Educate Parents on the Risks of Prescription and Non-Prescription Drugs

Introductory Paragraph

Nobody is free from the risk of drug use addiction. While parents tend to think of children as innocent and safely removed from the risk of drug use, the fact remains that they are highly susceptible to experimenting with and becoming addicted to a wide array of drugs. One motivating statistic to keep in mind is: 90% of people with addiction started using substances in their teen years. Whether they obtain them at home, at school, from friends, or elsewhere, it is all too easy for adolescents to fall into drug use which will impair their future.

One reason drug use is such a serious dilemma in our society is that it is the result of a complex set of issues. Parents play a key role in reversing current trends, but it is vital that they gain an understanding of the interplay of a few processes. The Key Information section of this article is organized to provide information on all four of the following themes:

• Implications of drug use
• Signs of drug use
• Reducing risk factors
• Increasing protective factors, which includes conversation skills that integrate all of the above.

In addition, the Relevant Research section of this article includes statistical data on common drugs, so that parents can be informed about the current status of national patterns.

Key Information

Perhaps the single and most important thing which can advance parental understanding of drug use is that substance use disorder is a disease. There is a social stigma surrounding drug use, a notion that one can “just quit” if they really wanted to. While there are people who’ve been able to leave substance abuse behind “cold turkey,” this is not as easy as it seems. Parents and guardians must come to recognize substance abuse as a disease that alters the brain and should be treated without judgment and with much care. The American Medical Association, the American Society of Addiction Medicine, and the DSM-V recognize substance abuse as a medical and mental health condition that requires positive intervention. The cognitive alterations caused by substance use rewire the brain and body to reward continued use, making cessation increasingly difficult based on duration and the type of drug used.

Once this foundation is clear, it is useful to gain additional detailed information about the implications of teenage substance use (including biological, psychological, and social impacts), the signs of substance use, and specific methods to take in reducing risk factors and enhancing protective factors.

Implications of Teenage Substance Use

The effects of substance use are long-lasting and far-reaching. Beyond the visible surface effects, substance use in children affects all facets of life, including their biological functioning, psychological well-being, and social health. Understanding the broad spectrum of potential consequences is vital for adult caregivers to know and understand in order to better equip themselves and their children in the fight against substance use.

Potential Biological Impacts

• Increased risk of disease transmission (HIV, AIDS, Hepatitis B & C)
• Overdose
• Risky sexual behaviors (disease transmission, unplanned pregnancy, anonymous encounters)
• Impaired brain functioning - disrupts areas of the brain responsible for reward, motivation, learning, judgment, reasoning & memory
• Increased risk of traffic accidents, may result in serious bodily harm to self or others
• Long term addiction and dependence - further physical harm
• Delayed puberty
• Negative impact on the reproductive system
• Low bone mineral density
• Risk of assault, physical and/or sexual

Psychological Impacts

• Increased suicidal ideations and attempts
• Increased risk of additional mental health conditions
• Learning problems - damage to short- and long-term memory and learning process
• Substance use may mask unaddressed mental health issues (depression, anxiety, schizophrenia, etc)
• Long term addiction and dependence - further psychological harm

Social Impacts

• Delinquency
• Aggressive social behaviors - fighting and stealing
• Decreased school performance
• Poor social engagement
• Increased conflict with family and peers
• Delayed or deferred education and career opportunities

Drug Specific Impacts

• Alcohol - racing heart, insomnia, headaches, withdrawal seizures, poor bone density, dysphasia, poor physical health
• Tobacco - chronic coughing & lung infections, airway obstruction, reduced lung function, shortness of breath, higher resting heart rate, increased headaches, vision and hearing loss, risk of heart & lung diseases, risk of lung or other cancers
• Cocaine - heart attack, stroke seizures
• Ecstasy - liver and heart failure
• Inhalants - heart, lung, liver, kidney damage
• Marijuana - impairments in memory, learning, problem-solving, & concentration; later-life psychosis
• Methamphetamines - psychotic behaviors
• Opioids - respiratory distress, death from overdose

Signs of Substance Use

Parents know their children and their behaviors best. Watching for changes, whether abrupt or gradual, can give an indication that there may be a problem. There are signs to look out for that may indicate substance use:

