I was 15 and looked like I was 12, but it was easy to get hold of that stuff: ecstasy, cocaine, benzos. I'd already been smoking weed before I started spending my weekends with my dad in Zurich. I was constantly arguing with my mum back then . She was strict when it came to mobile phone rules and curfews: I was the only one who had parental controls on my phone and had to be home by 10 pm.
«My father wasn't the reason I was travelling to Zurich more and more often – I wanted freedom. I got to know a group of people in the park. Many of them were fresh-faced youngsters like me; we weren't allowed into clubs. They were all taking drugs – quite a lot, and not the simple stuff. I was curious and didn't think for a moment that anything could go wrong.»
Addiction is always a multifactorial issue. It cannot be attributed to a single cause.
Three stories of addiction
Ben*, now 19 years old, is one of three people featured in this special report who talk about their addiction. Different substances led to their downfall, but their stories have much in common: the fact that the addiction crept up on them gradually and that those affected continued to deny it even when the consequences were obvious.
«I went to school high for a whole year and still got top marks,» says Noah*, 18. «Why should I change anything?» Claudia*, 52, describes herself as a «master of denial». «You get some white wine and discreetly pour it into plastic bottles. You suspect it's not good, but you push the thought aside. You run a spotless household and make sure the family wants for nothing. Everything's fine.»
The family factor
What drives people to take drugs? Why do some become addicted whilst others do not? Why is it that young people, in particular, are keen to experiment with substances? What gives them the strength they need to deal with this? This dossier addresses these and other questions. The focus is on dependence on psychoactive substances such as alcohol, nicotine, cannabis, medication and so-called «hard» drugs.
We want to know what distinguishes experimental drug use from problematic drug use, how to talk to teenagers about drugs – and what to do if your child is caught with cannabis or is hanging over the toilet bowl , drunk.
Genes play an important role, but so does the environment. Sometimes one has a greater influence, sometimes the other.
Wolfgang Sommer, addiction researcher
For decades, addiction research has been exploring the question of what makes people susceptible to addiction problems. One thing is certain: addiction is always multifactorial. It cannot be attributed to a single cause, but rather results from the interplay of various factors. Researchers have identified several risk factors in this regard, starting with genes.
«Addiction disorders often run like a common thread through family histories,» says Philip Bruggmann, chief physician at the Arud Centre for Addiction Medicine in Zurich. According to the US National Institute on Drug Abuse, 40 to 60 per cent of the risk of becoming addicted to drugs is attributable to our genetic makeup. What exactly does that mean?
«“Genes do play an important role,» says Wolfgang Sommer, an addiction researcher at the Central Institute for Mental Health in Mannheim, «but so does the environment. Sometimes one factor is more influential, sometimes the other.»
Genes and the environment interact
The issue is complex: «An increased risk of addiction cannot be attributed to a single specific gene. Rather, around a hundred genes play a role, interacting in various ways.» Genetic variants thus influence biological processes, as well as personality traits, which make people more or less susceptible to addiction.
Risk factors include mental health conditions and a predisposition to them, but also characteristics such as a low tolerance for frustration, difficulties with emotional regulation, limited cognitive abilities or underdeveloped executive functions. The latter refer to the mental abilities that facilitate social adaptation and cooperation, enable us to plan and carry out actions, and allow us to defer our own needs.
Genetics is not destiny
The good news is that such skills are not determined by genes alone. «We can develop them,» says Sommer, «from the very earliest childhood.» This requires appropriate learning experiences, made possible by reliable and loving caregivers who allow the child to flourish and are intellectually stimulating, and who instil values and a sense of stability in them.
Without this «fertiliser», Sommer knows, even the best seed will not thrive. Or to put it another way: «Genetics is not our destiny, but rather a framework that allows for a wide range of developmental possibilities.» Good environmental conditions could therefore offset genetic risk. Conversely, neglect, ongoing family conflicts, a parent with an addiction, and experiences of trauma are factors that increase the risk of developing an addiction, just as much as poverty, a low level of education or easy access to drugs.
