Parent/Adult Q&A

Yes. Fentanyl is a very potent controlled dangerous substance. The maximum penalty for distributing fentanyl is 10 years. The Maryland legislature recognized the increased dangers of fentanyl and its link to fatal overdoses by including two important components in the statute. First, the law prohibits not just the distribution of fentanyl but also the distribution of a mixture that contains heroin and a detectable amount of fentanyl. Users may not even realize that the product they ingest contain fentanyl. Second the law mandates that the sentence imposed for committing this crime be consecutive to any other sentence imposed. Pushing these drugs out onto the streets is inherently dangerous.

Yes. Distribution of a controlled dangerous substance is a felony regardless of whether the recipient paid money. In order to prove that an individual engaged in the distribution of drugs, the State need only establish that the defendant distributed or dispensed a controlled dangerous substance. The maximum penalty for distributing marijuana is 5 years and/or a $15,000 fine.  The maximum penalty for distributing a narcotic drug is 20 years and/or a $15,000 fine.

I have practiced in the college health setting for over 30 years. My advice to parents as they send their children off to college would be to continue to talk to them. Make sure they know where you stand on issues of underage drinking, drug use and sex. They may seem like they are not listening to you, but you are the best influence on them. Believe it or not, they want to know your views, even if they may not always agree with you. Let them know you will always be there for them as they navigate their new freedoms and responsibilities of college. Parents, make sure you know what services are available to your student at their college. Most colleges and universities have excellent websites which inform you of available resources. Don’t be afraid to call your student’s counseling center or health center if you are worried about your student. For Salisbury University students, The Director of the Counseling Center and I are available to assist a parent with resources here on campus as well as in the Salisbury area. Also, the Centers for Disease Control and Prevention (CDC) has a wealth of information on numerous topics. www.cdc.gov.

We start by really encouraging parents to have conversations with their student about alcohol and drugs before they arrive on campus. This will hopefully help set some expectations before the student even arrives on campus. Once the students get here we offer a variety of ways for students to engage that do not focus around the use of alcohol or drugs. These events offer students a way to connect and meet other students without the use of alcohol and drugs. Some of the programs are focused on alcohol and drug education. We understand that college students may be exposed to, or using these substances while at college, and we try to educate them on how to make safe choices. Our campus also provides students with many resources ranging from their Resident Assistants who live on their floor to the Counseling Center that is of no cost to our students to help support them.

Watching out for the health and well-being of our student-athletes is paramount to ensuring that they have a positive experience while participating in college athletics. Establishing strong drug and alcohol policies coupled with educational initiatives has proven to be a great deterrent to behaviors that interfere with the student-athletes pursuit of excellence.

According to Psychology Today, stress usually refers to one of these two things: “the psychological perception of pressure, on the one hand, and the body’s response to it, on the other, which involves multiple systems, from metabolism to muscles to memory”. The stress response, more commonly known as the fight or flight response is a short-term reaction to a stressor. The hormonal and metabolic changes in the body due to this response are meant to help prepare us to either fight the stressor or run away from it. The stress response is meant to be a short-term response mechanism, not a long-term response, so overtime the constant state of stress can lead to a constant fight-or-flight response in the body. This results in a whole list of physical and psychological health issues including depression, chronic fatigue, and cardiovascular issues.

Many studies have shown that there are ways to reduce the negative effects of the stress response and bring the body back to a homeostatic state. Moderate/intense exercise are proven ways to bring the heart rate down therefore reducing the elevated heart rate from stress. Physical exercise is a terrific way to help cope with stress and depression. Not only does it bring your heart rate down; it helps blood flow better throughout the body, including blood flow to the brain resulting in clearer thinking and an easier time focusing. There are so many different types of workouts, ranging from jogging, Zumba, CrossFit, yoga, kickboxing, and so many more. Dedicating at least 30 minutes a day to exercise will help you find time to focus on something other than your long list of things you have to do. The American Heart Association has recommendations for physical activity that you can find by visiting http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp#.WVpVPGeWy00

Besides physical activity, other things that can help maintain stress are meditation, spending time outside, and vacations. Many of us get wrapped up in always being on our cell phones and connected, that we forget to disconnect and shift our attention away from our everyday demands. It’s going to be challenging at first to not worry about outside stressors while you are disconnecting, but over time it will get easier to do.

Psychology Today has informative articles on stress at https://www.psychologytoday.com/topics/stress.

In my last response (see Answer #27) on the use of Naloxone to treat people who had overdosed on opioids such as heroin or pain pills, I had stated that “each overdose death costs taxpayers about $30,000.”  An alert reader wondered “why or how people who die of an overdose present a [financial] COST to society.”

Naloxone has the ability to reverse the life-threatening effects of opioids.  When it is administered and has the desired effect, the person who has overdosed survives, thus reducing any further costs that would have been incurred had the naloxone not been available.

At this point I’d like to reframe the reader’s query a bit by asking not what the cost of the death itself is, but what the costs are if we fail to revive someone with Naloxone.  In other words, if we are trying to judge the financial benefit of widely distributing naloxone for use by emergency personnel in the field, we have to look at the post-overdose costs. (I will note of course that the cost of human suffering from drug use and from overdose deaths is incalculable).

