It's Tuesday night, and behind the bar at an upscale Italian restaurant in Raritan, Corrine Cusumano mixes drinks and pours beer. The petite, perky, 26-year-old smiles and chats with the patrons. It's clear she's at ease with herself and with serving liquor. But that wasn't always the case.
Ironically, as a teen Corrine couldn't get through a day without using alcohol and drugs.
Her story is much like those of other adolescents who get caught in the downward spiral of drug abuse. She began drinking when she was 9 years old to escape the horrors of life with an alcoholic father. Gradually her so-called episodes went from a few times a week to daily.
But alcohol often made her sick, so she switched to marijuana. Next she tried LSD, cocaine and heroin. Before long, drugs completely dominated her life. "I'd do anything for a fix," Corrine admits. "I stole, I dealt, I even carried a gun."
By her 14th birthday, the Piscataway native was frightened, lonely and deeply depressed. "I didn't want to live anymore," she says. A friend told her about a teen recovery program, offered by UMDNJ's Department of Addiction Recovery Services. Meetings were held in the University Behavioral HealthCare (UBHC) building on the Piscataway campus, close to her home. She immediately enrolled.
"When I became sober I finally saw the color of life," Corrine says. "I formed values for the first time, and I realized I had choices. I still use the skills I learned in the program everyday."
Nearly 400 adolescents, like Corrine, have gone through UBHC's rehabilitation program since its inception in 1987. Known as TLC; short for Teens Living Clean;the program is under the direction of mental health clinician Nancy Till, LCSW, CDA, CPS. It is based on a holistic model that addresses both the biological, emotional and social needs of the adolescents and the concerns of their families.
The teens and their parents attend separate and joint group therapy sessions, and the kids also meet with individual counselors. They are required to abstain; their urine is screened randomly;and to complete three tiers of assignments, including attending outside sobriety group meetings like Alcoholics Anonymous.
Right now there are eight kids, ages 15 to 18, enrolled in TLC. Five are male, three are female; they're Caucasian, African-American, Hispanic and Filipino. Their families range from well-off to not so well-off; several are being raised by only one parent, others by two. But all are typical teenagers; clad in jeans, T-shirts or flannel shirts over turtlenecks and Doc Martens. Everyday they deal with classic adolescent concerns;peer pressure, dating, their grades and their parents' expectations; and all are trying to stop using alcohol and/or drugs. Some will make it; others won't.
There's Amy, who began "using," at age 12. She "ran away a lot and kept getting kicked out of school." Her older friends, no longer a part of her life, were her suppliers.
She's been in the program a year;longer than any of the others in this group;and has been clean almost from the start. As soon as she completes the last few requirements, she'll graduate. Amy is proud of her accomplishment, but hesitant to leave. In fact, she's hoping to return as a peer counselor.
"I love the program and these people," she says. "I feel at home, like I belong here." Even though Amy sometimes thinks about turning back to her old ways, she says firmly, "I know I can stick with it now."
Alan is not so resolute. He's had a few slipups during his three months in TLC. Like Amy, he started using at 12. "I would hang outside the liquor store and ask anybody standing around to get it for me," he says. His friends supplied him with pot.
The counseling and group therapy have helped him see things from a different perspective, and he's aiming to move to the next level of the program, but isn't at all sure he'll make it. "I hope I can," he says quietly."
The rest of the stories are similar. Juan, the only son of a Filipino couple, says he hid the smell of alcohol and pot from his unsuspecting parents with cologne. For him, drugs were a "crowd thing";he wanted to be accepted.
So did Cathie. Her family has moved a lot and she's continually had to make new friends. She drank to be "more outgoing," but could not stop at one or two. After several frightening blackouts, she asked for help.
Tanya struggled with alcohol and marijuana for years. Finally, last Thanksgiving, she attempted suicide. The newest member of the group, Tanya is still somewhat quiet and withdrawn.
Each Tuesday evening the kids meet and discuss the trials and triumphs of living clean. Counselors Doug Ford, BA, CADC, and Barbara Juchniewicz, MSW, LSW, teach the group coping skills, stress management, and how to set and achieve goals. They also act as sounding boards and confidants.
"It usually takes a month or two for new group members to trust us and the others," Ford explains. "When they feel comfortable, we encourage them to share their beliefs and to see the inconsistencies between what they believe and what they do."
Juchniewicz says because the nature of adolescence is to be impetuous, one of the main objectives is teaching the teens to take responsibility for their choices and to think before they act. Relapses, a normal part of early recovery, are treated as learning experiences, not failures. The same holds true if someone can't stick with the program. "Some kids simply need a more restrictive environment than others," she says.
At the same time that the teens meet, their parents gather in a room down the hall. It's here that the gut-wrenching guilt and fear surrounding drug abuse become almost palpable.
"When I first found out that Cathie was having problems with alcohol, there was this hole, kind of an empty sadness inside me that I can't describe," says her mom. "And then of course you ask yourself, 'What did I do wrong, and what could I, or should I, have done differently?' That awful feeling is always with you, it haunts you."
Juan's mother worries about the strained relationships that have developed at home. "My husband, he barely talks to Juan," she says, wiping tears from her eyes. "I know this is bad. I beg him, please, but he won't. My heart, it breaks. I don't know, what can I do?"
This is Tanya's mom's first meeting. A recovering alcoholic herself, she's been sober now for about six months. She's terribly frightened and confused and doesn't know where to begin. "How do I take control and still let Tanya know I love her?" she asks.
The veterans of the program reassure the newcomers. "It does get better," one mother promises another. "You'll be able to trust him again," another confirms.
