Howard Markel, MD, PhD


April 29, 2005

On March 29, the National Center on Addiction and Substance Abuse (CASA) at Columbia University released a comprehensive "white paper" documenting some alarming health risks and an epidemic in the making. Specifically, parents who use illegal drugs, abuse alcohol, and use tobacco put 50% of the nation's children -- more than 35 million of them -- at increased risk of substance abuse and of physical and mental illness.[1]

Joseph A. Califano, the center's chairman and president, and former U.S. Secretary of Health, Education and Welfare, astutely remarked what every pediatrician knows and needs to remind their patients' parents about disease prevention: "Kids don't read their parents' lips, they watch their parents' actions. That's what makes the findings in this study such a tragedy."

Tragic, indeed. Here's just a sampling of the data every pediatrician needs to know about and incorporate into his or her bag of diagnostic tricks.

  • 13% of children under 18 years of age in the United States live in a household where a parent or other adult uses illicit drugs.

  • 24% of children live in a household where a parent or other adults is a binge drinker or heavy drinker.

  • 37% of children live in a household where a parent or other adult uses tobacco.

The CASA paper also documented that parents who abuse alcohol or illicit drugs are 3 times more likely to abuse their children and 4 times likelier to neglect them than parents who do not abuse these substances. To make matters even worse, these children are at increased risk of suffering from physical injuries, illnesses, and academic failure. They are also more likely to experience depression, conduct disorders, or anxiety, which in turn can propel them to use mind-altering substances as a means of self-medicating the symptoms accompanying these mental health problems.

And let us not forget tobacco. Second-hand smoke increases the risk of sudden infant death syndrome, asthma, and ear, tonsil, and adenoid infections. And we cannot even begin to predict how many children will develop cancer or heart problems from long-term exposure to second-hand smoke.

"Too many parents set examples that increase the risk their children will smoke, use illegal drugs and abuse alcohol. Children of substance-abusing parents are much likelier to become substance abusers themselves," said Califano. "The good news is that parents who behave responsibly -- who don't smoke, abuse alcohol, or use illegal drugs -- have a positive influence on their children, steering them away from substance abuse," he added.

Toward that end, there are plenty of superb Web sites we can send parents to for additional advice on substance abuse information. Besides the CASA Web site,[1] which has 2 parent guides on preventing and recognizing teen substance abuse, anyone can gain solid information by accessing the National Institute for Drug Abuse,[2] Centers for Disease Control and Prevention,[3] and the Partnership for a Drug-Free America,[4] to name but a few.

Every pediatrician and children's health professional of the 21st century must incorporate this body of knowledge into their armamentarium of anticipatory guidance. Califano noted that studies conducted by his think tank indicate that 9 out of 10 primary care doctors fail to diagnose substance abuse in patients who display classic symptoms of the problem. As a result of this failure, it is imperative that our medical schools and residency programs dedicate more hours of formal instruction on the prevention, diagnosis, and treatment of substance abuse.

We also need to expand the insurance coverage for substance abuse problems -- through the thicket of Medicare, Medicaid, private insurers, and managed care organizations charged with covering millions of Americans' health. Some lawmakers have even suggested we may need legal accountability statutes for physicians who fail to diagnose substance abuse or addiction and neglect to encourage their patients to seek help.

And every parent needs to take the following basic but critical steps with their children daily:

  • set a good example in terms of his or her own use of these substances;

  • know the child's whereabouts;

  • eat at least 1 meal a day together;

  • set fair and consistent rules;

  • be caring, loving, spiritually nurturing, and supportive;

  • maintain open lines of communication;

  • surround the child with positive role models;

  • learn the signs and symptoms of teen substance abuse as well as the conditions that increase those risks; and, most importantly,

  • be prepared to act promptly if substance abuse problems occur.

These measures are not so simple, but may well prove to be the most potent medicine in what is rapidly becoming the epidemic of our era.


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