• Knowledgebase: Questions about Drugs and Tobacco

    Questions about drug use, for adolescents and their parents.

    17. AAP: SUBSTANCE ABUSE: PROTECTING CHILDREN - Top

    SUBSTANCE ABUSE PREVENTION: PROTECTING CHILDREN FROM TOBACCO, ALCOHOL AND OTHER DRUGS
    Thank you for the opportunity to speak with you all today. I'm here to talk about a very important issue. It's an issue that I'm willing to bet has already affected everyone in this room in one way or another. We all know someone who can't quit smoking... or who drinks too much... or who has a problem with one drug or another. We all know that our children will have to make the choice whether or not to light up or drink up or shoot up. And we all want our kids to make the right choice... the choice to stay away from tobacco... alcohol... and other drugs.

    That's why we're all here today. To discuss ways to prevent our children from abusing these substances... and to discuss ways to help children who may have already made the wrong choice.

    I am here representing the American Academy of Pediatrics, an organization of 53-thousand pediatricians dedicated to the health, safety and well-being of infants, children, adolescents and young adults. The information I'm presenting here comes from the Academy unless otherwise noted. Funding from Procter & Gamble assisted the Academy in developing this presentation.

    We at the Academy feel that substance abuse is such an important issue... we've made it the subject of Child Health Month for three years in a row. During October of 1997... 1998.... and 1999 we hope to focus the country's attention on substance abuse prevention among children and young adults.


    · Substance abuse is a pediatric issue. Today I'll show you some statistics that illustrate that point.

    · Then we'll talk a bit about the different substances our children may be using.

    · We'll discuss why kids use drugs... and how the media may be influencing their behavior.

    · And... what we can do to prevent our children from smoking... drinking... or taking other drugs.

    By the way... since we are focusing on recreational substance use... I will not be talking about performance enhancing steroids. But I do want to mention that they are a concern... and if you have an athletic child... I encourage you to talk to your pediatrician about steroids.

    Now... you are here because you care about children. You want to know how to convince them to stay healthy. Let me begin to advise you by quoting the writer James Baldwin.

    He said:
    Children have never been very good at listening to their elders... but they have never failed to imitate them.

    It's estimated that one out of every five children grows up in a home where someone is abusing drugs or alcohol.

    Even if a parent is not addicted to cigarettes, alcohol... or other drugs... a child who sees a parent smoking, drinking or doing drugs is more likely to try those things for himself.

    If a parent truly wants to keep his or her child tobacco-free... drug-free... and alcohol-free... that parent should try to make the child's home life as free of those things as possible.

    That being said... let's take a look at some data showing how many young people are abusing substances today.

    I'll start off with cigarette use.

    · In this country, one-hundred thousand children under the age of 13 smoke. Tobacco presents a particular threat to children. It is not only a hazard to their health, but nicotine is the more addictive than any other drug, and tobacco use is associated with use of more serious substances... especially marijuana.

    We know smokers start young because we can ask today's adult smokers when they started.

    · Among adults who smoke... we know that the average age at which they started smoking is 12-and-a-half. Most were regular users by the age of 14. Virtually all adults who smoke started before age 19.

    Now let's look at today's young smokers. The statistics I'm going to show you come from a study called "Monitoring the Future." This annual survey of 50-thousand high school students is done by the University of Michigan.

    The survey shows that cigarette smoking among American kids has risen for the fifth year in a row. Researchers asked eighth-graders... tenth-graders... and twelfth-graders... if they'd smoked within the last thirty days. Here are the results.

    · 21-percent of eighth-graders had smoked.
    · 30-percent of tenth-graders smoked.
    · 34-percent of twelfth-graders smoked.
    These rates are high when you consider this: 25-percent of adults smoke cigarettes. So more kids are now smoking than adults. This same study shows that increases in smoking are taking place across the board. Boys and girls... kids bound for college and kids who are not.... kids in urban areas and rural areas... are lighting up.

    · Other research shows us that every day... 3-thousand children in the United States begin to use tobacco. About 40-percent of those children begin to experiment with cigarettes in grade school.

