Monday, March 10, 2008

More on the Conversation that Never Ends

The last post garnered rather a lot of response, so I wanted to clarify a few things. Also, quite a few responses came via email. Please, comment publicly. There were several good points made, that I think could add a lot of value to the discussion. For those who are uncomfortable talking about this openly, I do allow anonymous comments - i.e. I don't get any information about you. I only ask that you sign off with some identifier, besides simply anonymous. I don't care what you choose to use as a screen name, just give me something to refer to. Unidentified comments will be deleted.

I would also take this opportunity to point out that another sciblogger has weighed in on this. Dr Free-Ride, at Adventures in Ethics and Science, makes some very similar points to my own.

First, Abel actually was referring to legal wrangling, when he talked about going over the line. And this is a very important factor in discussion of issues such as sex and drugs with our children.

This is a very real concern, for a lot of parents. The only real answer for it, is to be active and try to affect change in our communities. In many places it is possible to have one's children taken away or be otherwise oppressed for making very reasonable and sound parenting choices. And it's a catch twenty two. On the one hand, the only way to effect change is to talk about why these are perfectly reasonable choices. On the other hand, if one talks about it, it could be cause for serious legal problems. This is a tough enough issue that even living someplace as reasonable about these things as Portland is, it still makes me a bit nervous, talking about it.

I do know that this is a pretty big problem, one that is all the more difficult, having been raised to believe that the freedom of expression is akin to being a sacred ideal. Especially true when it comes to raising one's children and doing what we believe is right, to raise as functional, ethical and safe children as we can. There are no easy answers. Many contributors to the problem are rather obvious, but actually changing them, is as complex a problem as trying to break the deathgrip the republicrats have on American electoral politics. One advantage, is that this is very much a localized issue and we can all get very directly involved with local politics. It is still an uphill fight, but I think it is one worth fighting.

Drugmonkey also weighed in, with a very important point about risk assessment. This being that even a seemingly small chance, such as one percent, is not as small as it seems. To illustrate, take a group of five hundred kids, not far off the mark for a lot of graduating classes at high schools all over the country. If anything, it's probably a little small. But it works for illustrating the numbers easily.

Something that affects one percent of a teen population, is going to affect five kids in that group. But that leaves four hundred, ninety five kids who it doesn't affect, right? Of course it does, but I want you to consider exactly what this means. I want you to consider the odds of one of those five kids being someone you and your child knows. At the least, it is exceedingly likely that at least one of the five will be known to someone you/your child knows. Less likely, but still plausible, one of those five will be your child. So lets look at some numbers, kindly provided by Drugmonkey;

In this we are supported by the data in the sense that 50% of 12th graders have tried an illicit drug, 73% have tried alcohol and 56% report having "been drunk".

So lets look at how this translates into our group of five hundred kids. We have a full two hundred, fifty kids who will try an illicit drug. Two hundred, eighty of them will get drunk. And three hundred, sixty five will try alcohol. To be clear, it is virtually impossible that you/your child will not know several kids who will fall into one or more of those categories.

I would also like to take a look at the numbers for inhalant use among teens, from this context. Mainly, because this is the one that frightens me the most. According to a 2006 report by the American Academy of Pediatrics (Warning, PDF link), 11.1% of twelfth graders have used inhalants, holding steady since 2002. Finding statistics on the percentage of kids who use inhalants, who die of it is proving rather difficult, but according to this same report, of those who die, 22% are first time users. So of our group of five hundred kids, fifty-five or fifty-six of them will use inhalants. Here is a listing of likely side effects of inhalant abuse, from the National Institute on Drug Abuse. Note the stats are a little different for the frequency of use. Keep in mind that until this page, we have been looking at statistics for use before high school graduation. NIDA's figures are for lifetime use, not just use among youth.

So while it is easy to point at figures like one percent, and assume that this means something is safe, the reality is that one percent isn't that far away from us, at any given point.

Finally, I wanted to clarify what I am trying to encourage parents to do. I am not suggesting that parents tell their children that if they really need to use drugs, do such and such, because it's safer than other options. While for some kids, that might well become a reasonable method of harm reduction, most kids really don't need that. What I am advocating, is nothing more than providing our kids with enough information, to make an informed decision, should they choose not to abstain. Make sure that you aren't going to find them cold and dead in their bedroom, with an aerosol can in their mouth. Make sure they aren't going to drive intoxicated, or ride with an intoxicated driver.

Sunday, March 2, 2008

Drugs and Children, the Conversation that Never Ends

Abel Pharmboy has a great post up, about the dangers of prescription and even some over the counter medications, that kids use to get high.

