Wednesday, 27 March 2013

What about analgesics and young people?

Analgesics, commonly known as 'painkillers', are exactly that - drugs that are designed to relieve physical pain. There are a variety of medications that a doctor may prescribe a patient, but for the purpose of this piece we will be discussing some of the commonly used over-the-counter (OTC) analgesics, such as:
  • aspirin
  • codeine (usually in combination products)
  • paracetemol
  • ibuprofen
It is important to note that most analgesics are safe to use when taken as prescribed or instructed by a doctor or pharmacist, together with the manufacturer's instructions that are listed on the packaging. Over the last few months whilst visiting schools, however, I have become aware of some fairly frightening behaviour as far as analgesic use is concerned. Here are just a few examples:
  • a 15 year old girl who was using 4 Panadols at a time because she was feeling depressed
  • a Year 11 young man who was taking two Nurofen to ease his anxiety before taking an exam
  • a group of young men who played football for their school who took a couple of Nurofen Plus before a game just in case they received an injury during the match
The last example is particularly interesting because it is extremely similar to behaviour that we see by some young women when it comes to period pain - using high strength analgesics to prevent possible pain!

If you look at the results of the 2011 Australian Secondary Students Alcohol and Drugs (ASSAD) Survey you will see that the reported use of substances such as Panadol among school-based young people is extremely high. Among the entire sample, only four per cent of students had never used these medications. Over two-thirds of all students had used analgesics in the past month. As in previous surveys, at all ages, females were significantly more likely to have used analgesics in their lifetime, in the past year and past month. Females were more likely to have used analgesics in the past week at all ages except 12 years of age.

Not surprisingly, the most common reason for analgesic use for males and females was to help ease the pain associated with a headache/migraine while the second most common reason was to help ease symptoms of a cold or ‘flu. Interestingly, at each age more males than females reported using analgesics to help relieve pain from a sports injury. Just under 10% of females reported using analgesics to help with menstrual pain.

Should we be concerned about this use? Is there anything wrong with young people using these products? I'm certainly not saying that we shouldn't be helping our teenagers when they have pain - but I do think we have to start asking ourselves is a pill always the best answer?

Years ago I was told by a GP (although I haven't seen a reference for this) that around 90% of adolescent headaches are caused by dehydration and simply instructing your son or daughter to have a glass of water is most probably going to fix the problem pretty quickly. Here's a challenge to you. Think about the last time your child complained of a headache or a pain, what was the first thing you said to them? I can almost guarantee that you told them to go and take a pill of some description. I bet that you didn’t ask them why they had a headache or suggest a non-pharmaceutical option – you went for the quick fix. You went for the option that pharmaceutical companies have been extremely successful at selling us. We all do! Even though we're always told 'to see a doctor if pain persists' and 'to always use as directed' - grabbing a pill or capsule from the medicine cabinet is the easy option. It has got to the point that using a drug to solve a problem has become second nature and I believe this is why we're seeing young people use these OTC painkillers in such a bizarre way.

No-one wants to see anyone experiencing pain and certainly if there is a way to fix the problem we should use it but if we're going to provide our children with a pharmaceutical product we must make sure that we teach them to respect it and also understand how important it is to use it responsibly. It is also vital that they understand if they use it inappropriately then there could be severe consequences.

This doesn't take much effort. The next time you are thinking of providing a Panadol to your child (no matter how old they are - even teenagers (actually, especially teenagers!) need to be reminded that these products need to be used as directed), read the directions out loud to them. Have a brief discussion about the correct dosage and how many can be taken in a 24 hour period. If you're about to pop a Nurofen, make sure your teen sees you have a quick read of the packaging before you take it. Comment on your use. If you're buying a packet of Nurofen Plus or another product that you need to request from the pharmacist and your child is with you, have a quick chat about what he or she said to you as they were handed over (i.e., "make sure you take with food" or "are you on any other medication?"). Don't make it a big deal but make it clear that there are rules when you use any medication - any pharmaceutical product is potentially harmful if used incorrectly.

Parents often complain that it is difficult to begin a conversation about drugs - how about starting with the drugs you provide them?

Friday, 22 March 2013

Alcohol and the liver - the issue we don't always talk about

In recent years we have seen a great deal of information become available on the effect alcohol can have on the developing brain. Certainly there can be few parents who are not at least somewhat aware of the risks in this area when they make a decision to allow their teenage son or daughter to drink alcohol at this time in their life. Unfortunately, little has been said about the effect that alcohol can have on the developing liver.