• Loss of interest in enjoyed activities
• Sudden change in friend groups
• Sleeping more than usual or sudden hyperactivity
• Exhibiting aggressive, angry, rude behavior
• Rule-breaking
• Cutting classes or missing work
• Irresponsible behavior
• Isolating and avoidance of eye contact
• Making excuses for behaviors or lying
• Ignoring or resisting discipline
• Sudden weight loss/gain
• Watery eyes
• Shakes
• Nosebleeds
• Poor hygiene
• Sudden change in appearance
• Paranoid or anxious
• Change in mood, mood swings
• Dilated eyes

Reducing Risk Factors

The risks are severe. Youth fentanyl overdose has reached the epidemic phase; increased purchase of illegal prescriptions laced with fentanyl has led to a 94% increase in overdose deaths in teens.

The risk of a parent’s prescription drugs getting to their children is a real concern that must be addressed by any prevention effort. The Partnership for Drug-Free Kids states “Two-thirds of teens and young adults who report abuse of prescription medicine are getting it from friends, family and acquaintances." Three steps are promoted to ensure that the young people don’t have access to any medications at home -- monitor, secure and properly dispose of unused and expired prescription and over-the-counter medicine. According to one NSDUH Annual National Report, an estimated 316,000 adolescents aged 12 to 17 misused prescription pain relievers for the first time -- that’s 900 adolescents each day. Approximately 217,000 adolescents aged 12 to 17, misused prescription stimulants for the first time – that’s 600 adolescents each day.” Understanding how to keep prescription medications safe is essential to preventing youth from being able to access them.

Prevention is a function of balancing risk factor reduction and increasing protective factors. As noted above, there is no one child who is exempt from potential drug use. Thus, by definition, all youth are at risk. So, it is essential for all parents to understand both risk and protective factor approaches to the health and wellbeing of their children. Parents who are aware of risk factors can communicate more informed education to their children and be equipped to provide early intervention, if necessary. The CDC notes the following risk factors which increase the likelihood of adolescent drug use:

• Family history of substance abuse
• Poor parental monitoring
• Permissive parenting or parent-child conflict
• Parental substance use
• Family rejection of sexual orientation or gender identity
• Association with friends or peers who use substances
• Disconnection from school
• Poor academic performance
• Childhood sexual abuse
• Mental health issues (diagnosed or undiagnosed)
• Early aggressive behaviors

It is important for parents to understand that all of these risk factors can be addressed and intervention provided. Already occurring situations or factors have the opportunity for correction.

Enhancing Protective Factors

The simplest way to comprehend the role of protective factors is to move beyond knowing that a just-say-no approach is ineffective. The essential protective factors question is "to what should youth say yes?" The following list provides guidance on positive goals:

• Fostering good, healthy peer relationships
• Consistent, language-based discipline (as opposed to physical discipline)
• Supportive family relationships
• Extended family support
• Positive partnering between family and school
• Positive school and teacher engagement
• High but attainable academic standards
• Fostering and modeling healthy self-esteem
• Good coping and problem-solving skills, modeled and learned
• Clear expectations for behaviors
• Opportunities for meaningful engagement in school and community
• Promotion of physical and psychological safety
• Safe and healthy opportunities for autonomous behavior & decision making

Once equipped with this knowledge, parents, and guardians are at the advantage to have important conversations with their children to prevent or intervene where drug use is concerned. With every risk factor discussed above, there are protective factors that can be put into place. One of the most important is early education. Starting meaningful and open conversations about drug use and its short and long-term consequences. Beginning the conversation early and continuing with age-appropriate information provides key benefits and protective factors for the child. They are armed with the knowledge of what drugs are and the potential consequences of using them. This advanced warning prevents exposure from peer pressure. These conversations can foster an open, welcoming relationship in which youth feel safe to ask more questions, express concerns, and confide in and seek help from parents. SAMHSA points out an important reason why parents need to have conversations about drugs rather than avoid the topic: avoiding discussions about substance use can send the message to children that there isn’t any harm. Early and frequent talks set clear expectations and boundaries in a safe space.

Relevant Research

Parent-child discussions on substance use, especially those that are open and frequent, along with clear and firm rules, are regarded as a primary defense against teenage substance use. .

