Tag Archives: Substance Abuse

Purdue University study: Alcoholism in the family affects how your brain switches between active and resting states

24 Feb

Substance abuse is a serious problem for many young people. The Centers for Disease Control provide statistics about underage drinking in the Fact Sheet: Underage Drinking:

Underage Drinking

Alcohol use by persons under age 21 years is a major public health problem.1 Alcohol is the most commonly used and abused drug among youth in the United States, more than tobacco and illicit drugs. Although drinking by persons under the age of 21 is illegal, people aged 12 to 20 years drink 11% of all alcohol consumed in the United States.2 More than 90% of this alcohol is consumed in the form of binge drinks.2 On average, underage drinkers consume more drinks per drinking occasion than adult drinkers.3 In 2008, there were approximately 190,000 emergency rooms visits by persons under age 21 for injuries and other conditions linked to alcohol.4
Drinking Levels among Youth
The 2009 Youth Risk Behavior Survey5 found that among high school students, during the past 30 days
• 42% drank some amount of alcohol.
• 24% binge drank.
• 10% drove after drinking alcohol.
• 28% rode with a driver who had been drinking alcohol.
Other national surveys indicate
• In 2008 the National Survey on Drug Use and Health reported that 28% of youth aged 12 to 20 years drink alcohol and 19% reported binge drinking.6
• In 2009, the Monitoring the Future Survey reported that 37% of 8th graders and 72% of 12th graders had tried alcohol, and 15% of 8th graders and 44% of 12th graders drank during the past month.7
Consequences of Underage Drinking
Youth who drink alcohol1, 3, 8 are more likely to experience
• School problems, such as higher absence and poor or failing grades.
• Social problems, such as fighting and lack of participation in youth activities.
• Legal problems, such as arrest for driving or physically hurting someone while drunk.
• Physical problems, such as hangovers or illnesses.
• Unwanted, unplanned, and unprotected sexual activity.
• Disruption of normal growth and sexual development.
• Physical and sexual assault.
• Higher risk for suicide and homicide.
• Alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning.
• Memory problems.
• Abuse of other drugs.
• Changes in brain development that may have life-long effects.
• Death from alcohol poisoning.
In general, the risk of youth experiencing these problems is greater for those who binge drink than for those who do not binge drink.8
Youth who start drinking before age 15 years are five times more likely to develop alcohol dependence or abuse later in life than those who begin drinking at or after age 21 years.9, 10                                                                                             http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm

See, Alcohol Use Among Adolescents and Young Adults http://pubs.niaaa.nih.gov/publications/arh27-1/79-86.htm

https://drwilda.wordpress.com/2012/03/26/seattle-childrens-institute-study-supportive-middle-school-teachers-affect-a-kids-alcohol-use/

See,      https://drwilda.com/tag/alcohol-abuse/
https://drwilda.com/tag/alcoholism-clinical-and-experimental-research/
https://drwilda.com/tag/substance-abuse/
https://drwilda.com/tag/alcohol-and-children/

A Purdue University study found alcoholism affects those who may not be alcoholics.

Science Daily reported in Alcoholism in the family affects how your brain switches between active and resting states:

You don’t have to be a drinker for your brain to be affected by alcoholism.
A new study shows that just having a parent with an alcohol use disorder affects how your brain transitions between active and resting states — regardless of your own drinking habits.
The study, performed by researchers at Purdue University and the Indiana University School of Medicine, discovered that the brain reconfigures itself between completing a mentally demanding task and resting.
But for the brain of someone with a family history of an alcohol use disorder, this reconfiguration doesn’t happen.
While the missing transition doesn’t seem to affect how well a person performs the mentally demanding task itself, it might be related to larger scale brain functions that give rise to behaviors associated with addiction. In particular, study subjects without this brain process demonstrated greater impatience in waiting for rewards, a behavior associated with addiction.
Findings are published in the journal NeuroImage. The work was led by Enrico Amico, a former Purdue postdoctoral researcher who is now a researcher at EPFL in Lausanne, Switzerland.
How the brain reconfigures between active and resting states is like how a computer closes down a program after you’re finished with it.
“The moment you close a program, a computer has to remove it from memory, reorganize the cache and maybe clear out some temporary files. This helps the computer to prepare for the next task,” said Joaquín Goñi, a Purdue assistant professor in the School of Industrial Engineering and the Weldon School of Biomedical Engineering.
“In a similar way, we’ve found that this reconfiguration process in the human brain is associated with finishing a task and getting ready for what’s next.” Goñi’s research group, the CONNplexity Lab, takes a computational approach to neuroscience and cognitive science.
Past research has shown that a family history of alcoholism affects a person’s brain anatomy and physiology, but most studies have looked at this effect only in separate active and quiet resting states rather than the transition between them.
“A lot of what brains do is switch between different tasks and states. We suspected that this task switching might be somewhat lower in people with a family history of alcoholism,” said David Kareken, a professor of neurology at the Indiana University School of Medicine and director of the Indiana Alcohol Research Center.
The study defined a “family history of alcoholism” as someone with a parent who had enough symptoms to constitute an alcohol use disorder. About half of the 54 study participants had this history.
Researchers at Indiana University measured the brain activity of subjects with an MRI scanner as they completed a mentally demanding task on a computer. The task required them to unpredictably hold back from pressing a left or right key. After completing the task, the subjects rested while watching a fixed point on the screen…. https://www.sciencedaily.com/releases/2020/02/200210133222.htm

Citation:

Alcoholism in the family affects how your brain switches between active and resting states
Date: February 10, 2020
Source: Purdue University
Summary:
A new study shows that just having a parent with an alcohol use disorder affects how your brain transitions between active and resting states — regardless of your own drinking habits.

Journal Reference:
Enrico Amico, Mario Dzemidzic, Brandon G. Oberlin, Claire R. Carron, Jaroslaw Harezlak, Joaquín Goñi, David A. Kareken. The disengaging brain: Dynamic transitions from cognitive engagement and alcoholism risk. NeuroImage, 2020; 209: 116515 DOI: 10.1016/j.neuroimage.2020.116515

Here is the press release from Purdue University:

February 10, 2020

Alcoholism in the family affects how your brain switches between active and resting states

WEST LAFAYETTE, Ind. — You don’t have to be a drinker for your brain to be affected by alcoholism.
A new study shows that just having a parent with an alcohol use disorder affects how your brain transitions between active and resting states – regardless of your own drinking habits.
The study, performed by researchers at Purdue University and the Indiana University School of Medicine, discovered that the brain reconfigures itself between completing a mentally demanding task and resting.
But for the brain of someone with a family history of an alcohol use disorder, this reconfiguration doesn’t happen.
While the missing transition doesn’t seem to affect how well a person performs the mentally demanding task itself, it might be related to larger scale brain functions that give rise to behaviors associated with addiction. In particular, study subjects without this brain process demonstrated greater impatience in waiting for rewards, a behavior associated with addiction.
Findings are published in the journal NeuroImage. The work was led by Enrico Amico, a former Purdue postdoctoral researcher who is now a researcher at EPFL in Lausanne, Switzerland.
How the brain reconfigures between active and resting states is like how a computer closes down a program after you’re finished with it.
“The moment you close a program, a computer has to remove it from memory, reorganize the cache and maybe clear out some temporary files. This helps the computer to prepare for the next task,” said Joaquín Goñi, a Purdue assistant professor in the School of Industrial Engineering and the Weldon School of Biomedical Engineering.
“In a similar way, we’ve found that this reconfiguration process in the human brain is associated with finishing a task and getting ready for what’s next.” Goñi’s research group, the CONNplexity Lab, takes a computational approach to neuroscience and cognitive science.
Past research has shown that a family history of alcoholism affects a person’s brain anatomy and physiology, but most studies have looked at this effect only in separate active and quiet resting states rather than the transition between them.
“A lot of what brains do is switch between different tasks and states. We suspected that this task switching might be somewhat lower in people with a family history of alcoholism,” said David Kareken, a professor of neurology at the Indiana University School of Medicine and director of the Indiana Alcohol Research Center.
The study defined a “family history of alcoholism” as someone with a parent who had enough symptoms to constitute an alcohol use disorder. About half of the 54 study participants had this history.
Researchers at Indiana University measured the brain activity of subjects with an MRI scanner as they completed a mentally demanding task on a computer. The task required them to unpredictably hold back from pressing a left or right key. After completing the task, the subjects rested while watching a fixed point on the screen.
A separate task outside of the MRI scanner gauged how participants responded to rewards, asking questions such as if they would like $20 now or $200 in one year.
Amico and Goñi processed the data and developed a computational framework for extracting different patterns of brain connectivity between completing the mentally demanding task and entering the resting state, such as when brain areas rose and fell together in activity, or one brain area rose while another fell at the same time.
The data revealed that these brain connectivity patterns reconfigured within the first three minutes after finishing the task. By the fourth minute of rest, the effect had completely disappeared.
And it’s not a quiet process: Reconfiguration involves multiple parts of the brain at once.
“These brain regions talk to each other and are very strongly implicated in the task even though by this point, the task is already completed. It almost seems like an echo in time of what had been going on,” Kareken said.
Subjects lacking the transition also had the risk factors that researchers have seen to be consistent with developing alcoholism. These include being male, a greater number of symptoms of depression, and reward-impatience.
A family history of alcoholism, however, stood out as the most statistically significant difference in this brain reconfiguration.
The finding affects research going forward.
“In the past, we’ve assumed that a person who doesn’t drink excessively is a ‘healthy’ control for a study. But this work shows that a person with just a family history of alcoholism may also have some subtle differences in how their brains operate,” Goñi said.
The code used to analyze data in this study is available at https://engineering.purdue.edu/ConnplexityLab/publications.
This research was funded by the National Institute on Alcohol Abuse and Alcoholism (grant P60AA07611) and the Purdue Discovery Park Data Science Award “Fingerprints of the Human Brain: A Data Science Perspective.” The work was also partially supported by the National Institutes of Health (grants R01EB022574, R01MH108467, and R00AA023296).
About Discovery Park
Discovery Park is a place where Purdue researchers move beyond traditional boundaries, collaborating across disciplines and with policymakers and business leaders to create solutions for a better world. Grand challenges of global health, global conflict and security, and those that lie at the nexus of sustainable energy, world food supply, water and the environment are the focus of researchers in Discovery Park. The translation of discovery to impact is integrated into the fabric of Discovery Park through entrepreneurship programs and partnerships.
Writer: Kayla Wiles, 765-494-2432, wiles5@purdue.edu
Sources:
Joaquín Goñi, jgonicor@purdue.edu
David Kareken, dkareken@iu.edu