You sense that this isn't good, and you push the thought aside.
Claudia, 52
Genetics is the most significant factor when it comes to dependence on stimulants, also known as «pick-me-ups». These include cocaine and amphetamines. These are chemical compounds that increase the activity of the central nervous system and are found as active ingredients in party drugs or – in low doses – in prescription medicines such as Ritalin.
«Dependence on stimulants is largely due to genetic factors,» says Sommer. «Or rather, it is closely linked to ADHD – the disorder massively increases the risk of developing it.»
Addiction and ADHD
According to the researcher, the reason for this lies in the neurobiological characteristics of ADHD, in particular an altered response to dopamine. This neurotransmitter plays a key role in attention and motivation. It is released in response to positive stimuli – such as when we are flirting, playing sport or enjoying a good meal – but also in response to danger or warning signals.
«In people with ADHD, the system specialised in processing dopamine is less sensitive to such stimuli. As a result, they are more easily distracted and find it harder to concentrate,» says Sommer. «Whilst stimulants tend to boost energy levels in most of us, they often help people with ADHD to feel more calm and clear-headed.»
We humans want to reduce unpleasant feelings by any means necessary.
Wolfgang Sommer, addiction researcher
This self-medication effect, together with the typical interpersonal and emotional problems associated with the disorder, made adolescents with ADHD more susceptible to drug use in general and stimulant abuse in particular.
«But it is also a fact,» emphasises Sommer, «that treatment with low-dose stimulants significantly reduces the risk of addiction in people with ADHD. This is because these medicines help them to better regulate how they process stimuli. That is why early diagnosis is so important.»
What happens in the brain?
Nevertheless: «There is no such thing as an ‹addictive personality› that is predestined for addiction,» says researcher Sommer with conviction. Rather, he argues, it is an age-old learning process inherent in all of us that gradually paves the way towards addiction. It is, he explains, human nature to try by every means possible to reduce unpleasant sensations and to take pleasure in positive feelings.
The reward system registers the unexpected, positive consequences of our behaviour in a given situation – and generates a learning signal so that we repeat this behaviour in future. «This reward-based learning teaches humans and animals to find their way in their environment,» says Sommer. «It is crucial for the development of survival-essential behaviours such as foraging or reproduction.»
We therefore use substances for reasons similar to those for which we meditate, have sex or eat sweet things. «The difference is that drugs affect the reward system more directly and intensely than conventional positive stimuli.»
Claudia recalls: «As teenagers, we all appreciated the effect a drink has: you become exuberant and relaxed, and you pluck up the courage to talk to people.» Noah once gambled for large sums of money whilst high on cocaine: «On coke, you're full of energy and feel capable of anything.»
Substances make it possible to adapt our mental state to a situation and its demands, says addiction researcher Sommer, «as long as we use them in a controlled manner. With repeated use, the risk of losing control increases.»
Young people are only able to think rationally to a limited extent.
Toni Berthel, psychiatrist
Puberty: a rollercoaster ride
Young people are considered particularly vulnerable to drug use. «Initially, this willingness to experiment and take risks is due to structural changes in the brain,» explains Toni Berthel, a psychiatrist and addiction expert from Zurich. During puberty, the brain undergoes reorganisation. This process takes place gradually. It is only at the very end – between the ages of 20 and 25 – that the prefrontal cortex, which is responsible, amongst other things, for impulse control and planning, is affected.
«Until then, young people are only able to think rationally to a limited extent,» says Berthel. Consequently, teenagers are less able to control their impulses. And – again due to developmental factors – fewer stimulating signals reach their reward centre. This means that at that age, it takes more to experience a thrill or feelings of happiness.
On the one hand, it is our brain that causes an emotional rollercoaster during puberty. «On the other hand, however, it is also the enormous physical changes that lead to feelings of insecurity,» says Berthel. At the same time, adolescents have to tackle their key developmental task: «To break away from home, develop their own identity and find their place in society.»