This study provides clinical reassurance of the impact of discussions on substance use between primary caregivers and the children in their care. . Their results showed that scenario-based and learning talks created more comfort responses surrounding the topic and reduced the likelihood of substance use, while talks that only centered on rules or criticism/negative parenting increased the child’s stress responses and showed a greater likelihood of substance use.

This paper addresses the impacts of substance use on the adolescent brain, cultural factors influencing teenage use (parental, social, media, etc), the social cost, and health care practices that may mitigate the issue.

This literature review overviews the evolution of adolescent substance use, the influencing factors, risk and resiliency factors, and the results of previous intervention efforts.

Important Statistics and Types of Drugs Being Used The National Center for Drug Abuse Statistics has the most current and comprehensive data involving youth substance use by grade, substance type, and state. The Center reports that 21.3% of 8th graders and 46.6% of 12th graders have used an illicit drug, with teenagers being responsible for 11.2% of overdose deaths. Additional substance-specific statistics follow:

Alcohol:

• ⅔ of students have tried alcohol by their senior year
• Over 40% report binge drinking
• 72% of teenagers get alcohol at home, from a friend's house, at parties, or directly from an adult

Cigarettes

• ⅖ students have used cigarettes by age 18
• 13.4% high school students use tobacco frequently
• Most frequent form is e-cigarettes (11.3%)
• 4% of middle school students currently use tobacco

Marijuana

• 43.7% of teenagers have used marijuana at least once
• 22% of teenagers have used marijuana in the past month
• 6.9% of 17-18-year-olds use it daily

Prescriptions

• ⅕ of teenagers have taken prescribed medicine that wasn’t their own
• 2.52% misuse pain relievers
• Prescription medication is more likely to be abused than non-prescription opioids
• Legitimate youth opioid prescription use increases adult misuse by 33%
• These substances are easier to access than one might think, with prescription pills being sought out more by teenagers, whether they are obtained in the home or from peers.

Other Illicit Drugs

• 7.5% of teens have used hallucinogens
• 7.0% abuse tranquilizers
• 5.9% used LSD
• 0.42% used cocaine
• 0.17% used methamphetamines
• 0.02% used heroin

Impactful Federal, State, and Local Policies

• The American Academy of Pediatric Dentistry has published a national policy regarding the oral care of adolescents with substance use. It addresses the need for awareness and implementation of special treatment approaches.
• The American Academy of Pediatrics provides its national policy on screening, brief intervention, and treatment referral for pediatric substance use. It provides recommendations for pediatricians and health insurance providers regarding best practice information for adolescents using substances.

• Policy variations and gaps. Policies regarding adolescent use of substance use treatment centers vary state by state. Kerwin, et al. (2015) provide a table that shows each state’s policy regarding minor or parental consent for substance and mental health treatment. It is important to know local policies which protect the privacy of the adolescent seeking treatment, whether the parent needs to provide consent, and areas where adolescents can be forcibly put into treatment. As of this paper, only Virginia requires the consent of both the parent and child for inpatient substance abuse and mental health treatment. While adults are charged with the care of their children, not all youth have access to safe, caring grown-ups. They are less likely to have an adult who will educate them on the dangers of substance use and abuse. Interventions for such youth should be considered a policy priority.

Available Tools and Resources

• SAMHSA provides a quick sheet on the 5 conversation goals for parents when discussing substance use with their kids.

• The Partnership for Drug-Free Kids provides resources on how to address medicine abuse and addiction, with a focus on kids and young people.

• Teen Safe offers a variety of links to resources for adolescents, parents, and clinicians regarding data, toolkits, and resources.

• This video is a kid-friendly and shows the effects of drugs on the brain. Parents can use it as a visual aid during discussions.

• Infographics are provided on this website regarding adolescent substance use data and impacts.

Promising Practices

Guiding Good Choices is a family-centered competency training for parents to build skills to help reduce the risk of children using substances. It helps to:

• Identify risk and protective factors for use in family strategies
• Develop effective parenting practices
• Family conflict management
• Use “family meetings” for family management and positive involvement .

Parent SMART is an innovative technology-based parental intervention strategy. It increases parental involvement in adolescent substance use treatment, including questionnaires and behavioral intervention tasks following treatment. The intervention tasks showed significant improvement in positive parental involvement and parenting processes with the child undergoing treatment for substance use.