Saturday, 29 November 2014

5 simple things parents of primary school-aged children can do to help their kids make better choices around alcohol later in life

All parents want their children to have healthy attitudes towards alcohol. If their child does choose to drink when they are older, they want to do their very best to ensure that they drink responsibly and are as safe as possible. Too often parents wait until their child wants to try alcohol or be invited to a party where alcohol may be available before having a discussion about their expectations when it comes to teen drinking.

The earlier you start the discussion, the greater the chance you have of having a positive influence in this area. I wish I could get more parents of primary or lower secondary school-aged children to come to my Parent Information Evenings - it's a constant battle with many of them believing that it is not yet an issue and that they'll deal with that problem when it arises. In fact, parents of primary school-aged children, in particular, have a great opportunity to make a real impact in this area and if you put some effort in nice and early, there is a real possibility that you will not need to work quite as hard in the teen years. What you need to remember is that there are three basic principles that can lead to their child having a healthy and positive attitude towards alcohol, as well as ensuring they are a little safer if they do choose to drink:
  • Never underestimate the power of role modelling
  • Authoritative parenting, incorporating rules and consequences bound in unconditional love, reduces the risk of future risky drinking
  • Delay, delay, delay – try to delay your child’s first drink of alcohol for as long as possible

With these three things in mind, here are 5 practical things that parents of primary school-aged children can do to help them make better choices around alcohol when they get older: 

1. Occasionally decline a drink of alcohol
Such a simple thing to do but so powerful! If you are a non-drinker then you are already making a very strong statement about your views on alcohol (hopefully you're not making huge statements about the 'evils of drink' as that is most probably not the best idea!) but you are making it very clear to your child that you do not need to drink to socialise. If you do drink, however, a simple gesture of putting your hand over a glass when you are offered a drink at a family function says so much to your child - it shows them that you can say 'no' when you want to and that you can socialise with others without relying on alcohol. Make a big deal about this or do it begrudgingly, however, and it will have the opposite effect - children will very quickly pick up on actions that are not genuine.
2. Create rules around alcohol and parties as early as possible
If you make these rules before they want to drink or start being invited to parties where alcohol may be present you are going to make your life so easy in the future. Try to make a rule around a party the first time they get invited to one and you are highly likely to find yourself in all sorts of trouble! On the other hand, if you sit with your 12 year-old and talk about rules around alcohol (i.e., "alcohol is adult activity, you're not to drink!"), well before they've even thought about drinking, you're not going to meet nearly as much resistance. In fact, most 12 year-olds are going to be quite surprised that the discussion even came up but will most probably accept the rules without question. It is important to remember that rules around alcohol are not just for teenage parties, they need to be for all events - family functions (dinners and BBQs), special events (weddings, New Year's Eve) and the like.
3. Find family activities where alcohol is not involved
Sadly this can be one of the most difficult things to do for some parents ... alcohol is such a huge part of our culture and central to many activities we take part in but it is important for children to see that it is possible to have fun with families and friends and not drink alcohol. Of course, there are family excursions such as a visit to a museum or playing in the park where alcohol is highly unlikely to play a role, but trying to find activities involving socialising with other adults where your kids are present and not having alcohol being available can be hard - sometimes you just need to make your own rules in this area. Having a child's birthday party and not making alcohol available for the adults is a great idea, but unfortunately is not always popular. The same goes for a picnic in a park with friends - ask for it to be alcohol-free and there will be a lot of raised eyebrows ...
4. Identify a non-drinker in your family or friendship group
As already said, if you or your partner is a non-drinker then you are already doing some active role-modelling in this area. It's also important to acknowledge that if you drink responsibly, you're also practising some positive role modelling! If you do drink alcohol, however, finding and identifying a non-drinker in your family or friendship group can be extremely useful in exposing your child to the fact that 'non-drinking' is a real and valid option. There are three types of drinking - risky drinking, responsible drinking and non-drinking - we talk so much about the first two but rarely, if ever, acknowledge the third as a valid choice. It is important not to make a big deal about the fact that this person doesn't drink - they certainly shouldn't be presented as something 'special' - it's that different adults make different choices around lots of things, including alcohol, some people will drink, others won't - it's a personal choice and that's ok!

