Drug Use and Abuse: Perspectives of A Teen User Part 1

Let me introduce you to Jane. She is the daughter of one of my best friends in the whole world. I met her when she was 13, a tall, quiet, polite girl, with shoulder length brown hair who played the trumpet and did her homework. At the time I interviewed her last year, she had matured into a curvaceous young woman with bright blonde dreadlocks hanging down her back. She has a pierced tongue and several tattoos, and artfully applies makeup to emphasize the otherworldly appeal of her beauty. She is still quiet and polite, but now she plays the Ukulele, and she has no homework. When I spoke with Jane last summer in her father's kitchen, I was still worried about her. I was worried that she had still not found her joy, still hadn't found the thing that would make her happy. I was worried she would end up like so many of her friends - dead of an overdose. I am happy to report my worries were groundless. Jane is now 19, and has moved away from her hometown and begun a new life with her boyfriend. She works with the most vulnerable of our population - the very young and the very old with much love and tenderness. I applaud her for leaving. For Jane, her hometown is toxic.

When I first started writing and podcasting about patient safety, I collected stories from the people I was closest to. From my friendship with Jane's mom, I knew most of the "trouble" Jane had gotten herself into over the years. Her mom told me about catching Jane smoking pot for the first time, and the subsequent years of escalating drug use, including the sneaking around, the lying, the stealing and the skipping school. Everyone who knew Jane was concerned about her safety. Her mom tried grounding her (she snuck out anyway), taking away her phone (she didn't care), and her car (a hardship on any parent for so many reasons - then they can't work, or help out with younger siblings or get groceries) - no solution was simple or easy and nothing seemed to work.

Jane started hanging out with people who were doing harder drugs, and heroin was suddenly on the scene. Kids were dying. Jane's mom asked her to go live at a wilderness-style boarding school and Jane agreed. For her junior year of high school, Jane lived in a cabin in the woods with other teens who needed to get away. They lived with no electricity, and learned to chop their own wood, and kill and prepare chickens for food. As soon as Jane was away from her hometown, her mom reported a remarkable change. Jane chose to stay the entire year and returned home with a new perspective on life. She was still using drugs, but she was also slowly figuring out how to do so in a way that would keep her alive. Jane eventually dropped out of high school and moved to the west coast. She got her GED within weeks and began working on a cooperative farm. While she was there, she met her boyfriend, and seemed to finally find some peace.

As I was thinking of Jane and her story, it struck me that we don't often get the perspective of teenagers on the topics of drugs. Perhaps we assume we already know what they think, or perhaps we imagine what they think isn't important in the face of the rules we have set out for them? Maybe we are afraid to ask, and they are afraid to answer. Maybe we don't want to know what they really think, and they don't trust us to listen without judgment or punitive action. As a mother of four, with my the oldest approaching 13, I am seeking help in understanding how kids start using drugs, how they end up dead from a dose of fentanyl laced heroin, and what I as a parent can do to promote the safety of our children.

Jane told me about her understanding of drugs and alcohol when she was 13:

"My opinions on things have changed drastically - when I was in sixth grade I had a friend who was three years older, and she posted a picture of herself on FaceBook smoking weed, and I showed it to my parents, and I was thinking more that 'it's bad for your health to smoke anything' versus the idea of drugs being 'wrong' or 'bad', but I definitely didn't want to do it. I was scared of smoking it. In middle school they show you all these videos of what happens when you smoke."

"The first time I ever saw weed, was the beginning of 7th grade. I was with this kid - we were running around the neighborhood, and we were talking about it and I was all like, 'I don't even know what weed looks like' and he was like, 'You wanna see something? This is weed right here.' I didn't smoke it for the first time until later."

"My family didn't really talk to me about drugs until they caught me smoking weed. They told me it can mess with your brain growth if you smoke it too early, and the main point of their discussion was 'wait till you're older', not condemning it, but just wait - it's not for a 13 year old. My mom was worried there was something I was trying to run away from. I have seen first hand the effects of pot on people, it can make you forgetful, but any kind of smoking is bad for you. When I think about brain development, I feel like smoking weed has led me to think in different ways, it has made me more creative."

These comments caused me to call into question what I know about marijuana and how I know it. I grew up in a house that had the "cool dad". I can't recall a time when there wasn'tpot in the house. My first serious boyfriend would come over and smoke with my dad and play guitar. What is interesting to me is that I never partook of it. I tried it once and decided I didn't like the loss of control that came with it. I didn't like how lazy and confused smoking weed made me. Alcohol was easier to control - I could decide how much to drink, it wore off relatively quickly, and I liked that it didn't put me to sleep. Alcohol just made everything more fun. I wasn't impressed with how my step-dad behaved while high all the time, but I also didn't have the attitude that "drugs are bad." Somewhere along the way I accepted as a scientific fact that marijuana is bad for developing brains, yet I couldn't tell Jane where I had gotten that information. Off to the Internet I went to confirm my assumptions with hard facts and figures.

