Should My Teenager Be Drug-Tested?

If you suspect (or know) that your teenager is using drugs, then the short and rather obvious answer is "Yes!" But the details here are important: you need to be careful about who is doing the drug testing, what drugs are being tested for, what is done with the results, and how long the testing should go on for. A professional should guide you through all of this. I usually counsel against parents testing their own teenagers, because the parents are so easily fooled, and a positive result usually ends up with anger and recrimination, rather than the more clinical response of a therapist, who will help the teenager access treatment. (I am not saying that I or any other therapist cannot be fooled on a drug test, only that we are much more likely to do the test correctly, and find out what is really going on.) Also, it is important to test teenagers, even if they are actually telling you what drugs they are using. I am often confronted with a urine toxicology which is positive for cocaine or opioids, when the teenager professes to be "only" using marijuana. Oftentimes the teenager is in denial, or simply lying. But sometimes the teenager may be unaware of other substances being sprinkled on a joint.....
I usually agree with the teenager that I will give him or her the results of the weekly drug test, but not pass that information on to the parents. The teenager can then give the parents the drug test results or not, but not giving the results to one's parents of course sends the message that it was positive.  However, if a drug test (or anything else) tells me that the teenager is in immediate danger, I will call the parents. I would call the family of any patient whose life is in immediate danger!

How Do I Talk to my Teenager About Drugs and Alcohol?

The short answer is....any way you can. You should start the conversation as soon as you possibly can. When your fifth grader mentions learning about the dangers of smoking, or your third grader sees Lindsey Lohan on the cover of People magazine, you have a golden opportunity. Rather than delivering a monologue on the dangers of drug use, ask your child what he or she thinks about the subject at hand. Does she know anybody who smokes? Has he heard kids talk about drugs? You want to have an ongoing conversation

about this issue as your child grows, is exposed to drugs and alcohol, and as his views change about drugs and alcohol. You cannot really expect your teenager to hold the same perspective he did in 3rd grade, and the reality is that drugs and alcohol will be readily available in the High School years, at the latest. Even if he does not try addictive substances, he will have plenty of friends who have. I don't mean to say that your teenager should not have to hear your warnings, and your set of values. In fact, I think he will be much more likely to follow your lead if you give him the respect of hearing him out. You may have to listen to your teenager tell you that marijuana is "natural" and therefore safe, that laws against teenage drinking are unfair and anachronistic, or that plenty of kids use cocaine without any discernible problems. Engage your teenager in that conversation, and do not hesitate to give your own viewpoint. If you have nuanced views about drugs and alcohol - and most adults do - don't hesitate to tell  your teenager about those views. But also, don't hesitate to absolutely forbid some behaviors: your teenager will benefit from knowing exactly where you stand...... 

What if Your Teenager is Abusing You?

 I usually counsel families not to shut out their drug or alcohol using teenager, in the service of staying ready and willing to help the young person back to sobriety. I worry about families who use Tough Love as an excuse to abandon a young person who is essentially helpless to control his or her behavior. All the lying and cheating that addicted kids do can (quite understandably!) lead parents to eject the teenager from the family home, with the admonition to "get yourself together or don't come back!" Generally speaking this is unfair, in the same way it would be unfair to demand that a  person bleeding in the street get himself together and stop bleeding. He'd like to! However, there is one circumstance that absolutely necessitates that the teenager be cut off from his family, for the good of both the family and the teenager. That circumstance is when the teenager is abusing the family, or any members of the family. Although the most obvious issue would be physical abuse, I do include emotional and financial abuse. Are you afraid of physical harm from your teenager? Does your teenager browbeat you verbally? Demand and receive money from you? Steal money or goods from your home? If any of that is happening, your home is not a safe or sobriety-promoting place for your teenager, and he or she needs to be out. I say this not only for your own protection as parents, but for the well being of your drug or alcohol using teenager. The world simply does not work that way - outside of your house, offering physical violence or stealing things will get your teenager arrested, beaten up, or worse. And the abuse dynamic set up in your home makes it certain that your teenager will not get help for the drug or alcohol use, and you will be helping no one. Although an abusive teenager cannot stay in your house, you can still offer help by arranging for treatment elsewhere or  setting up insurance benefits. Aside from physical abuse, the definition of what constitutes abuse, emotional, financial, or otherwise, can be a bit subjective. But if you feel afraid in your own home, or you worry about not being able to reason with your teenager, you are probably being abused and you need to separate from your teenager for his benefit and yours!

