Author: Parents must get tough on drug abuse

DuPont is a former director of the National Institute on Drug Abuse and was the head of the White House Special Action Office for Drug Abuse Prevention from 1973 to 1975. A graduate of Emory University and the Harvard Medical School, he is president of the American Council for Drug Education and has a private psychiatric practice, specializing in drug dependency. He lives in Chevy Chase, Md., and is the father of two teenagers.

In Atlanta last week, he spoke about the dangers of drug use and what parents can do:

Q: You use the term "Drug Dependence Syndrome" in your book. What does that mean?  

A: One of the great enemies in the drug field is to separate the drug experience into two parts: the early part known as social use and then another category labeled addiction or sick use. When you create those two, you create an incentive. You hold out hope that unless a person has some genetic factor or character defect, it's reasonable to shoot for this target of use.

What I've done is put the two together. What appears to be safe use is a step in a progression. That's very shocking because it means that the most important stage for drug abuse prevention is not the step between occasional use and dependence but between non-use and experimentation. That's where the entry really is. The Drug Dependence Syndrome is a unified process that begins with experimentation and ends with dependence.

Q: But just because someone smokes one marijuana cigarette doesn't mean he's going to become a drug addict.  

A: There are lots of people who either don't progress or who go to non-use. They use marijuana once and don't use it again or use it a few times and then stop. But the point is that everybody is at risk. By the time a young person reaches his or her senior year in high school, 25 percent of the people who have taken one puff (of marijuana) will have spent two years or more as daily smokers. To me, that is incredible risk.

Q: Who becomes dependent and who doesn't? 

A: Nobody knows. The dominant view is that something biological is going on, that something in them makes them more vulnerable. A view that a lot of psychiatrists have had is that it's some character trait, that people use the drug to treat some deficiency or bad feelings. But my view is different. The one who gets the problem is the one who is willing to use any of these drugs at a high enough dose to get intoxicated on a repeated basis. That's because these drugs affect the brain to produce pleasure on a pharmacological basis. That's the biggest mistake most observers of the drug scene make. They think it's a fad, like a hairstyle, and don't realize that what is happening is a very fundamental biological process.

Q: What age group is most vulnerable?  

A: Almost all drug use starts in the teenage years. The peak in the United States is age 15. Drug abuse prevention is a struggle that is almost limited to the ages 12 to 20. The goal is to get through those vulnerable years without using the drug. The likelihood of starting at a later age is small and gets smaller all the time.

Q: How much marijuana does a person have to smoke before he is physically harming himself?  

A: There appears to be some adverse effect even from relatively small amounts. But obviously the effects are related to the amount and duration of use. Kids ask, "What's wrong with doing it a couple of times a month? Am I going to be a burnout?" My answer to that is probably not. But you're probably not going to be able to do it just a couple of times a month. You're going to find this thing sneak up on you. It'll get to be more and more. Besides, even occasional use isn't safe. A friend of my daughter was dead by the age of 16 because of marijuana use. She wandered in front of a car while she was stoned. She wasn't addicted. But that was that one day, and she was dead.

Q: What are the signs of a drug problem that a parent should look for?  

A: I think all parents should be suspicious. The biggest problem with parents is that they don't believe their kid would have a drug or alcohol problem. They're into denial.

For a period of time, between a few months and a couple of years, there is going to be no sign at all. It's a silent problem. But then the first part to be affected is extracurricular, achievement-oriented kind of activities, such as playing the piano or being on an athletic team - anything that requires extra effort. You'll also see changes in who your children's friends are. They'll drop their longstanding friends and take up with kids who have anti-adult attitudes.

The next step is that they get difficult for parents to deal with. They become rebellious and resentful. In the third stage, school performance fails. They get C's and D's where they formerly got B's. They'll say it's because they're not interested. As drug use continues, you get the malignant signs - missing money, violence in the home, aggressive activity. This is a progression. If parents don't intervene, there's a high probability it will just keep going.

Q: How should parents handle a teenage alcohol or drug problem?  

A: What I would suggest is an interventionist strategy that is only as much as is necessary to get a result. You start little and add if the problem isn't solved. The place to start is in the family itself by sitting down in a quiet, unfrightened but concerned way and deal with the problem directly. The parents need to think it through and do what they need to do. If that doesn't work, the next step for a teenage problem is the parent peer group. Get together with some other parents and talk about your concerns. PRIDE (Parent Resources and Information on Drug Education) here in town can help identify a support group. If that doesn't work, then I think you're talking about some kind of outpatient treatment program. The final step is inpatient or residential treatment. That's when the problem has gotten out of hand.

Let me say something here about psychotherapy. As long as the person is continuing to use drugs or alcohol, psychotherapy in the traditional sense is useless. And it may actually be negative because it gives the appearance of dealing with the problem without the substance of it. It can give the drug user a reason to use drugs - for instance, 'I'm using drugs because my parents were divorced when I was 6' - and all that kind of attribution is negative. Once a person is drug-free, then psychotherapy can be very helpful.

Q: How can parents help prevent a drug problem?  

A: Parents need to be clear about what they expect of their kids. They need to say it in words: "Here is where I stand." They need to be clear about the consequences. "If you do X, there will be adverse consequences." Parents need to get across that they're going to do whatever it takes to keep the person drug-free.

Q: What can parents say about alcohol, when so many parents drink?  

A: Alcohol is the toughest problem. The parents need to focus on the law. (The legal drinking age in Georgia is 19.) Whether you like it or not, the law applies to everybody. The drinking age is the community standard just like the speed limit.

Q: In your book, you talk about parents "enabling" their children in their drug use. What do you mean?  

A: Parents have a very big problem because they love their kids. They want to have open communication with them and have peace and tranquility in the home. For all these reasons, the parents are apt to intervene in a way that actually promotes the kid's drug use. For example, I know a 30-year-old guy who has a serious problem with alcohol and cocaine. He's had all kinds of terrible things happen to him, and his parents are talking about getting him a job, buying him a car, paying his rent. They say he's not going to make it otherwise. They feel very sorry for him. I tell them they've been doing this for him for 15 years and it's how he got where he is. But they cannot face it.

By taking away the painful consequences of the young person's drug use, parents rob the experience of its educational value. What parents ought to do is exactly the opposite - they ought to add negative consequences to the drug use instead of subtracting them. But for a lot of parents, that is more than they can understand.