Many of our children and young adults are taking psychoactive drugs. Parents are at a loss to know how to respond to this or how to talk to their children about this issue. That’s why the recent publication of a book entitled ‘How to talk to children about drugs’ is such a welcome arrival. The book called The Drug Conversation has been written, a Specialist in Mental Health. He is a Psychiatrist with over 20 years experience helping people with drug and alcohol problems. He is a father himself. He says he firmly believes that all parents need reliable information in order to support an effective conversation about drugs.
Drug use is common
Psychoactive drugs are chemical substances that alter the functioning of the brain causing changes in the way we think, feel and behave. All drugs can be divided into those that have psychoactive effects and those that don’t. Most drugs for example, medications like antibiotics are not psychoactive. Others that are psychoactive can be stimulating or sedating. They can cause hallucinations or produce an out of body state called dissociation. Some psychoactive drugs can cause more than one of these effects at the same time.
It is estimated that up to a 3rd of the population will have tried a psychoactive drug at some stage. In the past year up to one in twelve adults will have taken a psychoactive drug. About one in five of our young people will have taken a psychoactive drug in the past year. A quarter of children aged between the ages of 11 and 15 have been offered a drug although most refused to take it. Young people use more psychoactive drugs than any other age group and many in their mid teens. Cannabis is the most commonly used illegal psychoactive drug. This excludes the abuse of alcohol which is also a psychoactive drug and is very commonly abused.
So why do people take psychoactive drugs?
There are a number of reasons. People use psychoactive drugs to change the way they feel. Psychoactive drugs can result in new feelings that would be otherwise hard to experience but they can also take away feelings that are unwanted, unpleasant or distressing. Sometimes psychoactive drugs can be taken for social gain allowing people to feel a sense of belonging or identity with a peer group.
Adolescence is a period between the onset of puberty and the point in which adult roles are assumed. It involves rapid physical psychological and social changes. Profound changes take place in the mind and the body during adolescence. This is the time for the extension and development of major networks in the brain known as neuro-networks. These networks are constantly modified by new experiences. The adolescent brain develops in stages. One of the last areas to develop is the frontal lobe, the part of the brain responsible for decision making and assessing risk. Dr. Bowen-Jones makes the point “that just when the adolescent brain is at this delicate developmental phase, it is also most likely to be impulsive and drug use is also most likely”. Unfortunately drug use in adolescence disrupts brain development and this can lead to long term damage to brain function and unfortunately increase the risk of further drug use.
Information about drug use is poor
Many adolescence are surprisingly poorly informed about the substances they take, about their effects and about the harm that they can cause. People tend to believe the information they want to hear and adolescence tend to seek information about drugs from the internet or from friends or from dealers themselves. Accurate information however is available but young people and their parents often don’t know where to find it.
So how do we have the drug conversation with our children?
It’s a reasonable question. Some parents will think that there is no need to talk to their child about these. “After all this conversation is surely held at school”. However, the truth is that there is no consistent informed curriculum around drug use in schools and the matter cannot just be handed over to the schools. There have been attempts to unify the message about drug use but this is not currently the case. Therefore the parental conversation becomes all the more important. This is because parental influence matters a great deal. Even in adolescents where there may be conflict and a necessary degree of challenge between the adolescent and the adult, it turns out that the parents views really do matter and really do have an effect. In short it’s good to talk! The information that we can give will at the very least will modify or influence the choices our young people make.
So how do we have the conversation?
The first thing is to realise that it is a conversation and not a lecture. There is no really good time but probably it is better to have the conversation before a child is already exposed to drug use. The attitudes of young people to drug use change dramatically between the ages of 10 and 15. Younger children are very much opposed to drug use but by the time adolescence comes the attitude shifts quite substantially and the information unfortunately becomes more and more critical.
There are some practical dos and don’ts about having the drug conversation
Dr. Bowden-Jones makes these very clear. It’s important not to feel that it all has to be said in one conversation. It’s worthwhile trying to set the scene, to find the right moment, to make it clear that the conversation is not about blame. It’s worth trying to be consistent between both parents. Many parents may not be together but it’s important that both parents agree on the topic and have agreed on the importance of having this conversation.
It’s worth trying to be clear about what the conversation is about
Once again it’s a two way conversation rather than a lecture. It’s worth trying to be calm and to listen and not to accuse your child about drug use, but it’s important to be consistent. That’s why it’s so important for parents to agree on the messages they wish to give their child before they speak.
There is no value in interrogation of a child
Equally it’s important not to claim total ignorance or to pretend to know everything about this topic but you do want to give accurate information.
