Adolescent Corner

Welcome to the adolescent exhibit. Here you will find writings by adolescent expert Fred Dyer, PH.D, CADC. These articles will provide pertinent information on the prevention, intervention and treatment of African American adolescents with substance use disorders.



Dr Carl Bell Image 3.jpg

While preparing and gathering materials and articles for some upcoming conference work in Florida, and Georgia, I continued to come across articles written, or co-authored by Carl C. Bell, MD, who died on Friday, August 2, 2019 and whose memorial service will be this Friday August 23rd, at a church on the south side of Chicago. Regrettably I will not be able to attend the service due to being out of town. Nevertheless how clearly I remember that for thirteen years from 1999 to 2012, that I would take the red line train in Chicago, from the north side of town to 87th street on the south side, get off the train, and then catch the 87th street bus down to 87th and Constance avenue to Community Mental Health Council Inc where Dr. Bell was President and CEO. Dr. Bell is my mentor. Sometimes we would talk 5 minutes, or a half hour. On a few occasions our talks/discussions would last an hour. These talks/discussions would always be the first two weeks of the first month of the New Year. Talks with Dr. Bell would always center around child and adolescent issues, as well as juvenile justice issues.

Several things stand out for me as I write this post on my years of speaking, and more importantly learning from him. One, like many super successful people Dr Bell successfully juggled multiple tasks. He was President, and CEO of Community Mental Health Council Inc., a medical school professor, Director of the Illinois Juvenile Research Institute, a family man, and someone who was forever writing, and writing, and writing. I can recall quite clearly being in his office in January of 2007, and asking him, as busy as you are, how do you find the time to write as much as you do? His answer was profound, yet simple. He stated, that  in medical school you stay up and studying until  12 or 1 in the morning, and then you are right back up again at 4 or 5 am  studying again. In the dozens of  articles which I have written , Dr. Bell provided a strategy  for writing articles , which I have used in  my work for years.  Something else which I learned from  Dr. Bell is that the work of helping children, adolescents, and families is so serious and important and  is truly about saving lives! I learned from him that putting the time in to do the work, through reading, studying, asking the right questions, and not settling for fluff  answers is essential for those individuals who are in fact serious about this work. Lastly  of course I could go on, and on, and on, but the final thing for me about Dr. Bell was his willingness to sharing materials, or his wiliness to pointing you in the direction to put your hands on the material.

There is no doubt that there are several additional things I could say about Dr. Bell who has contributed , and shaped my career as a trainer, consultant, therapist, and executive director, but I will stop right here and say, I, like the hundreds he taught, shared and gave of himself to, that he will be missed, and that the psychiatrist , medical school professor, executive director, writer is gone, but the conversations he and I had are in my head, and in my heart,  and he’s gone but his work, and writings  on mental health, African Americans, children, adolescents, violence prevention will  live on.  We can continue to learn from his work.

African American Adolescents, Substance Use, and Suicide

In 2006, suicide was ranked as the 11th leading cause of death among persons aged 10 years and older, accounting for 33,289 deaths. However, suicide is the third leading cause of death among individuals aged 15 to 24. It accounts for 12% of all deaths annually within this age group in the United States

{Center for Disease Control (CDC}, 2010). Although overall rates of suicide attempts among adolescents declined from 2001 to 2007, rates among African American adolescents did not. In 2009 African American adolescents reported higher rates of suicide attempts than Caucasian adolescents (CDC, 2010). Key risk factors for suicide among youth include presence of a psychiatric disorder, a family history of suicide and psychopathology, stressful life events, access to firearms, lack or absence of a soothing interject, and substance use and substance use disorder. Dragisic, Dickov, Dickov, & Mijatovic 2015 inform us that people who abuse alcohol and or drugs or are dependent on them, attempt suicide nearly six times more often than people who do not abuse these substances. The rate of completed suicide among persons addicted to alcohol and drugs is 2 to 3 times higher than individuals, who are not addicted to alcohol and drugs,

Risk factors are defined as those characteristics that increase the likelihood that a person develops psychopathology or a problem behavior (Tebes et, al2001). Although some risk factors for suicide differ across racial and ethnic groups, depression is consistently identified as one of the most significant risk factors associated with adolescent suicidal behavior (Colluci &Martin et, al 2007). In a report  titled Reducing Suicide: A National Imperative 2002, by the Institute of Medicine, the report reminds those of us who are working with youth , of the very strong link between alcohol use prior to suicide and firearm use among youth less than 20 years of age. Teenage suicide victims who use firearms to complete suicides are 4.9 times more likely to have been drinking than those who used other methods. Additionally family dysfunction and personality traits can contribute to the effects of alcohol and substance use on suicide among youth.

