Paths to addiction

Sweet cocktails or vodka-cola at the weekend, plus a few cigarettes and maybe even a joint. After school they hang out with a beer and in the evening their best friend invites them to smoke shisha. There are so many temptations for young people these days. Many give in to them and try them out. Getting high in a shop or club is not a big problem.

Most young people just try it out, use it for a while and then stop completely. But some don't, they become addicted. Why is that? Why can some young people dance on ecstasy or snort cocaine two or three times without serious consequences, while others crave more and more, stronger and stronger intoxicants? At what point does a habit become an addiction? And what can parents do to protect their children from such experiences? Should they do it at all?

The alcohol industry's marketing measures are conspicuously aimed at the younger generation.

The focus of this dossier is on so-called substance-related addictions, i.e. addiction to alcohol, tobacco, cannabis, ecstasy, cocaine, LSD, heroin, medication or other substances. However, there are also non-substance-related addictions. The Internet has been at the top of this table for a number of years, closely followed by gaming, but it also includes gambling, workaholism and compulsive shopping.

Consumption is trivialised

The consumption rates for alcohol, cigarettes and cannabis in Switzerland have remained constant for around five or six years, says Addiction Switzerland, while at the same time warning of new developments. On the one hand, certain consumption patterns such as binge drinking are becoming more entrenched. On the other hand, the variety of products is increasing so rapidly that no one can keep track of everything. In the Suchtpanorama Schweiz 2020 published at the beginning of February, the experts from Sucht Schweiz emphasise that the marketing measures are conspicuously aimed at the younger generation and trivialise consumption.

The alcohol industry is therefore focusing on light drinks, flavoured drinks and colourful shots packaged like treats in order to offer something for every taste. At the same time, tobacco manufacturers are suggesting that the new tobacco heaters make clean smoking possible and that e-cigarettes allow you to enjoy smoking without the health risks. In fact, e-cigarettes are arousing the curiosity of 15-year-olds.

More than half of boys and more than a third of girls have already «vaped» and taken a puff on an e-cigarette. This is a higher proportion than for classic cigarettes. In addition, around 14 per cent of 15-year-old boys had smoked shisha in the 30 days prior to the survey.

«Of course, it would be ideal if we could completely protect children and young people from consuming addictive substances,» says Florian Ganzer, «but that's practically impossible: trying out what your parents want to forbid is typical of adolescence, so to speak.»

Ganzer is a specialist in child and adolescent psychiatry and worked for a long time on a youth addiction ward in Hamburg before moving to the Department of Child and Adolescent Psychiatry at the Psychiatric University Hospital in Zurich. Its day clinic in Winterthur treats some of its patients with various mental disorders and addiction.

How does adolescent experimentation turn into a dangerous addiction?

Ganzer also considers how quickly adolescent experimentation can turn into dangerous substance use depending on the level of development and performance. In this sense, drinking alcohol or trying cannabis at a party with peers is less risky for a 17-year-old who gets his daily routine together, goes to school regularly, gets good grades there and enjoys hobbies than for a 14-year-old who no longer attends school regularly and is already socially stunted because he lives in the world of social media and computer games, for example.

The earlier someone starts using addictive substances, the more difficult it is to get off them again.

In order for parents to act as seismographs and recognise suspected risky developments in good time, it helps to treat their offspring in a benevolent and appreciative manner. Studies show that intelligence and socio-emotional maturity can also be protective factors. But there is no guarantee. Even children from the most sheltered families become addicted to drugs, while conversely boys and girls from addiction-ridden or desolate homes are at a higher risk but can also start adult life free of addiction.

An addictive memory is formed

Using addictive substances is generally harmful to physical and mental health, no matter how old the user is. However, the earlier someone starts using addictive substances, the more difficult it is to get off them again. And another rule of thumb applies here: the earlier in life you start, the more the substances interfere with the development process.