Note to Journalists: The paper is available online open-access at https://www.sciencedirect.com/science/article/pii/S1053811920300021. An illustration and brain images are available via a Google Drive folder at https://bit.ly/2UE8aSL
________________________________________
ABSTRACT
The Disengaging brain: Dynamic Transitions from Cognitive Engagement and Alcoholism Risk
Enrico Amico1,2, Mario Dzemidzic3, Brandon G. Oberlin3,4, Claire R. Carron3, Jaroslaw Harezlak5, Joaquín Goñi1,2,6, & David A. Kareken3,
1Purdue Institute for Integrative Neuroscience, Purdue University
2 School of Industrial Engineering, Purdue University
3 Department of Neurology, Indiana University School of Medicine; Indiana Alcohol Research Center
4Department of Psychiatry, Indiana University School of Medicine
5 Department of Epidemiology and Biostatistics, Indiana University
6 Weldon School of Biomedical Engineering, Purdue University
DOI: 10.1016/j.neuroimage.2020.116515
Human functional brain connectivity is usually measured either at “rest” or during cognitive tasks, ignoring life’s moments of mental transition. We propose a different approach to understanding brain network transitions. We applied a novel independent component analysis of functional connectivity during motor inhibition (stop signal task) and during the continuous transition to an immediately ensuing rest. A functional network reconfiguration process emerged that: (i) was most prominent in those without familial alcoholism risk, (ii) encompassed brain areas engaged by the task, yet (iii) appeared only transiently after task cessation. The pattern was not present in a pre-task rest scan or in the remaining minutes of post-task rest. Finally, this transient network reconfiguration related to a key behavioral trait of addiction risk: reward delay discounting. These novel findings illustrate how dynamic brain functional reconfiguration during normally unstudied periods of cognitive transition might reflect addiction vulnerability, and potentially other forms of brain dysfunction.

Assuming you are not one of those ill-advised parents who supply their child with alcohol or drugs like marijuana in an attempt to be hip or cool, suspicions that your child may have a substance abuse problem are a concern. Confirmation that your child has a substance abuse problem can be heartbreaking. Even children whose parents have seemingly done everything right can become involved with drugs. The best defense is knowledge about your child, your child’s friends, and your child’s activities. You need to be aware of what is influencing your child.
Our goal should be:

A Healthy Child In A Healthy Family Who Attends A Healthy School In A Healthy Neighborhood. ©

Where information leads to Hope. © Dr. Wilda.com
Dr. Wilda says this about that ©
Blogs by Dr. Wilda:
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Dr. Wilda ©
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Kaiser Permanente study: More women using cannabis daily before and during pregnancy, research finds

20 Jul

The Ontario Ministry of Children and Youth Services explained why healthy babies are important. “Healthy babies are more likely to develop into healthy children, and healthy children are more likely to grow up to be healthy teenagers and healthy adults.” http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/health/index.aspx
Science Daily reported in Women, particularly minorities, do not meet nutrition guidelines shortly before pregnancy:

Black, Hispanic and less-educated women consume a less nutritious diet than their well-educated, white counterparts in the weeks leading up to their first pregnancy, according to the only large-scale analysis of preconception adherence to national dietary guidelines.
The study, published in the Journal of the Academy of Nutrition and Dietetics and led by the University of Pittsburgh Graduate School of Public Health, also found that, while inequalities exist, none of the women in any racial and socioeconomic group evaluated achieved recommendations set forth by the Dietary Guidelines for Americans.
Healthy maternal diets have been linked to reduced risks of preterm birth, fetal growth restriction, preeclampsia and maternal obesity.
“Unlike many other pregnancy and birth risk factors, diet is something we can improve,” said lead author Lisa Bodnar, Ph.D., M.P.H., R.D., associate professor and vice chair of research in Pitt Public Health’s Department of Epidemiology. “While attention should be given to improving nutritional counseling at doctor appointments, overarching societal and policy changes that help women to make healthy dietary choices may be more effective and efficient.”
Bodnar and her colleagues analyzed the results of questionnaires completed by 7,511 women who were between six and 14 weeks pregnant and enrolled in The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers to Be, which followed women who enrolled in the study at one of eight U.S. medical centers. The women reported on their dietary habits during the three months around conception.
The diets were assessed using the Healthy Eating Index-2010, which measures 12 key aspects of diet quality, including adequacy of intake for key food groups, as well as intake of refined grains, salt and empty calories (all calories from solid fats and sugars, plus calories from alcohol beyond a moderate level).
Nearly a quarter of the white women surveyed had scores that fell into the highest scoring fifth of those surveyed, compared with 14 percent of the Hispanic women and 4.6 percent of the black women. Almost half — 44 percent — of black mothers had a score in the lowest scoring fifth…. https://www.sciencedaily.com/releases/2017/03/170317082514.htm

See, https://drwilda.com/tag/pregnancy/

Science Daily reported in More women using cannabis daily before and during pregnancy:

The number of women using cannabis in the year before they get pregnant and early in their pregnancies is increasing, and their frequency of use is also rising, according to new data from Kaiser Permanente.
The research, published July 19, 2019, in JAMA Network Open, examined self-reported cannabis use among 276,991 pregnant women (representing 367,403 pregnancies) in Northern California over 9 years and found that cannabis use has increased over time.
From 2009 to 2017, the adjusted prevalence of self-reported cannabis use in the year before pregnancy increased from 6.8% to 12.5%, and the adjusted prevalence of self-reported cannabis use during pregnancy increased from 1.9% to 3.4% (rates were adjusted for demographics). Annual rates of change in self-reported daily, weekly, and monthly-or-less cannabis use increased significantly, though daily use increased most rapidly.
Among women who self-reported cannabis use during the year before pregnancy, the proportion who were daily users increased from 17% to 25%, and weekly users increased from 20% to 22%, while monthly-or-less users decreased from 63% to 53% during the study period. Similarly, among women who self-reported cannabis use during pregnancy, the proportion who were daily users increased from 15% to 21%, and weekly users from 25% to 27%, while monthly users decreased from 60% to 52%.
“These findings should alert women’s health clinicians to be aware of potential increases in daily and weekly cannabis use among their patients,” said lead author Kelly Young-Wolff, PhD, MPH, a research scientist with the Kaiser Permanente Division of Research. “The actual numbers are likely higher, as women may be unwilling to disclose their substance use to a medical professional.”
In addition, the prevalence of daily and weekly cannabis use may have risen even further in the past year and a half following legalization of cannabis for recreational use in California in 2018, Young-Wolff said.
The data come from women’s initial prenatal visits at Kaiser Permanente in Northern California, which usually take place at around 8 weeks gestation, and do not reflect continued use throughout pregnancy. Investigators were unable to differentiate whether self-reported cannabis use during pregnancy occurred before or after women were aware that they were pregnant.
While the current findings are based on women’s self-reporting, the results are supported by the Kaiser Permanente research team’s December 2017 JAMA Research Letter showing an increase in prenatal cannabis use via urine toxicology testing. In this newer study, the authors focus on trends in frequency of use in the year before and during pregnancy.
Some women may use cannabis during pregnancy to manage morning sickness, the authors noted. The authors’ previous work published in JAMA Internal Medicine in 2018 found women with severe nausea and vomiting in pregnancy were nearly 4 times more likely to use cannabis during the first trimester of pregnancy.
Women may get the impression from cannabis product marketing and online media that cannabis use is safe during pregnancy, said Young-Wolff. However, there is substantial evidence that exposure to cannabis in pregnancy is associated with having a low-birthweight baby, and the American College of Obstetricians and Gynecologists recommends women who are pregnant or contemplating pregnancy discontinue cannabis use because of concerns about impaired neurodevelopment and exposure to the adverse effects of smoking….
More research is needed to offer women better, specific advice, said study senior author Nancy Goler, MD, an obstetrician/gynecologist and associate executive director of The Permanente Medical Group.
“There is an urgent need to better understand the effects of prenatal cannabis exposure as cannabis becomes legalized in more states and more widely accepted and used,” Dr. Goler said. “Until such time as we fully understand the specific health risks cannabis poses for pregnant women and their fetuses, we are recommending stopping all cannabis use prior to conceiving and certainly once a woman knows she is pregnant….”
https://www.sciencedaily.com/releases/2019/07/190719173602.htm

Citation:

More women using cannabis daily before and during pregnancy, research finds
Current advice is to avoid cannabis exposure during pregnancy
Date: July 19, 2019
Source: Kaiser Permanente
Summary:
The number of women using cannabis in the year before they get pregnant and early in their pregnancies is increasing, and their frequency of use is also rising, according to new data.