5. Decide on an 'out' word or phrase
Peer influence is starting at a younger and younger age and deciding on an 'out' word or phrase to help them get out of situations and still 'save face' can be extremely helpful, particularly if it's done nice and early. Ask your child if they have ever been in a situation with their friends which they found difficult or uncomfortable. Talk about peer and social pressure and maybe discuss some of the things that you do to help you through difficult situations. Let them know that everyone, even adults, need assistance in trying to deal with peer and social pressure. Between you, come up with an 'out' word or phrase that can be used in either a text message, a phone call or a conversation whenever he or she wants to be taken out of a situation. Let them know that you're happy to be the 'bad guy' and will take the blame at anytime to help them get out of situations they feel uncomfortable in.

Friday, 28 November 2014

Can you get addicted to a drug after just one try?

Over the last few weeks we have seen story after story on the 'ice epidemic' (now also referred to as the 'ice age'). Interestingly, the media has decided to focus on the young people angle lately – the Sun Herald telling the story of four Sydney teenagers who had all tried the drug by the time they were 14 years old and the Canberra media running a story on users as young as 12!  One of the most common grabs that I have heard from the ex-users (and current users) of the drug that they use in these stories is "I tried the drug once and I was hooked!" – it’s a great line and I just wanted to spend a little time to discuss if it is actually possible to get hooked or 'addicted' to a drug with just one try …
 
We have used the 'one try and you're hooked' line for many years - we've even seen it in government mass media campaigns, particularly around smoking (I tried to locate the original images from the Australian campaigns that ran in the 80s (or was it the 90s?) but could only find the UK versions, one of which I have included in this blog). It's a great scare tactic and can certainly be extremely effective. If you talk to many people who have never used illicit drugs, often one of the reasons behind their decision is that fear of possible addiction (i.e., it may chemically change their brain and/or body, or they may simply like it too much) and that could all lead straight to a path of living on the street and injecting drug use. But is it true?
 
Addiction can be defined in many ways but put simply it means that a large part of a person's life is devoted to buying and taking drugs. Some people believe that addiction is a disease and that once people are addicts they will always be addicts and this is the basis of the Alcoholics Anonymous (AA) model and the support system they offer people who have a problem with their drinking. The theory behind AA has led to many other organisations being formed including Narcotics Anonymous (Nar-Anon) and even Tweakers Anonymous (for people who have problems with ice or crystal). This sort of 'treatment' is not for everyone and it is important to remember that there are many people who can and do change their alcohol and other drug using behaviour throughout their life and do not necessarily subscribe to the 'addiction as a disease' model.
 
Saying somebody is drug dependent is much more 'politically correct' than calling them an 'addict'. Dependency is a strong compulsion to keep taking drugs. There are two types of dependency – physical and psychological. Physical dependency results from the repeated, heavy use of drugs, with some drugs having a much greater addictive potential than others (e.g., heroin). Heavy and continual use of these drugs can change the body chemistry so that if someone does not get a repeat dose they suffer physical withdrawal symptoms - the shakes, flu-like effects. They have to keep taking the drug just to stop themselves from feeling ill. This change in body chemistry does not happen overnight – it takes repeated use over a period of time (e.g., it has been estimated that it may take a young woman three weeks of casual smoking to become addicted to the nicotine in cigarettes) and the belief that one try of a drug (no matter how it is used - swallowed, smoked, snorted or injected) can somehow result in some form of physical dependence simply does not make sense.
 
Psychological dependency, however, is more common and can happen with any drug. In this case people get into the drug experience as a way of coping with the world or as a way of feeling OK. They feel they could not cope without drugs even though they may not be physically dependent. You can become psychologically dependent on just about anything. If any activity becomes more important to you than everything else - including family or friends – that is when you should become concerned.
 
Dependency will often include both physical and psychological factors. While the physical aspect will only be present with certain drugs, a psychological aspect will occur with any form of dependence. Continual use of drugs like ecstasy and LSD do not seem to result in physical dependency, even though people may become psychologically dependent (e.g., ecstasy users often believe that they cannot have a good time without taking the drug and may become anxious about not having the drug if they are going clubbing or the like). With other drugs – and particularly stimulant drugs such as cocaine, amphetamine and the nicotine in cigarettes – there continues to be debate over the extent that physical dependence can occur.
 
