The Hidden Ten Percent

This article by David Sheff was originally published on Medium.

Our Children’s Drug Problem and What Parents Can Do To Solve It

A mother writes:

My son ______ was addicted to prescription drugs. At twenty one he was introduced to heroin. Two years later heroin took his life…. I found him in the bathroom in respiratory arrest. I started CPR until the paramedics arrived and transported him to the hospital. He was on life support for five weeks. He passed away on 12/11/2010. Some days the pain is so unbearable that I don’t think I’ll make it.

A father told me about his daughter, “so smart and kind and loving.”

She was 20. For the last 4 years, she was using marijuana and drinking. Then she tried meth, and that’s when I lost her. She had begun college — an ivy league school. She had good friends who loved her. After her third rehab, she was clean for six months, but then she relapsed. This time someone gave her pills. She was at a park when they found her. I can hardly write these words. We lost our beautiful girl.

More letters arrive. And more. Attached to many e-mails are pictures. Or when I open envelopes that come in the mail, photographs fall out like petals falling off a flower that has died. Parents sending pictures of their children. Their beautiful boys and beautiful girls. And they are beautiful. Every one.

In my book Clean, I write about the pain parents endure. When we become parents, a primal instinct takes over to protect our children—and one of the most pervasive threats is drugs. Every parent I know worries about them. Most of them aren’t sure if there’s anything that can be done to prevent their children from using. Most don’t even know how to try. And many of us try, but fail, like me.

My eldest son, Nic, was a lovely child—smart, precocious, funny, and kind. As he grew up, I tried to protect him from using drugs. I talked to him, telling him cautionary stories, including one about a college friend of mine who died of an overdose. I educated him about drugs and resisting peer pressure.

He didn’t.

By the time Nic turned seventeen, he was addicted to methamphetamine. He went on to use every drug you can name. He almost died on multiple occasions. Nic survived, but so many children don’t. In America, we lose a child from drug overdose and addiction every four minutes.

I look back and think, What could I have done differently?

I think, If I knew then what I know now.

What do I know now? Here, in a summation of the research about effective addictive prevention that I report in Clean, is a guide that may help other parents and caregivers.

Know the risk factors for addiction

First, I’d know the risk factors that lead to addiction. When we understand that some kids are more likely to become addicted, we can pay closer attention and get help before drug use begins or escalates. Risk factors include:

  • The age of first use in childhood: Addiction almost always begins in childhood, because that’s when humans are physically and psychologically the most vulnerable. Children start using drugs precisely at the time that it’s most dangerous for them; from the time they are twelve until they reach 25, their brains are developing more than at any time other than at birth to age two. Research shows that the younger they are when they begin using, the higher the chance they’ll become addicted. Drugs cause changes to the developing neurological system that can become intractable. The evidence is irrefutable that drugs change the developing brain, sometimes irreversibly. They negatively impact kids’ ability to think and remember and can lower their IQ.
  • Learning disabilities, behavioral problems, and psychological disorders: Many studies have shown that kids whose brains are wired differently are vulnerable. At high risk are those with ADD or ADHD; psychological disorders such as depression, anxiety, or other mental-health issues; dyslexia or other learning disabilities; eating disorders, and kids who are isolated or overly aggressive or who have battered self-esteem.
  • Trauma: Early childhood trauma or trauma later in life, from physical or sexual abuse or even from parents’ divorce, have been shown to contribute to the likelihood that a child will use drugs and become addicted.
  • Stress: Some stress comes in the form of the day-to-day ennui and time-honored pressures that are especially pronounced during adolescence. Many teenagers feel defeated, confused, anxious, alienated, or just weird. They may feel inadequate and insecure—about friendships, their appearance, or sex. Kids face bullying and cyber-bullying. Some feel as if they’ll fail in life if they haven’t filled out their college résumés by the time they’re twelve. It’s much worse for many other children: those without parents or competent caretakers, the ones who are barely in school, and the many coping with abuse, poverty, and bleak and dangerous neighborhoods. It’s unsurprising that kids who struggle are more vulnerable to drug misuse.
  • Quality of parenting: Children in families with dysfunction are at high risk for addiction. The children of parents with untreated drug problems are in a particularly high-risk group. Parents’ ability to communicate with their children—to nurture and protect them—and their permissiveness play a significant role in kids’ relationships with drugs and alcohol as they mature. The kids of parents who sanction drug use and drinking — even if they’re advocating moderation or “safe” use — are in a high-risk group too.

I wish I had known more about the disease of addiction when my son Nic showed these warning signs, but I also wish I had known that while about one-tenth of our children become addicted, they don’t have to. It is not inevitable for any child, even one in a high-risk group.

Know how you can prevent addiction

Once we educate ourselves about the roots of addiction — why people use, and why some become addicted—we move forward on a new course, reversing the trajectory and prevalence of this disease. This is what else I learned: That parents can make a tremendous difference. Here’s what you can do to protect your kids:

