How do I know whether my child is just experimenting with alcohol and drugs or has a real problem with them?

More than 90% of children will have tried alcohol by the time they have graduated high school, which makes experimentation with alcohol a fairly normal experience. Most young people are mature enough to recognize that heavy alcohol use is neither pleasurable nor in tune with their goals for pursuing jobs, families, or higher education. The children who get into trouble with alcohol are those who have begun to pursue it as an end in itself. As a result, school and family life suffer, and these children begin to associate only with themselves or other children with similar problems. If an adolescent is caught using substances, acknowledges it, and is otherwise showing no problems with school, family, or friends, then the likelihood he or she has a substance alcohol abuse disorder is low.

Table 16 Centers for Disease Control Criteria for FASD

Low, however, does not mean nonexistent, and some degree of vigilance must be maintained. Other risk factors raise one's suspicion, regardless of school or home life. Individual risk factors include other psychiatric disorders, such as ADHD, specific temperamental traits such as an interest in novelty seeking, irritability, impulsivity, and high motor activity. Other risk factors include a family history of alcoholism or substance abuse, a lack of parental attachment, or parents who have a generally permissive management style. Children who bond more quickly to peers at an earlier age and follow their lead rather than their parents are also at greater risk. Finally, other environmental risk factors include lower socioeconomic status and neighborhoods that have higher crime rates. Accidents with automobiles, bicycles, and even skateboards should raise one's degree of suspicion that alcohol or other drug use was involved. Other red flags include unsafe sexual activity or being a victim or perpetrator of a violent act.

How old do my children need to be before I start talking to them about alcohol?

You should talk to them as early as possible but should take into consideration the developmental level of the child. Often parents make the mistake of waiting until their children are driving or in high school to talk about drugs, tobacco, and alcohol. By then it may be too late to prevent a serious accident or perhaps addiction. Parents should keep the communication open and ongoing; otherwise, children will go elsewhere to get their questions answered. The answers from their peers are usually erroneous. The following are guidelines that include (1) some basic principles, (2) facts that parents should know, (3) tips for helping children cope with life's stressors, and (4) suggestions for parents that are age appropriate for each developmental level.

Often parents make the mistake of waiting until their children are driving or in high school to talk about drugs, tobacco, and alcohol.

Guidelines For Parents

1. Basic principles on discussing drug and alcohol use with your children

• Listen to your child. Start talking early. Seek your child's opinions about tobacco, alcohol, and drug use. Share your own opinions. Find out what they are learning in school and in the neighborhood and from their teachers, other children, and their own experiences. Ask children about what they think.

• Be a good example. Drink responsibly or not at all. Role modeling is a more powerful teaching tool than talking. Children do what their parents do — not what their parents say.

• Keep communication open. Start talking to your children about tobacco, alcohol, and drugs when they are young. If you find it difficult to talk to your child about substance use and abuse, you are not alone. Ask your doctor or pediatrician to discuss drug use with your child. Pamphlets are helpful. Give them to your child as a starting point for discussion. Encourage school officials to institute tobacco, drug, and alcohol-prevention programs.

• Immunize your children against drug and alcohol abuse. Parents have their children inoculated against measles and mumps at an early age. Parents also need to immunize their children at an early age against tobacco, drugs, and alcohol use by giving them the facts.

2. Facts parents should know

• Many children have tried to use alcohol or drugs before high school. Fifty percent of fourth through sixth graders report being pressured by peers to try alcohol. The average age when a child takes his or her first drink is about 12 years, which is the sixth or seventh grade. A 1998 Washington State Survey found that among sixth graders half of those who drank got their alcohol at home and their parents knew about it.

• The younger a person starts drinking alcohol, the higher the risk for dependence in later years.

• Drinking alcohol before the brain is fully developed may cause damage to the areas of the brain responsible for learning and memory.

• Alcohol affects judgment and decision making.

• The leading cause of teenage injury and death is alcohol related.

• Beer and wine are not safer than "hard" liquor.

3. Tips for helping children cope with life's stressors

• Tell the truth. Provide the facts. Do not exaggerate.

• Reassure children and allow them to express their feelings. Feelings are okay. You want your children to turn to you, not to a substance, when they are upset in order to feel better. Make sure they know that they are safe and loved.

• Make rules for your household clear; if the rules are broken, make the consequences explicit. Consequences should be appropriate to the misdeed. Remember rules for children convey the message that you love them and care about them.

• Do not threaten.

• Provide opportunities for activities that are alcohol free such as sports, theater, and music. Whenever possible, go to the child's sports and school events. Get to know their friends and the parents of their friends.

• Know where your children are and what activities they are doing.

• Create ways for "family togetherness," doing healthy activities.