Let's make it very clear you won't become addicted to a drug you never try! That cannot be debated. People who don't use drugs never end up hooked or in the hospital or finding themselves with a criminal record after being caught in possession of illicit substances. It is true that every person who ends up with a drug problem, whether it be becoming dependent or addicted or other issues, had a 'first time' using the drug. Did they become 'hooked' that first time? That is highly unlikely, in fact, in terms of physical dependence (i.e., their body needs the drug), it is almost impossible. Did their first shot of heroin or their first puff of crystal give them a feeling or sensation that they wanted to experience again, possibly leading them to a path of physical or psychological dependence? That is much more likely …
 
I am not for one second belittling the beliefs of those people who have been interviewed for these media stories - it is obvious that for them ice has caused huge problems in their lives and it is their view that they became hooked after one try (whatever 'hooked' means to them). However, we need to be extremely careful that we don't start using these throwaway lines to try to explain a very complex issue.
 
Absolutely, ice is a nasty little drug that can cause great problems for those who use it - but maybe we should be looking at who exactly is using it and why, and who is experiencing the greatest problems with it? Dig a little bit deeper here and it's not as simple as a 'nasty little drug' - there is an underlying social issue here that we're most probably not dealing with particularly well ... There are of course exceptions (e.g., the gay community and to a lesser extent, the nightclub/dance scene culture), but increasingly the greatest problems we are seeing with ice are in regional communities, particularly amongst lower socio-economic groups (exactly the same groups that they saw in the US). Is there an issue that we're not dealing with there that contributes to ice being much more likely to take hold amongst those groups?
 
So to answer the question this blog entry poses - no, it is highly unlikely that you will be addicted to a drug after one try. If the user is experiencing a range of social issues, however, it is possible that that first shot or puff could appear to provide an 'easy' way of avoiding the day-to-day problems he or she may be experiencing and lead to a cycle of possible dependence.

Saturday, 22 November 2014

Why do we only talk about ecstasy after someone dies and is that effective in terms of prevention?

Over the years we have had a number of ecstasy-related deaths that made the headlines, some of which have stayed in the public consciousness ever since. Most of these involved young women from 'good' and loving families, each of which appeared to have their whole lives in front of them, but due to a fateful decision to take a pill in search of a good time their future was snatched away from them. There have been other ecstasy-related deaths, however, that did not make the headlines (or even get any media coverage at all in some cases), usually male and most often a little older (although there have been a small number of female ecstasy-related deaths that did not attract media attention) but for the most part, when someone dies after taking ecstasy it generates a huge amount of attention. In fact it is extremely rare to find ecstasy ever really attracting any media coverage unless someone dies - yes, we see law enforcement announcements of large drug busts and drug detection dog operations get picked up by media outlets but I cannot think of one time over the past 20 years when we have seen a story around 'what can we do about ecstasy?' unless prompted by a death ... 
 
Let's make it clear, I couldn't care less what an adult wishes to do in a nightclub or a dance event! Ecstasy use is illegal and if you want to take the risk of getting caught and you are totally aware of the harms associated with the drug, that's your business! My concern is the growing number of 15 and 16 year-olds who are writing to me asking me questions about their ecstasy use, some of whom are taking as many as five pills in a night and, not surprisingly, experiencing some significant problems with their drug use. Somehow our prevention measures in this area are not being heeded and it is about time we started to ask ourselves why ...
 
An ecstasy-related death is a rare occurrence, but it does happen. Fortunately, for the vast majority of people who use 'death' is not their reality. Most ecstasy users have a pleasurable effect, that's why they continue to use the drug, and very few people have had direct contact with someone who has died after taking it. This has resulted in the growing belief that ecstasy is harmless, or at least considerably less harmful than a range of other drugs (I have a great problem with how we continue to compare one drug with others in terms of harm - what may be extremely harmful to one person may not be as problematic for another - 'different drugs affect different people in different ways at different times').
 
