Jack, from Northern California, was 12 years old when he began to smoke cannabis and drink alcohol regularly. His substance use helped muffle the emotional turmoil caused by a difficult family life. Jack, whose name has been changed, began using oxycodone soon after, and by his first year of high school, began injecting heroin.
If you think you know where this story is headed, you might be surprised. Now in his 20’s, after years of addiction, Jack is not only still alive, he is reclaiming his life in a process of incredible dedication and courage. He is undergoing recovery through medical treatment, which provides behavioral therapy, social support and, critically, medicine to manage addiction.
Jack is lucky. Finding treatment is a challenge—finding effective treatment, far more so.
As California is poised to invest hundreds of millions of dollars a year in youth substance use disorder prevention, early intervention and treatment, we need to look to the success of Jack and other young people to guide sound decision-making. Proposition 64, which legalized adult cannabis use, is just one of several sources of funding that promise to augment youth substance use disorder treatment by hundreds of millions of dollars annually. Additional millions earmarked for early detection and intervention must also be spent.
This new surge of funding addresses one of the two problems we face in California. The first problem is access to treatment. Nearly 150,000 California young people between 12 and 17 years old reported that they needed but did not get substance use disorder treatment. In 2016, nearly 480,000 young Californians between 12 and 25 misused opioids. Synthetics opioids such as Fentanyl are adding a highly addictive and deadly new danger.
But there’s a second, fundamental problem we must address: Access to treatment is not enough. Jack, for example, cycled in and out of half a dozen treatment programs that simply did not use evidence-based best practices. Non-evidence-based treatment failed him—and could have cost him his life.
Instead, we must provide access to effective, results-based treatment that is appropriate for young people, who have special and different needs—physically, emotionally, socially and academically.
Developmentally, a young person’s brain is simply different. The young brain finishes developing at age 25. Addiction changes the brain and interrupts crucial developmental processes related to judgment and decision-making. It hampers social development and derails the crucial final years of maturation.
Also, a young person who is struggling with addiction is part of a family, and the entire family may need help. Finally, we must be ever aware that children and teens struggling with addiction may be experiencing trauma now, rather than in the past, requiring additional intervention.
That is why my organization, the California Society of Addiction Medicine, is sponsoring legislation, Senate Bill 275, to create clear standards for youth substance use disorder prevention, early intervention and treatment. The bill would involve pediatricians, psychiatrists, social services and educational experts, as well as youth and parents to develop standards of care that every publicly funded youth substance use disorder treatment program would have to meet. The treatment approach would have to be backed by evidence, and every publicly funded treatment program would have to be licensed.
In addition, the standards would have to reflect the diversity of California’s youth population, including ethnicity, language, sexual orientation, gender identity and experience with homelessness or as a foster youth.
Every time a young person who suffers from addiction reaches out for help, we have an incredible and precious opportunity to find the road back to the youth’s full potential. Wasting that opportunity isn’t just a waste of public dollars, it is a matter of life or death. California has the opportunity now to save lives. California can prevent the wrenching and devastating effects that addiction inflicts on young people and their families. California must make the effort to get it right the first time, every time.
David Kan is a psychiatrist who specializes in addiction treatment. Kan is current president of the California Society of Addiction Medicine and a faculty member at UCSF.