Dr. Ruth Peters TODAY contributor • Profile • E-mail

In the latest installment from "Today" show contributor Dr. Ruth Peters' book, “Laying Down the Law: The 25 Laws of Parenting to Keep Your Kids on Track, Out of Trouble, and (Pretty Much) Under Control,” she shares advice on keeping kids substance-free. Here's an excerpt:

Law # 8:
Have Zero Tolerance for Substance Use
Any substance use (drugs and/or alcohol) is substance abuse. No ifs, ands, or buts about it. It’s illegal, dangerous, addictive, and has absolutely no place in your family. Learn the signs and symptoms of use and how to keep your children substance free. If you don’t take a stand, how can they?

***

Notice that the title of this law is “have zero tolerance for substance use,” not abuse. What’s up with this? Well, after years of working with kids who get involved in smoking, swallowing, huffing, injecting, and snorting anything that they can get into, I’ve come to the conclusion that kid substance use is synonymous with kid substance abuse. Even though they may try to convince you otherwise, these young critters just don’t know when to call it quits, before it’s too late. I know, I know, when we were kids and could get our hands on some beer to drink or cigarettes to smoke, many of us indulged. But it just seemed different back then, and not only because it was our generation doing it. It really was different. Yes, cigarettes were easy to obtain — you could often buy them from a vending machine when an adult wasn’t looking. And sure, a dedicated lush could scrounge up a six pack in high school or a keg in college, but that took some planning, money, and plenty of moxie. Today, the drugs that our kids are exposed to are more toxic and addictive. Kids tell me about alcohol and drugs brought to school, stashed in book bags, pockets, or sneakers. I have several clients who smoke marijuana on an almost daily basis — they go to school stoned, sleep through many of their classes, and do a crash and burn in the afternoon, telling Mom that they’re tired from classes and need to take a nap.

And then there are the even scarier risk seekers, those who are looking for the latest in designer drugs — mostly pills, but also inhalants and liquids. These kids, knowingly or unintentionally, are risking brain damage through organic toxicity as well as disruption to their daily routines, schools, safety, and families.

Substance abuse counselors often view drug or alcohol dependency as falling within four progressive stages of development or severity.

1. Initial usage involves a minimal number of episodes (about five or less) and the usage hasn’t yet interfered significantly with daily functioning. The child still attends and participates in classes, is engaged in regular extracurricular activities, friendships, and family relationships. The tween or teen may view the substance as a way to gain acceptance into a social group, to alter feelings, or to deal with discomfort.

2. Problem usage involves using the substance on a more frequent basis. In addition, the child’s thought process moves from perceiving substance use as “a possible way of” to “the best way of” altering negative feelings or being accepted by others.

3. Psychological addiction is stage three. At this level the youngster is often very open about his drug usage and quite defiant about others’ attempts to help or to stop it. Kids begin to look forward to binges, to depend upon the “good” (although temporary) feelings associated with substance use, and often show an increased tolerance for their drug or alcohol of choice.

4. The most severe stage, that of physiological addiction, contains all of the symptoms and signs of stage three but the body chemistry has adapted to the drugs taken. Therefore, detoxification procedures must be cautiously implemented if physiological withdrawal is to occur.

What’s out there to worry about
Liquor is often the substance of choice for many of our young people. Although illegal to sell to anyone under the age of 21, a determined teen can usually find a way to secure some booze. Kids raid their parents’ liquor cabinets (lock ’em up, folks!), pay an adult to buy it from the local convenience or liquor store, or use false identification to buy from a store themselves. Beer, wine, and hard liquor can become addictive, and alcoholism is one of the top health as well as mental health problems in our culture. Alcohol addiction often leads to loss of motivation, DUIs, and other illegal involvement. Safety can be compromised, as are judgment and self-control. The disinhibiting effect of alcohol may feel good, but the behaviors and consequences that follow are a large price to pay for continued usage. Psychological and physiological dependency follow, and detoxification procedures may be necessary.

In addition to liquor and marijuana, it’s important for parents to become aware of other drugs of choice of our kids. The following is a primer of some of the more common substances used.

• Ecstasy (MDMA). This is a widely available drug (in pill form) often known as the “happy pill” as it makes people excited and euphoric. However, ecstasy may cause permanent brain damage by killing cells that release the neurotransmitter substance serotonin. Side effects can include increased heart rate, possible stroke or heart attack, seizure, or dehydration.
• Nitrous oxide (whipits). This is a favorite of the middle school set — mainly because it is easily obtained and “legal.” Nitrous oxide is a gas that is used in some aerosol sprays, such as cans of whipped cream and other foodstuffs. Dealers also sell it in balloons. The effects that it can have on the user are very similar to alcohol intoxication. Seizures or permanent brain damage can be caused by the depletion of oxygen to the brain.
• Dextromethorphan (DXM). Another favorite of the younger group as it is legally and readily available. This liquid is taken orally and is found in many cough suppressants, such as Robitussin. If taken in high doses, it can be a hallucinogen and cause coma or suppress breathing.
• Crystal methamphetamine (crank). This stimulant can be smoked, eaten, snorted up the nose, or injected in a vein. It causes the user to feel happy, increases energy, and can result in psychotic behavior.
• Heroin. This narcotic is highly addictive. Heroin is a relaxant and can cause a dangerously slow rate of breathing. This substance is used by injection, snorting, or smoking.

With all of the drugs available and their potential side effects, you would think that parents are on top of their child’s substance use. Sadly, though, many are not. Kids can be so sneaky that often substance use has to become a distinct problem before parents notice. Consider Chas, for instance. This kid was 14 years old, a decent student and part-time athlete. On paper he looked good — went to school most days, although he rarely seemed to have homework to do, was present and accounted for at the dinner table, and dressed in a preppy manner. The bad news was that Chas was a pothead. The kid could smoke two to three joints a day, every day, and still function, although at a decreased level. His grades had dropped since beginning high school, and his hustle at football was marginal. Chas just seemed mellow — not argumentative as his folks Charles and Nancy thought a druggie would be. You can imagine how surprised they were when their kid’s urine screen for his high school physical came back positive for cannabis (marijuana) as well as nicotine. The boy had been smoking dope and cigarettes for over 4 months without his parents suspecting anything.

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Well, once Chas was nailed, his folks brought him to my office at his pediatrician’s suggestion. He knew that the gig was up, and although he personally saw nothing wrong with smoking dope on a daily basis, he did admit that it probably was not such a hot idea since it freaked out his parents. He also acknowledged that his motivation for academics and athletics had decreased over the months and that he had to make some changes if he wanted to go to college.

Since he was already in such hot water, Chas told me of his frequent alcohol use — mostly beer when he could get it. He noted that he preferred marijuana to liquor — it was easier to get and more difficult for his parents to detect. In order to work on Chas’s addictions, he needed to stop using, and to do so immediately. I told the family that no substance use should be tolerated — I don’t believe in “social” or “recreational” use of substances for kids. You either say “no” to all drugs and alcohol or run the risk of the recreational user becoming a frequent flyer.

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