Dr. Henry David Abraham, M.D. has counseled over 90,000 patients and families in his thirty-year career. He is currently the Director of the Substance Abuse Programs and clinical professor of psychiatry at Tufts University School of Medicine. He is also chief of Clinical Alcohol and Drug Treatment Services at Brown University, and a member of the psychiatry department at Harvard Medical School. He has won a Peabody and an Emmy, is a co-recipient of the Nobel Prize, and has been featured on a number of news networks. He has written a book entitled “What’s a Parent To Do?: Straight Talk on Drugs and Alcohol,” in which he gives parents a three-pronged approach to take real steps to prevent drug and alcohol abuse, identify the drugs putting your child at risk, and take positive action to protect your child. He is currently working on a new book for teens called “The No Nonsense Guide to Drugs and Alcohol.” We were able to get Dr. Abraham’s valuable and insightful opinion on a number of topics regarding teenagers and substance abuse, misconceptions about drugs and the topics of medical marijuana and gateway drugs, drug-induced disorders, the dangers of hallucinogenic drug use, and the alarming and rising trend of prescription drug abuse.
TestCountry: Dr. Abraham, you have had an incredible career in psychiatry and in working with parents and teenagers affected by substance abuse. If you feel comfortable, would you mind sharing with us why you are so passionate about this subject, and maybe one or two highlights of your career?
Dr. Abraham Well, I actually had no interest in substance abuse at all when I was in med school and became a pediatrician, but when I came to Harvard in 1971 I was at the tail end of the national epidemic of pharmacological abuse. I began to see in the emergency room one tragedy after another of the drug epidemics of the 60’s and 70’s, and while there were a lot of them, few people seemed to be paying much attention. One thing led to another and I developed a lifelong interest in what drugs do to people, how they change a person, and how to treat people in this terrible time of their lives. So that’s how I got interested.
In terms of high points, I am a writer and have written quite a few things that I am proud of, a play among others. I also shared in a Nobel Prize, which honestly brings in a lot of undue attention. You know that Nobel laureates are no longer referred to as geniuses, but by and large are instead people who worked really hard and it paid off and they actually got recognized for something that they did. It changed my life and I feel very lucky to have contributed to the collective efforts of the people involved and to stand on the shoulders of giants.
TestCountry: Thank you for that background into your work. My next question brings us closer to the topic at hand. Many of our readers are parents. Would you say there are any common misconceptions regarding teen substance abuse that parents hold about their children?
Dr. Abraham That’s tough. I think there are a lot of misconceptions about all groups. Right off the bat, one that I feel very passionately about is the concept of medical marijuana. Essentially, there is no real solid scientific evidence to support marijuana as medicine. You don’t smoke any other medicine. People who flock to those dispensaries are largely people who have been dependent and have none of the illnesses marijuana is supposed to help. I should mention that whether or not the drug even helps those illnesses is based on 100% anecdotal evidence and has very little scientific validity. If a company comes out with a drug and says it is good for glaucoma, they have to spend a billion dollars to prove it and get it through the FDA. Marijuana isn’t medical. There have been some studies starting to show that it is a backdoor to legalizing marijuana. If they were really honest about it, I would say that fine, prohibition has generally been a terrible failure and if you want to legalize something I would support your rights to do so, but it is incredibly dishonest to call it a medicine. It drives the medical profession into potentially playing a dishonest game with the public. It also makes other medicines seem not as dangerous as they really are.
There are a lot of reasons to not smoke marijuana, and those create a pretty long list. If you are responsible for flying airplanes, if you are fifteen years old with an undeveloped brain, if you have paranoid ideations—the contraindications go on and on. A lot of people get the idea that marijuana is so benign, but that isn’t true. A very small amount can crush you if you are a vulnerable individual, and the younger you are the more vulnerable your brains are. It kills brain cells and does terrible things to the ones it doesn’t kill. I could continue on about the number of misconceptions out there regarding drug abuse, but for me, I think the confusion of marijuana as medicine is one of the most harmful.
TestCountry: So in terms of abuse, are there one or two things in particular that parents can do that are the most effective in either preventing substance abuse or halting it?
Dr. Abraham What parents can do is really terrific; there are a lot of things. First and foremost they can clean up their own act. Kids mirror your behavior. You can’t tell them not to smoke dope if you are smoking dope. Parents need to establish themselves as a real role model around the consumption of drugs and alcohol. Really, the single most effective thing they can do is not smoke cigarettes. Cigarettes are a gateway and also a modeling behavior for kids. More kids smoke whose parents smoke and smoking is without a doubt the most important gateway drug and the only drug we legalize that has a 50% mortality rate.
Just as important is an open relationship with your teens. If they say “did you use drugs when you were a teen?” tell them the truth. You can then be free to say you didn’t because it was a bad idea, or you did and it was a terrible mistake. The truth really solidifies the relationships. It establishes kids who go through stuff, just because all kids go through stuff, and who also have a parent they can turn to for help. They are at a party and need a ride and call you to come get them instead of them driving home or their friend driving them home. Instead of being scared of being in a bunch of trouble and hiding, they come to you for help, which is so important and helps create dialogue. That saves lives and cultivates the art of talking to your children. All parents should try.
TestCountry: Besides for a lack of open communication like we spoke about above, what are some other factors that lead to substance abuse? I understand there are many. If you could describe a few for us here, I think it would be helpful to our readers.
