Drugs Alcohol our Kids and Their Brains-Some Answers

I have been under the impression for a long time that our kids issues relate to how we raise them and counsel them and whether our family life is stable and supportive. But, now I have a completely different view. I just returned from a trip to Virginia where I attended some amazing seminars that finally gave me answers as to what is going on in the heads of our kids.  I believe that what I learned needs to be shared so that we all understand our kids better and can do a better job helping them survive into adulthood.

There are two gentlemen from Duke University, Aron White and Jeff Georgi, who have studied adolescent behavior and have shed a lot of light on what is going on in our kids heads and why it seems behavior has been changing over the past several decades. If your like me you've been scratching your head when you look at today's young adults. They look more mature than we ever did. Thirteen year old girls sometimes look like mature woman. On the other hand even at age eighteen or older they seem lost regarding their future. They have a hard time committing to work or school and me and my friends constantly complain that today's kids seem immature compared to our generation.

Well guess what? They are! And, there is science to prove it and this science makes everything make sense. My goal is to give you a synopsis of what these two men from Duke taught me last week and using some of my own inferences I want to help us all to understand our kids and how we can help them make good decisions.

First, we need some definitions. Puberty is the physical changes we experience that turns our bodies from child like into an adult with adult sex characteristics that enable us to reproduce. These changes include our appearance with hair growth, voice changes, breast development, menstreuation, etc.
Adolescence is the changes our mind makes that moves us from childhood and dependence on our parents to adulthood with independence and the ability to raise our own families. Adolescence is characterized by anxiety, loss of interest in family, a need to develop a pack of friends, desire to experiment, boredom, lack of insight of the future, etc.. Particularly interesting is that during adolescence our ability to learn and remember is the best we will have in our entire lives and simultaneously our brain is firing off signals that cause us to be impatient and anxious.

Is it just me or do we all remember our parents complaining that our generation seemed to be unfocused, lazy, reckless etc.? Much to my dismay I recall having very similar conversations with my friends about the current generation coming of age. So, is this because as we get older we get more critical or is something really going on here? Surprisingly, something is actually going on. Over the past 60 or more years the age of puberty  is getting younger and younger. Sixty years ago onset was around twelve years old in girls and now it is at age nine. Therefore, our observation that these twelve year old girls look like young woman and nothing like the twelve year olds when we grew up is actually correct. Ironically, while puberty is hitting at a younger age adolescence has been turning on later. The result is that sixty years ago adolescence kicked in around age twelve and ended around eighteen now it starts around age fourteen and doesn't completely end until close to age twenty-five. I'm not making this stuff up there are actually publications on this.

So, think about this, our kids look more mature at a younger age but their brains are less mature until an older age. Not only is their brain less mature but it is taking dramatically longer for them to emerge from this. The result is that every new generation is taking longer to grow up and act like the adults they look like.

Now I'm going to really scare you. A whole bunch of studies have been performed on adolescents regarding drugs and alcohol and the impact on their behavior and development. First, remember their brains are firing off the anxiety neurons so much that they feel anxious and at the same time very bored. As an answer they use alcohol or drugs which calms down those hyperactive neurons and this makes them feel really good. The effect is way more powerful  than it is on us adults. At the same time the circuits in their brain are trained to learn. So their brain hardwires in that drugs or alcohol will make them feel really good. At the same time they are imprinting that this is an activity they can share with friends and creates very positive memories.

Unfortunately, the frontal lobe of the brain, the part that lets us look into the future and anticipate the consequences of our actions is still incompletely developed. Therefore, they don't "see" that they could hurt themselves by their actions.  We all remember the feeling of invincibility we had as teenagers. This is actually a biological result of incomplete development of the brain.

On the  other hand, teens have a very well developed cerebellum which controls balance and coordination. Therefore they can consume far more alcohol or drugs than an adult brain and still walk and look normal. On top of this their brain does not get sedated from alcohol but rather stimulated. So unlike us parents who have a couple glasses of wine and want to go to bed our teenagers are ready to hit the town.

Some of us wonder if maybe we could help our kids by teaching them to use alcohol responsibly. Maybe they would learn moderation and appropriate behavior. We have been told for years that the Europeans don't have alcohol issues in their youth and there isn't an enforced drinking age there. Sorry, the research shows once again that our perceptions are wrong. The European teenagers have a much higher rate of dangerous drinking than Americans with double the rate of drinking to get drunk. Studies also show that teens who are introduced to "responsible" drinking in the home have a much higher likelihood of getting drunk as well.

