Substance Use and Abuse Among Children and Young Adults
Experiences push children into drug dependence
Nurture them, give them love, care and guidance
Build their self-confidence, improve their resilience
For they are the future citizens, let’s make a difference
Children do not care how much you know... Until they know how much you care...
Rainbow Homes Program
I. The Trap
Many children on the streets are those who have fled their homes to escape the stress of poverty, family troubles, hunger or insecurity. On the streets, ironically, they end up experiencing more of the same and suffer further exploitation, neglect and abuse of many kinds. During this time, many of them get introduced either, unknowingly, willingly or forcefully to one or the other kind of substance. Some begin its use later in their adolescence and yet others get into it after they transition out of the home as young adults.
Substances stimulate the brain and release chemicals which boosts energy and leaves them feeling very happy and excited. But this feeling is only temporary and so the person uses it again and again to continue feeling good.
Drugs can have severe effects on the growth and development of children. This booklet will help us as carers, to expand our understanding about why and how children take to drugs and the different kinds of substances and how it affects them. With this information, we can help children to understand the risks, prevent them from falling into its trap and encourage them to make safe and healthy choices. It also offers practical tips to support children and teenagers who enter our care with a dependency of any kind.
Whichever way they enter into drug use, most children become trapped as they find it difficult to ‘survive’ without using it.
II. Why do Children take to Drugs
There are several reasons why children and teenagers take to drugs. These include peer pressure, curiosity, escape from stress, and emotional pain, easy availability, rebellion, etc.
It helps me to forget the emotional pain of the terrible things I have suffered in my life. I feel I can handle these situations better.
I started taking it as it helped me to suppress hunger and helplessness. It helps me sleep.
It provides me with pleasure and relaxation, excitement and relief from the pressures and gloom of life.
I needed it to cope with the trauma of the extreme weather of street life.
My friends pressurized me. I want to be like them and be accepted by them.
I am very curious and want to experiment and experience new sensations. That’s how I will become an adult.
My father is an alcoholic and my dear mother passed away 6 months ago from Covid. I feel so lonely.
I am unable to keep up with what’s taught in school. Maths, English, Physics… It’s getting tougher each day. I feel uneasy, ashamed and sad. I will never be able to finish school. I have no future.
I have seen my father, neighbours, my employer all of them drink every day. It’s ok, nothing wrong with it.
I feel anxious all the time, everywhere. I am confused…
I can’t do anything right. I am so thin & ugly, I have no friends, I have no parents, I don’t have any interest in studying… no one loves me.
It’s cool and stylish to smoke. Makes me look glamorous.
My close friend took me to a party where everyone was having it. Even I had it without knowing. It felt good. Ever since he has been giving it to me every now and then. I like how it makes me feel.
I
recently got to know that I am HIV+. It’s shocking. Life is so unfair.
III. Substances that are addictive
A vast variety of substances are widely available that are used and abused. Each of these substances and their combinations are given many different fancy names. The drugs most commonly consumed are:
Harmfulness of the drug means the degree to which is toxic and addictive to a user. More harmful drugs are called ‘hard drugs’ and less harmful drugs are called ‘soft drugs’
Hard drugs are known to be more toxic and addictive. However, both hard and soft drugs can have serious effects on a child’s physical and mental health.
Cocaine is a highly addictive stimulant made from coca plant. It comes in different forms. Users snort the powder through their nose or inject it into their bloodstream. It’s also called Brown Sugar, Smack etc.
Cannabis or Marijuana/Ganja/Hashish is one of the most used drugs. It is made from dried leaves, flowers, stems, and seeds of the hemp plant. Most people smoke marijuana, but it can also be added to foods and eaten.
Heroin comes as a white or tan powder, or a black sticky substance. Users inject, inhale or smoke it. It is made from the opium poppy flower. It is highly addictive as it is rapidly absorbed by the brain.
LSD became popular in the 1960s and is commonly used today. It’s made from an acid found in a fungus that grows on rye and other grains.
Alcohol is not seen as a drug, but just like cigarettes, it is a legal drug.
Inhalants - When inhaled, sprays, cleaning chemical, glue, rubber cement, whitener and correction ink are as good as drugs and are a favourite among children on the streets.
