You have been discussing substance use for years with your child and they well know that you disapprove of their substance use and you hope they will abstain or delay use for as
long as possible and use moderately when they start. You've told them over and over again to never get in a car with a driver under the influence and you may have given them additional tips on safety.
But now your teen is older and has their driver's license, more freedom and they are handling it all pretty well. They are entering junior or senior year in high school or about to graduate and go onto college, get a job or travel the world. They've been going to parties and returning home safely in an Uber or with a designated driver. They aren't staggering in, falling down drunk or high as a kite. No visits to the emergency room or calls from the police!
This is a typical scenario with the majority of teens by the time they are older. Maybe they have been honest with you about their substance use. Or maybe you just know they are drinking and/or using marijuana or may soon be doing so. They are good and high functioning kids - attending school, getting decent grades, participating in extra-curricular activities, volunteering or working a job. They are not perfect, always considerate and loving to you, but they aren't completely slacking off or horrible to you either!
So what should your approach be, given that your efforts by necessity must move on from prevention and abstinence? Its called a "Harm Reduction" approach and it is one that is reality-
based, focused on reducing the harms from substance use. A harm reduction approach acknowledges that adolescence is a time of experimentation, exploration, curiosity and identity search, and part of such a quest involves some risk taking. This doesn't mean that substance use is a certainty and an inevitable right of passage. But it does recognize that by the time teens graduate from high school, the majority of them will have experimented or engage in somewhat regular substance use on weekends.
HARM REDUCTION MEASURES*
Continue to discourage substance use. Don't give up! Parents still shouldn't be condoning or giving their children permission to use, even if its clear the child is doing so. Continue to express your disapproval and your hope that they won't regularly use and misuse. Explain the health risks, e.g., while they may be older, their brain is far from being fully developed. By doing so, your child may curb and moderate their use.
Encourage moderation. At the same time, discuss the importance of moderation. Tell them that they don't want to be "that kid" - the one who is the drunkest, sloppiest, etc. at a party - or the one who gets transported to the ER. Warn them of the dangers of alcohol poisoning and drug overdoses.
Talk to your teen about drug dosage and release time. Just like Tylenol doesn't stop headaches immediately, every drug works on a different schedule. Just because someone is not showing symptoms of being high now doesn't mean what they've taken won't kick in later.
Tell your teen to "take it slow". Because drugs can take time to kick in, teens should go slow if they drink (by alternating alcoholic drinks with water or another non-alcoholic beverage) or use drugs (wait at least 90 minutes to see the effects). According to Harm reduction expert Patty Denning, Ph.D., a good rule of thumb to reduce the risks of alcohol or other drug use is to "keep the dose low, and take it slow, until you know".
Stress safety above all else. Discuss specific measures they need to always be taking to stay safe.
Never drive or be driven by someone who is under the influence. This big one is obvious and something the vast majority of parents discuss with their children. Never drive after drinking ("even one sip") or taking any drugs ("even one hit") or ride with anyone who has. Make this a non-negotiable rule and be prepared to offer your child a non-judgmental "no questions asked" ride home if needed. Read our Blog about Driving Under the Influence of Cannabis, which many teens think of as safe. This is underscored by the fact that the most recent (2018-19) California Healthy Kids Survey results shows that a concerning 31% of Marin 11th graders report having driven a car after using drugs or been in a car with a friend who has used.
Have your teen understand the dangers of mixing drugs. According to Dr. Denning, "the more different drugs you put into your body at the same time, the more likely you are to get into trouble'.
Mixing substances can sometimes produce a different, and/or more powerful effect than you'd expect. Most opioid-related overdoses, for example, involve at least one other drug (like alcohol or benzodiazepines, which dramatically increase the risk of fatal respiratory depression when mixed with opioids.) So remember, when it comes to mixing alcohol and other drugs, 2 + 2 = 5!
Explain to your teen that they won't always know the contents of something they're given. Its important never to leave a drink unattended or take one from someone they don't know. Similarly, many illicit drugs can be cut with other dangerous substances such as Fentanyl, which has resulted in recent deaths in our communities. A drug checking kit can give a better idea of what's in something, but is not always completely reliable.
Discuss prescription drugs. These drugs are not necessarily "safer", and should only be taken according to a doctor's orders and only by the person they are prescribed to. Everyone reacts to substances differently, and someone's prescribed dose may have been calibrated based on a tolerance they have built up, or a certain chemical imbalance they have. As with illegal drugs, teens using prescription drugs should pay careful attention to dosage and the time it takes the substance to take effect.
Encourage your teen to use the buddy system. Teens should never abandon intoxicated friends, let them wander away, or let them pass out on their back. Help your teen prepare a plan in the case of an emergency, such as alcohol poisoning or overdose. Learn about your state's "Good Samaritan" laws, which can protect people from legal repercussions of alcohol or other drug possession when they call 911 to report an overdose or alcohol poisoning. Read our blog on "When to call 911 and "Good Samaritan Laws" which discuss those laws in California and Colorado.
Talk to your teen about drugs and sex. Explain to your teen that alcohol and other drugs can cloud people's judgement about sex. It can make people unsure if they want to say yes or if their partner is consenting. It also increases the chances that teens will have unprotected sex, putting them at risk for STIs/STDs and pregnancy. Educating teens about the importance of "consent" and the rules in effect on particular college campus is critical.
* This description of harm reduction measures is adapted from an article from the Drug Policy Alliance, which was reviewed by psychiatrist and author Julie Holland, MD and harm reduction expert Patty Denning contributed to it as well. BTI has provided additional content.
Seek Professional Help if Needed. Learn about the signs your child is in trouble and the self-tests for addiction. If professional help is needed, It is critical to find someone with specific experience in substance use and addiction. This can include a psychiatrist, therapist or Phd. Schedule a consultation or assessment with more than one professional to determine who your family, and most importantly your child, is most likely to trust and develop a rapport with. There are many approaches to dealing with problem use or addiction and one size does not fit all, Help may come in the form of group or individual therapy, support groups such as AA, intensive outpatient programs, residential treatment centers or wilderness programs. Early intervention is always best, especially while your child is still a minor and you have leverage. More on that in a blog coming soon!