Dr. James Schaller, MD
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Title: Early Moderate Drug Abuse

Kevin is a 14 year old with a grade decrease in his marks and who has decreased his involvement in baseball and track in the last year. He is interested in his neighborhood friends and they are friendly with you. He has decreased motivation, and mild moodiness and restlessness.


Any youth over 13 with behavior problems should have an unplanned urine toxicology screen, perhaps on Monday so that weekend partying shows up positive. Yet some youth do more drugs before, during, or after school than on the weekends.

If you find drug materials or again suspect drug use, do not depend on one testing. Kids that use drugs daily have come up fully negative for marijuana and other drugs. It is not important why this occurs, but it does.

So repeat the laboratory testing, and ask your physician to have quantitative metabolites done, not merely positive and negative results. Why does this matter?

A youth may have clear metabolites that come up just under the positive range of mere "cut off tests. If we find metabolites it means the youth is using! They may have merely taken a brief break, used lower amounts, or been around heavy users. But these are all issues to address. Also if you repeat quantitative levels you can see whether positive toxicology screens are going down.

This matters, because once positive, some youth are tempted to binge since they know they were just found positive, so why not "really party since I was already caught." Since it is commonly known marijuana testing can stay "positive" in screen tests for 4 weeks. If the quantitative levels are going down 2 weeks later it means the youth is at least cutting back.

Sample Solutions

At least once a week meetings with a therapist they like and "tolerate." 2x a month is coaching and minimal therapy. They must pick their therapist or at least have some input, unless they go through 5 people. If they refuse to go to see someone you will have to hold them accountable. Or perhaps even reward them for going. Why reward for what they should do? Simply, because it is torture for an active drug user to go to therapy.

Some special school programs have academics that mix studies or marketable skills training with modest group or 1:1 therapy. See if your child would be a candidate.

Treat what is compelling the youth to use. Drugs may be a way of making friends, decreasing social anxiety, decreasing general anxiety, decreasing depression, increasing confidence, numbing failure in other social areas—like school and romance.

As with all addictive compulsions, you have to wean the youth from people, places and things that promote use.

But one other important goal is to add satisfying pleasures, which do not need to be massive joys, to help replace the large pleasure of the drug(s).

Simply if the youth depends on you for their livelihood, you have more control than you may think.

Many other options discussed elsewhere.


Diplomate: American Board of Psychiatry & Neurology
Diplomate: Forensic Medicine & Forensic Examination
Certification: American Soc. Clinical Psychopharmacology

Community Bank Towers • Newgate Center
5150 Tamiami Trail, N • Naples, FL 34103
Phone: (239) 263-0133

Recognized in "America's Top Psychiatrists"

Bank Towers, Tamiami Trail, Naples, FL
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