Over the years I have received a number of emails from parents, most of whom work in the medical profession, who have attended my presentations who have wanted to express their concern about this growing health issue. They are usually liver specialists, or have close friends who are, who believe that this is a topic that just doesn't receive the 'air-time' it should. Here is an example of an email I received earlier this year (please note I have removed identifying information and I have received permission to use sections of the email in this blog entry):

Hi Paul, I have a daughter at ... and came to your talk tonight. I am a gastroenterologist at ..... Hospital and spend much of my time looking after patients with alcoholic liver disease. We have had countless patients die in their 20s - the next to go will be a 28 year old girl who at one time was an excellent student at a selective girl's high school in ..... She similar to many of my patients, started drinking in her early teens and this was condoned by her middle class highly educated parents. She now lives in a boarding house ..., and has an abusive boyfriend who regularly beats her when she is not in hospital.

I am glad you have sent a strong message to parents regarding the dangers of alcohol. I am frequently shocked at how many parents think it is okay for a 14 year old to have a few drinks and go as far as buying alcohol for their children.

A couple of years ago I was approached by a mother after a presentation and was invited by her to visit the hospital she worked at the following day to take a walk around the liver ward. She talked of her frustration at having to work with younger and younger patients, many of them female, and how over the many years she had worked in the area, the work she was doing had changed quite dramatically. In the past, the vast majority of patients had been much older men, she was now regularly seeing much younger patients and had recently had a woman in her early 20s die of alcohol-related liver disease. The walk around the ward was certainly an eye-opener - as I continue to tell the students I speak to - the patients were not all men in their 60s and their 70s, many of them were women, mostly in their 30s, but some even younger.

It is important to realize that young women are far more affected by alcohol when it comes to their liver. Male livers are fully developed by around 18-19 years of age - this process takes much longer to complete for the female liver, around 21 years, and so for many of their big years of drinking (18-21 years) - they are putting great strain on an organ that is not complete. This damage is of course compounded if they had already been drinking regularly during their mid teens.

What worries me is that some parents continue to believe that letting young people have a few drinks to take to a party is not going to be a problem. I've even been sent invitations to after formal parties that parents have organised that have have said that young people attending the event can bring four cans of alcohol to drink! Four cans - are they serious? If a young person decides to bring four Smirnoff Double Black cans, that is just under 8 standard drinks - not far short of half a bottle of vodka! How is that appropriate? Do these parents really know what they are doing here?

I'm pretty sure if some of these parents had the opportunity to walk through a liver ward of their local hospital, as I have done, they may just realise the potential damage they are causing and this type of attitude may begin to change.

Thursday, 14 March 2013

Should we still be calling it 'peer pressure'?

Years ago I was asked to present a short talk to a group of Year 6 students on the far north coast of NSW. It is unusual for me to present to such a young group of people but the teachers involved convinced me that it was appropriate. Before I began the actual talk I asked the students what they knew about drugs …. could they name some drugs that they had heard of? No real surprises there – the hands went up and we got a whole range of responses including alcohol, tobacco, drugs from a doctor, cannabis, Panadol, ecstasy and heroin. Then I asked them why people used drugs? With that, every hand went up in the air at the same time, and when I asked them for their answer the whole class responded in unison - 'peer pressure'.

This was a group of 11 and 12 year olds and I was surprised at the intensity of their response, so I asked them to explain what they meant. What does 'peer pressure' mean? My question was met with a deadly silence – not one of the students could give me an answer.

I've been telling that story for years, usually in response to a question about the influence of peer pressure on young people. Those Year 6 students like so many others around the country had heard the term, in fact they had most probably had it pushed down their throat for quite some time, and they had bought into it, without having any real idea what it meant. Unfortunately, so do many Australian parents.

Parents seem to love the concept of peer pressure. It appears to be a great way of shifting responsibility, somehow implying that whatever problem is being discussed cannot be blamed on their own child but rather that 'someone else made them do it'.

No parent wants to acknowledge that their child can do wrong, particularly if others have identified the problem. The concept of peer pressure allows parents an 'out' when it comes to their child's negative behaviour. When you think of peer pressure, images come to mind of one child pushing another into taking part in some activity that they may not really want to do. In my experience this does not usually happen, most young people do not put pressure on others to use illegal drugs. In fact, you often find the reverse is true.