    Let's move on to illicit drug use. How many kids are using illegal drugs? Take a look at this:

    · 24-percent of eighth-graders report using any illicit drug in the last year.
    · 38-percent of tenth-graders report such drug use.
    · As do 40-percent of twelfth-graders. Nearly half of our high school seniors have used illegal drugs.

    The Monitoring the Future study says that marijuana use accounts for much of the increase in illicit drug use.

    · In 1991, six-percent of eighth-graders said they used pot over the past year. In 1996, that figure tripled... to 18-percent.

    · The percentage doubled among tenth-graders... from a low point of 15-percent in 1992... to 34-percent in 1996.

    · And among twelfth-graders... from 22-percent in 1992... to 36-percent in 1996.

    When we talk about daily marijuana use, the numbers look like this:

    · Nearly five percent of high school seniors uses marijuana every day.

    · Three-and-a-half percent of high school sophomores uses marijuana every day.

    · The number is much lower for eighth-graders... at one-point-five percent... but if even one eighth-grader smokes pot on a daily basis, we've got a problem.

    Now let's talk about alcohol. The Monitoring the Future study shows us that drinking among secondary students has gone up by about 3 percent over the past few years.
    Here's the situation when talking about students who have had five or more drinks in a row... during the previous two weeks. Five or more drinks in a row constitutes binge drinking... a dangerous practice with the sole purpose of getting drunk.

    · 16-percent of eighth-graders...
    · 25-percent of tenth-graders...
    · and 30-percent of twelfth-graders fit in to this category.

    These statistics show that alcohol is the most prevalent drug being abused by our children. Don't be lulled into a feeling of safety or familiarity just because alcohol is a legal substance... and one you may use yourself. Remember... it is illegal for children and teens to drink alcohol... and drinking can cost those children and teens their lives.

    These are just a few statistics to help me paint you a picture. It is a picture of our kids in trouble. I'll add a little color to the picture by talking more about the various substances our children may be introduced to... and about the effects those substances can have on children.

    (CIGARETTES)

    I've already talked about cigarettes, but allow me to reiterate why it is that we don't want kids smoking.

    · As you know, cigarettes are highly addictive.

    · Cigarette smoking is the leading cause of preventable death in this country. It is responsible for approximately 20-percent of all U.S. deaths each year.

    · Smoking can lead to lung cancer, which is the leading cause of cancer-related deaths in the United States.

    · And children who smoke don't have to wait to grow up to feel the effects. They face the same variety of respiratory problems as adults who smoke. That includes chronic airway irritation... cough... and lower respiratory tract infections.

    (ETS)

    By the way, kids who grow up around cigarette smoke suffer ill effects as well. Second-hand smoke, also known as Environmental Tobacco Smoke, or ETS, is related to more ear infections and bronchial infections in children.

    (SMOKELESS TOBACCO)

    Let's not forget smokeless tobacco. This term refers to chewing tobacco and snuff. A recent survey from the Centers for Disease Control and Prevention asked ninth-though-twelfth-graders if they had used smokeless tobacco in the last month. Eleven-percent of those teens said yes. Chewing tobacco is a form of leaf tobacco. Snuff is finely ground tobacco. In both cases... the user places the tobacco between his lip and gum. Children and teens tend to view this form of tobacco as less dangerous... and less addictive than cigarettes. This is despite the fact that smokeless tobacco is directly related to an increased risk of cancer of the mouth and throat... and the fact that the nicotine in smokeless tobacco... absorbed into the bloodstream... makes it just as addicting as cigarettes.

    (HUFFING)

    · Have you heard of the term, "huffing?" Huffing is another name for inhalant abuse. That's when a child inhales fumes from every-day products... products you may have in your homes already... such as cleaning solutions... hair spray... glue or gasoline. Sometimes kids will use spray paint. They spray it into a bag, close the bag around their faces... and breathe in.
    · This is popular among young people because they can buy products like spray paint with no questions asked. Or they can find such products at home. Think of all the household products that give off these kind of fumes... the fumes that make you and me run to the window and open it to get fresh air. Kids are using these fumes to get high.

