JOHN MCLAUGHLIN'S "ONE ON ONE"
GUESTS: JOSEPH CALIFANO, DIRECTOR, THE NATIONAL CENTER ON ADDICTION & SUBSTANCE ABUSE; DR. GEORGE KOLODNER, CLINICAL ASSISTANT PROFESSOR, GEORGETOWN UNIVERSITY HOSPITAL, DIRECTOR SUBSTANCE ABUSE PROGRAM
SUBJECT: SUBSTANCE ABUSE AMONG AMERICAN TEENAGERS
TAPED: THURSDAY, AUGUST 17, 2006
BROADCAST: WEEKEND OF AUGUST 19-20, 2006
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MR. MCLAUGHLIN: Focus on the bottle: Actor-director Mel Gibson's drunken outburst and comedian Robert (sic/Robin) Williams self-imposed check-in at a rehab clinic have spotlighted alcohol abuse. But the problem hits much closer to home than Hollywood. A new study of teenage drinking and drug use reveals that one-half of all youths 17 years old say that marijuana, cocaine and alcohol are common at house parties where parents are present. Is substance abuse the new national pastime? We'll ask Joe Califano, director of the National Center on Addiction & Substance Abuse.
MR. MCLAUGHLIN: Welcome Secretary Califano. MR. CALIFANO: Nice to be with you, John.
MR. MCLAUGHLIN: It's a pleasure to have you with us.
Mel Gibson was arrested in Malibu, California, not long ago. And I'd like to know from you, from your knowledge of the case, whether or not Mel Gibson was exhibiting signs, clear signs, that he's an alcoholic.
MR. CALIFANO: Well, I think he -- well, he was certainly exhibiting clear signs that he's an alcohol abuser, that he gets drunk and loses any inhibitions and lets the demons out. Now, whether or not he's a full-blown alcoholic in the sense that he drinks so much so often that he can't function, he can't function in his creative life, he can't function with his family, he can't function day to day, or -- and that he drinks even though he knows it's badly hurting him in a whole variety of ways, I don't know the answer to that. Only the people that are treating him know that.
But you know, alcohol abusers as well as alcoholics need treatment. They need help.
MR. MCLAUGHLIN: Well, we can move that definition into a little bit more precision, perhaps, because it had been thought that to be an alcoholic, it goes beyond problem drinking. To be an alcoholic you have disruptions in your life, major disruptions. Either you can't hold a job, or you have serious marital relationship problems, or you have financial problems, or you can't get through the day without alcohol, or you're a morning drinker.
We're also joined in this conversation by Dr. George Kolodner. Dr. Kolodner is a staff psychiatrist -- or had been a staff psychiatrist -- at the U.S. Naval Hospital in Bethesda, Maryland. He is currently director of the substance abuse use disorders, and clinical associate professor of psychiatry at the Georgetown University Medical School. And he's also the medical director and founder of Kolmac Clinic, which is an intensive outpatient addiction treatment program in the United States, and I believe was the first.
Dr. Kolodner, on this matter of alcoholism, do you think that the behavior of Mel Gibson is that of a binge drinker or is it that of an alcoholic? And is it legitimate to make, and necessary to make, a distinction between the two?
DR. KOLODNER: I can't comment on Mel Gibson, but in terms of the definition of alcoholism, I would agree with you that people have to have a serious dysfunction in some area of their life. But what's so impressive to me about alcoholism is how well so many people who are "diagnosively" alcoholic can function in the world very effectively, despite their drinking. Therefore, they become hidden, because I think many people have stereotypes of alcoholics as being totally dysfunctional people, which they usually are not. MR. MCLAUGHLIN: Do alcoholics, true alcoholics, have hallucinations? Do they spin fantasies? And if that were the case, does that mitigate the other charge against Mel Gibson and his statements -- his ethnic statements? Perhaps he was spinning fantasies at that time, rather than speaking what he really believed, or what, in any way, actuated him?
MR. CALIFANO: Well, you know, I can't answer the question as to whether Mel Gibson is anti-Semitic, but I do think that alcohol abuse can let demons out of you. I mean, let me give you -- most rape occurs in social situations when either the guy is drunk or the girl is drunk. Alcohol does dis-inhibit. We've done studies of women in colleges and why their drinking has gone up through the roof, tripled over the last 15 years, and one of the two main answers they give is, "I'm under terrific pressure to have sex and this dis-inhibits me."
