It's never a slow day for Adolescent Counseling Services (ACS). The nonprofit's Palo Alto office is routinely packed during its late afternoon hours as teens and their families flood in to seek substance abuse treatment and counseling. And it's only a matter of months before another big wave of new cases comes rolling in.
"It's always after the first dance, the first progress report and the first sporting event," said Connie Mayer, director of outpatient services for ACS. "That's when we're most busy for substance abuse."
ACS is not alone. Officials from hospitals, nonprofit mental health organizations and local law enforcement in the North County area say they are seeing increasing numbers of teens and young adults routinely drinking alcohol and taking prescription and illegal drugs, prompting concerns that cultural and legal changes could be paving the way for more substance abuse. Mental health experts warn that these risky behaviors could also be a misguided attempt to self-medicate because of deeper problems, like depression and anxiety.
Seth Ammerman, an adolescent and addiction medicine specialist at Lucile Packard Children's Hospital, said he's been seeing an "unfortunately high" number of teens each year struggling with substance abuse across Santa Clara County, with alcohol and marijuana taking the lead as the two major abused drugs of choice. More troubling, Ammermann said, is recent research over the last two years that shows a strong link between early drug use and substance abuse disorders.
The most recent county-wide survey on teen drug use comes from Project Cornerstone, which operates out of YMCA of Silicon Valley and surveyed 16,214 high school students back in 2011. Of the respondents, 44 percent of seniors and 28 percent of juniors reported drinking alcohol at least once in the last 30 days, and 47 percent reported said they had smoked marijuana in the last year. Nearly one-third of the seniors reported getting drunk in the last two weeks, and one in four reported drinking and driving in the last year.
More recent surveys from the Mountain View-Los Altos High School District from the 2013-14 school year shows that 26 percent of juniors drank alcohol at least once in the 30 days prior to the survey -- of which 11 percent reported "binge drinking" -- and 17 percent reported smoking marijuana at least once over the same time period. The survey did not include seniors.
Drug use is higher at Los Altos High School across the board, where 21 percent of juniors reported smoking pot in the last 30 days, 31 percent reported drinking alcohol and 3 percent reported taking prescription medication to get high.
Organizations like ACS and the Community Health Awareness Council (CHAC) in Mountain View are seeing the results, as students flock to both mental health nonprofits in the North County area seeking substance abuse treatment. Veronica Foster, a therapist at CHAC, said parents start to see warning signs of drug abuse -- poor grades, getting in trouble with the law and skipping school. Social and recreational use can easily turn into habitual, regular use, Foster said, and they start to lose control as drugs become part of their lives. Most of the kids she sees are using marijuana, she said, but there's a rising concern about harder, more addictive drugs.
"Prescription drug abuse is about to blow up in Santa Clara County," she said. "So many kids are fishing through their medicine cabinets."
While the Project Cornerstone study had a massive sample size and gave local educators and health experts a clear picture of substance abuse among high school students, Ammerman said that the survey does a poor job of documenting substance abuse involving more serious drugs, including prescription and street drugs, which is less common but of particular concern to him.
"I'm seeing kids personally in my mobile clinic who are using a variety of different drugs and poly-substance use," he said. "Not that they necessary have an addiction, but it's obviously very worrying if they are using coke or meth," he said, referring to cocaine and methamphetamine.
Along with local health experts, law enforcement agencies are seeing a similar rise in drug use. School resources officers at the Mountain View Police Department say that marijuana use is going through the roof, and party drugs including Ecstasy, or MDMA, are becoming more common among teens.
Ease of access, and a general acceptance that marijuana is okay to use and could be on the verge of becoming legal in California has helped to push up drug use, according to officer Bobby Taylor. As more medical marijuana dispensaries open up shop in San Jose, he said, more pot and edible marijuana products are making their way to Mountain View schools and into the hands of students.
"There's so much more of it out there," Taylor said. "That's why there's an exponential increase in access. Everyone knows someone who has a (medical marijuana) card."
While a marijuana legalization bill will be on the state ballot this November, police say recent new laws have already helped to increase drug use among school-aged students. Proposition 47, which passed in 2014, bumped felony charges for drug possession down to misdemeanors, meaning teens caught with marijuana, methamphetamine, cocaine, psychedelic mushrooms or concentrated cannabis products can get a citation and never make the trip to county jail, said Sgt. Ken Leal of the Mountain View Police Department. Kids are more likely to slip back into their substance abuse habits, Leal argued, if there are no clear consequences for their actions and all they get is a court date to show up months after getting caught with drugs.
Last year, the Mountain View Police Department arrested or cited 35 people under the age of 18 for drug-related charges, mostly for possession.
