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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.”

Kate Moss Teaches Parents Seven Lessons about Drugs

December 16th, 2008 No comments

Robin Williams once said that cocaine is God’s way of saying you have too much money. That may be true for supermodels like Kate Moss, but it’s hardly true for most kids fooling with cocaine. Moss was featured in a recent article, along with “shocking pictures,” using cocaine in a London recording studio. Today her career is in danger, along with the custody of her child. Sad, yes, but it’s hardly shocking to see another celeb fall from grace. The list is too old and long to shock anymore. Coke is in the schools, on the street corners, and for unlucky families, under the kid’s bed. So what’s a parent to do? There are a number of important lessons from the Moss story.

1. Don’t let your income, no matter what level, make you complacent. Drug abuse does not respect incomes, high or low. A kid with too much money on his hands is clearly in danger of stepping on the accelerator in the bad judgment department. But studies also show that he lower the family income, the greater the chance a kid will use cigarettes or an illegal drug in his lifetime.

2. Use the Moss story to open up a dialogue with your child about drug use. I am not talking about wagging the finger or blaming the victim, no matter what her income. But a celebrity’s story can be a gift to parents. The Moss story for a brief time puts the topic of drugs and alcohol squarely in the middle of millions of kitchen tables. It can save lives, if parents are savvy enough to talk with their kids about it. In my decades as a psychiatrist I’ve come to believe that dialogue is the single best way to keep kids safe from drugs and alcohol. A parent can’t control every aspect of a teen’s life, but she can shift the balance towards safety by talking. Kate Moss can help you kick things off.

3. Talk about cigarettes and alcohol. Cocaine was the drug du jour for Moss. You will need to start talking about cocaine. But only one high school senior in the U.S. in twenty last year used cocaine in his senior year. The major drug killers today are still tobacco and alcohol. The Moss story can be a starting point towards the topics of cigarettes, alcohol, and marijuana. These three are gateway drugs to the hard drugs, cocaine and heroin. It makes sense, then, to start with the train wreck and move backwards in time to its cause. You don’t know Moss’ drug history, and you don’t need to. What you desperately need to know is your child’s use of drugs and alcohol.

4. Listen to your child. This is not as easy as it sounds. Most parents think they’re great listeners. Most kids likely think otherwise. It’s hard for many teenagers to speak with their parents. Treat what they say as gold, not because it is, but because the process of being listened to will pay benefits down the road. Part of the problem is that we as parents have spent more than a decade telling our kids what to do, and how to do it. But teenagers need to talk things out as much as they need to hear your opinions. It’s hard for us to move back and forth between the roles of limit setter and facilitator. But that’s the job.

5. Don’t moralize. Drug dependence is a disease. Kate Moss’s fall from grace is a story of chronic illness, not immorality. Nora Volkow, for example, Director of the National Institute on Drug Abuse, found that in cocaine addiction, the drug changes chemistry for months, and disturbances of the chemical in question, dopamine, are thought to be related to problems in motivation, focus, and pleasure.

6. Look for the red flags of drug use. There are times, perhaps more often than not, that teenagers are not in a talking mode. Some kids like to let their actions do the talking. Then it’s the parent’s job to pick up on the clues, and cues, a kid is giving off, and run with them. There are certain red flags that a child waves in front of you that mean trouble on the tracks. Common ones are cigarette smoking, frequent episodes of drunkenness, and run-ins with authorities. For parents specifically worried about cocaine, look to the red flags of unexplained weight loss, abnormal surges of exuberance or collapses into depression, and discoveries of drugs and drug paraphernalia. These are all indications for getting help from a professional.

7. If a child is in trouble, don’t wait for things to get better. That’s a gamble not worth taking.Drug use is a progressive problem, moving from casual experimentation to addiction. You don’t want to wait for your child to slip off the slope into dependence. The sooner you act, the better the outcome. Get help! For parents whose kids are clearly involved with drugs, there is a mantra you cannot forget: treatment works.

Sometimes a parent will ask if talking about drugs, especially when they are used by the glitterati, creates a copy cat mentality in kids that drugs are cool. My answer is that the risk is probably no worse than seeing hundreds of ads every week in magazines and televised sports. A study in the New England Journal of Medicine, for example, found that despite massive lawsuits, the cigarette industry in 2000 still managed to reach 80% of our kids with ads 17 times. We immunize our kids against the killers of diphtheria and polio. We can do the same for drugs and alcohol. The lives of superstars like Kate Moss can give parents the vaccine.

Henry David Abraham, M.D. is a psychiatrist affiliated with the Harvard Medical School and author of “What’s a Parent to Do? Straight Talk on Drugs and Alcohol,” New Horizon Press, 2004.

Categories: Advice on Parenting