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The Second Most Dangerous Year

April 9th, 2009 No comments

This spring hearts will flip-flop over fat envelopes in the mailbox, as high school kids and their parents pick colleges for the coming year. But too little thought may be given to whether the college getting the acceptance check is healthy and safe, even though as kids moves into the ages of 15 to 24, their death rate jumps fivefold, the largest percent increase in the entire life cycle. If asked to pick the most dangerous year after infancy, it would be the first year after high school, because of the misuse of alcohol.

Yes, college is the place for kids to find their own way. Yes, youth is the time for experimenting. And yes, Americans have the highest minimum drinking age in the world. That said, a third of our college kids in a study from the Harvard Medical School still met clinical criteria for alcohol abuse. Other studies have found that 1700 kids die a year in alcohol related events, 600,000 suffer alcohol related injuries, and 100,000 suffer alcohol related sexual assault. Parents sending their kids off to college are sending them into a war zone replete with risk, harm and occasional tragedy.
Certainly, college presidents can’t miss that their campuses are awash in alcohol. As one former college president now hiding out in a think tank told me, “Drugs and alcohol were the bane of my existence.” Colleges teach less when they have to devote time and resources to policing students and picking up pieces of the campus after the party.
A large part of the problem is that kids drink to get drunk, not to enhance a meal by candlelight. Why they do is complex. Compared to a first run night at the movies alcohol is cheaper, faster, and from the mouths of babes, “funner.” Research shows that the alcohol industry aggressively markets to children. One measure of their success is the marriage between drinking and watching professional, college, and now high school sports. Given the forces of fun, money, sports, ads, and normal experimenting, what’s a parent to do?
One important act is the choice of a college. Is the school on national radar as a “party school?” Does drinking start on Thursday night and run to Sundays?   Is the school a national Division 1 champion or contender in some sport? Any school with a football stadium greater than 75,000 is in the entertainment business, not the business of education. How about the ratio of students to fraternities? The number one party school, according to the Princeton Review, is the University of Florida in Gainesville. It has 46,000 students and 62 fraternities. Then there’s Haverford College in Pennsylvania, with 1,168 students and no fraternities. Haverford is not a party school. (Not everyone gets in, either, as I personally know). This is not to diss big schools in favor of small. Virginia Tech, for example, has an alcohol abuse prevention center and a pretty good football team.
But there is no substitute for knowledge on the ground. Picking a college without a visit is a mistake. Once there, parents and students need to ask about the school’s drug and alcohol policies and problems. Undergrad guides are likely to be refreshingly candid. A parent should look around for telltale signs of the prior night’s activities- bottles, cans, kegs, puke, and the beery smell of kids at a college where leaders hold their noses and look the other way. Parents may still be willing to do the same and shell out $40,000 a year for the privilege, but my bet is that they just want their kid out of the house- badly. But choosing a college is a vote for more of the same. Parents have power waiting to be used.

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.

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.”

Ten Steps You Can Take To Keep Your Kids Off Drugs

December 16th, 2008 No comments

Seldom do parents feel as helpless and guilty as when they learn that their kids have gotten into trouble with drugs. Lots of parents feel that way. A casual glance at today’s newspaper is likely to tell the painful story of a combination of permissive parents, teenage drinking, and heartbreaking tragedy. Studies show that in 2004 one eighth grader in five used an illegal drug. For seniors it was one in two. While drug use can be devastating, new research is identifying important tools a parent can use now to reduce the risk of drug use in the future, tipping the scale from disaster to safety before danger strikes.

Over the last thirty years I’ve come to call these factors Red Flags and Golden Haloes. A Halo is a factor that protects a child from drugs and alcohol. A Red Flag is a clear warning that a child is drifting towards trouble. Seeing flags or haloes doesn’t guarantee success. But it does increase the chance of a safer outcome for your child. Here’s a list of my top ten steps you can take today before you get a late night phone call about your child from a policeman or an emergency room.

1. Talk to your child early and often about drug and alcohol use .

Surprisingly, plain talk about drugs between parents and kids is at times as difficult as talk about sex, death, and divorce. It needn’t be. The biggest obstacle is the sea of misinformation we swim in when drugs are at issue. The answer is getting informed. The National Institute on Drug Abuse is a good place to start. Their home page (http://www.nida.nih.gov/ ) is a Google click away. It’s filled with information on nearly any drug topic you may be concerned about. Nothing helps a discussion more than facts.

2. Personality: Keep a double watch on the child who is by nature is an impulsive risk taker. This is the kid whose mother is forever shouting after him to go slow. “Slow” is not in this child’s vocabulary, because it’s not in his genetic make-up. This child is at higher risk for drug use. Because the child’s motor is genetically hardwired to rev at a high speed doesn’t mean that you can’t have an influence. Your job is to teach your child to go slow, and see the long range consequences of his actions. Remember, we are talking about an increased risk to drugs here, not a sure fire path to perdition.