Journal Reference:
Kelly C. Young-Wolff, Varada Sarovar, Lue-Yen Tucker, Amy Conway, Stacey Alexeeff, Constance Weisner, Mary Anne Armstrong, Nancy Goler. Self-reported Daily, Weekly, and Monthly Cannabis Use Among Women Before and During Pregnancy. JAMA Network Open, 2019; 2 (7): e196471 DOI: 10.1001/jamanetworkopen.2019.6471

Here is the press release from Kaiser Permanente:

July 19, 2019

More women using cannabis daily before and during pregnancy
Current advice from Kaiser Permanente is to avoid cannabis exposure during pregnancy.
OAKLAND, Calif. — The number of women using cannabis in the year before they get pregnant and early in their pregnancies is increasing, and their frequency of use is also rising, according to new data from Kaiser Permanente.
The research, published July 19, 2019, in JAMA Network Open, examined self-reported cannabis use among 276,991 pregnant women (representing 367,403 pregnancies) in Northern California over 9 years and found that cannabis use has increased over time.
From 2009 to 2017, the adjusted prevalence of self-reported cannabis use in the year before pregnancy increased from 6.80% to 12.50%, and the adjusted prevalence of self-reported cannabis use during pregnancy increased from 1.95% to 3.38%. Annual rates of change in self-reported daily, weekly, and monthly-or-less cannabis use increased significantly, though daily use increased most rapidly.
Among women who self-reported cannabis use during the year before pregnancy, the proportion who were daily users increased from 17.1% to 25.2%, and weekly users increased from 20.4% to 22.0%, while monthly-or-less users decreased from 62.7% to 53.1% during the study period. Similarly, among women who self-reported cannabis use during pregnancy, the proportion who were daily users increased from 14.6% to 20.9%, and weekly users from 25.1% to 27.4%, while monthly users decreased from 60.3% to 51.8%.
“These findings should alert women’s health clinicians to be aware of potential increases in daily and weekly cannabis use among their patients,” said lead author Kelly Young-Wolff, PhD, MPH, a research scientist with the Kaiser Permanente Division of Research. “The actual numbers are likely higher, as women may be unwilling to disclose their substance use to a medical professional.”
In addition, the prevalence of daily and weekly cannabis use may have risen even further in the past year and a half following legalization of cannabis for recreational use in California in 2018, Young-Wolff said.
The data come from women’s initial prenatal visits at Kaiser Permanente in Northern California, which usually take place at around 8 weeks of pregnancy, and do not reflect continued use throughout pregnancy. Investigators were unable to differentiate whether self-reported cannabis use during pregnancy occurred before or after women were aware that they were pregnant.
While the current findings are based on women’s self-reporting, the results are supported by the Kaiser Permanente research team’s December 2017 JAMA Research Letter showing an increase in prenatal cannabis use via urine toxicology testing. In this newer study, the authors focus on trends in frequency of use in the year before and during pregnancy.
Some women may use cannabis during pregnancy to manage morning sickness, the authors noted. The authors’ previous work published in JAMA Internal Medicine in 2018 found women with severe nausea and vomiting in pregnancy were nearly 4 times more likely to use cannabis during the first trimester of pregnancy.
“Women may get the impression from cannabis product marketing and online media that cannabis use is safe during pregnancy,” said Young-Wolff. “However, there is substantial evidence that exposure to cannabis in pregnancy is associated with having a low-birthweight baby, and the American College of Obstetricians and Gynecologists recommends women who are pregnant or contemplating pregnancy discontinue cannabis use because of concerns about impaired neurodevelopment and exposure to the adverse effects of smoking.”
“There is still much that is unknown on the topic, including what type of cannabis products pregnant women are using and whether the health consequences differ based on mode of cannabis administration and frequency of prenatal cannabis use,” Young-Wolff noted.
More research is needed to offer women better, specific advice, said study senior author Nancy Goler, MD, an obstetrician-gynecologist and associate executive director of The Permanente Medical Group.
“There is an urgent need to better understand the effects of prenatal cannabis exposure as cannabis becomes legalized in more states and more widely accepted and used,” Dr. Goler said. “Until such time as we fully understand the specific health risks cannabis poses for pregnant women and their fetuses, we are recommending stopping all cannabis use prior to conceiving and certainly once a woman knows she is pregnant.”
The study was supported by a grant from the National Institute on Drug Abuse.
Young-Wolff and Kaiser Permanente Division of Research colleague Lindsay Avalos, PhD, MPH, have received a new 5-year grant from NIDA to support further research on maternal cannabis use during pregnancy. They plan to study whether prenatal cannabis use is associated with increased risk of adverse maternal, fetal, and neonatal outcomes using data from urine toxicology testing, self-reported frequency of prenatal cannabis use, and mode of cannabis administration. They will also test whether legalization of cannabis for recreational use in 2018 and local regulatory practices (such as retailer bans) are associated with variation in prenatal cannabis use.
Additional authors were Constance Weisner, DrPH, MSW; Varada Sarovar,;Lue-Yen Tucker; Mary Anne Armstrong; and Stacey Alexeeff, PhD, of the Kaiser Permanente Northern California Division of Research; and Amy Conway, MPH, of the Kaiser Permanente Northern California Early Start Program.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 12.3 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.

Contacts
Jan Greene
janice.x.greene@kp.org
510-891-3653
Kerry Sinclair
ksinclair@webershandwick.com
310-710-0321

Humans have free will and are allowed to choose how they want to live. What you do not have the right to do is to inflict your lifestyle on a child. So, the responsible thing for you to do is to get birth control for yourself and the society which will have to live with your poor choices. Many religious folks are shocked because moi is mentioning birth control, but most sluts have few religious inklings or they wouldn’t be sluts. A better option for both sexes, if this lifestyle is a permanent option, is permanent birth control to lessen a contraception failure. People absolutely have the right to choose their particular lifestyle. You simply have no right to bring a child into your mess of a life. I observe people all the time and I have yet to observe a really happy slut. Seems that the lifestyle is devoid of true emotional connection and is empty. If you do find yourself pregnant, please consider adoption.

Let’s continue the discussion. Some folks may be great friends, homies, girlfriends, and dudes, but they make lousy parents. Could be they are at a point in their life where they are too selfish to think of anyone other than themselves, they could be busy with school, work, or whatever. No matter the reason, they are not ready and should not be parents. Birth control methods are not 100% effective, but the available options are 100% ineffective in people who are sexually active and not using birth control. So, if you are sexually active and you have not paid a visit to some agency, then you are not only irresponsible, you are Eeeevil. Why do I say that, you are playing Russian Roulette with the life of another human being, the child. You should not ever put yourself in the position of bringing a child into the world that you are unprepared to parent, emotionally, financially, and with a commitment of time. So, if you find yourself in a what do I do moment and are pregnant, you should consider adoption.
Children need stability and predictability to have the best chance of growing up healthy.

Children will have the most success in school if they are ready to learn. Ready to learn includes proper nutrition for a healthy body and the optimum situation for children is a healthy family. Many of society’s problems would be lessened if the goal was a healthy child in a healthy family.

Unless there was a rape or some forcible intercourse, the answer to the question is a woman who gets preggers with a “deadbeat dad” a moron – is yes.

