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.


Anonymous said...

I'm going to have to disagree with you on this, I was raised the exact way you are saying I shouldn't have been, and I never did any drugs or had sex outside marriage, and I have no regrets. I see nothing wrong with telling my child, just say no. The lesser of two evils is still evil and I do think giving them supposedly safer choices that are still bad choices doesn't make them do them, but does send a message that you seem okay with them doing them. The safest choice is saying no, and to teach them anything but that in my opinion is irresponsible.

Libertarian Girl said...

Anonymous, I was raised the same way you were and have never done anything, just like you. However, all my friends did and certainly all my friends in college engaged in this type of behavior. This included the prom queen, the good kids, the sorority girls, the football players, the law school students, everyone.

A friend of mine told me that when he first tried marijuana and didn't die from it, he immediately discounted everything he'd ever learned in DARE or from his parents about drugs. I think it's similar for a lot of kids. You have to be honest with them about the risks and what is safe and what is not. No one has ever died from marijuana use, and if you pretend otherwise, you risk losing your kid on the important stuff like whether to drink alcohol or do cocaine or heroin. The focus on these "traditional" drugs also leaves the kid open to finding alternatives like cough syrup or Robitussin, which can be quite deadly.

I do think that a lot of parents think "If Johnny is drinking, well, at least he's not doing drugs," and that is the wrong attitude to take as well. So many young people die from alcohol-related incidents that it's truly a tragedy to not deal with this in a manner that will encourage your kid to do something else. I think most parents figure the schools will handle it and never mention it altogether.

DrugMonkey said...

Great stuff, DuWayne.

My only caveat, perhaps expected, is to question the degree to which we can be "realistic" about relative risk. From the totally naive parent, to the drug abuse scientist, to the ex-substance-using-adolescent-turned-parent.

In an old, old, Pryor routine in which he says something like "you can't get hooked on no coke!" in the midst of a routine about his own dependence there is truth. At one point in the 70s, maybe early 80s, people really didn't think you could become dependent on cocaine. Because so many people were doing it relatively casually and because there is no heroin-like withdrawal. People didn't really believe, in the broad sense, that you could get acute cardiac failure from stimulant use...until Len Bias.

It is good to be "realistic" in terms of relative risk. It is also good to be aware of "realistic" risks in a more global sense of understanding what we don't know yet, individual risk factors and idiosyncratic responses. 5% seems like "not risky" until you look around your average high-school party and ask, which 1 or 5 (or whatever) of these people should take the toxic hit?

DuWayne Brayton said...

Anon -

First, please pick a name. If you post without one, I don't care if it's absurdly fake, I will delete the comment.

Second, what is irresponsible is to assume that your kids are actually going to say no. It isn't even a case of doing a bad job, kids raised by the very best of parents who do everything right, can still end up making bad choices. They just might end up doing it right - if they do, good for them.

But statistically speaking, most kids are going to engage in risky behaviors of some sort. There is simply no getting around it. Whether it's sex, drugs, theft or vandalism, most kids are going to do something.

When it comes to sex and drugs, there exists a very good possibility that the results could be fatal or otherwise debilitating. So when you decide not to educate your child on being safe, you are literally gambling with their lives.

OTOH, it is quite possible to educate your kids on being safe, without condoning any behaviors. In part, this is where providing honest risk assessments are important. The most likely risks are often enough to convince them not to engage in a particular behavior.

I have four teen/early twenties nephews who (as far as my brother knows) are sexually abstinent. When they were in middle school, my brother discussed condoms with them. He used the perspective that if the boys discovered they have any friends who are sexually active, they should encourage them to use protection and taught them why. He also taught them about drug use and what is more dangerous than another, with the same disclaimer. As they got older, he also made it clear that while he prayed they wouldn't fall into any of it, he wanted them to know how to stay safe. He honestly isn't certain that his boys didn't fall into any of it, but he does know they haven't fallen into the same troubles as many of their fellow LDS friends kids have.

And just because your kids don't tell you about the things they do, doesn't mean they abstain.

Drugmonkey -

I don't think it's really possible to find the perfect answer to risk assessments. No matter what, it will end up being somewhat subjective. My real point in focusing on that, is to encourage parents to realize that it is important to do more than cursory homework on this.

The bigger problem in that, which I hadn't really considered, is the fallacious assumption that less than ten percent, is a low probability. I tend to think in exactly the terms you put it, but realistically, most parents probably wouldn't. I think that put in terms of how many kids out of that group over there, is a very important distinction to point out. Thank you.