When an ecstasy-related death occurs we inevitably get two polarised responses - one from those not involved in the culture who demand that authorities get 'tougher' (conservative columnist Miranda Devine's piece 'We are losing the war on drugs' clearly illustrates this viewpoint) and the other from ecstasy users themselves who try to find a simple explanation as to why the death occurred – usually pushing the point that it couldn't be due to MDMA (what users actually want in their pill), it must have been due to an adulterant of some description (all media outlets ran a story on the possible use of 'purple speaker' pills - interestingly the Daily Telegraph called them 'purple death')!
Of course we need to talk about death as a possible outcome of ecstasy use, but focussing on death alone (which essentially is what we're doing currently) and hoping that it is somehow going to act as a deterrent is not going to be effective for some – it's not the norm and not their experience for most and, as a result, they reject it! Don't get me wrong, for some (most probably those who would never use the drug anyway), talking about death is going to work brilliantly but for those who are already using, or exposed to friends who are taking the drug and are considering taking it, it's highly likely to be regarded as such an extreme outcome that it will be rejected.
 
I believe that the information we should be providing in drug prevention education should focus on what is 'most likely' to happen and be regarded by young people as 'credible'. When I talk about alcohol to school students I always begin my presentation by trying to 'win them over' by highlighting harms associated with alcohol use that they would have already experienced (either through their own drinking or watching or looking after others) - vomiting is my usually way in! Most of them totally relate to vomiting as a very real harm linked to drinking alcohol and once I have them on that, I can pretty well take them anywhere I want! I have gained their trust, they regard me as credible and they are then willing to listen to other information I need to give them ... we need to do the same with other drugs, particularly ecstasy.
 
As already said, we certainly need to acknowledge the deaths that have occurred. They are tragic stories and can be extremely powerful if used correctly, but let's remember that there are a range of other far more likely harms experienced by ecstasy users that should be discussed that may be regarded as more credible by some: 
  • feeling sick and vomiting - almost every ecstasy user will tell you that at some point they have taken a pill and become extremely nauseous, many actually vomit. Some users experience this over and over again, each time they take the drug and it is one of the most common reasons why people stop using
  • 'comedown' and depression (mental health impacts) - this is without doubt the number one reason why most users stop taking ecstasy and it always surprises me that we don't use this more in our prevention work around the drug. We have a generation of young people who are very conscious of their mental health and we need to do far more about having discussions around the significant impact that an ecstasy comedown can have on school/university, relationships and/or employment
  • legal implications – drug detection dogs, roadside drug testing, etc - ecstasy is an illegal drug and that isn't going to change anytime soon! Young people need to know the implications of getting caught with the drug, the difference between 'possession' and 'supply' and how new law enforcement strategies can impact upon their lives
 
It is difficult to say exactly how many ecstasy-related deaths have occurred in Australia over the years, but when you consider how many people take the drug each weekend, death is not a likely outcome. As already said, when a death is reported users often look for other excuses for the incident – i.e. it couldn't be ecstasy that caused it, it must have been other drugs or the person had a pre-existing condition. In many cases that is true – it is rare for a person to die due to ecstasy poisoning as MDMA (the substance people are actually after in a pill) is not a particularly toxic drug. However, poisonings have occurred (in growing numbers recently) and no matter how much people may want to believe that ecstasy did not cause the death the truth is if the person did not take the drug they would still be alive.
 
There has been lots of discussion around 'pill testing' (having facilities available for users to test pills before they use them to identify any potential adulterants that are particularly dangerous) since the young woman's death, with some believing that having such a program could have saved her life! I am totally supportive of any strategy that provides more information on what people are taking (I believe the best idea would be to have an 'early warning network' similar to the TEDI program in Europe, which certainly incorporates pill testing) but it is extremely na├»ve to believe that simply because you know what is in your pill (or at least you know some of what is in it) that means it is safe to take! Ecstasy (or MDMA), like any drug, can attack weaknesses in the user. There have been cases where seemingly perfectly healthy young people use the drug and experience fits, strokes and heart attacks. Many times these are people who have used the drug many times and have never had a bad experience. Put simply there seems to be no rhyme nor reason why these deaths occurred at that particular time. Of course, 'knowledge is power' but it does not inoculate you against all possible harms ...
 
