Seth Walters was 16 when he first smoked marijuana in his high school bathroom. Amid the high, his family problems and bouts with anxiety linked to his sister's murder disappeared.
"It made me feel really good," he said. "It pretty much numbed all of the pain that I was feeling."
Like many teenage addicts, Walter's road to dependence started with smoking cigarettes and drinking alcohol socially. Then a friend convinced him to smoke weed. But that high wore off quickly and he turned to drinking large doses of cough syrup.
Walters, now 17, is among thousands of youths across the country who become addicted to drugs, using them to cope with life problems and mental illness.
Young people suffering from depression are more likely than others to begin using marijuana, hallucinogens and other drugs, according to the federal National Survey on Drug Use and Health. Some young addicts start using before they reach puberty. Recognizing the strong connection between mental health and substance abuse, many mental health and rehabilitation programs have begun jointly treating the two conditions.
Walters recently graduated from a residential mental health treatment program at Sheppard Pratt Health System, which began offering a substance abuse component four years ago. The Berkeley and Eleanor Mann Residential Treatment Center treats 12- to 21-year-olds with severe emotional and behavioral problems. About a third of them have substance abuse as well as mental health issues, reflecting the results of the national drug use survey, which found the number of adolescents who suffered with substance abuse problems as well as long bouts of depression made up 28.4 percent, or 340,000, of the 1.3 million youths who abuse alcohol and drugs.
"You need to treat it jointly," said Dr. Tess Carpenter, clinical director at Mann. "It is hard to take one or the other in isolation. You have to take a holistic approach to the issue."
Addiction specialists say treating adolescents is different than treating adults, who are better equipped emotionally to handle change, stress and life crisis.
"The coping mechanisms for teens in particular have not been fully developed yet," said Kathleen Westcoat, president and CEO of Behavioral Health System Baltimore, which oversees mental-health and substance-abuse programs in the city. "Adults have had negative experiences and developed skills to handle and cope with adverse life events. Teenagers are much more vulnerable."
Youths also are influenced more easily by peer pressure and popular media such as music videos and movies. They often see themselves as invincible and may not think they could become an addict.
"They understand addiction to be the low-down, dirty, drunk in the alley," said Duane Haley, a clinician with Mann. "When they reach the point of addiction, they have a hard time thinking that's them."
LaTavia Little, executive director of Treatment Resources for Youth in Baltimore, said the youngest person admitted to her addiction program was 11 years old, but she knows of children as young as eight who use drugs and alcohol.
Little's program focuses on helping youths realize the negative consequences of using drugs and alcohol.
"We have to find out what will make them consider change rather than make them change," Little said. "You can't just tell them what to do, you have to make them see what they are doing is contrary to what they need to do to succeed in life."
Patients at the Mann residential program at Sheppard Pratt are referred by their familes, the courts and local social service agencies. Patients of the 63-bed facility typically stay for six to 11 months of supervised treatment.
To help the young patients, the center mainly uses so-called dialectical behavior therapy, which focuses on mindfulness and how to change only what they can control. The therapy is meant to show patients how to see their lives as worth living.
Program officials said all the patients see a psychiatrist and many are prescribed psychotropic medications to treat their mental health symptoms, but not anything that may contribute to addiction.
Current patients and graduates gathered recently to celebrate their accomplishments. They talked about how the program helped them get off drugs.
Caitlyn, 18, said she had tried just about every drug she could before entering the program. She started smoking marijuana at age 13 while in middle school — her first time was at a friend's house.
"My immediate reaction was that I'm going to do this again," Caitlyn said. "I felt as if I could enjoy myself more. I didn't have to deal with any of the problems around me. I was just sort of in this safe space where I could relax for a moment and get away from the real world."
She turned to harder drugs after she said she was sexually abused. (The Sun's policy is to not identify vicitms of sexual assault.)
She described how she got a reality check as she detoxed during her first week at Mann. She lost control of her bowels and vomited for hours. Being that sick made her realize how far she'd fallen into addiction.
Now a community college student, Caitlyn said she sees life through a clear lens rather than a drug-induced fog — and she's happier.
"Mann gave me the skills to get better," she said. "It's coping skills. It teaches you how to think through your actions. To do the right thing is harder than doing the wrong thing."
Dojah, 17, talked about first smoking marijuana at age 13 at the urging of peers.
"I felt free," she said. "I didn't feel as worked up as I usually did. It calmed me down."
Dojah cried on stage as she recounted being gang-raped by a friend and others she didn't know after smoking marijuana laced with another drug. She became depressed and started using more drugs to try to manage the sadness that overwhelmed her.
She said the Mann program helped her see her self worth and that she needed to change her life for her young son.
"I learned that I have a lot of things to look forward to other than drugs," she said. "I knew that I was smart, but I didn't do anything with it because all I wanted to do was smoke and stuff."
Walters, who used drugs to ease his anxiety, said he had to hit rock bottom before he could begin to recover. He knew he hit it when he began stealing from his parents to support his habit.
Before taking part in the program, Walters said he'd never dealt with his sister's 2007 murder. He was very close to her and was just 8 years old when she died. He began having anxiety episodes that worsened on the anniversary of her death.
Now enrolled in an arts school in Baltimore County, Walters is studying dance and said he no longer uses drugs. When he gets anxious, he practices breathing exercises he learned at Mann instead of smoking a joint. He often repeats mantras to himself. Change what you can change. Radically accept.
"I don't know what would have happened if I didn't come here," Walters said.
He doesn't think he'll use again.
"I had to use it before or I couldn't function," he said. "I don't even worry about what will happen if one of my friends asks me to use. I know how it made me feel and what it led me to and that is not the way I want to go."