It is important to address the concerns and tensions that arise as a result. According to Berthel, there are various strategies for doing so: «You can cope with difficult feelings by enduring them, or you can escape them through numbing and avoidance.»
Experiences of intoxication give young people a sense of belonging and make it easier for them to fit in.
Toni Berthel, psychiatrist
When teenagers smoke cannabis, get drunk, smoke cigarettes or try party drugs, addiction experts say there is more to it than just substance use. «Of course, as parents, we think: ‹That's bad!›» says Berthel. «But young people use these substances precisely because it makes them feel good.»
«Experiences of intoxication are part of it»
Intoxication – that is, a deliberately induced loss of control – has a long tradition in our cultural history when it comes to so-called initiation rituals – ceremonies that mark a person's transition to the next stage of life, a new social status or a different group.
«Adolescence is a time of transition,» says Berthel. «Experiences involving intoxication are simply part of that. They give young people a sense of belonging and identity, making it easier for them to break away from their parents and fit in with their peers.»
Different substances depending on the peer group
The role that substances play during adolescence therefore also depends on one's peer group. Anyone who was a teenager in the 1900s will remember: skaters and hip-hop fans smoked cannabis, techno fans were more likely to come into contact with ecstasy, and alcohol wasn't just popular with punks.
Even today, every clique has its own peculiarities – and plays a key role for its members: it acts as a gateway to society, where teenagers prepare themselves for the challenges it presents and trigger processes of personal development amongst themselves that would not be possible at home. «Having a place in the group is crucial,» says Berthel. «That's why parents’ pleas fall on deaf ears when, out of fear of bad company, they suggest their child should look for new friends.»
Education is important
A new smartphone, their first monthly wage, going out, alcohol: «During puberty, young people are presented with many new opportunities,» explains addiction expert Berthel. They usually don't manage to make responsible use of these straight away.
«It is normal for them to lose control from time to time, just as it is normal for parents to worry. In most cases, it is unfounded to speak of addiction straight away when it comes to substances. We should not be too quick to pathologise young people when they go a bit over the top – the vast majority only do so temporarily.»
You don't want to go through a nasty hangover again any time soon.
Karina Weichold, psychologist
Crossing boundaries as a stage of development
Addiction specialist Philip Bruggmann is also aware that it is only a small minority of young people who develop an addiction. «Nevertheless, raising awareness is hugely important,» he says, «particularly with regard to newer phenomena such as poly-drug use, which we are seeing mainly among young people.»
Karina Weichold, a professor of psychology at the University of Jena whose research focuses on addiction prevention, is also aware that young people sometimes need to push boundaries in order to recognise them. To a certain extent, she says, youthful recklessness plays a role in supporting development, enabling teenagers to tackle the numerous challenges of this stage of life.
BACKGROUND INFORMATION, ADVICE AND SUPPORT
- Answers to questions about addiction and substances: feel-ok.ch
- Anonymous online counselling: safezone.ch
- Personal telephone helpline: 147
- Background information: Comprehensive information on around 30 substances, including their risks, side effects and guidelines for safer use, presented in an engaging, clear and accessible way: know-drugs.ch
- Overview of drug-checking services across Switzerland: infodrog.ch
«A teenager who comes home drunk may, in some circumstances, be demonstrating their independence to their parents – they want to take a step forward in their developmental task of making more autonomous decisions.»
Where does problematic consumption begin?
Learning to drink sensibly can also mean overdoing it once in a while, according to Weichold: «Anyone who's suffered through a terrible hangover won't be keen to repeat the experience any time soon.» The situation is similar when it comes to cannabis use. Weichold strongly advises against it, but also offers some reassurance: «Anyone who tries it won't immediately become a regular user; other risk factors have to be involved.»
The psychologist points to findings from several studies that reached a similar conclusion: amongst the young people who were classified as socially competent, psychologically resilient and equally stable in terms of their self-esteem, there were quite a few who had experimented with cannabis but did not use it regularly. According to the results, there were more stable young people in this group than in the group of peers who smoked cannabis excessively or had never tried it.