Obviously we can’t forget alcohol which is by far the most commonly used psychoactive drug. Many parents will feel more comfortable talking about alcohol, perhaps because they have greater knowledge and experience of it themselves. But the truth is that alcohol mixes dangerously with most psychoactive drugs and this is important information that your child needs to know. It’s worthwhile making time for plenty of questions and hopefully the dialogue opens up but you need to be prepared for tricky questions, perhaps about your own use or your own childhood. You need to consider carefully what you are going to say to your child as children are alarmingly good at spotting evasions. This is a good time to leave the door open for further conversation. It is worthwhile always finishing the conversation or each episode of it with some praise. This is difficult stuff for your children too and it is worth acknowledging that and praising your child for the ability to have an adult and responsible conversation about something that’s so important.
Dr. Bowden-Jones book gives very good examples of conversations that went well and conversations that didn’t. He summarises the position by saying “it’s best to decide when it is right to have the drug conversation with your child. Broadly speaking before they have been exposed to psychoactive substances is probably better than later”. It’s worthwhile preparing what you are going to say, ideally with the other parent in agreement and to set aside some time and to alert your child that there is some important things you need to talk to them about. It’s important to be calm and consistent and to begin with less personal questions such as ‘what have you learned in school about drugs, maybe we can talk about what you’ve heard elsewhere”. You tell your child where they can find accurate information rather than the sources they usually go to such as the internet or their friends. It’s worthwhile mentioning any history of drug problems in your own family and also to discuss alcohol and that history. A history of drug problems and of alcohol abuse in the family adds to the jeopardy which a child might experience if they are using psychoactive substances. Lastly, it’s worthwhile taking time for questions and giving praise and allowing some time for a return to the topic in a week or so.
Dr. Bowden –Jones goes on to explain the experience of psychoactive drug use and its effect on the psychological, social and physical wellbeing of our young people.
Unfortunately after using psychoactive drugs the brain needs time to recover. This is often experienced as a psychological crash or come down. If a drug is used regularly the desired effects become harder to achieve and this is a process called tolerance. Users often increase the amount of drug they take over time in an attempt to overcome tolerance. This increases the risk of drug related harm. Regular psychoactive drug users end up altering their brain functioning and sometimes permanently. This makes it harder to enjoy non-drug experiences and in time the world becomes joyless.
The key message is the psychoactive drug use causes physical, psychological and social harm. This harm can be due to factors related to the drug such as how it is used, or the amount taken or the length of its use. Harm can also be related to factors related to the person taking the drug. These include the genetic make-up of the person as well as their mental, physical and social health. In other words harm is a complex matter with many aspects to it.
Some people describe their use of psychoactive substances as a part of their recreation, even though this is potential risky and illegal. Unfortunately harmful use or dependant use is also common. Drug dependence results from faulty brain functioning caused by repeated exposure to the drug itself.
Psychoactive drugs can be divided into four broad groups according to their effects.
- Firstly there are stimulants. These drugs such as cocaine, amphetamines or ecstasy cause euphoria and increased alertness. Secondly there are sedatives such as cannabis or heroin. These tend to cause relaxation and a sense of calm. Thirdly there are hallucinogens. These are drugs that cause hallucinations and commonly they include LSD or magic mushrooms or synthetic hallucinogens such as those available in head shops. Lastly there are dissociative drugs, these are drugs which cause out of body experiences and common ones include ketamine and nitrous oxide or laughing gas.
Stimulants are very powerful and popular psychoactive drugs because they produce apparently desirable short term effects in the user. They make the user feel alert, euphoric and full of energy and briefly they can improve concentration and reduce fatigue. However they also cause both short and long term harm and they can be immediately life threatening. Stimulants are highly addictive and they can lead to dependence, withdrawal symptoms and marked tolerance. In other words they tend to create an effect where they need to take larger and larger amounts to achieve the same effect that dominates their use.
- Sedative drugs make the user feel calm, relaxed and serene. At higher doses the user can become disinhibited and lose physical coordination or control. Sedative drugs can be attractive for people who experience anxiety or those who have difficulty with their thoughts and feelings especially those that they want to suppress. Common sedative drugs include cannabis or heroin or benzodiazepines such as valium. Sedatives can be very dangerous in overdose, particularly those that slow breathing or when they are mixed with other sedatives. Repeated sedative use can lead to severe dependence.
A special word needs to be given to the topic of cannabis which is of course the world’s most commonly used illegal drug. This is made from the leaves and buds of the cannabis plant. Cannabis is usually smoked and the user experiences relaxation introspection and a change in perception of time. There may be uncontrollable laughter and only occasionally hallucinations. The main chemical causing the psychoactive effects in cannabis is called THC. Some types of cannabis have much higher quantities of THC than others and sometimes these are called ‘skunk’ forms. These forms are associated with particularly high levels of psychological risk. Cannabis related harm such as paranoia and psychosis is more likely with high THC content. Long term heavy use leads to a lack of motivation and to memory problems. Recently synthetic drugs mimicking cannabis effects have become available and these are generally much stronger than the natural elements and they also may be manufactured in ways which are very unclean and unregulated.
