With Child, With Alcohol

With Child, With Alcohol

Alcohol addiction : Portrait of a lonely and desperate drunk hispanic woman (image focused on her drink)

By Liv Spikes

At five-and-a-half months pregnant, the golden fluid flooded my body with a warm calm. I loved that feeling; I missed that feeling. My head swelled with the sense that everything was all right, now, in that moment. The drink was my insulin, it righted me, made me level. Giving myself permission to have a drink after all that time was like scratching at a scab, and once I started, an itch kicked in and I became singularly focused on ripping the whole thing off. I guess I’d forgotten that.

It was the night of my annual work Christmas party. I started closing up the fine art gallery I managed, when it occurred to me to pour myself one of the single serving bottles of wine we kept in the fridge for clients, and on occasion, the staff. It’s my company party, I thought. I deserve a glass. I poured one of the 6oz bottles into a clear plastic cup and sipped it as I counted the daily deposit.

Having a drink always felt like taking off stilettos that were half a size too small. Ahhh, my brain said after the first gulp. Now that’s better.

On my way home to change outfits and pick up my husband for the party the thought popped in my head that I should stop by the liquor store to get Jason a six-pack so he could enjoy a pre-party beer while I layered on eye make-up and perfume. And since I was there, I decided I should get myself a single serving bottle of champagne because two drinks were probably no big deal, and it was my party after all, and once I got to the party I wouldn’t be able  have anything to drink with the rest of the staff. In years past, I was the notoriously wasted, the manager who overdrank, and overshared.

Jason drank his beer and watched CNN. I decided on tight denim maternity trousers, a navy sequin tank, and a cropped navy wrap sweater. I sipped champagne while curling my hair and by the time we loaded into the car, my tummy filled only with amber bubbles was warm, I was comfortably buzzed, cozy in my adorable pregnant body.

When we arrived, the mingling staff were holding cocktails; they had eaten nearly all the baby quiches and warm brie laid out for them. Having promised to  announce the sex of the baby to them, I waited all of six minutes before tapping on my boss’ glass and saying, “Well guys, I’ve kept you guessing long enough. Jason and I are having a….BOY!” My coworkers clapped and a few even said “Ahh,” with damp eyes. Jason hugged me sideways and we made our way around the room smiling and accepting everyone’s congratulations.

“Livi!” our office manager Chrissy said, “Come here. I want you to meet Rosie.” Jason and I separated and I made my way to the bar next to Chrissy.

Rosie was a petite blonde woman standing behind the bar pouring wine. “Rosie is pregnant with her second boy,” Chrissy said.

I stood on my tip toes to get a total body look at the expecting bartender. Her belly was no bigger than mine, though her baby was due two months sooner.

“Aren’t you adorable?!” I said, as though Rosie was a little girl in a Halloween costume. She responded with a chuckle and in her charming British accent said, “Well I don’t feel adorable at the moment, but thanks.”

Chrissy and I made our way over to the gift table to scope out the presents up for exchange. Still feeling airy, and a little uninhibited, I said to her, “I wish you wouldn’t have introduced me as a fellow pregnant lady, now there’s no way Rosie’s gonna give me a glass of wine and I wanted to have one.”

She looked befuddled and said, “Course she will. She’s back there drinking

Champagne!” Delighted to have a fellow pregnancy rule-bucker on my side, I said, “Then go get me a glass! But please, find a way to make it discreet.”

My boss joined me near the gift table as Chrissy headed off on her secret mission. I spotted Jason across the room graciously chatting with our notoriously awkward frame shop worker. I watched the gentle tip of my husband’s head and thought, I love that man.

“Your hot tea little mama,” Rosie said in her accent as she handed me a white porcelain mug brimming with white wine. She winked as she passes it off to me.

“You’re a life saver,” I said. “Honestly Rosie, I was born in the wrong era.” I slid into my well-rehearsed routine about how I should have been born in the Mad Men era when women wore polka dot dresses and celebrated positive pregnancy tests with martinis.

“Oh, honey. You weren’t born in the wrong era, just the wrong country,” and with that, she returned to tend her bar.

After that exchange my memory of the night grows fuzzy. I remember standing in line for the buffet food. I watched in slow motion as Jason mistook the thick balsamic dressing for gravy and smothered his potatoes, pork loin, and dry role in it. I thought that was the funniest thing I’d ever seen. The food was horrible, so bad that aside from a few bites of cold beet salad, I left the majority of it on my plate, untouched.

I didn’t mean to, I never meant to. If this were a court case and intent was linked to culpability I’d get off scot-free. Over-drinking wasn’t something I ever set out to do, it’s just what happened whenever I had a drink. The obvious solution was to avoid drinking. I know that now and I knew it on some level then. But I couldn’t; I couldn’t leave the one thing alone that made me feel so much better in the short term and so much worse in the long term.

I awoke at 2:30 and discovered I was alone in our bed, lying on a bath towel, wearing only my bra and underwear. I found this strange. The carpet on the side of the bed was a darker shade of green than the rest. I felt thirsty. I went into the bathroom. My sparkly pregnancy tank and secret fit belly panel jeans lay on the floor in a heap, vomit trailing down the front of everything. The horror I felt was unmatched—incomprehensible.

I looked in the mirror and a puffy-faced, puffy-bellied alcoholic stared back at me. There was no other explanation; no way around the definition I’d been dodging for a decade. I thought for a moment that I may actually understand why cutters tear into their wrists with razor-blades; I could intellectually understand the need to convert internal pain to an alarming external statement.

I started piecing together the familiar scenario: I didn’t drink the one glass of wine I had intended to drink at the company Christmas party. I drank from a bottomless white coffee mug that Rosie ensured was never empty.

My husband got me home. Somewhere along the way, I vomited on myself. He tried to get me to stay in the bathroom, but I insisted on going to bed where I continued vomiting. I have done this to him dozens of times before, I have never done this while carrying his unborn son.

My breath quickened, I felt a throbbing anxiety. I ran down the stairs and found him sleeping on the couch. I sat next to him on the floor and shook him as gently as I could until he awoke. When his eyes were half-open, I started crying.

“I am so sorry. So very, very sorry. I don’t know what happened. Please come back to bed with me. Please. I am so sorry”

“Don’t tell me: tell that to our baby.”

The gravity of this statement didn’t resonate until later–how could it? I was too focused on getting him to comfort me, to lie by me in the hopes that his mere physical proximity would alleviate the horror of being in my skin. I kept begging; I declared I wouldn’t leave his side until he came back to bed. I said the words “please” and “sorry” over and over, knowing on some level that they had lost all meaning for him.

This was our dance. The dance I forced on him. We went out, we drank, I drank more, I blacked out. Sometimes I talked in circles until he wanted to smother me with a pillow, other times, I insisted on having numb sex for hours always proclaiming I was “almost there”, often, I picked fights with him, mean fights with below-the-belt punches. Fueled by vodka, I let him know he wasn’t making enough money and that our life was not the life I had imagined. Puking–on him, or off the side of the bed–was my typical indicator that this scene in our personal rendering of Who’s Afraid of Virginia Wolf was over. The curtain fell for the evening.

