Saturday, 22 July 2017

What does research tell us parents can do when it comes to alcohol and does 'one size fit all'? Does your child's temperament make a difference?

Regular readers of my blog may have noticed that I've been a bit quiet over the past couple of weeks. Unfortunately, it's not because I went on holiday or did anything particularly exciting, sadly I was bed-ridden with shingles! Wow it's painful and I've been told that the only way you really get over it was to have complete rest, so that's what I did ... well, almost! The one thing that I have been able to do is to catch up with some reading ... I had a couple of books I wanted to get finished and a whole pile of journal articles that I have had on my desk for a while. I thought I'd share a couple of things that I found really interesting.

Every parent wants their child to have a healthy attitude around alcohol, whether they choose to drink in the future or not. Unfortunately, many continue to believe that they can do little to influence their child's drinking behaviour, particularly during the adolescent years, however, the evidence continues to say that this is simply not true. So what can parents do and in really practical terms, what does the research say works?

Earlier this year an Australian study (Yap et al, 2017) was published that conducted a review of longitudinal studies that examined a range of parenting factors (that could be potentially influenced or modified) that were associated with adolescent alcohol initiation and levels of later use or misuse. What the researchers were attempting to do was to identify what behaviours are protective (i.e., what things can parents do to delay drinking and future problems with alcohol?) and what factors are more likely to lead to drinking at an earlier age and lead to issues as they got older (i.e., what should be avoided)? They identified 12 parenting factors, including the provision of alcohol; parental monitoring; rules about alcohol; parental discipline; and favourable attitudes towards alcohol use.
It's a really great piece of work (based on a review of 131 studies in this area) and once you get through all of the statistical analysis, the authors identify four protective factors that parents should attempt to increase and they are as follows:
  • parental monitoring
  • parent-child relationship quality
  • parental support
  • parental involvement
There are no real surprises here but the authors are very clear in the following statement - "... by being more aware of their adolescents' activities, whereabouts and friends, parents can help to protect their adolescents from later alcohol misuse". This supports the mantra that I have been spruiking for many years - if you want to prevent, or at the very least, delay early drinking or even illicit drug use - 'Know where your child is, know who they're with and know when they'll be home!' I get it that's not always easy, particularly as they get older and you want to give them more freedom as they become young adults, but when they're 14 or 15-years-old, it's a must. As I always say, start this early and it won't be so difficult in the later years ...

When it comes to risk factors, the authors highlighted three behaviours that parents should attempt to reduce or avoid. Once again, there were no real shocks, but some parents may find them a little unsettling, with the following being identified:
  • provision of alcohol
  • favourable attitudes towards alcohol use
  • parental alcohol use
The authors acknowledged that a recommendation that parents should not allow their children to drink underage or provide them alcohol at home or for parties is a controversial one, particularly within cultures where giving children a sip at a family meal is regarded as appropriate and protective. That said, they state "this review provided clear evidence to back up policies and recommendations against parental provision in cultures where tolerance of binge drinking is the norm". This is a very clear statement to Australian parents as the evidence is very clear in this country that we are a nation of 'binge drinkers'.

Now when good quality research comes out like this, with very clear recommendations about what parents should and shouldn't do, I'm sure there are some people who sit there and say "But I did all that stuff and it didn't work for me!" I certainly hear from many distraught parents from who believe they 'did absolutely everything right' but still find themselves with a teen who is totally out of control. They've either been arrested for drug offences, sneaking out of the house at all hours of the night and sometimes not returning for days, been hospitalised after a drinking binge and the list goes on and on ... So often, in the conversations I have with them they inevitably say "I don't know where it all went wrong, we have had no issues with our other children ..."

Why is it that what we knows works for most teens simply doesn't have the same effect on others? Of course, every teen is different but is there something about some young people that just makes them more resistant to rules, boundaries and consequences? A month or two ago I wrote about a wonderful book I had started to read written by Robert MacKenzie called Setting Limits with Your Strong-Willed Teen - it really is a great read and I thoroughly recommend it to any parent struggling with an adolescent who is 'pushing all their buttons'!

MacKenzie doesn't talk about 'rules' per se, rather he discusses 'limits' and 'limit setting'. According to the author, all teens test the limits being imposed on them, (i.e., when a parent asks their child to do something or change their behaviour) and they do this by conducting what he refers to as 'research' (i.e., trying to establish just how much the person means what they say). This is often referred to as 'pushing the boundaries' by other parenting experts and is used by teens to see just how far they can go without crossing the line. Now I think it is well understood that not all teens test limits in the same way, but what I found fascinating in this book is how it stressed that 'teen temperament' plays a vital role in this area.