Malcolm had been using ecstasy for over eight years when I spoke to him. He had first used the drug when he was 20 years old after associating with a group of clubbers for almost twelve months. He had observed his group of friends using ecstasy and had decided to try the drug. When he asked his friends to provide the drug the response he got was not exactly the one he was expecting. They asked him whether he was prepared to take the drug. Was he aware of the risks and was he really sure that he wanted to start using ecstasy? Malcolm was confused and surprised by the response and for a while viewed his friends as hypocritical. However, he quickly realized that they were trying to look after him and make sure that he truly did know what he was getting into.

Although this story challenges a lot of what people believe about peer pressure, the truth is that most young people do not 'push' their friends into doing something they don't want to do. It's usually much more subtle than that!

Of course, peer pressure is an influence on what young people choose to do in their lives. During their adolescence they start to pull away from their parents and seek greater acceptance from their peers (this is an evolutionary feature that we have little chance of fighting successfully), but it is important to remember that those peers make their decisions based on their observations of the world. What we are really talking about here is 'social pressure' or 'influence'. From a very early age our young people are absorbing information from watching their parents, other adults, television, movies and pop culture about what it is to be a teenager - this is particularly true when it comes to drinking alcohol and parties. This is something that we rarely talk about, but it is far more likely to affect teenagers' behaviour as it is much more subtle and far more difficult to control because it is everywhere and all pervasive. 

When you look at Malcolm's story the question needs to be asked what made him want to start using ecstasy? Had his friends suggested that he try the drug or put pressure on him in some way? According to Malcolm that was definitely not the case – what had influenced his decision was what he had observed. He had been associating with a group of young drug users who he had watched partying for almost a year and they had been having a 'good time'. He had been influenced by what he had seen, by what had been going on around him. Although there had been 'peer influence', it was much more an overall 'social influence' that had had the effect.

This social pressure comes in many forms. As mentioned already, this influence can be in the form of advertising, television and movies or by observing celebrities and their behaviour. Once again I need to emphasize that I’m not saying that peers don’t have an influence (they do and it has a major effect on the decisions most teenagers make each and every day) – but it is incredibly important to remember that there are many other influences that we often forget.


Saturday, 2 March 2013

Should you tell your child about your past drug use?

A study was recently released that looked at the effect parents telling their children about their past substance use had on the young person’s beliefs and behaviours around drugs. The research received a bit of media attention and pushed the line that admitting to past drug use was counterproductive.

When any research is reported on in the media it is important to go to the actual published paper and see what was exactly said before accepting the published headlines. Certainly the authors state that, based on their evidence, “parents should reflect on the potential negative impact of talking about their prior use”. They believe that in doing so there is the potential to ‘normalise’ drug use and “downplay” the negative consequences of using substances. That said, they have also made very clear that there are many limitations to this study. The major one is that the parent-child communication was not observed, it was all self-report data provided by the child. As far as I could see there was also no information collected on the context of the conversation.

Don’t get me wrong – this is an interesting study and as the authors say, it illustrates that some messages provided by parents “may be helpful and others may be harmful”. So what are my views on the topic?

First off it is important to remember that most parents do not have a problem answering this question as most people have never experimented with illegal drugs. The one illicit drug that is most likely to be used by Australian parents is cannabis, but that still is only a third of the population. That means that most Australians (two thirds of them) have not used the drug.

However, for those parents that may have experimented with illicit drugs in their youth, this is a question that they all dread their child asking. Unfortunately, it is a question that is almost inevitably raised at some stage during their child’s teenage years. When it is, essentially parents have one of three choices – they can tell the truth, they can avoid the question and hope it goes away or they can lie through their teeth! It really is a dilemma and one for which there is no simple answer.

Every parent will need to deal with this question in their own way. Each family is unique and there are so many different ways of handling this problem and the outcome will be different each time, depending on so many factors. In my book ‘Teenagers, Alcohol and Drugs’ I told the story of Nicole and Peter who decided to deal with the issue in their own way:

Nicole is a mother of three and back in the late 1980s and early 90s was a big party girl. Together with her then boyfriend, now husband, Peter, she was amongst the first generation of regular ecstasy users who attended large dance parties and inner city nightclubs. Her drug of choice at that time was ecstasy, but she also used a variety of other drugs including cannabis, speed and LSD.
 
