Archive for December, 2008

Marijuana and Parents: Yes, No, Undecided

December 28th, 2008 No comments
The Belding-Abrahams Unstoned

The Belding-Abrahams Unstoned

On Nov. 4 2008 voters in Massachusetts will get to decide if people caught with an ounce or less of marijuana will still be charged as criminals. The penalties for a first offense are mild. The crime is a misdemeanor, but there can be a fine of $500 and six months in prison. Since many users are among the young, parents will take a particular interest in this question.

The good news for those of us who toil in the fields of troubled kids and their parents is that in the last ten years the percentage of high school seniors trying pot has drifted downward from 50 to 42%. The bad news is when your kid is nailed with a pot rap. The current law appears stiffer than its application. The usual first timer gets off with probation, drug education, and community service. But in rare cases a pot offense can stand in person’s way out of proportion to the crime. As crazy as it sounds, a web of Federal and state rules prevents a person from adopting a child, driving a car, getting food stamps or a loan for school. That means even if a user gets treatment and remains in recovery our marijuana law can keep punishing.

But for most parents, the practical question is at home. What are the kids using, and besides criminalization, while bad enough, what are the consequences? It’s encouraging that kids’ negative attitudes about pot have increased in the last ten years. But regarding stopping the flow of pot into this country, the War on Drugs and the $200 billion spent in the last ten years have failed. Essentially the same number of high school seniors in 2007, 84%, reports pot is easy to get, compared to kids in 1997.

Is pot dangerous? An old joke went, “Sure, marijuana is dangerous. A ton of it can crush a man.” But for the majority of kids a ton of dope is never at play. Saturday night adventurers are likely to be at no greater risk than abstainers. Far greater dangers await a kid using the gateway drugs tobacco and alcohol. The problems from pot arise in daily smokers, half of whom will move onto the felony drugs of cocaine, heroin, and the like. And pot should never be used by vulnerable persons, such as the mentally ill or addicts in recovery. If a kid claims to need pot as self-medication, he needs professional care, not backwoods chemistry.

So what’s a parent to do? Straight talk with your child is a start. You can set the limit of zero tolerance, but short of locking up your Rapunzel in a tower, a parent can’t control every choice of a teenager. Neither can schools. This is where openness and good sense at home can rule the day. Parents need to live and teach that there are better things to do with a mind on Saturday night than parking it.

Parents can’t control everything in a kid’s life, but they can control a lot. Finding tobacco or weed in a kid’s room and saying nothing is practicing a dangerous form of denial. Fighting tooth and nail the battle over teen smoking is probably the single healthiest thing a parent can do.

A more subtle problem lurks in reducing pot penalties. That policy falls between two extremes, each of which brings its own problems. The first is prohibition, which describes our current laws. Prohibition as we know from Hollywood and police reports is very good for drug dealers and the prison industry. The greater the police work, the greater the street price. Prohibition is very bad for those scientists seeking better answers through research to the questions of drugs, disease and medicinal possibilities. The other extreme is drug freedom without limits. Decriminalization isn’t legalization, but it’s not far away. And if it is, isn’t that a slippery slope to commercialization by Big Tobacco? And what about pot dependence? Surely those numbers will go up, and at what cost? The vote on November 4 will be a test to see if we can keep our balance as we move between the extremes of prohibition and license. The former has fed the coffers of drug gangs the world over. The latter has led to the fall of empires.

Hallucinogen Persisting Perception Disorder

December 17th, 2008 15 comments

Hallucinogen Persisting Perception Disorder, HPPD, is a long lived problem arising from past use of strong hallucinogenic drugs. The majority of patients with HPPD report a prior use of lysergic acid diethylamide (LSD). Life LSD dose does not appear to increase the risk to developing HPPD. That is, I have seen some patients who have tripped on acid multiple times and then developed HPPD, and others develop the same disorder after one or two trips. I liken tripping on acid to playing Russian roulette, but using chemicals instead of bullets. Developing HPPD without ever tripping on acid can also happen, but in my experience this is quite rare, and suggestive of another disorder in the nervous system that needs medical attention.