A key financial impact of Naloxone is that it makes the need for emergency room and hospital visits less necessary. Here are some approximate costs:

• A trip to the emergency room in an ambulance requiring life support:  $1200
• Treatment in the emergency room followed by release to the community:  $3,640
• Getting your stomach pumped (gastric lavage):  $1,000 to $6,000
• A stay in the hospital (the average stay is 3.8 days):   $29,497
• If the overdose leads to death, a funeral costs about $8,000; direct cremation is $2,700

These additional figures from an article in the Journal of the American Medical Association are also quite sobering:

• Emergency room visits for drug overdoses reached 5 million in 2011, a 100 percent increase from 2004.
• About 1.25 million of those visits were due to illicit drugs.
• From 2001 to 2014, overdose deaths increased from nearly three-fold for prescription drugs to six-fold for heroin.

The opiate epidemic in America is very real and very costly in human and financial terms.  If a simple intervention like Naloxone – which costs about $40 – can save lives, reduce suffering and significantly reduce health care costs, it is well worth it for communities across the country to consider this as a key weapon in our fight against the devastating impact of drug abuse.

Your questions about opiate addiction and the use of Naloxone to treat overdose are valid and reflect the concerns of many citizens. But substance use and addictions, as well as national, state and local efforts to curtail use and its impacts on society, are complex subjects and not amenable to easy or quick analyses or answers. It’s a problem that we will all have to live with for a long time as a society, so let’s get acquainted with some of the facts so we can together as a nation develop thoughtful and effective approaches to a serious and growing problem.

I’d like to start with the notion of “choice” in addictions. Indeed, individuals do make the decision to “pick up” a drug for the first time and the many times that might follow, with addiction to one or several drugs being a possible outcome after repeated use. Although patterns of drug use are varied (not everyone who uses drugs becomes an addict), many of the people for whom substance abuse becomes a chronic illness have underlying emotional and physical problems that have contributed significantly to continued use. Childhood sexual and physical abuse, depression and bipolar disorder, overwhelming stress and anxiety, unbearable physical pain are all reasons that people might begin and continue to use drugs – even if they adversely impact the quality of a person’s life. The desire to minimize or eliminate emotional and physical pain is a powerful and understandable human impulse, and if healthier options are not available or known to someone who is suffering in mind or body, using drugs becomes a way of coping and getting on with a difficult life.

I say this NOT to imply that people who use drugs should have no responsibility for their actions – all of us are obligated to consider how our choices affect us personally, affect those we love and affect our larger community. But the social and psychological and biological forces that drive addiction are difficult to unravel and to overcome, and our solutions to drug abuse in America will only be as good as our ability to understand this phenomenon in all its (frightening) depth and complexity from a very individual, personal perspective.

There is, however, some good news in the addictions picture:  addiction – like diabetes and hypertension – is a treatable chronic disease.  Treatment programs across the country, using approaches based in medical research, have the capability to help people stop using drugs and to return to productive lives. As with any other chronic disease, relapse with addictions is expectable (40% across all drugs of abuse), but comparable to Type I diabetes (30%), hypertension (50%) and asthma (50%). Relapse from opiates can be considerably higher.

So being addicted to drugs – even opiates, which are among the more difficult substances to stop using – is not a life sentence. Many addicts want desperately to quit and resume a normal life, and will go through the hard mental and physical work of multiple relapses before they successfully achieve long-term recovery.

There is no question that opiate addiction is a huge national and worldwide problem. In 2012, it was estimated that 2.1 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, with an additional 467,000 addicted to heroin. The total number of opioid pain relievers prescribed in the United States has skyrocketed in the past 25 years; and globally, prescriptions for products like hydrocodone and oxycodone have escalated from around 76 million in 1991 to nearly 207 million in 2013.

And the easy availability of opioid prescribed drugs has been accompanied by increases in negative consequences. For example, emergency department visits for the recreational use of opioid pain killers increased from 144,600 in 2004 to 305,900 in 2008. More alarming is the increase in overdose deaths due to prescription opioid pain relievers – they have more than tripled in the past 20 years, escalating to 16,651 deaths in the United States in 2010.[9]

Which brings us around to Naloxone. Although the cost of Naloxone has increased in recent years, it still remains a relatively inexpensive alternative for saving the life of a person who has overdosed on opiates. It costs between $20-$40 dollars for a full naloxone kit, which includes everything a person would need to reverse an overdose. So money spent distributing naloxone provides tremendous value for every dollar spent.  Consider the alternative:  each overdose death costs taxpayers about $30,000. Let’s do the math:  with about 16,600 overdose deaths from prescription opioids in 2010 (this does not include deaths from heroin), the cost to society for losing these people to drugs is about $500 million. By contrast, the cost of Naloxone kits to save those same lives is about $664,000.

Finally, I want to address the idea that we are coddling drug users by saving lives and providing treatment. There is no question that drug addiction brings a great burden to all of us in terms of increased crime, increased health care costs, lost work productivity and the loss of loved ones and neighbors; and that tough law enforcement efforts are a necessary part of the overall picture of curtailing substance use in this country. But would decreasing the availability of Naloxone to treat opiate overdoses be the answer to the opiate addiction epidemic?