A mental health connection
While it's debatable what cultural and legal changes could be cultivating teen drug use, there is consensus that mental health problems and substance abuse often go hand in hand. Foster, who runs the outpatient substance abuse program "Well Within" at CHAC, said teens struggling with depression will often turn to drugs as a way to self-medicate.
"That's what they're coming in for -- the drugs -- but there's always something else," she said
The same is true for students coming to El Camino Hospital for mental health services. Michael Fitzgerald, director of behavioral health services at El Camino Hospital, works with teens through the hospital's ASPIRE program, and said youths often turn to drugs as a way to cope with anxiety, stress and depression. The connection is so strong that the hospital offers a dual-diagnosis program for young adults with mental health and substance abuse problems.
"Kids use drugs to feel different," Fitzgerald said. "They don't like the way they're feeling, maybe they have a lot of anxiety, and they end up using them to cope."
Through ASPIRE, which teaches high school students how to work through mental health problems and manage stress, Fitzgerald said the goal is to teach students that drugs are a poor coping mechanism that isn't really worth the risk of addiction and the legal trouble drugs can bring.
"In learning how to regulate their emotions, they eventually learn there's less of a need for the drug, and they realize it's ineffective," he said.
The knee-jerk reaction is to focus on the drug use itself, rather than the root cause, said Philippe Rey, executive director of ACS. He said the organization started out as a mental health clinic, and eventually took a greater focus on the substance abuse that often comes with with mental health illness.
Drugs are not the problem, Rey said, it's what the drugs are masking, and the rising substance abuse among teens indicates mental health is a problem among kids and young adults in the Bay Area. He blames the continued stigma associated with talking openly about mental health as one of the root causes for the problem.
"In Silicon Valley especially, if you look around there's this sense of 'not good enough, never good enough.' There's success in this area, and everyone on the surface appears to be successful -- the money, the houses, the cars," he said. "But we are human, we have weaknesses, and we forget that and get to a point where we completely burn out, or it's too late."
A dearth of data
Tracking drug use among teens in Santa Clara County is becoming an increasing challenge. The Project Cornerstone survey, which is still used by health experts in the area, is about five years old, and more recent surveys only show drug use for individual school districts.
Part of the problem is that many school districts and county agencies are no longer participating in the California Healthy Kids Survey, a consistent and comprehensive school climate survey conducted every two years. Participation in the survey was mandatory from 2003 to 2010 in order for school districts to receive Title IV funding, also known as the Safe and Drug-Free School and Communities program. But when the federal program ended, many districts in the state dropped the survey, leaving a patchwork of drug use data with an incomplete picture of just how widespread drug and alcohol abuse is in Santa Clara County.
The lack of data is striking. Earlier this year, hospitals on the Peninsula and the South Bay put together the 2016 Community Health Needs Assessment, which documents all of the major health problems facing the region. The report cited rising teen marijuana and methamphetamine use as a primary concern among community members, but it was based on data from the last county-wide California Healthy Kids Survey from 2007 to 2009.
Greg Austin is the director of health and human development at WestEd, and was part of the team that created the California Healthy Kids Survey. He said participation fell in 2010, but it was encouraging to see how many school districts continued to administer the survey without any real mandate. New state requirements to monitor school climate are also encouraging school districts to come back into the fold, and conduct the study as often as every year.
"We're back to the same level, and maybe even a little higher," Austin said. "The survey has long been considered the premier state survey in the country for school climate."
Despite the rebound, the Mountain View-Los Altos High School District won't be participating. Superintendent Jeff Harding told the Voice in an email Tuesday that the district has discontinued participation with the California Healthy Kids Survey.
One of the tricky questions facing substance abuse therapists is whether to adopt an abstinence model and tell teens not to take drugs at all. In working with youth here in the North County area, Mayer said it can be difficult to talk about "harm reduction" and bringing down drug use, because the question immediately becomes how much drugs can they use and get away with it. Through the outpatient therapy program at ACS, students are asked to "work with them on trying to clear their brain," Mayer said, and need to commit to at least 30 days of abstinence.
But striving for abstinence may not be the right direction. Foster told the Voice that trying to stop teens from taking drugs entirely does not work. The best strategy, she said, is teach youth about what the substance abuse represents in their lives -- whether it's their attempt to combat depression, or whether it's a result of negative influence from peers -- and help bring down the drug use to a less harmful level. And so far, it seems to be working.
"Our job is to get them to recognize the potential dangers and the facts, and it's up to them to make the choice," she said. "And many times, you do see them change. I've see kids come in who are suicidal and don't want to live, and now they are off in college, thriving, and in relationships."