The final issue on anxiety deals with adolescents who have come to be dependent on alcohol and other drugs. Dealing with this population requires many techniques, patience and remembering that you, the counselor, are trying to take something away from them that has worked for some of them for years.

These kids have already been given a mental health diagnosis and a chemical dependency diagnosis of abuse or dependence. As a counselor for many years with this population, the diagnosis of “oppositional defiance” fits 60 to 80% of the kids from 10 to 19. If I said “good morning,” to any male or female, some, a small percentage, would go back to bed and shut the door behind them. If they wanted something from you as their counselor, but hadn’t put the work in like their peers, they could be as charming as any adult, trying to play you, and demonstrate even though they are 14 years old, as the greatest actors and actresses in the world. Many of you as adults that do not have children will not understand this. My recommendation would be, talk to a mother and father with five children, or one child.

The fact that in trying to curb anxiety with alcohol or other drugs, it has created major problems in school, with the family, with law enforcement, socially with their peers, but the topper is with their own self-care and self-worth. Suicidal behavior and risk-taking negatively fit in with their thinking that stopping chemical use is to be avoided at all costs. I used to give them a list of physical activities, hobbies, household chores, writing, reading, listening to music, other than what fits in with the drug lifestyle.

In most cases, the urge to get drunk or high supersedes all other activities, even sex.

Gradually, as they stopped using in halfway housing or 28 to 42 day treatment, some began to feel the shame and guilt that their addiction had brought on them.

As a chemical dependency counselor, these kids become like your children and you want the best for them. Getting their best requires patience, fortitude, and consistency. Blowing off homework, rules of social behavior, perfectionism, as a counselor being inconsistent in responding to a child’s needs will reinforce his or her anxiety cycle. I have found in teaching, coaching basketball and counseling being consistent to what has been agreed upon will let the client know that the boundaries matter. If you’re inconsistent and give in, they will keep pushing you until they get what they want. The problem with many parents whose children keep pushing them, is that they have to suffer through this until it passes. I used to tell parents, “this, too, shall pass, and don’t let them rent space in your head.”

So here I am with an adolescent that has been to other treatments without success. In treatment, we have something we call “creative space” for difficult conversations. These include topics like sex, drugs, smoking, drinking, pornography, suicide and bullying. My first response to them, even though they’ve been through it, is asking open-ended questions, like “Xan you tell me more about your use of cocaine?,” or “after that happened, what happened next?,” or “what have you tried before?,” or “what do you give up if you do what you’re thinking?,” or “what are you anxious about today?,” or “did anyone make fun of you today?”

A word to anyone asking open-ended questions as a counselor or parent, shut your mouth and listen. What you’re looking for can be brought forth in other sessions. What are the feelings of anger, rage, shame, guilt, anxiety, depression and fear? Even if you are appalled by some of their answers, the experience of being a counselor with young people is that eventually nothing they can tell you is awful, terrifying or terrible. I may not agree with much of what they say, but I’m looking deeper for things like physical, mental or sexual abuse that has pushed many of them as to where they are now. Listening without interruption, watching their eye contact, body language and questions leading to “I’m asking you about suicide and this appears hard for you to respond. Could you tell me more?”

Counselors, like parents, have to learn to cope with their own anxieties. For example, I had a female that identified herself as gay and a male as homosexual. This was early in my counseling career. Since I was new to both lifestyles, we pursued the positive and negative aspects of gay and homosexuality. For me, by listening to both, I learned more about my adolescents’ lifestyles than any book could have ever taught me. When I validated both for enlightening me as a new counselor and listened to them without being judgmental, a certain amount of trust between counselor-client was born, validating negative emotions like sadness, shyness, anger and fear. Negative emotions are part of life also. But not to the extent that alcohol and other drugs act upon a child’s thinking and feelings.

Like anything we do in treatment, I try to validate them, because usually their own sense of self-worth is zero. However, this never means that you, as a counselor, don’t hold them accountable, because then you are enabling, and enabling is how they got here. Be firm, but fair, praise anything you think has been important to them. Realize this is uncharted water for many counselors and not everyone should be allowed to work with these kids if it’s “us vs. them.”

If any of your parents would like to know more, or want a head’s up on certain literature, my number is at the end of this article.

Mike Tramuta is a Rational Emotive Behavior Therapy instructor. He can be reached at 716-983-1592.