In Howard County, from 2011-2012, prescription opioid-related deaths increased 600%.  Ask any parent of a child who has died from an opiate overdose:  if your child had a second chance to live, no matter how difficult they had made their life, your life and the lives of those around them, would you deny them the one medicine that in their moment of crisis could keep them alive?  Would you deny them the one chance that, after many hard attempts at recovery, might allow them to pursue a happy, productive and normal life?  No matter how devastating and frightening and incomprehensible substance abuse may be to the rest of us, in the final analysis we are bound by the values of this country and of our shared humanity to honor the sanctity of life and to give everyone – no matter how troubled, how fallen, or how seemingly burdensome – the right to live and try again.

The synthetic opioids such as fentanyl and others are more and more commonly encountered for many reasons including cost. These drugs are incredibly strong, in some cases hundreds of times stronger then heroin or oxycodone. These drugs have proven fatal to those who didn’t realize what they were taking, and associated overdoses often require very high doses of Naloxone to reverse. In addition, these drugs pose a risk to responders who too may find themselves exposed to these dangerous materials.

Finding unknown or unrecognized pills can be scary, especially if you are not aware of anyone having a prescription for them. One of the best resources to help identify unknown pills is the Poison Control Center. They can be reached at 1-800-222-1222.

For more information, please visit https://www.howardcountymd.gov/Departments/Fire-and-Rescue.

In addition to getting free Nalaxone training from the Health Department, we encourage everyone to learn CPR. Being able to perform CPR is key to caring for someone in cardiac arrest who has suffered an overdose. Howard County Department of Fire Rescue Services provides free CPR training.

For more information, please visit https://www.howardcountymd.gov/Departments/Fire-and-Rescue.

I have heard similar questions raised by parents/adults in regards to allowing or condoning at-risk behaviors by adolescents.

First, each parent knows their son or daughter (both genders gamble) better than anyone.  What a parent allows their children to do with or without their friends is totally the responsibility of the parent(s) who may be “sponsoring” gambling in their home.  We know that allowing alcohol to be consumed by minors in your home is breaking the law and parents have paid the legal penalty for such behavior.

The example that I use is this: Would you as a parent give your child (someone who is still legally a minor) any of the following as a gift:

• a miniature bottle of alcohol
• a pack of cigarettes or tobacco products
• a small bag of marijuana
• a lottery ticket

What might be considered by the parent/adult as harmless behavior cannot be guaranteed to be the same for the adolescents involved.  It often is an argument based on the principal ‘lesser of two evils’. Simply put, what/who will stop gambling from becoming a problem for the adolescent? The parent/adult might mistakenly believe that they are in control of the gambling because of it being held in their home. I doubt that many adolescents would invite their parents to sit in on the entire gambling. How much is wagered, what is wagered and how much can the participants afford to lose is outside of the control of the parent.

Finally, the message that is heard and understood by the adolescents “it’s ok to do these things at home” because it is safer here! This attitude is too frequently restated by adolescents when they say, “I am in control (of my drinking, smoking, drug use, gambling, etc.) and I can stop anytime I want.” This attitude or approach is called: “Illusion of Control”.

Clearly, not everyone who attends Howard County schools is drinking or doing drugs. The last study I know of was done in 2011 and reported less than 60% of students using any substance in the 30 days prior to the study. Keep in mind, this 60% would have included any child having even 1 drink of alcohol – with family or not. While I do not feel that any alcohol use by kids or teens is acceptable, this number indicates that not everyone in high school is doing drugs or drinking alcohol. We also know that kids are under a great deal of peer pressure (hidden or passive) to look cool by saying they might have done something they have not. Unfortunately, it is clear in our society that drinking is cool – just look at the “coolest man in the world” advertising. It works for a reason. Remember the schools only have our kids for 6-7 hours a day. How many hours a day do our high school kids raise themselves every day? Many spend 3-4 hours a day by themselves after school before parents get home. We cannot expect the schools to do more than they do now.

This being said, I have good evidence that Howard County Schools are doing a great job of recognizing and addressing any substance use they find. I believe they also do a great job at prevention and limit setting. Thankfully, in Howard County Maryland, not only do the schools address what is put before them, they have teams of teachers and counselors trained to search out and address concerns before a child gets into trouble. There are Student Assistance Teams, part of the SAP program, in most Howard County high schools and many middle schools. These teams are trained to identify issues and bring any issues to parents. Despite these teams being cut in other counties, Howard County has made these teams a priority and found funding to keep them when other systems did not. Clearly, we are lucky in Howard County to have a school system that treats substance use as a priority.

Like the question above: The “easy” answer is to call your insurance company if you have insurance, but that is not always so easy.  Many therapists are not covered by insurance or are hard to find on the list of providers that is often out of date.  Luckily in Howard County, there are hundreds of licensed therapists.  Of course, I am not unbiased.  Congruent Counseling has 24 therapists on staff, all of whom take commercial insurance and have a wide variety of specialties. I encourage you to seek out only licensed counselors or therapists as Maryland has set standard requirements to protect consumers and to ensure counselors have appropriate training to help.

