Dear Dr. Kidorf
Our 14-year-old son, from the
time he was small, has always been interested in the latest and greatest toys
and attractions. Unfortunately, as he grows, the attractions have moved from
cool footballs to hoverboards and electric scooters to, most recently, vaping.
We have made our thoughts and feelings about vaping clear. We have watched
graphic videos about the dangers of vaping-related illnesses and injuries. We
have warned him about the consequences if we should ever find him with a
vape. And then we found out he was vaping (purchased from another
boy at a local shul). We took the vapes away, followed through with the
consequences that had been threatened, and reviewed the dangers. He doesn’t
seem remorseful and, if he ever gets angry about something, threatens to buy
more vapes.
We don’t know where to go from
here. Part of us thinks, he’s still a kid who is learning, and difficult as it
may be, we need to keep trying and doing whatever it takes. The other part
of us just wants to throw up our hands at this point. We really tried and did
everything we were supposed to. We are well aware that he can get more vapes
(or even worse) quite easily if he chooses to.
While the second option of giving
up is obviously not the right choice, the first option has not worked either.
Is there a third option? Where do you suggest that we go from here?
Response:
Thank
you for sharing these concerns; it is a real dilemma. I have a feeling that
many parents worry about the same thing. You want the best for your son, and
you worry about his health and safety. It must be incredibly frustrating to
discover that your son purchased a vape at shul.
Before
addressing your questions, I want to make sure that our readers understand that
vaping refers to the use of e-cigarettes, small battery-operated devices with
cartridges that contain nicotine (some vapes can adapt to cannabis). As most
people know, nicotine is a stimulant that is also the active ingredient in
regular (combustible) cigarettes. E-cigarettes are somewhat safer than regular
cigarettes because they do not contain tar or other chemicals that are strongly
linked to pulmonary and cardiac diseases. That being said, the aerosol that is
inhaled through vaping contains numerous toxins that are likely dangerous to
the lungs and other organs. A number of studies are trying to sort it all out.
Because
we strive to have a quiet community, many parents feel alone and do not realize
how widespread vaping is among our teenagers. The most recent survey results
show that about one in every five public and private high school students
reports vaping. You are not the only worried parent! Sadly, there is simply too
much stigma for parents in our community to speak openly about it.
The
message you are sending to your son sounds right. You clearly express the
expectation that he should not vape. You have also confiscated his vapes and
followed through with consequences. Your son may not recognize it (yet!), but
he is quite fortunate to have your concern and support. What I am going to
suggest is that you open up the lines of communication with your son to create
more of a two-way dialogue.
Your
14-year-old child is firmly within adolescence, wired to break boundaries. It
is part of his sacred obligation to roll his eyes and drive you nuts. In fact,
some kids vape for no other reason than to make their parents angry. The good
news is that he may simply grow out of it. In fact, we don’t really know his
true motivations, but a good way of understanding what he is after is to talk
to him about it.
One
thing to consider is that vaping may be helping your son in some valuable way,
providing a benefit that he cannot get elsewhere. Because nicotine is a
stimulant, it can improve short-term focus and attention. This effect may be
even more powerful for children with ADHD, especially if this disorder is not
properly treated. We also know that many other mental health concerns often
precede e-cigarette use, especially anxiety. Of course, vaping will make
attention, anxiety, and even depression worse over time, though this is often a
hard concept for kids (or adults) to understand. If you suspect that there may
be a mental health component to your son’s vaping, please speak with him about
it. You may come to a decision together to speak with his pediatrician or
another health professional.
There
may also be significant social benefits to vaping. It goes without saying that
teenagers are highly influenced by their peers. The crowd that he is choosing
to hang out with may be vaping, and it becomes quite difficult to stand out by
abstaining. Talking to your son about social or other pressures might help him
feel supported and give him strength to reject substance use.
The
key to these discussions is to find the right balance – to provide an
atmosphere in which your son is willing to share his thoughts without feeling
judged or criticized. This requires a spirit of sympathy and curiosity. It is
better to communicate worry than anger. You are interested in how vaping fits
in with his other interests and goals. He needs to have space to offer his
point of view. What you hope to accomplish is to provide enough factual
information to help him make better decisions and enough concern that he will
come to you if (or when) he makes mistakes. It is easier to work with the
natural flow of adolescence than against it.
As
part of these discussions, you might find out what he already knows, or thinks
he knows – what information he has acquired from friends, the internet, or
social media. Some kids are already well aware of the dangers of vaping. Others
might dismiss these concerns as misinformation. A recent study showed that a
majority of kids did not even know that e-cigarettes contain nicotine!
It
also seems worthwhile to fine-tune your child’s substance-use education. You
mention showing him graphic videos. This type of intervention usually falls
under the category of “scare tactics,” which are almost always unhelpful. Teenagers
are well aware that most kids who vape nicotine do not go to the hospital. Usually,
nothing terrible happens right away; the major dangers accumulate more slowly,
over time. I sometimes like to use the metaphor of a study evaluating the
behavior of a frog in water. If the water is heated quickly, the frog will jump
out. If the water is warmed slowly, the frog remains in it, unaware of the
danger, until it eventually dies from the heat. We should help kids recognize
the need to get out before it is too late.
In
that regard, the most worrying aspect of vapes is that nicotine is a highly
addictive drug. Many high school kids become nicotine dependent and have
problems stopping on their own, forced to bring their vapes to school simply to
combat uncomfortable and persistent withdrawal symptoms. The other thing is
that addictions tend to develop a life of their own, and it is a very short
leap from vaping e-cigarettes to smoking regular cigarettes, which was almost
completely eliminated among kids until vaping came along. Many kids who vape also
progress to alcohol or other drugs. We don’t know why this is, though there are
many social, psychological, and biological theories to explain the connection. You
want to keep the lines of communication open so you can more quickly identify
shifts from occasional to habitual use.
You
might also help your son understand the impact of nicotine on the developing
brain. Nicotine use in teenagers is associated with poorer cognitive
functioning, reduced attention span, and impulsivity. Kids are often protective
of their brains and receptive to this information. I don’t think this falls
into the category of “scare tactics” because these effects are well-studied and
understood; cigarettes have been around for a long time. More information about
the negative health impacts of vaping can be found on the National Institute of
Drug Abuse’s webpage (nida.nih.gov).
You
are already doing the important work of communicating your feelings about
vaping. I believe you now need to create some space for your son to speak about
how his desire to vape fits into his lifestyle and to understand his
willingness to take risks and whether he worries about potential harms. You are
in it for the long run. Your son has parents who love him
and care about his medical and mental health. One day, probably after
adolescence, he may even thank you.
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.