Whenever I regained enough consciousness to realize what I’d done, always I started in with the pleading, begging him not to be mad at me. I imagine he heard only, “I’m so window, so very door knob for what happened last night.” You do something enough times to a person and I suspect the word “sorry” sounds as much like an abstract inanimate object as a meaningful phrase.

I lay on the floor next to him for over an hour.  I felt like bugs had taken up residence beneath my skin and were scrambling in different directions. My head throbbed its familiar ache. I found myself adding up the prenatal vitamins, sleep aids, migraine meds, and over-the-counter cough syrup down the hall in the medicine cabinet, wondering if it would be enough.

I thought about the cautionary articles I’d read about drinking during pregnancy, articles describing how quickly alcohol crosses into the placenta: if you are buzzed, your baby is wasted. I wondered what level of drunkenness was beyond wasted, what my son must have felt like floating in his drunken caretaker’s middle. The fear was crushing.

I also wondered, only briefly, if my binge or subsequent vomiting could have killed him, but I could only stand the thought of my dead fetus inside me for a few seconds.  More horrible thoughts swirled around like the blizzard created by shaking a fragile snow globe, and I wanted to throw the globe against the wall and shatter it into a million pieces.

There are tragedies you can try on for size: horrible circumstances you can contemplate like, what if my spouse were killed in an accident? Or, what if our house caught fire when we weren’t home and everything burned to the ground? Our minds allow for this. But the one tragedy I was incapable of thinking about was the one in my head at that moment: What if my behavior, my choices, caused irreparable damage to my baby? What if he’s born with Fetal Alcohol Syndrome (FAS), something completely preventable, that I caused? I thought of moms at the grocery store shopping with their nine- year-old special needs kids holding onto the cart, and how we cant our heads and think, that poor woman.  What if I made my own almond-eyed boy, except rather than a genetic blip, his condition was caused by me, my actions. There is no pity for this woman, no forgiveness, no do-over.

I want to tell you that was the last time I ever drank. I want to “tell the truth but tell it slant,” and have that lie define my bottom, contain the messy and enigmatic disease of alcoholism; I want to make this story the trampoline beneath the high rise: There. Good came of it. I was saved.

Knowing I was an alcoholic wasn’t enough and neither was the degradation I felt that night. I can’t explain that, can’t swirl together pretty enough words to answer the nagging question of why I couldn’t fully surrender even in the midst of that pain.

When my next ultrasound indicated the baby was developing normally, and the shallow distance of a few weeks separated me from the Christmas party, I drank again. I drank two or three glasses of wine on several more occasions during my pregnancy. Is that true, was it only two or three? I didn’t vomit or blackout again, but in terms of quantifying my consumption, I’m hardly a reliable source.

The horror and disgust of that night blurred with passing days like a car accident in my rearview mirror. It wasn’t my fault, it was Rosie’s. I won’t have more than three, no matter what. It’s just that I didn’t eat enough. Yeah, but…. All alcoholic lies strung together in my diseased brain’s effort to defend my right to drink, to rationalize irrational behavior. This is what addicts do. We forget, we minimize, and we honestly believe the shame of a previous fiasco will insulate us from the next one. And then, we do it all over again.

My son was born on his due date and pronounced healthy. He bore no visible markers of a baby with FAS; I know because I’ve now studied it at length. It’s a dose-dependent syndrome and spectrum disorder, and no one knows just how much alcohol is safe.

When he was four-months-old I got confronted by a daycare worker when I came to get him after work. Another mom smelled alcohol on my breath when I passed her in the hallway and she reported it right away. I could tell you I just had a few glasses of champagne with some clients before leaving work, but that doesn’t change the facts.  It was another Lifetime Movie kind of moment. A moment that begged the question, Is this who I am now? Am I the mom who got drunk during pregnancy and who the daycare worker isn’t sure about releasing an infant to? My infant.

My drinking career is littered with these. I line them up in my head like landmarks on a cross-country tour, places I stop to take horrific Polaroid’s in my mind’s eye. The first time I drank I blacked out. I got so drunk on a college graduation trip in Hawaii that some guy delivered me to the doorstep of the room I was sharing with girlfriends, rang the doorbell, and left. When they opened the door, I was covered in sand and two cockroaches crawled out of my hair. I will never know where I’d been or what had happened. I got so drunk the night before my wedding that I peed in a hotel elevator; I got up the next morning, vomited, and had a mimosa. I have dozens and dozens of these snapshots stashed in my gray matter, experiences that would rationally define a bottom for an alcoholic. But none of them are the smoking gun for my sobriety, and I’ve got a few years now.

“Rational” and “alcoholic” have no business commingling in a sentence. I got my fetus drunk.

I have shameful memories of the more generic and even humorous variety like lots of women do, college snafu’s and stories of being cut-off at the bar.  Buried beneath those stories– beneath sheets of denial and layers of rationalization–are the stories I tell only a few women, stories I’d prefer not to share because saying the words out loud makes me feel like I’m standing naked beneath halogen lights in the cold. This story makes me feel ugly and dirty; it makes me want to throw rotten fruit at myself or spit at the reflection in the mirror. I hate this woman. I live with the odium that I jeopardized my baby; ironically, during the only time in his life I could completely control his environment.

When I get the courage to share the ugliness, a dark beauty unfolds. In the five years since this happened, I have shared this story a few times in the safety of a women’s recovery meeting. Not because I’m under an illusion that it might help prevent another woman from doing the same thing; it won’t. And not because I find it “therapeutic” to revisit the worst night of my life; I don’t. I share it sometimes because when I unfold the ugliest in me, it gives other women permission to unveil the ugliest in them. And there, with our worst sins splayed out on the floor, we can experience the intimacy of empathy. When I tell this story, some women cannot stop their faces from puckering, because repulsion is a visceral emotion, and I don’t fault them for that. But always after the telling, I talk with a woman who opens up about her own alcoholism colliding with pregnancy, breastfeeding, or motherhood at large.

In this one-on-one connection, the shared humiliation and humanity of my biggest screw up makes another struggling mom feel less lonely in her own, and that does help. It eases the isolating loneliness and the ache of regret. We share stories and through those I see that really good people make really big mistakes, and the alcoholism is a take-no-prisoners disease that you can’t outrun, outsmart, or outgrow.

These are not the glossy magazine stories of the follies of motherhood, of even the follies of drinking and motherhood (“My daughter calls my wine glass mommy’s sippy cup!” ha ha ha). These are the tales we swear we’ll never utter to a soul. The moments we hope God himself didn’t see. There is no “healing” from this shame. There is only time, and the slow cool comfort of taking right action.

My son tests at the top of his Kindergarten class. He is well adjusted and has no behavioral problems. His eyelashes curl all the way to his brows, they clump together when he cries. His enunciation of words is exaggerated and his delivery of sentences is emphatic, like a mini-Jerry Seinfeld.  He is too big to cradle in my arms; his legs and torso have grown long in the few years since his birth. I watch him sleep sometimes at night and like all parents and I wonder how he got so big, how this person grew from a cluster of cells to a sentient being on my watch, under my care. I remember not wanting that responsibility, feeling burdened by it.  I knew my husband was better qualified to insulate and incubate him and I couldn’t hand him off, couldn’t leave the egg in the nest and have him sit on it for me while I went to the bar.

