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Notes from a dependency service

Although my experience within the Teen Addiction Service is just at its beginning, there are already many considerations that I constantly find myself sharing with colleagues, and whether they are psychologists, psychiatrics, or specialists in toxicology, one of the recurring topics is surely the analysis of the question: are we sure this is the right place for this boy/girl?

Despite the heavy efforts that many people face, in fact, we more or less all agree in the common idea that one of the most difficult problems within the territorial services is the disarticulation of the services themselves, a widespread lack of communication between mental health professionals who have to take charge of children who access their departments “only” on the basis of the problem that families or competent authorities ask them to address and resolve, as if it were a sort of adjustment, a form of correction.

Often, however, the use of substances, whether or not associated with the so-called deviant behaviours, is only the visible part of the problem, and in fact, together with the kids, the respective families are also taken in charge, at times saturated of an invisible “toxicity” maybe made by kind or affectionate words (I call them verbal “caresses”!) whose inconsistency, however, is so irritating that you almost feel bad, as if they were radioactive..

I personally believe that a first distinction regarding the definition of the problem should be made on the basis of its severity, and this is essential in order to be able to proceed with the most appropriate attempt at understanding and response.

Anyone who has been for the most disparate reasons in an ER in fact, will know that the first thing that is asked (and evaluated) is the condition of the incoming patient, the so-called “triage” consisting of the 4 colours (white, green, yellow and red) corresponding to the degree of urgency that the doctor has to face, so that the different interventions can be postponed or sent to the most suitable departments or the better equipped ones.

Well, for teenage addiction, it seems to me that this is not how it works at the moment.

While it has certainly been useful to set up a specific service for this age group, the recent exclusion from diagnostic manuals of the distinction between the definitions of “use” and “abuse” has helped to widen the audience beyond measure, with kids that have been registered when in fact the use is related to exploratory forms or membership (or limited to specific contexts such as clubs, where it is easy to drink too much or too quickly) in which the affections necessary to the safeguard of oneself and of others are well alive and present, so that perhaps who drives does not drink..

It is not a matter of underestimating (or minimizing) the problem, but rather of making its differences more evident: in some cases, the kids would need a path of personal psychotherapy, as the use of substances is still just secondary to evolutionary problems that perhaps they cannot deal with, while in more serious cases (of addiction, and therefore dependence) it is rather the substance that “manages” them, often putting them in serious trouble, not only with law enforcement.

Therefore, to unify the various expressions of the phenomenon with the only criterion of the use or the degree of “recidivism” does nothing but making it meaningless, as if the experience was not a salient aspect, fundamental to a first attempt of understanding:

A glass of wine a day will not make an alcoholic, but if it is drunk in the morning before going to school takes on a completely different value..

Unfortunately, for some families it seems easier to accept that the kid is the victim of bad friendships (or worse, that they have taken a bad habit!) rather than to reflect on the possibility that at the base there may be a psychological much deeper discomfort.

It may be that the phenomenon does not know social levels, rather it goes across them, but the image of kids who are addicted to the repeated use of substances, as it has often been shown in films and TV shows, for example, is absolutely not able to describe a good part of the ones I meet, so much so that I think that the indicator capable of measuring the severity of the problem is rather the “investment” that each kid places in the use of substances or in the behaviour of “addiction” (from Latin “slave”) as gambling, that is, what it represents to them, compensates or even replaces, which of course is very different depending on the age group.

In fact, the service is open to kids aged 14 to 24, and when you decide to work together, in addition to being divided between males and females, groups are formed on the basis of age and their social commitments: tendentially those who still go to school are not included in the group of those who left or maybe work.

Another distinction I have observed is that although their number is much lower (in a scale of 1 to 10) it is the girls who find themselves in the most severe conditions, both for the “heaviness” of the substance (to which they are often seriously addicted) as well as for the modalities with which they end up trying to get these substances, majority of times very violent.

Currently those with whom I work are kids around 20 years old (many of them have attended the site since 5/6 years) and all have finished schools.

If this may perhaps indicate their minor “compromise” certainly means that no matter how messy those years may have been, none of them wanted to give up on a form of study, knowledge, relationship with classmates and teachers, maybe even with just one of them, and although they are quite different from one other, I was amazed by a common aspect: what they would like is not so much to leave the past behind, but to go back in time to try to change it, like they know that’s where there’s something to fix..

So, I think that the communication and social network that each of us may be able to weave, whether they are teachers, trainers or families, would be able not only as it is obvious to intercept potentially at-risk kids, but above all to constitute a specific protection factor for them.

To conclude, every now and then some colleague “reproaches” me to make the talks last too long (well, there is always a shortage of free rooms where I am) and when I am asked what I have to say for all that time I never know what to answer.

In principle, I spend most of my time listening to the kids, and the rest trying to understand what they said.

It might be that words are important, and sometimes we have only those to understand each other.

Marco Randisi

Thanks to Chiara Fanasca for the translation of this article


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