They are available over the counter and are very cheap. Other products like mosquito repellents, paint thinners, nail polish removers, cough syrups etc. are also used and are equally, if not more, harmful.
Khaini consists of roasted tobacco flakes mixed with slaked lime.
Pan masala is a betel mixture, which contains areca nut and some condiments, but may or may not contain tobacco. The same mixture, with tobacco added is called Gutka.
Beedi is an inexpensive, low-processed, hand-rolled cigarette.
Snuff is a black-brown powder obtained from tobacco through roasting. It is used by blowing directly into the nose or rubbing into the gums. It is also known as bajar and mishri.
Mawa is a mixture of areca nut, tobacco and slaked lime and is chewed.
Painkillers, sleeping pills, and sedative medicines are also addictive.
IV. Signs that a Child is using Drugs
• Decrease in interest in personal hygiene & personal appearance
• Physical changes, such as bloodshot eyes, runny nose, frequent sore throats, and rapid weight loss
• Unusual odour on breath
• Widely dilated pupils even in bright light
• Changes in sleeping patterns
• Poor appetite
• Behavioural problems and poor grades in school, avoiding school
• Dizziness and memory problems
• Intoxicated, Slurring of speech, unstable walk, saying/doing things without usual inhibitions
• Lying or avoiding talking about after-school whereabouts, keeping secrets from friends/family/carers
• Stealing or selling belongings
• Emotional distancing, isolation, or depression
• Anxiety, anger, or depression, hostility, irritability, or change in level of cooperation with friends and or family
V. Dangers & Consequences of using
Substances
Drugs have a serious impact on the development of children using it, as they are still growing physically and psychologically. Some of the significant dangers include:
a) Physical health issues
Headache
Dizziness
Numbness
Loss of coordination
Hearing loss
Seizure
Rash around the mouth
Choking (often on own vomit)
Liver damage
Irregular heartbeat
Chest pain
Nausea
Tingling in hands and feet
Fatigue
Severe breathing problems
Falls and accidents
Dental issues
Kidney damage
Mood swings & aggression
Death due to overdose
Sniffing can lead to fatal heart failure. This is known as sudden sniffing death syndrome (SSDS), and it can occur from just one attempt.
For those using and/ or exchanging contaminated syringes and engaging in risky sexual activities without protection, there is also a high risk of communicable diseases like HIV/AIDS, TB and STIs (Sexually Transmissible Infections).
b) Mental health issues
VI. Keeping Children Safe
Prevention enhances protective factors and reduces risk factors that might push children and young adults towards drugs.
Increases the likelihood of landing up with problemsProtective factors + Risk factors
Lowers likelihood of landing up in problems or reduces the negative impact of risk factors.
Let’s have a look at some protective factors:
a) Build a Great Relationship
Children who have a good relationship with adults and carers are less likely to get into drug use, so it is important for us as caregivers to take an active role in each child’s life. Make it a point to approach them even when they seem disinterested and make talking a regular part of each day’s routine. This will boost their self-esteem and they will feel good about themseles & therefore more self-confident.
Careful actions by carers can become powerful protection factors.
Carers who are trusting, honest, encouraging, and are involved with the children’s daily activities.
Carers who eat meals with the children as frequently as possible & play with them.
Carers who show interest in anything the child is passionate about, whether sports, video games, music, politics, or art.
Carers who create a warm, open home environment where children are encouraged to talk about their feelings, hopes, dreams, and fears, and their concerns and problems are understood.
Carers who encourage them to come forward with their questions and concerns and are offered practical recommendations.
Carers who recognise and praise the efforts and achievements of children.
b) Talk to children about substance & its abuse
Begin conversations about risky behaviours like drug use early and have multiple conversations with the children, especially the teenagers. Discuss reasons not to use drugs and about the dangers of the influence of drugs or alcohol. Experts can be called in to talk about this which could be followed up with several discussions among the children from time to time.
Possibilities that you or someone else might be killed or seriously injured.
Lose your health.
May not be able to complete your education.
Damage to your appearance and image.
Lose your family, friends, and peers.
Lose your interests, will not be able to play sports, drive etc.
