Saturday, 29 July 2017

The importance of having the 'alcohol and other drug talk': One mother's plea for others not to wait until it is too late

I can't imagine what it must be like for a parent to get a phone call from a hospital saying that their teen has been brought into the emergency department after drinking too much or having taken an illicit drug of some kind. To get a call like this when your daughter is only 13-years-old must even be more confronting! A few weeks ago I was contacted by a mother (let's call her Maria) who had recently received such a call. She asked whether I would consider sharing her story with other parents in the hope that, in doing so, she could possibly prevent others from going through the nightmare her and her husband had experienced. To protect Maria's daughter and other people involved, we have changed the names and slightly altered some of the events ...

"Our 13-year-old daughter (Sophie) had just started Year 8. She has always had lots of friends, most of whom we know very well. We also know most of their parents, a few of whom we even socialize with at school functions and the like. She had never asked to go to any large parties but she has been regularly going to sleepovers at her friends' homes since primary school. We have seen you present at Sophie's school a couple of times and we do all the things that you recommend - talking to the host parents and taking her and picking her up - so we weren't at all prepared for what happened a couple of weeks ago."

"My husband (Brett) had taken her to a sleepover (hosted by parents we know well) and when he got home we were all prepared for a quiet night. I had texted her at about 9.00pm to say goodnight and promptly received a text back and thought all was fine. Just after 11.00pm I received a call from the mother hosting the sleepover (Jessie) to tell me that she had just called an ambulance for Sophie. At the time all I heard was the word 'ambulance' and everything else became a blur - I remember hearing something about alcohol and vodka but at the time it simply didn't register. Brett took the phone and I remember very little about the conversation he had with her and the subsequent trip to the hospital ... When we finally got to see our little girl, she was in a hospital bed on life support, connected to tubes and a drip and drained of all colour. I have little recollection of the next few hours but I now know that it was 'touch-and-go' for quite some time. Sophie and her friends had managed to get their hands on a bottle of vodka (we believe via an older sister of one of the girls). They had played a drinking game (at 13!) that they had seen on social media (at 13!) and Sophie had drunk almost a third of the bottle in less than 30 minutes!"

"At the time (and in the days after) I was so angry with Jessie and what had happened at her home but since learning what actually happened, I realize that she had done her best. The whole drinking episode lasted less than an hour. The sleepover was actually well organized and monitored (she hadn't just left them to their own devices - she had been 'actively supervising' as you call it). If Jessie hadn't have checked in and found her when she did (some of the other girls actually tried to hide her when she had passed out) and immediately called an ambulance, Sophie may not be with us today."

"Over the past weeks my husband and I have come to realize that we had let our daughter down by simply not having the 'alcohol talk' with her. We had always planned to at some stage but Sophie is not one of the more well-developed and mature girls in her year and we thought we had more time. She had given us no reason for us to believe that things were changing - there were no new friends, no change in behaviour - so we just kept thinking that we would wait. Can I say to anyone reading this, don't wait! Have the alcohol and other drug conversation as early as you can. We don't know whether having that talk would have prevented this terrible thing from happening to our family but it may have done and I wouldn't wish this experience on anyone ..."  

As I said to Maria, I have no idea whether having the 'alcohol talk' with her daughter would have stopped her participating in a drinking game at a sleepover, so I don't think that she and her husband should beat themselves up over this, but I do agree that every parent should have this conversation sooner rather than later!

Unfortunately, most parents make the decision to talk to their child about drugs when a crisis situation occurs. This 'crisis' can be as serious as finding out that their child may actually be using drugs or drinking alcohol or as simple as when their child is invited to a teenage party for the first time. Trying to have a discussion about alcohol and other drug use at a time like this is unlikely to be a positive experience for either you or your child. Your teenager will feel uncomfortable at best, and threatened at worst, by this issue being raised at this time. As a result, you are likely to feel frustrated and angry at their response, leading to greater friction and a breakdown in the parent-child relationship.

It is important to remember that it is impossible for any relationship to exist without positive communication. The most important thing to remember when it comes to talking about any difficult subject is that it's not a five-minute 'talk' — it's about building an ongoing dialogue. Of course, there will need to be an opening conversation and that can be difficult but once you've broken the ice it will get easier. As your children grow up, they will need more and more information, so start early and build on the conversation as your teenager matures.

