TRICK OR TREATMENT

America loves its quick fixes. Think your child might be on drugs? Test
him. Think your child's school is full of addicts? Test them all. Institute
a policy of zero tolerance: One strike and it's off to a drug treatment
program. Get those rotten apples out and clean them up before they can
poison the whole batch. Last year's Supreme Court decision in Board of
Education v. Earls allowed for a massive expansion of drug testing in
schools. And increases in drug testing increase the numbers of offenders.
As a result, schools and juvenile courts are increasingly turning to both
"zero tolerance" and "treatment, not punishment" as a remedy.

The number of teenagers in drug treatment as a result of court coercion and
school diversion increased by nearly 50 percent between 1993 and 1998
according to the U.S. Department of Health and Human Services' Substance
Abuse and Mental Health Services Administration, and the number of teen
admissions to treatment programs in general rose from 95,000 in 1993 to
135,000 in 1999. But what if drug "treatment" doesn't work for teens? What
if, rather than decreasing drug use, teen treatment actually encourages it
by labeling experimenting kids as lifelong addicts? What if it creates the
worst sorts of peer groups by mixing kids with mild problems with serious
drug users who are ready and willing to teach them to be junkies? What if
suggestible kids respond poorly to the philosophies that have made
Alcoholics Anonymous and Narcotics Anonymous successful for many adults?
Then we'd be using "treatment" to turn ordinary adolescents into problem
drug abusers.

That's precisely what we're doing. A 1998 study of nearly 150 teenagers
treated in dozens of centers across the country found that there was 202
percent more crack abuse following treatment and a 13 percent increase in
alcohol abuse. In other words, recent research suggests that parents and
schools may be sending binge-drinking/social marijuana smokers off to
treatment and getting back crackheads in their stead.

Michael's case illustrates some of the dangers inherent in shipping
youngsters off to treatment programs. An 18-year-old marijuana smoker and
cocaine user I interviewed regarding drug treatment, Michael was recently
sent by his parents for drug treatment at the respected Caron Foundation.
But his $11,000 one-month treatment program degenerated into a fruitless
debate when his counselor wanted him to admit that he was "powerless" over
drugs. Michael, who didn't use daily, wouldn't accept that. What teenager
would admit to being "powerless" over anything? Michael used again within
four hours of leaving treatment.

Michael's reaction may be the rule for teenagers, not the exception. For an
adult who has lost his wife, his job, his health, and his home, admitting
to a loss of control might help him recognize that quitting drugs is the
only way to solve his problems. But a teenager may not be "in denial" when
he says he can control his intake. Most teenagers can. Conversely, forcing
a teen to assert that they have no control may do more harm than good, if
they have only been experimenting with drugs but are convinced, via
treatment, that they are serious addicts. If a teenager has been persuaded
that she's powerless and has a 90 percent chance of relapse, she's far less
likely to exercise self-control when confronted with a drink or drugs. In
fact, a 1996 study published by Bill Miller, professor of psychology at the
University of New Mexico, found that those adults who most accepted the
idea of personal powerlessness had the most severe and dangerous relapses.
Since teenage identities are fluid anyway, encouraging them to view
themselves as powerless addicts may cement an anti-social identity that a
teen was just trying on for size.

The core problem with teen treatment programs is that most teen drug or
alcohol users are just not out-of-control addicts. More than one teen in
six who's forced into treatment does not even fit the criteria for a
"substance abuse disorder" (the less serious diagnosis for an abuser), and
most also don't have substance dependence (the psychiatric term for
addiction) at all, according to SAMHSA. More troubling, SAMHSA statistics
also show that about three-quarters of the U.S. teens now being sent to
treatment programs are diverted there by courts or schools, rather than
being referred by professionals. In other words, many have problems no more
serious than those of their friends who've escaped detection.

In addition to labeling kids as addicts, drug programs may also surround
them with the worst possible influences. Studies show that teens are more
subject to peer pressure than adults-and more influenced by the people
around them. Teen treatment programs remove teens from a healthy peer group
and surround them with other problem kids, virtually guaranteeing that
their role models will be negative. Group therapy during such treatment
invariably involves discussions of their drug experiences-which only makes
the hard-drug users seem "cooler" because their stories are so much more
exciting. Worse, aside from providing a way for relatively inexperienced
kids to learn about different ways of getting high and obtaining drugs,
these programs frequently offer kids new connections. One 17-year-old girl
from Florida told me that she hadn't used cocaine until after treatment-her
new best friend from rehab scored it for her.

There are treatments for teens that don't reinforce the labeling or peer
problems inherent in most drug programs. Research presented at a spring
conference held by the National Institute on Drug Abuse compared teens
who'd been sent to traditional group sessions with peers to teens who
received family therapy, with a third group who had both kinds of care
combined. The kids in the peer-group sessions used 50 percent more
marijuana after treatment, while the kids in the combined treatment used 11
percent more pot. The teenagers treated with their parents, however,
decreased their marijuana use by 71 percent.

The greatest irony in the current well-intentioned treatment efforts is
that they ignore the few things we do know to be effective in helping teens
stop getting high, and chief among them is finishing their education. The
better educated someone is, the less likely he is to become an addict or to
have a lengthy course of addiction if he does. So removing kids from school
and placing them with a more deviant peer group in an unproven therapy is
madness-and not much smarter than simply expelling them and tossing them on
the street. Not only is the education provided in treatment programs often
inferior to that in ordinary school, but having a drug-related disciplinary
record diminishes the chances of admission to a decent college.

Ultimately, it's clear that the vast majority of teenagers (even those with
the very worst problems) simply "mature out" of drug use. This natural
recovery process is seen in statistics from the annual federal household
survey of drug use, which, for example, find that while 18.4 percent of the
population ages 18-24 in 2001 qualified for a diagnosis of alcohol or other
drug abuse or dependence, only 5.4 percent of those over 26 meet these
criteria. Since less than 2 percent of the total population annually
receives treatment (including self-help), most of these young people are
clearly recovering on their own.

Why, then, do we insist on herding teenagers into inappropriate treatment
programs when allowing them to finish school works better? Do parents
really want their pot-smoking, experimenting binge-drinkers (who are
actually typically more moderate than their own parents were at their age)
tossed into "therapy" with heroin injectors and told that they are
powerless to resist?

Studies show that family therapy and behavioral one-on-one counseling work
better for teens than programs modeled on adult addicts. Even for kids with
genuine drug addictions, these sorts of treatments may be more helpful, and
it's long past time that such programs were implemented in communities
rather than debated in the academy. For kids with minor drugs problems
or-as is more often the case-for kids who are just being kids, the
philosophy must be: First, do no harm. Although we may hate the idea,
leaving kids alone and letting them grow out of their habits makes far more
sense than testing, punishing, and "curing" them-by making them worse.