Ecstasy is not going to go away ... although we do not have data to suggest that we are seeing growing numbers of school students taking the drug, in my experience, those who are using it are much younger, they are doing it regularly and most worryingly, they believe what they are doing is risk-free! We must look at what we are doing around ecstasy prevention, when we are delivering it (we can't do it too early as for most young people it is not yet part of their experience and would be meaningless) and how we can do it better ... Deaths are rare but they do happen and when they do it is an absolute tragedy but focussing solely on these as a deterrent to use is simply not going to work!

Saturday, 15 November 2014

Choosing to film a drunk or drug-affected person instead of helping them: Why would someone do that?

In an Opinion Piece published in News Ltd papers during the week titled ‘Does Georgina’s drug death prove we have become a city of impassive bystanders?’, Louise Roberts commented on disturbing reports that instead of seeking help for the young woman who died last weekend after attending a dance festival, a number of people opted to video the incident instead:

"... we have a new playmate in town. The passive bystander, armed not with a conscience but a smartphone, filming all that real-time grief and watching Bartter's last gasps for life through a screen. By witness accounts, at least five of these "sick and twisted" male strangers were calculating and disconnected beyond comprehension and in position to perfectly capture those ­terrible moments. At what point, in the ­microsecond it takes to act on instinct, does someone reach for a phone instead of reaching for the hand of someone dying at their feet?"

She goes onto explain the phenomenon as follows:

"In the 1960s US psychologist Bibb Latane and a colleague coined the term "bystander apathy" for a number of east coast crimes chilling not only for their ­depravity but for the casual insouciance of neighbours and onlookers. One incident ­focused on the reported murder of a bar manager who was stalked and knifed while 38 people — obviously whoever counted these audience members was also a bystander — looked on as if watching a soap opera. Latane said it was the "diffusion of responsibility effect", a warped subconscious agreement between peers that someone else will help or already has helped."

This is not a new issue - in 2000 I wrote a piece on an incident that I was involved with after working at a major dance event and then deciding to go a nightclub with friends:

I was in the bathroom and washing my hands and in the corner of my eye noticed a young man hunched up in the corner, barely conscious, sliding into the urinal. I walked over and tried to wake him. When I touched his shoulder he came around and instantly told me that he was fine. He was sweating profusely, slurring his words and by this time his hand was in the urinal trough. The toilet area was quite hot and he obviously needed to get some air. I tried to get him up but that was proving quite difficult as he was slipping in and out of consciousness. Finally I got him to the point where he was relatively lucid and walked him to the washbasins. He washed his hands, his knees occasionally buckling beneath him. By the way, did I say that there were about 12-15 people in the toilet at this time? The guy was almost sitting in the trough, he was obviously in trouble and no-one – not one person – came forward to give me a hand and lift this guy up off the floor and away from the urinal and out of the bathroom!

On reflection, maybe I should have just asked someone to give me a hand – I'm sure if push came to shove someone would have helped if requested. However, what would have happened if I hadn’t been there? How long had he been in that state with no-one even asking him if he was okay?  At the time I wrote the piece I commented that I hoped we hadn't got to the stage where we stop caring about people who are in trouble. I get it that no-one wants to have their night ruined by other peoples' alcohol and other drug choices but I know that if I was in a bad place I'd want someone to stop and check and see if I was okay. Wouldn't you?
 
