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Why I Put my Drug-Affected Daughter Back on Drugs

Why I Put my Drug-Affected Daughter Back on Drugs

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8-year-oldgoesviralwithhard-rocktune

By Melissa Hart

“Stupid Mommy! I hate you! You’re an idiot!”

It’s 2:45, the end of the school day. I cower in a corridor like a kicked mutt surrounded by serene hemp-clad parents and their eight-year-olds. Patchouli oil emanates from their golden arms and legs. They bend their sunny open faces toward one another—faces that cloud and pinch at the sight of my second-grader.

She’s flushed and furious, sweaty curls standing on end. She smells of spilled tempura paint and noodle soup from her overturned Thermos on the floor. Her green dinosaur boots stamp a frenzied tarantella around me as she screams.

“You never do what I want. You’re the worst mother ever!”

Shame flames my cheeks. The other mamas in the hallway, the bearded longhaired papas, probably believe her. I’m Snow White’s Evil Queen, Rapunzel’s Mother Gothel. In short, I most surely suck.

I don’t meet the eyes around me, I don’t say a word. I turn, chin ratcheted at an ignoble angle, and walk out the door praying my child will follow. She does, still shrieking insults. Then, she kicks me.

My transgression? I’ve left the Honda in the garage on this sunny day and asked her to walk a half mile home with me.

*     *     *

“She needs medication if she’s going to stay at this school.”

My daughter’s principal, boyish and skinny as a weasel, sits in the counselor’s office across from the tranquil second-grade teacher and me, and delivers his verdict. “In the classroom,” he tells me, “she screams over math and reading assignments. She does cartwheels behind the teacher when she’s delivering a lesson. A boy called her ‘weirdo’ and she slugged him. She refuses to sit at her desk for anything academic and wants to spend all her time at the Peace Table.”

The Peace Table. Most schools have detention. My kid’s classroom has a hand-carved wooden table where a troubled student can go to chill out. My child has, I discover, taken up permanent residency there. We’re gathered together in the principal’s office today because two hours earlier, he bent low to her ear to suggest she return to her desk, and she shoved him.

“She threw my back out.” He reaches behind him to massage his injured lumbar. I bow my head, but he isn’t finished. “I saw a documentary on kids adopted from Romania. They had reactive attachment disorder—all the same issues as your daughter. The only thing that helps these kids is medication . . . mood stabilizers.”

Gently, the teacher’s mouth falls open. Marijuana’s about to be legalized in Oregon and the smell of it competes with patchouli in the afternoon corridor. My fellow parents may rock the ganja, but our school’s a hotbed of anti-vaccination activists. They carpool up to the Capitol to protest mandatory inoculation, hold chicken pox parties and embrace each other in celebration when their kids present with the itchy red spots. Once, I mentioned to a father in the corridor that I’d taken my child for a flu shot, and he got up in my face.

“Why,” he snarled, “Would you poison your daughter?”

Me, I’m a fan of modern medicine. My child is vaccinated, and when she falls ill, she takes Tylenol. But mood-altering drugs? For a second-grader?

I want to remind the principal that my husband and I adopted our daughter at 19 months old from a skilled foster mother in Oregon—not from Romania where kids once languished, cribbed in their own excrement, for a decade. Instead, I spread my palms out on the table in supplication. I’m beaten, pummeled by years of similar meetings in preschool, in kindergarten, in first grade. I think of a summer camp counselor who summed up my child’s temperament in one sentence:

“She’s not one who earns a lot of stickers.”

At last, I address the principal. “We’ll do,” I say, “whatever you think is best.”

The second-grade teacher stands up, long hair swinging. At six-foot-four, she’s quiet royalty in the shabby room. “I’ll meditate on her,” she says, by which she means she’ll actually stay up an extra half hour that night to sit in lotus position and ruminate upon my child and her issues. “I think there are alternatives,” she concludes mildly, “to drugging your daughter.”

I’d love to believe her. But I think we’ve run out of options.

*     *     *

Research abounds on the effects of constant loving touch and eye-contact with babies. In parks and grocery stores, infants dangle from frontal packs like Sigourney Weaver’s alien baby. My husband and I wore our own daughter in a soft cloth backpack until her feet nearly touched the ground; we gazed into her eyes and hand-fed her long after she could feed herself. But even those ministrations weren’t enough to soothe prenatal exposure to god-knows-what substances, coupled with early emotional neglect.

At birth, relinquished by parents who—in social worker speak—”had priorities other than child-rearing,” she moved in with a career foster mother—a woman who devoted her life to giving bereft babies a decent start in life in exchange for financial stipend from the state. The foster mom—a stoic big-hipped brunette with a passion for dragon decor–drove her charges to medical appointments and arranged for occupational and physical therapists to visit her home. With four children roughly the same age howling the same basic needs, she found little time to coo and cuddle. My husband once walked into her kitchen to find four toddlers arranged in a high chair assembly line, opening their mouths in turn to receive spoons of canned pears.

“She’s a feisty one,” the foster mother told us on the day we met our new daughter. She chuckled, a toddler under each arm, their chubby hands clutching hand-knit stuffed dragons. “Falls asleep squalling in the middle of the living room floor. I just step over her.”

I gazed at the strange little girl tottering across the sunny summer porch. She was dressed in a peach pantsuit with her curls gelled backward. Somewhere, she’d picked up a pointy lawn ornament, which she brandished it in my direction. With her face wrinkled into a scowl, she looked like an aggrieved elderly bingo player who’d been dealt a crappy card.

I didn’t know then about the trauma that foster babies experience—hadn’t considered what it felt like for her to be ripped from the only body, the only sounds and smells she’d known for nine months and embraced by an incubator for a week, and then a car seat and a high chair and a crib, but not by much else.

Perhaps, when no one responds to her pleas for assistance with a wet diaper or with a favorite ball that has rolled under the couch, she learns to holler like hell. She learns to kick and yell and scream because it earns her attention—even if it’s attention in the form of exasperated assistance. Lacking that, she shuts her eyes and withdraws into herself. Alone behind her closed lids, she ignores the fuzzy dragon-slippers that step over her. She searches for peace.

*     *     *

It’s Parent-Teacher Night. My husband and I walk into the second-grade classroom with its walls plastered in colorful drawings and watercolors around rows of two-seater tables. We weave through a crowd of parents embracing and planning play dates and roller-skating parties to which our child is never invited. We stop at a desk in front of the teacher’s podium. “Here’s her name tag,” I tell my husband. “Front and center.”

“She’ll always sit where I can put a hand on her shoulder if I need to.” The teacher looks down at me from her awesome height. “A soft touch helps to focus her.”

As other parents exclaim over their children’s hand-knitted flute cases and beeswax candles molded into the shape of Mozart or Lao Tzu, we look at the curious one-legged stool that stands in place of a chair at our daughter’s seat. “It gives her sensory information,” the teacher tells us, “and helps her to be aware of her body in space.”