Now was Mel Gibson dis-inhibited from saying -- he would not have said when he was sober what he said when he was drunk? Does he really believe everything in his heart that he said when he was drunk? I don't know the answer to that.
MR. MCLAUGHLIN: Well, alcoholics have DTs; they have delirium Â
MR. CALIFANO: Of course they do, John. Of course Â
MR. MCLAUGHLIN: Well, that's hallucination. Suppose he's hallucinating. Are you going to hold someone responsible for that?
MR. CALIFANO: I don't know whether he was hallucinating or not, but you know, when he came to, he certainly felt he'd done some terrible, terrible things.
MR. MCLAUGHLIN: Are you doing anything in connection with this -- in relation to some of the filming that's been done in Hollywood? You remember, of course, the film, "Lost Weekend," and you remember the riveting film -- let's see -- "Leaving Las Vegas" where a person just drank himself to death. Do you do anything with Hollywood on these other films like "Old School" or "Animal House" or "Cocktail" which makes alcoholic beverage taking fun, romantic, cool?
MR. CALIFANO: No, I think that's terrible. I think that Hollywood's obligation is to portray this stuff realistically. And "Lost Weekend" did portray it realistically. A fantastic movie. It had a big impact.
I think television's obligation is the same thing. Look at the "Will & Grace" show. They've got a character on there that's hooked on Vicodin and they make it look all fun and cutesy, but they don't have all the stuff that happens to you when you're hooked on Vicodin -- the diarrhea, the physical breakdown, the mental breakdown. This is not cutesy stuff. Getting drunk, using drugs is not cutesy stuff, and Hollywood has a responsibility to portray it realistically. Too many times -- I think "Animal House" is an appalling thing. I think these teen shows that glorify drinking and binge drinking and pill popping and pot smoking Â
MR. MCLAUGHLIN: Well, on the matter of pill popping, we have a gentlemen on the phone who does prescribe mood-altering drugs to a lot of people, I presume, because that is where psychiatry has moved to in America. Millions of people take mood-altering drugs.
Is that correct, Dr. Kolodner?
DR. KOLODNER: It's very commonly prescribed, yes. And there are certainly doctors that do that well and doctors that don't do that well.
MR. MCLAUGHLIN: Do you think we are over-prescribed?
DR. KOLODNER: I don't think you can generalize. I think that some doctors over- prescribe and some doctors under-prescribe. And it's sometimes difficult for a person to find a physician that does it right.
MR. MCLAUGHLIN: Well, we have a medical industry that's huge. We have a pharmacological industry that's huge. We have mood-altering drugs and we have lawyers who are involved in the whole process.
MR. CALIFANO: John, let me put the controlled prescription drugs in perspective. These mood-altering drugs -- opioids that Dr. Kolodner mentioned -- between 1992 and 2001, the population in the United States increased 14 percent, okay. The number of kids abusing prescription drugs went up 212 percent, abusing these drugs. The number of adults abusing these drugs went up 81 percent. A major study we did at our center and released a couple of years ago, prescription drug abuse is a major, major problem.
Now, Dr. Kolodner's point is, I mean, these drugs are good. They help people. There's no question about that and it's important to get the abuse stopped.
We've also done with some of the pharmaceutical mail-house company studies, and they point out that many, many doctors keep prescribing these drugs longer than they ever should be prescribed, and often in amounts they shouldn't be prescribed. That's wrong, but we've got to -- one of the main reasons to get rid of what's wrong here is because they do a lot of good for people.
MR. MCLAUGHLIN: Well, that's also true, it can be argued, that marijuana does a lot of good for people and marijuana can alter a mood that can have positive effects. What do you say about that? I mean, it seems to me you get into an impossible area of subjectivity if you try to say that it's okay for a pharmaceutical, what, Paxil to do this, but you can't do it with pot.
MR. CALIFANO: Marijuana is a dangerous drug, John. Let me explain something to you: One, the marijuana today is much stronger than the marijuana that kids smoked in the 1970s. That's number one. Number two, we know a lot more about it. Particularly for young people, it affects the development of the brain, it affects emotional development, it affects motor skills and your ability to pay attention. There are more teenagers in the United States of America in treatment for marijuana dependence than there are for alcohol dependence. Smoking pot for kids is Russian roulette. It's not a rite of passage.
MR. MCLAUGHLIN: Do you see a sharper difference between marijuana and other mood-altering drugs, Dr. Kolodner? DR. KOLODNER: Well, for one thing, there is legal pharmaceutical marijuana. It is the active ingredient in marijuana that can be prescribed and it has indications. And as you said, it does have definite medical uses.
