Poor Coping Skills in Adolescence Can Lead to Substance Misuse

For the average person who's never experienced or known someone with an addiction, the disease is baffling. How could he let this happen? Why couldn't she just stop? Didn't he see this would end badly?

The questions can swirl endlessly, mirroring frustration, fear, and grief.

Dr. Sarah Book, medical director for the Center for Drug and Alcohol Programs at MUSC Health and a professor of psychiatry and behavioral sciences, describes addiction as the use of a substance that gets out of an individual's control.

"Addiction interferes with someone's life in important ways, and they're unable to change their use to achieve their life goals," Dr. Book says. "Often, we know that people use substances fundamentally to feel good or to stop feeling bad, and it's the using of substances to stop feeling bad that we think tends to get people into trouble."

Dr. Book says the use and misuse of a substance can begin in adolescence, when teens have few, or poorly developed, coping skills to manage extreme or uncomfortable emotions that surface as they navigate their way to adulthood.

"One of the jobs as an adolescent develops is to learn to roll with that emotional roller coaster and cope with emotions in a healthy way," she says." If a person is introduced to an exogenous, or outside, substance that masks those emotions for them, they may tend to rely on that substance to get through stressors."

And moving into adulthood without those skills intensifies their reliance on substances to help them cope.

Dr. Book says the effects of alcohol and drugs on the brain are similar, enabling someone to switch back and forth among substances that pull them through stressful situations. She compares their effects on brain chemistry to pedals in a vehicle.

"There's a lot of overlap among substances. Alcohol gets everywhere in the brain. Think of it this way: The brain has a gas pedal and a brake pedal, and if you're very stressed, you press the pedal. When you have a drink, alcohol takes the foot off the gas and puts the foot on the brake."

Constantly pressing the gas pedal and the brake creates a chemical imbalance in the brain by blocking and simultaneously releasing certain chemicals.

"Your brain is always reaching for balance; it doesn't like imbalance and over time it eventually adjusts to regulating the release of certain chemicals," she says. "Suddenly, if you're in a situation when you can't drink, your brain gets imbalanced, causing withdrawal symptoms."

Dr. Book says people are possibly born with a predisposition to misusing substances, particularly alcohol.

"Being able to 'hold your liquor' and show less body sway has typically been regarded as a strength, but it can be a sign of a genetic predisposition to alcoholism,"she says.

In some family systems, alcoholism skips generations, often a result of environmental and social factors. "Someone who grew up in a family with an alcohol use disorder might be inclined to avoid drinking. On the other hand, that person's child might drink because they're unaware of the harmful effects of alcohol."

How addictive a drug is depends on how high someone gets, and how quickly, she says. Any drug that can get you high fast will be more addictive than a drug that takes an hour to make someone feel good.

Cocaine and pain pills are examples. Cocaine is snorted and absorbed by tiny blood vessels in the nose, but when volatized into a gas and inhaled into the lungs it acts more quickly. Pain pills enter the blood faster when crushed and snorted into the nose or injected into a vein.

Opioid addiction is not new and has been a public health problem worldwide since the turn of the 20th century, increasing because of the pharmaceutical industry's ability to create a stronger and faster-working opiate.

Heroin, developed in the late 1800s in Germany by Bayer, was used to treat addiction to opium, as well as cure severe respiratory ailments, before the medical community recognized its harmful effects.

Then came oxycodone, followed by fentanyl and an even more powerful class of drugs, nitazines.

Dr. Book says the growth of fentanyl is being outpaced by nitazines. Although they are not a big problem yet, nitazines are making inroads in the drug realm, based on death investigations in South Carolina.

"Up until the last few years, fentanyl, was the strongest opioid," she says. "Illicit labs throughout the world manufacture and distribute fentanyl-like drugs, and they're everywhere."

As the director of MUSC Health's clinical neurobiology laboratory, which tests blood and urine for drugs, Dr. Book routinely evaluates patients who have no idea that fentanyl is in their urine.

"They blame their dealer, but I caution them that their dealer probably doesn't know what's in the substances either."

For people seeking treatment and recovery, Dr. Book has encouraging news. "People absolutely can kick an addiction habit on their own, and there are a lot of great treatments for alcohol and other substance disorders."

Primary care physicians are very much involved in treatments and are an excellent source of information. Twelve-step programs provide depth and breadth and are accessible worldwide.

South Carolina counties have treatment programs under the banner of the South Carolina Department of Alcohol and other Drug Abuse Services (DAODAS). The National Institutes of Health website is also a resource for information.

MUSC Health evaluates and treats patients at its Center for Drug and Alcohol Programs (CDAP).

"It is important that people seek treatment because they want to and are ready," she says. "That is why at CDAP, we evaluate walk-ins on the day of their visit; they're motivated in that moment. We always ask, 'Why now? What is the thing that got you through the door?'"

Responses range from being sick and tired of being sick to threats by a loved one to leave, or strong encouragement from an employer.

To anyone seeking treatment and to those who ask her why she's chosen to practice addiction medicine, Dr. Book tells them: "There's nothing more awe-inspiring than somebody who has been at the bottom of the barrel and who has been able to climb out and make a significant change in their life.

It's an honor and an exciting thing to witness."

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To make an appointment with Dr. Book or CDAP, call 843-792-5200.