A second emotional pathway to alcoholism comes from a high level of agitation, impulsivity, and boredom. This pattern shows up in infancy as being restless, cranky, and hard to handle, in grade school as having the "fidgets," hyperactivity, and getting into trouble, a propensity that, as we have seen, can push such children to seek out friends on the fringe—sometimes leading to a criminal career or the diagnosis of "antisocial personality disorder." Such people (and they are mainly men) have as their main emotional complaint agitation; their main weakness is unrestrained impulsivity; their usual reaction to boredom—which they often feel—is an impulsive search for risk and excitement. As adults, people with this pattern (which may be tied to deficiencies in two other neurotransmitters, serotonin and MAO) find that alcohol can soothe their agitation. And the fact that they can't stand monotony makes them ready to try anything; coupled with their general impulsivity, it makes them prone to abusing an almost random list of drugs besides alcohol.58
While depression can drive some to drink, the metabolic effects of alcohol often simply worsen the depression after a short lift. People who turn to alcohol as an emotional palliative do so much more often to calm anxiety than for depression; an entirely different class of drugs soothes the feelings of people who are depressed—at least temporarily. Feeling chronically unhappy puts people at greater risk for addiction to stimulants such as cocaine, which provide a direct antidote to feeling depressed. One study found that more than half the patients being treated at a clinic for cocaine addiction would have been diagnosed with severe depression before they started their habit, and the deeper the preceding depression, the stronger the habit.59
Chronic anger may lead to still another kind of susceptibility. In a study of four hundred patients being treated for addiction to heroin and other opioids, the most striking emotional pattern was a lifelong difficulty handling anger and a quickness to rage. Some of the patients themselves said that with opiates they finally felt normal and relaxed.60
Though the predisposition to substance abuse may, in many cases, be brain-based, the feelings that drive people to "self-medicate" themselves through drink or drugs can be handled without recourse to medication, as Alcoholics Anonymous and other recovery programs have demonstrated for decades. Acquiring the ability to handle those feelings—soothing anxiety, lifting depression, calming rage—removes the impetus to use drugs or alcohol in the first place. These basic emotional skills are taught remedially in treatment programs for drug and alcohol abuse. It would be far better, of course, if they were learned early in life, well before the habit became established.
NO MORE WARS: A FINAL COMMON PREVENTIVE PATHWAY
Over the last decade or so "wars" have been proclaimed, in turn, on teen pregnancy, dropping out, drugs, and most recently violence. The trouble with such campaigns, though, is that they come too late, after the targeted problem has reached epidemic proportions and taken firm root in the lives of the young. They are crisis intervention, the equivalent of solving a problem by sending an ambulance to the rescue rather than giving an inoculation that would ward off the disease in the first place. Instead of more such "wars," what we need is to follow the logic of prevention, offering our children the skills for facing life that will increase their chances of avoiding any and all of these fates.61
My focus on the place of emotional and social deficits is not to deny the role of other risk factors, such as growing up in a fragmented, abusive, or chaotic family, or in an impoverished, crime-and drug-ridden neighborhood. Poverty itself delivers emotional blows to children: poorer children at age five are already more fearful, anxious, and sad than their better-off peers, and have more behavior problems such as frequent tantrums and destroying things, a trend that continues through the teen years. The press of poverty corrodes family life too: there tend to be fewer expressions of parental warmth, more depression in mothers (who are often single and jobless), and a greater reliance on harsh punishments such as yelling, hitting, and physical threats.62
But there is a role that emotional competence plays over and above family and economic forces—it may be decisive in determining the extent to which any given child or teenager is undone by these hardships or finds a core of resilience to survive them. Long-term studies of hundreds of children brought up in poverty, in abusive families, or by a parent with severe mental illness show that those who are resilient even in the face of the most grinding hardships tend to share key emotional skills.63 These include a winning sociability that draws people to them, self-confidence, an optimistic persistence in the face of failure and frustration, the ability to recover quickly from upsets, and an easygoing nature.
But the vast majority of children face such difficulties without these advantages. Of course, many of these skills are innate, the luck of genes—but even qualities of temperament can change for the better, as we saw in Chapter 14. One line of intervention, of course, is political and economic, alleviating the poverty and other social conditions that breed these problems. But apart from these tactics (which seem to move ever lower on the social agenda) there is much that can be offered to children to help them grapple better with such debilitating hardships.
Take the case of emotional disorders, afflictions that about one in two Americans experiences over the course of life. A study of a representative sample of 8,098 Americans found that 48 percent suffered from at least one psychiatric problem during their lifetime.64 Most severely affected were the 14 percent of people who developed three or more psychiatric problems at once. This group was the most troubled, accounting for 60 percent of all psychiatric disorders occurring at any one time, and 90 percent of the most severe and disabling ones. While they need intensive care now, the optimal approach would be, wherever possible, to prevent these problems in the first place. To be sure, not every mental disorder can be prevented—but there are some, and perhaps many, that can. Ronald Kessler, the University of Michigan sociologist who did the study, told me, "We need to intervene early in life. Take a young girl who has a social phobia in the sixth grade, and starts drinking in junior high school to handle her social anxieties. By her late twenties, when she shows up in our study, she's still fearful, has become both an alcohol and drug abuser, and is depressed because her life is so messed up. The big question is, what could we have done early in her life to have headed off the whole downward spiral?"
The same holds, of course, for dropping out or violence, or most of the litany of perils faced by young people today. Educational programs to prevent one or another specific problem such as drug use and violence have proliferated wildly in the last decade or so, creating a mini-industry within the education marketplace. But many of them—including many of the most slickly marketed and most widely used—have proven to be ineffective. A few, to the chagrin of educators, even seemed to increase the likelihood of the problems they were meant to head off, particularly drug abuse and teen sex.
Information Is Not Enough
An instructive case in point is sexual abuse of children. As of 1993, about two hundred thousand substantiated cases were reported annually in the United States, with that number growing by about 10 percent per year. And while estimates vary widely, most experts agree that between 20 and 30 percent of girls and about half that number of boys are victims of some form of sexual abuse by age seventeen (the figures rise or fall depending on how sexual abuse is defined, among other factors).65 There is no single profile of a child who is particularly vulnerable to sexual abuse, but most feel unprotected, unable to resist on their own, and isolated by what has happened to them.