May not be able to skill yourself and stand on your own feet.
c) Help them in handling peer pressure
Don’t wait for a situation to arise… have such conversations on a regular basis with the children. Let us discuss and help the children with practical ways to resist peer pressure.
What I Can Do:
I can avoid places where I know drugs and alcohol will be available.
I can surround myself with friends who don’t use drugs.
I can learn how to cope with stress and relax without drugs.
I can distract myself with activities like exercise or listening to music etc.
What I Can Say:
I am too cool to be taking drugs.
No way. I think you just want me to get in trouble.
Bhaiya would never talk to me if he found out.
Sorry, I don’t want to kill my future.
I don’t have time for drugs. I’d be suspended from the home.
Forget it. There’s no way I’m going to do drugs.
I’ve got more to do with my life.
No way. That stuff makes me sick.
Sorry, I’m not into that.
I have seen my brother suffer with drugs…. I will never do it.
d) Keep an Eye
As children grow up, the risk of trying out oneself or getting pulled into drugs by others will increase. As we know, teens have a high need to explore new experiences and push boundaries to do something novel and exciting. As a carer, what helps in such situations?
I try to maintain a warm and genuine relationship with the teen without being intrusive.
I pay attention to their whereabouts.
I try to be in the know of what the teen is up to at all times. Who they spend time with, what they do during their free time etc.
I try to know who the friends of the teens are.
I encourage them to limit unsupervised time between the end of school and return home.
I maintain regular communication with the school where the teen is studying.
I try to pay attention to their social media accounts, but of-course only with the intention to reduce their risk of drug use. We can tell the teen that by doing this, we are not being nosy or invading their privacy, but only trying to ensure they are safe.
I establish rules, making a written or verbal contract on the rules about going out. In fact, being loving and having rules in place will actually increase the likelihood of sticking to them. The consequences of breaking the rules were worked out by them. I follow the agreement consistently with all children and all times.
e) Be involved in their learning and education
Challenges with education and school has a very deep impact on the self-worth of children. We must ensure that they are able to cope in school and do well academically. Not just academically, children should also be encouraged to take part in hobbies, sports, and clubs that interest them. Teaching them self-control, coping skills, social behaviours, etc. will significantly enhance positive interactions and improve their self esteem.
f) In the Home
Make sure that mental health and substance use screenings are a part of regular health check-ups
Remember to observe World Drug Day, which is marked on 26 June every year to strengthen action and cooperation in achieving a world free of drug abuse.
VII. Supporting Children who are abusing/addicted
Despite all steps to prevent it, there may be children who do end up using drugs. Sometimes, new children who come to the home are already addicted.
a) Recognise & intervene early
The road to addiction is different for every child. But we must remember that drug use is a disease and therefore should not delay or wait for the situation to get serious to the point of the child dropping out of school, suffering a medical emergency or geting arrested etc. Some start slow and take time while others go rapidly in a short period of time. Whichever the cause may be, if the child is repeatedly using drugs they will become addicted to it sooner or later.
Initially, we may not respond thinking that the child is just experimenting and will get out of it when he/she matures a bit. The earlier an addiction is recognised, the better. But yes, if it is only a doubt, before taking action cross-check and verify by gathering concrete information about the reality.
Many children and caregivers feel that addiction can be overcome by oneself if they want to but that rarely happens. Quitting drugs or any other substance is one of the hardest things they will ever experience. They will need someone they trust who can provide them with the right kind of support. Be supportive and understanding to get the child or the young adult to get help.
b) Communicate
Discovering a drug problem can generate feelings such as shock, fear, and anger in a caregiver, making communication with the affected child challenging. Here are some things we must keep in mind:
Choose a time when the affected child and you are calm, sober, and free of distractions to talk.
Take the time to listen to what the child has to say, even if you don’t agree with it.
Talk calmly and without accusation. Let the child see that that you care and are genuinely worried about their well-being.
Be compassionate and offer help and support without being judgmental.
Express your concerns honestly and gradually encourage the affected child to seek help.
Try to argue or contradict. The more the child feels heard, the more he/she will see you as supportive carer, and will confide in you more.
Get angry or make emotional appeals. This will add to their feelings of distress and reinforce their compulsion to continue using drugs.
Threaten, bribe, or punish.