The “easy” answer is to call your insurance company if you have insurance. Many programs are not covered by insurance or are hard to find on the list of providers that is often out of date. Luckily in Howard County, there are several certified programs that specialize in working with teens. Our Howard County Health Department has an entire office with staff dedicated to assessment and treatment.  They can be reached at 410-313-6202. Of course, I am not unbiased as I started two programs in Columbia: Integrative Counseling and Congruent Counseling. You can also view the Maryland Alcohol and Drug Abuse administration Program Locator at: https://bha.health.maryland.gov/pages/index.aspx. Each program has different times, different costs, and a different focus. When working with teens, it is essential that family counseling is available and that the program recognizes and addresses social and other mental health concerns. Luckily in Howard County the question is not how to find one, it is how to choose one.

Yes, you do have reason to be concerned about your son’s use of an electronic cigarette, aka e-cigarette. A lot is still unknown about e-cigarettes and more research needs to be done; however, these products are currently not regulated by the U.S. Food and Drug Administration (FDA). Many scientists and public health advisors caution their use until there is more information about short and long term effects.  As of now, research findings do not indicate that e-cigarettes are either safe or that they are effective quit smoking aids, and there are concerns that e-cigarettes may serve as a point-of-access for youth to other tobacco products.

Although there is no conclusive scientific evidence that e-cigarettes are effective quitting smoking aids (Etter et al., 2011), and the U.S. Public Health Service has not deemed e-cigarettes as a viable alternative for smoking cessation (PHS, 2008), many ads and testimonials are marketing them as less harmful alternatives to smoking cigarettes.

While the jury is still out, here’s what we currently know about e-cigarettes:

Designed to mimic cigarettes in regards to shape, size, and experience.

E-cigarette devices do not have a single definition for all types of devices, and their design and use of ingredients can vary between manufacturers (Tobacco Control Legal Consortium, 2013)

E-cigarettes are nicotine delivery devices that heat, rather than burn, and vaporize a solution to be inhaled. These devices deliver nicotine and other potentially harmful substances in the form of a vapor. Although no tobacco is burned in an e-cigarette vs. a traditional cigarette, the type and amount of harmful components in e-cigarette cartridges have yet to be fully identified as well as their impact on the health of an individual.

E-cigarettes offer the availability of flavored nicotine cartridges to be inhaled, including cherry, grape, vanilla, piña colada, which appeal to the tastes of youth. The U.S. Food and Drug Administration (FDA) banned the sale of fruit-flavored cigarettes in 2009.

While your son is not inhaling cigarette smoke with an e-cigarette, he is inhaling a vapor which contains chemicals such as propylene glycol, which is also found in antifreeze and is used to de-ice airplanes.

We would recommend that you share this information with your son and have him check out some websites with more information on e-cigarettes.  We’ve outlined some good sites below and would suggest you view this short Powerpoint presentation on Electronic Nicotine Delivery Systems (http://mdquit.org/sites/default/files/event-archive-folder/Electronic-Nicotine-Delivery-Systems.pdf) by Dr. Jack Henningfield, a leading expert in tobacco use.

Maryland Resource Center for Quitting Use and Initiation of Tobacco (MDQuit) Visit us at MDQuit.org.

On February 25th of this year the Maryland Stadium Authority announced a complete ban on smoking at M&T Bank Stadium and Oriole Park at Camden Yards. This action brings the Baltimore stadiums more in line with other stadiums across the country. The smoking ban went into effect on March 4, in time for Opening Day at Camden Yards on April 5 and it does not apply to smokeless tobacco. Prior to the ban, M&T Bank Stadium had reserved space within the stadium gates for smokers.

I would recommend an intensive outpatient program (IOP) along with attending NA. There are more than a few IOPs in the area. I went to Kolmac Clinic, but there is Columbia Addictions and many others. If your son is a person with a strong organized religious background, Celebrate Recovery is an option. Because there aren’t many Celebrate Recovery meetings in the area, many people combine them with N.A. meetings.

There are several things you can do to help your son. One concern I have about sending teens off to treatment is that often no changes are made in the home and parents have not been prepared or taught how to help their child live in their house. Hopefully this is not the case for you, but just in case I’ll complete that thought. If your son has been in a therapeutic boarding school for a year, he is probably accustomed to a set of rules that are clear. That is to say, he knows what to do day by day to follow the rules. When he gets home, it could be hard for him to adjust to an environment where the rules or expectations are not clear. This is particularly the case if there are other siblings in the house or if there have been problems in the home in the past. If both parents are in your home, then I hope both of you agree on how things work and that you are co-parenting. If not, the rules will be unclear and your son is less likely to do well. I bring this up because I would encourage any family who sends a child off to treatment to be in treatment themselves. If you are not in counseling yourself yet, I would recommend it. Over time, having your own consultant counselor will allow you to have someone to ask about how to proceed as any concerns come up.

As for programs for your son to get help, we most often a recommend a slow step down. In other words, if your son is currently involved in a therapeutic environment 24/7, we do not all of a sudden drop off to no counseling or seeing a counselor once a week – this is too drastic a change. I would recommend attending an Intensive Outpatient Program (IOP) first (these programs meet three days a week for three hours each day). Then assuming progress is good, he would step down to two days a week, then to one. As time goes on I recommend a once a week support group and maybe an individual counselor for your son. I would hope this transition would last at least a year.