«Alcohol is a cytotoxin and toxic per se, which is evident on many levels, from the gastric mucosa to the function of nerve cells,» says Ganzer. In addition, certain reaction patterns are imprinted in the brain, forming what is known as an addiction memory. A smoker learns that a cigarette relaxes him after a difficult conversation, a drinker knows that a few bottles of beer loosen him up and make his fears disappear. But substance use also has indirect consequences. For example, alcohol-related falls and accidents can occur, or young people don't go to school because they are hungover.

Addiction is always a dysfunctional form of problem solving. One of the most important approaches if you want to rule out addiction as an option is therefore to teach children and young people how to deal with problems as early as possible.

«Carers should show them how to regulate their emotions, accept them, reflect on them and deal with them,» says Ganzer. If you have learnt that it is absolutely okay to feel sad for a while when you are heartbroken and that it might help to talk to friends or exercise, you are less likely to turn to addictive substances. The motto is to actively tackle the problem instead of fleeing from the unpleasant feelings and resigning yourself to them.

Parents have an important role model function

One risk factor that many parents overlook is their own substance use. Legal drugs such as alcohol and cigarettes in particular are socially accepted, and wine and beer are almost a standard part of social gatherings. «Parents should take a critical look at how much alcohol they themselves drink,» says Ganzer, "they have an important role model function.

For many people, it is quite normal to drink alcohol in the evening as a reward after a hard day or to relax. The harmful effects are usually not visible, but you should definitely ask yourself why you can hardly manage a day without alcohol."

The path to abstinence is particularly difficult for young addicts. This is because drugs have played a significant role in the formation of their identity.

Puberty is a phase of finding one's identity. Who am I? Where do I want to go in life? Which path will lead me there? This is a time of great vulnerability, and any influence, no matter how small, can have serious consequences: a rejected love, the «wrong» circle of friends, well-meant advice that is perceived as criticism. «Male adolescents in particular are probing here, testing their strength and dominance and like to be the tough guy who tries alcohol and drugs,» says Ganzer.

While girls have long tended to be reserved and introverted in their search for themselves, this has also been changing in recent years: It is no longer just boys who return home from parties drunk and drugged up, Ganzer knows from clinical experience. The senior physician estimates the gender ratio of young substance users to be around two thirds male and one third female.

Young people don't usually take the step towards withdrawal themselves

If there is a clinically diagnosed addiction, often only withdrawal can help. All experts agree that the most important thing in addiction treatment is the motivation of the addict. «The step towards withdrawal is usually taken by the parents or the authorities, so I mainly work with the young people on their motivation in the early stages,» explains Ganzer.

The path to abstinence is very difficult, especially for young people. «Anyone who is addicted at the age of 16 or 17 and has already been using for several years finds the thought of «I have to stop forever» almost unbearable,» says Ganzer. Drugs have been an essential part of the young person's life and - in their own perception - of their identity formation.

What remains when these are taken away? Who am I then? The fear of filling the resulting hole paralyses and makes the path more difficult. «We always advise people to take an intermediate step and say: reduce your consumption first,» says Ganzer, «it's less scary.» If this then fails, the realisation of the problem often increases.

If children do not learn to regulate their feelings because their parents cannot do so either, this creates a deficit that they have to fill.

Reliable relationships are an enormous support for young people on their way out of addiction. The Winterthur Day Clinic therefore places great emphasis on working with parents and families. With systemic therapy, for example, all family members learn the importance of rules, structures and reliability in their relationships with each other.

The young person's carers in particular repeatedly experience powerlessness, the feeling of wanting to help and yet not being able to do so. «That can be an extremely frustrating experience. It's good when someone from the outside comes in with distance and a professional attitude,» says Ganzer.

When 16- or 17-year-old addicts are being treated by Stephan Kupferschmid at the Integrated Psychiatry Centre Winterthur - Zürcher Unterland, the head of psychiatry for adolescents and young adults is also interested in their past: when did the young people first come into contact with substances?

«We then often see that the introduction to addictive substances, the trial use, has already started quite early. Eleven and twelve-year-olds start smoking,» says Kupferschmid. Even those who like to spend their time playing console games or on the internet in general often experience a form of addiction. «The vast majority of children can control this well, but the ten per cent who have a problem with it need therapeutic support,» says Kupferschmid.

