Q: I am concerned that my teen may be at risk for getting addicted to drugs and other substances. These are difficult times for teens. I worry my son is more likely to smoke marijuana when it is decriminalized by the Canadian government.
Epidemiological studies done over the past decade confirm that teen substance abuse is a major public health problem and some predict it may get even worse! Recent published data (Johnston LD et al: NIH publication No. 02-5105) reveal that by the end of high school:
- 80% of teens have consumed alcohol (more than a few sips)
- 61% have tried cigarettes
- 49% have used marijuana
- 54% have used an illicit drug (up from 41% in 1992)
No adolescent is immune to the risk of becoming addicted to various substances. A youth with a family history of substance abuse and dependence is more likely than his or her peers to abuse substances and to have continued problems as an adult.
Several articles written for the American Academy of Pediatrics have some interesting facts about substance abuse. In turns out that there is little difference in drug use between urban and non-urban youths (Sharon Levy: Office Management of Substance Use July 2003), males are more likely to use illicit drugs and be heavy drinkers than females, and teens who plan to attend university are less likely to engage in the use of illicit drugs than those not planning to attend university.
The drugs most commonly used by teens are alcohol, tobacco and marijuana; and, sadly, all of these substances are associated with the three leading causes of death in the teen years: accidents, homicide and suicide.
The question is why don’t doctors screen adolescents more often for drug use, given that teenage substance abuse is such a major concern for society? When the American Academy of Pediatrics surveyed fellows of the AAP a few years ago it became evident that less than half of the doctors surveyed screen adolescents for drug use (Periodic Survey of Fellows No. 31). This may be due to the fact that parental consent is not sufficient for a physician to perform testing (according to various position papers written by experts in the field - AAP, American Society for Addiction Medicine, Psychiatric Association and Academy of Child and Adolescent Psychiatry) yet, a physician must facilitate teen confidentiality and attempt to respect the parent’s request for performing a drug screen on the teen’s urine. Also, many addiction patients will only attempt to change their behavior if they believe that they can be successful.
Even if one assumes that urine testing is a good first step, some pitfalls have to be considered:
- A negative test indicates only that none of the substances in the test panel were detected in the urine (the half-life of most substances are brief).
- Urine tests can be positive for weeks in chronic marijuana users. Also, passive inhalation of marijuana will cause positive drug testing when exposure has been significant (i.e. being confined in a small, poorly ventilated space, such as a car, with many smokers).
- Teens can dilute their urine, to keep the level below “cutoff”, by adding water to the urine sample or by drinking excessive fluids before giving a specimen.
Another method of screening for substance abuse is the CRAFFT questionnaire. This practical questionnaire, devised at the Children’s Hospital in Boston and published in 1999, helps parents and doctors become aware of problems at an earlier stage:
C : Have you ever ridden in a car that was driven by someone (including yourself) who was high or had been using alcohol or drugs?
R : Do you use alcohol or drugs to relax?
A : Do you ever use alcohol or drugs while you are alone?
F : Do you ever forget things you did while using alcohol or drugs?
F : Do your family or friends ever tell you that you should cut down on your drinking or drug use?
T : Have you ever gotten into trouble while you were using alcohol or drugs?
Each “Yes” answer scores one point and a total score of 2 or more indicates high risk for serious substance-related problems. If your teen has a score of 2 or higher, when using the CRAFFT tool, it is important to seek help from a professional.
Some families rely on the Internet for dealing with the issue of substance abuse. According to a paper published in the April 2004 issue of Pediatrics, the usefulness of Internet-Base home Drug-testing products remains doubtful. The authors used three different search engines: Google, Yahoo and Ixquick to identify some popular sites (www.drugfreeteenagers.com ,www.parentsalert.com , www.homedrugtest.com , www.proveit.com ). The authors concluded that pediatricians must advise parents of the limitations and risks associated with home drug-testing products.
The good news is that there is something you can do. Prevention is always the best cure and risk reduction remains a noble goal (see www.saddonline.com and “How to Drug Proof Your Child” by www.focusonthefamily.ca ). According to a study from Columbia University, when fathers and their sons were close and when the communication channels were kept wide open, the risk of that child engaging in substance abuse was lower than 1%.
In addition, here are 5 strategies (provided by the AAP) for saying “no” to a ride home with an impaired driver:
1. Plan ahead. Have a ride home worked out before you leave your house.
2. Have a back-up plan. Be prepared to take a bus, call a taxi or sleep at a friend’s house.
3. If your ride has been taking drugs or drinking, tell him or her that you “feel sick” and don’t want to get into the car.
4. Don’t try to decide if you or someone else is “all right” to drive.
5. Sign the “Contract for Life” with your parents (www.saddonline.com/contract.htm)
For more information, and access to valuable resources, please visit my website (www.healthykids.ca ) and look for future seminars.
Access www.healthykids.ca for a terrific new resource in helping families raise healthy children - HealthyKids with Dr. Nieman will optimize your child's complete health.
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