Ultimately, it'll never be a perfect science. Parents as a rule, parent from one mistake to another - occasionally being able to celebrate the rare success. The very hardest thing for me as a parent, is accepting that no matter what I do, no matter how hard I try, I cannot guarantee that I won't still muck up my children. Nor can anyone else.

Abel Pharmboy said...

DuWayne, this is a very thoughtful post and gave me some pause to reflect even more on my statement that you cited above. In its original context, it read:

Adopting a parental attitude of complete substance abstinence is likely to be as successful as endorsing sexual abstinence, but condoning any substance use in minors will get you thrown in the slammer and have your kids taken away. Of course, you'd love for your kids to stay clean and not use alcohol until they are 21. You want to tell your kids how cough syrup can kill you and how huffing solvents will give you extremely serious brain damage. But it's stepping over the line to tell them if they're going to choose any illicit behavior, there are far safer alternatives.

I agonized over the wording here in part because I live in a liberal outpost of a very conservative area where discussion of relative risks of drugs is not looked upon kindly and has actually gotten parents in trouble. I agree completely that the safety of our kids should be our ultimate concern and we should be realistic about what they're going to choose to do.

What I probably should've said was that "it could be considered to be stepping over the line," when advising kids about the relative safety of illicit behaviors.

This is a great discussion you and DrugMonkey have started and I suspect it is one that will, and should, continue as our little ones get older. Thanks for all the time you spent on this post.

DrugMonkey said...

I attended what was perhaps the perfect size HS for risk assessment, if you were paying attention.

It was small enough that you really knew just about everyone in your graduation year and a big fraction of the other years, especially if you were on a few sports teams. This meant that when the inevitable DUI death, suicide, drug OD's, kid's dad beating his mom to death, heck even the odd leukemia case hit, it had a real personal impact.

The events were "rare", yes. But it helped to shape my viewpoint of looking around at the 100 people you know in a given group and asking "which one gets hit with the 1% so-called 'rare' event"...

DuWayne Brayton said...

Drugmonkey -

I am going to put up a quick post discussing statistical significance, hopefully this evening. You raise a very important point and one that I would be remiss not to mention. Thanks for stopping and mentioning it.

Abel -

Glad you stopped by. I hadn't really though of the idea that you referring to the legal angle, rather than your personal opinion. Glad for the clarification. In the aforementioned follow-up posting, I will discuss that too.

Libertarian girl -

Sorry for ignoring you, I meant to say welcome and thanks for commenting, but it didn't translate to actually happening. I'll have to blame it on the ADHD, which has been rather harsh the last couple of weeks.

So anyhow, thank you for stopping and commenting. I have loaded some of your posts and will probably get to them when the kids get to bed.

Beth said...

I apologize, I should not have posted anonymously.

I do not see where it is bad parenting to say to my child "this is bad for you, don't do it" rather than "this is a safer alternative, but is still not such a good idea". If they listen to you and respect you, then I think they will do as you ask of them.

Anonymous said...

Struggling with this issue hugely. Where I am from there is a lot of crack and meth available- and of course weed. A family member was kicked out of school for coming in high on weed. Started looking into all of the drugs of choice available- I was horrified by how prevalent it actually was in the community and how easily it could be obtained. Weed does seem like the lesser of the evils, and yet because we live in a very conservative area where people know each other well..... it would be folly for me to suggest that weed be the drug of choice. I was talking to the teen AA person and he was talking in terms of harm reduction. It makes sense---- but it makes more sense to just stay the hell away from this stuff altogether.

I am posting anonymously because I am a little stressed about this.

BTW I have had the necessary talks regarding alcohol, drugs and sex- or shall I say ongoing 10 plus year conversations, but I also have a kid who is a risk taker. They play risky sports, they are exposed to managed risk and have been throughout there life, but it almost seems like some people are born to push the envelope. This is not a bubble wrapped child or family. SO.... what can one suggest when a child is a thrill seeker as a general rule and these things are out there?

Because quite frankly being drunk or high is kind of thrilling if I remember back to my late high school days.

I will sign myself as :


DuWayne Brayton said...

Beth -

I think your misunderstanding me here. I am not suggesting that parents suggest safe alternatives. Ideally the kids will never engage in risky behaviors, but it is quite a lot to assume that they won't, simply because we tell them not to.