Now keep in mind, it will be hard for your son to go into an IOP program because there will be other people just getting clean or relapsing in those programs who he will have to deal with. Fortunately, he can learn to deal with these folks in a structured environment with the support of a counselor. He will also meet these same people in NA but there he will not have the support of a structured program. He will also be coming back into contact with old friends. He will need support. I also recommend a program geared specifically toward the needs of young adults and families. It is impossible for me not to be biased as I have created a program fitting these specifications here in Howard County called Congruent Counseling Services. We offer a Young Adult IOP Program specifically designed only for adults ages 17 to 26 and their parents.

Parents will come up with a variety of reasons why they think it is okay to allow kids to drink. Some parents even provide the alcohol. The most often cited reason for parents to allow their teens to drink is that teens will be safely drinking in controlled settings. Parents who allow this have already given up the battle. There is no need to assume that our teens will drink, instead we need to continue to educate and inform them about the dangers of underage drinking. As parents, it is our job to set the rules, be aware of what the child is doing, and follow through to make sure they’re listening.

There is also the problem of parents setting a bad example or not assisting youth who don’t want to drink. Some kids need the “out” from their parents. They need to be able to say, “My parents will ground me if I drink.” If parents are saying, “Go ahead, it is fine,” then those youth have no out. For many parents, if the ethical issue doesn’t change their minds, then they should look at the legal and financial ramifications of serving alcohol to minors. In Howard County the maximum fine for an adult providing alcohol to minors is $2,500 per person served. That can add up very quickly when there is a large group of teens present. Add legal fees if the underage youth (or the adult buying the liquor) is caught by the police and/or possible substance abuse treatment, and the costs are staggering. One DUI will cost you $20,000 without getting it off your record and will increase your insurance costs.

Kids who drink before they are 15 are FIVE times more likely to develop a serious problem with drugs or alcohol before the age of 21. If a parent allows drinking at home, they should expect that their child will drink elsewhere.

Kids in Howard County admit that when they are drinking, they are binge drinking. Kids who binge drink take more risks. They may try other drugs they wouldn’t use if they were sober, they may have unprotected or unwanted sex, and they may engage in violent behaviors. Underage drinking is a factor in nearly half of all teen automobile crashes. It also contributes to suicides, homicides, and fatal injuries and is a factor in sexual assaults and date rapes.

Experts state that parents have far more influence over their children than the parents would believe and that is important that as parents you talk to your kids, listen to your kids and then set limits with consequences. Tell them what you find acceptable and hold them to it.

As much as I would like to be reassuring, a sober review of this situation provides cause for alarm. First, let’s take a quick look at four research studies published in reputable medical journals over the past decade (for brevity’s sake, I have not included references, but would happy to provide them on request). Although these studies explored the concomitant use of alcohol with methylphenidate (e.g., Ritalin, Concerta), it is reasonable to assume that the results would apply as well to amphetamines (e.g., Adderall, Dexedrine). Here are the findings in a nutshell:

Methylphenidate is frequently taken together with alcohol for the purpose of enhancing the effects of the alcohol – i.e., to get high;

When alcohol is used together with methylphenidate, the alcohol is ingested in greater quantities than when used in its absence;

Alcohol drives up the blood level (and hence, the effects) of methylphenidate; and

The combination of methylphenidate overdose and alcohol can lead to death and has been used in several “successful” suicides

So what sense can we make of these findings? Most importantly, that the recreational use of stimulant medications with alcohol is not a harmless venture – the stimulant medications can drive up the quantity of alcohol consumed, the alcohol can drive up the blood levels of the medications and that together, at high enough dosages, the combination can be lethal.

What about your son’s safety? The answer is a complex one that depends on multiple factors – among others, his pattern of Adderall use, his level of self-control vs. impulsivity regarding alcohol consumption, the drugs his friends are bringing to the parties and his use of other recreational substances.

Let’s consider the following not improbable scenario (we hear these stories in our offices from our teen patients and in the community from our neighbors): a Howard County teen goes to a party for the purpose of having a good time with his (or her) friends, which often involves consuming enough alcohol to become extremely intoxicated. My teen patients frequently report sufficient alcohol use, particularly on the weekends, to result in vomiting, passing out, blacking out (awake but not conscious of one’s behavior), fights, unintended sexual encounters, drinking and driving, and trips to the ER for alcohol poisoning. The friends are likely to have in their possession marijuana, stimulant medications, anti-anxiety medications such as Ativan and Xanax (which are particularly dangerous and potentially lethal when combined with alcohol) as well as numerous other recreational drugs. The male ego being what it is, there is an unspoken pressure to drink (and/or drug) as much as possible. Alcohol being what it is, there is, as the party continues, a decreasing ability to make good decisions about alcohol and drug consumption.

The results are potentially frightening. Over 50,000 cases of alcohol poisoning are reported yearly in the US. One in 1000 of these people die. Combine the alcohol with stimulant medications or any number of other substances, and the potential for unintentional death – what we sometimes grimly call “death by stupidity” – is multiplied significantly.

Even in cases in which patients are using their psychiatric medications responsibly – e.g., I take my stimulant medication or antidepressant or anti-anxiety medication early in the day, and then have a few drinks at a party at night – the impact of combining medications with alcohol is unpredictable. Some patients report that the medication seems to have no impact on their experience of the alcohol. Others, however, feel considerably more intoxicated after a small number of drinks.

With regard to stimulant medication usage patterns, please note that these medications are typically intended for daytime use, for the purpose of improving performance in academic and employment settings. When my patients begin using their medications at odd hours (e.g., very late in the day), or using up their pills more quickly than prescribed, it is important to begin asking questions about overuse and misuse.