The psychological variables of suicide that have been studied in relation to suicide among youth include  memory and Cognitive Distortions, Hopelessness and hope, self- efficacy, locus of control, and Coping style and Affect Regulation.  The aforementioned psychological variables are essential areas of intervening, or in attempting to interrupt or address the psychological variables. Bell&Clark, 1998 in their article entitled  Adolescent Suicide remind us of two specific results or outcomes of adolescent suicide. The first result of completed  adolescent suicide is the loss of potential is no longer present, and the second outcome or result is the trauma the suicide causes the family, because a lot of adolescent suicides take place  in the home.  The trauma is caused by the family discovering their loved  ones body in the home. Carl C. Bell MD, provides the following  protective factors which are useful in reducing adolescent violence , as well  as useful in suicide prevention among African American adolescents. 1. increase the adult protective shield, 2. increase activities which increase  a sense of power, 3. increase and utilize social emotional skills, 4. utilization of modern technology, 5. social  fabric, 6. increase the ability to minimize trauma, and. 7. strengthen their connectedness.  It is important that  in working with adolescents that we as caring, empathic, professionals find a way to get them to hold on because a change is coming. Click on the link below to hear the song by the group Sounds of Blackness. 


 Positive Youth Development, and African American Substance Using Adolescents

Positive Youth Development (PYD) focuses on protective factors or assets of youth and adolescents (Scales et al.2005: Schwartz et al.2007:Learner et al.2005:Theokas et al. 2005). PYD embraces  the concept of youth  as having the capacity to thrive. It is defined as fulfilling one's potential and contributing positively to one's  community (Edberg 2008). In short, PYD emphasizes the potential of each adolescent. This view/approach represents a much needed  shift away from earlier conceptualizations  of youth as broken, dangerous, and problems to be managed, as well as a shift away from a deficit model, which understood positive development as the absence of negative or risk behaviors such as drug use, truancy, delinquency (Learner 2005: Learner et al 2013). Many models of interventions prior to the early 1990's focused  almost exclusively on reducing risk exposure (Learner 2005). With aforementioned  as a backdrop, or context, there is an important question which should be asked or explored as it relates to working with African American Substance Using Adolescents, and that is, how does Racial and Ethnic Protective Factors contribute to PYD and to the Promotion of Ethnic Minority Youth Development in addressing substance use?

In any work with adolescents, it is always necessary to gauge or asses where the adolescent is in relation to being connected to his/her family. The term used to connote such a connection is Familism. Familism encompasses a youth’s sense of family identification, solidarity, cohesion, and duty, as well as support received from the family (Gil, Wagner,& Vega). Further, more research has found that familial values attenuated the association of discrimination with risky behaviors, including substance use. Time and space as usual does not permit me to turn this blog into an article. However I would be remiss if I failed to  mention  or at least cite the significance of ethnic and racial identity, ethnic-racial socialization, and cultural orientation and how it can impact  an African American Adolescent's {PYD}, which can impact  his/her risk for using substances. First, these factors may bolster youth’s self concept. All three constructs are found to contribute to ethnic minority youth’s perceptions of their competence and adequacy. Second, there is evidenced that each of the protective factors may play a role in the cognitive appraisal process-how youth attend to, understand , and make sense of the world. Ethnic-racial socialization processes prepare youth  to perceive the world  in a certain way, while ethnic and racial identity and culture  may inform  the salience and significance of discrimination which has been demonstrated from various studies  to serve as a risk factor for substance use.

Lastly, Coping appears to be a critical intermediary process in the promotion of youth outcomes. Umana-Taylor et all., 2008, suggest that ethnic and racial identity, and ethnic racial socialization may facilitate the development of specific adaptive coping skills which help youth negotiate ethnic and racial discrimination. Similarly, cultural orientation and values such as familism may equip youth  with specific resources that help them cope. In summary, PYD seeks  to prepare young people to meet the challenges of adolescence, and help them obtain the emotional, ethical physical and competencies thru "asset" and resiliency building and to encouraging them to  as the recording artist Wee Gee reminded all the 8th grade  students in Chicago, Illinois, back in 1981, who were graduating into the 9th grade at their graduation ceremony in his song in unity " Children Hold On To Your Dreams" Click on the link below to hear the song. 