"These parents are terrified that their children are going to die," explains Phyllis Reilly, MA, CADC, an addiction counselor and director of Addiction Recovery Services. "They don't know what to do anymore, and often they do all the wrong things out of love and guilt and because they're so scared."
The program teaches parents to be reasonable, disciplined, even-tempered and to realize that they're in charge, not the kids. "Some of the parents aren't sure that it's right to take back control that's been given to an adolescent who abused drugs or is addicted," she explains.
While the need for caring, expert support from professionals is still a necessary part of recovery, Reilly says treating adolescent abuse and addiction has changed some in the past 10 years. Unless a teen needs close medical supervision, for example, she no longer does a stint in a residential rehabilitation facility before enrolling in an outpatient program. This allows her and her family to carry on their daily routines.
And, a decade ago teens who used drugs; regardless of the type of drug, how much or how frequently; were considered addicts, and those who drank excessively were labeled alcoholics. A clear distinction is now being made between addiction and abuse.
"Using these substances doesn't necessarily mean the teen is addicted or is an alcoholic," Reilly explains. "We look at how the substances are being used and what physical, behavioral and emotional changes have occurred as a result."
Continually lying to parents and school personnel and a preoccupation with drugs are major indicators of chemical dependency, she explains. If a kid spends most of his time, energy and money thinking about being high and ensuring he has a steady supply of drugs, it's likely he has become addicted. Withdrawal symptoms, an increased tolerance leading to an increase in use, and the belief that he can quit if he chooses;in spite of numerous failed attempts;are also signs.
"But there are adolescents who have problems with drugs or alcohol who are not addicted," Reilly explains. "When they get older, sometimes they're able to use alcohol on a social basis and suffer no internal conflict or externally harmful consequences."
"In fact, a few of our graduates, like Corrine, are bartenders. An abuser or addict who doesn't use alcohol anymore and knows he doesn't have to can be around it, as long as he's emotionally stable." She adds that being around alcohol is usually very difficult for a recovered addict or abuser, and rare is the recovering adolescent who can be where there is liquor and abstain.
Nevertheless, the problem of
substance abuse and addiction among adolescents is still a serious
one. Although it hasn't reached the peak proportions it did in
1978-79, recent national statistics show a steady increase since
1991. Even more alarming is the rise in drug and alcohol use among
preteens and their increased use of tobacco products.
(New Jersey Report on Substance Abuse)
Reilly says the rise in cigarette smoking among youth is particularly distressing because cigarettes are considered one of the gateway drugs; a substance that generally leads to the use of harder drugs. Obtaining and smoking cigarettes, she says, is the perfect training ground for using marijuana. And for young girls especially, she adds, the effects of tobacco on the body can be extremely harmful.
Experts agree alcohol and drug abuse or addiction are complex problems that involve an interplay of variables including family and peer pressure, living environment and personality traits. A family history of abuse is also a major factor. Research shows there is a two to one chance that a child living with an alcoholic parent will also become alcoholic. Even worse, a pattern of social learning forms in an addictive or alcoholic family, Reilly says, that will go from generation to generation if not broken.
Society, too, is part of the problem. A former advertising executive herself, Reilly says: "Everywhere kids look, they're bombarded with ads intended to attract young people. And they make smoking and drinking appear to be so much fun. Take the Budweiser commercial with the frogs, for example. Added to that is the fact that most teens think they're omnipotent and love taking chances and seeking thrills."
Parents may also contribute without realizing it, she says, by sending a mixed message about alcohol use. Despite legal age limits for drinking, often kids are permitted to drink in select situations, such as at weddings or on holidays.
"Most kids get their first taste of alcohol at home," Reilly says. "For some, the next step is drinking with friends, and it goes from there."
A survey done in 1993 by The Johnson Institute;an organization dedicated to the treatment and prevention of abuse -; asked a cross-section of teens in 13 U.S. communities whether their parents had taken a firm stand against alcohol. Less than a third of the 10th graders had received a clear "don't drink" message. Some of the parents, it was found, bargained with their kids. They allowed them to drink, for example, if they promised not to drive while they were drunk. The research also showed that teens who were permitted to drink at home were more likely to use alcohol and other drugs outside the home, and to drive while intoxicated or high.
Reilly suggests parents keep communication open while being consistent role models and that they watch for dramatic shifts in their children's behavior and/or attitudes. Changes in eating and sleeping habits, school performance or personality could be symptomatic of a drug- or alcohol-related problem.
As for Amy, Cathie, Alan, Juan and the others in the Tuesday night group, Reilly knows from years of experience that not all of them will be as successful as Corrine. But, like her staff, she remains ever optimistic.
"Addiction and abuse are chronic illnesses that have high mortality rates and notoriety because of what people do when they're drinking or taking drugs," Reilly says. "But these illnesses can be arrested. They're not death sentences like virulent forms of cancer or some other conditions. They can respond to a brief course of treatment;usually a few months;if there is no severe or persistent mental illness involved. And a person can remain in an arrested state."
Talking about the actual success rate of the program, however, is difficult, she says, because success depends upon the measurement of various outcomes, including interpersonal function, rate of relapses and vocational function. Based on those criteria, TLC has a positive impact on about 70 percent of those who enroll. But, she notes, it's hard work: "While we're getting them to abstain we're trying to teach them all the things they didn't learn while having family or drug problems or both. That's a big job."
But it's not without its rewards, she says, especially when former clients, like Corrine, graft their recovery experience onto their lives. "We get flowers and letters at first when clients begin living normal, sober lives," Reilly says. "However, as they get better and better, they are no longer beholden to us. They feel they own their recovery. It was something they did for themselves, not something we did for them. And that's as it should be."