Studies Give Clues About

 How

 Best to Reach Teens

By Daniel J. Glatt, M.D.

Trends come and trends go. However,  the continued experimentation and use of alcohol, tobacco, and other illicit drugs by our young people remains a real problem. Whether as a clinician or as a parent, many of us have witnessed firsthand the devastation and destruction that these can inflict on our patients and loved ones. Much frustration is generated when we cannot seem to help or “cure” those affected by alcohol, tobacco, or other illicit drugs.

How should we approach our teens and young adults about their (mis)adventures in experimentation? Should we present the “facts” about the dangers of drug use and abuse or should we “frame” the issue as a legal issue or a moral one? Although there may be no easy answer, especially in a 15-minute office visit, recent studies may help you focus your brief intervention with patients and their families.

In August 2005 The National Center on Addiction and Substance Abuse (CASA) at Columbia University reported that “teen perceptions of immorality, parental disapproval, and harm to health are far more powerful deterrents to teen smoking, drinking, and drug use than legal restrictions on the purchase of cigarettes and alcohol or the illegality of using drugs like marijuana, LSD, cocaine, and heroin.”

•   Teens who say their parents would be “a little upset” or “not upset at all” if they used marijuana are six times likelier to try marijuana than those whose parents would be “extremely upset.”

•   Teens who consider marijuana to be “not too harmful” or “not harmful at all” are eight times likelier to try marijuana than those who consider marijuana “very harmful” to the health of someone their age.

•   Most teens say that legal restrictions have no effect on their decision to smoke cigarettes (58 percent) or drink alcohol (54 percent), and nearly half say that illegality has no effect on their decision to use marijuana (48 percent) or LSD, cocaine, and heroin (46 percent).

 “Laws restricting smoking and drinking and making illegal the use of drugs like marijuana and cocaine play a significant role, but we must recognize that morality trumps illegality in deterring teen smoking, drinking, and drug use,” according to Joseph A. Califano, Jr., CASA’s chairman and president and former U.S. Secretary of Health, Education, and Welfare.

An additional survey outcome that offers some interesting consideration is the relationship between R-rated movie viewing and drug use. This year’s survey also found that 43 percent of 12 to 17 year olds see three or more R-rated movies each month either in theaters or on home video. These teens are seven times likelier to smoke cigarettes, six times likelier to try marijuana, and five times likelier to drink alcohol, compared with those who do not watch R-rated movies in a typical month.

The 2004 National Survey on Drug Use and Health (NSDUH) released on September 8, 2005, showed several encouraging and concerning trends. Although there was a  9 percent decline in illicit drug use among American youth between the ages of 12 and 17 from 2002 to 2004, the nonmedical use of prescription medications among young adults remained elevated.

While much is made of heroin use by the media and politicians, the increasing abuse of prescription opiates is alarming. According to the NSDUH, there are an estimated 166,000 current heroin users. Contrast this with the estimated 4.4 million current abusers of narcotic pain relievers. The lifetime prevalence of nonmedical use of narcotic pain relievers in the 18 to 25 age group is estimated at 24 percent.

In the 2004 NSDUH, 60.3 percent of youths aged 12 to 17 reported that they had talked at least once in the past year with at least one of their parents about the dangers of drug, tobacco, or alcohol use. Among youths who reported having had such conversations with their parents, rates of current alcohol and cigarette use and past year and lifetime use of alcohol, cigarettes, and illicit drugs were lower than among youths who did not report such conversations.

So, where does all this leave us? These two recent reports seem to suggest that interventions that enhance the interaction of parents and their young adults do make a difference. Getting young adult patients and their parents to talk about drug use and abuse may be a great challenge, but proves necessary and effective.

These issues are often difficult for many clinicians and patients to address because of stigma and the lack of a referral network for treatment options. As an internist, addiction medicine specialist, and parent, I encourage you to create a clinical environment that allows for your young adult patients to speak openly and honestly with you about their alcohol, tobacco, and drug use. Working together with our patients and their families, we, as clinicians, can make a difference.

There are excellent resources for clinicians, patients and their families regarding alcohol and drug treatment in San Mateo County. The San Mateo County Alcohol and Other Drug Services Help Line can be reached at 650-573-3950. Mills-Peninsula Health Services provides comprehensive alcohol and drug treatment services and referral information at 650-696-5909. Sequoia Alcohol and Drug Center information is at 650-364-5504. 

Dr. Glatt practices internal and addicition medicine in South San Franciscio.