The smoking of marijuana per se is different than taking pharmaceutical THC, because it's got many other substances in it and it's taken by a different route. My understanding of the literature is that there is no demonstration that smoking marijuana is superior to taking a pharmaceutical oral THC. And you have a whole lot of legal issues that are fraught around that.
MR. MCLAUGHLIN: Would you take the position that OxyContin is superior and preferable to Cannabis sativa?
DR. KOLODNER: The problem with OxyContin, in my mind, is the delivery system. The pharmaceutical companies that delivered it prepared it in a way that could be easily defeated, so that people could get huge doses of medication that was supposed to be slowly released, simply by biting down on the tablet or cutting it open and taking the powder out.
I think that both of these things have dangers in different ways. I think one of the problems with marijuana is that people don't take it seriously as an abusable drug. Its effects are much more insidious than those of OxyContin, where, you know, somebody could get an overdose and die from OxyContin and have severe withdrawal effects when they stop it, and marijuana does not have that kind of drama.
MR. MCLAUGHLIN: Just to clarify my own position: I'm arguing here as a devil's advocate more than I am about any fixed preference on my part, or on the true values of marijuana versus drugs, but the proposition is that America's public education establishment, in conjunction with pediatricians, have drugged an entire generation of boys, and to some extent girls, with behavior-altering medications and now they want to do the same, even more so, for girls. It's part of an over-medication of America and how we are creating a nation of addicts -- all legally. What would you say to that, Dr. Kolodner?
DR. KOLODNER: I've heard that charge, but the data doesn't support that. There were a lot of parents who have kids with ADD or ADHD who were very concerned about putting their children on stimulants and wondering if this was in fact making it more likely that they would become addicts. But there was a study done out of Harvard some years ago that documented that just the opposite occurred, so that if you had someone with ADHD and you medicate them properly with stimulants, they're much less likely to go on and become addicted. Many of the marijuana smokers that I see that are addicted to marijuana are kids with ADHD who are self-medicating with marijuana. They either haven't been diagnosed with their ADD, or they were diagnosed and they refused to take their medications. So I see the medications, if used properly, as being protective, not in fact leading to addiction.
MR. MCLAUGHLIN: Dr. Kolodner, thanks for joining us.
DR. KOLODNER: You're welcome.
MR. MCLAUGHLIN: We'll be right back.
MR. MCLAUGHLIN: Secretary Califano, you recently released a survey on teen use of alcohol and drugs. What did you find regarding teenagers' use of drug and alcohol?
MR. CALIFANO: Well, John Â
MR. MCLAUGHLIN: Particularly, parentally supervised parties.
MR. CALIFANO: John, 33 percent of 12- to 17-year-olds in this country go to parties where parents are present and alcohol, marijuana, ecstasy, cocaine, hallucinogens are also present. Half of 17-year-olds go to parties where parents are present and those drugs are present. And at parties that parents let their kids go to where nobody's present, it's a virtual certainty that alcohol and drugs will be there.
Now, what's going on with the parents? What's going on? One, they stay upstairs in their room. They don't want to -- their 15- year-old says, "Oh, Daddy, Mommy, don't come down; we're just having a party down here" -- and they want to be pals, not parents. They just want to get along with their kids.
Parents are not doing their job. They're "palooka" parents. I call them palooka parents because they don't -- they have no idea what their teen's world is like. The teenage world today is awash in alcohol and drugs.
MR. MCLAUGHLIN: How about access to drugs? How long does it take for a teenager to find marijuana?
MR. CALIFANO: Five million 12- to 17-year-olds can buy marijuana within an hour. Ten million can buy it within a day.
MR. MCLAUGHLIN: What age group?
MR. CALIFANO: Twelve to 17 -- 10 million, okay? That's Â
MR. MCLAUGHLIN: Within an hour?
MR. CALIFANO: Five to 6 million with an hour. It's been this way for the last three years since we started asking these questions: 10 to 12 million within a day, 20 percent. We're talking, you know, we have made no progress in this country in terms of the availability of drugs to our kids. There's been no change in that and, you know, basically, we live in a world, John, your kid is going to be offered illegal drugs before he or she graduates from high school and probably on several occasions and probably several different kinds of drugs. That means you, the parent, have got a hell of a responsibility to give that kid values to have the strength to say "no."
MR. MCLAUGHLIN: Is that what you would counsel parents to do?