• Freely offer praise. Take advantage of every opportunity to build a child's social and physical skills, which will enhance his or her self-confidence.

• Confidence helps children handle difficult situations without turning to a substance to cope.

4. Suggestions for parents that are age appropriate for each developmental level

a. Preschoolers

• Very young children are not ready for the facts about alcohol or other drugs, but they are ready to learn how to make decisions and how to solve a problem. For example, allow them to pick out their own clothes. Support their decisions. Let them help you around the house and thank them for their help.

• Parents can provide a good example for their children by exercising and eating healthy foods. Provide opportunities to eat with your child and to play with your child. Do healthy activities together, such as playing ball, swimming, or biking.

• Watch television with your children, and talk about the advertising messages. Ask your children questions about what they think of the ads.

• Monitor what your children watch on television. If a child sees something on a television show about drugs, alcohol, or tobacco and has questions, be available to listen to his or her concerns and answer questions.

• If there is an antidrug commercial on television or on a billboard or elsewhere, reinforce the message "just say no."

• When giving a child medicine during an illness, the parent can use this opportunity to teach a child about using the appropriate amount for the moment and the dangers of having too much medicine at one time.

b. Ages 5-7

• Children this age learn mostly by experience. Conversations should involve experiences or events that children are familiar with, such as what they have seen on television or what they have observed at home or other places.

• Teach your child about how the body works and why every person needs good food, clean water, and exercise. Teach them the importance of avoiding eating and drinking foods or substances that are not healthy.

• Inform your child in simple terms that alcohol can hurt the body by altering the way it makes you feel, the way you can see, and the way you think because it impacts the brain and makes changes in other parts of the body. Tell them it can make them sick and might make them feel like they had the flu with a headache, nausea, and vomiting.

• Children love stories at this age. Telling the facts in story form may be more interesting and provide a more powerful message to grade school children.

c. Ages 8-12

• Invite questions. Ask your child what he or she knows about drugs and alcohol. If parents start giving the message to children early that they are available to talk about touchy subjects, children will be more open in the future to come to the parents about their concerns.

Ask the child about what his or her friends know about alcohol or drugs.

• Start talking about facts, such as the long- and short-term effects and the consequences of using alcohol. Teach children why alcohol is especially dangerous for them when they are young because of the impact of alcohol on the developing brain.

• Teach children to say no to peer pressure. Practice with them on how to say no. Reassure your child that he or she can say no without losing friends.

• At this age, children are influenced by their friends. Be sure to meet their friends and families and know what the children are doing when they visit one of their friends. Discuss the rules of the house at their friends' homes and compare them with your rules. Discuss the differences.

• News items, such as steroid use in professional sports, can be the stimulus for conversations about tobacco, drugs, and alcohol use.

d. Ages 13-17

• This is the age when children start experimenting with alcohol or drugs.

• Continue to make your expectations clear and encourage the teen to come to you for help or to answer questions.

• By now, children should know what the rules are and what the parents think about the use and abuse of tobacco, alcohol, and drugs.

• Focus on keeping the lines of communication open. Ask your child about their attitudes and their friends' attitudes. Teens are more apt to want privacy. You can help the relationship remain open by showing your respect, love, and concern. Avoid preaching or threatening. Remain nonjudgmental.

• Teenagers strive for independence and thus often participate in risky behaviors. Know what your child is doing. Warn him or her of any dangers.

• Parents should encourage their children to invite friends to their home; however, do not permit any alcohol or drugs in the home.

• By 16 years old, most children are driving. It's a good idea to develop a written or unwritten contract on the conditions for using the car.

• Discuss the rules about cars and drinking: (1) Do not drink and drive. (2) Do not get into a car with a driver who has been drinking. (3) Do call home to have parents come to get you and your friends, rather than driving home with someone who has been drinking.

• Review how to say no to tobacco, drugs, and alcohol or other risky behaviors.

• Teach children to ask questions before ingesting anything that is an unknown.

• When in any uncomfortable situation, encourage the teenager to call home. Praise him or her for good judgment.

e. Tips for helping teens to say "no"

• Say it like you mean it.

• You don't have to give excuses. "No" is enough of a reason.

• Suggest doing something different.

• If you continue to get pressured, walk away.

No family is immune to the effects of the alcohol and drug culture in our society. Some of the best children from the best homes can end up in trouble. Be involved in your children's lives. Parents should recognize when a child is having a difficult time so that the parents can support the child if needed. Seek additional help for the troubled child through participation in a drug program, counseling, or accessing other resources. Parents should elicit the school's assistance and other community organizations to provide a healthy community in which to raise a child. A supportive family, school, and community environment working together is the best for tobacco, drug, and alcohol prevention.

No family is immune to the effects of the alcohol and drug culture in our society. Some of the best children from the best homes can end up in trouble.