    · And what does huffing do to a child? In rare cases, children have died instantly from what is known as Sudden Sniffing Death Syndrome.

    (MARIJUANA)

    Marijuana is also very common, as we discussed earlier. But it's not the same marijuana people used to smoke back in the 1960's... when John Lennon called pot a "harmless giggle." He may have been correct back then, but not any more.

    · A study by the National Institute of Drug Abuse shows that marijuana is nearly four times as potent today as it was in 1975.

    · That means the negative effects of marijuana could be four times as bad.

    · Short-term memory loss... lack of motivation... motor coordination loss. Kids are experiencing these ramifications more and more, because the pot is getting stronger and stronger.

    · And they may be smoking larger quantities if they follow the trends. Right now it is trendy to smoke a "blunt." A "blunt" is when you cut a cigar open length-wise, pull out most or all of the tobacco and replace the tobacco with pot. If you've seen the size of the average cigar then you know it takes a lot of marijuana to fill one. So, as I said, children today may be smoking stronger marijuana... in larger amounts... than kids did in years past.

    (ALCOHOL)

    · As the earlier statistics indicated... Alcohol continues to be the most common substance used by young people.

    · Along with the damage alcohol does to the liver over time... it poses immediate health threats to young people.

    · Excessive drinking can lead to alcohol poisoning... which can be fatal.

    · And let's not forget...the leading cause of death among Americans 15 to 24 years of age is alcohol-related motor vehicle injuries.

    Please... remember what I said earlier. Just because alcohol use is so common... doesn't mean it's not deadly.


    (COCAINE)

    Cocaine is not as prevalent as alcohol, but it is a concern... crack cocaine in particular. Cocaine can be snorted or injected... but crack... which is also known as freebase... is a smokeable, less expensive, and highly addictive version.

    · Smoking crack generates an instant and extremely intense euphoria... or "rush."

    · Crack is sold in very small rocks that cost as little as five-to-ten dollars each... making it financially accessible for teenagers.

    · The "high" doesn't last long though... so the user will often re-dose at frequent intervals.

    · The most common types of medical problems stemming from cocaine use are usually related to the method of drug use. Those who snort cocaine may experience sinus headaches, nasal congestion, nasal sores and nasal bleeding. Crack smokers may have chest congestion, wheezing and sore throat. Intravenous users may have abscesses at the injection sites, hepatitis, and of course, exposure to AIDS.

    (LSD)

    · LSD... also known as Acid... is slowly regaining some popularity among young people. The University of Michigan reports that high school seniors have the highest rate of use--- with nine-percent of seniors having used LSD in the last year.

    · LSD is a hallucinogen. The LSD solution is sprayed onto sheets of blotting paper. The paper is then dried and perforated... and sold in squares. The user swallows the drug... most often swallowing the paper as well.

    · One child told his pediatrician... "Taking acid is like turning on a TV set in my brain. I take acid in the morning... go to school... and watch that TV in my head all day long. No one knows the difference, but me." That's what he thinks.

    · The effects of LSD show up in the user's perception... thinking... emotion... arousal... and self-image. Nearly all users report altered visual perception such as heightened brightness of colors... and halo-like lights around objects. Shapes and sizes of objects are often distorted... and either blend into each other or seem to melt. This melting effect often results in terrifying illusions... such as the melting of a person's face. Such visions can cause panic attacks or reckless behavior. LSD can also cause severe depression leading to suicide attempts.

    · The immediate effects of Acid include dilating pupils... rapid heartbeat and gastric distress. The lasting effects of Acid can include flashbacks... which are a type of hallucination that occurs after the LSD has worn off. Most people who experience flashbacks have used Acid at least ten times. (Source: Schwartz, Richard H. LSD; Its Rise, Fall, and Renewed Popularity Among High School Students, Pediatric Clinics of North America, April 1995)

    (EPHEDRINE)

    · Ephedrine is a drug that is referred to as "street speed"... and is sold over-the-counter. But don't be fooled. That doesn't mean it's necessarily safe. Ephedrine is simply a form of speed, which can do damage to the heart over time. It is often used by teenage girls who are trying to lose weight. The federal government has recently limited the amount of ephedrine that can be used in over-the-counter doses. Regardless... as a pediatrician, I would not recommend that children use this product, no matter what the dose... and even though it is technically legal. The same thing goes for over-the-counter diet pills... decongestants... and caffeine pills. Children may be using these drugs to "catch a buzz."