There are lots of opportunities for parents to introduce the issue of alcohol and other drugs to their children. Rather than setting aside a specific time in the day to sit down with your child and raise the topic, thus making the whole experience like a school lesson, parents should look for opportunities in everyday life to talk about the issue. Here are just a couple of tips to consider to help start the conversation or ensure that it goes as smoothly as possible:
  • Start the conversation in the car. There's no better place to discuss a difficult issue than when it's just you and your teen (or pre-teen) in a car - they can't get away and they don't have to look at you!
  • Start by talking about their peers and what they're doing. Young people can get very defensive when you ask them about their behaviour but they're often more than happy to talk about others. It can even be easier if you talk about classmates and not their friendship group - they're much more likely to tell you about those kids that they don't particularly like and what they think about their behaviour
  • Use what you see in the media to start the conversation. Unlike the talk in the car, this is best done in a family context. News stories, movies and TV programs, even popular music can contain alcohol and other drug themes – asking a simple question about something you've just seen or heard while watching TV and getting their views on it can plant a seed that you can use at a later date
  • Use your own alcohol use as a conversation starter. If you drink wine with the family meal or you have a brown paper bag with a couple of bottles in it under your arm when you go out socialising, take the opportunity at that time to quickly discuss the role alcohol plays in your life and the rules you follow when you drink, e.g., you never drink and drive. Ask them what rules do they think they will have when they get older and they choose to drink. What rules do they think would be important?
  • Don't try to cover everything in one talk. The first couple of chats (possibly even grunts from their end!) may just be about trying to find out what they're thinking about the issue and their level of exposure. Setting rules and boundaries at this time could be problematic. You should certainly clarify your expectations around their behaviour in this area if it is appropriate to do so, but try to discuss your values in a more general sense rather than explicitly laying down rules at this time

You may not believe you have much of an influence over your teenager but your children are going to learn an awful lot about your attitudes and beliefs towards alcohol and drug use from these type of conversations. They may not always be easy but they'll be well worth the effort! One more thing to remember is that all the starter conversations (those mentioned above) should be relatively low-key and informal if they are to be successful, however, when it comes down to the 'let's talk about rules' discussion, both parents should be there, if at all possible, and it should be conducted in a reasonably formal manner (we're not talking 'judge and jury' here but sitting down together, no distractions or other children present). Of course this isn't always easy, particularly in a split family, but if it can be done it illustrates a united front and if there are any negotiations that are to be made, everybody is on the same page.

Maria and I have had a couple of conversations about what she believes she and her husband could or should have said to Sophie if they had actually had the 'talk'. She admits that the issue of underage drinking had never been raised (as she said, she didn't believe there was any need to - there were no obvious warning signs that she may be even considering experimenting) and acknowledges a simple discussion about the role alcohol played in their family would have been useful. Talking about your values and the use and misuse of alcohol, as well as your expectations about how they will deal with alcohol in the future is important. The one thing, however, that she really regrets raising with Sophie is 'outs' - helping her to develop simple strategies should she find herself in a situation where she feels pressured to take part in potentially risky activities.

One word of warning though …. if your child does not wish to enter the conversation for whatever reason, do not push. Talking about difficult subjects like this can be embarrassing for an adolescent and any effort to make them can actually be counterproductive. Do and say what you can and then back off, making sure you leave the door open for them to come to you should they ever wish to discuss the issue and move on. At some point another opportunity will arise (even if unfortunately it ends up being due to a crisis of some kind), take a step back and wait for another opportunity to arise when you are able to start a positive dialogue. It will happen!

Saturday, 22 July 2017

What does research tell us parents can do when it comes to alcohol and does 'one size fit all'? Does your child's temperament make a difference?

Regular readers of my blog may have noticed that I've been a bit quiet over the past couple of weeks. Unfortunately, it's not because I went on holiday or did anything particularly exciting, sadly I was bed-ridden with shingles! Wow it's painful and I've been told that the only way you really get over it was to have complete rest, so that's what I did ... well, almost! The one thing that I have been able to do is to catch up with some reading ... I had a couple of books I wanted to get finished and a whole pile of journal articles that I have had on my desk for a while. I thought I'd share a couple of things that I found really interesting.

Every parent wants their child to have a healthy attitude around alcohol, whether they choose to drink in the future or not. Unfortunately, many continue to believe that they can do little to influence their child's drinking behaviour, particularly during the adolescent years, however, the evidence continues to say that this is simply not true. So what can parents do and in really practical terms, what does the research say works?