We look at her, blankly. She smiles. “It calms her down.”

We heft the weighted blue blanket under our child’s desk—another calming device—and note the noise-canceling headphones. There’s a necklace on her desk—a black string with a blue and white rubber triangle. It’s for chewing; otherwise, she gnaws her pencil in half.

We move toward the Peace Table at the back of the room. “She spends a lot of time here looking at books,” the teacher tells us, “particularly if she’s having a rough day.”

My husband and I sink into the little chairs at the scrubbed wooden table. We grip each other’s hands, no words for our humiliation.

“Breeze is racing through the Little House series,” I hear one mama tell another. “She wants to be Laura Ingalls Wilder. She sewed her own sunbonnet and apron.”
“I wish Moss would read,” a father says. “It’s all about lacrosse at our house.”

My daughter refuses to read. We’ve blown through soccer lessons, basketball, ballet, gymnastics, horseback riding, aerial silks. Each coach and teacher says the same thing. “She doesn’t like to listen,” by which they mean, “She’s giving us a boatload of grief, and we’re sinking. Please, please bail.”

“We’re sorry,” we tell them and slink away from the field or gymnasium or dance studio in the wake of our failure.

At home, presented with requests to feed the cats or set the table or finish lessons sent home from school, our eight-year old howls. If we persist, the insults begin. “I hate you! You’re stupid!” And—wait for it—”You’re not my real parents.” She calls it the “Everything Feeling,” those emotions that collide within her and explode in all directions, causing her hands and feet and words to lash out and hurt someone else as much as she’s hurting.

I look around at the life we’ve created for her—the bedroom full of books and dress-up clothes and musical instruments, the photos on the wall of our family vacations to tropical beaches and wildflower mountains and national parks. I fight an urge to shake her little shoulders and stare into her big brown hostile eyes and yell, “Why can’t you just be happy?”

            But I don’t . . . because I know better. The Everything Feeling’s got me in its grip as well, and has since I was her age.

*     *     *

            I’m eight years old. My mother—my confidante and playmate and Brownie leader–buckles my siblings and me into our station wagon and flees from our chic Los Angeles suburb. She deposits us in a scrappy duplex half an hour north in a scrappier beachside community. A makeup less woman–Budweiser in one hand and Marlboro in another–embraces her. She’s my mother’s new lover. “We’re leaving your father,” Mom tells me.

And, I add silently, my friends and my school and my Brownie troop, our cats and never-ending rabbits and the cute neighbor boy who’s taught me to shoot the bird and pass gas like the Fourth of July.

I don’t say a word; I don’t cry. I’ve heard the midnight screaming and the shattered glass. I’ve seen the black eyes, her bruised nose. I’ve felt her fear and mine, and I’m old enough to grasp the necessity of loss.

To a point, and then, not.

Something in me begins to hate my mother for not protecting me from trauma. I despise her new girlfriend—her rasping voice and her habit of striking a match on the zipper of her Levi’s. I flee our duplex every chance I get and run wild on the beach with a pack of stray dogs. I go feral. I growl at the nicotine stink of the living room as we eat dinner on tired carpet in front of the cold empty fireplace. I fall asleep to the wail of the foghorn on the jetty with my teeth and fists and stomach clenched tight.

It takes my father three weeks to find us. He appears at the front door with a patrol car’s lights whirling behind him and demands that my mother meet him outside. She and her girlfriend stand in the doorway, arms folded across their Superman t-shirts, sans bras. They shake their heads. “No way,” they say.

An officer steps from the car. Red and blue beams flash across the sandy volleyball court between duplexes. He walks up the steps and presents a piece of paper. My mother’s face crumples. We follow our father—me first, then my younger sister and brother, down the stairs and into his Buick. It’s 1978. The DSM IV has recently deigned to remove homosexuality from its list of mental illnesses. Still, a psychologist declares my mother unfit to raise children.

I never live with her again.

As a concession, the judge allows us to see her two weekends a month; apparently, she can’t turn us gay in 48 hours’ time. Every other Friday, she drives down in her VW bus to pick us up from our father’s house. I murmur tearful goodbyes to the stepmother we’re learning to love and shed more tears on Sundays when I’m ripped from my mother. I can’t feel her arms around me, smell her, or see her for ten days at a time. I forget how to draw a deep breath; I walk on tiptoe and read a novel a day between school and bedtime, four on the weekends I’m not with Mom.

“Why can’t you just be happy?”

Each of my parents demands this throughout my adolescence. Every other Sunday night, I sit in my bedroom on the ice-blue carpet, head pillowed on the rosy bedspread, and replay my weekend at the beach. Saltwater and sand still cling to my calves as I sit there for hours, eyes shut tight, hands shaking. No one comes into comfort me.

Therapy? No one has time. Mood stabilizers—out of the question. The Reagans are in the White House; red ribbons tied on the fence around my school remind me to just say no to the hooded stoner kids lounging in my classroom’s back rows. Drugs are for weak people, my father and stepmother tell me, mixing a third gin and tonic. “We’re fine. We’ve got this.”

My insomnia begins that year. My mother’s first girlfriend leaves her. I lay rigid in the darkness, worrying about her until the wee hours. Is she lonely? Is she suicidal? What if she dies? In my father’s bedroom, the battles begin anew—the slamming doors, the screams, the shattering glass. My brain waves twist and warp, training themselves into terror.

But I know nothing of neuropsychology. All I know is a longing to run the safety razor across my wrists as I stand in the shower at six AM. A crushing depression follows me to school, trailing me onto the high school track and the drama club stage.

I don’t do drugs—I do musical theater. I try unconsciously to restructure my neuropathways, boosting serotonin with exercise and music and laughter with friends. Some days, I almost achieve a retraining. But fear triggered by years of Sunday-night separations, by domestic disturbance and an officer at the door suggesting my stepmother take us to a friend’s house until my father stops losing his shit—these incidents reinforce my faulty neuropathways until I stand sobbing in the shower at dawn

*   *   *

I make it through college eschewing all other meds save Benadryl—two of the pink pills at night when chamomile tea and melatonin tablets fail. When diphenhydramine stops knocking me out, I add acetaminophen to the mix. Tylenol PM enables graduate school, marriage, and the adoption of my daughter.

In the daylight, I’m functional. My child is in preschool each morning with a teacher who loves her. But then, she hits kindergarten. Our world becomes afterschool meetings with principals, IEP circuses. The rooms of our house echo with screaming and slammed doors. At night, I lay in my husband’s arms and curse the anxiety that robs me of sleep.

He finds me a psychologist, a mellow and intelligent young man who tells me how much my husband loves me, how much I need help. He tells me a story of his husband—a man my age plagued by insomnia until he went on a low dose of Ambien. “It’s okay to take sleep aids,” the therapist concludes, but I shake my head.