  • Pay attention to your children. Parents are wired for denial—we can deny what’s in front of our eyes, thereby allowing problems to fester and build until they explode. Don’t ignore signs of depression, intense anxiety, anger that seems excessive, or dramatic mood swings. Pay attention if a child is isolated, struggling in school, or experiencing great stress in her life—a divorce or death of a loved one, for example. As a pediatrician told me, “If you think there’s a problem, there’s a problem.” If you’re uncertain, get help from teachers, counselors, therapists, or physicians. Parents may feel alone and isolated, but they don’t have to. Consult specialists before these problems lead a child to drugs.
  • Address family problems. Dysfunction in families can lead to drug use, but families can be fixed. If there are problems in your family, get help. Drinking or drug problems must be addressed. Seek help for anger problems or if there are arguments and persistent tension in the home. Be sure your children know they’re valued. Kids with low self-esteem are vulnerable. Parents influence the self-image of their children. Accept them for who they are, not what you want them to be. Parents can become better parents with couples counseling, family therapy, and programs such as Parent Effectiveness Training.
  • Talk to your kids. Educate yourself about drugs so you can educate your children. Don’t talk at them, talk with them. And don’t just talk—listen. It sounds easier than it is. It takes patience and practice and practicing patience. Various couples and family therapies or Parent Effectiveness Training can help with this too. You can’t do it all yourself. Insist that your child’s school educates students by using strategies that have been tested and shown to work. Just Say No, scare tactics, and the most popular program used in America’s schools, DARE, aren’t effective. In fact, DARE has been shown toincrease drug use because it normalizes it.
  • Teach your children well. Use facts, not exaggeration. Teach your kids about the impact of specific drugs on the brain. Stories and pIctures are worth a thousand words: I’ve witnessed kids who had rolled their eyes when they were told about the effect of drugs start to pay attention when they heard a compelling speaker with whom they related. They also responded when they saw scans (available on the Internet) of the brains of drug users’ compared with normal brains. Teach them what happens to kids who use—the toll on memory, IQ, and learning; the lower likelihood that drug users will achieve college degrees and their reduced earning power. Acknowledge that there are exceptions to these rules—retain your credibility by being honest—but make sure that they must know these risks. Finally, teach them practical strategies to help them safely negotiate situations in which they’ll be offered drugs and practice the way the strategies might be used. The Partnership At [] offers suggestions. Indeed, the Partnership website is an indispensable resource for parents.
  • Have dinner with your children. This may seem quixotic to many families. Yes, it’s hard—parents work long hours, they’re making a living, and they’re exhausted. But this applies to anyone who is raising a child. If you can’t have dinner together, find other consistent ways to spend time with your kids. Quality matters, but so does quantity. Your children need you there.
  • Take a strong stand. Parents’ values matter. You may think that your kids don’t care what you think or that you have no power to combat the other influences in their lives, but you have more influence on your children than does any other force in their lives. Some parents think a little use is okay as long as their kids use “responsibly.” Others tell their children that it’s all right to drink, but not to smoke pot. Some feel that a little pot in moderation is acceptable, but not hard drugs. Some tell kids it’s all right to use, as long as they don’t get in a car with a driver who’s high. But no matter what conditions you impose or rationalizations you make, you are sanctioning drug use and drinking. I’ve also heard quite a few parents say, “I’d rather have them get used to drinking now, so they learn moderation. Otherwise, when they go off to college, they’ll go wild.” In fact, this made sense to me, until I read the research. Postponing use is safer. There’s no evidence that kids who drink and use as teenagers will drink and use less than they otherwise would when they’re older. Again, the opposite is true: Almost every adult who has a drug problem started using as a teenager, whereas kids who haven’t used by the time they reach college age have more likely learned how to handle stress, modulate their behavior, and sustain relationships. As one doctor said, “Teenagers with drug problems will not be prepared for adult roles…. They will chronologically mature while remaining emotional adolescents.”
  • Help your kids find safe ways to be kids. Teenagers are naturally impulsive and drawn to pleasure—like toddlers. “Adolescent humans are supposed to taste and to experiment,” explains Steve Shoptaw, a psychologist and addiction specialist at UCLA. Curiosity drives both teenagers and toddlers to experiment and push boundaries in order to enter into a new phase of life. Sometimes their explorations are dangerous. A toddler may touch a hot stove. A teenager may try drugs. Rather than try to fight the teenage brain, work with it—help kids find safe and healthy ways to experiment, take risks, and feel exhilaration, through sports, engagement with the community, wilderness programs, the arts, or “healthy risk activities,” as Dr. Shoptaw describes them, things like motocross riding or rock climbing. Encourage their passions.

Know what to do if drug use begins

Research shows that parents can help protect their children, but for now, there are no guarantees. However, even if a child experiments or begins using more drugs or more-serious drugs, parents can effectively slow or stop use. In these situations, we must:

  • Intervene immediately. This a progressive problem: That means it often gets worse unless it’s treated. Remember that drug use doesn’t have to escalate to addiction for people to die or have irreparable damage. One-time use can cause accidents and fatal overdoses.
  • Rely on professionals. Consult with a psychologist or psychiatrist trained in addiction medicine, and have the child assessed. As a doctor has told me, “If you suspect that your kids are using, they’re probably using.” Rely on doctors who are trained to diagnose and treat drug problems. There are listings of such professionals and
  • Consider drug testing. There’s evidence that drug testing works as a deterrent, plus you’ll have more information that can help guide you. Some kids cheat drug tests—there are how-to guides online for how to pass them falsely. Most experts advise against parents on their own testing their kids. They say that drug tests instead should be administered by professionals.
  • Seek evidence-based treatment. If a child’s use escalates and an assessment indicates that treatment is required, find evidence-based treatment—that is, treatment that in clinical trials has been shown to work. Every child is different, and there’s no one-size-fits-all treatment. Some kids need dual-diagnosis treatment if there are co-occurring psychiatric disorders. To find appropriate treatment programs, rely on doctors trained in addiction medicine. Again, listings of doctors with this training can be found on the AAAP and ASAM websites. Don’t rely on the Internet alone. Don’t choose programs with harsh discipline—boot camps or tough-love programs. These programs have been shown to do more harm than good.

So there’s the good news. We can effectively prevent our children from becoming addicted, and treat them if they do. But there’s cautionary news, too. Even if we do everything right—and which parent does everything right?—our kids are vulnerable. We must do the best we can.

Here is something else I know, something I’ve learned from those parents who have lost their kids and who have written to me: We must never give up trying to save the life of a child.