Criticise, demean, or shame. Drug abuse is often an attempt to cope with painful issues, so criticizing, demeaning, or shaming will only push them away and may even encourage them to seek further comfort in substances.
c) When meeting a child in a drugged state
It is important to approach the child in a non-judgemental way. Some general guidelines for approaching when a child is in an intoxicated state are as follows:
Reduce light, noise and movement. If possible, move to a quieter environment. Encourage the child to remove heavy or restrictive clothing if necessary.
Avoid overcrowding. Preferably one person could approach and take control of the situation (with support close by if needed).
If the body feels hot to touch, offer a cool, wet towel or compress on the back of the neck to cool them down. Encourage them to have regular sips of water.
Be respectful of the child’s personal space, approach from the front or side so they don’t get surprised. Approach slowly and with a sense of confidence.
Keep language simple and speak calmly and clearly. Do not confront, blame, or threaten.
Let the child know that you are there to help and not blame or confront.
Allow the child to express any concerns. Listen carefully.
Gently encourage the child to sit down or lie down and rest. Do not use physical force.
REMEMBER: Drug use is dangerous but that doesn’t mean the teen is a bad person. No one plans to become an addict. While handling all this, remember to maintain confidentiality and refrain from disclosing any information to anyone other than the team members and family members or for medico-legal requirements.
d) Be prepared for denial
Denial means not wanting to believe that there is a problem and convince oneself that the problem does not exist. People using substances deny they are addicted.
Accepting that the problem is real is the first step to overcoming the problem. However, initially the child may become defensive or angry and refuse to discuss their drug use. Instead of arguing, put away the matter and bring it up another time.
Don’t expect one single conversation to fix the problem. In fact, it may take several conversations for a child to even acknowledge that there is a problem.
VIII. Treatment of Addiction
When a child or young adult is addicted to hard drugs, formal professional advice and treatment must be sought. The more help and support a child/young adult has, the better their chances of successfully overcoming addiction. Encourage the child to take up support and treatment as early as possible.
It is time to go to a deaddiction service when it becomes difficult to carry on the daily routine.
a) Assessment
Treatment usually starts with a thorough examination of the body. The doctor will first ask questions about the kind of substances being used, frequency of use, how it is affecting daily living, social, academic activities and whether the use of the substance is increasing.
I am going to see if you have any disturbance in your heart rhythm, liver damage, kidney damage, lung problems etc.
I am going to do a neurological test to see if there are any permanent effects on your brain function and memory.
I would also like a trained therapist to check your mental and emotional health.
Depending on the type and duration of substance use/abuse the line of treatment is decided.
b)
Detoxification
Detoxification is the process of safely and gradually reducing and removing drugs from the body. It is usually done in a detoxification centre or a hospital because when drug levels in the body reduce, it can cause high discomfort for which some medication may have to be given.
These uncomfortable conditions experienced are called Withdrawal symptoms.
Physical
- Sweating
- Heart palpitations
- Muscle tension
- Tightness in chest
- Difficulty breathing
- Tremors
- Nausea
- Vomiting or diarrhea
Psychological - Anxiety
- Restlessness
- Irritability
- Insomnia
- Headaches
- Poor concentration
- Depression
- Social isolation
Depending on the severity of the addiction, these symptoms can be mild, moderate or severe.
The mild & moderate symptoms include headache, runny eyes and nose, sore throat, sneezing, shakiness, palpitations, loss of appetite; hunger craving, abdominal cramps; joint & muscle ache, nausea; chills, vomiting; diarrhoea; restlessness, sleep disturbances, and fatigue.
They can also show irritability, sad mood, anger, aggression, anxiety, nervousness, agitation, restlessness, difficulty in concentrating, and feelings of unreality can be experienced while undergoing treatment.
Severe symptoms include seizures, severe agitation, confusion, disorientation and even delusions and hallucinations.
Detoxification with medication may be done in a short period or it can require longer time depending on the substances and severity of the substance use disorder.
There are diferent kinds of facilities that help with detoxification and rehabilitation.
Residential Services:
Those who have more serious substance use problems, have been unsuccessful in other types of treatment, or have complex treatment needs should receive residential rehabilitation services, where they can receive intensive, structured treatment service while living for an agreed period of time.