My husband is a logical man, he isn’t one for lyrical declarations. I told him several years ago that I needed to really apologize once and for all for many of the things I did drinking. He chuckled an exhausted sort of huff and said simply, “I don’t want you to apologize. Just quit doing it.”

“Sorry” is defined as, “feeling sorrow or regret”. It is a feeling, and the problem with that word is that it offers no call to action, no promise of restitution. In his early infancy when I was still drinking I whispered I was sorry to my baby boy as he lay sleeping in his crib. I did it nearly every night. I thought I meant it, because I felt horrible about continuing to drink, I just couldn’t yet will myself to take the necessary action to quit. And unless you happen to be an alcoholic, that probably doesn’t make any sense.

I no longer whisper that I’m sorry to him. These days, I focus on making constant and consistent amends for what I did. To amend is, “to put right.” I try to right that wrong by giving him a sober mom, which is what he deserves and frankly, the only shot I’ve got at living without the crippling shame a drunk mother incurs.

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Do You Lock Up Your Liquor Cabinet?

Do You Lock Up Your Liquor Cabinet?

different bottles and glasses of alcoholic drinks isolated on a white background

By Vicki Doronina

I read it often, this time in a parenting journal: “If you have a teenage child, lock your liquor cabinet.

Well, I’m not going to put a lock on it: Not the cabinet, or in our case, the cupboard. Our bar is stored in a kitchen cupboard: gin and tequila for me, rum and brandy for my husband. There’s no list – or lock – attached to the cabinet. No form of accountability. We don’t sign in and sign out.

As a biologist, knowing that alcoholism is often hereditary, I should worry. I do worry: There are plenty of people in our extended family who qualify as alcoholics. But my husband and I are casual drinkers. Still, I  am on constant watch to prevent over-drinking – not that I have desire to drink daily but in my forties I did start drinking hard liquor verses wine and beer (see above contents of cabinet).

I just don’t think that locking the drinks cabinet is the best way to prevent my son from drinking. If a teenager desperately wants a drink, no lock or clever hiding place will stop him/her. Prevention comes, I think, from preparing a teen to make smart choices, and in the case of drinking, perhaps taking away the temptation–the mystique.

Just think about forbidden fruit and all that jazz. When our 14-year-old son is visibly interested in what we are drinking, he is offered a taste. So far, he has not liked any of what he has sipped and I think he puzzles over the fuss. It’s as if he’s thinking; “What’s the big deal?”

I don’t doubt that he’ll try alcohol — one drink or many — under peer pressure, which many of his classmates already do. But perhaps if he tries a drink at home, it will lessen his desire to drink. Maybe if he has a sip of the good stuff, it will prevent him from over-imbibing the cheap stuff purchased by teens in dusty dorm rooms. Perhaps it would be like giving him a good, hand-grinded bean coffee, to attempt to deter him from cheap energy drinks.

We’ve talked to our son, and I hope, taught him to be smart about his health and well being. From his early childhood we rationed two things he likes a lot – cheese crisps and Pepsi. Again, as a biologist I know that these two items are not the healthiest food, so I have always given my son a quota of one bag of chips and one can of soda per week. We always have a supply of both, and my son has never indulged, which gives me hope that he’ll be sensible about alcohol as well. In talking with him, and explaining the dangers, in taking away the mystique, and allowing small sips of quality alcohol to deter his curiosity, I hope we’ve set him on the right track.

Of course, I cannot exclude that as a part of teenage rebellion or heartbreak he may not listen to our alcohol admonitions or deeply consider our dinner table discussions. In the end a parent can’t totally prevent a child from drinking. And lock and key won’t prevent it either.

Vicki Doronina is a recovering scientist, a veteran of Living Together Apart (LTA) and a mother of one red-haired teen. Originally from Belarus, she works and lives in Manchester, UK. Her writing appeared in Science (Careers), The Scientist, Her View From Home, Soapbox Writers and biotech blogs as well as in Russian and Belarusian media outlets. She can be found online at her blog and twitter.

 

 

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Parenting With a Drink in My Hand

Parenting With a Drink in My Hand

By Jessica Zucker

Screen Shot 2015-07-19 at 1.05.51 PM

“Mama, put down your beer so we can play tag!” says my son, alerting me to the fact that the drink in my hand is not only being noticed by my 6-year-old but might also be informing his idea of leisure.

It wasn’t until I became a mother that beer became a dear friend of my fridge.

I don’t drink to get drunk, I rarely if ever have more than one or two beers, and it’s not like my IPA intake impacts my overall functioning. But what it does do, in those final hours before my children go to bed, is punctuate my adulthood in a world of diaper changing, Pokemon cards, and pasta sauce stained ceilings. It provides me with my own personal pause button, calming the mood.

When I talk about beer, I’m not referring to just any beer. I mean the rich, warm-noted kinds that hug the belly and enliven the throat on their way down. These ones make a robust statement; they create an experience. The comfort found mid-way through is reliable, a guarantee. I feel similarly about my morning cup of coffee, although the effect is different. But both drinks enhance the way I parent and you can’t make a claim this bold about many other things on days when kids are teeming underfoot, and pawing at your body.

A glass of beer creates an inch of space from my actual life.

It cools anxiety.

It marks celebrations, disappointments, and joy.

It provides refuge in a chaotic kitchen.

It is a comma.

But, I have to ask myself what my son is seeing and what my daughter will eventually drink in of my actions, if I continue to crack open liquid getaways in front of them on a nightly basis.

For months now I’ve assumed that my sips don’t have meaning to them, even though they hold great relief and pleasure for me. But, last night when my 17-month-old daughter uttered “hold it,” referring to my Racer 5, something clicked. “Oh sweetie, this is mommy’s drink,” I said shamelessly as I held the bottle to my lips. “Would you like your water?” She studied me.

In the dimly lit part of our mornings together my daughter presses me for my coffee. “Hold it,” she says with great hopefulness. I beam with excitement that my girl has begun putting two words together, and once again respond, “This is Mommy’s drink. Would you like some water, honey?”

I have two drinks that are mine and mine alone, off limits for these little people who mirror back my every move.

Do these drinks that I hold in my hand at the start of the day and the end of some of my days—the first a stimulant, the last a soother—assuage feelings I’m loathe to embrace? Am I playing hide and seek with my emotions?

I’d like to argue that I’m just as present when I have a beer in me than when I don’t, but that’s probably not altogether true.

As I happily play with my kids I’m simultaneously enjoying what I have come to think of as an adult-only party, at 5 o’clock. There’s something about this private experience that feels juicy and somewhat stealth.

“I’ve earned this!”

Like so many other aspects of parenthood, though, I am required to consider what this small but profound decision means to my children, if anything. It’s not just about me anymore. I vacillate between feeling like this benign ritual is simply that, and wondering if they will begin to question my reasons for it, whether I’m overwhelmed, overworked, or overextended.

I wouldn’t want my children to internalize my desire for an end-of-the-day drink as being a result of their exuberance: their excited questions, their whimsical ways, or their attempts to learn something new in moments of burning frustration. It’s not. They are doing exactly what they are supposed to do. Being little people, growing at a pace none of us can actually keep up with. And, here’s the thing: I love every inch of this madness, even when I don’t, even when a beer feels like the wisest way to pave a little more grace into our nighttime routine.