The usual HPPD patient knows better than his doctors what is going on. The patients I see in consultation often have seen an average of six other medical specialists before they found their way to my office. This is probably because HPPD is a rare disorder, and not something that neurologists, psychiatrists, psychologists, and ophthalmologists usually encounter in training. Ironically these are the specialists most often consulted by the HPPD patient. Too often the first (and mistaken) clinical impression is that the patient has a psychosis. This can set treatment on a wrong path.

The majority of HPPD patients do not suffer from psychosis, or other signs of psychotic illness, such as auditory hallucinations and delusions. The disorder is for the most part a perceptual disorder in which visual information from the perceived world enters the brain but then cannot shut itself off. The result is lingering visual information, or a disinhibition of visual information processing, in the form of after-images, the trailing of images as they move through the visual field, flashes of light, and the formation of complex imagery on otherwise blank surfaces. Typical drawings from HPPD patients of what they see are shown on the right.

The first scientific description of the persisting visual phenomena described by LSD users may be found here.

Research in my laboratory later documented quite clearly that in the HPPD patient, when a visual signal from an image enters the brain, the signal stays around in consciousness longer than it does in the control subject who does not suffer HPPD. This finding has been found in three different studies of visual psychophysics. One finding, shown in Figure Five, was that LSD users see a flickering light as fused more often than non-users, because the eyes of the LSD user continues to see the light after it’s gone. For details click here.

A similar event occurred if a subject was exposed to bright light, and then tested for the ability to adapt to darkness. In this experiment, Dr. Ernst Wolf and I found that the dark adaptation of LSD users was reduced compared to non-drug controls because the LSD group could not mentally shut off the original light enough to see a tiny light when in the dark. See Figure 6.

This impairment could be important, for example, to persons needing night vision such as airplane pilots.

My colleague, Frank Duffy, and I also found characteristic abnormalities in the brain’s electrical activity in HPPD subjects, documenting that HPPD is a disorder which clearly takes place in the brain, and not simply in the imagination. Figures 7 and 8 below are examples of brain electrical activity maps (BEAMs) of an HPPD patient side by side with a group of normal individuals for comparison.

For scientific details please visit:

Categories: HPPD

Frequently Asked Questions – F.A.Q.

December 17th, 2008 No comments
  1. Why did you write this book?
  2. Most parents feel pretty helpless about what their kids are doing about drugs and alcohol.
  3. What is the single best thing a parent can do in preventing drug abuse?
  4. What drew you to leave pediatrics and specialize in psychiatry and why are you focusing on kids; use of drugs and alcohol?
  5. Have you had to deal with any of these issues with your own relatives, children or friends?

  6. How can former Saturday night adventurers parent their own young Saturday night adventurers?
  7. What warning signs of drug and alcohol use should parents look for in their kids?
  8. A lot of nationwide programs attempt to teach kids not to use drugs. What are the benefits of such programs and what weaknesses need to be addressed?
  9. Some parents believe in allowing their underage children to drink at home with supervision, preferring that the child’s exposure to alcohol be in safe surroundings. Is this strategy in the best interest of the child?

  10. In your book you talk about dangers in the medicine cabinet. How come?

  11. Are drugs for children over-prescribed or wrongly prescribed?
  12. What are “gateway drugs?”
  13. Is social class a risk factor for teenage drug abuse?
  14. How much hope is there for a kid with addiction?
  15. If there was one thing you could tell every parent in America about keeping their kids safe from drugs, what would it be?

Why did you write this book?

Because I was sick and tired of seeing intelligent, vibrant formerly healthy kids get sick from drugs and die. I remember one day a teenager came into my hospital to detox from heroin. “O.k.” I said. “We’ll clean you up and get you into rehab.” Then his blood test came back positive for hepatitis C. I had to sit down with the kid and his parents and tell them the child has a potentially fatal infection of his liver. This is not the kind of thing that makes a doctor’s day.

Most parents feel pretty helpless about what their kids are doing about drugs and alcohol.

They shouldn’t. I want parents to feel empowered. I give them tools in my book, What’s a Parent to Do? that turn them onto what I call “Heads-Up Parenting.” This stuff is not magic. It’s looking at each kid and identifying the factors that either increase or decrease the child’s risk for future drug use. And then I help parents begin to reduce the risks. It’s not foolproof, but each finding has the weight of scientific studies behind it.

What is the single best thing a parent can do in preventing drug abuse?