Related to the DrugMonkey post, PharmGirl just tipped me off to this Benadryl nightmare at the Sweet Hill (OR) High School. Students have turned up in local emergency rooms after having taken 20 to 30 of the tablets, each containing 25 mg of diphenhydramine.

At high doses, diphenhydramine's central antimuscarinic effects become apparent as hallucinations but this is a terribly risky approach. Suppression of parasympathetic drive to the heart can cause tachycardia and lead to fatal cardiac arrhythmias. The story is deeply concerning...

He then goes on to describe the problems with a couple other commonly abused medications, well worth reading the entire post and comments. Towards the end of the post, he poses a very important question;

But it's stepping over the line to tell them if they're going to choose any illicit behavior, there are far safer alternatives.

How do other parents ethically approach this conundrum?

First I would like to comment on the very notion that it's stepping over the line, to tell children there are far safer alternatives.

One of our very important responsibilities as a parent, is to do everything that we can, to ensure they survive childhood. The point that we decide that something this important is off the table, is the point where we really start to gamble with the lives of our children. Kids are all individual, different beasts. They each have unique needs, what works for one child, won't work for another. Thus it is important to recognize that one needs to tailor this discussion, to the needs of their child – also realizing that the approach you take with one of your kids, may not work for the next one that comes along.

This is much akin to the discussion of sex. It's a hotbutton issue, with no easy answer. But just as we gamble with the life and well being of our children, if we refuse to teach them about making sex safer, we also gamble with their lives, if we just say no. It is not telling your child it's ok, to make them aware of ways to keep themselves safer. But we owe it to our children, to give them information that can and probably will, keep them alive and safe.

While every kid is different, there are some very standard, near universal steps one should take, when making their child aware of the dangers of drugs. Most of this also applies to every single hotbutton issue we should discuss with our kids.

Honesty – Always

This cannot be emphasized enough. There is nothing more important, than always being honest, when talking to our kids about sex, drugs, dangerous activities or any hotbutton issue. Never, ever lie about anything. Never even exaggerate anything with them. Always be honest with your child. If they ask a question your not comfortable answering, at the very least tell them your not comfortable talking about that. The best policy is to be open with them, occasionally telling them you will be happy to discuss it when they are a little older, if it really isn't age appropriate. But if you just can't bring yourself to respond, then have the courage to tell them that.

The point that we start to lie or overstate the case for something, is the point that we lose all credibility about that issue. Do it enough and we lose credibility all together. For a good many kids, the credibility we are talking about, is a lot easier to lose, than it is to ever regain it, should it be lost. If the goal is to have a child that is confident and comfortable with bringing up any and every topic they wish, then this credibility is essential. We throw that away at our own peril. More importantly, we throw that away at our child's peril.

Get Your Facts Straight

Do not approach the topic of drugs, without doing your homework. If, like me, you have personal experience to draw from, by all means use it. Even if your experience is limited to only small aspects of the discussion, they are far more valuable than anything else you will bring to the table. First, this is establishing credibility. They know you're being honest, when you discuss your own failings, or even less dire experiences, with licit or illicit drugs. Too, they place a lot more value on your actual experiences in life, than they usually let on.

For those with less experience, or even those with a lot of them, read and question people who've been there. Don't depend on sites the government provides. Read a wide range of information, from different perspectives. Call organizations such as narcotics anonymous and even alcoholics anon. Tell them you are interested in finding someone who can talk to you and your kids about substance abuse. I can virtually guarantee that they can and will be very keen on helping you. The perspectives of people who have lived the worse of drug use, are extremely valuable.

But the most important aspect of this, is to never overplay the very worse of consequences. Talk to your kids realistically. Taking alcohol as an example; Focus the majority of your attention, on the potential consequences to their bodies development, especially the brain. Make it clear that in their early to mid twenties, the consequences of having a drink, are far less dire. The brain is pretty well developed, having a drink or smoking a little pot, is going to do far less damage. While the brain is still developing, THC or alcohol (not to mention a whole lot of different drugs) will inhibit proper neurological development. It may not translate to significant loss, but there is no getting around it, they will impair neurological development.

Use Realistic Risk Assessments

Yes, you are right in sensing a theme here. But it is critical that we make sure we use the best possible information. Risk assessment, is where a lot of drug campaigns really falter. They want to scare kids out of using drugs, so the focus is on the very worse potential consequences, consequences that are the least likely to be observed by the child. Meanwhile, the milder, but far more common consequences are virtually ignored.

The thing is, most kids, unless they are sheltered to an extremely unhealthy degree, are going to observe the milder, more common consequences of various sorts of drug use. The more dire consequences are less likely to ever be observed. Focusing more on the realistic, provides another source for the credibility that is so important.