Treatment Needs of African American LGBTQ Substance using Adolescents

LGBTQ youth constitute a minority group for whom concerns at one time were salient during adolescence. But now clinicians, counselors, schools , and school districts are beginning to address and pay attention to those adolescents who are not only struggling with the question of "Who Am I individually, but  Who Am I in terms of my sexual identity.  African American Substance Using LGBTQ Adolescents not only have to address  the typical identity tasks of any adolescent, they also have to address issues of racism, oppression and homophobia, at the issue in light of school, with friends, family and the larger community.

Some adolescent may find homophobia frightening and try to deny feelings of attraction to the same sex peers. African American LGBTQ Substance using youth as mentioned earlier, must also deal with the stress of racial discrimination, face the additional challenge of developing an identity that reflects both their racial or ethnic status and their sexual identity can be a contributing factors to heavy substance use.

In addressing the issue of substance use the two important areas of focus are the schools, and most certainly the family. There is a saying in working with adolescents which I heard over 20 years ago, "the way you help a teen is by helping the family." When adolescents experience anti-LGBTQ victimization in school, it could change their positive feelings towards school and peers in a manner that facilitates increased substance use. According to research, LGBTQ youth report less”school belonging" (a construct similar to attachment) relative to heterosexual students (Rostosky, Owens, Zimmerman, & Riggle 2003).  This can result from school based victimization (Murdock& Bolch 2005). An intervention to consider beside having anti -bulling rules at school is attempting to increase the youths commitment to school, with input from the youth on what would help them feel a greater sense of connection. This is important as low commitment to school is also a risk factor for adolescent substance use. School protective factors includes: having at least one supportive adult they can talk to, making sure the school is inclusive in terms of policies, curriculum, social activities and social clubs. It is also helpful to enforce anti-bullying education, and the development of safe programs which educate peers, faculty and staff.

Finally the family, according to the Black and African American LGBTQ Youth Report, 2019, parents and families have a critical role to play in creating open environments that foster positive self -esteem, mental health, and well being among African American LGBTQ youth. Supportive  and affirming families can act as a a buffer against some of the discrimination, harassment and bullying that Black and African  American  LGBTQ youth may experience at school and in their communities.  

Protective factors at home include, talking openly about sexuality and gender with youth (thus removing secrecy), letting or expressing affection so the youths know that they are loved, supporting the youth’s identity even if it makes you uncomfortable, and advocating.  Lastly, join (PLAFGS) which stands for parents, families and friends of lesbians and gays. To learn more about how to support LGBTQ African American youth click here . Bob Dylan wrote a song in 1964 called the "the times are changing." Although he was not writing about LGBTQ challenges faced by LGBTQ adolescents, times have in fact changed, and we need to start servicing and supporting African American LGBTQ teens with substance use disorders more effectively. Click on the link below to hear Dylan sing The Times Are Changing.

African American Adolescent Girls, Substance use, and the Development of Resiliency

I can recall quite clearly from the literature especially from about 1995- 2005, there was a plethora of studies on resiliency in adolescents. Those studies included but were not limited to development, or cultivating, or promoting, and establishing resiliency in adolescents. In this blog I want to pick up from 2005 and continue the conversation of resiliency, and address the topic as it relates to African American Adolescent Girls with substance use Disorders. Hawkins, Catelano, and Miller (1992) provide an excellent listing and delineation of not only the risk factors for adolescent alcohol and drug use, but also of corresponding prevention principles and practices. Likewise Bell & Suggs (1998) offer a useful blueprint and road map of resiliency in adolescents from the work of Wolin & Wolin. 