Get your kid to avoid cigarettes. Easier said than done, but not impossible. You can quit the weed yourself, for openers. Kids model their parents’ behaviors, even the bad ones. You can pay attention to their behaviors, give them the loving smell when they walk through the door, and let them know what you’re thinking. Your words matter, if when your kid says they don’t.

What drew you to leave pediatrics and specialize in psychiatry and why are you focusing on kids’ use of drugs and alcohol?

I practiced pediatrics before I went into psychiatry. And before I was a pediatrician, I thought I was going into psychiatry. So like lots of young people, I had trouble making up my mind. I talked over my dilemma with a mentor in medical school, a British guy who always seemed to see things perfectly clearly. “Pediatrics? Psychiatry? There’s no difference!” He meant that a pediatrician sees all of the changes happening now, and a psychiatrist sees the results years later. After seeing those results in my practice for years, I felt now was the time to try to help kids deal with the changes they were facing now, some of the biggest involving drugs and alcohol.

Have you had to deal with any of these issues with your own relatives, children or friends?

Are you serious? The life time prevalence of alcohol dependence in this country is roughly one person in seven. Anyone who doesn’t know a problem drinker or drug abuser personally just doesn’t want to know, probably because they feel so helpless to do anything about it. Yes, I have seen family and friends get into trouble from alcohol and drugs. But the greatest suffering I’ve seen in numbers over the years has been in the patients and families who have come to me for help. I see “What’s A Parent to Do?” as a force multiplier in saving our kids.

How can former Saturday night adventurers parent their own young Saturday night adventurers?

This question means you’ve read my book, but not everyone has, at least, not yet, though they should. A little definition is required. I call any kid a Saturday Night Adventurer who dabbles in drugs and alcohol experimentally. This is not a drug dependent kid, but the kid who is at risk to get into trouble from a single use of drugs or alcohol, trouble like overdoses, accidents, rapes, fights, homicide, suicide. Drugs and alcohol figure heavily in all these, so the label of Adventurer should not be worn lightly. A parent of a teenager is much like a person driving across a railroad crossing. You have to Stop, Look, and Listen. Stop conducting the parenting business as usual. Look hard and often at how your child is doing- in school, sports, with friends. And listen to your kids. They almost always let you see signs of danger. And then you have to act to keep them safe.

What warning signs of drug and alcohol use should parents look for in their kids?

Any kid who abruptly changes his mood, mental abilities, interests, friends, grades or relationships with the police is telling you something. Drugs or alcohol may be at play. It’s hard for a kid to hide being drunk or tripped out on acid. Paying attention is the key, and then most importantly, not denying the problem, but calling it as you see it.

A lot of nationwide programs attempt to teach kids not to use drugs. What are the benefits of such programs and what weaknesses need to be addressed?

There have been heroic efforts made by a number of organizations. DARE comes to mind, and the pioneering work of Gerald Botvin. Education works, and programs work, but some work better than others. The key to any kind of prevention program is scientific evidence, proof, really, that people are getting their money’s worth. This is hard to do, but not impossible. The folks at the RAND Corporation have shown, for example, that for every dollar spent in prevention programs, over five dollars are returned in benefits. Drug prevention is a no-brainer.

Some parents believe in allowing their underage children to drink at home with supervision, preferring that the child’s exposure to alcohol be in safe surroundings. Is this strategy in the best interest of the child?

I don’t think so. Supporting a kid’s underage drinking in the home is a tacit approval of underage drinking outside of the home. There are good reasons why teenagers don’t vote, enter into contracts, or run for President. A teen brain is a work in progress, wonderful to behold, but dreadful when deranged by alcohol. Think decreased judgment plus increased impulsivity. Is that what you want for your kid?

In your book, you talk about dangers in the medicine cabinet. How come?

One of the biggest factors in drug abuse is drug availability. And the family medicine cabinet is availability writ large. Drugs are for the taking, selling, and using. Kids don’t think about drugs the way a patient does. If a doctor gives you a prescription, you will want to know what it’s for, and whether it’s safe. A kid only wants to know if it gets you high. Since there are prescription drugs that do much more than that, a kid fooling around with someone else’s prescription is playing Russian roulette with chemicals instead of bullets.

Are drugs for children over-prescribed or wrongly prescribed?