You are wise to be concerned about your son’s use of alcohol while on stimulant medication. I would certainly begin a conversation with him about the risks of combining these substances. If he is forthcoming about the reasons for his use and his responses feel trustworthy, guide him with regard to the responsible use of alcohol. My experience with my teen patients and my own children has led me to believe that attempting to prohibit alcohol use in this age group, although commendable from a safety standpoint, is unrealistic and has the potential for diminishing honest communications between parents and children.

If on the other hand, you feel that your son is less than transparent regarding his use of the stimulant medications and alcohol, it might be time for a more direct approach. Consider who gets access to the medication bottle and who administers the meds: is your son able to take his meds whenever he wants, without adult supervision? Given what you know about your son, is this in his best interest?

In general, I think that a more careful, supervised approach to medication use is appropriate for this age group. Pressures to drink and drug, the desire for stimulation and experimentation, less mature brains that are less capable of controlling impulsive desires and the ready access to prescription meds, alcohol and street drugs all argue for a strong parental presence in this aspect of our teens’ lives.

Although some risks are necessary for our children to grow up, please impress upon your son that a long and healthy life is rooted in his ability to evaluate consequences, learn from his mistakes and make thoughtful choices about his behaviors.

When you take into consideration that over 3 million teens in the United States abuse prescription medications and 70% of them admit to getting the drugs from family or friends, purchasing a lock box for your family’s medications could save a life.

There are different companies and styles on the market, you can even get a zip pouch much like a bank deposit bag which makes it easier to travel with your prescriptions.

A good site to visit is: http://www.lockmed.com.

Flushing is the most common practice, but traces of pharmaceuticals are showing up in water supplies across the country and some states have even made the practice of flushing medications illegal.

Incineration is too costly and requires medication to be transported to facilities.

Discarding can be dangerous and can lead to medication entering the drug trafficking market.

Contact HC DrugFree for more information about Take Back Days in Howard County.

First of all, it’s impressive that your 14-year-old likes to have his friends over to your house. It’s a good sign that he seems to be comfortable having you in the “same vicinity” as his social life.

Nowadays it may be more practical to say that parents need to help teens with how to handle the situation of when, rather than if, they are faced with drugs and alcohol. Communication is the key to staying in touch with your teenager, preparing them for difficult situations, and being open to talking with them when things take a wrong turn.

I suggest that parents pick a quiet, calm time to have an honest talk with their teen. Let them know you just want to check in with them and see how they’re doing. Ask them what they know about drugs and alcohol, rather than lecture, and talk through some possible scenarios. Chances are they already understand the dangers of drugs and alcohol on some level but haven’t imagined what exactly they would do if someone, say, brought a bottle of vodka to a casual gathering.

Parents can help by practicing with their teen ways to say “No.” Let them know that peer pressure can be subtle and it’s unlikely they would be openly ridiculed by being assertive and saying “Nah, I’m good,” or “No thanks, I’m not into that.” If your child does make a mistake, work on understanding the situation and talk about what happened and how to prevent the situation for the future, rather than yell, judge, or blame.

Another good tip for parents is to help their teen build confidence in themselves and find a “niche” in their high school. Belonging to a certain group or club where drugs and alcohol are not common and teenagers have things in common with others increases their self-esteem. Teens who have good self-esteem are more likely to resist negative peer pressure, which may include feeling like they have to “fit-in” by using drugs and alcohol.

Lastly, “Emotional Regulation” or being able to deal with strong emotions is a particularly important skill. Those people who learn strategies to deal with stress, such as talking with others, exercising, meditating, keeping a journal, and asking for help, are less likely to turn to drugs and alcohol as a way of “self-medicating” feelings of anxiety, being overwhelmed, or feeling depressed.

The best thing a parent can do for their teenager, and it sounds like you are already doing this, is BE PRESENT. Be present in their lives, be open and available to talk, and be there when they need help.

Parents should be greatly concerned with their children acquiring and/or using fake IDs- for any purpose… it is illegal! Not only is using a fake ID a misdemeanor and the violator subject to 6 months imprisonment and/or a $500 fine, simply possessing a fake ID also carries a criminal charge with an identical penalty. These charges will become part of the child’s permanent record. This can be harmful when applying for future military or other government service jobs, as well as positions of trust in private industry. In addition to a possible criminal record, a violator could also be sanctioned by the Motor Vehicle Administration in the form of a suspended/cancelled driver’s license for a minimum of 6 months. These consequences would also apply to a person attempting to use the genuine license of someone else.

Possibly, the most damaging issue, which is often overlooked, is the likelihood of identity theft. When a child furnishes his/her personal identifying information to a stranger, it is uncertain where this information could appear in the future. In fact, it has been reported that many customers of a now defunct fake ID website had their personal identifying information sold to identity thieves overseas. The ironic part is that these identity thieves had it easy…the personal identifying information was voluntarily provided to them by the customers- to include their addresses, dates of birth, and photos! Not only is this a potential nightmare if it occurs, but this nightmare can continue throughout the child’s adult life.