After my daughter’s insistent “hold it,” it dawned on me that perhaps this 17-month-old utterance could eventually morph into, “Why do you drink beer when we are together, Mama?” And it is this imagined future question that gives me pause.

My kids may never explicitly wonder why I often had a beer in hand during many of the evenings when they were little. And yet, that beer I down in front of them at the end of a long day still might have to go. Not because I no longer receive massive enjoyment from it, but because I’m anxious that I’m making some sort of imprint I won’t be able to erase. I want them to see that playtime doesn’t necessarily include the older people in the room psychologically escaping to another place. And I want that to be true for me: I don’t want to be constantly trying to take the edge off when I am with them.

My morning coffee feels like a parental requirement. A mainstay. But my evening drink, my beer, is a liquid I’m willing to consider letting go of, at least for a time.

Jessica Zucker, Ph.D. is a Los Angeles-based psychologist and writer. She launched the #IHadaMiscarriage hash tag campaign with her New York Times piece in 2014. Find her online: www.drjessicazucker.com and on Twitter: @DrZucker.

Family Portrait

Family Portrait

WO Family Portrait ArtBy Anne Spollen

I am a recent refugee from the life I planned since I was twelve. For the last twenty years, I have been a mostly stay-at-home mom.  I was the kind of mom who read to my kids pre-natally, breastfed, pureed baby food made from organically grown community supported agriculture, and dreaded their inevitable discovery of soda. I carried not only Band-Aids in my purse, but Neosporin and dry socks.

My kids had music lessons and birthday parties, religious instruction, family connections, parents who loved them. They had a community they were part of; they had success at school. They had safety and health and friends in abundance.

My dream had been delivered; here they were: bright eyed and bright, creative and thriving. For some people, life never gets this good and I knew it. I thanked Providence every day for my luck and love with these kids.

And then it all changed.

One spring day in the eighth grade, my middle son began drinking with a group of new friends. There was no warning: the kids arrived on bicycles at my front stoop in the same way a summer storm arrives. They had squeaky voices and acne. The boys seemed harmless. They told me they were going on the bike paths and I watched my son leave with them. When he came home, I smelled the alcohol on his breath.

By late summer, the scent of weed drifted from his room. Pills arrived as the leaves changed. Then he changed. He grew agitated and violent. He struck me when he didn’t get what he wanted.

I would think back to the days before the boys on bicycles arrived. How had this happened? And how had it happened so quickly?

We hired counselors and had him hospitalized. Sometimes the calm reigned for a few weeks, then the cycle would begin again. The drugs created strange behaviors, which led to multiple diagnoses. Some doctors said he had major depressive disorder; others pronounced him bipolar. They gave him pills. I had never heard of pill-chasing behavior, but I quickly came to see that my son could manipulate psychiatrists into giving him drugs. He knew the names of the pills he wanted and the symptoms he would feign to get them. Ultimately, he had no psychiatric illness aside from addiction.

A former honor student, my son began failing subjects. His intellectual energy was utilized in creating ways to obtain drugs. He was good at it. Money disappeared. Jewelry. Then trust and communication. He hid his phone and his thoughts. I would look at my son, only fifteen years old, and his eyes would glint in a way I had never before seen.

Then came the bombshell: his older brother told me that their father, an alcoholic supposedly in recovery for years, had participated in the first drinks with him back in the eighth grade. On that spring afternoon, they bonded over their mutual addictive behaviors.

My twenty three years of marriage ended as his father sheltered our son’s behavior. He allowed him to leave school at fifteen and take online high school. I fled to a New York apartment with my fourteen-year-old daughter. It was a refuge. From there, I would try to find a way to help my son.

One night after the divorce, I was cancelling email accounts in both names, my ex-husband’s email account accidentally opened. That’s when I saw the summons for my son’s arrest.

Arrest? I had not been told.  Addiction thrives in secrecy.

This boy, a former National Honor student who had played in a Philharmonic band at the age of thirteen, had three felony counts against him.

They each involved heroin.

I used to think of heroin along with an image of poverty, of disenfranchised individuals who slept through rainstorms on city sidewalks. But of course, like any economic system, drug dealers need clients – and theirs tend to die young. Affluent teens of suburbia have stepped in to fill that vacancy. My son was one of them.

My son. I shut the computer off and sat there for a very long time after the reading the words of the arrest. I wished for someone to come into that living room and make everything better: I wanted Mary Poppins with a pocketbook full of songs and suboxen.

I spent that night looking through my son’s baby pictures, through his drawings and cards that he had given to me over the years. I Googled what type of person becomes a heroin addict until I realized I was looking for a reason so I could stop blaming myself. But there was no Neosporin for a heroine addiction, no amount of Band-Aids or dry socks.

I called his father. “What arrest?” he asked in a happy sing-song voice, despite the fact that the arrest summons was in his email. That is the voice of denial: it’s like living in a margin somewhere between surrealism and Dr. Seuss. Addicts and alcoholics live in that space where nothing is real; if it’s not real, it doesn’t have to be addressed.

My son, still a teen, is a heroin addict. I write that sentence and it is dream-like to me. Some nights I still Google heroin addiction. The experts state over and over that addiction is genetic. Still, I know this only intellectually; my emotions haven’t learned that yet.

I study addiction statistics. I go to open meetings for any kind of addiction. I want to know why doctors dispense scripts for hydrocodone as if it’s Tylenol when it is routinely listed as one of the three most addictive substances on earth. My son has told me that he first became addicted to hydrocodone, or Vicodin. “It was love,” he said. “It was all I ever wanted to feel.”

These pills change brain function. The drug makes itself the number one priority to the brain; life is second. Its use stops the creation of positive feelings. The user needs more and more of the drug. Tolerance builds. Then hydrocodone turns nastier. It no longer brings any type of euphoria; it only relieves the unbearable symptoms of withdrawal.

But pills are expensive, between twenty and thirty dollars a pill. Heroin runs about four dollars a fold now and does the trick. And it’s running through American high schools with the strength and speed of a rumor.

I got my son into a rehabilitation facility several states away. I cried as the plane lifted off because I knew he was on heroin even as he sat in his seat. But he was safe. I could breathe. Until the director of the facility called to let me know that my son’s  father had sent a plane ticket back two weeks into the program. The director had wanted him to stay there for ninety days, then go to a halfway house. But my son was eighteen by now, there was nothing I could do.

At least after rehab, we could talk, my son and I. It was guarded conversation, but we could connect on some level. My son is trying to stay clean now. Involved in a program and meetings, I call him each day to make sure he has not relapsed, that his heart is still beating. I have to will myself not to think about him all the time or I wouldn’t be able to function. I have moments now where I do not think about him. I can’t afford to.

Two days ago, my young teen daughter went to visit her father and brother. When she came home, she was clearly under the influence of opiates. She refused a drug test.

Anne Spollen is the mother of three children. She has published numerous essays, poems and stories, in addition to two young adult novels: The Shape of Water and Light Beneath Ferns. She currently lives in Staten Island where she teaches college and is working on a book of essays exploring the effect addiction has had on her family. She can be reached at her website: annespollen.org

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First Communion

First Communion

By Rowen Wilson*

First Communion ArtIt is a school night, and my daughter, in first grade, tries to set the table in the cute way that first graders try to help.  She sets the silverware all around, then the plates and napkins, and the glasses.  “And for you, Mama,” she smiles, setting the wine glass at my place.  An unsettling thought rises in the back of my mind and I push it back.

