welcomes back Dr. Robert Oelhaf for our final discussion of addiction in teens.

Columbus Parent: We welcome back Dr. Robert Oelhaf for our final discussion of addiction in teens.

We have certainly covered a lot of ground in this series. The last time you talked about what a parent should do to get their child help once active signs of drug use are discovered. That parent may be feeling confusion, wondering what they could have possibly done wrong to have this happen. Can you give these parents any reassurance that they are in fact still good parents?

Dr. Robert Oelhaf: As we discussed before, if there is drug use or some other source of social disorder in the home there is a risk that there will be drug use by the child. However, we know there are teens that use drugs where we cannot find risks other than the teen themselves going and finding the chemicals and taking them. I actually think some parents of drug-using teens are good parents whose children have gone and done something wrong and need help.

CP: So if the parenting was okay, does this mean that these are bad children, destined for a life of illegal activities?

RO: This may not actually be true either.

CP: If it's not the fault of the parent or the teen, then what is causing the drug use?

RO: I think that's a fascinating question that many people don't bother to ask. So I ask my patients why they took their second dose of their drug of choice. I am speaking from my clinical experience with heroin addicts who are mostly in their 20s to 30s, and the majority of them got started on opiate abuse in their teens. The first dose of a drug was usually stupidity, or boredom, or availability, or some combination of the above. The most recent dose was usually to cover withdrawal. These are not the answers I am interested in. I want to know why they took that second dose.

CP: Why is the second dose of a drug so important?

RO: Because in patient after patient I interview, almost every patient I have, that's the dose they took deliberately to reproduce a particular effect on their brains.

CP: So are you saying they got themselves addicted on purpose?

RO: That's a logical trap that many fall into when thinking about this topic. Many people I talk to seem to think drug addicts are weak, stupid people who cannot achieve the brain power needed to get normal again like the rest of us. However, in my ER work, I noticed that drug addicts are actually intelligent, creative, highly motivated people who manage to fool me time and again to get pills or injections out of me to satisfy their cravings. So this seemed inconsistent, and in my drug rehab practice I found that I was often interviewing intelligent people desperate for a resolution to their problems. Why would intelligent, motivated people get themselves stuck in a crazy situation like addiction?

So I asked them specifically what they recalled was pleasing about their drug of choice which made them take dose after dose after dose. What I find is that very often patients have an interesting answer. Many say fascinating things like the heroin made them more social, gave them energy, made them calm, gave them better job performance, made them forget their problems, made them stop having flashbacks about prior trauma, or made them less depressed. And the people who give these answers are generally not on any proper medications to address these issues in a healthy and legal manner at the time they enter drug rehab.

CP: Are you saying they are taking drugs to treat themselves for mental illness?

RO: I think given the clinical data I have that is an inescapable conclusion. I have begun to assume that all of my patients in my practice have an undiscovered trigger for use. And that is why I insist on only working with patients in a comprehensive setting, where counseling is done on a regular basis to try to get some of these root causes to come forth. Because you can tell a patient to avoid drugs, but if you do not address the initial trigger for use, the trigger will persist and be an ongoing risk for relapse.

CP: So can we conclude that a parent could have prevented the drug use by taking their teen to a psychiatrist?

RO: That may be an over-generalization. And let me clarify that I am not a psychiatrist myself. But if we are confused about a teen's behavior, if we can't figure out if it's drugs or some kind of psychosocial problem, as parents we need to not take uncertainty as an acceptable answer, if we really want our children to optimize their development. We need a professional opinion about that child. And we need to be open-minded about what the professional says. If the opinion is that our parenting is lousy, I think it is appropriate to swallow our pride and say, "can you be more specific?" Then we may make some progress, and potentially save our entire family from a lifetime of anguish and legal issues.

We simply want the best outcome we can get for our kids, and the method is less important than the actual achievement of that goal. I think the phrase "Parents: The Anti-Drug" contains a terrific and medically valid concept.

CP: Do you have any books to suggest to parents who want to read more about this issue?

RO: There are a lot of books out there. One is Addictive Thinking by my fellow Pittsburgher Dr. Abraham Twerski, MD. Another is Bradshaw On: The Family by John Bradshaw. The book I have seen that seems most directed at your audience would probably be Choices and Consequences: What To Do When a Teenager Uses Alcohol/Drugs by Dick Schaefer. A book I am looking forward to reading is How To Raise A Drug Free Kid by Joseph Califano, Jr., but this is not yet in bookstores.

CP: Well Dr. Oelhaf, this has been a fascinating discussion. Thank you so much for spending time with us on this important topic.

RO: My pleasure. Thanks for inviting me to discuss this with you.