As I said in the summary, this article is not a comprehensive overview of the pros and cons of pot smoking, so I will just give you a few articles that I thought had merit. One longitudinal study of over 1000 marijuana users showed a persistent neuropsychological decline from childhood to midlife¹. In another article, it was reported that, "The relationship between cannabis use by young people and psychosocial harm is likely to be multifaceted, which may explain the inconsistencies among studies. For example, some studies suggest that long-term deficits may be reversible and remain subtle rather than disabling once a person abstains from use." (McLeod, et al., 2004)². The NIH has an article that you should read if you want more info - I have provided the open access link to the article, "Adverse Health Effects of Marijuana Use (2014)³" and it does a decent job of discussing this topic in detail. It highlights all the evidence, and provides sound reasoning for why teens should NOT smoke POT. Preconceived notion CONFIRMED!

Kids have the same access to the Internet that we do, but what they often don't have is the ability to distinguish good research from propaganda. In addition, you may provide them with all the research in the world, and they may just do whatever they want to anyway, because that is what teenagers DO. Rebellion is what they are programmed to do - it's their Erikson's life stage (Ego Identity vs. Role Confusion...remember that NCLEX question?). These are good kids doing things that are bad for them. Jane was and IS a good kid. She is smart and funny and caring, and a decent human being. So what dowe do? The "just say no" thing isn't working, these kids are just too smart for that. Drug use is too complicated for black and white answers.

More from Jane,

"I was the person bringing weed into my friend groups - I was the bad influence. I introduced my friends to it. But I'm sure someone else would have if I hadn't."

"I got a lot of my information about weed from the internet. I don't remember what sites, and I probably chose websites that told me what I wanted to hear. I have read things that say marijuana stunts brain development, but I have also read positive stuff as well."

"In my home-town, the parents are so laid back. Most of them are fine with weed. There is always the 'cool mom', who says that as long as no one is driving, you can smoke here. A lot of my friends had parents that didn't really care. My parents did it right in my opinion - they were strict, but they weren't TOO strict. I still tell my parents everything."

"Kids aren't going to say anything to you if they know there will be a negative consequence immediately. There is a price to telling though, your parents will worry about you, and will start making decisions based on what you tell them. So it may be a mistake to tell them too much. They have given me consequences, I have been praised for being honest, and when I get that praise, I am more likely to do it again. But I did lie for a long time. I do think that stricter rules would have made it worse."

What Jane is describing is called "positive parenting", and it is very different from the old "tough love" stuff I grew up with (well, not in my OWN home, but it was the time of Nancy Reagan, and "just say no" was her slogan). The National Institute on Drug Abuse (NIDA) has a website on positive parenting⁴. Videos present positive and negative examples of key parenting skills. The five key questions to ask yourself are, 1) Can you communicate calmly and clearly with your teen? 2) Do you encourage positive behaviors in your teen on a daily basis? 3) Can you negotiate emotional conflicts and work towards a solution?, 4) Can you calmly set limits? 5) Do you monitor your teenager to assure they don't spend too much time alone with peers?

Reading over the NIDA website, and witnessing how Jane was parented through her teen years gives me hope that there are solutions. I don't think there is a one size fits all approach, or that this will work for everyone, but it's a start.

References:

1. 2012 longitudinal study of over 1000 participants shows neuropsychological decline from childhood to midlife: Persistent cannabis users show neuropsychological decline from childhood to midlife | PNAS

2. Macleod J, Oakes R, Copello A, et al. Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies. Lancet. 2004;363:1579-88.

3. Adverse Health Effects of Marijuana Use - NIH: 400 Bad Request

4. Family Check-up: Positive Parenting Prevents Drug Abuse: Family Checkup: Positive Parenting Prevents Drug Abuse | National Institute on Drug Abuse (NIDA)

5. link to podcast of interview: Safety Rules by Kristi Miller, RN, PhD, CPPS, HNB-BC on Apple Podcasts

OR Safety Rules | Listen via Stitcher Radio On Demand

6. Link to information about Rose Katiana - the young lady I am sending to nursing school:Rose Goes to Nursing School - Changing lives in Haiti | Volunteer & Service Projects - YouCaring