Beholden to a prescription, I explain, means more than just a half hour wait at Rite Aid once a month. It means inadequacy, a failure to function like everyone else, to get a grip.

“Lots of people take prescription meds,” he argues.

I think of Nancy Reagan’s red ribbons and shake my head. “I’m fine,” I tell him. “I’ve got this.”

I take up long-distance running; now I’m thin and muscular and exhausted. Periodically, I break out in hives. An allergy, I tell myself, to sports gel or Gatorade or the flax seeds I spoon into kale smoothies. But when my lips bulge and my eyes swell shut and my husband drives me to the emergency room looking like the Elephant Man and with his same wheeze, the doctor refers me to another who diagnoses Hashimoto’s Disease. Three and a half decades of anxiety and sleeplessness have caused my immune system to attack my thyroid.

“Take this pill every morning.” The pharmacist at Rite Aid shows me the little blue oval of Levothyroxine.

“For how long?” I ask him.

He blinks surprise behind his spectacles. “For the rest of your life.”

*     *     *

Shortly after Parent-Teacher Night, I attend a regional adoption conference. Adoptive parents, foster parents, and social workers share watery coffee and stale maple-glazed donuts in a chilly borrowed office suite, listening to a sociologist talk about the effects of early trauma on a child’s neurological development. Brain scans appear on her PowerPoint like a couple of cauliflowers. “This is the brain of a normally-developing child at three years old,” she tells us. “And this is the brain of a three-year old foster child who’s experienced trauma and neglect.”

We study the runt cauliflower, significantly smaller, and listen to the list of potential stressors affecting our kids. They start in the womb with little pre-natal care and periodic baths in drugs and alcohol. They extend to the shock of delivery and removal from the birth mother, then placement in a sterile neo-natal unit and a transfer to foster parents who may or may not offer physical affection and a tranquil, structured environment.

Some foster parents—mostly retired and courting sainthood—have the luxury of accepting one drug-affected infant at a time. They carry the child everywhere, cuddling, crooning, and feeding them pudding while gazing into their eyes–the works. Others juggle several needy kiddos at once. Money and time, in short supply, don’t permit a whole lot of baby wearing and eye contact.

“Foster kids’ brains have a different structure,” the sociologist tells our goose bumped group of conference participants. “They have a low volume of calming chemicals and a high volume of excitatory chemicals. Our kids view conflict—any conflict—as a threat to their survival. Adoptive parents, no matter how noble their intentions, represent one more trauma.”

Someone raises a hand. “What about medication? Anti-anxiety drugs, anti-depressants?”

The presenter taps the poor little wrinkled cauliflower on the screen with her pencil. “Meds can help,” she says. “A lot.”

She clicks off her laptop and invites questions from the group. I flee to the restroom. In a sterile stall I sit and stare at the door. Right there on the cold toilet seat, I have an epiphany that changes my life.

My brain needs help.

I slink toward my little white anti-anxiety pill at 44 years old, resolute but convinced that I’ve failed at the basic human tasks of sleep and moderate optimism. Within two days of swallowing it, I sleep an eight-hour night. “Everyone’s getting medication for Christmas!” I joke with my husband.

Everyone that is, except our daughter.

            *   *     *

Our eight-year old, I continue to insist, needs affection and attention and hip hop lessons—not mood stabilizers. Never mind that she screams over her plate of spaghetti because it’s got the wrong sauce, screams over the loss of her favorite TV show, chases the cats, fists me in the stomach, and falls into bed squalling. “We’ll find her a good therapist,” I tell my husband. “That’ll help.”

We agree on a kind Polish counselor who does sand play therapy with innumerable plastic Disney figures and teaches our child to lie on her back in a warmly carpeted office and blow soap bubbles, breathing deeply to combat stress. The woman teaches her “rabbit breaths” —short bursts of inhale and a long exhale designed to replace hyperventilating over second-grade math assignments and requests to set the dinner table.

None of it helps. My daughter shoves the principal, who begins sending her home from school mid-morning. “We’re a charter school,” he says. “We’re not set up for behavioral disorders. Think about moving her to a special education class at the public school.”

I grit my teeth. I’ve been a special ed teacher, know first-hand the challenges of wrangling a class full of kids—each with specific needs and none getting optimum attention. I’ve stepped over plenty of squalling children myself to attend to the one toppling computers from desks and punching holes in the walls. “She is not,” I tell the principal, “switching schools.”

In the dank patchouli corridor, when my daughter actually does manage to make it to 2:45, I meet no parent’s eyes. The other second-graders line up in the doorway and shake the teacher’s hand and grasp their hand-woven lunch baskets, heading off in pairs for afternoon play dates and Friday night slumber parties. My child’s the last to leave. She huddles at the Peace Table while the teacher gently reprimands her for the latest shrieking/hitting/spitting incident. At home, she shuts herself up in her room and slumps on the bed.

“I feel like a broken light bulb,” she tells me, surrounded by piles of schoolwork she hasn’t completed.

“What do you mean?” I ask her.

“I’m different from everyone,” she mutters. “I shouldn’t be here.” And then, “I want to be dead.”

I stare at her—my suicidal eight-year old in her blue Frozen t-shirt. The words under a smirking blond Elsa read “My castle, my rules.”

For the second time in a month, I experience an epiphany. What other choice did Elsa have, I think, after 18 years of loss and neglect? Her parents were dead. A propensity for frigid temper tantrums kept her locked in her room. Why wouldn’t she retreat to the top of a mountain, build a fortress of solitude, and take charge of her environment?

Maybe if she’d just swallowed a little mood stabilizer once a day, she wouldn’t have iced an entire kingdom.

I call my husband. He phones a developmental pediatrician and makes an appointment for diagnosis and a prescription. I call the principal and withdraw our daughter from her second-grade classroom. “We’re going to homeschool her,” I say, the sentence absolving me of IEP meetings and outrage and shame. Elsa’s words ring through my head, full of triumph.

My castle, my rules.

*     *     *

It’s 2:45, the end of the school day. My child, a third-grader now, runs to meet a bus full of friends outside the building that houses their afternoon program. They race into a classroom full of art supplies and sewing machines and games and books and beanbags. She has time for a quick hug, a swift, “I love you, Mama,” before melting into a group of giggling girls.

At home, I open my laptop beside her colorful math and literature textbooks, the flash cards, the globe, the Borax crystals and the paper-and-string robotic finger she’s created. We’ve been homeschooling for six months now. We laugh a lot. Sometimes, we argue. On our worst days, when I resent having to wake up too early and stay up too late to attend to my own work, or my daughter fumes at having to study when she wants to lounge on the couch reading Garfield comics, we cry. But mostly, we relish small daily revelations and the one big one—she’s finally happy.

She takes mood stabilizers for six months. They chill her out, but give her a Winnie the Pooh physique and a slowness not conducive to gymnastics and hip-hop classes. With the pediatrician’s permission, we cut the dosage in half and wait for the return of our demon child.

