Does anyone still want to do drug tests on their children?

    Apparently so, because there are plenty of kits for sale (this is not the place to publicize them; they’re easy to find) and voices calling for the practice. Drug test-kit manufacturers don’t report their sales data, so it’s impossible to estimate prevalence—which is also a reflection of the lack of evidence for home testing as a screening tool.

    But it’s a plain bad idea, according to a physician, a pediatrician, a social worker, a substance use disorder treatment provider, and a bereaved mom interviewed for this article. They all say much the same thing: Don’t do it.

    And their main reason?

    “Drug testing is a betrayal of trust,” said Darleen Berg, a mother of four sons, all in their 20s.

    Berg is on the board of directors of Broken No More/GRASP, an organization of parents impacted by addiction and overdose. She raised her sons in Norway, where she previously lived, after losing her father and then her boyfriend to overdose.

    “The foundation of any relationship is trust,” she told Filter. “I would never go in their room, or their drawers, or open their letters. If I was concerned at school, I would ask them what do they do at school … I’m not going to punish them. We talk openly, and they give me honest answers.”

    Berg describes drug testing as good a way to ruin your relationship with your children. However, she did have the “hard discussions” with her sons. “They know there’s nothing wrong with alcohol, but they get a ride home if necessary,” she said. “Everything in moderation, everything being sensible, and that does lead to good choices.”


    Cheating Tests Is Easy—And Human Nature

    There are plenty more reasons not to drug-test your kids. These include: the importance of trying to handle problems in other, more appropriate ways (such as good communication, perhaps through family therapy); the danger of driving problems underground; and the fact that drug testing just doesn’t work very well.

    “Drug testing is easy to cheatteenagers know about this,” Dr. Peter Grinspoon, a primary care physician at an inner-city clinic in Boston, told Filter. Grinspoon is also on staff at Massachusetts General Hospital, teaches at Harvard Medical School, and authored the memoir Free Refills: A Doctor Confronts His Addiction (2016). “Kids know they can dilute it,” he said. “Any savvy teenager can outsmart a drug test a parent buys. This is human nature.”

    Grinspoon is an interesting example. “I started using marijuana was I was 14,” he said. His father is the famous Dr. Lester Grinspoon, a psychiatrist who wrote extensively about marijuana. It was smoked in the home—including by Grinspoon’s younger brother when he was terminally ill.

    Grinspoon later developed an opioid addiction, but does not connect this with his earlier marijuana use. “If I had to attribute my addiction to anything, it would be a combination of things,” he says, citing childhood trauma (his brother died of leukemia, aged eight), a miserable marriage and a crushing work schedule. “Vicodin made me profoundly euphoric,” he said. And the access—he could write himself prescriptions—made it even easier.

    If it’s positive, what will you do? And if it’s negative, does that mean all is well?

    Grinspoon, who spent two years as an associate director for the Physician Health Service, part of the Massachusetts Medical Society, working with physicians who suffer from substance use disorders, knows all about how to beat drug tests. As a physician who was in addiction treatment himself, he and his fellow-MD patients were given a “complicated rigmarole” because it was assumed that they would be good at cheating the tests. Yet “there will still be false positive and false negatives,” he said. “Drug testing is not an exact science.”

    This a reality that any drug-testing parent must contend with. If it’s positive, what will you do? And if it’s negative, does that mean all is well?

    “It will just give the parents a false sense of security,” said Grinspoon. “And if the kid is on drugs, it undermines whatever the parent was trying to accomplish.” He warned: “If you police teenagers in that type of fashion, they do whatever they want to do anyway, they just take it underground and not tell you about it.”  


    The Social Worker’s View

    “I can totally understand parents’ fears,” said Dr. Sheila P. Vakharia, policy manager for the Office of Academic Engagement at the Drug Policy Alliance and a social worker. “There are so many things–screen time, whether they’ll get into the right college…” and of course drugs. “It’s hard to know what to do if you’re afraid,” she said. “Parents don’t feel as if they have control.”

    Critically, demanding a drug test is a punishment in itself.

    But while Vakharia can sympathize if a parent is tempted to drug test, she doesn’t recommend it. Noting, like Grinspoon, the tests’ unreliability, she also describes the dilemma if a parent drug tests a kid and it comes back negative: “Are you ready to apologize? Or will you be disappointed?”

    If the test does come back positive, punishment isn’t good either, said Vakharia. Taking away hobbies, for example, can further isolate and harm the child.

    Critically, demanding a drug testby demonstrating that the parent does not trust the child—is a punishment in itself.