Earlier this year an Australian study (Yap et al, 2017) was published that conducted a review of longitudinal studies that examined a range of parenting factors (that could be potentially influenced or modified) that were associated with adolescent alcohol initiation and levels of later use or misuse. What the researchers were attempting to do was to identify what behaviours are protective (i.e., what things can parents do to delay drinking and future problems with alcohol?) and what factors are more likely to lead to drinking at an earlier age and lead to issues as they got older (i.e., what should be avoided)? They identified 12 parenting factors, including the provision of alcohol; parental monitoring; rules about alcohol; parental discipline; and favourable attitudes towards alcohol use.
It's a really great piece of work (based on a review of 131 studies in this area) and once you get through all of the statistical analysis, the authors identify four protective factors that parents should attempt to increase and they are as follows:
  • parental monitoring
  • parent-child relationship quality
  • parental support
  • parental involvement
There are no real surprises here but the authors are very clear in the following statement - "... by being more aware of their adolescents' activities, whereabouts and friends, parents can help to protect their adolescents from later alcohol misuse". This supports the mantra that I have been spruiking for many years - if you want to prevent, or at the very least, delay early drinking or even illicit drug use - 'Know where your child is, know who they're with and know when they'll be home!' I get it that's not always easy, particularly as they get older and you want to give them more freedom as they become young adults, but when they're 14 or 15-years-old, it's a must. As I always say, start this early and it won't be so difficult in the later years ...

When it comes to risk factors, the authors highlighted three behaviours that parents should attempt to reduce or avoid. Once again, there were no real shocks, but some parents may find them a little unsettling, with the following being identified:
  • provision of alcohol
  • favourable attitudes towards alcohol use
  • parental alcohol use
The authors acknowledged that a recommendation that parents should not allow their children to drink underage or provide them alcohol at home or for parties is a controversial one, particularly within cultures where giving children a sip at a family meal is regarded as appropriate and protective. That said, they state "this review provided clear evidence to back up policies and recommendations against parental provision in cultures where tolerance of binge drinking is the norm". This is a very clear statement to Australian parents as the evidence is very clear in this country that we are a nation of 'binge drinkers'.

Now when good quality research comes out like this, with very clear recommendations about what parents should and shouldn't do, I'm sure there are some people who sit there and say "But I did all that stuff and it didn't work for me!" I certainly hear from many distraught parents from who believe they 'did absolutely everything right' but still find themselves with a teen who is totally out of control. They've either been arrested for drug offences, sneaking out of the house at all hours of the night and sometimes not returning for days, been hospitalised after a drinking binge and the list goes on and on ... So often, in the conversations I have with them they inevitably say "I don't know where it all went wrong, we have had no issues with our other children ..."

Why is it that what we knows works for most teens simply doesn't have the same effect on others? Of course, every teen is different but is there something about some young people that just makes them more resistant to rules, boundaries and consequences? A month or two ago I wrote about a wonderful book I had started to read written by Robert MacKenzie called Setting Limits with Your Strong-Willed Teen - it really is a great read and I thoroughly recommend it to any parent struggling with an adolescent who is 'pushing all their buttons'!

MacKenzie doesn't talk about 'rules' per se, rather he discusses 'limits' and 'limit setting'. According to the author, all teens test the limits being imposed on them, (i.e., when a parent asks their child to do something or change their behaviour) and they do this by conducting what he refers to as 'research' (i.e., trying to establish just how much the person means what they say). This is often referred to as 'pushing the boundaries' by other parenting experts and is used by teens to see just how far they can go without crossing the line. Now I think it is well understood that not all teens test limits in the same way, but what I found fascinating in this book is how it stressed that 'teen temperament' plays a vital role in this area.

Three types of teen temperament and how they respond to 'limit setting' are discussed:
  • compliant teens (around 55% of teens match this profile according to Mackenzie) – these teens don't push their parents too much as their underlying desire is to please and cooperate. They accept the information their parents or teachers provide them and usually don't require a lot of consequences to complete their 'research', therefore accepting the limits imposed on them without too much conflict
  • strong-willed teens (10% of teens) – these young people test frequently and they require regular revision of consequences before they are willing to accept parents' authority and follow rules. MacKenzie provides an example of a strong-willed teen called Daniel and describes him as follows - "To him, the word stop is just a theory or hypothesis. He's more interested in what will happen if he doesn't stop, and he knows how to find out. He continues to test ..." I'm sure there are many parents out there who can relate to a teen like that!
  • fence sitters (35% of teens) – this is a mixed group that can go either way depending upon the situation. These teens are more likely to co-operate when they encounter clear, firm limits. However, they will have no issue testing rules and authority when the limits are unclear or when they see others getting away with something. The author stresses that this group requires "generous helpings of consequences to complete their research"
I'm sure many parents reading this will relate to at least one of these 'types' and if you have more than one child, I can almost guarantee that you have at least one of them that fits into a different category than the others! What MacKenzie stresses is that when you set limits (or create rules) for a teen it is vital that you need to acknowledge the different temperament you are working with ... and if you are lucky enough to have a 'strong-willed' one, well, it's going to be a heck of a lot tougher!

