Sunday, 27 March 2016

How many young people don't drink alcohol? Let's focus on the positive for a change

Anyone who has ever seen me present to secondary school students knows that one of the basic foundations of my approach is the promotion of 'positive norms' - i.e., letting young people know that most adolescents do not necessarily drink to excess and that the vast majority of school-based young people are not using illicit drugs. What I do is 'flip the figures' - taking the data on how many people take part in such behaviour and then turn it on its head - looking at those who don't do it! What this hopefully does is make those not involved in those activities feel good about their choices, particularly in a world that is constantly hammering the message that all teens take drugs and binge drink!

This is known as the 'social norms' approach. The idea evolved from research conducted in the mid 1980s by two American researchers, H.W. Perkins and A.D. Berkowitz, when they reported that college students involved in their studies held exaggerated beliefs about the use of alcohol amongst their peers. This idea that many students were drinking alcohol regularly, and in large quantities when they did, when in fact far fewer were actually partaking in this behaviour, was then identified across other educational institutions, across different cultural groups and locations. What the researchers found was, that despite the fact that college drinking was at elevated levels, the perceived amount almost always exceeded actual behaviour. Based on these findings, the social norms approach was developed and has been used to challenge misperceptions about not only the use of alcohol and other drugs, but other behaviours, including bullying, cyber safety and the like, i.e., providing the actual number who are taking part in such activity compared to the perceived number.

Regular readers would know that when talking about school-based young people we use data from the Australian Secondary Students' Alcohol and Drug (ASSAD) Survey. Every three years (or so) students aged between 12 and 17 are recruited from government, Catholic and Independent schools across the country and complete a survey examining their use of both licit and illicit substances. As far as alcohol is concerned one question asks students to classify their own drinking (i.e., are they a non-drinker, an occasional, light, party or heavy drinker?) and it is these results that I use to highlight to students that there are in fact a significant number of them who regard themselves as 'non-drinkers'.  The figures from the 2011 survey are as follows:
  • 75% of 14 year-olds describe themselves as 'non-drinkers'
  • 59% of 15 year-olds
  • 43% of 16 year-olds
  • 31% of 17 year-olds
When you say to a group of Year 10s (most being 15 years-old) 'you're in the big group if you don't drink' or '1 in every 3 Year 12s say they're non-drinkers' you can see all those students in the audience who aren't part of that world all of a sudden feel pretty good about themselves! The looks on the faces of those who don't drink and have no intention of doing so in the immediate future is priceless! For many of them the idea that there are a significant number of others in their year group who don't drink is something they have never heard before. The media is constantly telling them that 'everyone does it', and when you add those students in their class who are involved in such activity being so vocal about their drinking behaviour it's not surprising that some of them really do start to think that it is the norm and that something is wrong with them if they don't do it!

Now we've been talking about the 2011 data for some time now and waiting for the 2014 results to be made public - with an election looming I don't like the chances of us seeing the national data anytime soon but two states (SA and WA) have released preliminary findings. As far as alcohol is concerned, here are just a couple of the results that may surprise many:
  • WA results
  • The proportion of school students choosing not to drink alcohol has more than doubled from 12.3% in 2005 to 31.5% in 2014
  • In the same period, those young people reporting having drunk alcohol in the past month has reduced (43.5% to 23.9%) and in the past week, halved (28.9% to 13.9%)
  • SA results
  • The proportion of students who had never consumed alcohol had risen from 22.5% in 2011 to 32.5% in 2014. Among 12-15 year-olds the proportion rose from 27.9% to 40.1%
  • Those who had drunk alcohol in the previous week also decreased significantly, from 15% in 2011 to 10% in 2014
Neither state has released the full results, including how many students describe themselves as 'non-drinkers', so it'll be interesting to see if they have continued to rise at the same rate. Looking at what we have so far, I'm guessing they will and if they have it'll give us even more positive news for those kids who choose not to drink alcohol.