I am a high functioning person.  I am a teacher, a distance runner, a book reader.  I have a Master’s degree and I teach graduate courses.  I read to my three children daily and I help my daughter practice the violin each morning before school starts.  I don’t smoke and I eat healthy foods.  I enjoy my wine.

I am not an alcoholic.  I can control my drinking.  I don’t drink until after five. I drink chilled Chardonnay while I prep dinner at night on autumn evenings, a couple of glasses during dinner and while we move through bedtime.  I read to my kids every single night.  I bathe them and brush their teeth, and I often get up to run five miles or more before they wake up for breakfast.

The hours between when I pick up the kids from school and when Andy gets home from work are long.  The kids are tired and wild.  I try not to turn on the television, to help with the math homework, to negotiate peace between my three and six year old, to keep my toddler busy, to make something resembling dinner.  I reward myself with the bottle of wine and a plan for a nice meal.  The package store sells pretzels; the children call it the pretzel store.

I do go through a lot of wine. My husband drinks less beer.  My empty bottles pile up in the recycling bin.  Sometimes I throw a few soda cans on top.  My husband suggests we switch to drinking only on the weekends.  I agree.  Bath time is long and the kids slop the water out of the tub.

Winter drags on.  The winter coats are dingy now and the sky is dull.   I can’t drink only on the weekends.   Eventually, I go underground.  I start to hide my wine.  I drink before he gets home.  I pour wine into a water bottle and leave it behind the house.   I pay in cash so there is no record of the sale.  I have a secret now.

Something takes control of me in spring.  It is cunning. It begins planning our day.  It plans when we will get wine, how much we will need, how we will hide it, when we will drink it, how we will hide our drunk.  This becomes the priority of our life.  It is getting warmer; daffodils coming up through the earth.  On weekends I am drinking much more.  Sometimes I can barely read the words of my kids’ books at night; the letters spin.

One morning I wake up and I cannot remember putting the kids to bed.  I look in on them.  There they are, in their footsie pajamas, tucked in and sleeping with their sweet flushed cheeks and peaceful mouths.  At breakfast I ask my daughter what books we had read, hoping it will spark my memory.  “Mama, why did you ask me that?” she says.

Near the end, I have blackouts.  I hide wine in my closet.  I have to be careful to remember to throw it away when I am out.  Sometimes I drink in the morning.  One summer day my husband comes home to find me and the kids in the yard.  We are playing “Drive-in Movie.”  I have blown up a camping mattress and set it up behind the mini-van and let them jump on it and watch DVD’s in the car.  I am there on the mattress with a smile on my face and my eyes closed and the kids are climbing all around me.  I have been drinking all day.

I am afraid now.  I wake up in the morning sick.  I feel sick until I have something to drink.  I look in the mirror and I feel panic rise and I tell myself it is not going to happen again.  But it does.  I do not have control anymore.  I have lost control.  I am not the driver.  Alcohol is the driver.  I have not been the driver for a long time and now it is too late.

One of the last times I drink I almost die.  I go to the liquor store alone at ten o’clock in the morning.  I buy a bottle of wine and a bottle of brandy and I drink both of most in my car right there in the parking lot.  I do not know why.  A small voice inside me asks me to stop but we push it back.

I went into a store.  That’s all I remember.  I was very, very drunk.  Somehow, a clerk in the store helped me.  She called my husband with my cell phone.  He got me to his car using a shopping cart because I was too drunk to walk.  He thought I might die.  I was forty years old, the mother of three.  He thought that I might die.  And I got drunk again all the rest of that week, just as soon as we got the chance.

Alcoholism is a terminal disease.  According to the World Health Organization, it is the third leading cause of premature death.  There is no cure.  However, people who seek treatment and stop drinking can fully recover.

I am powerless over alcohol.  I cannot manage my own life.  I must admit defeat or die.   I pick defeat.  I let my husband take my car keys, my cell phone, my credit cards.  I let my father leave me at High Watch Recovery Center in Kent, Connecticut, where I spend three weeks in treatment.  I let the therapists and counselors tell me what to do.  I don’t fight.

I stop with the rationalization.  I stop comparing.  I begin to identify with who I am.

In rehab, I have the profound experience of sharing a secret with a room full of strangers that I had not shared with myself.   Out loud, I say I am alcoholic.  I say I can’t drink safely.  I say I lied so I could drink and say I schemed so I could drink and say I drank around my children.  I shake and I cry and I rail and other women meet my eye, they don’t look away and they say “Me too,” and they say “I know,” and they say “oh, that was me.”  I see I am them.  I identify.  I see I am a million other women, alcoholic women suffering from this disease, keeping this awful secret and dying from it alone and hating themselves for it silently while loving their children like all mothers do, all while alcohol wants them nothing else but dead.

We sit in a circle and we say our names.  We say we are alcoholic.  To hear so many others say these words aloud is an affirmation.  I begin to breathe.  We begin to speak.

The communion I experience among these women saves my life.  I learn that in fact I am not alone. I learn that lies and secrets corrode my self-esteem and waste my dignity.  I learn that damage to my self-respect fuels my disease to drink.  I hear their stories, and in listening I see the cycle.  In their stories I become awake.

Today, I consider myself pretty lucky.  In the U.S, only 11% of alcoholics seek treatment.  Only 11% of the people in this country who have this disease, from which more than 75,000 people will die from every year, will seek treatment.  I am in that 11% and alcoholism is not going to take me down.  But my God, did it try.

One of the darkest factors of this disease is the stigma that is attached to it, and particularly to those who are parents.  People who have diseases like diabetes or heart disease do not develop resulting behaviors that cause them to drive recklessly, act belligerently, black out, or engage in other types of socially inappropriate and dangerous conduct.  People don’t worry about letting their kids sleep over the girl’s house whose mom has diabetes.  Nobody wants to carpool with the alcoholic mom.

Alcoholism is a disease of the mind and the body.  The shame that comes with this disease makes it difficult for the alcoholic to talk about her disease with doctors, friends, and loved ones.  To make matters worse, her disease tells her brain not to, because her disease doesn’t want her to stop.

I can’t be left alone with the whispering voice perched on my shoulder and I shouldn’t be.  I enter into the rooms of Alcoholics Anonymous and I am no longer alone; I break my silence; I find communion; I hold the hands of my sisters.  I do the next right thing.

I will always be an alcoholic, just like I will always be a redhead and I will always be a mom.  My disease is a part of who I am.   There are many things that I am still afraid of.  I am afraid that one day I will slip and drink again.  I am afraid for my three young children, who will have to navigate their own course through life, with its many liquor stores, its college days, its interstate miles.  I am afraid they might inherit my disease and be alcoholic like me.  There are plenty of things to fear.  More important, though, for me to focus on today and watch my seven year old set the table for supper, fully present.  She smiles at me, gap-toothed, the way that second-graders are.  What a gift.  What an incredible gift life is.

About the author:  Rowen Wilson is a pen name. The photo used here is stock photography.

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Brain Doping

Brain Doping

By Valerie Seiling Jacobs

This feature story is from Brain, Child’s Special Issue for Parents of Teenagers, to order the full magazine, click here.