Doctors like other humans can make mistakes, but I haven’t seen a national trend of “overprescribing” of drugs for kids. The field of pediatric psychopharmacology is in its infancy, and children, like adults, suffer from serious psychiatric disorders for which there may be hope in the form of medication. I ask two main things when it comes to using medication in children: Is there proof that the medication works in this condition? And does the child in question have this condition? If the answer to both is yes, a careful med trial is indicated. If not, it’s back to the drawing board. This holds for possible diagnoses of kids with depression, attention deficit disorder, and even drug abuse.

What are “gateway drugs”?

A gateway drug is one that leads to the use of others. But a gateway drug, as W.C. Fields put it, is not simply “a fatal glass of beer.” For most people, a single glass of beer is not a problem. (Not so for alcoholics, for whom that same glass can initiate a slide into a devastating relapse.) Similarly, the majority of kids who smoke marijuana will not progress on to harder stuff. But a significant number of heavy pot smokers will move on to heroin and cocaine. For them pot is a gateway. Among the commonest gateway drugs are cigarettes and alcohol. Of the two, cigarettes are the worse.

Is social class a risk factor for teenage drug abuse?

I am a great fan of parents taking note of risky business their kids may be vulnerable to, but social class is not one of them. I have treated 17 year old heroin addicts from upper middle class families side by side with kids from the other side of the tracks. No matter how much you’re giving to your child, no kid has “everything,” and every kid is at risk, for drug abuse, or the drunk driver careening down the road.

How much hope is there for the kid with an addiction?

Lots. The younger they come into treatment, the better the prognosis. But treatment for addiction is not a set-it-and-forget-it operation. It takes time, often years, and along with it, patience, understanding- not the milk toast kind, but the kind the recognizes addiction as a disease. Just as it takes a village to raise a child, it takes one to keep one sober.

If there was one thing you could tell every parent in America about keeping their kids safe from drugs, what would it be?

Become a Heads-Up parent. Look for the danger signs, build on the child’s strengths, and keep up the dialogue. A parent doesn’t hold all the cards. That’s for sure. But we can all learn to play the game better to keep our kids safe.

Categories: Advice on Parenting

What’s a Parent To Do?

December 17th, 2008 No comments

What's A Parent To Do

Book Description

In his empowering new book, “What’s a Parent To Do? Straight Talk on Drugs and Alcohol,” Nobel Peace Prize co-recipient Henry David Abraham, M.D. gives parents a three pronged approach that shows you how to take real steps to prevent drug and alcohol abuse, know the drugs that put your child at risk and take positive action if your child is already using drugs or alcohol. Clear and concise, Abraham’s book gives you the vital facts and latest medical information you need to keep your children safe. Now you can open a dialogue and guide your child or any child you care about towards a drug-and alcohol-free future.

Henry David Abraham, M.D. has counseled over 90,000 patients and their families in his thirty-year career. He has been Director of the Substance Abuse Programs and clinical professor of psychiatry at Tufts University School of Medicine, chief of Clinical Alcohol and Drug Treatment Services at Brown University, and a faculty member of the Department of Psychiatry at the Harvard Medical School. Winner of a Peabody and Emmy, he is a graduate of Johns Hopkins University School of Medicine. Dr. Abraham has appeared on 48 Hours, NBC News and Court TV and has been published or quoted in Time, Newsweek, The New York Times and The Boston Globe.

Product Details

Paperback: 227 pages
Dimensions: 10.25 x 7.5 x 0.5 in.
Publisher: New Horizon Press, Far Hills, New Jersey
In-Print Editions: Paperback
ISBN 0-882882-238-1

Editorial Reviews
“Great book. Take Home Lesson 7) Never give up hope. Ever. It made me cry.

Hope it sells well!” H. Thibodeau, Enfield CT

“Drug use among children and teens is a leading national health concern.
Henry David Abraham’s text is an accessible “how-to-guide” for parents,
which not only educates parents on the facts of drugs and alcohol, but
more importantly provides them the tools necessary to be their own
researchers of the ever changing drug culture. This text does not merely
inform the parent on the current drug epidemic, but more importantly
teaches parents on how to inform themselves.