As a parent, you should be vigilant as to what your child is doing when he/she is not in the house. Pay attention for any obvious signs of deception or unwillingness to be open with you. Take the opportunity to talk to your children about the consequences mentioned above. Keep an eye on their possessions and be on the lookout for any IDs they may have that are from another state or that belong to someone else. Many times, when a fake ID is purchased, more than one copy of the ID is provided. Maintain an open dialogue with your children regarding alcohol and fake IDs.

This happens more frequently than you would imagine and I applaud your efforts and wisdom to seek guidance with this issue. You have several options to handle the situation. My first suggestion would be to confront your teenager with the item and encourage your teen’s explanation. Based on his/her response, you have several options; you can bring the item to our office for visual identification. If we cannot identify it based on a visual inspection, we have a relatively inexpensive “swipe” test. This is a test kit that will identify a substance by “swiping” the surface. A second, but rather costly option is to send the item to the lab for an “unknown substance” identification. While this method can be rather costly ($300.00) it will definitively identify the substance or substances. You can also require your teenager to submit to a drug screen to detect any drug use. In many cases, I have found the teen will initially deny any knowledge of the item or usage; however, when confronted with the probability of the item being identified as well as the drug test, they will most often “come clean”. We have also had the scenario where the teen will admit to the item, but claim it belongs to a “friend”. We can send the item for DNA testing which can also be rather costly ($300.00). The good news is; each time a parent has opted to send the item for DNA testing, the child has subsequently admitted their DNA will in fact be present on the item, and the parent has not had to incur the expense of DNA testing. The bottom line is; you as the parent must confront the child and let him /her know you will get the truth one way or another: by his/her own admission, or through scientific methods. Be strong, be firm, be loving, and tell you child you would much rather hear it from his/her own mouth than from total strangers, but you will do what you need to do.

The following guidelines were developed by HC DrugFree in partnership with the PTA Council of Howard County. To view and print the full document, click here.

Do you know if your student is with a limousine company that uses these guidelines?

Zero Tolerance – These companies take a zero tolerance approach to alcohol, tobacco, and drug use. Any offender will be removed from the limousine, the contact parent will be called, the offender’s parent(s) will be called and the evening will end.

Safety – Limousine service is a safe way for students to travel to proms and graduation activities. Students are afforded a sense of independence and glamour while still being “supervised” by an adult.

Contact Parent – Throughout the evening, limousine drivers call the contact parent to keep them apprised of the evening’s progress.

Peace of Mind – The limousine service provides parents/guardians with the peace of mind of knowing their student(s) is with an adult who is looking out for their well being.

Students are only transported to destinations that are pre-specified by the adult that makes a contact with one of the partnership companies.

Contacts are not made with anyone less than 18 years of age.

No backpacks are allowed in the limousine. All backpacks are kept in the trunk until the last drop off.

Change of clothes bags are also kept in the trunk.

All policies are reviewed with the student before they enter the limousine.

One pick-up location per contract to eliminate opportunities to “smuggle” zero tolerance items into the limousine.

No additional passengers allowed in the limousine. If a student is not in the original party, they are not allowed in the limousine.

No hotel drop offs.

There may be additional cleaning fees or vehicle damage fees.

Check with company for policies regarding loss or theft of personal belongings.

Check with company for policies regarding payment expectations, refunds, etc.

The American Academy of Neurology (AAN), the world’s largest professional association of neurologists, is releasing a position paper on how the practice of prescribing drugs to boost cognitive function, or memory and thinking abilities, in healthy children and teens is misguided. The statement is published in the March 13, 2013, online issue of Neurology, the medical journal of the American Academy of Neurology.

This growing trend, in which teens use “study drugs” before tests and parents request ADHD drugs for kids who don’t meet the criteria for the disorder, has made headlines recently in the United States. The Academy has spent the past several years analyzing all of the available research and ethical issues to develop this official position paper. “Doctors caring for children and teens have a professional obligation to always protect the best interests of the child, to protect vulnerable populations, and prevent the misuse of medication,” said author William Graf, MD, of Yale University in New Haven, Conn., and a member of the American Academy of Neurology. “The practice of prescribing these drugs, called neuroenhancements, for healthy students is not justifiable.” The statement provides evidence that points to dozens of ethical, legal, social and developmental reasons why prescribing mind-enhancing drugs, such as those for ADHD, for healthy people is viewed differently in children and adolescents than it would be in functional, independent adults with full decision-making capacities. The Academy has a separate position statement that addresses the use of neuroenhancements in adults. The article notes many reasons against prescribing neuroenhancements including: the child’s best interest; the long-term health and safety of neuroenhancements, which has not been studied in children; kids and teens may lack complete decision-making capacities while their cognitive skills, emotional abilities and mature judgments are still developing; maintaining doctor-patient trust; and the risks of over-medication and dependency. “The physician should talk to the child about the request, as it may reflect other medical, social or psychological motivations such as anxiety, depression or insomnia. There are alternatives to neuroenhancements available, including maintaining good sleep, nutrition, study habits and exercise regimens,” said Graf.

The statement had no industry sponsors.

View the full statement here.

View the AAN’s full statement on neuroenhancements and adults here.