MR. CALIFANO: I think parents are the key here. They're key in two respects. One, I counsel parents, one, not to have alcohol at parties, to go and find out what their teens are doing at parties, and when their kids go to a party at another house, call up and say to the parents: "Are you going to be there? Are you going to know what's going on and are you going to make sure alcohol isn't there?" That's one thing.
The other thing they've got to do -- the schools. Our schools are riddled with drugs -- riddled with them. The way to get drugs out of schools is parents. If there's asbestos in the ceiling of a school, parents raise hell. They take their kids out. They won't let them back in the classroom till all the asbestos dust is out. But they send those same kids to school every single day when they know the schools are riddled with drugs.
When parents feel as strong about drugs in school as they feel about asbestos in school, we'll start getting the drugs out of schools.
MR. MCLAUGHLIN: There's a larger question here and that's a cultural question and whether you're saying more than you're really saying with regard to the very nature of the society we live in, but let's not go there quite yet.
Your survey found that the transition between 13 years of age and 14 years of age is a particularly risky one for teenagers. You say that in comparison to 13-year-olds, 14-year-olds are four times likelier to be offered prescription drugs to abuse, three times more likely to be offered ecstasy, three times more likely to be offered marijuana and two times likelier to be offered cocaine. And that's why you call them the dangerous years. Is that correct?
MR. CALIFANO: Yeah, it's a dangerous divide. We think it shows the move from middle school to high school, because if you look at the middle school, about 20 percent of the middle schools are schools where drugs are used, kept and sold. About more than 50 percent of the high schools are schools where drugs are used, kept and sold. That's a big jump.
When your kid goes to high school, he's entering an entirely different world. And boy, if you're a parent, you've got to be engaged with your kid during that transition.
MR. MCLAUGHLIN: What would you counsel parents with regard to allowing their children to attend parties put on by teens of their age at other homes?
MR. CALIFANO: I counsel parents to call up the other home and say: "Are you going to be there? Are you parents going to be there? Are you going to watch what's going on and be there?" I mean, be there.
You know, these parents are so out of touch, John. You know, one of the things, 80 percent of the parents we've surveyed said that neither alcohol nor marijuana was available at the parties their teens went to, okay. Fifty percent of the teens -- and these are the teens of these parents -- said alcohol and marijuana are available at the parties we go to. It's usually available. I mean, they either don't know what's going on or they don't want to know what's going on.
MR. MCLAUGHLIN: Your survey terms age 17 a time of quote "rude awakening," unquote. Why do you say that?
MR. CALIFANO: Because by 17, you're almost certain to be offered drugs. We were stunned to find out that a quarter of the 17-year-olds in these United States knew someone their own age who'd been the victim of gun violence -- personally knew them. A quarter of 17-year- olds had seen drugs dealt in their neighborhood.
I think risk goes up over those years, but 17 is an age in which alcohol and drugs are everywhere in your life.
MR. MCLAUGHLIN: How many teenagers or what percentage of teenagers will have been offered illegal drugs by the time they reach 18 years of age?
MR. CALIFANO: Eighteen? I would say almost 100 percent.
MR. MCLAUGHLIN: Let's say 17.
MR. CALIFANO: Seventeen -- the survey shows about 70 percent, but our guess is that by and large you ought to figure that you can't get out of high school in the United States without being offered illegal drugs.
MR. MCLAUGHLIN: But that doesn't mean they necessarily accept the illegal drugs.
MR. CALIFANO: Oh, no, that's right. That's why I say parents are important. They're the guys that have to help give these kids the values not to take -- not to say "yes." Old Nancy -- you know, Nancy Reagan took a lot of ridicule for her "Just Say No" campaign, but "just say no" is the right message.
MR. MCLAUGHLIN: What about a racial component?
MR. CALIFANO: The racial thing that disturbed us most in the survey was that 12- and 13-year-old Hispanic and black kids are three times likelier -- 12 and 13-year-olds -- to be offered drugs than 12- and 13-year-old white kids. Twenty percent of black and Hispanic kids we surveyed said they'd been offered drugs at 12 and 13. Only 7 percent of white kids said that. And that says, you know, that says those drugs are widely available. Availability is the mother of abuse, and it also says something about law enforcement.
I mean, we tolerate, you know, here in Washington, in South Central Los Angeles, and in New York in Harlem, and Bed-Stuy and in California -- in South Central Los Angeles, here in Washington in Southeast -- drug bazaars that would be wiped out in five minutes on the streets of Georgetown or Beverly Hills or the Upper East Side. There's not equal law enforcement.