Her eldest daughter, Hannah, is now 15 years old and is getting to the age where she is beginning to ask questions about her parents’ partying years. Nicole is now facing the dilemma of how to talk to her teenage daughter about her drug use during a significant period of her and her husband’s life. Should she tell the truth, avoid the subject or simply lie and say that it never happened.
 
“This time was always at the back of my mind, even during the early days of my drug use,” Nicole told me. “What was I going to tell my children when the time came when they asked me about my past?” 
 
She decided to lie. In fact she has become extremely ‘hardline’ when it comes to the messages that she gives to her children about drugs. As far as Nicole is concerned, drugs are extremely dangerous and she wants her children not to use them.
 
“If I found out that Hannah was experimenting with any drug I would be horrified. I know it sounds hypocritical, particularly with my history, but as I’ve got older I’ve really become more and more worried about my children and drugs. Maybe it’s because I know so much more about them and the risks involved with their use. I simply don’t want my children to use.”
 
The effect that this hardline has had on Hannah is interesting. A bright girl who is doing very well at school she told me that illegal drugs are not a part of her life, although she has just got into the party scene and drinks alcohol occasionally – something her mother frowns on.
 
“I would never talk about drugs with Mum and Dad,” she told me. “Mum has made it very clear about how she feels and often talks about people she knew who took drugs that got into real trouble. I can’t even imagine what she would do if I did try drugs and she ever found out.”
 
Unfortunately Nicole’s attitude towards drugs appears to have caused a real barrier in terms of communication between her and her daughter.
 
“I have a friend who I think has a problem with drinking,” confessed Hannah. “She drinks every weekend and I do worry about her. I’d love to be able to talk to Mum about it but I wouldn’t dare. I couldn’t trust her to keep it secret and not tell my friend’s mum. In so many other ways I have a great relationship with Mum but I wouldn’t even try to talk to her about this – she would just over-react and hit the roof.”

What is difficult to fathom out with Nicole and Peter is that when asked about their drug use and the experiences they had during that time they both talk about it in a very positive way. Her justification for lying to her daughter is that she wanted to scare her and if she had told her the truth it would have simply made the drug too attractive.

Nicole and Peter are not alone in this type of major turnaround. There are many parents who did experiment and had ‘positive’ drug experiences and then when they have children of their own and they start to get older their memories of their own drug use fade and they become very ‘anti-drug’. My concern is what would happen if Hannah ever found out the truth about her parents’ past? The breakdown of trust here could be devastating for this close-knit family.

So what is the answer?

In my humble opinion I actually believe that honesty is the best policy. Now this doesn’t mean that you should be ramming the fact that you once had a puff of a joint in 1983 down your children’s throat. However, if you’re asked a direct question by your child, I believe that you should answer it honestly.

We know that by far one of the most important elements of a positive parent-child relationship is honesty and trust. When you ask your child a question about something that they have done you would like them to answer it honestly, doesn’t your child deserve the same respect?

So if you have used drugs what should you say? To my mind the most important thing to focus on in your answer is why you stopped using (if you’re still using illicit drugs there are a whole pile of other issues that need to be talked about in another blog entry!). If you think about it, the reasons you give to your teenager about why you stopped are so important and say so much about the ‘real’ risks associated with drug use. It’s also an honest and real approach and young people, in my experience, really appreciate that. Some of the reasons that parents have given to their children for stopping include the following:

“I used cannabis once or twice and it just made me feel really sick. Some of my friends really liked it but it just wasn’t me – I didn’t enjoy smoking and I made the decision not to do it again.”
 
“Cannabis was a big part of my life for a couple of years. I used almost every week until I finally realized that I wasn’t doing anything else. I only hung out with other cannabis users and I lost contact with other friends. Although it was fun at the beginning it certainly wasn’t at the end.”
 
“Drugs can be fun. I certainly had a good time for a while but the bad experiences started to outweigh the good and I just got bored with the whole thing.”
 
“I stopped smoking when a very close friend of mine got busted. He got caught smoking a bong in a park and found himself at a police station. It wasn’t until that happened that I really realized that cannabis was illegal and you could really get into trouble if you got caught. It just wasn’t worth the risk.”
 
“I stopped using when I met your mum. She thought drugs was for losers and forced me to make a decision – it was her or the dope. I chose your mum!”

All parents want an honest and open relationship with their child. If, god forbid, something should ever go wrong and a child needs help with an alcohol or other drug problem, every parent hopes that they are the first port of call for their child when it comes to help and advice. However, if you’re not honest with them, why in heavens would they ever be honest with you?