It does need to be said that the authors of the SA findings make an important point that there was a methodological change in 2014 in SA (I'm not sure if this was the case across the country - we'll see when the national data is released) and for the first time 'active parental consent' was required (only children with a signed parental consent form could participate). This could have impacted on the results and the authors say comparisons should be "interpreted with caution", but the positive results follow the trend that we have seen for a while now so let's hope they do reflect what is happening. From my perspective, this is certainly what I see across the country and to see two 15 year-olds spontaneously 'high-five' each other when I talk about how many non-drinkers there are in Year 10 is heart-warming!

The social norms approach has not been totally embraced by the research community and certainly I know quite a few experts in the alcohol area that don't believe that it has an effect, particularly when used in targeted health promotion campaigns (I need to say that it is much easier to do with illicit drugs simply because many more young people don't use those substances). However, with growing numbers of Australian secondary students choosing to be 'non-drinkers', the job is getting easier in the alcohol area as far as school-based young people is concerned and I believe that parents, in particular, should embrace this approach and focus on the positive whenever possible ...

We live in a world where we will rarely see the media 'flipping the figures' - as I was once told by an editor of a major newspaper "No-one is interested in hearing that people don't take drugs - that's not news!" It's a sad indictment on our society but I actually think for the most part he was right. The magazines that sell the most copies in this country are the ones that have photographs of celebrities looking 'too fat', 'too thin' or wearing no make-up and not looking as glamorous as they usually do ... good news stories do not sell papers. Telling the Australian public that not all our teens drink to excess or take drugs is not going to ever make the front page of any newspaper and you can bet your life that A Current Affair is never going to do a story on the fact. It's up to us to keep up the fight and make sure that we tell our kids as often as possible that as far as illicit drugs are concerned, they're absolutely normal if they don't do this and they're certainly in the 'big group' and when it comes to alcohol, the non-drinking group certainly appears to be growing all the time!

Saturday, 19 March 2016

10 tips for parents around alcohol and other drugs

Adolescence is such a difficult time for both teens and their parents. As their mind and body is changing, the child is trying to work out exactly where they fit in the world, struggling to establish an identity that is separate and distinct from that of their parents. At the same time parents are desperately trying to stay connected to a creature that they sometimes barely recognize as the little boy or girl that they seemed to have a loving and warm relationship with only a short time before! When parents contact me to discuss the problems with their teen (particularly in relation to alcohol and other drugs) I usually feel pretty helpless. Firstly, I am not a psychologist or counsellor and don't have training in assisting parents (or young people) in that way, and secondly, when I talk to those professionals who do have the expertise they are very clear that there aren't simple answers to these type of problems and usually the family is just going to have to 'ride it out'!

That said, when it comes to the alcohol and other drug area I have come up with my top ten tips for parents. They're certainly not going to solve all the problems that parents may face in this area but they do provide a really good starting position ...

Talk to your child and really listen to them
This is the key to building understanding and trust in your family. The more you know about your teenager's life and their concerns, the easier it will be for you to pick up a problem before it gets too big to deal with effectively. Get to know all that you can about your children, without being too intrusive or trying to be their 'best friend'. By showing interest, and being genuine about it, it shows them that you love them. Make sure that you ask them about things that are important to them - you may not really like the music they listen to or the TV programs or movies they like watching, but for most teens those kind of things are far more important than what went on at school that day. And remember, you may not get a lot out of them about what they're doing, but ask about their friends and peers and the floodgates are likely to open!

When you go to talk to your child about alcohol and other drugs – choose a good time
Constantly be on the look out for opportunities to talk about alcohol and other drugs - if the topic comes up in a TV program, ask them what they think about the subject. But be sure you don't force the issue, if they don't want to talk about it at that time, move on. These conversations should be natural and should never be a chore for either party if at all possible.
If you suspect or find your teenager has been drinking or using other drugs give yourself time to calm down and think through what is happening if you are upset. Don't react on the spur of the moment or when you and your teenager are not at your best. Remember this mantra - 'Stop, breathe and don't panic'! Strong reactions due to fear are natural but are not necessarily going to help the situation. There is a very real danger that a big argument may put you in a situation where you say things you don’t mean and may harm your relationship with your child.

Keep informed
This will help you answer questions that your teenager may ask. It will also help you work out your own views about drugs well before you have to discuss the issues with them. Don't rely on friends or the media to get information and if you have to use these sources, be critical of what you see, read or hear. Always use a number of sources for information before you make your mind up about an issue.