Kid_brain_300dpiIt’s 7:00 a.m. on a chilly Saturday in March—the SAT is due to start in less than an hour. Sam (not his real name), a junior at a New England boarding school, sits alone in his dorm room. Across campus, a few students are already filing into the test center. Sam is almost ready. He’s been studying for months.

There’s just one more thing he needs to do. He reaches into his backpack and retrieves the pill—a single capsule of Adderall. It only cost five bucks. A real bargain.

Mention the word “Adderall,” a drug often prescribed for Attention Deficit Hyperactivity Disorder (ADHD), and you are likely to elicit strong opinions. Add the words “cognitive enhancement” or “adolescent” and you are liable to start a brawl. As soon as I announced that I had taken on this project—that I was trying to figure what parents and teenagers think about these drugs—people began clamoring to stake out their positions.

Take the mother of the 16-year-old boy who was recently diagnosed with ADHD, a condition characterized by impulsivity, inattention, and hyperactivity. To her, Adderall is a godsend, a magic pill that enables her son to sit still for hours and stay focused. “His grades have improved and we’re not fighting about his homework anymore,” she said, before insisting on anonymity to protect her son’s privacy.

Or take Adam (also not his real name), the college student at an Ivy League university who uses it—without a prescription—to cram for exams. To him, Adderall is a great study aid that allows him to “power through” tests and assignments. “It’s like No-Doz,” he said, “only better.” (“Walk through the library during finals and everybody’s got it,” his girlfriend added.) He doesn’t under- stand why it isn’t sold over-the-counter. [Because these stimulants are Schedule II Controlled Substances—possession without a prescription is a felony in most states—no one wanted his or her name in print.]

One law school student estimated that half his peers are using it. A third-year medical student told me that he thinks he’s the only one in his class who’s not using it. One graduate student described how she and her friends use it to party. “We call it taking ‘wings,'” she said.

And then there were the professionals: high-powered Wall Street types (traders were mentioned a lot) who are buying it on the street or quietly asking (read demanding) that their internists write prescriptions. A fiftysomething female banker admitted that she had “borrowed” her son’s medication and used it as an appetite suppressant. I heard of one 70-year-old woman who is using it, with her physician’s encouragement, for the “lift” it gives her.

Most surprising, however, were the high school students—kids like “Sam” who told me how they had used it to take the SATs—again, without a prescription. (Sam estimated that 25% of his boarding school class had used it.) “It definitely helped on the math and reading,” he said. “Not so much on the writing.”

Another teenager described how her classmates would borrow, trade, and sell their ADHD medication (experts call this “diversion”) at her public high school, the going rate ranging from a dollar to twenty dollars a pill, depending on the number of milligrams, the type (regular or extended-release), and the demand. High stress events, like midterms and AP exams, apparently send the price skyrocketing.

To all of these people, Adderall and the other drugs in the ADHD arsenal, including Ritalin, Vyvanse, Concerta, and Focalin, are great drugs that increase focus and boost productivity and performance. Indeed, the axiom that the drugs would not work for those without ADHD has proven to be untrue—though some ADHD experts still cling to the idea that people who experience benefits must have a subclinical case of ADHD.

In fact, current research suggests that people who take the drugs not only feel better, but perform better, though improvement may not be as dramatic in non-ADHD individuals. As Dr. Stephen Donovan, an Assistant Professor of Clinical Psychiatry at Columbia University’s Center for Psychoanalytic Training and Research, explains: “The drugs certainly increase vigilance and focus and allow you to plow ahead where there is no immediate reward. So if you just have to get through something, they can help a ‘normal’ person.” Whether these drugs can actually make you more intelligent, however, is “very doubtful,” says Donovan.

But to some doctors and mental health experts, the widespread use of these drugs, with or without a prescription, is problematic—and especially so for teenagers and young adults. Indeed, recent data suggest that the number of people who are experiencing problems with these drugs is growing. According to a report released by the Substance Abuse and Mental Health Services Administration (SAMHSA) in January 2013, the number of emergency room visits involving ADHD stimulants more than doubled in the five years ending in 2010, with the largest rate of increase (282%) among 18- to 25-year-olds. Of those visits, half involved “nonmedical use” of the drugs, almost three times the comparable rate in 2005.

Evan Flamenbaum, an ADHD specialist and private therapist who works with teens at an intensive outpatient clinic in New York City, has seen first- hand how adolescents can get into trouble with these drugs. These stimulants have been so “integrated into study styles” and so “normalized,” he says, that people don’t appreciate that they are psychoactive drugs.

And this is particularly true of teens, Flamenbaum says, who often have no fear: “They think it’s like taking aspirin, but wind up abusing it: they take too much, or grind it into a powder and take it intra-nasally to get a bigger hit, or mix it with other drugs to make a cocktail.” Thus, while Flamenbaum believes that these stimulants can be extremely beneficial for people with ADHD, he thinks that we need to be really concerned about the potential for abuse, especially when it comes to high school and college students.

Flamenbaum is hardly alone in his worry. One segment of the medical community has been sounding the alarm about these stimulants for years, repeatedly citing the health risks, including addiction. There’s a reason, those folks say, that these drugs are classified with cocaine. The website of the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, warns that these stimulants have a high potential for abuse, which can lead to a host of problems, including hostility, paranoia, and psychosis. Even without misuse, NIDA’s website cautions that high doses can lead to irregular heartbeats, dangerously high body temperatures, seizures, and heart failure.

In fact, it was the risk of addiction and cardiac complications that finally prompted the Food and Drug Administration to recommend “black box” warnings on these stimulants in 2006. The label on Vyvanse and Adderall, for example, now underscores the risk of abuse, dependence, and sudden death—and specifically states that the drug should be “prescribed or dispensed sparingly.” The warning on Ritalin is slightly less threatening, though still severe, warning of dependence and noting that people with a family history of drug or alcohol abuse should tell their doctors.

The warnings, however, have done little to dampen enthusiasm for the drugs. The sale of ADHD drugs is now a $7.9 billion a year business. An estimated 32 million prescriptions for ADHD drugs are written in the U.S. every year and the number appears to be increasing, especially among older teens. The number of prescriptions for ADHD medication for 10- to 19-year-olds has risen 26% since 2007. And a significant number of adolescents and young adults continue to use ADHD drugs without any medical supervision.

Reliable statistics are difficult to obtain, but the prevalence of non-prescription use among college students and young adults, a group that some have dubbed “Generation Rx,” appears to be significant—and growing. A 2005 study reported that of the 11,000 college students polled, 6.9% admitted to illicit use of the drugs. A 2007 survey conducted by Duke University found that approximately 9% of 3,407 students admitted that they had used ADHD drugs without a prescription while in college. A 2008 informal poll by Nature found that 25% of the 1,400 responders under the age of 25 admitted to using Ritalin for nonmedical reasons. And a 2008 study conducted by researchers at the University of Kentucky found that 34% of the almost 2,000 college students who had been surveyed admitted to having used ADHD meds without a prescription. Other factors, including the presence of sororities or fraternities on campus or the geographic location (e.g., being in the Northeast), can push the percentages even higher.