    (CRYSTAL METHAMPHETAMINE)

    · Ephedrine is also the main ingredient in a drug called crystal methamphetamine. You may have heard news reports about this one recently. It's also known as "crank" and "ice." I also call it "super speed." It is the most potent psycho-stimulant ever... more potent than cocaine... and its high lasts longer. Its lasting negative effects include increased blood pressure. Over a long period of time, use of crystal meth can lead to a stroke.


    (HEROIN)


    · Heroin has come back into fashion in the last few years. This is the most addictive drug... second only to nicotine. The body needs more heroin each time to achieve the same original high. Some young people are injecting this drug into their veins... also known as "shooting up." Of course along with the dangers of heroin itself comes the danger of HIV infection... since needle-sharing is a major cause of HIV transmission. But most kids who use heroin choose to smoke or snort it. Heroin-users are at risk of gastrointestinal problems... and in females, heroin affects fertility. In overdose situations... heroin-users risk lung and heart failure... because the brain stops telling the body to breathe.

    (RITALIN)

    · If you have a child who has been diagnosed with Attention Deficit Disorder... and who is taking Ritalin... you may want to monitor that child carefully. Some children are crushing Ritalin and snorting it... or selling their prescribed drugs to others who snort it. In the crushed and snorted form, Ritalin is very potent and causes a kind of euphoria. Over time, the health effects of this kind of use are increased heart rate and blood pressure... which can lead to a stroke.

    (WHY KIDS USE DRUGS)

    Okay... we've talked about some of the substances children may be abusing. Now let's back up a step and talk about what leads a child to substance abuse in the first place.

    There are many different factors to consider... and not necessarily in this order:




    · Family history is important. Children of substance abusers are at high risk for substance abuse and other problems. We know that both genetic factors and family role models can have an effect.

    · Family attitudes and behavior also have an effect. As I mentioned earlier... even if a parent is not addicted to tobacco...alcohol... or other drugs... a child who sees a parent smoking, drinking or doing drugs is more likely to try those things for himself.

    · And a parent's role doesn't stop there. Studies show that parents who rarely discipline their kids and are very permissive with them... or parents who discipline their kids constantly but give them little praise... those parents are more likely to have children who have higher rates of substance abuse.

    · Children at the highest risk for substance abuse may be those whose families move around a lot... and must enter new schools and social systems. The peer groups most likely to welcome new arrivals... are the same groups who are willing to take risks. Those risks can include skipping school... sexual activity... body piercing... and substance abuse.

    Even if you don't move to a new place... your child's peers have a crucial role to play.

    · Children whose friends... siblings... or both... use alcohol and other drugs... are much more likely to use them than those whose peers do not. Think back to your own childhood. You did what your friends did. Your kids are most likely the same way. Having friends who are drug users is one of the strongest predictors of drug use. In fact... there is good evidence that friends are usually the ones to introduce kids to drugs and alcohol... rather than the stranger lurking in the shadows that we might imagine. This peer influence is especially strong in the pre-teen and early teen years. After that... older teens pick their friends according to the likings and dislikings they've already developed.

    Clearly every child is different... just as every adult is different. So let's look at some individual characteristics that may affect decisions to abuse substances.

    · Stress relief and the desire for relaxation may prompt substance abuse.

    · Differences in the values... attitudes... and aspirations of young people can influence their risk of drug abuse.

    · Children who fail in school for whatever reason... lack of ability... boredom... behavioral problems... or learning difficulties... are more likely to experiment with substances earlier... and to become regular users... than those who do not fail.
    · Adolescents who simply have a normal need to test limits and take risks may try cigarettes... alcohol... and other drugs...