I cannot recommend this book strongly enough, not only to parents but to anyone who works with young people. If you find yourself with a teen who is 'strong-willed' and is testing you at every turn, this book is a must! It provides practical advice on how to set limits, how to develop appropriate consequences and even how to deliver them in a way that will hopefully minimise conflict. 

Research continues to show that parents continue to have a powerful influence on their child's attitudes and behaviours around alcohol use, even during their adolescence. Effective and age-appropriate parental monitoring during the teen years has been proven time and time again to be protective and the provision of alcohol to teens is a risk factor and should be avoided ('delay, delay, delay' being the key). That said, when it comes to rules and boundaries (or 'limit setting') in this or any other area, every child is different and their temperament is going to affect how you parent ... It's not going to be as simple as the evidence seems to suggest ...

Identifying and acknowledging what type of teen you have (and that if you have more than one, they may all be very different) is the first step in applying what the research says to your family situation. For some teens, simply setting rules and monitoring them will be enough to keep them protected and will likely instil positive values and attitudes without too much effort. Unfortunately, for others, they will continue to push boundaries and test you over and over again to see just how far they can go. It's not going to be easy but hopefully it'll be worth it in the end!

References
MacKenzie, R.J. (2015). Setting Limits with Your Strong-Willed Teen. Harmony Books: New York.
Yap, M., Cheong, T., Zaravinos-Tsakos, F., Lubman, D., & Jorm, A. (2017). Modifiable parenting factors associated with adolescent alcohol misuse: a systematic review and meta-analysis of longitudinal studies. Addiction 112, 1142-1162.

Saturday, 15 July 2017

Schoolies: Should I be worried and should I try to stop them going?

Schoolies Week (or 'Leavers' as it is called in WA) has been around in one form or another for a long time. When I finished high school I can remember a range of things that some of my classmates did in the days or week following the last day of exams. We may not have travelled across the country or overseas, but there has always been some type of 'letting off of steam' at this time. These 'celebrations' undertaken once high school has finally ended (whatever form they may come in), have always been regarded as a distinct marker of the transition from childhood to adulthood. I hate the term but Schoolies' events are now regarded by many school leavers as a 'rite of passage' ...

One of the main reasons for this is the commercialisation of Schoolies Week, particularly over the past couple of decades. There is big money to be made here and there are plenty of people ready to take advantage of a group of young people with money to burn. There are a number of companies that deal only with Schoolies events and they promote these events very aggressively. You only need to watch MTV a couple of times to understand the increasing social pressure on young people leaving school to attend Schoolies Week celebrations in one form or another. Community and media interest has also grown and you can pretty well guarantee that every year crews of TV reporters will venture up to the Gold Coast (and other spots around the country) to try to capture the most sensational footage they possibly can. Without fail they usually manage to find some young people who agree to be interviewed on national television and talk about their alcohol (or even better, drug) fuelled week at Schoolies, thus reinforcing many parents' belief that it is an event that is out of control and one without any merit. Add social media (and some young people's stupidity) to the mix and you can certainly see why so many parents worry ...

Every year I get emails from both parents and young people on this topic. Teens asking for tips on how to convince their parents they should be able to go (to see my response to that question - have a quick look at my entry on my Real Deal on Drugs blog for young people), while others are from Mums and Dads (usually Mums!) who are absolutely terrified about letting their son or daughter go to the event, requesting advice on what they should do. They want their teen to have a great time with their friends at this important time in their lives, aware that they are young adults and they can't protect them forever, but are still very worried about what they've seen and heard about the Schoolies phenomenon.

One of the best things about all the attention is that the promoters of Schoolies' events have been forced to 'up the ante' in terms of organisation and must now do their very best to provide a safe environment as possible for the young people attending their event. But that can be difficult when the whole idea behind Schoolies is to give young people who have been studying for the past twelve years the opportunity to 'let off steam'. So what do we know about what happens at these events?

