Drug Mistreatment

As he waited for the drug counselor to return, Bill hunched his wiry frame forward, his leg jittering. He wasn't going through withdrawal -- he was just nervous. He didn't know what to expect or exactly what the point of this questioning was. All he knew for sure was that he needed to enter a drug-treatment center, or be kicked out of school.

Minutes earlier, the sandy-haired 15-year-old (whose name has been changed) had answered a series of questions. Yes, he occasionally smoked marijuana with his friends -- but not on a regular basis, and always in moderation. No, he had never tried any other illicit drug and did not drink alcohol.

Bill's drug use, in other words, was by most people's standards nothing remarkable for an American adolescent, certainly no worse than that of hundreds of thousands of other healthy, thriving teenagers. But the counselor at New Bridge Adolescent Treatment Center apparently thought otherwise.

"She told me I was 'between abuse and dependency,'" the highest level of drug abuse, Bill says.

The counselor told Bill's mother, Karen (whose name also has been changed), that Bill would have to attend after-school treatment four times a week for the next two to three months, and then once a week for the remainder of the year. Karen herself would have to attend Alcoholics Anonymous meetings each week, a requirement for all parents with kids enrolled in the treatment program, one of the several at the Center. She would also have to remove all alcohol from her house. To top it off, Bill's father was to administer random urine tests whenever the facility's officials ordered him over the phone to do so. The program costs $100 a day, of which Karen's health insurance would only cover half.

Such intensive treatment for such a relatively minor problem -- if one even considers drug use at Bill's level a problem -- may sound extreme, but is increasingly common across the US. Bill is just one of tens of thousands of adolescents whom a raft of experts say are coerced into entering drug treatment each year by schools, parents, or the courts, despite not having any serious drug problem.

Over the past 10 years, more than one million adolescents have been removed from school for drug-policy violations, according to Joel Brown of the Center for Educational Research and Development, who is currently studying the effect schools have in forcing youths into treatment. In a great number of those cases, Brown says, students have only one way to get readmitted to school: enroll in a treatment facility. No one knows the full extent of this trend, because there are no centralized statistics kept on drug-related school expulsions. The trend does, however, seem to help explain why adolescent treatment admissions have shot up by about two-thirds since 1990, according to a recent study by the federal Substance Abuse and Mental Health Services Administration.

Brown estimates that "less than 10 percent" of the kids who enter treatment at the insistence of their schools actually have a problem.

"The assumption is that if a kid gets caught in school with drugs, they automatically have a drug problem, but there's a great number of kids that are experimenting with substances and still succeeding in school," says Brown, who stresses that he does not encourage adolescent drug use.

"You know who gets put into treatment? It's the kids who get caught," seconds Ernest Drucker of New York's Montefiore Medical Center, who headed a methadone clinic for 20 years from 1970 to1990.

Bill says he was pushed into treatment by officials at his school in Northern California. In January, Bill's principal told Karen that he suspected Bill of "using" and urged her to have him assessed at a treatment facility.

Karen, in fact, knew that her son occasionally smoked marijuana. She wasn't happy about it, but she believed he was using the drug responsibly. But before Karen had a chance to do anything about the principal's advice, one of Bill's teachers caught him smoking marijuana in the school parking lot with one of his friends. Karen says she was called back to the school and given an ultimatum.

"This time, they basically said, 'You either enroll him into a drug treatment program or we're going to start procedures for expulsion,'" she says.

The principal at Bill's school would neither confirm nor deny Karen's account.

Some experts say many school officials are encouraged to offer the treatment-or-expulsion ultimatum by the example set by the federal government's hard-line policy on drugs. The federal government cannot require schools to follow a set drug policy, but the Department of Education does offer "model program" guidelines emphasizing a pro-active approach to drug prevention and intervention, according to DOE spokeswoman Melinda Malico.

School drug policies vary by state and district. Schools usually have discretion to suspend or expel students who are caught with drugs. Some simply require a student caught with drugs to go in for an assessment. But, as Bill's situation reveals, it does not take much to be diagnosed as an "abuser."

Consider these unassuming questions from the New Bridge Foundation's self assessment for teens: "Do you sometimes hang out with kids who drink/use? Have you had anything to drink in the last week? Have you ever felt guilty or bummed out after drinking/using?"

Such vague questions, many researchers say, help to explain how kids without real drug problems end up thrown in as hard-core addicts.

Though schools are a primary culprit in pushing youths into unneeded treatment, parents do their share too. Alan Leshner, director of the National Institute on Drug Abuse (NIDA), told the Dallas Morning News in 1997 that most youths in treatment "are either court-mandated or what we call 'mommy mandated.'" At such facilities as the Hazelden Foundation in Center City, Minnesota -- one of the largest treatment centers in the country -- relatives accounted for nearly half of all youth admissions in 1998.