"Dad, Did You Smoke Pot In College?"

That question can be the feared moment-of-truth for parents who don't want their kids to use drugs. Although you are under no obligation to tell you children everything about yourself, be glad you are getting this question! Frankly, unless your teenager is brain-dead, he already knows that the statistical liklihood that you at least tried marijuana is very high. The question is an opportunity to talk about drugs with your teenager, and an opening for you to get your opinion out there at a time when your teenager is actually listening to you. Before you answer, start a conversation - why is he asking, now, about what you did in college? Do a lot of kids smoke marijuana at school? Does your teenager smoke? How often? What's it like? The understanding you have gained over the years, including the change of perspective we all experience when we become parents, are perfectly reasonable ideas for you to promote here. Here are some responses parents I know have used when asked "Did You Do It?"

1. "I did, and I didn't like it very much."
2. " I tried it a few times, but it made me so groggy I just couldn't function."
3. "I did, and I really got into trouble with it. Made me miss classes, hang out with the druggies all the time..."
4. "Yes, and it really didn't do me much harm. But I had a friend who dropped out of school because of marijuana."
5. "Yes, but the marijuana around now is much more potent. You could really hurt yourself with it."

       Remember, the fact that you did or did not do something in college hardly proves that it is OK for your teenager to do that same thing. Make that logical point but, more importantly, use the "Question" as an opening to talk with your teenager about his drug or alcohol use in an open and honest way. If you listen respectfully to what they have to say, they will take your opinion with them, whether they admit it or not.

Celebrity Addiction

Amy Winehouse's death provoked much speculation about her drug and alcohol use, the cause of her death, and her hit song "Rehab." But regardless of what actually happened to Amy and other celebrities whose personal pain is so often covered in the media, the stories do offer you a starting point for talking with your teenager about drugs and alcohol. For instance, you could ask your daughter if she knows about Lindsey Lohan's court appearances. What does she think of the drug-using behavior? Are celebrities protected from the consequences of their actions? Does an artist need to use consciousness-changing substances? Your first instinct may be to turn off the news reports about celebrities and their public struggles with addiction. Don't! Use the situation to talk to your teenager!

When is it Time For Inpatient Treatment?

Your teenager needs inpatient treatment for his addiction if his use is life-threatening, or if he is suicidal or has a serious mental illness, or if he just can't stop without going to an inpatient facility. Inpatient facilities -where the patients stay 24 hours a day, 7 days a week - are naturally more intensive, and can monitor your teenager in a way no clinic can possibly match. "Life-threatening" is of course sometimes a subjective term, but if your teenager cannot stop using cocaine, that would be a good time to consider inpatient treatment, given the lethality of that drug. And if your teenager hints at or even acts out at being suicidal, an inpatient stay will probably necessary to secure his safety. Also, if your teenager just can't stop using his drug of choice, even if it is marijuana, then an inpatient stay will likely be necessary. Teenagers often say that they don't want to go to inpatient treatment, since nothing external will change when they return home. That is true: the pressures of school, drug-and-alcohol using friends, and the vagaries of adolescent  adjustments will not have changed. But your teenager will have changed, gaining new strategies for refusing and moving ahead with a drug and alcohol- free life. Inpatient isn't perfect, nor is it usually curative of addiction. But it can safeguard your teenager's well being and start him on the road to sobriety!