The reason for this again points back to how their brains are developing. They have an enhanced response to alcohol with fewer side effects and a poor ability to foresee consequences. So, now we ask, What should we do?

We asked the lecturers this very same question. They were very clear. First of all, these guys aren't Puritans. They understand that alcohol and recreational drug use can be done responsibly. But, it can't be done responsibly until after someone has begun to emerge from adolescence around age 21. Therefore, they recommend that we do everything in our power to keep our kids from using drugs and alcohol. They even recommended routine drug screening or hair samples since it can show drug use 90 days old and the test can't be beat. They didn't say what age to start but I suspect probably in middle school.

This seminar was very enlightening to me because it basically killed all of my assumptions. I now know that my kids are maturing slowly and are very susceptible to the effects of drugs and alcohol and I should be vigilant in trying to keep them from using them. I will probably consider routine drug testing. I figure that if a test is positive it gives us a chance to talk about what's going on. And, preferably, if negative it gives my kids the excuse to say "no" when peer pressured.

What do you think? Have I presented anything here that might change the way you raise your kids?

Privatize Medicare? Why give up a cruddy system for certain disaster?

Everyone has heard the screaming on the Hill about Medicare. Should we change the system and if we do how should it be done? Paul Ryan made a risky and probably foolish move when he suggested phasing Medicare into privatized fee for service insurance. Everybody with a pulse is aware of the absurd salaries and bonuses paid to executives of insurance companies for successfully avoiding paying for care. So, obiviously, if we privatize Medicare we are throwing these guys a huge multitrillion dollar bone.

I suspect that unless Mr. Ryan has a special kick back set up he was suggesting this because he recognizes a truth we all wish to ignore. Private industry is not afraid to make decisions that government leaders lack the back bone to achieve. For example, it is well known that the final six months of life tally up about one half of the entire money spent on a lifetime of health care. No one in government leadership is willing to discuss this issue. I suspect that if Medicare was privatized the insurance industry would figure out a way to deal with this. The profit potential of reducing these costs is just too staggering.

On the other hand, if Medicare is privatized there probably wouldn't be any sympathy for the dying patients who desire care. By the way, I find it very curious that a Republican leader came up with a strategy of dealing with our elderly that would most likely result in a real death panel. For those of you who think that I am reaching a bit far I can tell you that only private insurance has subjected me to panels to evaluate whether a surgical procedure I would like to perform is appropriate. Medicare and Medicaid do no such thing. Instead they try to discourage procedures they don't like by reducing payments until the reimbursement is too unpalatable to consider performing.

I suspect if we privatize Medicare the incentive to make a profit will be so strong that patient care will be delayed as long as possible. Once the insurance companies have squeezed every last drop of profit they will abandon the model and beg the government to take over. By then we will have delayed so much care that just like failing to perform routine home maintenance we will be stuck with enormous expenses. So I do suspect certain disaster if we follow that route.

Despite this, I would like to thank Mr. Ryan for his willingness to at least discuss the Medicare disaster that is looming. I suspect that if we just raised the age when full benefits kick in and phase in an increase in copays and deductibles we can delay the disaster.

An even better idea is to reform the fee for service system. We need to put more responsibility with the consumer. I mentioned in a previous blog that physician compensation has not kept up with inflation. I also understand that Medicare cannot afford to pay physicians appropriately. But, the free market can. Currently, no matter what I bill a patient I am restricted to how much money I can be paid. Because of this, each year physicians are face with either leaving the Medicare program or in order to maintain income they need to perform a larger volume of services at ever decreasing payments. The upside is consumers get more services performed the downside is that for every dollar the physician generates in an additional procedure there may be associated expenses for facility fees, lab testing, etc. And, there will always be some doctors who bend the rules of indications for procedures and do things only to generate revenue. Those dogs make the rest of us look bad. Most of us just shorten our visit times and work longer hours to keep the revenue from sinking.

Perhaps we should allow doctors to charge what they feel the market can bear. Medicare doesn't have to increase rates they just need to allow the physician to pass those costs on to the consumer. They should require us to publish what our fees are so the consumer can compare. The free market will result in people reducing their usage of services if the cost is too high. They may travel to areas where cost of care is lower. Expensive hospitals would have to prove to the consumer that they are better. We could do away with the crazy red tape that Medicare uses to show quality of care. The consumer themselves would want to know who is the best for the money.

All this without a highly paid executive trying to transfer your money into his pocket. What do you think?