    · Or children and teens may be modeling adult behavior they see around them or in the media.

    A child who exhibits the following may be susceptible to substance use and abuse:

    · Anti-social behavior...
    · strong rebellious feelings...
    · alienation...
    · lack of strong bonds to family... school... church... and other conventional social institutions...
    · lack of a sense of direction...
    · and low self-esteem.


    All children exhibit many of these characteristics at one time or another. But if a child shows these characteristics to a great extent and with great frequency... that child could be heading for trouble.

    (ADVICE FOR PARENTS)

    So, what can parents do to help a child escape from these risk factors? There is no short answer.

    · We do know that kids who have a desire for independence... and who want to achieve that independence through personal achievement... are pretty well protected from drug abuse. If they do choose to experiment with tobacco, alcohol or other drugs... they are likely to stop after experimentation.

    · Young people who know a lot about the medical... social... and legal consequences of drug abuse... and who care about their health and future tend to be less likely to experiment with drugs.

    · Positive family relationships also appear to discourage teens from getting into substance abuse. Parents can still provide authoritative discipline... but if they do so with warmth... and a willingness to discuss the rationale and consequences of behavior... their children tend to stay away from drugs.

    Now... you must keep in mind... your child is getting messages about substance abuse every day... from yet another outside influence. That outside influence is... the media.

    (MEDIA EDUCATION)

    Consider this:
    · The average American child views more than 23 hours of television per week (ages 2 through 11).
    · That means that by the time today's children reach age 70, they will have spent 7 to 10 years of their lives watching television.
    · Studies show that the average teenager watches up to two hours of music videos daily...
    · and listens to the music an average of 40 hours per week (ages 14 through 16).

    And not all of what they're watching is good for them.

    · The average child views 360-thousand TV commercials before graduating from high school, including 2-thousand beer and wine ads.

    Beer and wine ads. Videos showing people smoking cigarettes... drinking alcohol and doing drugs. Not to mention the TV shows... whose content is often based on substance abuse.

    Twenty hours a week adds up to a predominant influence on a child's life. The messages your child is getting during that time could influence him or her to take some dangerous chances. And what about the time spent listening to music or at the movies? Do you know what messages about substance abuse your child is getting during that time?

    So what can you do to combat the negative influence the media can have? Here's some advice for parents.

    · Seek out media education. That means you should understand and talk about what you and your child see and hear in the media, so those messages don't have undue or inappropriate influence on that child.

    · The AAP recommends that parents limit children's total media time to no more than 2 hours a day, and spend more time on other activities... like reading... sports.. and hobbies.
    · Parents and children should plan what programs they will watch ahead of time, not just turn on the TV and see "what's on ."

    · To help children resist commercials, parents should explain how advertising works.

    · If you are offended... or pleased... by programming you see... contact the TV station and let the management know why.

    · And finally... TV can play a positive role as well. You can use issues shown on TV as springboards to valuable discussions with your children about those issues.

    (CONCLUSION)

    The main point I'd like to make to parents today is... don't be afraid to talk to your children about substance abuse. Let them know it worries you... and why it worries you. This same advice holds true if you suspect your child may have a substance abuse problem. Communication is the first step.

    If you'd like more information about ways to approach the subject with your child... ask your pediatrician for guidance.

    If you suspect your child is abusing substances, your pediatrician can take what we call a drug history. He or she can sit down with your child and ask questions to determine whether or not your child is at risk or already on drugs.

    And of course... if you smoke, quit. If you can't quit, don't smoke in your home or around children. And if you or someone in the home is abusing other substances... get help to stop.


    Remember the words of James Baldwin...

    Children have never been very good at listening to their elders... but they have never failed to imitate them.

    Let's hope that when our children imitate us... they are imitating behavior that will lead to healthy, happy lives... free from tobacco... alcohol... and other drugs. - Updated: March 22, 2001

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    • James L Horwitz, MD

    David C. Thomas, MD

    Barbara Lindberg, PNP