Three types of teen temperament and how they respond to 'limit setting' are discussed:
  • compliant teens (around 55% of teens match this profile according to Mackenzie) – these teens don't push their parents too much as their underlying desire is to please and cooperate. They accept the information their parents or teachers provide them and usually don't require a lot of consequences to complete their 'research', therefore accepting the limits imposed on them without too much conflict
  • strong-willed teens (10% of teens) – these young people test frequently and they require regular revision of consequences before they are willing to accept parents' authority and follow rules. MacKenzie provides an example of a strong-willed teen called Daniel and describes him as follows - "To him, the word stop is just a theory or hypothesis. He's more interested in what will happen if he doesn't stop, and he knows how to find out. He continues to test ..." I'm sure there are many parents out there who can relate to a teen like that!
  • fence sitters (35% of teens) – this is a mixed group that can go either way depending upon the situation. These teens are more likely to co-operate when they encounter clear, firm limits. However, they will have no issue testing rules and authority when the limits are unclear or when they see others getting away with something. The author stresses that this group requires "generous helpings of consequences to complete their research"
I'm sure many parents reading this will relate to at least one of these 'types' and if you have more than one child, I can almost guarantee that you have at least one of them that fits into a different category than the others! What MacKenzie stresses is that when you set limits (or create rules) for a teen it is vital that you need to acknowledge the different temperament you are working with ... and if you are lucky enough to have a 'strong-willed' one, well, it's going to be a heck of a lot tougher!

I cannot recommend this book strongly enough, not only to parents but to anyone who works with young people. If you find yourself with a teen who is 'strong-willed' and is testing you at every turn, this book is a must! It provides practical advice on how to set limits, how to develop appropriate consequences and even how to deliver them in a way that will hopefully minimise conflict. 

Research continues to show that parents continue to have a powerful influence on their child's attitudes and behaviours around alcohol use, even during their adolescence. Effective and age-appropriate parental monitoring during the teen years has been proven time and time again to be protective and the provision of alcohol to teens is a risk factor and should be avoided ('delay, delay, delay' being the key). That said, when it comes to rules and boundaries (or 'limit setting') in this or any other area, every child is different and their temperament is going to affect how you parent ... It's not going to be as simple as the evidence seems to suggest ...

Identifying and acknowledging what type of teen you have (and that if you have more than one, they may all be very different) is the first step in applying what the research says to your family situation. For some teens, simply setting rules and monitoring them will be enough to keep them protected and will likely instil positive values and attitudes without too much effort. Unfortunately, for others, they will continue to push boundaries and test you over and over again to see just how far they can go. It's not going to be easy but hopefully it'll be worth it in the end!

References
MacKenzie, R.J. (2015). Setting Limits with Your Strong-Willed Teen. Harmony Books: New York.
Yap, M., Cheong, T., Zaravinos-Tsakos, F., Lubman, D., & Jorm, A. (2017). Modifiable parenting factors associated with adolescent alcohol misuse: a systematic review and meta-analysis of longitudinal studies. Addiction 112, 1142-1162.

Saturday, 15 July 2017

Schoolies: Should I be worried and should I try to stop them going?

Schoolies Week (or 'Leavers' as it is called in WA) has been around in one form or another for a long time. When I finished high school I can remember a range of things that some of my classmates did in the days or week following the last day of exams. We may not have travelled across the country or overseas, but there has always been some type of 'letting off of steam' at this time. These 'celebrations' undertaken once high school has finally ended (whatever form they may come in), have always been regarded as a distinct marker of the transition from childhood to adulthood. I hate the term but Schoolies' events are now regarded by many school leavers as a 'rite of passage' ...

One of the main reasons for this is the commercialisation of Schoolies Week, particularly over the past couple of decades. There is big money to be made here and there are plenty of people ready to take advantage of a group of young people with money to burn. There are a number of companies that deal only with Schoolies events and they promote these events very aggressively. You only need to watch MTV a couple of times to understand the increasing social pressure on young people leaving school to attend Schoolies Week celebrations in one form or another. Community and media interest has also grown and you can pretty well guarantee that every year crews of TV reporters will venture up to the Gold Coast (and other spots around the country) to try to capture the most sensational footage they possibly can. Without fail they usually manage to find some young people who agree to be interviewed on national television and talk about their alcohol (or even better, drug) fuelled week at Schoolies, thus reinforcing many parents' belief that it is an event that is out of control and one without any merit. Add social media (and some young people's stupidity) to the mix and you can certainly see why so many parents worry ...

Every year I get emails from both parents and young people on this topic. Teens asking for tips on how to convince their parents they should be able to go (to see my response to that question - have a quick look at my entry on my Real Deal on Drugs blog for young people), while others are from Mums and Dads (usually Mums!) who are absolutely terrified about letting their son or daughter go to the event, requesting advice on what they should do. They want their teen to have a great time with their friends at this important time in their lives, aware that they are young adults and they can't protect them forever, but are still very worried about what they've seen and heard about the Schoolies phenomenon.

One of the best things about all the attention is that the promoters of Schoolies' events have been forced to 'up the ante' in terms of organisation and must now do their very best to provide a safe environment as possible for the young people attending their event. But that can be difficult when the whole idea behind Schoolies is to give young people who have been studying for the past twelve years the opportunity to 'let off steam'. So what do we know about what happens at these events?