There have been a number of studies examining the Schoolies phenomenon and, sadly, their findings have only added to parental concern. A South Australian study of Schoolies attendees (Hutton et al, 2015) found that for many, alcohol was their major focus when it came to planning. They reported spending most of their preparation time deciding the type of alcohol they would consume, how they would purchase alcohol before attending the event and making sure they had suf´Čücient money to last across the days they were away. This is supported by other studies that looked at how much they drank when they were at the event. A WA study looking at 'Leavers 2009' on Rottnest Island (Lam et al 2014), found males drank an average of 18 standard drinks per day (that's the equivalent of just under a bottle of spirits) whilst away, and females consumed an average of 13! These are staggering numbers and not surprisingly, a large majority reported experiencing at least one adverse outcome such as hangover, vomiting, blackout, or unprotected sex ...

That said, over the years I have attended a number of Schoolies Week celebrations (I wrote a blog entry a couple of years ago about my wonderful experience at the SA 'Schoolies Festival' held in Victor Harbour - a great event put on by Encounter Youth), and although there are always incidents, usually linked to excessive alcohol consumption, most young people are well behaved and reasonably sensible. Saying that, it is important to remember why they are there – their intent is to let their hair down and that is exactly what they do, but the majority are pretty responsible and most importantly they all try to look after each other.

There is great social pressure on young people attending Schoolies to behave in a certain way. The media, in particular, does a great job of convincing young people that teenagers going to Schoolies will drink to excess and as a result, behave badly and this is the type of behaviour expected of them. Unfortunately, many of them try to live up to it (as you can see by the research findings) and find themselves failing badly.

It is important to remember that trying to prevent your son or daughter from attending this type of event could damage the relationship you have with them. Young people attending Schoolies are not in their early teens, they are usually very close to the legal drinking age or in some cases, have already turned 18 years of age. That is where many of the problems lie. If they have recently had their eighteenth birthday that can often mean that they want to celebrate in a big way and as a result their younger friends get carried along in the undertow. Young people wanting to attend these events are at the age where they are going to have make decisions on their own and trying to prevent them from doing so is not going to be helpful and will result in conflict.

Regardless of that, you are still the parent and you are still allowed to voice your concerns about what they are doing and the potential risks they may encounter. That part of being a parent is never going to stop and you wouldn't be doing your job if you didn't do it.

My advice is to take a moment and sit down with your child and talk through the concerns you have. Then after you have finished, give them the opportunity to let you know how they intend to deal with the potential problems you have raised. What many parents discover during conversations like this is that we have a generation of young people to be proud of, with many of them doing their very best to look after themselves and their friends. Young people of today definitely don't know it all, but they do try to reduce the risk of something going wrong the best way they can.

Most importantly, if they do go you need to make sure you repeat the same mantra that you should be saying to them every time they leave the house:

"You can call me anytime, anywhere. If something goes wrong and you need me – I'll be there"
Not surprisingly, there are many young people who decide to leave Schoolies' events early. They run out of money, the weather is bad and they find themselves stuck in a hotel room (or tent) for a couple of days, they get bored, or the event just simply doesn't live up to the hype. When I tell Year 12s to lower their expectations around Schoolies and say to them that some young people leave early, you can see that they don't believe me, but I get at least a couple of emails every year from teens who write and just say 'you were right!'
Discuss 'outs' with them. Let them know that you are willing to play the 'mean parent' so that they are able to 'save face' should they want to leave for any reason. If they should find themselves in a situation where they are not getting along with their friends (as much as many teens believe Schoolies will bring their group even closer together, it is surprising how many close friends are torn apart when they find themselves living together for four or five days!), or they have had a bad experience, they need to know that you will be there to bail them out if they need you ... Now, forking out the money for a quick airfare home from Byron Bay is not going to be cheap but if your child is suffering and you can do it, you need to ... That doesn't mean the money doesn't get paid back to you at some time in the future but when they make the call, you want them home ...
All parents want is for their teen to come home safely. Although many Schoolies are 18 and now legally an adult, they are still your child. Keeping a positive dialogue happening throughout the whole Schoolies' process, highlighting the potential risks and providing ways of reducing these without being judgemental, is most probably the best way to begin the next stage of your parent-child relationship.
If you are a parent of a Year 12 student who is going to a Schoolies' event, I have developed a Checklist for Students, as well as an Information for Parents fact sheet that may be helpful when it comes to planning and discussions. They are both available on the Schoolies' page on the DARTA website.
References:
Hutton, A.,Cusack, L., Zannettino, L., Shaefer, S., Verdonk, N., & Arbon, P. (2015). What are school leavers' priorities for festival preparation? Australian Journal of Primary Health 21, 249–253.
Lam, T., Liang, W., Chikritzhs, T., & Allsop, S. (2014). Alcohol and other drug use at school leavers' celebrations. Journal of Public Health 36, 408-416.