She doesn’t resurface.

Instead, she wakes up smiling, singing, even—excited about her day.

We quarter the pills, then abandon them altogether for a low dose of Ritalin which allows her to learn multiplication and fractions and spelling without chewing her pencil in half.

Several mornings a week, we walk up the hill to a forested park, on a quests for newts in the stream and Cooper’s hawks in the Doug firs. We discuss planets and poetry and how baby chickens can breathe inside the egg.

One day, on a sunny morning on which we’ve discovered four types of lichen on a fallen branch and spent 20 minutes identifying a colossal mound of gleaming black opossum dung, she slips her hand into mine.

“Remember when I was so bad at school?” she asks me.

“You weren’t bad,” I respond automatically. “You were scared and angry.”

We walk past a patch of sunny daffodils. I point out a deer path winding through the tall grass, but she persists.

“I was mad at you for leaving,” she says. “Every day, I missed you.”

I squeeze her little shoulders and stare into her big brown affectionate eyes, remembering what it felt like to be torn from my own mother 10 days at a time.

“I know,” I tell her, and we walk hand in hand toward home.

Author’s Note: It’s been almost a year since I completed the final draft of Rabbit Breaths–a year of homeschooling, of meetings with developmental pediatricians and counselors who diagnosed my daughter with severe ADHD. We’re still looking for the right medication that allows her to function calmly and happily in the world. Not medicating isn’t an option, but my husband and I have greatly stepped up our attention to nutrition and sleep and exercise and outdoor exploration and the arts. As well, we discovered Russell Barkley’s excellent Taking Charge of ADHD and a local parent/child support group. We take each day an hour at a time, practicing (and sometimes failing) our patience and creativity. Most days, we remember to laugh.  

Melissa Hart is the author of the YA novel Avenging the Owl (SkyPony, 2016) and the memoirs Wild Within: How Rescuing Owls Inspired a Family (Lyons, 2015) and Gringa (2009). She’s a contributing editor at The Writer Magazine.

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Short-Term Memories

Short-Term Memories

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mighty old tree with green spring leaves

By Donna Brooks

You went down on August 26—my 29th birthday. That’s what the doctors and nurses kept calling it, anyway. It didn’t take long for me to understand that this is one of many ambiguous terms medical practitioners use to speak without saying anything.

Jack and I got the call around 9 p.m. and drove through the night; buzzed on the champagne and bottles of beer we drank to celebrate the last year of my twenties, despite it being a Wednesday. In the middle of nowhere Iowa, your doctor called to ask my permission to use life-saving measures while they transported you from the VA hospital in Des Moines to the neurotrauma unit at Mercy. I gave it, even though I promised you eight years earlier that I’d never let you live in a vegetative state. DNR you had me repeat to you over the phone. Do Not Resuscitate.

I found you drenched by the rising sun, entangled in a menagerie of machinery. Fate found us together again at Mercy, as we were on that very day 29 years before; the hospital I was born in.

Black circles of dried blood ringed your nostrils. When I asked why they hadn’t bandaged your engorged, bleeding ear, which had nearly tripled in size, a blonde nurse said, “She was down for a long time. Maybe eight hours. The blood coming from her ear is the least of our concerns.”

I had an overwhelming impulse to slap her, but buried my fingernails into my palm instead. My little brother is on his way for God’s sake. I moistened a paper towel and eased the blackness away.

A machine blew air into your lungs. A machine cleaned your kidneys—the first organs the body lets go of in an attempt to preserve the lungs, heart, and brain. Your body was the most impressive machine of all.

The neurologist and nephrologist told me to go get some rest—I’d need it for making big decisions. Big stroke. Big sister. I drank instead.

Your MRI showed what they called Shower Emboli; twelve strokes at once. The glossy photograph of your brain looked like a series of constellations mapped in a wrinkled galaxy. The doctor said your heart collected these shooting stars for years, maybe decades before the big bang. Blood pumps in quicker than it can pump out, sloshing and coagulating in the meaty basin of your left ventricle. Atrial fibrillation, he called it, a result of habitual drug use.

His tone carried a tinge of delicate inquiry, just in case the news he was delivering might come as a surprise. As if we could have possibly overlooked the last twenty years of our lost childhoods. Or maybe missed your propensity to, repeatedly, choose meth over motherhood; prison and halfway houses over our upper-middleclass suburb; crime over comfort. Dallas and I nodded. He looked relieved.

I wanted that image—my brother and I sitting there, hunched and raw, on the couch in your hospital room—to be used in D.A.R.E. programs across the country. Particularly in the Midwest where methamphetamine continues to turn mothers, fathers, brothers, sisters, and friends into the poison it’s made of. The message: Meth will come back to bite you. Sometimes, years after you quit using it. It destroys everything, inside and out.

Meth changed the beat of your heart.

I prayed for the first time in years. Prayed for your recovery. For your forgiveness. For relief from my opaque guilt for casting you out of my life. Jack read to you from your worn and heavily annotated bible Cousin Angel brought from Spring Hill. His voice was low and soft, a relief from the sterile, rhythmic reminder that you were not breathing on your own. Your bookmark was a picture I’d sent you from the night Jack asked me to marry him. It held the place of Corinthians 13:4-8. Love keeps no record of wrongs.

For ten days this went on. Sooner or later, the doctors said, this stroke will kill your mother. Don’t talk to me like I’m a child, I snapped, and immediately felt guilty, because I am a child. Your child. We agreed to extubate.

She may not breathe on her own, they said. You did.

She will be paralyzed on her left side of her body, they said. You are not.

She will have substantial brain damage, they said. You do.

You’ve lost your ability to create new memories—anterograde amnesia—which is pretty much on par with the cruelty life has shown you. What if, I thought, you awoke with a blank slate? Unburdened by the abuse of your childhood. The suicides of your brothers. The manic depression. What if we could meet between the wrinkles of time and start again.

 

Donna M. Brooks holds an MFA in creative writing from Queens University of Charlotte. She was a 2013 finalist for the Iowa Review Award in nonfiction and a finalist for the Santa Fe Writers Project Award in nonfiction. Her work has appeared in Mamalode. She lives in Sioux City, IA with her husband and daughter.

 

Cities of My Body

Cities of My Body

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Silouette of Woman's BodyBy Liz Rognes

With her long, perfectly manicured fingers, the checkout girl methodically lifts each item out of my shopping basket. She scans a box of almond milk, a package of pasta, then the container of prenatal vitamins.

I shift my weight from one leg to another. I’m barely showing, but if you look closely, you can already tell. I’m sixteen weeks pregnant with my first baby. This was not something I thought would come easily. My body, now generally a place of health and reliability, has in the past been the site of rampant destruction. My doctor had said subclinical infertility. My slow thyroid and elevated hormone levels worried her. She had said it could take many months, maybe years, to get pregnant. She had said she could refer me to a specialist.

