Archive for the ‘Advice on Parenting’ Category

Prescription Drugs and Teens

November 6th, 2012 No comments

If you haven’t had a cup of coffee yet today, here is an eye-popping curve that will wake you up. The national Centers for Disease Control and Prevention discovered that over the last forty years the death rate from prescribed drugs rose over 400%. The curve below tells the story. It shows the death rate from accidental drug overdoses per 100,000 people. In math class this curve would be called exponential. Of prescription drug deaths, about ¾ are from pain relievers. In 2008, for example, these drugs- opioids- killed 14,800 people. The total drug death rate now is roughly the same as the death rate from car crashes. This figure means that the abuse of prescription drugs is the fastest growing drug problem in America.

A big problem with legal drugs is that they can move from the people who need them to those who don’t. The DEA calls this diversion. Take, for example, the recent story of methadone. This drug has a proven benefit for treating addiction and patients with terminal illness. In recent years doctors began to use it for patients with chronic pain. Although it is prescribed only 2% of the time for this indication, it’s responsible for more than 30 percent of prescription painkiller deaths. Most likely this is in part because of drug diversion.

Kids are world champs when it comes to drug diversion. They find drugs at home, and pass them like candy from friend to friend. Surveys find that they fool with prescription drugs more than they do heroin, cocaine, and methamphetamine combined. Among 12 and 13 year olds, prescription drugs are the drugs of choice. In 2011 8% of high school seniors had tried them. The most common ones are pain medicines (e.g., Vicodin, oxycodone, OxyContin), stimulants (e.g., Ritalin and Adderall), and less often, tranquillizers (e.g., Xanax, Ativan).

Why do they do such stuff? Most of all, because the drugs are available. Open your medicine cabinet and see if you have any mind altering left-overs there. You don’t? Good! Some folks do. Kids can purloin them from purses, or from the medicine cabinets of their grandparents. 54% of high school seniors say that pain drugs like Vicodin are easy to get. Boys tend to abuse stimulants to get high. Girls take them to stay alert.

Kids also mess with them because they think they’re safer than street drugs. Nothing could be less true, which is why you need to go to medical school to learn how to prescribe them safely. They can also get them at the local pharmacy in the form of over-the-counter drugs (e.g., DXM, or dextromethorphan, a component of cough syrup).  Finally, doctors and dentists have made them more available in past years, nearly always for the compassionate relief of pain.

Since this report, the response from government has been both admirable and scary. States have targeted doctors in pain clinics and patients who divert drugs illegally. Computerized patient drug data now flow across state lines to catch those who shop for sympathetic or unethical doctors. The right of privacy is rarely defended against the trampling of regulatory feet. But some ideas are enlightened. One bill in Massachusetts sponsored by Steven Tolman and others would increase the availability of the drug naloxone, which is life-saving in any narcotic overdose.

This mix of bad policy and good in the last few years appears to have helped more than it’s hurt. For example, the number of people who abused prescription drugs fell from 7 million people to 6.1 million in 2011. In 2009, 2.1% of the population abused pain pills. Two years later it was 1.7%. This is the lowest rate since 2002. The drop was particularly encouraging among 18 to 25 year olds. The numbers may seem small, but from a public health perspective these gains are great, especially when you consider the rising tsunami of prescription drug deaths over the last decade.

But the game of preventing prescription abuse starts at home, and parents hold the best cards. You play them by educating your kids about drugs, keeping the meds secure, and getting rid of them once they’ve done their job. Stockpiling drugs is always a no-no. There are those situations when, despite your best efforts, you make no progress in keeping a kid safe from drugs. That’s a time for professional help.

Remember, though, that the drugs in the medicine cabinet were put there for good reason. For the right person and the right dose they reduce suffering and save lives. When they are in the wrong hands and used for the wrong reasons, drugs are trouble. This is especially so when kids free to help themselves to some of the most powerful chemicals in history.  This is not new knowledge. In 1960 the Massachusetts physician Oliver Wendell Holmes said “if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be better for mankind- and all the worse for the fishes.” Certainly this should apply to your medicine cabinet, when its contents are no longer needed.

Categories: Advice on Parenting

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.

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