Learn more about prenatal and preconception care.
http://www.nichd.nih.gov/health/topics/preconceptioncare/Pages/default.aspx
http://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/Pages/prenatal-care.aspx

See, Prenatal care fact sheet http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html

Our goal as a society should be a healthy child in a healthy family who attends a healthy school in a healthy neighborhood. ©

 

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

Rand Corporation study: Study questions link between medical marijuana and fewer opioid deaths

11 Feb

Often children who evidence signs of a substance abuse problem come from homes where there is a substance abuse problem. That problem may be generational. eMedicineHealth lists some of the causes of substance abuse:

Substance Abuse Causes
Use and abuse of substances such as cigarettes, alcohol, and illegal drugs may begin in childhood or the teen years. Certain risk factors may increase someone’s likelihood to abuse substances.
Factors within a family that influence a child’s early development have been shown to be related to increased risk of drug abuse.
o Chaotic home environment
o Ineffective parenting
o Lack of nurturing and parental attachment
Factors related to a child’s socialization outside the family may also increase risk of drug abuse.
o Inappropriately aggressive or shy behavior in the classroom
o Poor social coping skills
o Poor school performance
o Association with a deviant peer group
o Perception of approval of drug use behavior
http://www.emedicinehealth.com/substance_abuse/article_em.htm

Substance abuse is often a manifestation of other problems that child has either at home or poor social relations including low self-esteem. Dr. Alan Leshner summarizes the reasons children use drugs in why do Sally and Johnny use drugs? http://archives.drugabuse.gov/Published_Articles/Sally.html

Science Daily reported in: Depression among young teens linked to cannabis use at 18:

A study looking at the cumulative effects of depression in youth, found that young people with chronic or severe forms of depression were at elevated risk for developing a problem with cannabis in later adolescence.
The study led by UW Medicine researchers interviewed 521 students recruited from four Seattle public middle schools. Researchers used data from annual assessments when students were ages 12-15 and then again when they were 18. The results were published in the journal Addiction.
“The findings suggest that if we can prevent or reduce chronic depression during early adolescence, we may reduce the prevalence of cannabis use disorder,” said lead author Isaac Rhew, research assistant professor of psychiatry and behavioral sciences at the University of Washington School of Medicine.
What researchers called “a 1 standard deviation increase” in cumulative depression during early adolescence was associated with a 50 percent higher likelihood of cannabis-use disorder.
According to researchers, during the past decade cannabis has surpassed tobacco with respect to prevalence of use among adolescents. Cannabis and alcohol are the two most commonly used substances among youth in the United States. They pointed to one national study showing increases in prevalence of cannabis use disorder and alcohol use disorder in the United States, especially among young adults.
Longitudinal studies looking at the link between depression and later use of alcohol and cannabis, however, have been mixed. Some show a link. Others don’t. But most studies have assessed adolescent depression at a single point in time — not cumulatively, said the researchers. Further, there have been differences in how substance use has been measured ranging from the initiation of any use to heavier problematic forms of use.
The study oversampled for students with depressive and/or conduct problems. The researchers were surprised to see that the prevalence of cannabis and alcohol use disorder in this study was notably higher than national estimates with 21 percent meeting criteria for cannabis use disorder and 20 percent meeting criteria for alcohol use disorder at age 18.

What effect the easing of marijuana laws in Washington state had on the youth is unclear. Researchers said it would be informative to conduct a similar study in a state with more strict marijuana laws to understand whether the relationship between depression and cannabis misuse would still hold in areas where marijuana may be less accessible…. https://www.sciencedaily.com/releases/2017/07/170717151031.htm

Citation:

Depression among young teens linked to cannabis use at 18
Seattle-focused study suggests earlier intervention with depressed youths could reduce rate of cannabis-use disorder
Date: July 17, 2017
Source: University of Washington Health Sciences/UW Medicine
Summary:
Young people with chronic or severe forms of depression were at elevated risk for developing a problem with cannabis in later adolescence, found a study looking at the cumulative effects of depression in youth.

Journal Reference:
1. Isaac C. Rhew, Charles B. Fleming, Ann Vander Stoep, Semret Nicodimos, Cheng Zheng, Elizabeth McCauley. Examination of cumulative effects of early adolescent depression on cannabis and alcohol use disorder in late adolescence in a community-based cohort. Addiction, 2017; DOI: 10.1111/add.13907

Science Daily reported in Study questions link between medical marijuana and fewer opioid deaths:

The association between medical marijuana and lower levels of opioid overdose deaths — identified previously in several studies — is more complex than previously described and appears to be changing as both medical marijuana laws and the opioid crisis evolve, according to a new RAND Corporation study.
The report — the most-detailed examination of medical marijuana and opioid deaths conducted to date — found that legalizing medical marijuana was associated with lower levels of opioid deaths only in states that had provisions for dispensaries that made medical marijuana easily available to patients. Opioid death rates were not lower in states that just provided legal protections to patients and caregivers, allowing them to grow their own marijuana.
In addition, the association between medical marijuana dispensaries and fewer opioid deaths appears to have declined sharply after 2010, when states began to tighten requirements on sales by dispensaries.
“Our findings are consistent with previous studies showing an association between the legalization of medical marijuana and lower deaths from overdoses of opioids,” said Rosalie Liccardo Pacula, co-author of the study and co-director of the RAND Drug Policy Research Center.
“However, our findings show that the mechanism for this was loosely regulated medical marijuana dispensaries, and that the association between these laws and opioid mortality has declined over time as state laws have more tightly regulated medical dispensaries and the opioid crisis shifted from prescription opioids to heroin and fentanyl,” Pacula said. “This is a sign that medical marijuana, by itself, will not be the solution to the nation’s opioid crisis today….”
When the researchers narrowly focused on the time period from 1999 to 2010 and replicated a model used by other researchers, they obtained results similar to those previously published, showing an approximately 20 percent decline in opioid overdose deaths associated with the passage of any state medical marijuana law. However, these general findings were driven by states that had laws allowing for loosely regulated marijuana dispensary systems.
When researchers extended their analysis through 2013, they found that the association between having any medical marijuana law and lower rates of opioid deaths completely disappeared. Moreover, the association between states with medical marijuana dispensaries and opioid mortality fell substantially as well.
The researchers provide two explanations for the decline in the association between medical marijuana dispensaries and opioid harm. First, states that more recently adopted laws with medical marijuana dispensaries more tightly regulated them, in response to a U.S. Justice Department memo saying it would not challenge state-level medical marijuana laws so long as dispensary sales were in full compliance with state regulations. Second, beginning in 2010, the primary driver of the opioid crisis and related deaths became illicit opioids, mainly heroin and then fentanyl, not prescription opioids…. https://www.sciencedaily.com/releases/2018/02/180207090111.htm

Citation:

Study questions link between medical marijuana and fewer opioid deaths
Association appears to be changing as medical marijuana laws and opioid epidemic change
Date: February 7, 2018
Source: RAND Corporation
Summary:
Several studies have shown an association between legalizing medical marijuana and lower death rates from opioids. A new study finds that link is more complex than previously described and appears to be changing as both medical marijuana laws and the opioid crisis evolve.
Journal Reference:
1. David Powell, Rosalie Liccardo Pacula, Mireille Jacobson. Do medical marijuana laws reduce addictions and deaths related to pain killers? Journal of Health Economics, 2018; 58: 29 DOI: 10.1016/j.jhealeco.2017.12.007

Here is the press release from RAND:

