My daughter refuses to take the medication prescribed and continues to abuse drugs and alcohol. She repeatedly points out that she doesn't see any difference between a drug that the doctor prescribed to help her moods and the more "natural" approach that she chooses. How do I counter that?

One of the most common rationales teens give for their continued noncompliance is that they regard a prescribed psychotropic medication as synthetic and therefore unsafe and marijuana as natural and therefore safe. Additionally, because of that, they regard the psychotropic effects of marijuana as a reasonable alternative to continue to "medicate" their mood or anxiety disorder. How much of this is a lame excuse for continued use as opposed to a legitimate concern depends on the teen making the claim. As mentioned in Question 81, teens are ever on the prowl for what they consider hypocritical thinking and behaving on the part of adults, and this can be just another example of that.

First, the notion that because a drug is "natural" as opposed to "artificial" makes it healthier is rampant in our culture. Marketers have capitalized on this, and alternative medicine, herbal, and vitamin stores thrive on it. What makes something natural as opposed to artificial is often completely arbitrary, and the FDA has no control over this type of labeling. Second, even when we are able to distinguish clearly between compounds found in nature from those synthesized in a laboratory, there is absolutely nothing about any particular compound that makes one safer than the other for that reason alone. A compound is safe or dangerous based on its actions on the body and not based on where it comes from. Before the development of organic chemistry and our ability to synthesize chemical compounds, plenty of naturally occurring compounds were available that were well known to be either health giving or toxic. Many of the earliest poisons such as arsenic and strychnine are natural. Many opiates and hallucinogens are natural. Others are manmade. The earliest antibiotics were natural compounds. Many of the latest and most effective antibiotics are now synthesized.

Second, because an intoxicating substance is immediately pleasurable, it should therefore be used to aid with one's mood or anxiety is a notion discussed in previous questions (see Questions 67 and 68). Any immediate effects create a vicious cycle leading to addiction and long-term negative effects as previously outlined — including the underlying mood or anxiety disorder that the teen is now arguing can be treated with only marijuana. It is a paradox that the very substance that one claims to be helping his or her mood and/or anxiety is actually perpetuating it. Trying to remind the child of this fact can often be an exasperating experience. One's memory for events preceding the drug use and resulting mood swings is often lacking because of continued use. Medications used to treat the underlying mood or anxiety disorder, alternatively, have the opposite effect on mood from marijuana or alcohol. They have little to no immediate effects and are not immediately rewarding. They have potentially long-term benefits; they serve to stabilize mood and anxiety over time so that the issues of drug addiction can be dealt with more effectively. One has greater emotional resources to draw on when one's mood and anxiety level are stable.

Often, the issues of compliance have nothing to do with previous reasons. If your daughter is angry with you, what better way to express her anger than to refuse to comply? Teen rebellion is common at this age and may be part of the reason for her noncompliance. You and your daughter can explore why she feels the need to self-medicate with drugs or alcohol. Listen carefully without judging her. Ask her how you could best help her so that she does not have to turn to illicit drugs to deal with her distress. Speak to her physician about the problem, and elicit his or her cooperation in working with you to address her noncompliance. Ask the physician to discuss in greater detail the medicine he or she is prescribing, including what it is for, how it is expected to be helpful, and how long it may take to reach its maximum effectiveness. Side effects and drug interactions should also be addressed. Let an alliance form between her physician and her so that she owns the decision. Help her to begin to assume greater responsibility for her medication and psychotherapeutic care so that the issue of noncompliance is less likely to be viewed as a rebellious act against you. If, however, she still cannot comply, then a different, more comprehensive approach is needed. The search for a drug and alcohol program for teens should be the next step.

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