Here are three other quick examples of stories that I have been told in the last couple of months by either parents or young people around the same issue:
  • parents answered the door at their daughter's 15th birthday party to find three girls all expecting to enter the house. Behind them lying next to the driveway was their extremely intoxicated friend who had fallen out of the taxi they had just arrived in. When asked about their friend the girls told the parents that she had got too drunk at the 'pre-party' and had almost thrown up in the cab, had embarrassed them and they now wanted to have nothing to do with her ...
  • a 16 year-old young man attending a party found an unconscious drunk guy he went to school with propped-up, hidden behind a tree at the back of the house. He found a couple of his friends and was told that they had warned him to not get too drunk this time as they had had enough of looking after him week after week - their nights being ruined by his drunkenness. They would pick him up at the end of the night and make sure he got home safely but they were not willing to look after him until then ...
  • after being tipped off by neighbours, a mum hosting a 16th birthday party found an unconscious girl around the side of her house, positioned by the garbage bins. She was later told by her daughter that she had been put there by her friends who were concerned that her drunken state would mean that they wouldn't be admitted into the house ...
To ignore people in trouble who you don't know is of concern enough (sadly we all do it, walking past that person in the street who asks for help) but when you hear of young people who don't look after their friends it is devastating! A study conducted by Macquarie University a number of years ago found that teens had almost an unwritten 'law' about looking after drunk friends - they were more than willing to help someone the first time they got into trouble, the second time was pushing it - but keep doing it and there's a breaking point! To have their night out affected over and over again was regarded as just not fair - as a result, some were just not willing to help a friend in trouble.

But Roberts added another dimension - the filming of the incident. I have now been involved with a couple of cases when young women have been sexually assaulted when they were drunk, not been aware of what happened due to their intoxication and only found out about it later when they were sent a video of the incident. You have no idea how completely destroyed these girls (and that's what they were - 15 year-old 'babies' who just didn't have the capacity to cope with this type of situation) were and it is difficult to imagine how they will ever recover from their terrible ordeal. The sexual assault is disturbing enough - but the fact that there was someone holding the smartphone and filming the crime is beyond belief!

There is so much about social media that I don't understand - I am from a completely different generation and the idea of photographing a drunk friend, videoing a sexual assault or the like and then sharing this with others is beyond me. I must say that I get a lot of young people who say they have videoed their friend when they have been intoxicated to show back to them when they have sobered up in an effort to get them to change their behaviour - sounds great in principle but I'm not sure that 'shaming' people in this way is necessarily effective and could be devastating should the video get into the wrong hands ...

Capturing every moment on film, good, bad or in between, is just what we do today. When it comes to filming people in trouble maybe it is the 'diffusion of responsibility effect', as Roberts described, and these people really do believe that someone else will help or already has helped. I hope so - wouldn't it be terrible if it wasn't and in fact, it was just that we have become so desensitized to these type of events that we have simply stopped caring? Drunk or drug-affected people can be scary, even if you're an adult, particularly if alcohol and other drugs are not really part of your world. At the very least, there is always the fear that you could get hurt in some way - I get that and putting yourself into danger to help others is not advised but if you do nothing else, all it really takes is to take a few steps back from the person, pull out a mobile and call 000. 

One of the key messages we push to our young people at every opportunity is 'look after your friends'. For the most part teens grab this message with both hand and run with it - they are always looking for new strategies to help them look after others effectively. I hope we don't lose that - however, I think we also need to make clear to them that if a friend is repeatedly getting into trouble (e.g., regularly getting drunk or getting 'messy' on drugs) and they are finding this too difficult to deal with, there are things they can do rather than just simply 'dump them on the side of the road and forget them'! Not only do we need to develop and give them messages on how to safely pass them onto others but also ensure that they know who to pass them onto and when.

As for filming drunk or drug-affected people, you only have to look at many 15-16 year-olds' Facebook pages to see that this is common practice for some. YouTube also provides thousands of videos of young (and not so young) intoxicated people, many of whom look as though they could be in real trouble. Does it desensitize young people to the real risks associated with intoxication? I'm sure it does but it is not going to go away so we need to quickly try to work out how best to deal with the issue ...

Monday, 10 November 2014

Why does an ecstasy pill cause the death of one person while others do not seem to be affected at all?

Almost every year at the beginning of the dance event season we see yet another senseless ecstasy- related death. This weekend a 19 year-old Sydney girl fell ill after reportedly taking one a half pills at the Harbourlife Festival. According to newspaper reports, by the time she arrived at St Vincent's Hospital she had already gone into cardiac arrest and died shortly after. As soon as I heard about the incident I not only thought about the tragic loss of a young life but also the devastating effect such an incident will have on her parents (who will through no fault of their own be thrust into the media spotlight, at a time when they need to grieve privately and try to deal with the tragedy), the rest of her family and her friends - I can't even begin to comprehend what they are currently going through and what is ahead in the next few days and the weeks and months ahead ...