Set a good example
Keep your own use of alcohol, medicines and other drugs within safe and sensible limits. Young people learn most about the world by watching those around them. Overuse of prescription medicines, over-the-counter medications or alcohol sends a very strong message to young people about your attitude towards drugs. One thing that many teenagers cannot tolerate is hypocrisy. Telling children you have strong anti-drug feelings and then using large amounts of painkillers or drinking to excess does not make sense to young people. Try not to make alcohol an automatic inclusion every time you get together with friends – let your teenagers that it's possible to have fun without alcohol.

Be honest about drug use
The truth about drug use is scary enough without trying to frighten your child with tales of death and destruction that may not match their own experience. The one thing that you need to try and maintain is your credibility when it comes to issues such as alcohol and other drugs. A sure-fire way of losing that is by telling tall-tales or perpetuating myths about drug use. Stick to the facts, acknowledging why some young people may use alcohol and other drugs, and then challenge this with the negative consequences. A balanced approach is much more effective and realistic.

Always be willing to be the solution but know your 'non-negotiables'
Sometimes parents forget that their children are just that – children. Adolescents, in particular, are going through a difficult time in their life and parents need to try to remember what a complicated period the teenage years were for them. Remember, you are the adult and as such there are times when it is entirely appropriate to cross the 'halfway point' and come to a compromise in an attempt to solve parent-child disputes. Every parent, however, must decide on what issues are 'non-negotiable' as far as their child is concerned and once this stand point is made clear, their child should know and respect this decision. Trying to make every issue non-negotiable will lead to constant conflict and grief. Choose your battles carefully and be willing to compromise on some issues and things should run much more smoothly.

Negotiate rules about acceptable behaviour and review them regularly
Think back to when you were a teenager and how you felt about rules. Remember that as your child grows up many rules need to be reviewed regularly and sometimes relaxed bit by bit (always remembering your 'non-negotiables'). Your teenager is on the way to becoming an adult and needs some freedom to gain the experiences that help them cope with the adult world. However, it is also important to remember that teenagers want and need limits and boundaries, so let them know what your expectations are regarding acceptable behaviour.

Be willing to say 'no' to your children
Young people who get everything they want don't usually turn out to be very happy children. Teens learn discipline, self-control and how to delay self-gratification when they are told no by their parents. It may be hard, particularly if you have a number of children and you've been through the 'teen stage' a number of times before, but saying no, meaning it and carrying it through will help you to have a happy, healthy and cooperative family.

Remember, that of all the drugs your child is most probably going to have a problem with it will most probably be alcohol
While there is a lot of concern about illegal drugs, the most harm and the greatest risk to young people comes from using legal drugs such as tobacco, medicines and of course, alcohol. However, young people want to experiment with new things and test limits, so it is not surprising that some of them may try illegal drugs. Fortunately, out of those who try, few will go on using drugs regularly and only a small number will develop serious problems. We certainly don't advertise that fact but it's true and incredibly important for parents to remember should things go amiss ...

Tell your children that they're great … at every opportunity
It is very rare that we talk about the great things our young people do. Even though we usually let them know when they are not doing the right thing, it is also very important to let them know how great they are the rest of the time. It is particularly important to tell them this when they’re not at their best. Make it a point to tell them specifically what you think is great about them. This will be more meaningful and effective for them than more generalized praise.

For more Top 10 tips and other information for parents, go to the DARTA website for a range of downloadable fact sheets.

Saturday, 12 March 2016

Teens, parties and parents and 'duty of care': One Dad's experience

So many things can go wrong when hosting a teen party, with even the best planned event sometimes going 'pear-shaped'! Ensuring that all partygoers are safe is paramount and that can be really difficult when you're dealing with teens who are 'missing a piece of their brain' ... The dramatic increase in pre-parties (where young people drink just enough to avoid detection when they enter the main party of the night) makes this even more difficult for those putting on parties. As I've said many times before, the most important thing parents can do is to find out as much about the night your child is planning and then drop them off and pick them up. They're not going to like it and it's not going to be a pleasant experience for you every weekend but at least you'll be more aware of what they're up to and that they're as safe as possible. But even if you do that there are no guarantees ...