To take an honest risk assessment approach, means that you will be telling your children that there are safer, albeit still dangerous alternatives out there. Such as, you will be telling them that smoking pot isn't nearly so dangerous as huffing canned air or gasoline. You will be telling them that freebasing cocaine (crack) is more addictive and dangerous than snorting a line of cocaine. You will be saying that it is far safer to only drink where it is safe and stay there, if they decide to drink, instead of following their parent's advice. Because always, above all else, we have to focus on safety first.

Do Not be Afraid to Tell Kids How to be Safe

We can be clear that something is a bad idea, while maintaining that there are things that can make certain activities far more dangerous than they inherently are. To tell a kid to use a condom if they are going to have sex, does not have to mean we condone them having sex. Likewise, telling a child the difference between smoking crack and smoking a joint, is not telling them they should go smoke pot. What we are doing, is refusing to gamble with our children's lives.

The consequences of having unsafe sex, can be as bad as death, or at least a horrible, ravaging disease. The consequences of using various substances to get high, can also be as bad as death. There are all sorts of potentially dire consequences, to all sorts of activities. There are also ways of reducing the potential for the very worse consequences, for any number of activities. Some people, in the name of ideological or dogmatic purity, feel the need to take an abstinence only approach to all of these topics. They want to make it as simply black and white. Then they trust that there kids will just do as they are told and abstain.

This is nothing less than gambling with your child's life. You are doing nothing less than throwing your child to the wolves, without the least bit of protection. You make them vulnerable to perfectly natural impulses they may be unable to control. If they are going to break down and have the sex, they're going to do it. Statistically, it is far more likely they're going to than they're not – no matter what try to teach them. Likewise, it is entirely likely that they are going to use some sort of inebriant, some time in their youth. The only question becomes; What sort of risk assessment are they going to use? Because if one's just as “bad” as the rest, one of the easiest ways to get high, is using highly toxic, very dangerous inhalants. They are bar none, the easiest to get their hands on.

Build Confidence

The more confident the kids, the less likely they will fall prey to peer pressure. Peer pressure is a huge part of using various substances. Most dangerous, it takes the control out of the hands of our kids, and gives it to their compatriots. By themselves, our kids are probably in pretty good shape for staying safe and listening to us parents. It's when they feel it's more important to fit in, than to be safe (or safer), that they really can get into the worse trouble.

Start Early

It is never too early to talk about the hard stuff. Make it a habit from the git go. We first discussed drugs with our son, when he was three. He saw a friend of ours rather drunk and the conversation began. A few months later, we saw someone smoking crack in the streets. When he was five, he actually had quite the q&a with a guy he saw hitting a crack pipe. He has also talked with a friend of mine, who has been dealing with some serious substance abuse issues for much of his life. We started with very general, very basic ideas and haven't progressed far beyond them. But we have begun the habit of talking about drugs and inebriation. Likewise, we have done the same with topics such as sex, bigotry, hatred, environmental issues, social issues. It doesn't take much, but with even the tiniest foundation, you pave the way for talking about it when these issues become very relevant to your child.

Showing them you have the courage to talk about difficult issues, also makes it more likely they will want to involve you in their decision making process. As much as I would love to see my children retain their virginity until they are secure, mature adults, I would settle for them being comfortable asking my advice, when they decide they are going to do it anyways. Likewise, I would love to see my boys forgo smoking pot or drinking, until they are much older, if ever. But I will settle for them talking to me about it, before they decide to do those sorts of activities. Remember, if they don't feel they can trust you, they aren't going to talk about it. They will however, likely make decisions you aren't going to like anyways – you just won't know what it is.

This means biting your tongue. It also means standing your ground and making it clear what the consequences are likely to be. It means knowing your child well enough to know when they are likely to do something dangerous and when you just have to bite it and do what you can to keep them safe while they do it. Because it may be the difference that prevents them from transmitting HIV, or means they have a beer instead of dying with a can of air freshener in their mouth. Most importantly, it means making sure that they never have to question your love for them, no matter what they choose to do. Let them know when you are disappointed, but never let them question your love. Like your credibility, if they question the love, you've lost important and hard to restore ground.

There is plenty more involved with this topic. I would love to go on about it far more than I have here and may well do so, but these are what I consider the most important keys to keeping one's children safe. For certain, they are pretty universal.

I am also going to just have to admit that it is unlikely I will get to a lot of things any time soon. We just have a lot on our plates and things aren't slowing down anytime soon. I will keep up posting as much as I can, but please bare with me, it will be slow.