Synthetic Marijuana and Your Teenager

Your teenager may come across a variety of substances known as "synthetic Marijuana," the most common being Salvia and K2. Marketed to teens on the Internet, in head shops, and gasoline stations, these substances look and act like marijuana, but (some) are technically legal. Some of the substances are packaged like marijuana, and some are powders that can be smoked on a cigarette. Recently, the DEA banned the most common 5 drugs in this category, but others will likely take their place. Since these   drugs are so different from each other, their effects are quite different, but you should look for hallucinations, "out-of-body" experiences, dizziness, slurred speech, and paranoia. If your teenager displays these symptoms, you should get help from an addictions specialist immediately. The argument that the substances are technically legal is just plain silly: the legality or illegality of a particular substance has no bearing on the danger it poses to your teenager.

Cigarettes and Your Teenager

Cigarettes kill more Americans every year than alcohol, heroin, and cocaine, put together. This is why it is vitally important for you to help your teenager kick cigarettes, even though they are not as immediately lethal as cocaine,or heroin, for instance. But studies have shown - in adults, at least - that there is no harm in stopping cigarette use at the same time the addicted person is stopping alcohol or other drugs. That is, there is no truth to the idea that stressing the person by stopping cigarettes will prevent achieving abstinence from other drugs. If your teenager smokes, you must yourself stop, and get help if you cannot stop on your own. Your teenager can attend groups therapies, like Smokenders and Smokestoppers, run by local Lung Associations and other groups. There are numerous complementary treatments available, like hypnosis, acupuncture, and mediation which have some effect in helping smokers stop.Finally, medications like Chantix, Zyban, and Nicorrette Gum can also help. But whatever you do, make sure your teenager tries, and keeps trying to stop smoking. It's important.

Sexual Addiction and Teenagers

With all the recent news about celebrities engaging in "sexting," extramarital affairs, and prostitution, one wonders about the sexual behavior of teenagers. How does a parent know when his teenager's behavior is dangerous or addictive in nature? While it is certainly normal for teenagers to experiment with sexuality, sexual behavior which is compulsive and/or destructive is certainly a problem, and should be addressed that way. I am not talking about whether or not your teenagers engages in sexual behavior, and at  what age,  or how many partners she has, or even what gender she is attracted to. You may have family values which necessitate rules about all these sorts of behavior, but they are not addiction. (Good luck enforcing those rules, by the way.) Sexual addiction, by contrast, is compulsive sexual behavior which is destructive to your teenagers and/or others.  For instance, posting pornographic images on oneself on the Internet is both illegal and can  be very harmful to one's future educational and job prospects. Trading sexual favors for money, drugs, or anything of value similarly suggests a dangerous precedent. Having multiple sexual partners, putting oneself in danger of becoming pregnant or contracting a sexually transmitted disease, or being raped, all constitute thoughtless and compulsive behavior, at the least. If yo see any of this, you will need to get your teenager to a therapist knowledgeable about teenagers and their sexual behavior, to sort out teenage experimentation from addictive behavior. No parent can handle this one alone.

What's So Bad About Marijuana?

Marijuana use has been increasing amongst teenagers for the past two years: 38% of High School Seniors acknowledged having used marijuana over the past year, according to the annual Monitoring the Future Study, conducted by researchers at the University of Michigan. What exactly does this mean for your teenager? First, marijuana use is not so harmless as teenagers would have you believe. The profound effects on motivation, social relatedness, memory, and decision-making ability are unquestioned. And your teenager's brain is still developing, making him or her even more vulnerable to the noxious effects of marijuana and other drugs, including alcohol. So, when your teenager says that the marijuana use if "just for fun,:" and "natural," you need to refute the idea that the drug is harmless. But you will also temper your assessment with a real risk assessment: how is your teenager functioning in school? In relationships? Health?Given the understanding that marijuana remains illegal, how much legal jeopardy is he or she in? You will need to fashion a plan for helping your teenager move forward in life: for some teenagers addicted to marijuana, a stay at an inpatient treatment center is necessary. (And yes, you can get addicted to marijuana!) For other marijuana users, however, meeting with an addiction-knowledgeable therapist suffices. The most important thing is to find  out what exactly is happening with your marijuana-using teenager, and then respond to that, rather than the mere fact of marijuana use!