Addictive substances are used to stabilise one's own emotions

However, he and his colleague Ulrike Sanwald, Head Physician and Co-Head of the Integrated Addiction Support Centre in Winterthur, do not like the frequently used term «addictive personality» at all. This is because what causes problems for children and young people is usually a so-called emotion regulation disorder. Addictive substances may then be needed to stabilise themselves.

«Another mechanism can be that you can do everything you like to do excessively without finding a healthy balance,» explains Sanwald. Parents who know that their child is susceptible in this area should be particularly vigilant if they realise that their offspring may be making their first contact with substances.

Developmental psychologists assume that the brain matures by around the age of 25. The control of emotions is also part of this process of change. «Executive functions are also located in the frontal brain. This area is therefore also responsible for saying stop and making judgements: Is your own action reasonable or not right now?» explains Kupferschmid. Accordingly, the immature brains of young children still lack impulse control. The younger children are, the more difficult it is for them to deal with their feelings.

In principle, all people have to go through this learning process. Sometimes, however, the brain is disturbed during the maturing process. This can be caused by very different factors. For example, doctors now know that early childhood influences such as attachment play a major role. If children do not learn how to regulate their emotions, perhaps because their parents are unable to do so themselves, this creates a deficit that the children have to fill themselves: By developing their own strategies because they lack a role model. Or the situation does not allow it.

«We often see children who have to constantly withdraw and overadapt because a sibling is seriously ill, for example, develop psychological problems. These can only materialise later, in adolescence or adulthood,» says Sanwald. It is particularly important in the developmental phase that children and young people have a framework within whose boundaries they can act out and work on things in order to get to know themselves intensively.

«You don't need perfect parents»

Parents who forget themselves, overreact or shout - it's not nice, but it doesn't immediately lead to developmental disorders in the child. «You don't need perfect parents,» says Kupferschmid, «but parents who are «good enough». Even with really great parents, not all interactions work well and there are always misunderstandings. The important thing here is to quickly find a good way to work together, even after an unsuccessful interaction.»

First rule for parents: don't panic. The fact that children use drugs does not mean that they will become addicted.

Experts speak of various factors that can increase or decrease the risk of a child or adolescent becoming addicted. For example, mentally ill parents or a desolate and unstable environment are considered risk factors, as are frequent spatial changes due to relocations or changes in caregivers, such as a change of school or a new circle of friends when starting an apprenticeship.

Important protective factors are stable relationships with adults - who do not necessarily have to be parents - and peers as well as the experience of self-efficacy.

This is particularly possible with hobbies. «Feeling part of something - a music group, a sports club, any joint activity that takes place in a public space - creates a positive activity that releases endorphins and is therefore an alternative to addictive substances,» says Sanwald.

In addition, young people very quickly realise what the substance they consume can do to them: Their performance drops sharply. Anyone who drinks a lot the evening before a game is not fit. The addiction is experienced as disruptive and a hindrance. Another plus point in clubs: The coaches or group leaders are positive role models.

My child is taking drugs - what should I do?

If parents discover that their children are using legal or illegal addictive substances, the first rule is not to panic. «Just because they're using doesn't mean they'll become addicted,» says Sanwald. «A lot of this is trial and error.» Parents should nevertheless take this phase seriously and investigate: What does my child use? In what situations does it do this? Where does the consumption perhaps help them, what effect does it have? Then the following applies: stay in contact and in dialogue, but signal a clear attitude. In the sense of «You, I don't think this is good and I'm worried».

It is essential to avoid abandoning the parental role and becoming best friends in order to obtain information or - at the other extreme - imposing draconian punishments. This does not mean that parents should not set rules. «If you know that a young person regularly uses drugs when they go out during the week and that school or their apprenticeship is suffering as a result, the rule can be: no use if education is waiting the next day,» says Sanwald. «In this context, a combination that is both gentle and persistent is recommended.»