Dr. Abraham first provides parents the framework for understanding the
factors that often lead to substance abuse, and then provides a
no-nonsense discussion on the substances commonly used by children.
Drawing from his extensive clinical experience, the author illustrates
the potential consequences of each drug with heartbreaking stories of
children affected by drug-induced disorders. A very novel and powerful
section of this text is an easy-to-follow guide on how to understand the
significance of scientific studies: a parent learns that not all drug
facts they encounter in the media are equal. The author explains how to
interpret the implications of the various forms of reported scientific
research – ranging from single-patient case stories to well designed
research studies- allowing a parent to make their own educated judgments
on the importance of the drug information they come across in the media.

For parents who feel powerless approaching their children on the topic
of drugs, Dr. Abraham provides, in a very straight forward way, the
important facts on the newer, exotic drugs children are taking.
Additionally, Dr. Abraham examines the often overlooked, but serious
consequences of hallucinogen use.

As the President of the National Organization on Drug-Induced Disorders,
and also an administrator of a support forum for individuals with
hallucinogen-induced disorders, I have heard hundreds of stories from
teenagers and college students affected by rare and underreported
drug-induced disorders caused by hallucinogens. This is the first text I
feel comfortable recommending to parents of these individuals, as it is
the first to accurately describe and address these disorders.”

David S. Kozin
National Organization on Drug-Induced Disorders

Categories: Advice on Parenting

Should We Drug Test Our Children?

December 16th, 2008 No comments

There is no secret that our kids use drugs. More than half use an illegal substance before they graduate from high school. If children are subjected to random drug testing, goes the logic, testing might stop their drug use, or at least serve as a red flag to their parents. The problem is that not all of our kids use drugs, and even the ones who are at greatest danger are in the minority. So should we treat all kids as guilty until proven innocent? As a physician who has drug tested patients thousands of times, my answer is simple: no drug tests without reasonable suspicion.

People who work with addicts know there are perfectly good reasons for drug testing. Testing helps guide them when an addict is detoxing, or has just taken an overdose. Drug testing tells you important things when the patient can’t. Drug testing can be an aid in working with addicts as they flirt with relapse. In a word, drug testing is a terrific clinical tool. So why all the fuss about drug testing our kids in school?

People are split on the issue of drug testing. At issue is a conflict between the desire to keep our children safe on the one hand and the rights of privacy and freedom from illegal searches on other.

In 2002 the Supreme Court heard the case brought by high school student Lindsay Earls against her Board of Education. As a member of the Tecumseh High School marching band, she was required to submit to random urine checks. Earls knew she was drug free, and defended her privacy. She correctly felt that being in a marching band did not automatically put her at risk for drugs. Supporting her case were the National Education Association and the American Academy of Pediatrics.

But in a 5 to 4 decision, the Court ruled against the high school student. Writing for the majority, Justice Thomas argued that schools have a greater interest in protecting children than maintaining their privacy. The four dissenting justices called the drug test program “capricious, even perverse.” The dissenters further noted that the Tecumseh drug testing policy invaded the privacy of students who need deterrence the least, kids motivated to take part in extracurricular activities, while keeping kids at risk away from activities that might actually keep them off of drugs.

Despite the Earls case, there has been no stampede by schools to drug test our kids. One optimistically thinks that common sense may be loose in the land. Variations on drug testing have been proposed, such as having parents “register” their children for random testing in schools. Results would go to the parents, and parents would be educated regarding treatment options.

But a random drug test does not answer the critical questions of how much, how often, or even what a kid has been taking. Testing does not discriminate between kids who experiment and kids who are seriously involved with drugs. Testing can be inaccurate. A crafty child can sabotage it. Testing ignores the most medically devastating drugs, tobacco and alcohol. But most instructive of all, scientific data show that random drug testing does not reduce drug use. A 2003 survey of 722 secondary American schools involving 76,000 students by the University of Michigan found virtually identical rates of drug use in schools that have drug testing and schools that do not.

A clean kid does not need to be drug tested. A kid involved in drugs usually doesn’t, either. If a parent can already see the red flags, one more won’t make a great difference. So is there a place for drug testing our kids? Sure, when a parent has suspicion of drug use, or when a kid has something to prove. Otherwise, the best drug test I know is the hug-and-sniff when they walk through the front door, with a heart to heart for a eye-opener the following morning. The strongest weapon we have to combat drug use in our children is not the chemistry lab, but heads-up parenting.

Henry David Abraham, M.D.’s recent book is “What’s a Parent to Do? Straight Talk about Drugs and Alcohol.”