There have been a number of studies examining the Schoolies phenomenon and, sadly, their findings have only added to parental concern. A South Australian study of Schoolies attendees (Hutton et al, 2015) found that for many, alcohol was their major focus when it came to planning. They reported spending most of their preparation time deciding the type of alcohol they would consume, how they would purchase alcohol before attending the event and making sure they had suf´Čücient money to last across the days they were away. This is supported by other studies that looked at how much they drank when they were at the event. A WA study looking at 'Leavers 2009' on Rottnest Island (Lam et al 2014), found males drank an average of 18 standard drinks per day (that's the equivalent of just under a bottle of spirits) whilst away, and females consumed an average of 13! These are staggering numbers and not surprisingly, a large majority reported experiencing at least one adverse outcome such as hangover, vomiting, blackout, or unprotected sex ...

That said, over the years I have attended a number of Schoolies Week celebrations (I wrote a blog entry a couple of years ago about my wonderful experience at the SA 'Schoolies Festival' held in Victor Harbour - a great event put on by Encounter Youth), and although there are always incidents, usually linked to excessive alcohol consumption, most young people are well behaved and reasonably sensible. Saying that, it is important to remember why they are there – their intent is to let their hair down and that is exactly what they do, but the majority are pretty responsible and most importantly they all try to look after each other.

There is great social pressure on young people attending Schoolies to behave in a certain way. The media, in particular, does a great job of convincing young people that teenagers going to Schoolies will drink to excess and as a result, behave badly and this is the type of behaviour expected of them. Unfortunately, many of them try to live up to it (as you can see by the research findings) and find themselves failing badly.

It is important to remember that trying to prevent your son or daughter from attending this type of event could damage the relationship you have with them. Young people attending Schoolies are not in their early teens, they are usually very close to the legal drinking age or in some cases, have already turned 18 years of age. That is where many of the problems lie. If they have recently had their eighteenth birthday that can often mean that they want to celebrate in a big way and as a result their younger friends get carried along in the undertow. Young people wanting to attend these events are at the age where they are going to have make decisions on their own and trying to prevent them from doing so is not going to be helpful and will result in conflict.

Regardless of that, you are still the parent and you are still allowed to voice your concerns about what they are doing and the potential risks they may encounter. That part of being a parent is never going to stop and you wouldn't be doing your job if you didn't do it.

My advice is to take a moment and sit down with your child and talk through the concerns you have. Then after you have finished, give them the opportunity to let you know how they intend to deal with the potential problems you have raised. What many parents discover during conversations like this is that we have a generation of young people to be proud of, with many of them doing their very best to look after themselves and their friends. Young people of today definitely don't know it all, but they do try to reduce the risk of something going wrong the best way they can.

Most importantly, if they do go you need to make sure you repeat the same mantra that you should be saying to them every time they leave the house:

"You can call me anytime, anywhere. If something goes wrong and you need me – I'll be there"
Not surprisingly, there are many young people who decide to leave Schoolies' events early. They run out of money, the weather is bad and they find themselves stuck in a hotel room (or tent) for a couple of days, they get bored, or the event just simply doesn't live up to the hype. When I tell Year 12s to lower their expectations around Schoolies and say to them that some young people leave early, you can see that they don't believe me, but I get at least a couple of emails every year from teens who write and just say 'you were right!'
Discuss 'outs' with them. Let them know that you are willing to play the 'mean parent' so that they are able to 'save face' should they want to leave for any reason. If they should find themselves in a situation where they are not getting along with their friends (as much as many teens believe Schoolies will bring their group even closer together, it is surprising how many close friends are torn apart when they find themselves living together for four or five days!), or they have had a bad experience, they need to know that you will be there to bail them out if they need you ... Now, forking out the money for a quick airfare home from Byron Bay is not going to be cheap but if your child is suffering and you can do it, you need to ... That doesn't mean the money doesn't get paid back to you at some time in the future but when they make the call, you want them home ...
All parents want is for their teen to come home safely. Although many Schoolies are 18 and now legally an adult, they are still your child. Keeping a positive dialogue happening throughout the whole Schoolies' process, highlighting the potential risks and providing ways of reducing these without being judgemental, is most probably the best way to begin the next stage of your parent-child relationship.
If you are a parent of a Year 12 student who is going to a Schoolies' event, I have developed a Checklist for Students, as well as an Information for Parents fact sheet that may be helpful when it comes to planning and discussions. They are both available on the Schoolies' page on the DARTA website.
References:
Hutton, A.,Cusack, L., Zannettino, L., Shaefer, S., Verdonk, N., & Arbon, P. (2015). What are school leavers' priorities for festival preparation? Australian Journal of Primary Health 21, 249–253.
Lam, T., Liang, W., Chikritzhs, T., & Allsop, S. (2014). Alcohol and other drug use at school leavers' celebrations. Journal of Public Health 36, 408-416.