Moreover, the research shows that the practice has trickled down to high school students. In December 2012, the University of Michigan released the results of its annual “Monitoring the Future Study,” an anonymous survey of 45,000 to 50,000 teens sponsored by NIDA and the National Institutes for Health. The study found that while the use of tobacco, alcohol, and ecstasy was down in 2012, the illicit use of Adderall among twelfth graders was on the rise. According to the study, 7.6% of twelfth graders reported using Adderall without a prescription during the previous year, up from 6.5% in 2011 and 5.4% in 2009. NIDA has labeled this finding an “Area of Concern.”

In addition, while the number of even younger users appears to be holding steady or declining slightly, they are worth noting: 4.5% of tenth graders and 1.7% of eighth graders reported using Adderall without a prescription in the last twelve months. In any event, these statistics make ADHD medication the third most popular illegal substance among eighth, tenth, and twelfth graders—right behind marijuana and narcotics.

What is fueling this increase in prescriptions and illicit use? For those who obtain the drug legally, the increase may be the result of more publicity about ADHD, combined with better detection and diagnosis—though under the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), unless the symptoms appeared before the age of seven, the diagnosis may be considered suspect (there is a proposal to push that age limit to twelve in the new DSM-V, which is due out later this year).

But many believe the huge demand is simply the result of a growing desire among adolescents to enhance academic performance, a conclusion supported by the research and my unofficial survey. It’s no secret that the world has become a more competitive place, where getting good grades and doing well on standardized tests can provide a huge advantage in the cutthroat college admissions game. And for those already in college, boosting one’s GPA can help improve the odds of nabbing a much-coveted internship or getting into graduate school. It’s easy to see why students are drawn to these “good-grade” drugs.

Moreover, the demand for these ADHD stimulants—what some call “academic steroids”—is facilitated by the drugs’ easy availability. For those willing to brave arrest (many teenagers seem to be unaware of the potential legal consequences— I spoke to one high school sophomore who was shocked when she was arrested and charged with a felony after being caught with Vyvanse), it does not appear to be difficult to find someone to pro- vide a few pills. And the internet has made things easier: a number of websites now advertise ADHD drugs pursuant to “cyber-prescriptions,” a matter of increasing concern to the Drug Enforcement Agency and federal prosecutors.

For those who decide to go the legal route and obtain a “real” prescription, the process can also be relatively easy. Some doctors rely on a simple checklist or a patient’s self-reported description of symptoms— even though the DSM-IV requires historical and other evidence from a constellation of sources and even though the better practice is to conduct rigorous testing to rule out other mental disorders such as depression, bipolar disease, and oppositional-defiant disorder, which have high co-morbidity rates. All of this, according to Flamenbaum, can take eight or more hours and cost thousands of dollars.

Moreover, the official DSM-IV diagnostic criteria, which include subjective symptoms such as “the patient is often easily distracted” and “the patient is often forgetful in daily activities,” are easy enough for a savvy teenager to fake. One study found that test givers could not distinguish between those who were faking and those who were “real” ADHD patients. As Flamenbaum observes, “It is really not hard to go to a one-hour meeting with a psychiatrist and say all the right things to get the medication—especially if mom and dad are pushing for it.”

Which raises another point. Although people are loath to talk on the record, there is anecdotal evidence that some parents may be pressuring therapists and/or coaching their children to get the diagnosis—and the drugs—as a way to gain a competitive advantage and gain entry into the country’s most elite colleges and universities. (The diagnosis alone may, if properly documented, entitle a student to extra time and other accommodations on the SAT, which are not flagged for admissions officers—a whole other debate.)

With or without parental help, the use of ADHD drugs solely to enhance cognitive functioning, what is sometimes called “brain doping,” is the source of huge controversy. To naysayers, the risks of these drugs outweigh their benefits, at least in people with- out ADHD. In other words, they say, while the side effects of these stimulants might be acceptable for people whose lives are truly impaired by ADHD, the ratio of risk to benefit cannot justify non-medical use in healthy individuals. And this is especially true, they argue, when it comes to adolescent brains, which are still developing. Moreover, opponents argue, the use of these drugs raise “fairness” and ethical questions.

Last year, a commentator in the Journal of Law and Education called for mandatory drug testing in schools to “eliminate the unfairness that currently exists” due to the “super-enhanced focus” and “academic advantage” that the drugs provide. A number of legal journals have noted that the illegitimate use of these drugs may violate basic principles of equality and justice. In 2011, Duke University officially declared that the unauthorized use of prescription medication—and in particular ADHD drugs—would hence- forth constitute “cheating” under its academic honesty policy (possession without a prescription was already a violation of its drug policy). Wesleyan University also considers the use of the drugs (without a prescription) a violation of its honor code and other schools are considering whether to follow suit.

Proponents of these stimulants, on the other hand, argue that the risks have been sensationalized. People have been safely using these amphetamines for decades, they say. And besides, they argue, there’s nothing wrong with wanting to increase one’s academic performance. After all, the argument goes, this isn’t like professional sports, where there are rules that prohibit steroids, blood doping, or other artificial means of enhancement. Unlike in the Olympics, society does not place a value on “natural” academic ability. Who cares if a student took a pill before her SATs? — It’s the end result that matters. And by the way, they ask, don’t we want to maximize everyone’s cognitive capabilities?

So who’s right?

According to most doctors and experts, the three most serious risks associated with ADHD medication are cardiovascular events, psychosis, and addiction. But how many patients actually experience those side effects?

When it comes to cardiac complications, the answer appears to be not many. According to two retrospective studies published in JAMA and The New England Journal of Medicine in 2011, researchers found no increase in the number of heart attacks, sudden cardiac death, or stroke among children or young adults who used ADHD drugs as compared with a matched control group of nonusers. (The researchers did note that due to certain statistical limitations, a doubling of the risk could not be ruled out among the youngest population, but nevertheless concluded that the “absolute magnitude of any increased risk would be low.”)

What these and other studies suggest is that the likelihood of cardiac complications from ADHD drugs has indeed been exaggerated. Dr. Carl Hart, an associate professor of psychology at Columbia University who specializes in the study of the impact of drugs on human behavior and the brain, agrees. In his opinion, the risk of cardiac complications from ADHD drugs is over-blown. “We overstress these risks,” he says, “when the fact is, in young people, it’s not an issue—the likelihood of cardiac risks is quite low.”

Dr. Wilson Compton, a physician and the Director of the Division of Epidemiology, Services and Prevention Research at NIDA, has a similar view. “These drugs are not going to result in major cardiac complications, except in persons with other risk factors,” he says. (And since children, teenagers, and young adults generally have healthy hearts, what researchers sometimes call “healthy-user bias,” those other risk factors are not a big problem when it comes to cardiac complications.)

But Compton’s caveat about other risk factors is worth remembering when it comes to psychosis, another potentially serious side effect. Certain patients, including those with a personal or family history of schizophrenia, depression, anxiety disorders, or bipolar disease, are known to be particularly vulnerable to drug-induced psychosis. For that reason, doctors are advised not to prescribe the drugs for those people or to proceed cautiously. Thus, although the official risk of psychosis may be relatively low (less than 10%), the numbers may not tell the whole story. The statistics may be artificially depressed as a result of the exclusion of susceptible individuals from the patient population. (In fact, in one 2009 study, more than 90% of the patients who experienced psychosis had no relevant history of disease.) The point is that for people who are not properly screened by a physician, the risk of psychosis may be higher than the official numbers indicate.

