School Relations Luncheon 2017 – Stress, Anxiety & Substance Abuse in Youth: A Primer In Prevention

By Lori Gaon


Anxiety is the most common category of mental health disorders and the most likely to affect children, surpassing even the more widely known ADHD. This was one of the startling facts parents learned at the December 5th NYC-Parents in Action School Relations Luncheon with guest speaker Dr. Marianne Chai, Medical Director of the New York Center for Living.* Dr. Chai provided the rapt audience with eye-opening statistics on anxiety, its prevalence, and its link to depression and addiction. Recent data shows anxiety is the number one issue bringing students to college counseling centers, surpassing depression and relationship problems.

New Yorkers pride themselves on handling a certain level of anxiety; it goes with the territory in a fast-paced, competitive city. But adding children into the mix changes the equation for parents. We say we want our kids to be happy, so as we see them struggle to navigate social media, academics, personal relationships and more, we may wonder – how much is too much? The more screen time, the higher the incidence of feeling isolated and anxious, and the more stress they experience, the more their troubling feelings are compounded, which can then contribute to various social disorders, depression and addictive behaviors. For our children, if not for ourselves, anxiety can become a threat.

“A certain amount of stress is good,” Dr. Chai began, emphasizing that problems arise when the stress becomes chronic, upsetting emotional balance and leading to substance problems, addiction, or worse. Dr. Chai warned that we have seen an alarming rise in teen suicide, suicidal ideation and self-harm. “This trend is not going away,” she added.

“Stress and anxiety can change your brain,” Dr. Chai said. Stanford researchers found that the larger the amygdala (where the “fight or flight” response and emotional center live), the greater the anxiety level in kids.

Most anxiety is normal, and every child goes through phases where levels rise or fall, normally a temporary and harmless part of development. Dr. Chai explained that anxiety can become “pathologic” when it impairs the ability to function and increases risk for additional health issues, such as substance abuse or addiction. “Pathologic” anxiety is a disorder.

Some eye-opening statistics about anxiety disorder include:

  • 25% of kids in the US will have an anxiety disorder between ages 13 and 18 (vs. 7% in Australia).
  • 1 out of 3 people will have an anxiety disorder during their lifetime
  • 75% with anxiety disorders see signs before age 21
  • 3% will have “severe anxiety disorder”
  • the disorder may incur up to $42 billion in annual health costs
  • only 18% of teens with anxiety disorder receive treatment.

Anxiety affects women twice as often as men. It may be “silent,” receiving less attention than ADHD because it’s less noticeable; for instance, a child suffering anxiety may sit quietly in the back of a classroom in contrast to the student with ADHD, who may be disruptive.

Anxiety disorder may be diagnosed when symptoms:

1) are present for at least six months,

2) significantly interfere with a person’s routine,

3) are out of proportion to the actual danger present.

Cultural changes may be implicated in the rise in teen anxiety. Students who have technology at their fingertips with the introduction of smartphones, appear to experience declines in what were, until quite recently, typical aspects of teen life. Notable changes include:

  • Less dating
  • Less time spent hanging out with friends
  • Fewer teens obtaining drivers licenses
  • Fewer hours of sleep
  • Less face to face connectivity with others (thereby increasing feelings of loneliness).

To put things in perspective, Dr. Chai said, kids who spend three hours or more on a device are 35% more likely to have a risk factor for suicide.

Anxiety affects emotional balance and wellbeing. It can trigger feelings of fear, irritability and anger, while impeding happiness and joy. Physical symptoms may include increased heart rate, stomachaches, headaches, dizziness, loss of sleep and loss of bone density, thus impairing overall health over time, according to Dr. Chai.

“Anxiety can be a silent killer,” Chai said, becoming ugly when it affects a person’s thought processes. It can negatively color quality of life through experiences of frightening thoughts and scenarios, fear, and development of “tunnel vision” with respect to every possible negative scenario.

“Seeing the world through the lens of fear is a very sad perspective,” Chai said. Often kids avoid whatever makes them anxious, giving preference to familiarity and repetition, which then gives the fear more power. A familiar example of this is separation anxiety in small children. If diagnosed early and treated, a preschooler who is prone to anxiety “can change their trajectory in life,” with intervention.

Many students self-medicate, thinking that pot is helpful in reducing social stress and anxiety. However, with persistent usage, pot can have the reverse effect. “Teenagers who smoke pot weekly are more than twice as likely as nonusers to have an anxiety disorder in their late 20s, even if they stop using,” Dr. Chai said.

Kids seeking ways to alleviate stress and enhance their ability to study, may turn to the easily accessible drug, Xanax. “It’s being implicated with almost every unintentional overdose in college- and post-college-aged kids we see in the city today. It interplays terribly with alcohol and opiates, causing respiratory failure,” said Dr. Chai.

The good news, Dr. Chai noted, is that anxiety disorders are highly treatable and treatment is effective in 60-90% of cases. Unfortunately, only 18% of those in need of treatment receive it, compared to 79% for ADHD.

Are we, as parents, at the root of this anxiety issue? According to Dr. Chai, many parents try, with good intentions, to ease their children’s suffering, but in doing so, may actually reinforce the anxiety by allowing the child to avoid stressful situations.

Psychoeducation for parents (parent training), is a treatment boasting high success rates by focusing on educating the parents rather than treating the child. The parent is trained to discontinue the negative reinforcement of the anxious behavior, and to refrain from automatically protecting the child from anxiety or fear.

Dr. Chai concluded her talk with some professional wisdom for parents: “Research has shown that the most successful people are those who experience failure and develop resilience to keep going. We have to allow our children to fail fast and early, and learn coping skills.”

Although this may be easier said than done, it’s advice we should heed, and well worth the effort, to help our children develop strength. We all must learn to cope with the inevitable stressors that provoke anxiety; let’s not forget our children deserve to develop that ability, too, just as we did.


* The New York Center for Living is an outpatient treatment center for adolescents, teens and their families that focus on issues of substance and alcohol abuse. Dr. Marianne Chai is board certified in general, child and adolescent psychiatry, as well as in addiction psychiatry and integrative and holistic medicine. She completed her residency training in general psychiatry at New York University, followed by fellowships in child and adolescent psychiatry at the New York University Child Study Center and in addiction psychiatry at New York University Medical Center Division of Alcoholism and Substance Abuse.

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