohol.

Each year, almost 2,000 people under the age of 21 years die in car crashes in which underage drinking is involved. Alcohol is involved in nearly half of all violent deaths involving teens.  Teens who drink are more likely to engage in sexual activity, have unprotected sex, have sex with a stranger, or be the victim or perpetrator of a sexual assault. Alcohol abuse can mask serious emotional problems, such as anxiety or depression. 

What Are Some of the Risk Factors in Teen Alcohol Abuse?
Teenagers who develop drinking problems may present with family risk factors including minimal to poor parent supervision or communication, family conflicts, inconsistent or severe parental discipline, and a family history of alcohol or drug abuse. Individual risk factors include problems managing impulses, emotional instability, thrill-seeking behaviors, and the perception that the use of alcohol does not present a great risk. Girls who drink, as well as teens who begin drinking prior to 14 years of age and those whose mothers have drinking problems, are more likely to develop alcoholism.

What Are Some of the Signs and Symptoms of Alcohol Abuse?
You may find your child or teen smells of alcohol on their breath or skin.  Eyes may be glazed or bloodshot, skin may get flushed and the child/teen may become particularly argumentative or physically abusive.  There may also be significant memory loss.  In addition, some common behavioral symptoms include lying, making excuses, breaking curfew, staying in their room, mood swings, stealing, and changes in friends. 

In some extreme cases, alcohol poisoning can occur.  Alcohol poisoning is the potentially fatal result of drinking excessive amounts of alcohol in a short period of time. It is caused by alcohol slowing down the body's functions (for example, breathing, heart rate, and gag reflex), thereby potentially leading to choking, coma, stopped breathing, stopped heart, and death. Treatment involves getting the person to the hospital immediately so he or she can be closely watched by medical professionals, given oxygen and fluids, and so that other measures can be taken in order to prevent choking, as well as stopped breathing or heartbeat.

What Can Parents do to Prevent Alcohol Abuse in their Children and Teens?
Children need to hear from their parents about the negative effects of alcohol.  Children need to be told clearly by their parents that alcohol abuse is not acceptable.  Parental supervision in this area is crucial.   Extracurricular activities and other appropriate social involvement are important ways of preventing alcohol abuse in teens, especially during those times that parents are not around to supervise them directly. Parents can also help educate teens about appropriate coping and stress-management strategies. For example, religion has been shown to be an effective way to cope with stress; studies have indicated that teens who turn to religion to cope with stress tend to use drugs significantly less often and have fewer problems as a result of drinking than their peers who do not use religion to cope.

GETTING THE HELP YOU NEED
Alcoholism treatment is usually treated based on the stage of the addiction, ranging from management of risk factors and education, to out-patient treatment such as counseling by an alcohol and substance abuse specialist, to intensive residential treatment followed by long-term outpatient care.  There are medications that are considered effective in treating alcoholism.  Cognitive behavior therapy techniques, like helping the teen recognize what tends to precede and follow their episodes of alcohol use, are often used to address alcohol abuse in teens. Twelve Step programs, such as Alcoholics Anonymous, and other program specifically designed for teens have been proven most effective in the treatment of alcohol and substance abuse.  As with all child and teen treatment, parental involvement and supervision is crucial.

At OHEL, we are here to help.

Remember, at OHEL, we are only a phone call or a click away from your road to recovery.