A Q&A with Dr. Oelhaf about teens and tobacco
Columbus Parent is pleased to welcome Dr. Robert Oelhaf back to the Health and Wellness section of our magazine. He has been offering advice on addictive substances and current strategies for prevention and treatment of addiction.
Columbus Parent: In your last article, you suggested that parents should talk to their 8- to 10-year-olds about tobacco and alcohol. Could you offer some tips on how to talk about this with children?
Dr. Robert Oelhaf: It is very important to talk to your children about tobacco and alcohol use and the problems that can occur. This seems fairly obvious on the face of it, but parents can have difficulty starting the conversation. The first thing to recognize is that children seem to not respond much to statements about bad diseases that happens to adults. It's just too distant in the future for them to matter much at that age.
CP: So talking about cancer, emphysema and liver cirrhosis doesn't mean much to kids?
RO: Exactly. The data show that regarding tobacco use for example, the major risks of chronic use are the age of the child at the time of first use and number of peers who use tobacco. Those seem to be two major things that have to be addressed to make any serious difference in outcome.
CP: So what do you say about tobacco and alcohol to get kids to not use them?
RO: I think there is a major difference in what you can successfully say as a parent if you use the substance or don't use it. I can use myself for an example. I smoked a quarter of one cigarette in my entire life, so I have no problem saying to my children that "nobody is going to smoke in our house, including you."
CP: What can a parent who smokes say to a child to keep them from smoking?
RO: That's a tough question to answer. The way to make a child do something is to address them from a position of strength. For example, if they do not clean up a mess they made, the parent can punish the child by taking away a special toy until it is clean. But if a smoking parent tells their child not to smoke, it's like a parent saying they have the right to make a mess in the home and never clean it up but the child must always clean up their own mess. It's a setup for the child to not respect what the parent says.
CP: Are you saying that a smoking parent has to quit smoking in order to get the child to not use tobacco?
RO: It just seems to make sense to me. It is well documented that if spouses quit together they are more likely to successfully quit and also stay abstinent for a longer period of time. So here we have a child who sees a parent who continues to smoke or chew despite danger. To remain abstinent from tobacco, that child needs to assume something of a caregiver mentality, that is to say the child knows more about what's good for their own health and wellness than the parent. This is a very difficult family power structure and one I don't recommend. So when a parent removes a substance from their lives, which seems to have some addictive properties, that parent shows the child they have the capacity to be a leader in the family structure, which I think is a much more healthy arrangement for the child.
CP: It sounds like you would say the same thing about alcohol. How does that apply to you? You did state you are an alcohol consumer.
RO: I drink about six alcoholic drinks a month, so I concede I have a more difficult time providing an answer for this question. It is strong for the parent to say for example that neither the adult nor the child will smoke in the home because the adult does not like it and will not have it in the home. It is not as strong for the parent to say that the child may not drink alcohol yet the parent may drink alcohol because that is "the rule." It leaves a lot more questions in the child's mind about what exactly the parent finds desirable about alcohol. I think sampling the substance follows as a natural outcome of these silent questions.
CP: How do you make sure your own children do not drink alcohol?
RO: They are too small to get to the supply. It's on a shelf they can't reach. The oldest is a large 8-year-old. There are some wine bottles in the basement but I think that even at his age and size a corkscrew is more than he can handle as a tool. So that's an easy solution, but one that will not remain adequate for long. I also concede there are a couple of liquor bottles on a shelf about six feet off the floor in my home. We never leave unattended alcoholic drinks around the house that the children might find. ER doctors hear about accidental alcohol ingestions by children that happen this way, particularly among grade school children.
CP: So what is the plan for when your 8-year-old can open his own bottle if he wants to?
RO: I think the problem and the solution are found in the degree of access the child (or teen) has to the substance. If I do not have alcohol in my home, there will probably not be alcohol drinking in my home. I certainly have seen a number of underage drinkers in my ER practice over the years. I can say with certainty that I have rarely ever heard that a teen obtained alcohol then brought their own supply to their own home to consume it. Time and again the story I hear is that alcohol was consumed in the location in which it was found by the underage drinker.
CP: There are parents who have a very small average daily consumption of alcohol who would be reluctant to get rid of their collection of fine wines. What do you say to them?
RO: I enjoy fine wine myself from time to time. Even so, there will come a day when it becomes clear that my oldest child has the strength and coordination to get access to alcohol in my home if he puts his mind to it. I will need to make a decision on that day about alcohol, and my personal decision would be to not have alcohol in my home.
CP: So you are just going to stop drinking alcohol completely at that time? That seems a little extreme.
RO: I don't plan to stop drinking alcohol, I just plan to stop drinking it in my own home.
CP: Aren't you concerned about getting a DUI [Driving Under the Influence offense]? I'm sure some people drink in their homes instead of elsewhere to avoid the risk of injuring someone with a motor vehicle.
RO: Now let's back up a bit here. I think it's a presumption that I, or anyone else, would necessarily drink alcohol to the point of being at risk for a DUI. That is a choice, not a certainty. I think it makes sense to discuss this as safe and unsafe driving in general. If you have alcohol in your blood and are driving, those two facts in and of themselves do not constitute a crime in the location in which I live, as long as the blood alcohol level is below a certain concentration according to the law. Now, does this mean this person is a safe driver? Of course not.
This presumes no co-ingestants like some medications, which can dramatically degrade a person's mental function in the presence of alcohol, including over-the-counter medications. Antidepressants combined with any alcohol in the bloodstream can place the consumer at significant risk of erratic and dangerous operation of a motor vehicle. Other examples would be antihistamines, pain medication, sleep aids, anti-seizure medications, the list goes on and on. It's also known that alcohol can trigger seizures even if someone takes their seizure medications properly.
Of course, it is optimal to have a designated driver who does not drink alcohol. I'm sure we all know people with bad allergies, or other medical conditions, who have to get to work, and need to take medications to get through the day. It then becomes a question of care on the roadway. Can you control your vehicle adequately to be safe driver? If you cannot safely operate a vehicle, then you should not operate a vehicle until it is safe for you to do so. If that means sitting around at a party until you are no longer intoxicated, or sleeping on the couch until morning, then that's what needs to be done. It's just common sense. If you are driving yourself home, you should drink very little alcohol if you drink at all. Alternatively, you can walk home, or ride a bus or take a cab. Make sure you avoid hurting other people with the decisions you make. The bottom line is, I believe that alcohol can be consumed outside the home safely, but you need self-discipline to do so.
CP: So that covers access to alcohol, but the question remains of what to say to children about alcohol use.
RO: There really isn't much out there that has been established to conclusively decrease teen alcohol consumption. The one thing that comes to mind is a study where teens involved in alcohol related trauma, generally from motor vehicles, were reminded by ER staff at the time of the visit to care for their injuries that this was related to someone's alcohol use. This actually seemed to suppress the likelihood of future alcohol use by those teens. Unfortunately, I have not seen much data to support conversational intervention that does not involve kids getting physically injured.
CP: Is there a difference in the effects of alcohol between men and women?
RO: Yes there are. It seems clear that generally women have delayed onset of intoxicating effects. These effects then seem to degrade mental function more per unit of alcohol in women compared to men when fully effective. So I think women need to be especially careful with alcohol to avoid over-consumption.
CP: One last question. I'm guessing you would not recommend parents give young children a sample of alcohol hoping the child will dislike it and not drink again?
RO: Generally the literature suggests that the earlier a child samples an addictive substance, the more likely they are to become chronic users. So I think it's a bad idea to expose children to alcohol early in life.