I'm going to let the following piece written by a Dad who contacted me recently speak for itself ...

"I frame this as an open letter. It is not a witch hunt or a comment on behaviours, morals or values. It is intended to raise an issue, generate some discussion, visibility and opinion, and maybe some solutions. Please read on.
I recently escorted my 16 year-old daughter and a group of friends to a party. It was about 10.30pm on a Saturday night. The party was at a local venue, and intended to continue until 11.30pm. Our late arrival was due to the girls participation in an event which ended around 9.30pm.
As we approached the venue, social media feeds, into which teenagers seem to be permanently connected, generated noise as to whether the party was still in progress. It appeared that something had happened. Exactly what, was unspecified. As we approached the venue, we happened across a boy, alone, of similar age to my girls – clearly intoxicated, or under the influence of something – wandering unsteadily and aimlessly. The girls checked whether he was ok, and without much thought we continued on to the venue.
At the venue, it was clear that the party was over. Security guards prominently blocked the entrance. On explaining that I was delivering my daughter and her friends to the party, I was informed that the party had been shut down. On further enquiry, I was told that a boy had jumped/fallen/been pushed from a balcony into the water below. He was taken off in an ambulance (but, with some injuries, was now ok). Furthermore, a number of kids were intoxicated and "on drugs" and so, the party was shut down.
As we walked away, my initial reaction was that this was entirely appropriate. Break the (explicitly stated) rules, and bear the consequences.
The girls said that we should check on the boy we had encountered earlier. We wandered into the park alongside the venue. Very prominent, was a group (probably 20-30) of teenagers. Amongst the group were a number of friends/classmates/peers of my daughter and her friends. It was blatantly clear that alcohol and/or other substances were present in a significant proportion of this group. Just as obvious were a number of kids who were sober.
My daughter asked me to stand back, (which I initially did) as she approached the group. She was greeted warmly. On seeing me (despite remaining detached), a large proportion of the group, almost magically, dispersed. An encounter with an adult was definitely not desirable. To them I represented authority, and consequences. The throng evaporated. Only a single boy remained. Not by his own volition, but because he was flat on the ground, comatose, unmoving. I approached and prodded. As he groggily came to life, we checked whether he was ok (clearly not); was someone looking after him (clearly not – the group was more focused on self-preservation and escaping from authority); was someone picking him up (no coherent answer). The other kids were nervously observing from a distance. Eventually, a 'friend' approached (full credit to whoever this was). Together, we were able to ascertain that "someone" would look after him, and that '"someone's" parents were coming to pick him/them up. I was relatively satisfied that the situation was safe.
This sets the scene. A bunch of teenagers – some sober, many not – unstewarded in a public park at 11pm on a Saturday night.
The purpose of writing this is not to be moralistic or judgemental. Rather, it is to raise a bunch of issues. I do this from the perspective of allowing our kids to develop within a safe environment; to extend and test boundaries; to balance authority with freedom; and as a father.
Where does duty of care end? Technically, there had been no breach.
  • The venue abided by clearly stated rules
  • The rules were broken
  • There were consequences
However, there were also unintended consequences…
Unintended that: A large contingent of under 18s – children - had been ejected from a venue, where they had adult eyes on them. They were now unsupervised, in an uncontrolled space, late at night. Further, a significant proportion of these children were in no state to be in control of themselves, or able to understand the implications of the prevailing situation. They were literally just wandering the streets. They had been cast out from a venue early, and not necessarily by choice. I assume that if the party had continued to its designated end point, most of this contingent would have been picked up by parents, or had arrangements to get home. Also, as a parent, I would have assumed that my own children would, in similar circumstances, be in one safe place, at least for the intended duration of the party.

Of course, any of these teenagers could have left the party of their own volition. Intoxicated or not, they could have wandered the streets themselves. However, forcing them, as a group, out of a party, was not their choice or desire. Is there a collective duty of care, to ensure that there is some degree of safe oversight until the designated end time for the party? This should operate independently of whether the party ended prematurely or not.