But it happened faster than we had expected. Jason and I were shocked and elated when one home pregnancy test after another appeared with a plus sign, only weeks after the appointment with my doctor. I had worked so hard to prepare myself for disappointment, for the reality of subclinical infertility, that I did not believe the results. I took three, four, five, and then six pregnancy tests over the course of a few days, and all came back with the same unbelievable message.

There will be a baby.

I will be a mother.

I am short with a short torso, and there’s nowhere for this expanding uterus to go but out. I’m proud of this, and I wear my growing belly like a marker of glowing wellness and peace and love and all of that motherhood mythos, but standing there on the other side of the checkout counter, I am swept with insecurity. I do not feel like a mother. I am not glowing.

***

I know little about the woman who scans my groceries, but I know more about her than I know of the other cashiers. Only months ago, before I became pregnant, before I quit coming to the grocery store because of morning sickness, I stood behind the checkout girl, partial stranger, partial familiar face, in the garage of a house I’d never before seen, after bar close, with a slew of skinny, tattooed men circling the cold room and line after line of cocaine appearing on a workbench.

 

When she finishes unloading and scanning my basket, she asks, “Paper, plastic, or reusable?” She does not make eye contact. I realize that we’re pretending not to know each other.

***

Six months earlier, Jason and I walked into a party after bar close, on the heels of a magnetic, fast-talking British musician who now lived in Spokane.

We had recognized him from his moment of fame; his band had a hit song in the eighties. He was not the kind of person we usually hung around, but something about him was alluring; Jason and I were both inexplicably swept up with him and his exaggerated manner. We joked that his arrogance was endearing. He didn’t give a fuck about what people thought, and we were nothing like him.

 

When she finishes unloading and scanning my basket, she asks, “Paper, plastic, or reusable?” She does not make eye contact. I realize that we’re pretending not to know each other.

 

We were bookish, responsible, rule-followers; Jason was a librarian, and I was an English teacher. When I did get pregnant, my own mother joked that our baby would inevitably be a nerd. “Nerd plus nerd equals nerd,” she said, smiling. She meant this lovingly; we were creative, but we went to bed early. The musician, on the other hand, was tall in stature and presence, and he commanded the attention of everyone in the room. We were seduced by his fame. And ever since we had begun talking about trying for a baby, even before my visit to the doctor, I had started to feel a little impulsive, like there was a limit to this moment in my life as I knew it. I felt myself yearning for spontaneity. So when the musician invited us to the bar for a drink that night, we went. When he invited us to the after party, we went. We were somewhat star-struck, and, despite a slew of signs indicating the opposite, were convinced that there could be something positive, or at least productive, about this friendship.

At the bar, his girlfriend leaned into me and she whispered in my ear, “It’s a hard party, if you know what I mean.”

I looked her in the eye.

I knew exactly what she meant.

***

Ten years ago, I signed in to the last of many rehab centers I had been to. I’d hallucinated my way through hospital detox a handful of times, blood pressure exploding in my ears and the sick expulsion of poisons pouring out of my mouth and pores. Then, I was a young twenty-two years old, with the face of a girl of about eighteen. I was small, with big eyes and a quiet demeanor that convinced people I wasn’t trouble. I got away with almost everything—drugs, constant drunkenness, promiscuity, hanging around with a rough crowd, finding myself in rooms with guns and coked out drug dealers—and the outside world likely pinned me for a brooding teenager, not a girl mixed up with the kind of stuff I was doing.

Even when I started accruing consequences, I managed to maintain a certain naïveté. I’d been drinking and drugging like that for only a year or two, and I was simultaneously heavily medicated on antidepressant drugs and a pharmacy of other pills that were supposed to help with my anxiety and bulimia. The cocktail of drugs, combined with the heavy drinking, took a quick, serious toll on my liver. I was confused when I started experiencing withdrawals from alcohol, telling myself that was crazy—I was only twenty-two, after all. That was the kind of thing that happened to old men who’d been drinking for decades, not to promising Midwestern farmer’s daughters who went to fancy women’s colleges like me. I kept the extent of the chemical dependency a secret.

Most of the time, I didn’t care that I was a mess. I didn’t want to take care of myself, and a future of motherhood—the possibility of one day being responsible for someone else—was not even a consideration. My body was a burden that I wanted to escape.

***

At the party, the checkout girl was drunk and high already, and she walked right over to me, announcing to the people around her that I was her grocery store customer. This was not how I wanted to be identified. Normally, in this mostly sober adult life I have crafted in the past decade or so, I think of myself as a woman who no longer takes unnecessary risks, a woman who eats kale and root vegetables, who wears a seatbelt and a sunhat, who cares about whether or not there are laureth sulfates in her shampoo or fluoride in her toothpaste. After years of therapy and hard work crafting a more or less healthy lifestyle, I am no longer the woman who shows up at after parties to do lines of cocaine with strange men on workbenches in cold garages. I have learned how to take care of this body and how to quiet my anxiety. I have learned how to reach out, how to ask for help, how to be accountable and to maintain relationships. I wanted to bring a baby into this place of steadiness, to enter motherhood with the firm footing of ten years away from the chaos of my past. But on that night, I didn’t want to be the careful, healthy woman I had worked so hard to become, I didn’t want to think about motherhood, and I did not want any reminders about who I was, now.

The truth is, I was feeling itchy, and I had been for a while. The musician’s arrogance and gestures, his constant phone calls and quick disappearances were familiar to me, and while I didn’t tell Jason about the old cravings swirling around in the back in of my mind, I intuited that hanging around this fast-talking man with a palpable residue of aging fame could eventually lead to something like this. The musician’s cues represented something I had put away, and the nearness of it was intoxicating. When I walked into the party and saw the woman who nearly always scanned my groceries, I was jolted. She made me think of the natural foods store, of my chosen lifestyle of health and sobriety and intention.

That night, I didn’t want any reminders of what my life was outside of that party.

***

“Sixty-three forty-nine,” the checkout girl says.

I pull out my credit card and run it through the swiper, even though I know it won’t work. The strip has been busted for weeks. I try again. It doesn’t work. After the third try, I have to hand my credit card to her so she can manually enter the numbers. I watch her hold my card, and I can’t help but think about her long, skinny fingers holding onto a different credit card on a different night while organizing the white powder into neat, short lines, before turning to me and saying, one hand by her nostril, head tipped back, leaving the last line for me: “All yours, sweetie.”

***

I’ve been buying groceries at this overpriced natural foods store since I moved to Spokane four years ago. Even while I was a broke grad student and then a broke adjunct instructor at a community college, I would count my quarters, trudge through the snow from a few blocks away, and buy onions and garlic and potatoes to make hearty soup that would last me for a week. The boiling potatoes curled steam across the windows of my tiny, cold second floor apartment.