In addition, the risk of psychosis is known to increase with larger doses and long-term usage. Why this happens is not clear. It could be the pharmacology of the drugs, or it could be the insomnia that often results, one of the most predictable precipitators of psychosis. In Hart’s view, the sleep issue may be the most important public health message when it comes to ADHD drugs. Even for those who only use the drugs sporadically, large doses can disrupt sleep. “I can’t state it any stronger,” he says. “You need to attend to your sleep—and this is especially true for adolescents.”

In sum, the risk of psychosis appears to be low, though assessing one’s true chances of experiencing this side effect may depend on family or personal history, the size of the dose, and the length of the treatment.

And finally, the risk of abuse and addiction.

What makes these drugs so susceptible to abuse? Researchers believe that the answer lies in the drugs’ repeated stimulation of pleasure pathways and their effect on dopamine levels in the brain’s reward centers. Recent studies by Dr. Nora Volkow, the Director of NIDA, and other researchers suggest that the drugs may also impair one’s “inhibition reaction” and disrupt “executive functioning,” which can interfere with a person’s ability to recognize dependence and need for treatment.

But here again, personal and family history can make a difference and the likelihood of experiencing this side effect is difficult to predict. Researchers do not have reliable data on rates of addiction. What researchers do know, however, is that some subset of users will wind up abusing or becoming addicted to these drugs and that a family or personal history of abuse makes addiction more likely.

In addition, the method of delivery of the drug can make a difference. As Compton explains, “All other things being equal, getting it into your brain more quickly makes it more of a ‘rush’ and more addictive.” Thus, snorting or injecting Adderall is more likely to produce an intense high than swallowing a pill. Cocaine abusers report that injecting ADHD drugs can produce the same kind of high as cocaine.

So, assuming that patients are pre-screened and assuming that the drugs are used as prescribed, these drugs probably do not carry a terribly high addictive risk, though withdrawal is always a consideration. The problem, however, is that adolescents don’t always take the drugs as directed. As Compton says: “Sometimes they take more than prescribed, or what’s prescribed for somebody else, so the dosage might be quite high, or they crush them and take them intra-nasally, or even inject them sometimes.”

And for those teens who are using the drugs illicitly, no one is screening for risk factors—or monitoring the dose. According to Compton, this is one of the prime problems with non-medical use: “There’s no one looking over your shoulder.” As he says, “There’s a great propensity to minimize and ignore the symptoms because these drugs feel good—that’s part of the problem around becoming addicted—the surreptitious nature of the onset.”

In addition, the effects of the drugs can be exaggerated by the presence of other substances, including alcohol. There is little data on this subject, but the results of one 2011 study indicate that the combination of alcohol and certain amphetamines can elevate heart rates and boost the “good drug effects” of both drugs (compared to either drug alone). As Hart, who participated in the study, explains, “Mixing amphetamines with alcohol can decrease the disrupting effects of alcohol and allow people to drink longer, while at the same time enhance the euphoria.”

The potential interaction of these drugs with other substances makes their use as a “party drug” (or “wings”) worrisome. Indeed, of the 31,244 ADHD drug-related emergency room visits described in the recent SAMHSA report, 25% involved one other drug (19% involved alcohol), and 38% involved two or more other drugs, suggesting that this is a valid concern.

Another troublesome question when it comes to ADHD drugs and addiction is whether they are a “gateway” to the abuse of other drugs. The answer seems to depend on where you sit.

To those like John Schureman, a therapist who has been treating ADHD patients for three decades and who is active in CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder), a support group that bills itself as “the nation’s leading nonprofit organization serving individuals with ADHD and their families,” the answer is a resounding “no.” In Shureman’s view, the drugs actually help patients avoid drug abuse because they increase “competent agency.” In other words, they increase a child’s ability to control impulsivity and other symptoms of the disorder, which are linked to poor school performance and risky behaviors—including drug use.

Addiction specialists, however, are less sanguine.

Compton and his colleagues at NIDA, for example, believe that the jury is still out as to whether the medications are a risk factor for the onset of drug abuse later in life. While Compton acknowledges that “we’re not seeing an epidemic of drug abuse in the children who were treated with these agents,” he doesn’t think “the protective benefits are as clearcut either.”

Part of the problem may be the data itself. For instance, while the use of ADHD drugs has been correlated with the use of other illicit substances, no one has isolated or proven causation. In other words, did the ADHD medication or the disorder itself cause the addiction? Moreover, when the ADHD drugs are acquired illegally to begin with, there may be additional factors at work. As Hart notes, “Kids who do these things—who are willing to buy Adderall on the street—may be more likely to experiment or break the law anyway.”

So where does that leave us? What do we do when it comes to these drugs and teenagers? The prudent response is to exert caution—and avoid jumping on the ADHD medication bandwagon too quickly. Thus, in milder cases of ADHD, it might be wise to give behavioral therapies a chance first—a strategy that Hart and Compton endorse. But once the decision is made to medicate, the data suggest that even the more serious risks can be managed with proper diagnosis, screening, and monitoring. (Make no mistake: it’s not that these drugs are not dangerous—some subset of the population is likely to get into trouble with them no matter what—but for those whose lives are impaired by ADHD, the benefits appear to outweigh the risks.) Of course, this means that physicians will need to do a better job. But it also means that parents will need to educate themselves about these substances and get more involved. Simple steps like taking control of the medicine bottle and checking that your teenager actually swallows a pill could go a long way.

But what about for people without ADHD, those who want to use these drugs simply to enhance cognitive performance? Given the risks of unsupervised use, it’s almost impossible to argue that the drugs should be sold over-the-counter, though whether they should be classified with cocaine or whether possession should give rise to a felony is open to debate. But should people be permitted to use the drugs as long as they are screened and monitored by a doctor? After all, if the drugs are safe enough for people with ADHD, then why aren’t they safe enough for “normal” folks?

Bioethicists generally have two answers. First, if we allow non-medical use, we will wind up with a two-tiered system: those who can afford the drug and those who can’t. As a number of commentators have noted, however, this is not a terribly compelling argument. We already live in a world that’s pretty unfair—the cost of living in a capitalistic society. Is this really any different from hiring a tutor or paying for an SAT prep course—two things that our system already permits?

To many, the more persuasive argument is the bioethicists’ second claim: that allowing non-medical use will result in coercion. In other words, even people who don’t want to take the drugs will eventually feel that they must take them in order to compete. (One might legitimately ask whether we are already at that point.) The recent debacle in professional cycling is a case in point: How many of Lance Armstrong’s teammates have said that they felt that they had to use blood doping just to level the playing field? It’s not difficult to imagine a world where employers require workers to take the drugs or where students feel compelled to take the drugs in order to compete. And that is a brave new world that should frighten every parent.

Valerie Seiling Jacobs teaches writing at Columbia University where she is also working on an MFA. Her essays have appeared in The Atlantic, The New York Times, and other publications. Before turning to writing, she practiced law for over two decades. She lives with her husband in Westport, Connecticut. You can find her on the web at www.valerieseilingjacobs.com.

This feature story comes from Brain, Child’s Special Issue for Parents of Teens, now in its second printing.

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