Ignore reality
Nevertheless, the question remains: where does a spirit of experimentation end and problematic use begin? «At first, smoking weed was all about having fun for me,» recalls Noah. «Once, we went shopping straight afterwards. Right in the middle of the shop, I was hit by a fit of laughter. That was legendary.»
Noah is convinced that he didn't have any problems back then. «They started when I no longer needed company or a special occasion to smoke a joint,» he says. «I wasn't doing it for fun any more, but to block out reality – the things that were going wrong.»
I wanted to be the best at something – even if that just meant being the one who took the most pills.
Ben, 19
Claudia, too, talks of wine as a sedative she used to try to drown out the pain of old wounds. And Ben drank by the motto «The more, the better». «In the end, it was all about attention,» he says. «I wanted to be the best at something, just like I used to be at school – even if it just meant being the one who took the most pills.»
When drugs become a crutch
If a pill makes us feel happy, a few drinks lead to a lively evening, or a joint turns us into a laughing stock, that's no cause for concern, says addiction expert Toni Berthel.
«It becomes problematic when fun and social factors take a back seat and we gradually come to rely on the substance to sustain our functioning: when motivation and relaxation, feelings of happiness and concentration, and dealing with problems and everyday demands can only be achieved with its help.» Or, as psychotherapist Kinga Gloor puts it: «When the drug becomes a crutch.»
We can rejoice in our successes; we grow from our failures.
Kinga Gloor, psychotherapist
It is often young people with a history of difficulties who need this support, because they come from difficult family backgrounds or have ADHD or underlying mental health conditions, according to the counsellor and therapist at the Centre for Addiction Disorders in Bülach, Zurich. However, her experience also shows that the assumption that addiction problems only affect those who have always struggled is too simplistic.
« Adolescence is a huge challenge when it comes to regulating emotions,» says Gloor, “and that goes for everyone. «I have many clients who were previously completely unremarkable. Former top pupils, for example, who couldn't cope with being left behind at sixth form. Anyone who used to be at the top and finds themselves in the middle of the pack needs a certain level of self-esteem to avoid becoming discouraged . If that isn't firmly established, a substance that makes everything seem a bit less important might come in handy.»
BACKGROUND INFORMATION, ADVICE AND SUPPORT
- Advice by telephone and online: Swiss Parents’ Helpline, 0848 354 555
- Overview of counselling and addiction support services by canton of residence, substance and type of service (ranging from online and telephone counselling to therapy places): infodrog.ch
- Facts and figures, information on prevention, support services and research relating to addiction: suchtschweiz.ch
- Parenting advice on addiction prevention, written in simple language and accompanied by explanatory videos: meinteenager.ch
- Five guides for parents set out what we can do to protect children from problems with alcohol, cannabis, online media, psychoactive medicines and tobacco. Parents can find tips and advice on prevention, early detection and early intervention
- Nine letters to parents on addiction prevention in everyday life
- Counselling, support and assistance for mothers, fathers and families affected by addiction and poverty
Addiction prevention starts early
According to Gloor, one thing is certain: addiction prevention begins many years before adolescence. It starts with caregivers who recognise and take the child's needs seriously, and provide them with a sense of security. Caregivers who also foster the child's independence, allow them to have their own experiences, and encourage them to find solutions for themselves. Caregivers who have faith in the child's ability to «cope with frustration, too – and above all»,” says Gloor.
«We can rejoice in success, and we grow through failure.» Our role models play a key role here, and on a small scale: «How do we react when we don't succeed at something? Do we bury our heads in the sand? Or do we persevere and remain confident that things will go better next time?»
Self-esteem, coping with failure, self-efficacy – unwieldy terms for the inner conviction that one can overcome difficulties and achieve goals: that, says Gloor, is what matters. «The stronger young people's sense of self-efficacy is, the more likely they are to believe they can overcome crises under their own steam, rather than turning to alcohol, cannabis or similar substances as a crutch.»
* Names have been changed by the editors