Dr. Abraham There is a handful, absolutely, but I can rattle off a few. Genetics is very important. If your father was an alcoholic, and you are male, your chances go up a lot. If your identical twin is an alcoholic, your chances of developing alcoholism are 50 to 75%. Not 100%, because environmental factors play a role, too. If you have a healthy environment that will reduce your risk, but if you are in a drug-laden environment your risk increases. Parenting counts. Peers count; if all of your friends are using the chance of you using is extremely high. If they are not using, your chances are lower. And finally, most importantly, bipolar disorder or ADHD, or other mental illness, all raise your risk to use drugs. Your personality style, as well. If you are a risk taker and want to go out on a Saturday night and participate in risky behavior to enjoy yourself, you becoming involved in further risky behaviors like substance abuse through experimentation is higher. Risk takers gravitate towards those new and dangerous experiences.
TestCountry: So, what are the most important substances for parents to be aware of today?
Dr. Abraham Cigarettes, cigarettes, and cigarettes. I assure you, alcohol sort of slips in there because it is available and there is a culture of drinking among kids, but cigarettes have high mortality rates and high rates of death. They are highly addictive and fatal, and it is definitely a gateway drug.
TestCountry: You recently discussed prescription drugs and teenagers in your blog. What are some of your opinions about this new, dangerous trend?
Dr. Abraham It took us by surprise. I have been in this field for 30 some years now. You probably saw my website and I published the curve that shows the exponential rise in deaths from prescription drugs found at home in the past ten or fifteen years. That’s a dramatic curve. That’s what was so shocking to me—it isn’t heroine per se or alcohol, it is stuff they are getting out of the medicine cabinet at home. In my own practice, I see a lot of people in these situations. I had a very tragic death of one of my patients who got her start in prescription drugs and opiates and you know, you live through these things and after a while, it’s like what is going on here? There is now a growing effort, thankfully, to get family, and parents, in particular, to have a little better management of meds in the home.
TestCountry: Does drug abuse impact only the user, or have you seen it impact the surrounding community and family members?
Dr. Abraham It does, on every level. It takes a village to cure a drug addiction. You can’t just tell someone to sober up—it’s going to be really hard. You have to go to meetings, you need to help them get psychiatric prescriptions, they need support from family, a sponsor, to go through rehab, maybe support through a halfway house. There is a lot of stuff needed for someone to turn their corner. Drug tests are a good example. You can’t drug test everyone in society for no reason and infringe on basic human rights, but some people have to be tested if they have proven they are a risk to themselves, society, and their families. These aren’t simple questions with simple answers, but it still affects the way that we function as a society at large. It takes a village to cure a drunk, and the drunk affects the entire village. Spousal abuse, poor performance at work, influence on the future behavior of children. It is a multisystem influence that comes out through the abuse of drugs and alcohol.
TestCountry: You have mentioned disorders a couple of times in this interview, and in your books and your blog you have also mentioned a different type of disorder called “drug-induced disorders.” Can you explain to use a little about drug-induced disorders?
Dr. Abraham First of all, all drugs induce disorders. No drug is perfectly safe. Most of the drugs in the pharmacy can kill you. All drugs have the capacity to be toxic. Certain ones that are particularly abusable can secondarily lead to any number of disorders. I was one of the folks who originally discovered widespread infection of Hepatitis C in middle-class individuals. If you have ever used a syringe at all for any drug the probability of you having Hep C is 78%. That’s a drug-induced disorder. HIV is very similar in terms of being a virus spread by use of injectable drugs. There are other long-term psychiatric illnesses, like HPPD. Unlucky individuals who use hallucinogenic drugs have a nice time and then a day or week or month later they have visual disturbances as part of their trip and those disturbances become a permanent part of the rest of their lives. Some recover and some can’t. I have many patients who have persistent visual hallucinations. They see dots and blobs and distortions, trails of light behind moving cars that they see every minute of every day. It is uncommon, but it exists, and there are many others. Some can make you depressed. I published a paper years ago showing that for those who abused alcohol the chance of developing major depression was greater than those who do not. Of course, is it the alcohol causing depression alone or is it alcohol and drugs causing a terrible life which causes depression? But really it is a continuum from infections to chronic psychiatric illness. We now know that marijuana use in certain individuals will lead them to develop psychosis. But it doesn’t stop there, it is a vast topic.
TestCountry: If someone suspects that a family member or friend is involved with substance abuse of any kind, what is the first step that person should take?
Dr. Abraham I think going to the police would be the last thing on my list, unless you feel physically threatened, in which case that is the first thing on your list. They are here to protect society and you are society. That’s the only real place I think the police have in substance abuse. Addiction is a disease, but it is also a crime in the books, and the books should be changed. They shouldn’t be punished for being sick; they should be treated as being sick. There are lots of ways to do that. Talk to the person, and see if they are willing to take that first step. Not every person is a patient, and not every addict wants to be a patient. Often they have a problem but don’t want to accept help. Take them by the hand; tell them you love them and care for them, and that you will do whatever you can to help. You can drive them where they need to go, and you can be a friendly ear and a support. That’s a great little speech, and it can help a lot. A loving person or a loving family taking the person by the hand is a lot better than just making them feel bad about being an addict.
If you love them, try to get them help. If they don’t want help it becomes a difficult thing, and everyone is different with how much they will tolerate in a relationship. These are difficult questions and aren’t easy to answer for everyone and say that everyone should do one thing or another. But if you love them, you should start by trying to get them help.
You can learn more about Dr. Henry Abraham by reading his blog at www.drabraham.com. His book "What’s a Parent To Do?: Straight Talk on Drugs and Alcohol" is available for purchase on Amazon. He is working on a new book for teens called "The No-Nonsense Guide to Drugs and Alcohol."