- Hallucinogens are powerful psychoactive drugs that make the brain misinterpret sensations or indeed experience sensations when there is nothing to actually experience in the environment. These drugs can cause confusion, disorientation and a loss of touch with reality. Experiences can be very intense and frightening. Users call these episodes bad trips. Hallucinogens don’t cause dependence but they can damage the brain once repeatedly used. More particularly accidental injury while intoxicated is the greatest risk.
- Dissociative drugs cause disorientation, disturbances of perception and trance-like feelings or out of body near death experiences and rarely hallucinations. Ketamine and nitrous are the most commonly misused dissociative drugs. Intoxication causes confusion and a loss of physical coordination which can lead to accidental injury. Long term use of Ketamine causes serious damage to the bladder and long term nitrous oxide use can cause memory causes and vitamin deficiency.
In recent years there has been a dramatic increase in synthetic products which are psychoactive. A huge number of synthetic psychoactive substances have been marketed with more than 500 new drugs detected worldwide since 2008. These drugs are designed and marketed to mimic the effects of traditional psychoactive agents such as cocaine or heroin or cannabis. The new drugs are typically cheaper and more powerful and cause more harm than the range of drugs they mimic. Online sites are used to promote and sell these newer drugs to younger audiences accustomed to the internet. These represent a new challenge to law enforcement for the sheer number of these new chemicals makes existing systems of regulation and health promotion difficult to keep up.
So how can you tell when your child is using drugs?
There are a number of ways. Firstly, they may actually tell you themselves, particularly if you are open to the conversation. Otherwise someone else may tell you, a concerned person who has noticed a deterioration in their function or their behaviour. You may see them intoxicated or see the after effects of drug use or you may find the drugs or their paraphernalia in their rooms. The key message is that detecting drug use in adolescence can be difficult as puberty and development through adolescence can mimic many of the physical and emotional warning signs of drug use itself. It’s important to be vigilant but don’t suggest to your child that he or she is using drugs unless you have very good reason to think so.
What do you do if you suspect your child is using drugs?
It is useful to talk to your partner or close friends and family and to try to act as a coherent team. Talk to others, the school and people who may know your child well. It’s worthwhile seeking professional help if that’s needed. Dr. Bowden-Jones suggests that professional help will be needed if your child is injecting or if you suspect they are injecting any drugs. Seek help if your child actually asks to speak to a professional or if there is the emergence of suicidal thinking or coexisting repeated self-harm such as cutting or burning. Obviously symptoms of psychosis such as intense paranoia, hearing voices, bizarre behaviour or odd beliefs would prompt the involvement of a professional.
Consider involving a professional if your child places themselves at risk through the emergence of promiscuity or driving while intoxicated. Physical violence actual or reported is also a concern but repeated mental health problems such as depression and anxiety may call your attention to actual drug use. A repeated pattern of harmful drug use on the background of a strong family history of addiction is also a worry. Parents who are unable to communicate with their children about what’s going on or who notice a rapid deterioration in academic, social or emotional functioning may also wisely seek professional help.
Lastly there is effective help and treatment for people who develop dependency or repeated harmful use. It is important to stay calm. While many of our children are offered a psychoactive substance, most refuse and most do not take these substances. A number do take them but even then dependency involves a minority. It is important to remain hopeful and positive about this important area. Ultimately the relationship you have with your child is important but the relationship you have with yourself is also important. There are few more stressful situations than seeing your child’s physical psychological or social health deteriorate and so it is important to look after yourself. Staying calm, finding out what the underlying problems are and getting help are important routes to recovery but it is important not to lose sight of the fact that wellbeing can be achieved. Better communication and understanding through accurate information are important bases for that recovery.
Much of this blog is taken from the recent excellent publication by Dr. Eoin Bowden-Jones of his book called The Drug Conversation.How to talk to your child about drugs. – Recently published by the Royal College of Psychiatrists Publications.
Prof Jim Lucey
Prof. Jim Lucey is Medical Director of St Patrick’s Mental Health Services, Dublin, since 2008, and Clinical Professor of Psychiatry at Trinity College Dublin. He has been working for more than 30 years with patients suffering from mental health problems. In addition to medical management, he maintains his clinical practice at St Patrick`s, where he specialises in the assessment, diagnosis and management of Obsessive Compulsive Disorder (OCD) and other anxiety disorders. He gives public lectures and is a regular broadcaster on mental health matters on RTÉ radio, featuring on ‘Today with Sean O’Rourke’.