I'm often asked by students why it is that when such a death occurs, why we don't see a whole pile of young people dying at the same event. There were apparently 5000 partygoers at the event on Saturday - you can bet that there were a reasonable proportion of those who had taken a drug of some description, some of them using exactly the same substances as the girl who died. Why did it go so terribly wrong for this one young woman? If it really is due to a 'bad batch' or the like, why don't more people die, or at the very least get very sick? Too often we try to look for simple answers to extremely complex problems. In the papers today, there is discussion that the young woman's death could possibly be due to the fact that she had allergies, once again, we're trying to find a simple reason or explanation for this incredibly sad event and this may not be possible.

Some of you may be aware that I have a blog for young people where I answer their questions called 'The Real Deal on Drugs'. I have taken one of these blog entries that tries to explain ecstasy-related deaths and included it below (with a few adaptions). The question I was asked was as follows:

Why would someone die after taking an ecstasy pill and the others in their group who took exactly the same pill not even get sick? If there is something poisonous in a batch of pills, why wouldn't everyone who took those pills get sick? Is it that there was something wrong with the person who died in the first place?

Here was my response:

Ecstasy deaths are unusual but they do happen and when they do they attract a great deal of media attention. When they happen the story is splashed over the front pages of newspapers and there is always a great deal of speculation about what could have caused the death. Often authorities talk about a 'bad batch' of ecstasy, i.e., that the drug could have contained some particularly dangerous substance, but this is not always based on any real evidence. Unfortunately, it can take a very long time to work out what caused the death and by the time the actual cause has been confirmed, the media has forgotten about the death and moved onto another story and the public never finds out what really happened.

There have been many high-profile cases where someone has died after taking a pill or capsule that appeared, on the face of it, to be exactly the same as the one their friends took, i.e., it was bought at the same time, from the same dealer, having a similar design, apparently coming from the same 'batch', and nothing happened to them. In many cases, their friends didn't even get sick. So why would different people have such different effects after taking what seems to be the same drug?

The most important thing to remember for anyone considering using any drug (legal, illegal or pharmaceutical), is that different drugs, affect different people in different ways. More importantly, each time a person uses any substance, they are likely to get a different effect. This effect depends on so many things, including where they take the drug, what they've eaten and even their mood or the time of the day they take it! It must also be remembered that ecstasy is not a safe drug - things can and do go wrong when people take it. Even if the user takes a pill that contains MDMA (the drug users want when they take ecstasy), this does not mean that it is safe - people have died from MDMA poisoning or overdose.

If we look at the information we have on ecstasy-related deaths, apart from those that are caused by poisoning, they can be the result of overheating (usually resulting in respiratory collapse), 'water intoxication' (water is retained, flooding to the brain) or heart failure.Why this may happen to some and not others is not always clear but in some cases they could certainly be the result of an undiagnosed medical condition. However, the death could also be due something as simple as a tragic set of circumstances and the user being 'unlucky'.

Certainly we can't ignore that some ecstasy deaths are caused by poisoning, whether that be due to MDMA itself or another particularly toxic substance that was in the pill or capsule.In Australia, as in other countries, we have had a number of ecstasy deaths that have been PMA-related. What is difficult to explain to ecstasy users is if PMA is so toxic, why don't more people die when a batch of PMA-adulterated ecstasy pills come onto the market? Pills are not manufactured in lots of 10 or 20. When people produce ecstasy, tens of thousands may be made at a time, so if PMA is in the mix there is a real good chance that it will be found in many, if not all of the batch. One explanation that some have put forward is that because ecstasy and other drugs are not manufactured to pharmaceutical standards there is the possibility that substances are not evenly distributed across all pills, i.e., there could be more PMA in some pills than others. Once again, however, many of these poisonings could possibly come down to individual difference (e.g., some unique reaction to a substance in the pill) or plain and simple 'bad luck'.