What I am saying is to make very clear that there are far more dire consequences to some behaviors than there are for others. Again, this could be the difference between getting upset that one's child has tried a beer or two, maybe smoked a little pot and finding them cold and dead in their bedroom with a can of air freshener in their mouth. Make it clear that drinking is bad enough, but driving while intoxicated or riding with an intoxicated driver is far more dangerous.

My parents did it "right." They were sober people who used the just say no propaganda. I figured out it was propaganda and discounted a lot more of what they had to say that wasn't just scare tactics and bullshit. It's truly miraculous that I survived it all, plenty of kids don't.

Also, if it makes you more comfortable, please feel free to use a pseudonym. The only reason I get pissy about people posting as simply anon, is that others do the same and it becomes hard to differentiate who's saying what. I don't care if you call yourself little bo peep, as long as I can refer to it.

March 5 Mom -

I totally understand wanting to be anonymous, especially when talking about drugs.

It is remarkably easy to come by a host of drugs. I recall having a very easy time finding the pot, meth and acid. Alcohol was actually the harder one to come by.

Having fairly severe ADHD, I actually was a pretty big risk taker. It is hard to say without knowing a kid, what will work the best. But I would focus on the natural consequences of certain behaviors. STDs and pregnancy, when discussing sex, the potential for a host of consequences, specific to this drug or that.

There is a lot to be said for trusting our kids to take into account, the less in your face consequences too. A lot of kids think seriously when their parents explain that using most any mind altering substance, will impair the brains development. It may not be significant, but it is a virtual guarantee that every time you use an enthogen as a adolescent, you are further reducing your eventual brain function.

Beth said...

Well I can agree that honesty is the best policy, and every child is different, so what you say to one may not have the same impact as another. I just thought giving alternatives seems plain wrong and contrary to what you think that it does seem to give your blessing when you talk in terms of making choices other than teaching your child to stay away completely from drugs or sex.

DuWayne Brayton said...

Beth -

Again, it's not about providing choices. Be clear and firm that there are a lot of reasons for abstaining from the sex and drugs. For such things as inhalants, I wouldn't even present it as part of the drug issue, if you're concerned about sounding like your advocating safer alternatives for getting high. Just tell them that using inhalants is very likely to cause irreparable, severe brain damage, if it doesn't kill you.

The idea is not to present it as all being the same, it's not. That doesn't mean you have to present it as choices. It just means giving your child enough information, that if they decide to ignore your admonishment that abstinence is the best policy, they will at least be capable of making safer choices.

kehrsam said...

Beth: I think you and DuWayne are both making valid points. Thanks for the comments. But the two positions are not mutually incompatible. By all means teach your children to abstain; at the same time, teach them what the risks are.

The key, I think, is presentation. If you present a given object (sex, alcohol, drugs) as a forbidden fruit, that is how it will be perceived. Fascination and imagination will do the rest.

If, instead, you present the benefits of abstention, they will have something to weigh against the attraction. It certainly does not hurt to model the proper behavior, either, especially in sexual relationships: If they see how loving adults form a committed pair, they are much less likely to be drawn to the back seat of a Camaro on Friday nights. Similarly, children from families where responsible drinking is modeled at home tend to do less binge drinking (but a very high percentage of these kids do drink; that's the tradeoff).

I can't lecture anyone else: I never did illegal drugs, but made up for it with plenty of legal ones, especially alcohol. Had I been more of a social person, I imagine things could have gone a lot worse.

Also, I don't have children, although I work with a lot of kids at my church, especially the 4th-7th graders, which is where these issues are first hitting their radar. Trust as mentioned earlier, is key. A lot of these kids will tell me things that I know they are not discussing with their parents or the Youth Pastor, even though Teddy is a lot younger and way cooler than I could ever be. But he has to tell them Just Say No, it is always wrong. It's a good message, but they've already heard it plenty of times and they still have the questions.

So I tell them about responsibility. That if you're going to make adult decisions, you need to start thinking and acting like an adult. That there are consequences, and that the fun you have at the party may not be worth the way you feel the next day, even if nothing bad happens. I tell them what its like to be in rehab, what it is like to completely give away your freedom, what it is like to reach the point where you are completely unable to take care of yourself.

But mostly I tell them what a wonderful joy it is to be alive each day. To treasure the moments of each sunny afternoon, to know that no stimulant is needed. And some of them understand. Which is worth all the tears in between.

Beth said...

Thanks Kehrsam, good thoughts.