"Bath Salts" and Your Teenager

"Bath Salts" are packaged drugs sold under  innocent sounding names like "Ivory Wave," "Purple Wave," Hurri9cane Charley," and "Aura." Although some of these packages have been found to contain mephedrone, a central nervous system stimulant, since there is so little oversight, the packages could in fact contain amphetamine, or sugar. (Or cyanide, for that matter.) These misleadingly labeled substances are sold in head shops, gas stations, and over the Internet.Stimulants can cause euphoria, high blood pressure, strove, and heart attack, and the DEA has named these substances "Drugs of Concern" in a prelude to making them illegal. ( http://www.cbsnews.com/stories/2011/02/01/earlyshow/health/main7305536.shtml )Don't assume your teenager is treating herself to a bubblebath if you see these packages in your house!

Heroin and Teenagers

Over the last 10 years, the US  have been flooded with cheap, high quality heroin. The wide availability of this highly addictive drug has caused some teenagers to become addicted in numbers which would have been unthinkable a generation ago. Teenagers who see party drugs as marijuana, Ecstasy and alcohol, sometimes try heroin with the same casual attitude, not realizing its' highly addictive nature. Since the heroin available is so pure, teenagers can snort the drug, rather than having to inject it into their bodies with a needle, thereby lowering the bar to use. Some, but not all, teenagers progress to actually injecting the drug. Signs of heroin use include profound sedation( to the point of falling "asleep" into a plate of food), as well as pinpoint pupils and an overall silly mood.Overdose from heroin includes an unconsciousness from which you cannot arouse the person, can progress to death from paralysis of the breathing muscles, and necessitates an immediate call to 911. Withdrawal from heroin consists of a runny nose and eyes, goosebumps, muscle cramps, and diarrhea, and is the most common reason for return to heroin use. If your teenager is using or addicted to heroin, don't despair. Excellent treatments are available, and like all drug problems, your teenager can return to a healthy, gratifying life without substances. But you will have to help by getting him or her to professional help as soon as possible!.

Steroids and Teenagers

In our performance - obsessed culture, the use of performance enhancing drugs like Anabolic Androgenic Steroids (steroids) is all too common, among adults as well as teenagers. Teenagers most often get mixed up with steroids after reading about them on the Internet or taking advice from a "trainer" who foists these illegal and dangerous drugs on naive gym-goers. (No legitimate athletic trainer would recommend anything of the sort.) Many teenagers use steroids for bulking up and looking good for girls, rather than  for pure athletic performance. And teenagers often believe that if the dose they read about on the Internet is good, then double, or triple, that dose must be even better. If you see your teenager rapidly gaining weight or muscle, showing newfound aggression, or receiving packaged substances in the mail, you should take action by confronting him! The profoundly damaging effects of long-term steroid use on the adolescent body make it an absolute necessity for your teenager to avoid steroid use. However, DO NOT let your teenager stop these substances without guidance from a physician who can help - withdrawal can provoke or worsen suicidal thoughts. Bottom line, if you suspect your teenager is using steroids, get professional guidance immediately.

I Caught My Teenager Drinking with Friends: Now What?

