I had a patient in the office today with his parents. They were concerned because they thought their son had been using marijuana, which he denied, and they wanted me do a urine drug screen to determine if he was telling the truth or not. This is a tough one for parents, kids and doctors alike.

We had a long discussion about the pros and cons of drug tests. The pros are pretty straightforward: knowing with some certainty whether or not your child has used drugs in the previous couple of days and sending a message that you take even the possibility of drug use very seriously. The con is less obvious: sending a harsh and strong message that you do not trust your child and by demanding a drug test you could be building a wall of distrust and anger between you that is difficult to tear down.

This was a kid who had always had a good relationship with his parents and open communication. As he entered high school, he naturally pulled back a bit from sharing everything. During his sophomore year, he shared even less with them and didn't want them seeing his text messages, and kept the door to his bedroom closed all the time while he was doing his homework on his laptop in his room. Although his grades remained good, his parents felt he had withdrawn from them in a way that was concerning. Aware that several other kids at the school have been caught with marijuana, they worried that this sort of withdrawal in their son meant he was experimenting with drugs too. They approached their son who denied trying or using marijuana. The parents were still very worried and brought him to the office for a drug test to know one way or the other if he was telling the truth.

This is where I came in. I entered the exam room and the boy was sitting in the chair with his arms crossed, looking angry and staring at the floor while the parents were sitting on the couch, clearly anxious and angry. I had known this young man since birth and knew his parents well. When this was the 'chief complaint' I decided to ask some questions. First I asked the parents why they were worried and they shared the circumstances that piqued their concern. Then I talked with the parents and their son together about normal adolescent changes including withdrawal from parents, close association with peers, and desire for independence and privacy. It was at this point that the boy chimed in, "See I told you! I am just normal! Just because I don't want to tell you everything doesn't mean I'm smoking pot!"

I agreed with him but also talked again about the fact that his parents' concerns are so intense because they care about him so much and love him enough that they even brought him to the doctor to make sure that he wasn't getting mixed up with drugs. I talked to him about the fact that his parents want desperately to trust him and give him his privacy but with the reality of drug use at his school, they would be fools to not ask and be worried about it. As many kids do at this point, he offered to pee in the cup and prove his innocence but I discouraged his parents from having him actually do it. I encouraged them instead to use this as an opportunity to talk about drug experimentation, alcohol use, and smoking and reinforce their values. We all talked about how the boy could continue to gain his parents' trust while reassuring them at the same time by sharing more about his daily life with them. I then encouraged the parents to keep the lines of communication open and then discussed briefly the differences between experimentation, social use, habitual use, and addiction.

When teens are experimenting with alcohol, drugs or tobacco, they are doing just that: they are trying to see what it feels like to use it. They don't have an agenda, don't anticipate that they will use again, and are not using any of these medicinally (trying to make themselves feel better or avoid reality). This is the first stage and most kids who try drugs do not go beyond this stage although many will move on to the social or habitual use of alcohol and/or tobacco.

Social use means that the teen uses drugs, alcohol or cigarettes in social settings like group parties where the main purpose is not substance use but it is an adjunct to the event.

Habitual use means that the person uses drugs, alcohol, or cigarettes on a regular basis for many different reasons including depression, avoidance, desire to 'feel good', and escape.

Addictive use means that the person feels compelled to use the substance. That he thinks about when he can have it again, plans for it, and continues to use the substance even if he has had negative experiences with it. Often the person will even use the substance when she is alone or will create a small group event for the purpose of using the drug.

Teenagers will undoubtedly make bad choices once in a while throughout their years of growing independence and it is our job as parents to be open and available to them, to talk them through the difficult times, and love them no matter what. It is this love and a desire to protect them that makes parents react at times with anger or fear when they worry that their child has tried drugs. Remember the basis for these feelings is love and open the lines of communication rather than lower the boom initially. Of course if your child is experimenting with drugs or more, it is essential that parents respond and communicate their values and give both incentives to not use and deterrents to discourage its use. It is a good idea to have your pediatrician or a counselor help you open these lines of communication if you aren't having success on your own and if they cannot be opened, then drug testing may be your only choice.

Here are some links for more information about teenage drug use:

Parents. The Anti-Drug.

HHS Drug and Alcohol Abuse Information

National Institute on Drug Abuse

Birmingham Bloomfield Community Coalition