Day treatment or partial hospitalization:
In these kinds of services, the child only attends/receives treatment at a facility for four to eight hours per day.
Outpatient Services:
Outpatient services are received in the community. This is appropriate as a way to continue treatment and to maintain sobriety after residential or other intensive treatment. services while living for an agreed time.
Along with the detoxification and medicines for withdrawal symptoms, they are also taught important life skills to help them focus on their future and make healthy decisions. Therapy sessions include group work, individual counselling, peer support groups, family therapy, and relapse prevention education are also provided. Recreational activities that involve physical action and multisensory stimuli like sports, music and art are used often.
Substance use disorders develop over a period of time, and therefore recovery also takes time. Different drugs respond differently and vary in the length of time to fully leave the body, but on average, a minimum of three to four months of treatment is required.
Most addiction centres allow limited communication with carers/ families/friends during their stay in residential treatment. Contact will be allowed only at set times, such as family workshops and supervised phone calls or sessions.
If the family is involved, they need to be supported to reduce their anxiety about this phase by encouraging and facilitating them to attend family sessions.
c) Caregivers’ role in treatment
We as Caregivers have an active role in treatment and continuing the care plan.
We should make sure that the services are not neglected and that we are present and involved in the entire treatment.
Ensure regular contact with the treatment staff regarding the child/youth’s progress.
Ideally, there will be a staff assigned whom we can contact with questions and will involve us in planning the treatment and post-discharge support.
We should participate in family activities and should carefully follow the recommendations given by the treatment team.
IX. Support during Treatment and Beyond
a) Be realistic
We would expect that after treatment, the child/young adult will be able to live their life without further concern about substance use problems. However, this is not always the case. Detoxification may be only the first step.
When they return to environments where they were using it, it can be hard to maintain what they learned in treatment. They can easily return to old behaviours as their bodies will continue to want these substances. In desperation, they may try ways to obtain drugs. They will try to manipulate carers and/or families with their needs. They may try to physically harm themselves.
b) The reality of Relapse
Relapse refers to the return to using substances after a period of staying clean. Although it does not mean a permanent return to drugs, it creates challenges. Therefore, we have to provide an environment that will support their sobriety and recovery and minimize the chance that they can return to earlier risky behaviours.
REMEMBER: Relapse is not a failure of treatment or the individual. The child will need help to find ways to cope with drug cravings and triggers.
Distract them with other activities or motivate them to learn how to overcome the urge. Encourage them to develop new interests that add meaning to their life to help them avoid slipping back into old habits. Most importantly, help the child to get back into a regular routine, i.e. continue attending school, participate in activities etc. Acknowledge and address the stressm loneliness, frustration, anger, shame, anxiety, and hopelessness that may resurface in them from time to time.
Staying clean is a lifelong process. If the child or young adult has repeated relapses, facilitate the child to join a support group. There are support groups specifically for teens and younger people where they meet others who have gone through the same experiences as them.
The problems that triggered drug use in the first place will still be there once they get sober. If they turned to drugs due to psychological issues, such as anxiety or depression, we will have to support them in finding healthier ways of coping with these issues without resorting to substance abuse.
If that happens, patiently encourage the child to recommit to getting clean and support them as they try again. Although it does not automatically mean a permanent return to drugs, it creates considerable challenges. Therefore we have to provide an environment that will support their sobriety and recovery and minimize the chance that they can return to earlier risky behaviours.
In December 1987, the General Assembly of United Nations decided to observe 26 June every year as the International Day against Drug Abuse and Illicit Trafficking as an expression of determination to strengthen action and cooperation to make the world free of drug abuse.
This day aims to educate people about the harmful impact of drug abuse and encourages individuals across the world to participate in the efforts to prevent drug addiction and combat the illicit drug trade. The theme for 2024 was “The evidence is clear: Invest in Prevention.”
Care is the backbone of our relationship with children and is central to their emotional well-being. This booklet is a part of a series that will inform us about how we can extend the best care to the children so that they can heal their traumas, attain stability & rediscover themselves, evolve and flourish.
Let us discover the joy of working with children…
Nightingale Social Welfare Society
H No: 1-3-183/40/21/51. Flat 202, K K Rao Residency, Road no: 5, Gandhinagar, Hyderabad - 500080