Dr. Stanley Goldstein - Author and Psychologist

The alleged "mystery" of substance abuse is well-known: that, after using an illicit drug or alcohol, one feels better though these are habits which are best left unacquired.

The etiology of substance abuse is not to be found in genes but in early life experience. Substance abuse usually begins during adolescence though, rarely, it begins earlier or later.The basic ego capacities, those governing control of thinking and behavior, are created beginning in infancy and, for their successful development, require a "good enough"  though not perfect parenting. When lacking, the child will have difficulty surmounting the critical adolescent tasks of separating from parents, developing a sturdy sense of who they are ("sense of self"), dating, and making sound education and career decisions. If unsuccessful at these and seeking relief from stress, some turn to alcohol or drug use for relief. Which does work though at great cost to health and emotional stability. Psychological treatment is required to heal the personality deficiencies but this, unlike the substance, requires time and why many fail substance abuse treatment.

Better and more widespread parenting education is one solution to this problem, to stop childhood based problems from developing early and provide earlier mental health treatment when needed. Another is more substance abuse education beginning in the early years. One six-year-old girl said, apropos of nothing as we played a board game, "Don't use drugs. They're bad!" Her mother later told me she had a DARE (Drug Abuse Resistance Education) class that day.

The developmental origin of drug abuse has long been known. Early in life a child develops the basic ego capacities governing human functioning: the ability to control their thinking and behavior; the ability to modulate their mood; the ability to distinguish reality from fantasy; and their development of the sense of who they are or, as it is termed, their "sense of self."

No one experiences perfect parenting but if it was greatly inadequate a weakness of one or more of these capacities develop. This can cause difficulty with paying attention in school, socializing, and enabling later success with the critical development tasks of adolescence: dating, gaining appropriate separation from parents, and constructing realistic educational and vocational goals. These failings cause distress and, with some youth, the attempt to alleviate it using alcohol or drugs.

Substance abuse occasionally begins earlier or later but mostly during adolescence. Treatment is difficult because undergoing psychotherapy to heal the underlying personality issues that cause the substance abuse takes time while using a drug lessens pain quickly. The need for many episodes of in-patient treatment to become "clean" begins their life-long struggle to remain so. Longevity is not associated with substance abuse.

This article was inspired by my reading in The Wall Street Journal ("The Dark Side of Addiction Recovery for the Rich"/Feb. 16, 2025).