Teens and alcohol: an international snapshot

From his office in Sydney, Australia, psychologist Gunter Swobota routinely meets with a number of adolescent patients who are, as he puts it, “well funded.” These affluent teens can and do purchase cocaine with ease. But Swobota says the drug he is most worried about is alcohol, with abuse among youths reaching what he calls crisis proportions.

Around the world, alcohol abuse among teens is preoccupying many addiction experts. This article features the perspectives of individuals in Australia, the Netherlands and Bermuda, on the extent of the problem and the solutions being pursued.

Australia: a drinking culture

A registered psychologist in private practice, Swobota says binge drinking in particular is becoming a major problem in Australia. “Anywhere up to 30% of the teen population is doing that at some point in their adolescence,” he says. Of those binge drinkers, Swobota says 75% have consumed to a point of potential harm.

“We are a culture that is very much steeped in social drinking,” he says, with 13 and 14 the typical ages of initiation. He describes the Sydney/Melbourne area as “a very affluent, Southern California type lifestyle.”

Despite routine reports of alcohol poisoning emergencies on weekends, Swobota says Australians seem to be reluctant, almost apologetic, about addressing the issue. While the country executed an effective anti-smoking campaign, “With alcohol we have a high level of tolerance in our community,” he notes. Swobota says it's almost as if parents and others urge teens to drink responsibly, “then giggle and move on.”

He adds, “We need to sit down and have a strategic plan that looks at targeting the problem at the grass roots.”

Swobota says it's very rare for a parent to tell him that his/her child has a drinking problem. It's almost always described as a behavior problem. “The attitude toward their children quite often is, ‘They'll be fine,’” he says.

The trigger for seeking help is usually deteriorating grades at school. By then, many teens are already trying other drugs as well. “Most kids start experimenting with other drugs because they have drunk,” Swobota explains.

The Netherlands: multi-problem youths

Jean Paul Wils started his career working as the manager of a middle school in one of Amsterdam's most troubled areas. His students often set fires in the building. Determined not to close the school, he began examining his students' lives, looking for meaningful ways to reach them.

“In Amsterdam,” Wils says, “there are some 4,000 students whose parents are immigrants. Most of them have multi-level problems-poverty, broken families, stealing and drugs. Every day they see things that are on the bad side of life. They are at a stress level that is much too high.”

Today Wils works for a private program for troubled teens that is trying to help them see success in their new homeland. He estimates that 30 to 40% of the target population has alcohol and drug problems.

According to Brenda Langezaal of the Dutch Ministry of Health, Welfare and Sport, binge drinking is also a problem in the Netherlands. More than half of 14-year-olds say they have experimented with alcohol. Of teens who say they drank in the last month, 75% admitted to binge drinking.

“Sixteen is the legal age in the Netherlands for beer and wine,” Langezaal says. “Eighteen is the legal age for stronger liquor.”

The country has developed prevention programs in schools, targeting parents' role. Meanwhile, the private program Wils is working with is hoping the Dutch government will help with funding. “After struggling five years, having practically no money, perhaps our situation will ameliorate,” he says.

Bermuda: becoming family-focused

Alfred Maybury, director of child and family services for Bermuda's government, says the vacation paradise's heavy tourist trade might help make alcohol more accessible to young people. “We're trying to really look at it in terms of how that's impacting our young people,” he says.

Since 1991, the Bermudan government has surveyed teens every three years to determine how many are using alcohol and drugs and in what quantities. “About 40% indicate they've tried or experimented with some kind of drug,” Maybury says, “either marijuana, tobacco or alcohol. Of that 40%, we may have 25 to 30% we actually end up having to provide services for.”

Maybury says that while drug use overall appears to have declined slightly over the past five years, there also has been a drop in the average age of children trying substances. He says more 12- and 13-year-olds are now reporting use or experimentation.