As a veteran “senior” parent having two children survive senior week in two different years, I offer the following advice: 1) trust your instincts about with whom you allow them to share a house; 2) keep the numbers in one house or apartment to six or less; 3) make it mandatory for students to attend one of HC DrugFree’s “Senior Week: Staying Safe in Ocean City” programs; 4) have a mandatory parent and student meeting to decide “rules of the house”; 5) do not allow them to have a car for the week; 6) have a time each day that they must check in with you by phone (no texting – hear their voices); 7) consider sending students for 3-5 days instead of 7; 8) make them get a bus pass for the week so they are riding the bus which is free and the safest way to travel; and 9) warn them about jaywalking across the highway.

Even when you follow all of the guidelines above, expect your student to be exposed to, and to possibly participate in, drinking alcohol. Therefore, make sure they understand the signs of alcohol poisoning and the importance of getting help if a friend is in trouble.

One of our children came home after only 24 hours due to the wild behavior of housemates including the use of alcohol. (Those same students all signed a pledge in front of all the parents not to bring alcohol.)

Who can be more macho in front of the girls is a pastime for the boys at senior week in Ocean City, so warn your son to ignore this behavior which leads to frequent fights on and near the boardwalk. Consider having a parent chaperone the house. If that is not acceptable, consider what we did one year which was alternate a parent staying nearby, but not in the same house as the students. This was acceptable to the kids and kept them “honest” because they never knew when they might run into the parent. Several parents split the week so that no parent had to be there more than two nights.

Senior week is a good experience for students who must learn to be responsible. However, it is also a lot of time, temptation, and freedom all at once. You must clearly set the expectations, be present if possible, and then hope they make good choices.

Working with HC DrugFree has been a family affair for us. Our son, Joshua Peoples, is also a Howard High School HC DrugFree Teen Advisory Council Representative and we, my wife and I, share the responsibilities of the Howard High School HC DrugFree PTSA Representative. Our work with HC DrugFree has been a catalyst for many insightful conversations. The work Joan (Executive Director) and Molly (Hispanic Outreach Coordinator) do is very much needed in today’s society if we are to help students navigate the plights of high school and life…Alcohol and DrugFree!

(Parents interested in serving as HC DrugFree PTSA/PTA Reps should contact HC DrugFree and your PTSA/PTA Presidents. Teens interested in joining HC DrugFree’s Teen Advisory Council should contact HC DrugFree.)

The Tragedy of Drug Addiction – it destroys the pleasures of life. It destroys that which makes life worth living. A warm summer’s day, a good hug, grandma’s homemade apple pie, a promotion at work, an “A” on your exam, that first love, hearing your newborn baby cry for the very first time, that song that brings a smile to your face, the smell of a flower, the colors of a rainbow. Our enjoyment of all of these is deadened by the addictive drugs of abuse. One of the common denominators of these drugs is that they all stimulate the pleasure centers of the brain, and eventually lead to their destruction. We substitute a natural high for an artificial high. Repeated use leads to tolerance where weakened pleasure centers require higher doses to produce the same highs. Addicts are constantly seeking that first drug-induced high that will never come again.

FamilyeJournal is a simple, free and fun interactive website that improves family communication and connection using an easy Q&A format to help users share their thoughts and feelings. Family connection and communication leads to reduced high risk behaviors. Visit www.familyejournal.com and enter HCDrugFree in the Partner Code.

Drugs and alcohol change the way the brain receives, processes and sends information. This alters behaviors and thinking. The troubling behaviors that parents are witnessing are not the product of poor parenting or upbringing nor are they symptomatic of a person who is anti-social. Rather they are the result of a brain that has been altered with substances that can be described as “brain-altering substances.” Chapter 4 of my book, What Is Wrong With My Kid?: When Drugs or Alcohol Might Be a Problem and What to Do About It, has an excellent discussion of the impact of illicit substances upon our youth’s developing brains.

It is parental denial, which is not lying, but rather it is a subconscious, psychological process we engage in to block out reality. As I note in my book, What Is Wrong With My Kid?: When Drugs or Alcohol Might Be a Problem and What to Do About It, parents stay in denial by engaging in minimizing, intellectualizing, rationalizing, justifying, and excuse making to avoid reality. It arises from guilt (blaming self for the kid’s problems) when in reality it was a free will choice the kid made to engage in the drug scene. Guilt must be overcome and it is suggested parents utilize the “3 C’s”: 1) I didn’t Cause the addiction (it was a free will choice the kid made); 2) I can’t Control the addiction (witness my vain efforts to control his/her behaviors); 3) I can’t Cure addiction (that can happen only when the drug user chooses to stop using drugs).

You are correct that marijuana is not a good drug. Of course, neither is alcohol. Both drugs (alcohol is a drug) are even more harmful to adolescent brains as they are still developing. The main concern I have for pot is that it decreases a person’s ability to control his/her emotions, decreases motivation, and decreases memory retention. It definitely affects learning. Not only does the person have more trouble learning, but they don’t care as much that they are not learning and then they get mad when people ask about the change!

Here is a web page you might want to look at:

https://www.drugabuse.gov/publications/marijuana-facts-parents-need-to-know/letter-to-parents

This one is from a study showing decreased testosterone levels for over 24 hours after smoking. If a male uses 1-3 times a week, then his body is not receiving the needed level of testosterone for days at a time. Over time, this can cause ongoing problems and decreased muscle growth. Men look like men because of the regular introduction of testosterone – Regular being key!

http://www.ncbi.nlm.nih.gov/pubmed/6316036