Do Medical Marijuana Laws Reduce Addictions and Deaths Related to Pain Killers?
Published in: Journal of Health Economics Volume 58 (March 2018), Pages 29-42. doi: 10.1016/j.jhealeco.2017.12.007
Posted on RAND.org on February 08, 2018
by David Powell, Rosalie Liccardo Pacula, Mireille Jacobson
• Related Topics:
• Drug Markets and Supply,
• Marijuana,
• Substance Use Harm Reduction
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Read More
Access further information on this document at Journal of Health Economics Volume 58 (March 2018)
This article was published outside of RAND. The full text of the article can be found at the link above.
Recent work finds that medical marijuana laws reduce the daily doses filled for opioid analgesics among Medicare Part-D and Medicaid enrollees, as well as population-wide opioid overdose deaths. We replicate the result for opioid overdose deaths and explore the potential mechanism. The key feature of a medical marijuana law that facilitates a reduction in overdose death rates is a relatively liberal allowance for dispensaries. As states have become more stringent in their regulation of dispensaries, the protective value generally has fallen. These findings suggest that broader access to medical marijuana facilitates substitution of marijuana for powerful and addictive opioids.
Access further information on this document at Journal of Health Economics Volume 58 (March 2018)
Link Between Medical Marijuana and Fewer Opioid Deaths Is More Complex Than Previously Reported
FOR RELEASE
Tuesday
February 6, 2018
The association between medical marijuana and lower levels of opioid overdose deaths—identified previously in several studies—is more complex than previously described and appears to be changing as both medical marijuana laws and the opioid crisis evolve, according to a new RAND Corporation study.
The report—the most-detailed examination of medical marijuana and opioid deaths conducted to date—found that legalizing medical marijuana was associated with lower levels of opioid deaths only in states that had provisions for dispensaries that made medical marijuana easily available to patients. Opioid death rates were not lower in states that just provided legal protections to patients and caregivers, allowing them to grow their own marijuana.
In addition, the association between medical marijuana dispensaries and fewer opioid deaths appears to have declined sharply after 2010, when states began to tighten requirements on sales by dispensaries.
“Our findings are consistent with previous studies showing an association between the legalization of medical marijuana and lower deaths from overdoses of opioids,” said Rosalie Liccardo Pacula, co-author of the study and co-director of the RAND Drug Policy Research Center.
“However, our findings show that the mechanism for this was loosely regulated medical marijuana dispensaries, and that the association between these laws and opioid mortality has declined over time as state laws have more tightly regulated medical dispensaries and the opioid crisis shifted from prescription opioids to heroin and fentanyl,” Pacula said. “This is a sign that medical marijuana, by itself, will not be the solution to the nation’s opioid crisis today.”
The study was published online by the Journal of Health Economics.
Researchers from RAND and the University of California, Irvine, analyzed information about treatment admissions for addiction to pain medications from 1999 to 2012 and state-level overdose deaths from opioids from 1999 to 2013. They also identified state laws legalizing medical marijuana, examining provisions such as whether the regulations made marijuana easily accessible to patients by allowing dispensaries.
When the researchers narrowly focused on the time period from 1999 to 2010 and replicated a model used by other researchers, they obtained results similar to those previously published, showing an approximately 20 percent decline in opioid overdose deaths associated with the passage of any state medical marijuana law. However, these general findings were driven by states that had laws allowing for loosely regulated marijuana dispensary systems.
When researchers extended their analysis through 2013, they found that the association between having any medical marijuana law and lower rates of opioid deaths completely disappeared. Moreover, the association between states with medical marijuana dispensaries and opioid mortality fell substantially as well.
The researchers provide two explanations for the decline in the association between medical marijuana dispensaries and opioid harm. First, states that more recently adopted laws with medical marijuana dispensaries more tightly regulated them, in response to a U.S. Justice Department memo saying it would not challenge state-level medical marijuana laws so long as dispensary sales were in full compliance with state regulations. Second, beginning in 2010, the primary driver of the opioid crisis and related deaths became illicit opioids, mainly heroin and then fentanyl, not prescription opioids.
The study also found no evidence that states with medical marijuana laws experience reductions in the volume of legally distributed opioid analgesics used to treat pain. Even if medical marijuana patients were substituting medical marijuana for opioids in medical marijuana states, these patients did not represent a measurable part of the medical opioid analgesic market.
“While our study finds that medical marijuana dispensaries reduce some of the harms associated with the misuse of opioids, there is little evidence that this is happening because a large number of patients suffering from pain are using marijuana instead of opioid medications,” Pacula said. “Either the patients are continuing to use their opioid pain medications in addition to marijuana, or this patient group represents a small share of the overall medical opioid using population.”
The RAND study was conducted before any any states had begun to allow retail sales of recreational marijuana.
“Our research suggests that the overall story between medical marijuana and opioid deaths is complicated,” Pacula said. “Before we embrace marijuana as a strategy to combat the opioid epidemic, we need to fully understand the mechanism through which these laws may be helping and see if that mechanism still matters in today’s changing opioid crisis.”
Support for the study was provided by the National Institute on Drug Abuse. Other authors of the study are David Powell of RAND and Mireille Jacobson of UC Irvine.
RAND Health is the nation’s largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.
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About the RAND Corporation
The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous.
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RAND Office of Media Relations
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Researcher Spotlight
• Rosalie Liccardo Pacula
Director, Bing Center for Health Economics
Rosalie Liccardo Pacula is a senior economist at the RAND Corporation and a professor at the Pardee RAND Graduate School. She serves as director of RAND’s BING Center for Health Economics, co-director of the RAND Drug Policy Research Center, and associate director of the data core for RAND’s new…
The Drug Enforcement Agency (DEA) has a series of questions parents should ask http://www.getsmartaboutdrugs.com/content/default.aspx?pud=a8bcb6ee-523a-4909-9d76-928d956f3f91

If you suspect that your child has a substance abuse problem, you will have to seek help of some type. You will need a plan of action. The Partnership for a Drug Free America lists 7 Steps to Take and each step is explained at the site. http://www.drugfree.org/intervene

If your child has a substance abuse problem, both you and your child will need help. “One day at a time” is a famous recovery affirmation which you and your child will live the meaning. The road to recovery may be long or short, it will have twists and turns with one step forward and two steps back. In order to reach the goal of recovery, both parent and child must persevere.

Related:

University of Washington study: Heroin use among young suburban and rural non-traditional users on the
https://drwilda.com/2013/10/13/university-of-washington-study-heroin-use-among-young-suburban-and-rural-non-traditional-users-on-the-increase/

Resources

Adolescent Substance Abuse Knowledge Base
http://www.crchealth.com/troubled-teenagers/teenage-substance-abuse/adolescent-substance-abuse/signs-drug-use/

Warning Signs of Teen Drug Abuse
http://parentingteens.about.com/cs/drugsofabuse/a/driug_abuse20.htm?r=et

Is Your Teen Using?
http://www.drugfree.org/intervene

Al-Anon and Alateen
http://www.al-anon.alateen.org/

WEBMD: Parenting and Teen Substance Abuse
http://www.webmd.com/mental-health/tc/teen-substance-abuse-choosing-a-treatment-program-topic-overview

The U.S. Department of Health and Human Services has a very good booklet for families What is Substance Abuse Treatment?
http://store.samhsa.gov/home

The National Institute on Drug Abuse (NIDA) has a web site for teens and parents that teaches about drug abuse NIDA for Teens: The Science Behind Drug Abuse
http://teens.drugabuse.gov/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

Lancet study: Parental provision of alcohol to teenagers does not reduce risks, compared to no supply, Australian study finds

28 Jan

Substance abuse is a serious problem for many young people. The Centers for Disease Control provide statistics about underage drinking in the Fact Sheet: Underage Drinking:

Underage Drinking
Alcohol use by persons under age 21 years is a major public health problem.1 Alcohol is the most commonly used and abused drug among youth in the United States, more than tobacco and illicit drugs. Although drinking by persons under the age of 21 is illegal, people aged 12 to 20 years drink 11% of all alcohol consumed in the United States.2 More than 90% of this alcohol is consumed in the form of binge drinks.2 On average, underage drinkers consume more drinks per drinking occasion than adult drinkers.3 In 2008, there were approximately 190,000 emergency rooms visits by persons under age 21 for injuries and other conditions linked to alcohol.4
Drinking Levels among Youth
The 2009 Youth Risk Behavior Survey5 found that among high school students, during the past 30 days
• 42% drank some amount of alcohol.
• 24% binge drank.
• 10% drove after drinking alcohol.
• 28% rode with a driver who had been drinking alcohol.
Other national surveys indicate
• In 2008 the National Survey on Drug Use and Health reported that 28% of youth aged 12 to 20 years drink alcohol and 19% reported binge drinking.6
• In 2009, the Monitoring the Future Survey reported that 37% of 8th graders and 72% of 12th graders had tried alcohol, and 15% of 8th graders and 44% of 12th graders drank during the past month.7
Consequences of Underage Drinking
Youth who drink alcohol1, 3, 8 are more likely to experience
• School problems, such as higher absence and poor or failing grades.
• Social problems, such as fighting and lack of participation in youth activities.
• Legal problems, such as arrest for driving or physically hurting someone while drunk.
• Physical problems, such as hangovers or illnesses.
• Unwanted, unplanned, and unprotected sexual activity.
• Disruption of normal growth and sexual development.
• Physical and sexual assault.
• Higher risk for suicide and homicide.
• Alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning.
• Memory problems.
• Abuse of other drugs.
• Changes in brain development that may have life-long effects.
• Death from alcohol poisoning.
In general, the risk of youth experiencing these problems is greater for those who binge drink than for those who do not binge drink.8
Youth who start drinking before age 15 years are five times more likely to develop alcohol dependence or abuse later in life than those who begin drinking at or after age 21 years.9, 10 http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm
See, Alcohol Use Among Adolescents and Young Adults http://pubs.niaaa.nih.gov/publications/arh27-1/79-86.htm
https://drwilda.wordpress.com/2012/03/26/seattle-childrens-institute-study-supportive-middle-school-teachers-affect-a-kids-alcohol-use/

According to a Science Daily article, parents might want to think about the risks of providing alcohol to their underage children.

Science Daily reported in Parental provision of alcohol to teenagers does not reduce risks, compared to no supply, Australian study finds:

There is no evidence to support the practice of parents providing alcohol to their teenagers to protect them from alcohol-related risks during early adolescence, according to a prospective cohort study in Australia published in The Lancet Public Health journal.
The six year study of 1927 teenagers aged 12 to 18 and their parents found that there were no benefits or protective effects associated with giving teenagers alcohol when compared to teenagers who were not given alcohol. Instead, parental provision of alcohol was associated with increased likelihood of teenagers accessing alcohol through other sources, compared to teenagers not given any alcohol.
Alcohol consumption is the leading risk factor for death and disability in 15-24 year olds globally. Drinking during adolescence is of concern as this is when alcohol use disorders (ie, dependence on or abuse of alcohol) are most likely to develop….
The study recruited teenagers and their parents between 2010 and 2011 from secondary schools in Perth, Sydney and Hobart (Australia). The teenagers and their parents completed separate questionnaires every year from 2010 to 2016 including information about how teenagers accessed alcohol (from parents, other non-parental sources, or both), binge drinking levels (defined as drinking more than four drinks on a single occasion in the past year), experience of alcohol-related harm, and alcohol abuse symptoms. In the final two years, teenagers were also asked about symptoms of alcohol dependence and alcohol use disorder that could predict alcohol misuse problems in the future.
At the start of the study, the average age of the teenagers was 12.9 years old and by the end of the study the average age was 17.8 years old. The proportion of teenagers who accessed alcohol from their parents increased as the teenagers aged, from 15% (291/1910) at the start of the study to 57% (916/1618) at the end of the study, while the proportion with no access to alcohol reduced from 81% (1556/1910) teenagers to 21% (341/1618).
At the end of the study, 81% (632/784) of teenagers who accessed alcohol through their parents and others reported binge drinking, compared with 62% (224/361) of those who accessed it via other people only, and 25% (33/132) of teens who were given alcohol by their parents only. Similar trends were seen for alcohol-related harm, and for symptoms of possible future alcohol abuse, dependence and alcohol use disorders. The group of teenagers supplied with alcohol from both their parents and other sources were at the greatest risk of the five adverse outcomes, potentially as a result of their increased exposure…. https://www.sciencedaily.com/releases/2018/01/180125161255.htm