American adolescent girls are using tobacco, alcohol, illicit drugs, and controlled  prescription drugs at  rates surpassing those of their male counterparts (Johnston,O"Malley,Bachman&Schulenberg,2004,205:National Center on Addiction and Substance Abuse at Columbia University, 2005). Once girls use substances, they are more likely than boys to become dependent, and they fare more poorly in treatment (Moochan&Schroeder, 2004: Rowe, Liddle, Greenbuam, &Henderson, 2004). Girls also suffer disproportionately from such consequences of alcohol and drug use as poor nutrition, exposure to unprotected sex and STDs, pregnancy, and domestic violence (U.S. Department of Health and Human Services, 1994). It is clear that Culturally Competent Gender- Responsive Resiliency Substance use prevention would be an effective, and efficacious approach. What then makes a resilient African American adolescent girl who is faced with substance use? Resilient African American adolescent  girls are individuals who despite exposure to toxic environments manage to achieve positive  outcomes because  of unique  personal  strengths and environmental protective factors (Alvord&Grados,2005).

Examining resiliency factors aids and assists in the cultivating of resiliency in African American adolescent girls. Cohesion in three of its contexts i.e., family, school, and community provides insight into the dynamic adaptive  relationship between adolescents and their environments (Lerner etal.,2013). Ethnic Identity, according to Rotheram and Phinney (1987), is defined as one’s sense of belonging to an ethnic group and the part of one’s thinking, perceptions, feelings and behavior  that is due  to ethic group membership. A positive ethnic identity is a substance use protective factor for adolescent African American girls. Carl Bell MD, provides seven strategies for reducing violence  and re-engaging youth back into society, which it is this writer’s opinion that these same principles can be used in developing resiliency in African American Adolescent girls. They include: 

  • Rebuilding the Village- This involves churches, schools and families working together to create networks to support African American Adolescent girls. 

  • Providing Access to ancient and modern technology in counseling-ranging from tried and true mentoring programs and activities to modern manualized evidence based family and trauma recovery curriculum. 

  • Providing a sense of connectedness-Helping professionals may need to help adolescent African American girls develop a sense of community.  

  • Provide Opportunities to learn social and emotional skills. 

  • Provide opportunities for her to develop self esteem via daily affirmations and other techniques. 

  • Provide the adult protective shield. This can involve rallying the family to help assure that African American Adolescent girls experience safety. 

  • Minimize trauma-As there is a strong link between trauma and heavy substance use. 

In my work with Adolescent African American girls I often use videos to demonstrate resilience principles and to instill hope. One video scene I use is from the movie Flash Dance which illustrates that you can fall down and get right back up. Click on the link below to view a clip from the movie.

African American Adolescents and Substance Use

It is with great pride and appreciation that I begin the journey of writing this very important blog. The subject matter is one that I am familiar with in several ways, first, as a writer/publisher of over 150 articles. Two as a professional my work began with adolescents in the summer of 1972. Third, having a firsthand knowledge a growing up as an adolescent in the sixties, and early seventies gives me perspective concerning "today’s" adolescent. Finally, I’ve had the privilege of working with adolescents in multiple settings with substance use disorders and mental illness. This would also include adolescents who ran away from home, and wound up sleeping in abandoned cars, youth who would hop on freight trains, youth who were being sexually and physically abused, and youth living in poverty.

Studies are clear regarding the importance of Cultural and gender differences which substance use disorders treatment providers should address. With this as a context, it is important in understanding African American adolescents that their behavior, including substance use is not only molded and shaped by the environment in which they reside (e.g., family context, peers, neighborhoods, and historical context), but they become integral parts  of their own identity development process (Spencer 2006,2008). African American adolescents in the United states are not only expected to undergo typical developmental experiences that are the hallmark of adolescence, such as physical growth and development (Susman%Dorn, 2009) and developing a desire to assert their independence (McElhaney et, al 2009), they are also coping with a world in which they will experience racial prejudice (Sellers, et al 2003).

It is important to not only help African American substance using adolescents with recovery, but to also help them  as said in 12 step circles "to live life on life’s terms." This can involve counselors having sensitive discussions with African American youth on their experiences with racism and oppression and to understand how they cope with these psycho-social stressors, which in unaddressed could lead to apathy, anger and relapse. In light of these challenges let’s help them become aware of their resilience and further developing resilience, by first focusing on obstacles they have overcome already, connecting them with needed community support so that they will not have to face these challenges alone, affirming their resilience, instilling hope and encouraging them to "hang in there". The Five Stairsteps reminded us of the importance of hope and encouragement in the summer of 1970, with their song "Ooh Child." Click on the link below to listen to the song.