Thursday, 27 February 2014

2014: What drug trends are we going to see amongst young people?

It may seem a little strange giving predictions for 2014 at the end of February (you usually see things like this in early January at the latest) but I've just completed my first month back in schools and I now feel a little more confident in writing about what I believe are some of the most concerning drug trends amongst school-based young people this year.

Last year was definitely the year of the 'synthetics'. It was so-called 'synthetic cannabis' that first attracted media attention and of course, we then had a number of young men who died across the country after taking a new synthetic product (NBOMe) that they believed was LSD. Synthetics have not completely disappeared but when new laws came into place and many of the compounds and products became illegal, they lost their attraction for many and even though many continue to be able to be bought over-the-counter (or rather 'under-the-counter' as one Year 10 told me last week) they appear to have peaked in popularity and are not as much of an issue as they once were.

So what do I see as the 'new' alcohol and other drug issues for 2014 and what do I believe we'll see in the headlines in the year ahead? I'd like to make it quite clear at this point that alcohol remains the main issue for school-based young people, it always has been and I don't see it changing anytime soon, but what I'm about to discuss are emerging or, in some cases, reemerging trends that anyone who works with young people should be aware of ...
  1. The increasing use of sports supplements and other performance and image enhancing drugs (PIEDs) by young men. Although it is steroids that usually attract media attention, there are a range of other products that are now being used by the very young. Late last year I was approached by the parents of a 14 year old boy who were holding a list of products that their son was using. They wanted my opinion on the risks associated with the use of these supplements which included protein powders, creatine monohydrate and amino acids. When I asked them why their son was using them their answer floored me - "Well, everyone else on his football team does ..."! I believe that this is an issue that is going to explode in the media this year - last year we saw the supplement scandal in professional sport play out in the daily news, it's only a matter of time before we see something similar with high school use of these products.
  2. Cannabis, cannabis, cannabis ... cannabis use has been on the decline amongst Australian high school students since the 90s but that seems to be changing. Almost every school I go to has had to either suspend or expel (or be 'removed from the school' as it is now sometimes called) students (usually Year 9s) who have been caught either using or selling cannabis. Most surprisingly I'm even seeing it at girls' schools - something we didn't really see even when cannabis rates were at their highest in this country ... When it comes to looking for reasons why this is happening I think you most probably have to say it is because we are now talking about cannabis in a much more positive way, what with discussion about the medical use of the drug, as well as the legalisation debate that is currently happening in many parts of the world. Talking about a drug more positively certainly leads to an increase in use ... no surprises there!
  3. I hope this next issue is due to growing awareness but I have never been contacted by as many young people concerned about friends who they believe may be developing a mental health problem associated with their cannabis use. These are usually young females worried about boyfriends but I'm also hearing from young men wanting advice around helping mates who they believe may have problems. Admittedly I talk about this issue to Year 11s in the schools I visit so I may be 'triggering' concerns, but what really concerns me here is that they have no idea of where to go for advice in this area. That astounds me when you consider the huge range of options that young people now have when it comes to places they can go to should they have mental health problems themselves or be worried about friends. Why isn't that message getting through and/or why don't they want to access these services?
  4. Police have had the power to issue a caution to juveniles who are found with small amounts of drugs, ensuring that these young people don't find themselves with a criminal record at such an early age for some time now. This year I have come into contact with a growing number of students with cautions for drug possession who seem to have absolutely no idea of the consequences of what this actually means ...  Two that particularly stick in my mind are a 16 year old girl with three cannabis cautions (one more and she will find herself in court) and a Year 12 student with a caution for cocaine possession (how could he possibly afford that drug?) and there have been many more who have approached me after a presentation to share with me that they have a caution and what did that actually mean? I'm certainly not suggesting that we need to get tougher on young people, I just think that when we talk about illicit drugs with students, we need to talk more about the legal consequences (realistically, they're the ones they're most likely to experience) and what these can mean for their future.
  5. Younger and younger people attending dance festivals - this is one area that gets me into trouble and I just filmed a spot on tabloid news program 'A Current Affair' about this issue and I can almost feel the backlash I am going to get! I've worked in the nightlife area for many years, I've even helped put on many major dance events over the past 25 years, and I'm sorry, I simply don't believe they're events that 15 and 16 year olds should attend ... I know some people don't agree with me and I'm sure there are some very young people who do love the music and do actually have the maturity to go to music festivals and dance parties and not be affected adversely by the drug culture, but they would certainly be in the minority. As I said in my interview with ACA, if you're a parent of a 15 or 16 year old and you think these are events that your son or daughter should attend, go there first and have a look for yourself! I am seeing greater and greater numbers of really young people (15 year olds) who are going to these events and put simply, that's not their intended audience and they are going to be exposed to a culture that can be difficult for some to cope with ...
As anyone who has ever heard me speak, I always like to end on a positive note! So what are the great things I am seeing in schools?
  1. Even though I've raised some illicit drug issues above it is still extremely important to remember that we currently have less school-based young people use illicit drugs than we have for some time. The 2011 ASSAD Survey shows that we have the lowest rate of current illicit drug use (use in the last 12 months) since Australia-wide data was first collected (apart from cannabis use that did rise slightly, but still far lower rates than in the past) and that certainly reflects my experience in schools. Of course there are some who will use illicit drugs and many who will be exposed to a drug culture but let's not forget the huge number of young people who will not have any interest in this activity ... we never talk about them!
  2. More young people are now making the decision not to drink alcohol and being brave enough to let others know about their choice. Years ago when I would talk about 'non-drinking' as an option it would be extremely rare to see a student admit to being a 'non-drinker' themselves, in fact, they would almost try to hide. That is now changing. Friends will often turn to the non-drinker in their group, often acknowledging their choice in a very positive way, and that young person will smile and nod, obviously quite proud of themselves. These young people are now often regarded as extremely important members of friendship groups as they are either the people who look after those that do drink, or become the designated drivers. They are no longer seen as the 'social pariah' they once were and this should be celebrated. This is a major cultural change and, to be honest, something that you don't necessarily see in the adult world!
It'll be interesting to see what else pops up ... we can only wait and see!