Citation:

Parental provision of alcohol to teenagers does not reduce risks, compared to no supply, Australian study finds
Date: January 25, 2018
Source: The Lancet
Summary:
There is no evidence to support the practice of parents providing alcohol to their teenagers to protect them from alcohol-related risks during early adolescence, according to a prospective cohort study in Australia.
Journal References:
1. Richard P Mattick, Philip J Clare, Alexandra Aiken, Monika Wadolowski, Delyse Hutchinson, Jackob Najman, Tim Slade, Raimondo Bruno, Nyanda McBride, Kypros Kypri, Laura Vogl, Louisa Degenhardt. Association of parental supply of alcohol with adolescent drinking, alcohol-related harms, and alcohol use disorder symptoms: a prospective cohort study. The Lancet Public Health, 2018; DOI: 10.1016/S2468-2667(17)30240-2
2. Stuart A Kinner, Rohan Borschmann. Parental supply and alcohol-related harm in adolescence: emerging but incomplete evidence. The Lancet Public Health, 2018; DOI: 10.1016/S2468-2667(18)30006-9

Here is the abstract from the Lancet:

Association of parental supply of alcohol with adolescent drinking, alcohol-related harms, and alcohol use disorder symptoms: a prospective cohort study
Prof Richard P Mattick, PhD Correspondence information about the author Prof Richard P Mattick Email the author Prof Richard P Mattick
,
Philip J Clare, MBiostats
,
Alexandra Aiken, MPH
,
Monika Wadolowski, PhD
,
Delyse Hutchinson, PhD
,
Prof Jackob Najman, PhD
,
Tim Slade, PhD
,
Raimondo Bruno, PhD
,
Nyanda McBride, PhD
,
Prof Kypros Kypri, PhD
,
Laura Vogl, PhD
,
Prof Louisa Degenhardt, PhD
Published: 25 January 2018
Open Access
DOI: http://dx.doi.org/10.1016/S2468-2667(17)30240-2
|
Summary
Background
Some parents supply alcohol to their children, reportedly to reduce harm, yet longitudinal research on risks associated with such supply is compromised by short periods of observation and potential confounding. We aimed to investigate associations between parental supply and supply from other (non-parental) sources, with subsequent drinking outcomes over a 6-year period of adolescence, adjusting for child, parent, family, and peer variables.
Methods
We did this prospective cohort study using data from the Australian Parental Supply of Alcohol Longitudinal Study cohort of adolescents. Children in grade 7 (mean age 12 years), and their parents, were recruited between 2010 and 2011 from secondary schools in Sydney, Perth, and Hobart, Australia, and were surveyed annually between 2010 and 2016. We examined the association of exposure to parental supply and other sources of alcohol in 1 year with five outcomes in the subsequent year: binge drinking (more than four standard drinks on a drinking occasion); alcohol-related harms; and symptoms of alcohol abuse (as defined by Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV]), alcohol dependence, and alcohol use disorder (as defined by DSM-5). This trial is registered with ClinicalTrials.gov, number NCT02280551.
Findings
Between September, 2010, and June, 2011, we recruited 1927 eligible parents and adolescents (mean age 12·9 years [SD 0·52]). Participants were followed up until 2016, during which time binge drinking and experience of alcohol-related harms increased. Adolescents who were supplied alcohol only by parents had higher odds of subsequent binge consumption (odds ratio [OR] 2·58, 95% CI 1·96–3·41; p<0·0001), alcohol-related harm (2·53, 1·99–3·24; p<0·0001), and symptoms of alcohol use disorder (2·51, 1·46–4·29; p=0·0008) than did those reporting no supply. Parental supply of alcohol was not significantly associated with the odds of reporting symptoms of either alcohol abuse or dependence, compared with no supply from any source. Supply from other sources was associated with significant risks of all adverse outcomes, compared with no supply, with an even greater increased risk of adverse outcomes.
Interpretation
Providing alcohol to children is associated with alcohol-related harms. There is no evidence to support the view that parental supply protects from adverse drinking outcomes by providing alcohol to their child. Parents should be advised that this practice is associated with risk, both directly and indirectly through increased access to alcohol from other sources.
Funding
Australian Research Council, Australian Rotary Health, Foundation for Alcohol Research and Education, National Drug and Alcohol Research Centre….. Continue Reading at http://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30240-2/fulltext

Assuming you are not one of those ill-advised parents who supply their child with alcohol or drugs like marijuana in an attempt to be hip or cool, suspicions that your child may have a substance abuse problem are a concern. Confirmation that your child has a substance abuse problem can be heartbreaking. Even children whose parents have seemingly done everything right can become involved with drugs. The best defense is knowledge about your child, your child’s friends, and your child’s activities. You need to be aware of what is influencing your child.
Our goal should be:

A Healthy Child In A Healthy Family Who Attends A Healthy School In A Healthy Neighborhood. ©

Related:

More school districts facing a financial crunch are considering school ads https://drwilda.wordpress.com/2012/06/04/more-school-districts-facing-a-financial-crunch-are-considering-school-ads/

Should there be advertising in schools? https://drwilda.wordpress.com/2011/11/10/should-there-be-advertising-in-schools/

Talking to your teen about risky behaviors https://drwilda.wordpress.com/2012/06/07/talking-to-your-teen-about-risky-behaviors/

Television cannot substitute for quality childcare https://drwilda.wordpress.com/2012/04/23/television-cannot-substitute-for-quality-childcare/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

Columbia University study: Marijuana smokers 5 times more likely to develop an alcohol problem

18 Feb

Often children who evidence signs of a substance abuse problem come from homes where there is a substance abuse problem. That problem may be generational. eMedicineHealth lists some of the causes of substance abuse:

Substance Abuse Causes

Use and abuse of substances such as cigarettes, alcohol, and illegal drugs may begin in childhood or the teen years. Certain risk factors may increase someone’s likelihood to abuse substances.
Factors within a family that influence a child’s early development have been shown to be related to increased risk of drug abuse.
o Chaotic home environment
o Ineffective parenting
o Lack of nurturing and parental attachment
Factors related to a child’s socialization outside the family may also increase risk of drug abuse.
o Inappropriately aggressive or shy behavior in the classroom
o Poor social coping skills
o Poor school performance
o Association with a deviant peer group
o Perception of approval of drug use behavior
http://www.emedicinehealth.com/substance_abuse/article_em.htm

Substance abuse is often a manifestation of other problems that child has either at home or poor social relations including low self-esteem. Dr. Alan Leshner summarizes the reasons children use drugs in why do Sally and Johnny use drugs? http://archives.drugabuse.gov/Published_Articles/Sally.html

Science Daily reported in Marijuana smokers 5 times more likely to develop an alcohol problem:

Adults who use marijuana are five times more likely to develop an alcohol use disorder (AUD) –alcohol abuse or dependence– compared with adults who do not use the drug. And adults who already have an alcohol use disorder and use marijuana are more likely to see the problem persist. Results of a study by researchers at Columbia University’s Mailman School of Public Health and the City University of New York appear online in the journal Drug and Alcohol Dependence.

“Our results suggest that cannabis use appears to be associated with an increased vulnerability to developing an alcohol use disorder, even among those without any history of this,” said Renee Goodwin, PhD, associate professor of Epidemiology at the Mailman School of Public Health. “Marijuana use also appears to increase the likelihood that an existing alcohol use disorder will continue over time.”

The researchers analyzed data from 27,461 adults enrolled in the National Epidemiologic Survey on Alcohol and Related Conditions who first used marijuana at a time when they had no lifetime history of alcohol use disorders. The population was assessed at two time points. Adults who had used marijuana at the first assessment and again over the following three years (23 percent) were five times more likely to develop an alcohol use problem, compared with those who had not used marijuana (5 percent). Adult problem drinkers who did not use cannabis were significantly more likely to be in recovery from alcohol use disorders three years later….. https://www.sciencedaily.com/releases/2016/02/160217112847.htm

Citation:

Marijuana smokers 5 times more likely to develop an alcohol problem

Date: February 17, 2016

Source: Columbia University’s Mailman School of Public Health

Summary:
Adults who use marijuana are five times more likely to develop an alcohol use disorder (AUD) — alcohol abuse or dependence — compared with adults who do not use the drug. And adults who already have an alcohol use disorder and use marijuana are more likely to see the problem persist.