Buying groceries has nearly always been a knotted task for me. As a kid, I hardly entered a grocery store because my mom would drop my siblings and me off at my grandma’s house across the street in our little farm town while she went in to shop. I had no idea where our food came from, immediately or long-term, even though we lived smack on a farm in the middle of Iowa, with hundreds of acres of corn and soybeans surrounding us. I was sensitive to the cultural messages about femininity and thinness that permeated the strange mix of culture of rural farming and mainstream media of the late eighties and nineties. And as the eldest child in a homogenous culture, I was a perfectionist. I developed an eating disorder in my pre-teen years, and my relationship to food was severely stunted. Grocery stores became terrifying and overwhelming places where the thing that I most feared and most coveted lived. I loved food, and I hated it. As a teenager and then as an early twenty-something, I cycled through bouts of severe restriction and uncontrolled devouring of food. Adding drugs and alcohol to the mix, I was completely unable to find a middle ground or to even recognize that a middle ground could be possible.

***

After the party, we didn’t get home until the sun was beginning to slowly lighten the sky behind our house. In our domestic life together, we had never stayed out until sunrise.

I had been offered the last line of cocaine at the party. I would have done more, but that’s all there was. I kept thinking of it as “only one line,” but after ten years of complete abstinence from hard drugs, one line and the guilt that sank into me nearly immediately afterward was enough to keep me awake. The late spring sun uncovered the valley below our bedroom window pine by pine, and I felt the old shame of addiction begin to crawl through the synapses of my brain.

We invited our dog onto our bed as an apology for leaving him alone all night. My head spun. Jason knew that I had done a line, but he did not see it, nor had he done any cocaine. In fact, he had never done cocaine. He had hardly smoked pot in his life, and I loved this about him. Once, I had been knitting a foot for a stuffed animal, and without the body attached, it kind of had the shape of a pipe. Jason asked why I was knitting a bong, and I burst out laughing, completely in love with him. I found his lack of expertise about drug paraphernalia extremely endearing. This man was the person I wanted to spend my life with. He was funny, smart, and sweet, and he cared deeply for people. A library member had threatened him once; the man had slammed the desk and screamed at Jason until he called the police to remove him. The library had to exclude the man for a year. Instead of being angry that he had been threatened, Jason said, “I just hope he has another safe place to go.” I could see in my partner a man who was sincerely motivated by his heart, who was patient and thoughtful and empathetic; he would be a wonderful father.

I began to cry softly, afraid that my choice to do a line of blow had jeopardized this life I had with him—this beautiful distance from the darkness of drug use, this life of books and mornings and dog walks, this life of music and love and happiness. My past and my present were polar opposites, two cities that could not be any more different or further apart, but that night they had appeared in the same room. Two versions of me had inhabited my body.

I curled into Jason’s arms and listened to him comfort me. He said it would be okay, that one line of coke didn’t mean the end of the world, that we could sleep for a few hours and wake up and go about our day. We could still start trying to get pregnant, like we had planned. Even after the party, he believed I could one day be a good mother. He was soothing and loving, and I was not sure that I believed him.

 

After the party, we didn’t get home until the sun was beginning to slowly lighten the sky behind our house. In our domestic life together, we had never stayed out until sunrise.

 

We managed to sleep for a few hours, and when Jason’s alarm went off, the sun was beating through our bedroom window and I could hear the sounds of cars climbing the hill, people going places, doing normal things, like this were any other day. Birds chattered loudly. Jason hit snooze and closed his eyes again. The dog, a happy, rowdy Rhodesian Ridgeback mix, yawned and stretched, rolling onto his back, his giant red paws extended into the air, exuding the musky sweet smell of sleeping dog. I felt my love for these two creatures surround me, thick and tangible.

The truth is that for weeks afterward, I would feel the itchiness. I would try to talk Jason in to calling the musician. I would say things like, “I only got to do one line at that party—I should have a real last hoorah.” If we were going to try to get pregnant; this could be my last chance. I would say these things with a smile on my face, as though it were no big deal. I half-joked about buying an eight ball, just for fun, but then I had to define “eight ball” to Jason, and my two worlds knocked heads. My past and the possibility of relapse loomed over us, a storm waiting to break. But it wasn’t what I really wanted; I wanted the stability that we had created, I wanted this partner who loved me, I wanted to become a mother.

***

His alarm went off again—the opening riff to one of his favorite songs, on repeat. He opened his eyes and looked over to see me watching him. He smiled a sleepy greeting. “Good morning, baby,” he said. “How are you feeling?”

I felt awful. My head was pounding, but I knew that I couldn’t just stay in bed. “I’m coming with you,” I said.

***

Jason’s job is pretty straightforward: he manages a library, helping people access information. He goes to the same place every morning, works more or less the same hours every day, and he has reliable income and responsibility. But once in a while he gets assigned something like driving the district library van in a small-town parade on a Saturday. So the morning after I sniffed my first line of blow in ten years off a dirty workbench, I climbed into the passenger seat of a loud, bumpy van with the library logo painted on the sides and rode along to a tiny town on the edge of the Washington Palouse, surrounded by wheat fields and rolling sky to hand out library pencils to the kids who lined the single street.

It was the kind of day that is not supposed to exist when you’re trying to wallow in the shame of your past. Even though it was still spring, it was stunningly summer-like, the sun filling the street and warming the backs of the horses and local equestrians who proudly showcased their riding gear in the parade. People were giddy with the weather and the atmosphere of celebration. There were craft vendors, tractors, a high school marching band, and a man with a microphone from a shoddy P.A. system in the center of the five-block parade route, his voice crackling with static and pride as he announced each float and organization as it went by. “And here’s the library. Everyone loves the library!” he said cheerfully, as we slowly drove past. I waved out the window at rows of grinning children and adults, and library staff in screen-printed T-shirts walked to the curb to hand pencils to excited kids. Everyone cheered.

I smiled, but I was holding back tears of gratitude. This is my life now, I thought. This: libraries and sunshine and happy children, not last night.

***

Once, while I was living in a halfway house, the house manager told us about a dream she had in which she had relapsed. She had been sober for many years, and the dream had disturbed her. But she said that she was grateful for the dream because it reminded her about how horrible her addiction had been. It reminded her the life she had now was her chosen life, the life she truly wanted. I have relapsed before, moments that initiated dramatic falls, landing me deeply in old habits. I worried that this time would not be any different. That one line of cocaine could be a sentence: that I would have no choice but to succumb to the old patterns.

***

My card finally goes through, and the checkout girl prints the receipt. She has bagged my groceries, and she smiles at me. “Have a nice day,” she says.

