Pubdate: Tues, 15 Dec 1998 
Source: Washington Post (DC) 
Copyright: 1998 The Washington Post Company
Page: Z06
Contact: http://washingtonpost.com/wp-srv/edit/letters/letterform.htm 
Website: http://www.washingtonpost.com/ 
Author: Abigail Trafford

TEENS, DEPRESSION & DRUGS

During my awkward adolescence, my grandmother used to take me to lunch at
the Wenham Tea House, a combination gift shop, lending library and ladies
restaurant in our small Massachusetts town. Gran with her liquid eyes, red
hair and deep bassoon voice would grill me about my life. How were my
classes? (So-so.) Did I play sports? (Oh, sure.) Was I looking forward to
all the holiday parties? (Sort of.) Finally after one lunch, Gran leaned
over and took my hand. Being young, she said in dulcet, Dubonnet-laced
tones, is not the best time of your life.

Her words were a comfort then and they're a comfort now. Indeed, the
teenage years are a national challenge for both parents and children. It's
the period when each generation gets forged into adulthood. It's also a
high-risk time of experimentation--which often includes taking illegal
drugs as well as drinking too much and smoking.

Until recently the general anti-drug message to kids was simple and
focused: Don't do it. Drug abuse will fry your brains and you'll end up a
failure. But this one-size-fits-all strategy to prevent drug abuse has
missed a whole subgroup of teenagers at risk.

Alan I. Leshner, director of the National Institute on Drug Abuse, divides
teenage drug abusers into two general categories: the Sensation Seekers,
who are the majority, and the Self-Medicators, who make up a minority.

The second group is finally getting attention from the medical community.
For these adolescents, the teenage years are not just a period of normal
hell. They are the time when mental disorders such as depression emerge.
Taking drugs is a way to control the symptoms of their depression, explains
Leshner.

In developing anti-drug programs for teenagers, "we may not be looking at
kids who are just miserable," says Leshner. "Saying your brain is going to
fall out in a month means nothing to the kid who's depressed."

A generation ago, many people didn't think children could get depressed.
Now that view has changed, and physicians are diagnosing and treating a
small but significant group of children and adolescents with major mental
disorders.

Earlier this year, researchers at the Scripps Research Institute in La
Jolla and Yale University School of Medicine explored the link between
depression and drug abuse. In an article in Neuropsychopharmacology, the
scientific journal of the American College of Neuropsychopharmacology,
Scripps researcher Athina Markou and her colleagues reviewed the science of
drug dependence and depression and noted alterations in the same part of
the brain, involving some of the same brain chemicals. "Depression and drug
dependence are likely to be linked disorders with shared neurobiolobical
mechanisms," the authors conclude. "Further, self-medication of depressive
symptomatology with drugs of abuse may be an important explanatory concept."

This means a very different prevention strategy has to be designed for
these kids. For starters, their mental disorder has to be identified and
treated. Leshner points out that an estimated 8 million to 10 million
children have an untreated mental illness. In his eyes, many are at risk of
self-medicating with drugs.

And while drug use may temporarily alleviate some of the pain of depression
or another mental disorder, drug dependence ends up exacerbating the
underlying condition. The implications for treatment are also obvious:
These kids need to be treated for both depression and drug dependence, he
says.

At the same time, most children going through adolescence do not suffer
from a mental or conduct disorder, and a significant proportion of them try
drugs. The average age at first use of marijuana is about 13 1/2.

The problem with Sensation Seekers is that they are playing a game of
Russian roulette. While 80 to 90 percent of the 70 million American adults
who smoked marijuana got through the experimentation phase with no lasting
effects, about 8 to 10 percent developed major problems. Leshner suspects
this group is genetically vulnerable to becoming dependent on drugs. But at
the start of adolescence, it's not clear who will fall into that vulnerable
10 percent.

By the time a person ends up in a treatment center with a dual diagnosis of
depression and drug addiction, it's not easy to determine which came first,
the depression or the drug use.

When you put together the drug-using population of teenagers with
underlying disorders and the vulnerable group of Sensation Seekers, that's
a lot of broken lives.

For parents, the challenge is sorting out where your child fits into the
spectrum of dependence on drugs, including alcohol and nicotine. Is your
child a Self-Medicator or a Sensation Seeker? As Leshner says: "The more
insight we have into Harry or Louie's motivation, the better shot we have
at saving him from a lifetime of problems."

There is no simple anti-drug strategy. The issue is much larger than
watching what a child smokes or drinks. It means knowing your child and
being alert to signs of depression or other problems. "It's not simply
talking to kids about drugs," says Leshner. "It means getting involved in
the life of your kids. It means asking how are you, who are your friends.
You have to have an interaction."

In other words, it means having lunch with Gran. I wish all kids could have
such a loving watchful adult as my Gran. She made sure we both survived the
teenage years--and flourished. 
- ---
Checked-by: Richard Lake