Journal Reference:
1. Andrea H. Weinberger, Jonathan Platt, Renee D. Goodwin. Is cannabis use associated with an increased risk of onset and persistence of alcohol use disorders? A three-year prospective study among adults in the United States. Drug and Alcohol Dependence, 2016; DOI: 10.1016/j.drugalcdep.2016.01.014

Here is the press release from the Columbia’s Mailman School of Public Health:

Chronic Disease, Community Health

Feb. 17 2016

Marijuana Smokers Five Times More Likely to Develop an Alcohol Problem

Adults who use marijuana are five times more likely to develop an alcohol use disorder (AUD) —alcohol abuse or dependence— compared with adults who do not use the drug. And adults who already have an alcohol use disorder and use marijuana are more likely to see the problem persist. Results of a study by researchers at Columbia University’s Mailman School of Public Health and the City University of New York appear online in the journal Drug and Alcohol Dependence.

“Our results suggest that cannabis use appears to be associated with an increased vulnerability to developing an alcohol use disorder, even among those without any history of this,” said Renee Goodwin, PhD, associate professor of Epidemiology at the Mailman School of Public Health. “Marijuana use also appears to increase the likelihood that an existing alcohol use disorder will continue over time.”

The researchers analyzed data from 27,461 adults enrolled in the National Epidemiologic Survey on Alcohol and Related Conditions who first used marijuana at a time when they had no lifetime history of alcohol use disorders. The population was assessed at two time points. Adults who had used marijuana at the first assessment and again over the following three years (23 percent) were five times more likely to develop an alcohol use problem, compared with those who had not used marijuana (5 percent). Adult problem drinkers who did not use cannabis were significantly more likely to be in recovery from alcohol use disorders three years later.

“From a public health standpoint we recommend that further research be conducted to understand the pathways underlying these relationships as well as the degree to which various potentially vulnerable population subgroups — youth, for example — are at increased risk,” noted Goodwin. “If future research confirms these findings, investigating whether preventing or delaying first use of marijuana might reduce the risk of developing alcohol use disorders among some segments of the population may be worthwhile.”
Co-authors are Andrea Weinberger, Yeshiva University and Yale University School of Medicine; and Jonathan Platt, Mailman School of Public Health.

The study was supported by the National Institutes of Health/National Institute on Drug Abuse (grant R01-DA20892). https://www.mailman.columbia.edu/public-health-now/news/marijuana-smokers-five-times-more-likely-develop-alcohol-problem#sthash.PuhZAXLD.dpuf

The Drug Enforcement Agency (DEA) has a series of questions parents should ask http://www.getsmartaboutdrugs.com/content/default.aspx?pud=a8bcb6ee-523a-4909-9d76-928d956f3f91

If you suspect that your child has a substance abuse problem, you will have to seek help of some type. You will need a plan of action. The Partnership for a Drug Free America lists 7 Steps to Take and each step is explained at the site. http://www.drugfree.org/intervene
If your child has a substance abuse problem, both you and your child will need help. “One day at a time” is a famous recovery affirmation which you and your child will live the meaning. The road to recovery may be long or short, it will have twists and turns with one step forward and two steps back. In order to reach the goal of recovery, both parent and child must persevere.

Related:

University of Washington study: Heroin use among young suburban and rural non-traditional users on the
https://drwilda.com/2013/10/13/university-of-washington-study-heroin-use-among-young-suburban-and-rural-non-traditional-users-on-the-increase/

Resources

Adolescent Substance Abuse Knowledge Base
http://www.crchealth.com/troubled-teenagers/teenage-substance-abuse/adolescent-substance-abuse/signs-drug-use/

Warning Signs of Teen Drug Abuse
http://parentingteens.about.com/cs/drugsofabuse/a/driug_abuse20.htm?r=et

Is Your Teen Using?
http://www.drugfree.org/intervene

Al-Anon and Alateen
http://www.al-anon.alateen.org/

WEBMD: Parenting and Teen Substance Abuse
http://www.webmd.com/mental-health/tc/teen-substance-abuse-choosing-a-treatment-program-topic-overview

The U.S. Department of Health and Human Services has a very good booklet for families What is Substance Abuse Treatment?
http://store.samhsa.gov/home

The National Institute on Drug Abuse (NIDA) has a web site for teens and parents that teaches about drug abuse NIDA for Teens: The Science Behind Drug Abuse
http://teens.drugabuse.gov/

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COMMENTS FROM AN OLD BLACK FART: Drink and drugs make college kids STUPID

18 Oct

Here’s today’s COMMENT FROM AN OLD BLACK FART: We live in a society with few personal controls and even fewer people recognize boundaries which should govern their behavior and how they treat others. Aftab Ali wrote in the Independent article, Students more likely to have sex after using marijuana or binge drinking, according to US research:

Students are more likely to have sex on days they’ve used marijuana or binged* on alcohol, according to new research on intercourse and condom use while under the influence.

Professor of psychological science at Oregon State University (OSU) in the US, David Kerr, also found binge drinking and being in a serious dating relationship were linked with less condom use, which puts young adults at risk for sexually-transmitted infections (STIs) and unplanned pregnancies.

The findings – published in the Journal of Studies on Alcohol and Drugs – came to light after researchers recruited 284 students to report on their marijuana use, alcohol use, sexual activity, and condom use every day for 24 consecutive days.
According to the professor, two findings stood out. He said: “Students in serious relationships had almost 90 per cent of the sex reported in our study, but serious partners used a condom only a third of the time – compared to about half the time among single students. More frequent sex, plus less protection equals higher risk.”

The stereotypical image of students drinking and having casual sex is ‘real’, he added. However, in the OSU study, he said it was ‘striking’ how often those in serious relationships were putting their guard down, indicating how people may judge risks differently while under the influence….http://www.independent.co.uk/student/news/students-more-likely-to-have-sex-after-using-marijuana-or-binge-drinking-according-to-us-research-a6685676.html

For many college students, college brings more freedom and fewer restrictions than they may have been accustomed to during their high school years. Many college students are naive about the consequences that can arise from certain social situations. So parents when you are preparing to drop your children off at college, in addition to what type of frig or microwave to buy for the dorm room you need to have the following conversations:

1. Another candid conversation about sex, this conversation should be ongoing from when they were age appropriate children

2. Sexually transmitted diseases and pregnancy

3. Binge drinking and substance abuse

4. Personal safety issues such as always letting at least one person know where they are going

5. The college’s code of conduct

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American Academy of Pediatrics opposes drug testing in schools

5 Apr

Substance abuse is often a manifestation of other problems that child has either at home or poor social relations including low self esteem. Dr. Alan Leshner summarizes the reasons children use drugs in why do Sally and Johnny use drugs? http://archives.drugabuse.gov/Published_Articles/Sally.html The National Council on Alcohol and Drug Dependence lists Signs and Symptoms:

1. Physical and health warning signs of drug abuse
• Eyes that are bloodshot or pupils that are smaller or larger than normal.
• Frequent nosebleeds–could be related to snorted drugs (meth or cocaine).
• Changes in appetite or sleep patterns. Sudden weight loss or weight gain.
• Seizures without a history of epilepsy.
• Deterioration in personal grooming or physical appearance.
• Injuries/accidents and person won’t or can’t tell you how they got hurt.
• Unusual smells on breath, body, or clothing.
• Shakes, tremors, incoherent or slurred speech, impaired or unstable coordination.

2. Behavioral signs of drug abuse
• Drop in attendance and performance at work or school; loss of interest in extracurricular activities, hobbies, sports or exercise; decreased motivation.
• Complaints from co-workers, supervisors, teachers or classmates.
• Unusual or unexplained need for money or financial problems; borrowing or stealing; missing money or valuables.
• Silent, withdrawn, engaging in secretive or suspicious behaviors.
• Sudden change in relationships, friends, favorite hangouts, and hobbies.
• Frequently getting into trouble (arguments, fights, accidents, illegal activities).

3. Psychological warning signs of drug abuse
• Unexplained change in personality or attitude.
• Sudden mood changes, irritability, angry outbursts or laughing at nothing.
• Periods of unusual hyperactivity or agitation.
• Lack of motivation; inability to focus, appearing lethargic or “spaced out.”
• Appearing fearful, withdrawn, anxious, or paranoid, with no apparent reason.
Signs and symptoms of Drug Dependence:
Drug dependence involves all the symptoms of drug abuse, but also involves another element: physical dependence.
1. Tolerance: Tolerance means that, over time, you need more drugs to feel the same effects. Do they use more drugs now than they used before? Do they use more drugs than other people without showing obvious signs of intoxication?
2. Withdrawal: As the effect of the drugs wear off, the person may experience withdrawal symptoms: anxiety or jumpiness; shakiness or trembling; sweating, nausea and vomiting; insomnia; depression; irritability; fatigue or loss of appetite and headaches. Do they use drugs to steady the nerves, stop the shakes in the morning? Drug use to relieve or avoid withdrawal symptoms is a sign of addiction.
In severe cases, withdrawal from drugs can be life-threatening and involve hallucinations, confusion, seizures, fever, and agitation. These symptoms can be dangerous and should be managed by a physician specifically trained and experienced in dealing with addiction.
3. Loss of Control: Using more drugs than they wanted to, for longer than they intended, or despite telling themselves that they wouldn’t do it this time.
4. Desire to Stop, But Can’t: They have a persistent desire to cut down or stop their drug use, but all efforts to stop and stay stopped, have been unsuccessful.
5. Neglecting Other Activities: They are spending less time on activities that used to be important to them (hanging out with family and friends, exercising or going to the gym, pursuing hobbies or other interests) because of the use of drugs.
6. Drugs Take Up Greater Time, Energy and Focus: They spend a lot of time using drugs, thinking about it, or recovering from its effects. They have few, if any, interests, social or community involvements that don’t revolve around the use of drugs.
7. Continued Use Despite Negative Consequences: They continue to use drugs even though they know it’s causing problems. As an example, person may realize that their drug use is interfering with ability to do their job, is damaging their marriage, making problems worse, or causing health problems, but they continue to use…. https://ncadd.org/learn-about-drugs/signs-and-symptoms

Remember, these are very general signs, specific drugs, narcotics, and other substances may have different signs, it is important to know the specific signs.