Children usually don't seek treatment until around age 15, and the majority of them are boys, he says. “That's when they are transitioning from middle school,” Maybury explains. Most often referrals will come from teachers who report behavior problems or a drop in grades. Occasionally parents will seek help for their children. Even rarer, law enforcement will refer a child, he says.

The government is trying to expand its outreach, with a focus on family treatment. “We recognize that some children are picking up the use of drugs from the adults in the family,” Maybury says. “Now we're looking at the family as a system so that we don't find ourselves treating a child and having that child go back to an environment that has the problem.”

Seeking new approaches

Treatment experts in many countries are taking a closer look not only at their own programs, but also what appears to be working in other countries. Bermuda's Maybury and Australia's Swobota both recently visited the United States to learn more about wilderness therapy programs-something neither country presently offers.

The Netherlands' Wils, though not a representative of government like Maybury and Swobota are in their countries, also is intrigued by wilderness therapy and would like to develop something similar to what he saw at Utah's RedCliff Ascent program. “It was an energizing, good feeling that we got there,” Wils recalls.

Since RedCliff's program incorporates a wilderness area covering more than 600 miles, Wils acknowledges that duplicating that experience in his land-starved country would probably be impractical. But he thinks it could work if the program were located in France or Morocco where there's more space.

Langezaal says Dutch adolescents with substance abuse problems are treated by a network of specialized addiction care centers. The government provides therapy at no cost as part of the country's nationalized health care system. There are waiting lists to receive help, but Langezaal thinks the waits will disappear when the government opens additional addiction centers later this year.

Swobota, who says all but one residential program in his area is adults-only, is intrigued with the therapeutic orientation of a wilderness approach because “it dislocates the children and puts them out of their comfort zone. It's over a longer period of time and they really have to reflect.” He says he also likes “the whole issue of being accountable and taking emotional responsibility” that is asked of young participants in these programs.

Swobota says lack of program availability in Australia means most care is provided on an outpatient basis. He says more psychologists are moving into private practice now that the government has launched a partial fee payment for private care. But he worries that many of these practitioners don't have enough education or experience when it comes to adolescent substance use. “I see a lot of clinicians colluding because they haven't had the training to put in place some of therapeutic interventions that need to happen,” he says.

Maybury says the emphasis in Bermuda has been on outpatient care as well. There is some individual and group therapy, and “we have support through Alateen. They have a group for young people who have successfully come through treatment and they have formed a group to be more of a support for one another.”

He adds, “The numbers in terms of trying to put together an inpatient unit are not there.” But the government does contract with private providers outside the country to provide some specialty services. The RedCliff Ascent program is one of them. Maybury says that in deciding to place a child in a program outside the country, “One of the things that we really look for in the program is the family component because we believe that in order to be successful in treating any child there has to be some work done with the family.”

The Bermudan government pays for the care of these children, as well as those who receive treatment at home. The duration of therapy is open-ended. “It all depends on when that child feels strong enough and the therapist recognizes he can handle things on his own,” Maybury explains.

Future hopes

Maybury says he hopes to be able to reach children in need even earlier. He says a partnership with Bermuda's Ministry of Education is helping to get drug awareness campaigns into schools. His agency also is working with youth sporting organizations to spread the word about services that are available.

In Australia, Swobota hopes his government will increase funding. “Government should be offering a much broader service,” he says. Although private hospitals offer some substance abuse treatment, the cost is out of reach for average Australians who must pay out of pocket unless they receive treatment from a government-sponsored program, Swobota says.

In the Netherlands, Langezaal hopes earlier diagnoses and more cooperation between general hospitals and addiction care centers will also improve the country's treatment approach.

Maybury concludes, “No one has the magic key to treatment. But everyone has a good part somewhere. If we can get all those parts together, and that's what we're trying to do, that helps a lot. It's important to us to ensure that families get the best possible treatment because a healthy family is a healthy country.”

Sidebar

For more of Jennifer Jones' perspectives on the wilderness therapy program RedCliff Ascent, visit https://www.addictionpro.com/jones010206.