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Frequently Asked Questions – F.A.Q.

December 17th, 2008
  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.

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