Kathryn Doyle of Reuters wrote in Experts caution against random drug testing in schools:

Schools should not be using random drug tests to catch or deter drug abusers, the American Academy of Pediatrics advises in an updated policy statement.

The Academy recommends against school-based “suspicionless” drug testing in the new issue of the journal Pediatrics.

Identifying kids who use drugs and entering them into treatment programs should be a top priority, but there is little evidence that random drug testing helps accomplish this, said Dr. Sharon Levy, director of the adolescent substance abuse program at Boston Children’s Hospital and lead author of the new policy statement…

Scientifically, the best way to test the value of random drug tests would be to put some kids into a drug testing program and others not, in a single school, but practically, that is difficult to accomplish. Instead, researchers have compared schools with drug testing programs to similar schools without them – and found mixed results.

One study did find a short-term reduction in kids’ self-reported drug use at a school with random testing, but the kids were followed for a relatively short period and reductions in use applied only to the drugs included in the testing. This is a problem since most drug testing panels do not include alcohol, Levy said.
“It’s possible that you do get some prevention out of these programs, but on the other hand it seems very expensive, very invasive, and has pretty limited results,” she said.

Adolescent drug use is usually sporadic, so even a kid who does use illegal substances may easily pass a random annual test and then feel comfortable to use freely for the rest of the year, she said.

Drug tests can result in false positives, and even a true positive says nothing about frequency or quantity of drug use, according to Ken C. Winters of the psychiatry department at the University of Minnesota Medical School in Minneapolis, who is not in the AAP.
http://newsdaily.com/2015/03/experts-caution-against-random-drug-testing-in-schools/#eI8U6EOrbeuGbOZZ.99

Citation:

• From the American Academy of Pediatrics
Adolescent Drug Testing Policies in Schools
1. Sharon Levy, MD, MPH, FAAP,
2. Miriam Schizer, MD, MPH, FAAP,
3. COMMITTEE ON SUBSTANCE ABUSE
Abstract
More than a decade after the US Supreme Court established the legality of school-based drug testing, these programs remain controversial, and the evidence evaluating efficacy and risks is inconclusive. The objective of this technical report is to review the relevant literature that explores the benefits, risks, and costs of these programs.

Here is the AAP statement:

AAP Opposes In School Drug Testing Due to Lack of Evidence
3/30/2015
Drug testing can be useful for pediatricians and other health care providers to assess substance use or mental health disorders in adolescents, but random drug testing in schools is a controversial approach not recommended by the American Academy of Pediatrics (AAP).

In an updated policy statement and technical report, “Adolescent Drug Testing Policies in Schools,” in the April 2015 Pediatrics (published online March 30), the AAP encourages and supports the efforts of schools to identify and address student substance abuse, but recommends against the use of school-based drug testing programs, often called suspicionless or random drug testing.

Proponents of random drug testing refer to potential advantages such as students avoiding drug use because of the negative consequences associated with having a positive drug test results, while opponents of random drug testing agree that the disadvantages are much greater, and can include deterioration in the student-school relationship, confidentiality of students’ medical records, and mistakes in interpreting drug tests that can result in false-positive results.

The AAP recommends against the use of school-based drug testing programs because of limited evidence of efficacy and potential risks associated with this procedure. Pediatricians support the development of effective substance abuse services in schools, along with appropriate referral policies in place for adolescents struggling with substance abuse disorders.
# # #

The American Academy of Pediatrics is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.
https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Opposes-In-school-Drug-Testing-Due-to-Lack-of-Evidence.aspx

The National Institute on Drug Abuse (Institute) has some great information about drug testing. In Frequently Asked Questions About Drug Testing in Schools, the Institute discusses drug testing.

Why test teenagers at all?

Teens are especially vulnerable to drug abuse, when the brain and body are still developing. Most teens do not use drugs, but for those who do, it can lead to a wide range of adverse effects on the brain, the body, behavior and health.
Short term: Even a single use of an intoxicating drug can affect a person’s judgment and decisonmaking—resulting in accidents, poor performance in a school or sports activity, unplanned risky behavior, and the risk of overdosing.
Long term: Repeated drug abuse can lead to serious problems, such as poor academic outcomes, mood changes (depending on the drug: depression, anxiety, paranoia, psychosis), and social or family problems caused or worsened by drugs.
Repeated drug use can also lead to the disease of addiction. Studies show that the earlier a teen begins using drugs, the more likely he or she will develop a substance abuse problem or addiction. Conversely, if teens stay away from drugs while in high school, they are less likely to develop a substance abuse problem later in life….
Is random drug testing of students legal?
In June 2002, the U.S. Supreme Court broadened the authority of public schools to test students for illegal drugs. Voting 5 to 4 in Pottawatomie County v. Earls, the court ruled to allow random drug tests for all middle and high school students participating in competitive extracurricular activities. The ruling greatly expanded the scope of school drug testing, which previously had been allowed only for student athletes.
Just because the U.S. Supreme Court said student drug testing for adolescents in competitive extracurricular activities is constitutional, does that mean it is legal in my city or state?
A school or school district that is interested in adopting a student drug testing program should seek legal expertise so that it complies with all federal, state, and local laws. Individual state constitutions may dictate different legal thresholds for allowing student drug testing. Communities interested in starting student drug testing programs should become familiar with the law in their respective states to ensure proper compliance. http://www.drugabuse.gov/related-topics/drug-testing/faq-drug-testing-in-schools

The primary issue is whether students have privacy rights.

Your Debate.com summarizes the pros and cons of School Drug Testing:

PRO 1
The main purpose of random school drug testing is not to catch kids using drugs, it to keep them from ever using them. Once their using drugs its harder for them to break their addiction. With many employers drug testing its very important for a kid’s future not to use drugs. Drug use is responsible for many crimes. Its worth the inconvenience for all our future.
CON 2
One of the fundamental features of our legal system is that we are presumed innocent of any wrongdoing unless and until the government proves otherwise. Random drug testing of student athletes turns this presumption on its head, telling students that we assume they are using drugs until they prove to the contrary with a urine sample.
CON 3
“If school officials have reason to believe that a particular student is using drugs, they already have the power to require that student to submit to a drug test,” said ACLU-NJ Staff Attorney David Rocah.
CON 4
The constitutional prohibition against “unreasonable” searches also embodies the principle that merely belonging to a certain group is not a sufficient reason for a search, even if many members of that group are suspected of illegal activity. Thus, for example, even if it were true that most men with long hair were drug users, the police would not be free to stop all long haired men and search them for drugs.
PRO 5
Peer pressure is the greatest cause of kids trying drugs. If by testing the athletes or other school leaders, we can get them to say no to drugs, it will be easier for other kids to say no.
CON 6
Some also argue that students who aren’t doing anything wrong have nothing to fear. This ignores the fact that what they fear is not getting caught, but the loss of dignity and trust that the drug test represents. And we should all be afraid of government officials who believe that a righteous cause warrants setting aside bedrock constitutional protections. The lesson that our schools should be teaching is respect for the Constitution and for students’ dignity and privacy, not a willingness to treat cherished constitutional principles as mere platitudes. http://www.youdebate.com/DEBATES/school_drug_testing.HTM

See, What Are the Benefits of Drug Testing?http://www.livestrong.com/article/179407-what-are-the-benefits-of-drug-testing/

Substance abuse is often a manifestation of other problems that child has either at home or poor social relations including low self-esteem.

Resources:

Adolescent Substance Abuse Knowledge Base

http://www.crchealth.com/troubled-teenagers/teenage-substance-abuse/adolescent-substance-abuse/signs-drug-use/

Warning Signs of Teen Drug Abuse

http://parentingteens.about.com/cs/drugsofabuse/a/driug_abuse20.htm?r=et

Al-Anon and Alateen

http://al-anon.alateen.org/

National Clearinghouse for Drug and Alcohol Information

http://www.samhsa.gov/

The U.S. Department of Health and Human Services has a very good booklet for families What is Substance Abuse Treatment?

http://www.samhsa.gov/kap

The National Institute on Drug Abuse (NIDA) has a web site for teens and parents that teaches about drug abuse NIDA for Teens: The Science Behind Drug Abuse

http://teens.drugabuse.gov/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

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