I lift the bags, one in each hand. We make eye contact. I thank her, and I take the groceries. I leave the store with my food and prenatal vitamins. I walk across the parking lot to my car parked in the crisp late fall air that smells like ponderosa pine and wood smoke and I tell myself that it’s going to be okay. This is my life now, and I am lucky. This body has surprised me; it has been through destruction and healing more times than seems reasonable or possible or fair. I am lucky to live in this chosen city, in this place where my days are filled with meaningful work and love and songs and mornings when I wake tucked into Jason’s arm.

But my body is more than a chosen city—it is many cities, all of them imperfect and strange and beautiful. Its geography is informed by the proximity and relationships between dots on the map, and I need all of these cities to appreciate the span and breadth of terrain. Doing one line of cocaine was a stupid, momentary decision, but it didn’t mean that I had to relinquish the life that I have chosen. Even the ugliest, darkest parts of a city see sunlight, and to live without acknowledging that those dark corners exist isn’t realistic or even fair. That line was not a sentence, but it did offer me a chance to reaffirm my commitment to the life I have now. The health and stability I have worked so hard for is not perfect, and it is not indestructible, but it is a place that, given the choice, I want to live.

I open the trunk to my car and set the bags inside, and then I pause, stunned.

A new landscape is forming in this imperfect, strange, beautiful city: I feel the unmistakable tiny flutter of a baby moving in my belly.

Author’s Note: The months leading up to the birth of my son were some of the most exciting and reflective months of my life. Pregnancy was this surreal occasion, where I was literally carrying pieces of my past and my future within the boundaries of my body. This essay was a way for me to grapple with that bridge between the “two cities” of my past and present/future, and especially to consider the lingering shame that I still carried. But that past, with all of its darkness and healing, is a part of who I am today. I am the mother I am partly because of that past, which has taught me about recovery and empathy. My son is now a healthy, happy, toddling, singing, and chattering 14-month old.

Liz Rognes is a writer, musician, and teacher who lives in Spokane, Washington with her rock ‘n’roll librarian and their son.

 

Family Portrait

Family Portrait

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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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Skate Park

Skate Park

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By Carrie Mesrobian

winter07_mesrobianI go to the skate park to relax. I bring my nephews and their friends, and while they drop off the ramps and grind the rails and furiously attempt to ollie, nose-manual frontside pop-shove-it casper slide, impossible-out on their sticker-plastered skateboards, I crochet, sip soda, listen to public radio on my headphones. I leave my daughter Matilda at home with my husband and let my mind wander, with the sun on my face, free of housework, yard work, phone calls, clutter. As far as kid duties go, it’s a good gig.

Today we’re going to the skate park over by St. Anthony Park, a few neighborhoods away from ours. In the car I’ve got my nephew Sid and his friend Joey. They’re both nine years old, fourth graders, and both sport shaggy blond hair and narrow, thin bodies. As usual, Sid carries his glossy eight-ball helmet. His mother—my sister—insists that he wear it. Both boys are wearing long t-shirts and pants that drag over their skate shoes, which also drag and scrape against the asphalt.

Both boys endlessly catalogue and compare the skate shoes everyone else wears. They bicker back and forth like an old couple: Do they sell Etnies at the Hot Spot? Or Zumiez? Do they sell stickers there? Geoff Rowley decks? Would Rodney Mullen go to Zumiez or the Hot Spot? Definitely the Hot Spot. Zumiez is a chain store in the mall.

Rodney Mullen is Sid’s hero. He can do a 540 shove-it, double kickflip, a nose manual impossible-out, a nose manual darkslide, double caspers and varial heelflips. He is known as the king of freestyle skating and his favorite place to skate is atop picnic tables. Rodney Mullen can flip a skateboard under his feet and land on it, teetering on the deck’s edge. In 1980, when I was in first grade, Rodney Mullen turned pro and skated for legendary skateboard maker Powell Peralta. In 1980, Sid’s parents were in fourth grade.

“St. Anthony’s is better than New Brighton,” Joey tells me with the sharp-eyed certainty about everything skate-related he and Sid share.

Whatever. Here we are. The boys burst out of the car and run ahead of me.

Since I’m not Sid’s parent, I don’t feel obliged to watch every skateboard trick. Besides, Sid is now too cool to ever ask me; he is quite conscious of the older boys who are sometimes hanging around, the ones who aren’t made to wear helmets, the ones with tattoos and pierced ears and heavy hooded black sweatshirts.

The Black Hooders. That’s what I privately call them. Last week at the New Brighton skate park, I saw one of them tamping a pack of cigarettes against his palm, which should have outraged me. The signs at all the skate parks we visit clearly state, “No smoking, drinking, drug use, profanity”—your basic list of swimming pool rules. But I can remember being fourteen years old and slapping a new pack of cigarettes against my own palm, an act filled with pleasure and anticipation. I remember having watched a girl named Kalli do the very same ritual before opening a pack and I imitated her because she was sharp and savvy in other deviant ways. Still, I wish those Black Hooder boys would not smoke in front of younger kids.

I lean back on the park bench and sigh. I listen to a cooking show on public radio while keeping a lazy eye out for my charges. The St. Anthony skate park is right behind a police station. I take comfort in that, figuring if the Black Hooders show obvious signs of delinquency or if someone hurts himself, I’ve got backup.

Today, I see no Black Hooders. Which is good, in a way, because watching my nephew navigate around this kind of kid fills me with an uneasy nostalgia. When I was just a few years older than Sid, I was a boy-crazy fiend for the Black Hooder type. Their quiet, unimpressed manner was such a challenge. I was desperate to make them notice me, to get the attention of boys who barely looked up even to dismiss me. Not all of them were skaters, but they were all on the fringe of acceptable behavior. They smoked Camels and drank Jack Daniels and bought and sold pot and swiped their moms’ cars and played in bands with stolen amps and guitars. They wore their hair shaggy over their faces, and long in the back. The kids today would call that style a mullet. I’ve always loved boys with long, shaggy hair.

Shaggy hair like Sid’s and Joey’s.

Who are now scrounging up change for the soda machine. I step to attention and hand over some dimes from my coin purse. I ask them how it’s going.

“Didn’t you see that manual I did?” Sid asks. “From off the piano?”

“Uh, no, I missed it,” I say, feeling like a fraud. “Could you do it again?”

I take off my headphones and pay attention now. I watch both boys drop in from the biggest ramp and perform various kinds of twists and flips into the middle, shorter ramp, which I guess is the “piano.” As they wipe out and their boards fly from under their feet, I start surveying the rest of the group.

There is one older boy who is shirtless and covered with tattoos. He’s lanky but with whips of muscle everywhere. He smiles at Sid and Joey and asks them if they are all right when they fall down. Okay, Tattooed Shirtless is nice. Then there’s a taller kid with a strange body shape who waved to me when I made eye contact. I’m not sure if the taller kid is a boy or a girl—the body shape is unrecognizable under the baggy clothing. The face is clean and smooth, but the hair is short. But then again … are those boobs under that shirt? Or is it just a slightly chubby boy? From the standpoint of pity, Gender Confused earns my approval immediately, because he/she has obvious vulnerabilities. Plus, Gender Confused is alone; Tattooed Shirtless has a buddy talking to him from the sidelines.

