Perhaps the most prevalent cultural myth in America is that money and professional success are salves that heal what ails us. When substance abuse strikes in a culture of affluence, the American dream of wealth and power quickly turns into a seemingly unmanageable nightmare.
This article will address the treatment of affluent adolescents with substance use disorders through a family systems approach. This approach considers not just the “problem adolescent,” but also the family dynamic within which the adolescent is raised. To accomplish this objective, the major psychosocial risks unique to adolescents from affluent families, as well as the challenges that the professionals who treat them face, will be addressed. Finally, through a case study, this article will provide a real-life example, thus offering suggestions for working with this population.
Although it is commonly believed that children from highly educated, affluent families constitute a “low-risk” population, several studies have found that these youngsters are as susceptible to substance use disorders as adolescents from lower socioeconomic “high-risk” populations.1,2 There are several reasons for this. The first maintains that children from affluent families must manage achievement pressures from their successful parents and siblings. In this context, the message that affluent children receive from their perfectionist parents is that failure to succeed equals personal failure.
This overemphasis on accomplishments while underemphasizing personal character and resiliency leads to increased rates of anxiety and depression, which in turn lead to higher rates of substance use. The theory is that these pressured children use substances to “self-medicate” intolerable emotions.3
The second reason offered for increased rates of substance abuse among affluent youth is that these children frequently are isolated from the parental figures in their lives. This isolation manifests itself both in a literal and emotional context. While wealthy parents are out of the house pursuing their careers and the trappings of wealth, their children frequently are left alone or in the care of professional caregivers. Without parental figures in their lives, these children are hungry for firm yet authentically compassionate role models.2
In addition, studies show that affluent children frequently feel emotionally isolated from their parents even when their parents are physically around. In their own self-absorbed drive to succeed, affluent parents fail to provide their children with the unconditional nurturing that is so essential to their growth as assured and confident human beings. Again, this isolation leads to increased levels of anxiety and depression, which in turn lead to unhealthy ways of coping with unacceptable feelings.4,5,6
Just as affluence is too frequently celebrated as a substantive quality possessed by the privileged, substance abuse and imperfection are still too frequently stigmatized as a moral failing or character weakness that affects lower socioeconomic classes. As a result, affluent parents feel a great deal of shame in admitting that there may be a substance abuse problem in their family. This view keeps the problem hidden deep behind the family’s manicured façade, impairing the willingness to seek treatment.2
This misplaced belief that “if it looks OK, then it is OK” leads to affluent families turning a blind eye to telltale signs of problems and denying when problems exist. One of the most common ways this denial manifests itself is in overscheduled days and additional academic pressures. Although often grounded in the family’s genuine concern to see the child succeed, these pressures continue in spite of the child’s cries for help. In these families, an idle mind and body are seen as the “devil’s playground.”
At the heart of this hyperactivity is the fear that if they slow down or stop, family members will be overwhelmed by the truth and will be forced to address issues that they are unwilling or unprepared to handle. So instead of addressing nascent problems when they emerge, families driven to succeed try to cover unwelcome tracks with a whirlwind of activity.
And it is not just the affluent family system itself that is challenged by wealth and success. The outside systems that treat affluent adolescents are often faced with obstacles to effective care. These challenges include dealing with the families’ exaggerated privacy concerns, overly pressured lifestyles, and denial of the problem.7,8 As a result, these professionals frequently hesitate to report their concerns to affluent parents for fear of resistance, intimidation, or even the threats of a lawsuit.
As a result, research has found that affluent youth too frequently have less access to school-based counseling services than economically disadvantaged students.9
Several months ago I received a call from a 46-year-old mother of an adolescent son and daughter. The mother requested a family session “to get her husband into treatment.” In a pressured voice, she told me her husband was using cocaine and she saw his use as a negative influence on “her” children. Apparently, the 14-year-old son had been caught smoking marijuana in the bathroom of his exclusive prep school and was in serious academic trouble.
The mother warned me that her husband was “difficult” and that they “had been down this road before.” Although she had never met me, she asked during our initial call “if I thought I could handle [her husband].”
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