It’s time for a better system for adolescents
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By Dr. Sara Polley
It’s been a challenging couple of years for adolescents. Teens have had less opportunity to interact with people, which has led to increased mental health challenges. That same isolation ironically has resulted in less access to situations and people that enable, normalize or glorify alcohol and other drug use. Now, as our young people again move into the world and re-engage with peers, communities and schools, we need to support and change those environments.
As a clinician and leader in the field of adolescent psychiatry and addiction, I felt a bit of whiplash at the end of an already unpredictable past year. In early December, the U.S. Surgeon General published an advisory which outlined that young people are struggling more than ever with symptoms of mental illness, urging us all to take action within our communities, healthcare systems and schools. Rates of depressive disorders, anxiety, suicidal thoughts and suicide attempts have been rising for years and now are at especially alarming highs, a trend my colleagues and I have seen and felt for some time. As our friends in primary care hustled to fight COVID-19 on the front lines in hospitals and clinics, we continued a similar battle against suicide and trauma among our youth. And we could empathize with limited hospital capacity because scarce resources are unfortunately the norm in mental health care.
Also in December, we learned that the percentage of adolescents reporting substance use decreased significantly in 2021, according to the annual Monitoring the Future survey. At first glance, those results appeared inconsistent with both the Surgeon General’s advisory and my experience on the ground treating young people who seem sicker than before.
How could mental health concerns be significantly up but substance use significantly down? Adolescence is a time of exploration, movement away from the family of origin, and experimentation with identity. Teens are driven to this because their still-developing brain points them toward pleasure-seeking and impulsivity. They crave their peers and the ability to roam. The pandemic has prevented engagement in these normal behaviors, which — it is well established — increases the risk of mental illness and distress. Conversely, I hypothesize that the same thing harming mental health — isolation — is preventing substance use among our lowest-risk youth.
Most of the young people I’ve been treating were already using substances or experiencing the onset of addiction at the beginning of the pandemic. Isolation was less protective for them. They were more motivated to find substances despite the obstacles. And the lack of structure, increased family system stress, and lack of healthier activities to engage in during the pandemic propelled them further down the path of uncontrolled use just as mental health concerns ballooned and the deadly opioid fentanyl became more prevalent, increasing risks further.
So, how do we move forward, knowing we cannot confine, or isolate, our youth to prevent substance use and addiction — it’s not practical and has other negative consequences — and knowing that our highest-risk youth are struggling more than ever?
I think it’s time to build a better system. As our young people again move into the world and re-engage with peers, communities and schools, we need to support and change those environments.
I advocate that we infuse the spaces young people occupy with learning related to substance use and brain development, teach youth how to forge deep and genuine connection with others, and instill skills for emotional regulation and decision making.
We need to motivate them using things they care about like experiences, excitement, and meaningful relationships.
We must also show by example that it’s normal to seek help for symptoms of mental distress and problematic substance use.
Most importantly, we must invest in providing ready access to all of this, and to all kids — with extra emphasis on those who need more protective factors to overcome social disparities.
I know more than most that youth are resilient. They represent the best of us as it relates to stamina, passion and ambition. They’re also not immune to the impacts of stress and upheaval.
The time for adults to help is always. May we use this new year to do something.
Sara Polley, MD, is a triple-board certified physician and psychiatrist. She is medical director at the Hazelden Betty Ford Foundation’s national substance use and mental health treatment center for adolescents and young adults in Plymouth, Minn.