MR. MCLAUGHLIN: We'll be right back with Joe Califano.
MR. MCLAUGHLIN: What's the larger issue behind this?
MR. CALIFANO: The larger issue is -- and I call it -- I have a new book coming out next year, "High Society." We have a country in which we increasingly think there's a drug for every ill. If we feel lousy, we get a drug to make us feel better. If we can't sleep, we get a drug to help us sleep. If we ache, we get a drug to ease our pain. If our kids are a little scattered and need discipline, it's easier to give them Ritalin and Adderall than discipline them. And worst part about it is, these drugs are very valuable and they can be very helpful to people, but we don't use them to help us just when we're really sick or really need them. We use them to push the envelope.
You know, the baseball player takes the steroids because he wants to get the extra home run. The guy cutting the deal on Wall Street, you know, takes a little cocaine or he takes Â
MR. MCLAUGHLIN: Amphetamines.
MR. CALIFANO: Amphetamines so that he can work around the clock and make the deal go. We use them to further abuse ourselves.
MR. MCLAUGHLIN: It's a values question.
MR. CALIFANO: There's a values question. There's a -- and we're besieged. I mean, turn on your television set. If you have arthritis, pop this pill and you can dance like Fred Astaire and Ginger Rogers. You know, you can't sleep? Here's a pill, guaranteed to sleep. No problem.
MR. MCLAUGHLIN: What's the corrective?
MR. CALIFANO: Oh, I think the corrective goes deep, John. I think the corrective is self-discipline. I think the corrective is we've lost a lot of spiritual values in this country and I really think that affects this. We're full of instant gratification, got to have it right now. Lives are so busy and wild.
MR. MCLAUGHLIN: The tempo.
MR. CALIFANO: The tempo. We want to do more and more and more and more.
MR. MCLAUGHLIN: Where's leisure? MR. CALIFANO: You know Â
MR. MCLAUGHLIN: Is leisure anywhere in our society?
MR. CALIFANO: Well, leisure may not be there for guys like you and me, but I mean, leisure is there for a lot of people. They take time off, but you know, it's not what it used to be.
MR. MCLAUGHLIN: I arrange for my reading time, Joe. But the tempo is fierce.
MR. CALIFANO: The tempo is fierce.
MR. MCLAUGHLIN: And the adjuncts that assist the tempo, like the technology -- the cell phones and the other ways of staying in touch and staying on top and working around the clock.
MR. CALIFANO: Go to an airport and you see all these guys on their BlackBerrys and they're sending their e-mails. They get 100 e- mails Â
MR. MCLAUGHLIN: What's the corrective, Joe? We're almost out of time.
MR. CALIFANO: I think people have got to count to 10 before they start taking these substances, and they've got to ask them some questions about their life. Are there other things they can do?
MR. MCLAUGHLIN: It's a matter of the spirit?
MR. CALIFANO: The spirit is very important, John, very important.
MR. MCLAUGHLIN: Words to live by. Thank you very much, Joe. Good luck with the book "High Society."
MR. CALIFANO: Thank you.
MR. MCLAUGHLIN: If you could answer the issue of who should prescribe antidepressants and other psychopharmacological medications for mood-altering drugs, should it be psychiatrists only or M.D.s or Â
MR. CALIFANO: No, it Â
MR. MCLAUGHLIN: What are doing with regard to that?
MR. CALIFANO: It should be M.D.s, but they should be much better trained in how to do it. And there can be more controls now, because most of these drugs come out through these mail-order houses, and we know when a doctor is over prescribing or prescribing too much for a patient. But there's a problem. You know, you talked about OxyContin, John. OxyContin is an incredibly effective painkiller. It's incredibly addictive. It should only be used in the worse pain, but what happens is the family doctor's got 40 people sitting in his room every day, gives him to somebody and they say, "God, Doc, I feel fine." And he says, "My God, I've got a drug that works" and then he promiscuously puts it out there and we have it everywhere.
And the other thing, parents again -- parents have got to start thinking about locking their medicine cabinet the way 50 years ago they used to lock their liquor cabinet, because kids get these drugs from their parents.
MR. MCLAUGHLIN: I understand. But you've made progress in that regard?
MR. CALIFANO: We're making progress. We're making -- we're not making progress in the availability of illegal drugs, and the abuse of prescription drugs by kids is going up, but a program like this will help get the word out.
MR. MCLAUGHLIN: Great.