When asked, about a quarter of U.S. teenagers said they had participated in binge drinking (5 or more drinks in a row) in the previous two weeks.(http://monitoringthefuture.org/pubs/monographs/mtf-overview2010.pdf) That being said, if you find out your teenager has been drinking, you should focus  on the harm, and potential harm, he or she faces. First, take two deep breaths. Then, use the incident as an opening to talk about the issue. Regardless of the immediate details, you now have an opportunity to address your teenager's choices about drugs and alcohol. Certainly you should find out if immediately dangerous behavior has occurred: is anyone drinking so much that they are intoxicated? Passed out? Is there a need for an ambulance right now? Also, ask about driving while drunk, including allowing a friend who is "less" intoxicated to drive. Ask about safety: - is your teenager putting herself in a vulnerable position because of her drinking? With these emergency concerns as the framework for a discussion, ask your teenager about what the effects of alcohol are, who is getting the alcohol, and where they are drinking. There is a big difference between a 12 year old drinking to intoxication, and an 18 year old having a beer at a family picnic. You can (and should) set rules and consequences which make sense in your family, with the full understanding that once your teenager leaves High School, there will be few effective bars on his or her ability to use alcohol. Plan for that time when your teenager will be on his or her own!

Teenagers and Oxycontin

Oxycontin and other opioid drugs (like Percodan, Vicodin, Morphine, and even heroin) can be taken orally, snorted, or injected. Teenagers can gain access to these drugs through their parents medicine cabinets, over the Internet, of from drug dealers. Effects of these drugs can be impaired thinking, profound lethargy, and even death from overdose. Withdrawal from these drugs - which often causes the user to return to drug use - can include insomnia, muscle crampimg, tearing eyes, a runny nose, and large pupils. If you suspect your teenager is using these sorts of drugs, ask about it! You will probably have to get your teenager drug-tested and under the care of an addiction specialist to detoxify him or her, and help avoid harmful drug use in the future.For more information about the use and abuse of opioid drugs, you can look at the Office of National Drug Control Policy's web page on Painkillers, at http://www.theantidrug.com/drug-information/otc-prescription-drug-abuse/prescription-drug-rx-abuse/painkillers.aspx.

Is My Teenager Abusing ADD Medications?

The stimulant medications(like Adderall and Ritalin) used to treat  Attention Deficit Disorder(ADD),can be very helpful for the young person appropriately prescribed the medication,  but they can also be used in an addictive manner. How can parents tell the difference? Most importantly, if your teenager has had a comprehensive diagnostic assessment and is carefully monitored, negative consequences from the stimulant medications are unlikely. Watch out  if he or she is getting the medication illicitly, snorting it, or experiencing negative side effects like anxiety, insomnia, tremors, and weight loss. A good treating psychiatrist  will make sure none of those side effects continue: the medication will be modified or discontinued. Interestingly, multiple research studies have shown that ADD sufferers appropriately prescribed stimulant medications are less likely to have addiction problems than ADD sufferers who are not prescribed stimulant medication. One article about this, "Substance abuse in patients with attention-deficit hyperactivity disorder : therapeutic implications," can be found at http://www.ncbi.nlm.nih.gov/pubmed/16097847
The bottom line with ADD and stimulant medications is the following: make sure  your teenager is getting comprehensive care and ongoing monitoring for the use of any medication,  but especially the stimulant medications used to treat ADD.

My Kid is Smoking Pot!!!!

As a psychiatrist who treats drug-using teenagers, I can tell you that parents' reactions are extremely important in helping the teenager. Parents should neither over-react nor under-react when they find out that their teen is using marijuana or any other drug. Obviously, if your kid is putting himself in immediate danger, you need to do something immediate: if she is unarousable after drinking a lot of alcohol, for instance, you should call 911. But the more common circumstance is finding out that your teen is smoking pot, and has been for a while. The important things to find out are the following: is the marijuana use affecting my teen's schoolwork? Relationships? Physical health? Is there other drug or alcohol use going on? Is my teen putting him/herself in dangerous driving situations? Or making him/herself vulnerable to being sexually abused? Arrested? Is he/she aware of the long-term consequences of marijuana use? Is he/she aware of the legal consequences of illegal drug use? You can't make an informed assessment until you know the answers to those questions, and you and your teenager might be in need of professional help to get to the bottom of it.. It's not that I think marijuana use is a good idea for teenagers - it never is - but you will need to know if the marijuana use is an occasional goof, or a self-destructive pattern of behavior. Bottom line, you are better off starting a conversation about the issue, rather than screaming at your teenager....