3. Peers: Know your child’s friends. This becomes harder as they become teenagers, but the payoff is great. Teens learn more from each other than we’d like to think. If a child has drug using friends the risk is increased that she will try them herself. A parent ruling with an iron hand is seldom successful in making or breaking a teenager’s friendships. But knowing who your child’s friends are- their names, addresses, phone numbers- is a start. Your antennae should go up if your child’s best friend only goes by a nickname and a cell phone. You are not, however, looking for the Devil Incarnate. The odds are that your child’s friends are terrific kids. But even great friends make mistakes from time to time. Playing a broader role in helping your child select healthy activities, sports, jobs, camps and schools also tips the scale in a good direction.

4. School: Encourage hard work, not necessarily high grades.

Kids with good grades and those who value good grades are more likely to stay clean from drugs. But this is tricky. It’s important to remember that the B student who tries hard for her grades gets a Halo as much as the A student. And pressuring a child for A’s can backfire as part of a teen’s rebellion against her parents’ values. It’s hard to realize that in this age of the overscheduled child, the average honors student aspiring to a “good” college can put in a seventy hour week. Pressure is on teens to get good grades, play sports, get high SATs, and log in months of community service and exotic extracurricular activities. The result can be that a teen turns to drugs just to escape from overwork. The answer is balance.

5. Help you teens pick their colleges wisely. That means colleges that take drug and alcohol misuse seriously. College is a time of complete release from a parent’s constraints. Mix one part immature student, one part fraternity hazing, and one part alcohol and you can imagine the kind of trouble kids can get into. A third of college students fulfill diagnostic criteria for alcohol abuse. The President of Notre Dame University has called the problem a “culture of irresponsibility.” But not all colleges are equal. The University of Rhode Island, which was called in 1994 the nation’s “number one party school” by the Princeton Review, undertook serious reforms to shed that dubious distinction. When the time comes for a teen to leave for college, make sure you are satisfied that the college enforces the ban on underage drinking and illegal drugs.

6. Religion: Support your child’s involvement in religious activities. Studies show that children with exposure to religion are less likely to become involved with drugs. This should come as a no-brainer. The world’s great religions have taught the virtues of abstinence or moderation in the use of drugs for millennia. This step becomes relevant to the child who is thinking of dropping out of Sunday school to read the Sunday comics instead, or the one who is identifying a spark of an interest for the first time in the ethical or cosmic issues of religion. Try to tip the scale in the right direction. You can be the chauffeur to religious activities. If you are predisposed, make it a family affair. Even a dyed in the wool agnostic or atheist can help a child get the ethical education he needs, consistent with the family’s beliefs.

7. Tobacco and alcohol: Ban the use of alcohol and tobacco by your underage children.

Fight the battle against tobacco at home. You can only win. That’s because even if you lose the fight over cigarettes, the loss may be temporary, and you may set the stage for sober reconsideration about drugs in the future. Make your home a tobacco free zone. There is no healthy reason to smoke. Multiple studies show that the early use of tobacco is a gateway to the use of marijuana, and the heavy use of marijuana is a gateway to harder stuff. If a child is experienced with alcohol, tobacco and marijuana, by age 25 there is a one in three chance he will also be into hard drugs.

I do not condone the practice of giving an underage child “sips” of alcohol at home. An underage child also has an underage liver and brain. Underage sipping also sends the wrong message- that skirting the law governing drugs and alcohol is o.k. It’s not.

8. Double trouble kids: Get help for the child with depression and other psychiatric problems. Too often I see adolescents who are suffering psychiatric disorders which have never been diagnosed, and who are self-medicating with street drugs. Kids begin taking drugs because they elevate their mood in minutes. But the depressed child needs mood elevation to last months. Daily use becomes the disastrous result. Psychiatry has wonderful tools to help children. If you suspect emotional problems in your child, help is a phone call away- to your pediatrician, school counselor, or community psychiatrist.

9. Genes: Respect your family history. If alcohol dependence runs in your family, your biological children are at an increased risk to develop this disease. It’s only sensible, then, to educate yourself and your family, including your children, about the family’s vulnerability. But genes don’t automatically mean inevitability. In fact, if an identical twin has alcoholism, the chances the second twin will only have a 30-60% chance of being addicted, too. What protects the second twin? The environment. That’s where you come in. For kids their parents are the environment.

10. Your own behavior: Take a hard look at your own use of drugs and alcohol. Kids learn much from what you tell them, but even more importantly, what you do. A father who drinks hard liquor increases the chances his children will as well. A mother who uses psychoactive drugs increases the odds her child will experiment with illicit ones. This is not to say that abstinence from alcohol is the answer for every family. There is a strong cultural tradition of moderate drinking for you to address in your family. But teens don’t drink in moderation, though you will be the first one who can teach them moderation if and when the time comes.

I didn’t say these steps were easy. But they may just tip the balance towards saving your child’s life.

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