Sunday, 23 February 2014

Should I expose my child to a family member who has an alcohol problem?

Concerned parents often ask my opinion about how they should they deal with a family member who they believe has alcohol problems, particularly in terms of exposure to their children. Should they stop their child from seeing this relative (if they are able) or should they be using the very obvious problem as a 'teaching moment', hopefully one that will ensure their child will have a more healthy attitude towards alcohol? Sadly, many of these parents are talking about their husbands or wives, some separated or divorced and no longer sharing the same home, but others still live together and really struggling with this extremely difficult issue.

The sheer number of parents who contact me about this particular issue just goes to show how many people in our society have significant problems with their drinking (whether you want to call them 'alcoholics' or whatever). Research suggests that about one in 10 people who drink alcohol will develop significant problems so when you consider the sheer number of drinkers it's no surprise that there are so many people affected.

When it comes to a partner who you are still living with, there are very specific issues that need to be considered and I will leave that particular situation for another time. For this posting I will be looking at issues around family members that do not live with you, and even though some of the information discussed will be appropriate for ex-partners, once again, there are some very specific issues in that situation that may be best looked at in detail at some other time.

Last week I received this email from a mother who had recently attended one of my presentations:

"I am a non-drinker and have always been that way. However I am the daughter of a full blown, full-on alcoholic, who is still married to my wonderful father. They are both in their 80s. Dad is very active and healthy and is her primary carer and I in turn am his primary carer. My two daughters, one in Year 9 and the other in Year 5 are fully aware of their grandmother's disease. They have seen her in action, from being passed out on the floor to a bit starry-eyed and vague to visiting her in intensive care after a particularly nasty incident. My question is, do you think it's good for my kids to see this? And continue to see it?"

"I have never hidden it from them in the past so they have really seen first-hand what alcohol does. But I now wonder if they (especially my Year 9 daughter) should be exposed to it. I've always thought that this would hopefully turn them right off drinking, like it did to me. But I don't think shock tactics work in this day and age."
Firstly and most importantly, if children are at any risk (physical, emotional or otherwise) around a relative, no matter who they are, then they shouldn't be exposed to them. However, if they are not at any immediate risk (and as a parent, you are going to need to assess whether this is the case or not) and they want to continue to see the relative (warts and all) I wouldn't advise you stop them doing so. Obviously then, one of the first things to do is to ask the child whether they want to continue to see whoever.

Young people start to pick up messages about almost everything, including alcohol, from a very early age from a range of sources - some of these you can control, others you can't. This woman's daughters have most probably already developed some fairly powerful attitudes towards alcohol by being in the presence of their grandmother when she has been intoxicated, but it is also important to remember that they have also learnt a lot by watching their mother's reaction to the problem. Always remember, that as a parent you are your child's biggest influence, how you as a parent respond to a relative's drinking behaviour is mighty powerful and how you communicate with them about what they are observing and how it affects those that love him or her, including you, is crucial.
I certainly wouldn't advise that a relative with a 'drinking problem' is used as a ‘teachable moment’ to lecture them about the dangers of alcohol and try to convince them that 'this could happen to you!'. This really is a 'scare tactic' and, although tempting for some parents as a way of trying to discourage teen drinking, is not likely to have much of an effect on an adolescent who may just be starting to become interested in partying and drinking alcohol. Think about it for a couple of seconds – is a 15 year old girl really going to relate to an adult relative who drinks too much? It's certainly not the alcohol experience she is likely to have at her age and as a result she will probably totally reject the notion that this could happen to her, as well as any other messages you're trying to convey.

