Decreasing the Risk for Adolescent Substance Use by Intervening With Parents

The following is a case of an adolescent girl who has been more argumentative recently, despite ongoing therapy for ADHD and anxiety. You, the clinician, wonder if her mother’s recent job loss and history of substance abuse may be contributing factors to her daughter’s behavior, and you decide to meet with your patient’s mother alone.

Questions to consider after reading the case
• You normally meet with your patient alone or with the patient and her mother together. How would you present to your patient and her mother the change in appointment structure to meet with the mother alone?
• What questions would you ask the mother to assist her in disclosing alcohol use or substance use if she is using substances?

CASE VIGNETTE
Katie, age 13 years, entered treatment 2 years ago for ADHD and general anxiety disorder. She presents for a routine psychopharmacologic appointment. Katie’s mother, Laura, reports that things have been particularly stressful at home recently. She states that she recently lost her job and her daughter has been more confrontational than usual and spends too much time on the computer late at night. The mother has a psychiatric history significant for marijuana dependence and you wonder what else might be going on at home.

Normally you meet with Katie alone and then with Laura and Katie together. Today you wish to speak with the mother privately to discuss her substance abuse and to further assess home stressors.

You discover that Laura is worried about the family’s finances since she lost her job. Katie’s father found extra part-time employment and has been at home less frequently to help with parenting Katie and her younger brother. Laura says she has been considering using cannabis again to “help her relax.” Instead, she tries to unwind by drinking 2 to 3 glasses of wine over the course of the evening.

You continue to screen for problematic alcohol use by asking Laura if she ever has more than 4 drinks at a time. You also ask about other risky behaviors, including driving under the influence, which she denies. Her answers give you reason to believe that Laura has been drinking heavily and that she would benefit from further evaluation.

Katie’s behavior patterns in the evenings raise your concern that stressors at home may be exacerbating her ADHD and anxiety symptoms. Because ADHD is a risk factor for adolescent substance use disorder, close monitoring of ADHD symptoms and monitoring for signs and symptoms of substance use is suggested.

For therapeutic achievements and outcome, click here.

Therapeutic achievements
Open-ended questions can help you elicit Laura’s own concerns about her drinking. By letting her know that her drinking increases her daughter’s risk of a substance use disorder, you may help motivate Laura to change her behavior and seek treatment.

In addition to helping minimize Katie’s exposure to her parent’s substance use, you also educate Laura on the principles of social control theory to help potentially decrease Katie’s risk of developing a substance use disorder. Social control theory suggests that it is essential for parents to be aware of what their child is doing and with whom they are spending time. You also encourage Laura to let Katie know that her parents disapprove of adolescent substance use.  

Outcome
Laura contacts her primary care physician for a referral to treatment and establishes care with a local substance abuse program. With individual and group therapy, Laura is able to successfully stop drinking and develops alternative coping skills to help her manage increased stress. Laura reports that Katie has been less argumentative. Although Katie continues to want to spend more time on the computer, Laura has been more effective in setting limits around technology use and there has been less conflict at home.

[Note: This is an expanded case from Familial Influences on Adolescent Substance Use, by Amy Yule, MD and Timothy Wilens, MD.]

References:

References

1. Wilens TE, Martelon M, Joshi G, et al. Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD.

J Am Acad Child Adolesc Psychiatry.

2011;50:543-553.