Dear Dr. Kidorf,
I started
cleaning for Pesach this week and took the opportunity to clean my eighth-grade
son’s room while he was in school. I was going to surprise him with a clean and
orderly room. It occurred to me that maybe I shouldn’t go into his drawers, but
I had to put things away, and I figured he is still young, so he probably
wouldn’t object. Anyway, I found some things that are concerning. I wasn’t sure
what they were, but my friend confirmed that the small colorful tubes and other
paraphernalia are used for vaping. I am quite upset. I realize that young teens
experiment with smoking, but I didn’t think my son would do it. Although he is
not the most popular kid in the class, he has friends, and he is a fairly good
student. He was never a troublesome kid and basically gets along at home and in
school. I have two questions: Is this dangerous for a child his age? More
importantly, what is the right approach now that I have made this discovery? Should
I just ignore it and pretend I didn’t see, or should I confront him. If so,
how?
Response:
I know it
feels unsettling to find vaping paraphernalia in your son’s belongings. Our
kids are growing up quickly and becoming more complicated. They are acting like
teenagers! We are slowly learning as a community that they are not immune to
substance use. Yet finding the vapes might actually be the best thing that
could have happened to him. You now have new and important information about
your son. Let’s figure out what to do with it.
I
want you to know that you are not alone in your worries. According to the
latest NIH survey, about 17% of eighth graders report some experience vaping
nicotine, which is now the most commonly used substance in this age group.
About half of these kids report vaping on a regular basis. These
children also have parents who are very worried about them.
The
first question you ask is if vaping is dangerous for a child in eighth grade. I
will focus exclusively on vaping nicotine, although it is quite possible to
vape marijuana. The short answer is that it could be very dangerous. Once a kid
starts to vape, we never know where it will lead. Some kids can vape a few
times and never have problems. Others start on a road toward regular cigarette
use. Vaping is also strongly associated with drinking and smoking pot.
The
primary danger of vaping is the ingestion of high doses of nicotine. Nicotine
“pods” contain the equivalent of about a pack of cigarettes. Because vaping is
convenient and essentially odorless, it is easy for kids to vape just about
anywhere and at any time of day without easy detection, all of which serves to
increase the amount of nicotine getting into the body. What this means is that
more and more kids in our community are developing a nicotine addiction at a
very young age. The earlier drug use starts, the harder it is to stop.
As
with most drugs, there is a general misunderstanding about addiction, or what
is referred to clinically as substance-use disorder. Most people think of it as
only using too much of a drug. But that is only a small part of an addiction. Teenagers
who develop a nicotine-use disorder become tolerant to the effects of nicotine
and experience withdrawal when they do not have it. They will risk using it at
school simply to get through the day without feeling uncomfortable.
Another
unfortunate part of addiction is how it impacts multiple areas of life.
Teenagers who have a nicotine addiction spend an inordinate amount of time
thinking about, acquiring, and experiencing the drug. At the very minimum, this
means less time dedicated to other, more meaningful pursuits, like learning or
playing sports. It could also mean hanging out more with other kids who vape. By
finding the vaping products, you now have an opportunity to help your son,
hopefully while nicotine use is still at an early stage.
Talking
to your child about vaping requires some preparation. As I have mentioned in
other articles, it is good to become familiar with the scientific research. The
NIH and CDC have accessible websites that provide up-to-date information
written for the public. It is likely that your child has many misperceptions
about vaping that will need to be addressed. Many kids, for example, have no
idea that they are ingesting nicotine and think, instead, that they are simply
inhaling innocuous fruity vapors, like smoking Fruit Loops.
I
also want you to consider whether vaping might be a form of self-medicating for
your son. Nicotine is a stimulant. As you may be aware, stimulants like
Adderall and Vyvanse are used to treat ADHD. There is a strong link between
ADHD and nicotine use, which in the short-term can have a positive effect on
focus and concentration. Children who feel depressed or anxious may also feel
that they benefit from a stimulant drug. Knowing your own child’s strengths and
vulnerabilities will allow you to be more sensitive when discussing vaping or
other substances. There are many more effective ways of addressing mental
health conditions or ordinary fluctuations in feelings other than through
nicotine use.
You
also asked whether you should “confront” your child. This sounds ominous. In
the field of substance abuse, a strategy of confrontation is often mistakenly
viewed as the only (or best) way to help people “admit” to having a problem. I
want you to understand that confrontation is neither necessary nor usually
effective. Multiple studies show that this style of communication is more
likely to hurt than help, increasing resistance and anger and harming relationships.
I
am bringing this up to help you understand that the purpose of talking to your
child is not to extract a confession at all costs. This is not a time to bring
out the water-boarding interrogation kit. Your task is to start a (hopefully)
long-term discussion on the drawbacks of vaping and other drug use, especially
as a teenager.
This
does not mean that these are easy conversations. Your son may quickly become
defensive, claiming that he only tried it once (and did not inhale!) or that
the vapes you found are owned by somebody else. He might take an offensive
approach, accusing you of violating his sacred privacy. There is probably some
underground course that teenagers attend in which they learn plausible
deniability. For all of their misbehavior, teenagers are often quite
predictable.
Your
job is to take a deep breath and remember that your son is in eighth grade. He
is only 13 or 14 years old. It is likely that nothing terrible has happened
yet. Your job is to use this new information to help him make better decisions
about his health over the course of his lifespan.
It
is probably best to start the initial conversation at a time other than right
after you provide the vape evidence to your son. He may react strongly, and you
may not be at your most empathic, especially if he starts with the excuses. I
would also speak with him when other children are not around to respect his
privacy concerns.
I
might begin a discussion by asking what he is getting out of vaping. Perhaps it
makes him more relaxed or helps him connect to other people in his grade. Remember,
you were once a teenager! If you ask him to give up vaping, you may also be
asking him to forgo his perceived social standing. There may be nothing more
important to a teenager than popularity.
If
he does not want to talk about it or responds by denying use, you can ask what
he already knows (or thinks he knows) about vaping. He might say that he heard
that it was not dangerous. You might respond with something like, “That’s what
I thought until I learned more about it. I want to make sure that you
understand what you are putting in your body.”
As
part of the discussion, you could slowly come to address some of the health
concerns associated with vaping. I usually emphasize the impact of smoking on
the developing brain, information that is easily found on the NIDA and CDC web
pagers. You can also gently correct the perception that everyone is vaping; the
fact is that most kids don’t. And while we don’t know enough about the
chemicals that kids ingest with the nicotine, it is not going out on a limb to
suggest that that he is not doing his lungs any favor.
The
most important message to send to your son is that you are concerned about his
health. This cannot be accomplished with one talk but, rather, through an
ongoing discussion throughout adolescence. While it is extremely important to
articulate your expectation that he not vape or use other substances, you must
also convey an understanding of peer pressure and the desire to fit in, and express
your willingness to continue to talk about substance use and other
uncomfortable subjects. One thing we know for sure is that the more parents
talk about these issues, the less likely their kids will use substances or
experience problems with them.
Michael Kidorf, Ph.D., is a clinical psychologist,
Associate Professor of Psychiatry at Johns Hopkins University School of
Medicine, and Director of Education at Chayeinu. The Where What When welcomes
readers’ questions to this column.
