The connection between drug use and youth violence has been well documented. The 2001 National Household Survey on Drug Abuse noted that this relationship is “strong,” and more recent data from this survey (now called the National Survey on Drug Use and Health) indicate that youths ages 12 to 17 who used an illicit drug in the past year were almost twice as likely to have engaged in violence as nonusers were. After working in adolescent residential treatment settings for more than nine years, I began to get the picture: Teens, drugs, and fighting are intertwined, yet something else is happening in this mix.
Chris Bowers, MDiv, CSAC
First note that adolescents show at least four patterns in using and fighting:
Use of alcohol or drugs followed by loss of control and getting into an unplanned fight
Use before a planned fight, whether or not a specific opponent is in mind
Substance use that prompts more aggression in attitude and behavior because of weakened inhibitions, increased irritability, and lowered motivation for self-control
Using right after a fight to calm down
With using and fighting, two urges mix: Thinking about using and aggressive behavior become crossed. The adolescent may view quitting the fighting as a bad option, and quitting drug use without stopping the fighting can be seen as “dumb.” The “I just can't stop myself” awareness is real to the teen about both behaviors, yet feeling stuck and unable to “just quit” repetitive fighting can become a problem.
There is a point at which the fighting takes on a life of its own. Like the advance of substance misuse, it becomes compulsive and chronic. In the words of one adolescent I've spoken to, “I just wake up in the morning wanting to fight someone.”
In the treatment setting, I have found that if teens can see where they could go in positive behavior change, they might be able to start going there. I have had success in using a printed “self-dialogue model” in assisting adolescents to stop fighting. The stages in this model include self-talk that adolescents might have as they confront their aggression and need for change.
The model marks out a possible recovery pathway for compulsive fighting by assisting a separation between the feeling urge and a course of action steps in self-help. One approach I have taken over many weeks is to ask teens to write their name and date next to the stage where they see themselves in this change journey. Here is an overview of these stages:
Fighting to fight.“I want to fight. I've got to fight. Who can I fight?” One teen described being in this stage: “When I am irritated, I just want to fight…. It doesn't have to be the person who made me mad. I just carry it, then flip.” As with most change, discontent about the outcome of the behavior offers the place to start in treatment. Clinicians can focus discussion on the teen's internal friction over what happens because of the fighting.
Thinking there may be reasons not to fight.“Maybe I can't keep on fighting. Are there reasons not to fight? Do I have any reasons that are strong enough?” As is the case with finding reasons not to use drugs, the teen must explore what is valuable or scary enough to prompt avoiding a fight. Keeping this before the adolescent will start providing a counterweight to the aggression impulse and a renewal of healthy, value-based decision making.
Deciding on the right reasons to stop fighting.“There are some people I care about, and they have expectations for me. I do have some reasons to avoid fighting, but why should I?” In therapy this may be a process of elimination: helping the adolescent to make a list of reasons to avoid fighting and see what he/she easily writes off; the reasons left may be the beginning of what will motivate change. This is the fuel in therapy discussion about the right reasons to stop fighting.
Finding out how to avoid fighting.“I think I need to stop this, but I don't know how to stop. I keep repeating it. I feel stuck in it. What can I do?” Stopping aggressive behavior is a journey and a challenge. The adolescent will need supportive encouragement when trying to “do good” for a while but falling back into aggression, even wanting to give up. Exploring what to do, raising new ideas, and affirming the teen's effort to deal with fighting are important at this stage.
Trying ways to stay out of fighting.“I'll talk about it, let myself feel guilty about it, avoid people who want to fight. I decided to not fight, but I did anyway. I keep doing it anyway! Maybe if I just walk away….” With any decision made to change, the old behavior continues. Whatever is tried and works at first may not stay atop the list of considerations, so experimenting with different ways to stop fighting helps. The clinician can work with the adolescent to walk through the decision and action steps resulting in a failure to live up to the commitment to change. Short-circuiting the flow of thinking and behaving that makes the adolescent vulnerable to repeating aggression, with talk about self-help alternatives, will support the teen's emerging confidence about avoiding a fight.