Several questions:
  • Where were the parents who were hosting the party? Shouldn’t they have remained until the designated end time, to ensure that the children were safely picked up (they may have been inside the venue, but to us, they were not present)? Maybe they should have alerted parents/carers directly, that the party had been terminated. Perhaps they should take some responsibility to ensure that their guests left in a safe way (rather than just left)
  • Although not breaking any rules, should or could the venue have corralled the kids and assumed a role in ensuring that they were passed on to safe hands? I know this opens a can of worms, with respect to liability, legal obligation etc. So, removing a potential issue is in their own interest (even if not the most responsible action)
  • What happens to parents who had an expectation that their children would be at the venue until the designated finish time? I personally operate under this assumption. In this case, my daughter would have been ejected, and would probably have ended up in the park, along with the large group mentioned above
  • How should kids who are intoxicated, or under the influence of other substances, be handled? I have been told, that kids often arrive at parties already in this state. Should they be breathalysed or checked on entry? If they are positive, then what? Should parents be notified (after all, they are minors)?
  • How do we create a safer environment? We will not be able to eliminate the alcohol or other drugs, despite any amount of effort. Can we make sure that kids – both sober and not – are never cast loose? That at all times they are under care? That they are not ever left without eyes on them?
  • There is a tension between duty of care and obligation. No one in a carer position (the venue, the parents) has done anything 'wrong'. However, for our children, the outcome is a gap in the system. This has put them at risk

All this opens a host of further questions and issues. I don't have solutions – just thoughts, which I hope sparks reaction, discussion and dialogue.

To reiterate: How far does duty of care extend - to the limit of the rules, or further? Anything, which will lead to action or guidance would be a good outcome. This situation is not unique. It is not a one off. It will arise again. There will be more parties, events, situations. Our children will push limits and boundaries. They will continue to drink/take drugs/put themselves at risk. How do we create a safer framework to them and for us? How do we balance obligation, liability, the law and individual and collective duty of care?"

I'd love to know people's thoughts about this issue. Could the parents hosting the party really have done more? How do you realistically get contact numbers of everyone attending a teenage party when you're looking at 100-200 invitees? How many of the partygoers turned up to the event already intoxicated? If they did, how did they get there? What does a host of a party do with a drunk 16 year-old that turns up at their door? Do you turn them away and run the risk of something terrible happening to them? If not, what do you do? The list of questions goes on and on ...

What this father discovered that night is not news to anyone who works with young people ... many teens (some of them ridiculously young) are wandering around the streets of cities and towns across the country on a Saturday night with their parents completely unaware of what they're doing. Yes, the people hosting the parties have a duty of care here but so to do the parents of those invited to attend ... As I said, I'd love to hear your thoughts on the matter.

Saturday, 5 March 2016

How do you deal with the alcohol issue if your teen is on medication?

In the past year I have met students who have had a wide range of medical conditions including diabetes, peanut allergies, epilepsy, depression, ADHD and cystic fibrosis. All of them approached me after my presentation with exactly the same query - how should they deal with the issue of drinking and did I know anything about the interaction between their medication (and boy, was there a wide assortment there!) and alcohol? The vast majority of these students made it very clear that they weren't drinking at the moment and didn't really think they were going to try anytime soon but thought they'd take the opportunity to ask me what they should do if they ever decided to have some alcohol at a party or the like.

A couple of weeks ago, however, I met one young man who was really struggling. He was a great kid and I felt so sorry for him as he was obviously having a difficult time dealing, not only with his medical condition, but also the potential impact his diagnosis could have on his social life.

Asher was 16 years-old and had recently been told he had epilepsy. Apparently it was a genetic condition, with two of his older cousins also being diagnosed, although he was the only one who had it in his immediate family. He had experienced a number of highly embarrassing seizures over the past year, one at school, and now was on medication to try to control his symptoms. His parents had told him that it was now too dangerous for him to go to parties at the moment and he wanted to know what my thoughts were on the issue. Did I know anything about epilepsy? His cousins had told him not to worry and that you can drink alcohol and not be at risk but his parents had come down on him hard and made it clear that parties were a 'no-go' for at least the next few months, particularly while they were trying to get the medication right. He got very upset, some of his friends already thought he was a 'freak' because of the epilepsy, if he wasn't allowed to go out to parties he was fearful he wouldn't have any friends left at all ...  

