What brought me here? You mean all the drugs I used?" asks Crystal.
She is sitting on a folding chair a rehabilitation center. But the defiant set of her mouth is a poor mask for the unresolved emotions that brought her here and still roil within. Growing up in a home marked by violence and drug use, Crystal, now 15, believed she should live up to a different standard: good grades and excellence in sports.
She believed she was failing. So she gave up on herself.
"I didn't like myself. Whatever I could do to change, I wanted to do it," she says flatly. Drugs were her first choice.
Crystal is one among an alarming number of high-school girls who are abusing drugs, most commonly to medicate emotional problems involving body image and self-esteem. An upsurge in girls seeking treatment for addiction - an illness often compounded by an eating disorder - has forced local counseling centers to tailor their treatment strategies to address girls' unique problems.
In studying girls and addiction, researchers have identified a number of issues unique to them. Girls, for instance, become addicted much more quickly than boys.
Crystal is a case in point. "In seventh grade, I started drinking, and then I didn't like that anymore, so I started to smoke weed," Crystal says. "I started throwing up in eighth grade, and I started using K to lose weight. You don't eat when you take it."
Crystal, a pseudonym chosen by the East Setauket, L.I., girl at her parents' request, is referring to ketamine, one of a variety of drugs girls are using to get high and suppress appetites that threaten their chances of living up to the unrealistic standards they see in magazines and on TV.
Tall, ivory-skinned, with long red hair and meticulously applied makeup, Crystal cultivates the appearance of a grownup. But the glittering purple polish on her manicured fi ngernails reveals a more adolescent sensibility. "You look in the magazines and the girls are perfect," she says.
As is the case for many of the girls being treated in the metro area for drugs and eating disorders, the emphasis Crystal placed on looking like a model was a mask for more complicated self-esteem issues. Sniffing K up to seven times a day and smoking cocaine-enhanced marijuana
when she couldn't fi nd ketamine, Crystal came to feel insecure without the drugs.
A little over a year ago, she tried to commit suicide. "Unless I was high, I was depressed," she says simply. "It wasn't me anymore after a while. It was just the drugs."
Crystal's loss of her sense of self is among the particular effects of drugs on girls - and one of the many consequences they must overcome to be successfully treated.
MORE VULNERABLE
Other gender-specifi c realities play into their experience, as well. Girls move faster from experimentation to addiction than boys. They are quicker to get hooked on nicotine, will get drunk faster than a boy who drinks the same amount of alcohol and will experience greater cocaine dependence. They are more likely to suffer Ecstasy-induced brain damage and be hospitalized for prescription-drug abuse. And they often engage in dangerous sexual encounters to pay for their addiction.
"The glamour it gives off is an illusion, because the things you have to do to get it are disgusting," says Jackie, a 16-year-old Staten Island girl being treated at Pennsylvania's Caron Foundation for problems with cocaine and anorexia.
Without a trace of emotion, she ticks them off: "Steal. Pretend I was going to have sex with somebody. Have sex with somebody sometimes.
"I've gotten beat up. I was almost raped four times."
The legal system seems to be recognizing these ripple effects. For example, eighteen-year-old NYU freshman Julia Diaco was arrested last month for selling marijuana. Such recognition may partially account for the growing numbers of girls in drug-treatment programs.
"There's not as much leniency as there used to be, maybe because you see the results - prostitution, pregnancy and suicides,"says Kim Terero, assistant director of Daytop's adolescent program in Huntington.
"The courts are taking a much closer look at the females and what's going on."
The responses of parents and the school system are less uniform. Crystal says she was thrown out of school twice - she was getting C's and D's, skipping class and getting in fi ghts when she was high. But others say many schools are not as firm or as quick to get help for their
students.
"Their parents grew up in the '60s and '70s and the cocaine '80s, and there's not a strong value that using drugs is unacceptable," says Denise Murphy, director of the outpatient adolescent program at Manhattan's Phoenix House. "Out of all the people we offer a spot to, 70% decline the offer because the parents don't feel the use is that bad."
A DIFFERENT AGENDA
Money also is an issue. Sometimes private schools don't force students into treatment because they don't want to lose their tuition, say Murphy and other counselors who work with the city's independent
schools. Although there are not many adolescent-based treatment programs in general and even fewer dedicated to girls' special needs, some facilities are starting to think about how to respond to their female patients, says Susan Foster, vice president and director of policy research analysis at the Center for Addiction and Substance Abuse at Columbia University. While the counseling strategies used to get boys and girls off drugs are the same, both genders need extra attention in specific areas.
For example, counselors might spend more time addressing anger management and sexual compulsivity among boys than they would among girls. Conversely, they might dedicate more time to eating disorders, sexual trauma, depression and other mental illnesses in girls than they would in boys.
They might also counsel them in samesex, rather than coed, groups. Some experts believe girls should be treated by women and boys by men.
"Women, because of our culture, tend to defer to the men and focus on helping the man talk about his own feelings. As a consequence, they'll miss talking about themselves," says Nancy Waite-O'Brien, vice president of clinical services at the Betty Ford Center, which was one of the first facilities to adopt a gender-specific approach to drug treatment.
"The women will try to measure up to what the masculine values are. They'll edit things they perceive as unattractive or things like sexual abuse or physical abuse," she says. "That doesn't happen so much when the women are together. If they're tracking with women, they'll get
something they've never gotten, and that's a woman mentor."
A MORE STUBBORN PROBLEM
Treating accompanying eating disorders often is more challenging. Girls have been bombarded with images of superthin, large-breasted and otherwise flawless women for years, leading to deeply rooted notions of beauty, says Dr. Robert B. Millman, director of drug- and
alcohol-abuse services at New York Presbyterian Hospital. Yet those beliefs don't necessarily go away when girls sober up, especially since getting clean often leads to weight gain.
Moreover, many girls develop an eating disorder almost by accident, either when they take cocaine or amphetamines recreationally, or when they take prescription medications such as Ritalin for attention-deficit disorder or attention-defi cit hyperactivity disorder. All these drugs suppress the appetite, giving girls the unexpected"bonus" of thinness, Millman says.
"Often these drugs do improve their school performance and concentration. While they're feeling the effects, their appetite goes down and they lose weight," Millman says. "When the effects wane
and you get tolerant, your appetite returns with a vengeance.
"It's a complicated issue because many programs have to do with saying, 'I'm powerless over the drugs, I have to stay away from them.' But food is necessary, you can't stay away from the food," he says. "The eating disorder tends to be more resistant to change; it persists when the drug use is taken care of. Many women who had an eating disorder move on and are fi ne. But they'll say they are always conscious of these issues."
Nine months into treatment, Crystal no longer fi ts into pants that once sagged on her hips. Grossed out by her bulimia, she was able, without treatment, to stop throwing up and says she has no interest in doing it again.
But it's unclear how she really feels about her body. "I've been jogging. I'm trying to fi nd other ways to lose weight," she says, then adds, "I could be skinnier, but I feel fine the way I am."
Late at night, Crystal lies awake thinking about the last four years of her life, and she cries. "I could've been dead right now," she says. "I'll be like, 'What did I do? I could have not done that and stayed in
school.'
"This place saved my life, literally," she says. "I'm positive I can stay clean. That's not the hard part. It's dealing with high school and my parents. I can get through that, so I'm hopeful.".
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