In 1990, Afshan Malik had no concerns more pressing than where she might travel for college.

She had just graduated high school and was weighing her options. Her family lived on the ninth floor of a luxury apartment building in Kuwait, which she filled with watercolor landscapes and pencil drawings. Her parents were expats from Pakistan, and had moved to Kuwait when she was a baby. Although Afshan was always keenly aware that Kuwait was not her home, it was the only home she had ever known. She filled pages of her diaries with romantic poems, and designed and sewed clothes for herself and her friends.

But then Saddam Hussein invaded. The invasion changed everything.

At first, expats were confused about what would happen to them under the new regime. The televisions stopped broadcasting news. Her parents would go into their car in the evenings to listen to BBC over the radio. Many Pakistani families began to flee. Her parents had their money and assets tied up in Kuwait and considered waiting it out.

Then they started hearing stories of girls being raped by soldiers. That night, her parents told Afshan and her younger brother and sister they would be leaving in the morning. “Pack a small bag,” her mother said.

Afshan asked if she could take her paintings. Her mother asked her if she was crazy. The car was going to be loaded with canned food and a few sets of clothing. Her father saw her crying and suggested she take a small journal so she could record all the countries they were going to pass through. Their plan was to drive from Kuwait to Mosul, Iraq to Turkey to Iran, where they would cross the border into Pakistan.

The next morning, they filled the trunk of their maroon Crown Victoria and started driving toward a border.

They lived out of their car for the next 28 days.

Afshan’s mother would take some of the cans of chickpeas, tomatoes and red beans out of the trunk and put them in a bag in the front seat every night. She would make just enough room for Afshan to curl up and sleep in the trunk of the car, with the door slightly ajar, to shield her from unwanted attention. Her parents slept on the ground on either side of the trunk. Her younger brother and baby sister slept in the back seat. There were refugee camps along the way, and sometimes, they slept in those.

When they finally got to the border of Iran, there was a military bathroom they were allowed to use. Afshan was walking back with her sister when her father handed her a rare piece of chocolate he had somehow gotten.

“Happy birthday,” he said to her. At first, she argued with him. It couldn’t be her birthday. But she had lost track of days, and it was indeed her 18th birthday.

They finally made it to Pakistan, where the five of them crammed into one bedroom of a relative’s house for months. Afshan remembers crying the first time she was able to sleep with her legs stretched out instead of curled up inside the trunk of a car. Her father went back to Kuwait to work, while Afshan tried to fit into her parents’ native country. She started college, but was bullied and isolated because of her upbringing abroad. Their living situation was far worse than Kuwait, but the sense of not really fitting in was familiar.

“You felt like a lost soul, like you didn’t belong anywhere,” she said. She finished her bachelor’s degree and then started an MBA program. A semester before she graduated, she was married in traditional Pakistani fashion. She finished her degree and two years later, in 2000, she left Pakistan to join her husband, who was working in America.

She had all her possessions with her in three suitcases when she arrived at John F. Kennedy airport in New York City. During the 18-hour flight, she thought to herself how long it would take to reach her family if anything ever happened to them.

When she arrived at customs, she approached the official at the counter. He took her passport and smiled as he said to her, “Oh, it’s your birthday! Happy birthday. Welcome to America.”

He noticed her birthday, she thought. She felt different in America than she had anywhere else.

“For the first time in my life, I felt like I belonged somewhere,” she said. It was an indescribable feeling for someone who had been displaced and homeless and rejected by people in the countries of her birth and of her childhood.

“I felt like I was wanted and accepted.”

This is where I was supposed to come, she thought.

The woman who took her paperwork at immigration complimented her long, black hair and noticed her birthday on the documents, too. She wished her a happy one, as did the next official Afshan encountered.

She caught the connecting flight to St. Louis, where she settled and eventually had two children. She went back to school to get her master’s in counseling and now works as a therapist. She thinks about how she was only a few years older than her teenage daughter when she was forced to leave a comfortable, middle-class life at a moment’s notice. And then, having to leave her family thousands of miles away to start over again. It was in this new country that the first people she met all welcomed her.

Some people take the long way home.

It can be a difficult group to advocate for: high-achieving teens going to the best schools, living in comfortable homes with successful parents.

This group sounds like the most privileged among us. Professor Suniya Luthar also sees them as among the most vulnerable.

Luthar, professor of psychology at Arizona State University, recently published research based on the New England Study of Suburban Youth, which followed two groups of adolescents from affluent communities into early adulthood. Luthar’s research suggests accomplished teens in great schools are an under-recognized at-risk population facing higher risks for substance abuse than their peers.

“We found alarmingly high rates of substance abuse among young adults we initially studied as teenagers,” Luthar said. By age 26, the rates of addiction for men in this study were twice as high as national norms; rates were three times as high for women. Rates of addiction ranged from 23 to 40 percent among men and 19 to 24 percent among women, according to the study, published in the May journal of Development and Psychopathology.