If you want to 'use' what is happening, it would be much better to talk about your relative in a caring and loving way and discuss your concerns about her choices and how they have not only affected her but everyone around her … Topics such as "How do you think this started?", "This doesn’t happen to everyone who drinks so why did it happen to her?" and talking about the impact it has had on your drinking behaviour are all fairly safe discussion points that will hopefully start an open and honest dialogue around drinking and the potential harms … you're not telling them what to do but you're certainly getting them to think about the issues …
The other topic that you will need to discuss is the issue of a genetic predisposition to alcohol problems – recent research suggests that if you have an alcoholic (I hate that word!) parent you may be 'more vulnerable' to developing similar problems. For more information on the genetics of 'alcoholism' take a look at this easy-to-read summary of the evidence from the NIAA.

Having a family member with a drinking problem is difficult enough, but working out how to deal with the issue as far as your children are concerned can be incredibly tough, particularly in regards to keeping them as safe as possible. There are no easy answers but always remember that you are the most powerful influence in your child's life, particularly in the pre-adolescent years - your responses to the problem are likely to go towards shaping your child's attitudes towards alcohol and drinking, as well as have a major impact on how your child will react to similar situations in later life.

Friday, 14 February 2014

What role do genetics play in how much your child will drink?

Some of the saddest parents I meet are those Mums and Dads who approach me after a presentation desperate for help who simply don't understand where they went wrong with their 'out-of-control' teen! These are good parents who usually have a number of children, some of whom have already got to the other side of adolescence without too many problems, and all of a sudden they have found themselves with a son or daughter who is completely different to the rest of the family. They just don't understand why their son or daughter is acting out to such a great extent, particularly when it comes to drinking alcohol.

What really confuses them is that they believe that their parenting style hasn't changed – they are doing exactly the same thing with this child as they did with the others – why then are they getting such a different result? Sadly, my presentation to parents doesn't help them much, in fact it usually makes it worse, because in it I stress the importance of parenting styles and discuss the growing amount of evidence that shows how you parent has a major influence on their future drinking behaviour.

At this point it is important to acknowledge that in reality it is almost impossible for parents to 'parent' each of their children in exactly the same way. There is always going to be differences in what you do and how you do it with each of your children. For example, there is research that shows, where siblings have been asked to say who their mother and father favour, that mothers do tend to a show a preference for their first-born son, but fathers often dote on their youngest daughters. It sounds like a huge generalisation but there is also evidence to suggest that parents will often be drawn to the child who is easiest to get along with — or the child that shares similar traits to them, e.g., mum will have a special bond with her sensitive, arty son, while dad lavishes attention on his sporty daughter.

That said, there must be something else happening here and that's where a recent Dutch study may start to provide some of the answers. To my knowledge this is a world-first, a study that not only looked at the influence of parenting style on future drinking behaviour, but also what role genetics may play?

The researchers looked at almost 600 young men each year over a six year period and divided them into one of three groups – 'light', 'moderate' and 'heavy' drinkers. They conducted saliva samples to enable genetic testing and identified different genotypes that could result in different neural responses to alcohol or motivations to drink (these were identified as 'risk' and 'non-risk' genotypes). They also looked at parenting styles and examined whether parents had set specific rules regarding alcohol.

The paper makes for an interesting read (the reference is included at the end of this entry) but the basic findings were as follows:

  • 'light drinkers' - often 'non-risk' genotype and reported stricter parental rules
  • 'heavy drinkers' who carried the 'risk' genotype were largely affected by parental rules – more rules, lower levels of alcohol use
  • however, heavy drinkers who carried the 'non-risk' genotype weren't so influenced by rules
What they found in this groundbreaking study was that strict parental rules certainly appeared to prevent most young people from drinking to excess (no surprise there!). However, they found it wasn't always that simple and "the interaction of specific genes and parental rules may determine whether a teen will have alcohol-related problems in the future." The group of young people who carry the 'non risk' genotype who do drink to excess are obviously a group that we will have to try to keep safer in a different way – if rules and consequences aren't going to work effectively, we're going to have to develop other strategies to help parents.

What I love about this study is that we can finally say to a parent who is having a problem with just that one teen – you are not to blame. It may not have anything to do with your parenting, instead, it may be due to genetic factors - something that is totally out of your control!  That certainly doesn't mean you roll over and give up but this study does start to begin to provide somewhat of an answer to a parent who is really struggling with an adolescent that is difficult to parent.

Reference: Van der Zwaluw, C.S., Otten, R., Kleinjan, M., & Engels, R.C. (2014). Different trajectories of adolescent alcohol use: Testing gene–environment interactions. Alcoholism: Clinical and Experimental Research, doi: 10.1111/acer.12291. (Epub ahead of print).