As I made very clear to Asher - I know little if anything about epilepsy and I couldn't tell him anything about the interaction between his medication and alcohol. There was really only one person who could help him and that was his specialist - the person who prescribed his medication. Even his cousins who supposedly had the same condition as him couldn't advise him in this area - they may also have epilepsy but they don't know what medication he's on (and even if they did, they may not know the exact dosage or how it is being used), why he was put on that particular one and, most importantly, they're not doctors! When I asked him whether he'd discussed the issue of alcohol with his specialist he looked blankly at me and said "My parents were in the room, how could I?"

This is the problem that many of these young people with medical conditions face around 16-17 years old. Unlike Asher, some of them have had these conditions for many years, many of them have the same specialist that they had when were diagnosed and although they're now becoming young adults, these doctors often do not recognize that they're growing up and could be facing a range of adult decisions including whether or not to drink alcohol. The family GP who prescribes antidepressants for a 14 year-old can also find themselves in the same situation. We live in a world of an 8-minute Medicare consultation and keeping up with young patients and their changing social life is almost impossible for doctors. If the issue isn't raised by the teen it isn't usually raised at all and the young people are then left grappling in the dark about how to deal with the issue, many of them relying on friends or the Internet for information.

The decision to allow your child to visit the GP by themselves (i.e., without you present in the room) is a big one! Of course you want to know what your teen is saying to the doctor and what the doctor says back to them, but as soon as they first enter that surgery by themselves, those days are pretty well gone. If your teen is on medication for any condition and they have hit that age when they are starting to go to parties regularly, it is vital that you raise the issue of mixing alcohol with that medication. In my experience this discussion has to be handled carefully - you certainly don't want your child to stop using their medication (a real risk if you try to scare them stupid about what mixing them will do) and to be honest you most probably don't really know what the effect will be (unless you're a doctor yourself and even then you may not know the whole story!) so you don't want to overstate the harms and lose what little credibility you have left!

This is why I suggest that parents hand this over to the GP or specialist ... When a young person asks me what to do I always say the following to them:
  • How long have you had your specialist (or GP if it's for things like depression or anxiety) for? How do you get on with them?
  • Do you see them by yourself or do your parents attend your appointments with you?
  • If a parent is present, would you feel comfortable asking questions about the mix of your medication and alcohol in front of them? If you do, (and some of them do, particularly those that aren't planning on drinking anytime soon) make sure you ask the question the next time you see your doctor
  • If they are present and you don't feel comfortable, you are now getting to the age when you can ask your Mum or Dad if you can see your doctor without them. You don't have to tell them why you want this to happen but they are bound to ask. Tell them that you want to ask some personal questions about your condition and ask them to respect your decision
  • Before you see your doctor write down the questions you want to ask so you don't forget anything. If you are drinking alcohol, let your doctor know how regularly your drink and how much you usually consume and then ask them about mixing your medication with alcohol - what effect will it have?
  • Most importantly, listen to what your doctor says - if they say don't mix the two, take that on board! Remember you can always ask if there are alternative medications that you can use that don't have the same effect - sometimes a doctor will change a teen's medication when they know they have started to drink regularly
It's also important to remember that the teen may simply want to know more about the impact alcohol may have on their medical condition, e.g., if you suffer from depression, does regular drinking make it worse? Does a teen with epilepsy have to be more careful about drinking alcohol? You would be surprised how many students I meet who know absolutely nothing about the impact of drinking on their health condition. Once again, this is a discussion best had with a medical professional and not a parent. Of course, parents should be aware of the consequences of drinking but spouting these off to a child is most probably not going to go down too well, particularly when it comes to 15-16 year-olds. They're just going to see it as you trying to 'ruin their lives'!

I always make sure I tell young people who approach me about this issue that the best way forward is not to mix alcohol and medications, but realistically for some of these teens that just isn't going to happen. They need to know the facts and the best person to go give them those is their doctor ... this conversation needs to happen and needs to happen early in a 'drinking career'! Make sure you give your teen the opportunity to have this discussion and if you don't believe they will initiate the conversation, have a chat to their doctor beforehand and ask if they could bring up the issue in as sensitive a way as possible ... it's really important!