So there's no easy answer here. Ecstasy deaths are rare but they do happen and unfortunately they're not always simple to explain. But it's important to remember that using any illicit drug, including ecstasy, is a little like playing Russian Roulette - you never really know what you're taking and what effect you're going to get.

Friday, 7 November 2014

Giving parents permission to say 'no' (but reminding them to always look for opportunities where they can say 'yes')!

Last week I met the most wonderful mother after my Parent Information Evening ... as she approached me she had a big smile on her face but as she started to speak she burst into tears! In an effort to placate her I quickly told her that her crying was very quickly going to result in a similar response from me if she wasn't careful and she responded by laughing through her flood of tears and said "I'm not upset and nothing bad has happened, it's just that after hearing you I finally feel okay about saying 'no' to my daughter! It's just such a huge relief!"

Recently she had been facing great pressure from other parents to 'loosen up' and give her daughter a little more space. There was a party coming up and it was to be hosted by the same parents who had put on an event the previous year that had got out of hand and she did not want her daughter to attend. Unfortunately she had been convinced by others that to say 'no' and not let her 15 year-old go was tantamount to child abuse and, although it went against everything she felt was right, she was willing to follow the other parents. My talk had really resonated with this woman and she felt empowered to finally follow her heart and tell her daughter that she would not be attending - she just didn't feel comfortable letting her go!

A number of years ago there was a belief amongst some parenting experts that saying 'no' could somehow 'damage' a child. I remember going to an information session where the speaker presented some very dodgy research that suggested that saying 'no' could somehow stifle a child's creativity! If you're just going to say 'no' to everything and not explain why you're doing the things you do, of course that isn't going to be helpful, but the word 'no' is one of the most important words that a parent can use if it's used appropriately.

Parents need to remember the following rationale behind saying 'no', as well as be absolutely clear about what may happen next and how best to respond ...
  • adolescence is a time when young people work out where they fit in the world. It is also a time where they are more likely to take risks 
  • parents need to set limits for teens to push against, as well as to keep them safe as possible
  • 'no' provides limits and sets boundaries
  • you cannot control how your child feels about these limits or how they react to them so don't even bother to try
  • you are only able to control yourself and your behaviour
  • remember that the only reason you have rules is because you love them - make that clear and then walk away

No child likes being told that they can't do or have something they want. This gets worse when they become adolescents as in their minds they are now far more grown up and should be able to take part in adult activity that they observe all around them. Parties (or 'gatherings') are where they learn how to socialize and it is no surprise that some teens want to take part in this activity as most adults do, i.e., with alcohol. Most parents who have a problem with saying 'no' talk of their dread as to how their child may react, i.e., screaming, name-calling, throwing things or the like. Others just give up and end up saying 'yes' because of the constant badgering, with their teen following them around begging and pleading or cleverly setting up one parent against another.

As I have already said, just saying 'no' for the sake of it is just as damaging as letting your teen run off and do whatever they want. As Laurence Steinberg says in his book Age of Opportunity (everyone's going to get so sick and tired of me quoting that man!), parents should "gradually relinquish control and try to permit - rather than protect - when you can." Every opportunity you get to allow them to extend themselves a little, which you believe to be as safe as possible, and doesn't compromise your values and beliefs, grab it with both hands!

It's worth remembering that as far as alcohol and parties are concerned, there are a few certainties when it comes to saying 'no' to your teen - these are as follows:
  • they're not going to like it
  • you're in for a fight, or at the very least the 'cold shoulder' for a while
  • you will be accused of being the 'worst parent ever'
  • they're going to go behind your back and try to find someone else to say 'yes'
  • no matter what they say, they still love you!

And of course, there are going to be some teens who will just go off and try to do it anyway - that's where parental monitoring comes in! If they break the rules you have set, there have to be consequences.

Most teens who hear 'no' from their parents won't like it very much, will respond in an emotional way and, as a result, it won't be very pleasant around the house for a day or two. There are cases, however, where it gets much worse - adolescents running away to a party on a Saturday night and not returning home, physical violence and a range of other unacceptable behaviour. It is vital that parents understand that if this sort of behaviour occurs they must seek professional help as soon as they possibly can. Don't try to deal with this by yourself.