“The most common one we hear about is Adderall,” Luthar said. “Who has it. Can I buy it. Who can give it to me.” She finds that experimentation starts younger in this cohort and continues through college, where it can turn to ecstasy and cocaine. “When you are drinking vodka in Polar Springs bottles in seventh grade, it’s a problem.”

So why did these students in suburban schools, with high standardized test scores, robust extracurricular activities and white-collar professional parents, show consistently higher use of substances?

The reasons are likely multifold, according to Luthar: High pressure among teens to get into elite universities, access to disposable income, widespread peer approval for substance use and parents lulled into a false sense of security. When parents see their children performing well in school and in demanding activities, they don’t believe they could have serious underlying issues with drugs and alcohol. It makes sense that the earlier children start to use alcohol and drugs, and the more frequently they do, the more likely it is they will develop addictions down the line.

“It’s hard to face the truth,” Luthar said, “that it may be your child who is cutting or snorting Adderall.”

In her samples, the parents were educated -- doctors, lawyers and teachers -- families with access to resources for treatment, but also less likely to openly talk about deaths due to overdoses. She says a key to addressing the problem is drawing more attention to the data, funding more research on the topic and talking to teens about the research results.

“For high-achieving and ambitious youngsters, it could actually be persuasive to share scientific data showing that in their own communities, the statistical odds of developing serious problems of addiction are two to three times higher than norms,” she said.

It makes sense that public policy has focused on the risks at the opposite end of the economic spectrum. Children born into chronic poverty face greater challenges and risks of negative outcomes than their peers. It can be difficult to argue for supports for affluent children already born into such a strong safety net, as opposed to those struggling to have their basic needs met.

But Luthar argues that it’s a different type of intervention needed with the population she studied. It’s not a call for diverting resources, but for widening the conversation to include the risks they face. It’s also worthwhile to figure out how to minimize the risks for this population, she says. She wants more research on kids who grow up in pressure-cooker, high-achieving schools.

One school she studied had six students die of overdoses in a single year.

“How many times are we going to look the other way?”

Clayton Lessor, 56, talks openly about his terrible childhood.

He describes his late father as an alcoholic who was very abusive at home. He grew up with broken bones, black eyes and chronic abuse. He remembers the nights he slept in the backseat of a car.

He lived with his grandparents six months out of each year from when he was 4 years old until he was 16. One week from his senior year of high school stands out as particularly awful: His mother burned down their house, his dog died in the fire and his girlfriend dumped him.

“I don’t remember being in school the last two months,” he said. Still, he managed to graduate and eventually joined the Air Force, a decision he credits with saving his life. During his 24 years of military service, Lessor got married and divorced twice. He decided to get a degree in psychology, hoping to figure out why he kept picking the wrong people to marry.

“I needed to look at myself,” Lessor said. What he discovered was a significant amount of pain from his troubled and estranged relationship with his father.

“I missed out on a lot of developmental stuff,” he said. Lessor worked on “re-parenting” himself and learning the lessons he never got from his father. From this work, he decided he wanted to help other boys in similar situations. He created a 10-week “rite of passage” therapy group for boys who missed out on growing up with a healthy father figure.

He also self-published a book for mothers of adolescent boys, “Saving Our Sons: A Parent’s Guide to Preparing Boys for Success,” which serves as a guidebook for his 10-week Quest therapy program. In it, he lays out a path for healing those suffering from what he calls “father wounds.”

What exactly is a father wound? It could be the pain from having a physically or emotionally absent father, an abusive father, or one who just doesn’t know how to raise a son, Lessor said. It could even be a lost connection over time.

More than 2,000 boys have gone through the Quest program over the past 17 years. The groups meet for 90 minutes once a week in Lessor’s St. Louis-area office. He tells the boys, between the ages of 11 to 19, the things he wished he’d known at their ages. The session topics include identifying their own pain, facing it and learning how to cope with it in healthy ways. He wants to give them a place to deal with shame and anger, feel supported by a community and find a sense of achievement through their deeds.

He was 31 years old before he went into therapy, and says most men who suffered in their childhoods will end up self-medicating or running from the past to avoid dealing with how it impacts their present lives.

“The wound doesn’t heal itself,” he said. “It doesn’t just go away with time.”

He recalls the final straw with his own father. He had come home from the Air Force to get married when he was 20 years old, and went to visit him.

“He tried to kill me. He choked me. He was drunk,” Lessor said. “That was it. I was done.” He spent a long time working through his own grief, and says it’s possible to come through the other side stronger than before.

“It’s scary and painful,” Lessor said, but “you come out better if you finish the work.”

For him, it also brought a sense of acceptance.

“My childhood was suffering,” he said. And yet, he’s forgiven his parents. The emotion that comes up occasionally from the past traumas is just sadness.

“I don’t have any anger or hate,” he said. “It comes up once in awhile -- what comes up is just sadness, and then I move on.”

More importantly, he has found meaning and purpose through those life experiences.

“It wasn’t the childhood I would have chosen,” he said. “(But) my mom and dad were a gift to me.”

It was those dysfunctional relationships that led him to do the work that is so meaningful to him today.