Thus begins my rally for Gender Confused. I think of how scary and painful it is to be teased and ostracized. As a female, I can relate to being embarrassed and ashamed of my body. I imagine skateboarding as the savior of Gender Confused, a rebel activity in which he/she seeks solace from a cruel, conformist world.

I locate Sid and Joey in the middle of a clutch of boys their age, none of whom look the skateboarder part. These younger boys have short haircuts and jock clothes and look like they’ll be frequenting sports bars in another fifteen years. One of them is yelling snottily and the rest are giggling like fiends, showing a lot of pink gums, hollering. Sid and Joey stand by them, grinning and talking. Instantly, I am annoyed.

This is the boy who was The Enemy for me as a young girl. He’s the Anti-Black Hooder, the Class Clown Boy who tormented other kids by heckling, by seeking too much attention, by noticing too much detail. Class Clown Boy yelled mean jokes and snapped bra straps. The Class Clown boy ran with a pack of human laugh tracks, stalking those with unusual plumage. Thanks to my adult status, though, I’m no longer fearful of the Class Clown. Conventional, respectful of authority and status quo, the Clown is only as powerful as his cackling cohort. If they mouth off to me, I can stand up, hands on hips, and deliver a shrill smackdown. Instant Adult! (A move that could send Sid into orbit with embarrassment.)

So now I am sure the hateful Class Clown and his friends are mocking Gender Confused and this worries me. I am concerned for Gender Confused and wondering if there’s anything I could do or say that might let him/her know I am not an asshole like the Class Clowns. When s/he skates past me, I wave. I get a nod and a hello back. Okay, good.

Still, I am bothered by Sid and Joey’s apparent alliance with the Class Clowns. I resolve to underscore to them the evils that beset the paths of the Cackling Cohort. Perhaps Tattooed Shirtless will set a better example for everyone at the skate park before my pent-up indignation makes me do something dramatic.

I am puffed up with self-righteous annoyance by the time Sid and Joey, sweaty and ruddy-faced, come to tell me they want to go.

As I pull out of the parking lot, Sid and Joey tell me that another kid offered them some pot.

“WHAT?!!” I hit the brakes. “Pot? Who?”

They give me a pitch-perfect description of Gender Confused.

“You mean the one that you couldn’t tell was a boy or a girl?” I say.

“Uh huh,” Sid says. Then he and Joey giggle.

I am shocked at Gender Confused’s betrayal. I waved at that kid! I felt bad for him! Or her! Goddammit!

“How do you know it was pot?” I ask.

“Because he…” Joey stammers, “…I mean, she…”

“It!” Sid tosses in helpfully, which makes Joey collapse in laughter.

“‘It’ asked us if we wanted a hit,” Joey says.

A hit? While they snicker about pronouns in the backseat, I frantically review all my cumulative marijuana knowledge. Yeah, sometimes we called it taking a hit. Then I wonder if it wasn’t some new other drug. I want to ask the boys more detailed questions—Was it a pipe or was it like a cigarette? What did it smell like?—but I don’t know if that is an appropriate Drug-Free America line of questioning.

The car is stifling. The seat upholstery is scratchy and I can feel sweat dripping down my back into my butt crack. I am a thirty-one-year-old mom driving around two fourth grade boys who have just been offered marijuana by a gender-confused teenager and I’m not sure what to say.

I rush through my thin knowledge of child development, a semester of educational psychology. Um, are fourth graders still using either/or thinking? Are they in an authority-testing phase? Should I bolster their self-esteem in an effort to keep them immune from drug abuse? Do I attempt to foster empathy by explaining Gender Confused’s possible rationale for getting high, his unfortunate situation in an oppressive, binary-gendered world? Where are they on Maslow’s hierarchy of needs?

Uh, maybe not.

Do I tell them the reality, that skateboarders don’t tend to grow up to be Sunday school teachers? I sigh. I know which route I’m going to take. I’m not sure it’s right.

“So, what did you do?” I ask, trying to seem cool.

They tell me how they and some other kids—the Class Clown brats—said no to the offer. The Class Clowns, in turns out, were actually making fun of Gender Confused because of the pot-smoking, not the indiscernible gender.

Great. The fucking Class Clowns are the heroes.

I tell the boys the next time we go to the skate park to let me know if someone offers them drugs.

“Why?” Sid asks. “Are you going to say something?”

“I won’t embarrass you,” I say. “I’ll just tell them that if they have any brains, they won’t smoke pot right behind the cop shop.”

It’s the light-hearted route, my usual schtick. This is my role in Sid’s life: Wisecracking Aunt Who Occasionally Swears.

I know that no matter my approach, at age nine, Sid and Joey are independent souls. At age fourteen, they will be independent souls who might experiment with cigarettes, drugs, or booze. I realize, against the evidence supplied by Frontline documentaries and lurid news reports, that I honestly believe that this experimentation is natural, even desirable. I recall cracking beers behind the grocery store before high school football games. I see myself illegally buying cigarettes from Dirty Ed’s Superette. I remember coughing and choking on pot smoke in my friend Becky’s car one winter night before a school dance. I see those events as plot points in the story of my life. Some people I know who smoked pot turned out to be losers. Some of them are now in middle management at big corporations. I am unable to manufacture an alarmist, mother-hen reaction.

As I cruise past at thirty miles per hour, I see people in their driveways washing cars, in their yards mowing grass, standing on the sidewalk chatting with neighbors. It’s a beautiful day, and I am one of those neighbor-people, going to home to wash, mow, chat. But I also want to stick my head out the car window and holler.

I feel sorry for Gender-Confused!

I would probably smoke pot, too, if I were him or her!

I think Tattooed Shirtless has a hot body!

Furthermore, those little giggling fuckers who probably are A students and star athletes? If my daughter brings one home, I might be slightly disappointed! Hoo Rah for the outcasts and for flirting with disaster!

And, yes, as a matter of fact, I am somebody’s mother!

Sid, Joey—and my own baby, Matilda: You might be extremely good and law-abiding or you might be much cleverer than your parents and I were. The former will keep you safer, and the latter is the only way you won’t get caught. Chances are that you won’t be either/or.

Though I am in charge of you, I remember what it feels like to be young. I still haven’t figured out how to mix those two together.

Did you know that sometimes I still dream about that first cigarette I had every morning before school, the last few puffs I had before the last few stoplights and then the school parking lot, where I had to stealthily crush it out on my heel, then toss it out the window?

Damn. I remember. And even then I knew better. We all know better.

Brain, Child (Winter 2007)

Carrie Mesrobian is a freelance writer in Minneapolis. Her writing has been featured in the Minneapolis Star Tribune, Calyx and other publications.

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Brain Doping

Brain Doping

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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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