"C.D.", a Connecticut teenager who recently completed treatment at an outpatient center in Connecticut says that most of the teenagers were placed in the program by their parents, often against their own will. "Some of them were forced into it by threats by their family," she says, estimating that only "50 percent" of the kids in the program had real drug-abuse problems.

"Parents are scared shitless about this," says Stanton Peele, a New Jersey psychologist and author who specializes in addiction. "They're afraid their kids are going to end up like David Kennedy and die of heroin or something."

Just ask Al Levesque, who says his mother forced him to enter three separate rehab clinics in Connecticut over a three-year period, beginning at age 14. He was admitted for marijuana use every time, despite the fact that he used the drug moderately. His mother, he says, saw him as an "out of control teen."

"I don't think that I ever did -- or do -- have a drug problem. I've always been a good student, and I've always been very productive," says Levesque, now 23 and finishing his last semester at Western Connecticut State University.

Levesque literally spent years in treatment at his mother's bidding. Most of his stays consisted of outpatient treatment -- in which the client is not hospitalized but attends day sessions -- but he often spent "every waking hour of his day" at the treatment facilities. In one instance, he was required to attend treatment 40 hours a week for nine months.

The results of his "rehabilitation"? Levesque continued to use marijuana responsibly, and has not moved on to regular use of harder drugs. He is currently vice president of the WCSU chapter of the National Organization for the Repeal of Marijuana Laws.

Of course, many in the federal government and the treatment industry heartily approve of the increase in adolescent treatment, saying the trend parallels an overall increase in teen drug use over the past decade.

"We know that drug use remains very high [among teenagers], and we're working to lower that," says Bob Weiner, spokesman for US drug czar Barry McCaffrey.

Drug use among teens increased after 1990, but has begun declining again in recent years, according to school surveys. But the only significant increase has been with marijuana use, which rose substantially from 1991 to 1999, according to the NIDA-funded Monitoring the Future Study. In 1997, marijuana was the primary substance of abuse in about half the treatment admissions for people younger than 20. The use of all other illicit drugs, including cocaine and heroin, has increased by only a few percentage points.

Carol Falkowski, a senior researcher at Hazelden, says the rise in marijuana admissions is justified. "More kids are being exposed to a more potent form of [marijuana] at a younger and younger age," she says. "Kids are running into real problems."

But, says Drucker, an increase in use does not necessarily lead to an increase in abuse, particularly in the case of a drug that has never been proven addictive and is considered by many to be safer than alcohol.

"How the hell do you treat somebody for using marijuana?" he asks. "Frankly, there's no evidence of an effective form of treatment for those who do have problems with marijuana."

By definition, however, the federal government's "zero tolerance" policy considers virtually any drug use -- regardless of the type of substance or frequency of use -- as "abuse." The result, say critics, is a "one-size-fits-all" model of drug treatment. This model is based on complete abstinence, which many criticize as simplistic, even some whose job it is to advocate abstinence-based treatment.

"If teenagers use drugs at all, they've already met the criteria [for drug abuse]," says Pat Harrison, manager of health care research at the Minnesota Department of Human Services. "We can't teach safe and responsible use to minors because of the zero-tolerance policy. So you're left with no choice but advocating total abstinence, which isn't particularly effective."

The scarce statistics the government keeps on frequency of drug use by teens entering treatment seem to support the notion that many of them do not belong there. According to the federal government's Treatment Episode Data Set for 1996 -- the year in which teen marijuana use was at its most recent peak -- close to 30 percent of the kids who were admitted for marijuana use reported "no use in the past month" upon entering treatment. Another 15 percent reported using only "one-to-three times in the past month." Only 32 percent reported daily marijuana use.

Meanwhile, while kids with minor drug problems fill treatment slots, others with serious addictions are left out in the cold.

According to a July 1999 report by the California Legislative Analyst's Office, only 10 percent of adolescents who are estimated to need publicly funded treatment receive it. Nearly 2,000 wards of the California Youth Authority are waiting to get into drug rehab programs, according to a recent Los Angeles Times article.

Access to treatment often depends on being able to afford it, says Brian Greenberg, a psychologist who is vice president of the Walden House Adolescent Treatment Center in San Francisco. For many low-income families, says Greenberg, the only adolescent treatment available is through the juvenile justice system. This puts the parents of many young addicts in a tough spot. "If a family doesn't have health insurance, sometimes they will err on the side of calling the police when their kid gets into trouble because it's the only way to get treated," he says.

"Ironically, the kids that are labeled 'at risk' by the government [often] don't get any of the help that they need," Brown says.