Parents who discover that a teenager is using drugs usually face two fears at once: what the drug is doing, and what will happen to the child socially and educationally if anyone finds out. Both are legitimate, and the second is the reason a great many families delay seeking help until the problem is considerably harder to treat.
Adolescent dependence is not adult dependence in a smaller person. It develops faster, it interacts with a brain that is still developing, and it responds to a different approach — one built around the family rather than around the individual alone. Islamic Medical Centre treats young people in Islamabad with that distinction in mind.
What is actually being used
The substances that bring young people to treatment have shifted. Charas remains the most common, but ice has become considerably more prevalent among teenagers than most parents realise, and it is cheap. Vaping and sheesha are near-universal in some circles and are frequently the entry point.
Prescription medicines are also involved more often than families expect, in part because they are available at home. Cough syrups containing codeine, sleeping tablets and painkillers are all taken by young people who would refuse anything they thought of as a drug.
- Charas, hashish and cannabis, most commonly, and often begun socially
- Ice, which is cheaper than heroin and increasingly present in schools and colleges
- Vapes and sheesha, frequently the first nicotine dependence
- Codeine cough syrups, sleeping tablets and painkillers taken from home
- Solvents and inhalants, including Samad Bond and petrol, in younger adolescents
- Gaming, social media and pornography, which often accompany rather than replace the above
Why adolescence changes the clinical picture
The parts of the brain governing impulse control, planning and judgement of risk continue developing into the mid-twenties, and are the last to mature. Regular substance use during that period appears to interfere with the process, which is why dependence forms faster in young people and why the effect on motivation and concentration is more pronounced.
It also means that the reasoning families rely on — explaining consequences, appealing to the future — lands on the part of the brain least developed at that age. This is not defiance. It is a developmental reality, and treatment works better when it accounts for it rather than arguing with it.
Signs worth taking seriously
Adolescence involves change in any case, which is what makes this difficult. The signs below matter most when several appear together and represent a clear departure from how the young person was previously.
- A sudden change of friends, with the new group kept away from the family
- Marks falling, attendance slipping, or a sudden loss of interest in education
- Money or valuables going missing, or unexplained spending
- Sleeping through the day, awake through the night
- Abandoning sport, prayer or activities previously mattered to them
- Secrecy about the phone, and irritability out of proportion when questioned
The mental health question underneath
A substantial proportion of young people who develop dependence have an untreated psychiatric condition first — commonly anxiety, depression, attention difficulties or the after-effects of bullying, abuse or bereavement. The substance frequently began as something that made an intolerable situation manageable.
Removing it without treating what lies underneath takes away the only coping mechanism the young person had and leaves the original problem untouched, which reliably leads back to use. Psychiatric assessment is therefore part of treatment for every young patient rather than something reserved for obvious cases.
How treatment is arranged for a young person
Most adolescents do not need residential admission, and where it can be avoided it usually should be. Outpatient treatment combined with sustained family work is the normal starting point, and it succeeds more often than parents expect when the problem is identified within the first year or two.
Where admission is necessary — because withdrawal requires supervision, because there is psychosis or serious risk, or because outpatient treatment has repeatedly failed — it is arranged with attention to keeping a young patient appropriately separated from long-established adult patients.
- Assessment of the young person, including psychiatric review
- Outpatient treatment wherever it is clinically appropriate
- Family counselling, which for this age group is central rather than supplementary
- Attention to education, so that treatment does not end schooling
- A home visit where the young person is refusing to attend
- Follow-up over an extended period, since risk continues past the end of formal treatment
What parents can do, and what makes things worse
Confrontation at the moment of discovery rarely produces anything useful, and threats that will not be carried out cost credibility that is needed later. What helps is a single agreed position between both parents, calm and repeated, and separating the behaviour from the person clearly enough that the young person does not conclude they have already been written off.
It also helps to be honest that punishment alone has a poor record here. Families who arrive after two years of escalating restriction are usually describing a relationship that has deteriorated without the use reducing. Family counselling exists to work through this, and for adolescents it is often the part of treatment that changes the outcome.
Confidentiality and the family
Young people will not engage with treatment they believe is simply a channel back to their parents, and parents cannot support treatment they know nothing about. The balance is explained openly at the start: what will be shared, what will not, and the circumstances — principally serious risk to the young person — in which confidentiality would be set aside.
Outside the family, treatment information is confidential. It is not disclosed to schools, colleges or employers.
Frequently Asked Questions
- At what age do you treat young people?
- Assessment is available for adolescents and young adults. The approach differs from adult treatment: outpatient care and family work are the usual starting point, and residential admission is avoided where it is not clinically necessary.
- My teenager only smokes charas. Is that serious enough for treatment?
- It is worth an assessment. Cannabis dependence forms faster in adolescence, and its clearest effect at that age is on motivation and education. Heavy use beginning in the teenage years also carries a raised risk of psychotic illness in those already vulnerable.
- Will my child have to stay in a centre with adult addicts?
- Not usually. Most young people are treated as outpatients. Where admission is genuinely necessary it is arranged with attention to keeping a young patient appropriately separated from long-established adult patients.
- Will this affect their education?
- Treatment is planned around continuing education wherever possible. Untreated dependence is far more likely to end a young person's schooling than treatment is.
- What if my child refuses to come?
- A home visit can be arranged so that assessment and a first conversation happen at home. Parents can also be seen on their own first, for advice on how to approach the situation.
- Should we search their phone and room?
- Parents differ on this and there is no single right answer. What matters more is a consistent position between both parents and a relationship in which the young person still talks to you. Surveillance that destroys the relationship generally costs more than the information it produces.
- Could there be a mental health problem underneath?
- Frequently, yes. Anxiety, depression, attention difficulties and the after-effects of bullying, abuse or bereavement are all common in young people who develop dependence, and often came first. Psychiatric assessment is part of treatment for this reason.
- Will the school be told?
- No. Treatment information is confidential and is not disclosed to schools, colleges or employers.