    “What will you do to repair that trust?” Vakharia asked, noting that “there was some reason your child didn’t tell you” they were using drugs. These reasons might include self-medication and a lack of alternative coping avenues, like a nonjudgmental adult to confide in.

    Finally, drug testing encourages teens to use things that don’t show up on drug tests. This might include replacing marijuana with K2 or Spice, or other higher-risk synthetic substances. “We need to think about this consequence,” said Vakharia.


    So What Can You Do?

    A good starting-point is to ask yourself, as a parent, about how to have a conversation with your child.

    Some parents say they have learned to “embrace the moment,” such as when both parent and child are in the car, looking at the road, not at one another, and having a more casual conversation.

    Conversely, going into their bedroom (knocking first, of course) and announcing that you want to have a talk about drugs may not be the best approach, notes Vakharia. “I’m going to come in here and talk because I’m ready to talk” is neither respectful nor useful, while the car conversation introduces far less pressure than going in and sitting on their bed.

    Here are some simple suggestions from Vakharia, based on her social work skills, for parents worried about their kids’ potential drug use:

    *Have small conversations

    *Take advantage of small moments

    *Broach topics tentatively

    *Be interested in what your child is interested in

    *Don’t present an agenda

    *Don’t have an agenda

    *End the conversation when the moment passes—don’t drag it out


    Young people often are on their guard against parents. “They don’t know if their parents really understand what it’s like to be a kid these days,” said Vakharia.

    Is the parent helping them to develop their own decision-making skills?

    She noted the “power differentials” in families: “Parents are authority figures.” But if this creates a situation in which children—of any age—learn that their feelings don’t matter, this can be damaging. Obvious rules for parenting include: Be respectful; take the child into account; don’t yell; don’t be physical.

    For teens, being treated with age-appropriate respect is particularly importantand this demands that parents adjust. “We need to loosen up and become more egalitarian, developmentally, as the children get older,” Vakharia said. “We have to match our parenting to where the young people are.”

    This includes respecting an increased need for privacy, and a recognition that soon enough, a teen will be out of the house, making decisions on their own. Is the parent helping them to develop their own decision-making skills?

    “You care about this person; you sacrificed for this person,” Vakharia concluded. “Your approach will dictate what this person will look like in 10 years.”


    Focus on Behaviors, Not Drugs

    Erin Goodhart, senior clinical director of Women’s Services at Caron Treatment Centers, said her gut reaction to drug testing is simple: “Having parents test their children for drugs is not a good line of defense.”

    Like Vakharia, she recognizes that the idea is appealing to parents because it gives them a sense of control over their fears. “What’s driving parents to have the desire to do drug testing at home is fear,” she said. “We’re living in a world right now, with legalization of marijuana, with an opioid epidemic, drugs coming into school, their motivation is out of fear.”

    And she sympathizes. “It’s hard enough raising a kid; throw in a behavioral problem or a substance use problem, and parents don’t always feel like they have a safe place to go.”

    But she added that drug testing can only bring a “false sense of control.”

    “Even if we took the drug and alcohol out of the picture, the behaviors would still be there.”

    Instead of doing a drug test, Goodhart recommends talking to the pediatrician, the school guidance counselor, the coach, the theater teacher—whoever the child works closely with—not about drugs, but about any concerning behaviors.

    “When I have talked to parents about home testing … parents are often seeing other behaviors that are concerning to them,” Goodhart told Filter. “They start to grasp at straws at what could be going on.” But being a “probation officer” for their child is not a solution. “Even if we took the drug and alcohol out of the picture, the behaviors would still be there, whether it’s the lying, the grades falling, stopping activities they were involved in.”

    Another approach she recommends is family therapy—both to address fear and anger on the parents’ side, and also to create a safe space for the child to communicate.


    Even Conservative Voices Emphasize Trust

    Dr. Sharon Levy, director of the Adolescent Substance Use and Addiction Program at Boston Children’s Hospital and associate professor of Pediatrics at Harvard Medical School, is probably on the conservative side of this issue. But as lead spokesperson for the American Academy of Pediatrics on this subject, she still does not believe in home drug testing.

    Her recommendation: Talk to your kid. And leave drug testing, if anything, to the professionals.

    “Here’s what I advise. Drug testing is a tool and there’s a time and a place for it, but general surveillance isn’t it. If you’re really worried, the first thing I would do is talk about it and ask, and tell them specifically what you’ve noticed. Have that conversation.”

    Levy did say that if what a parent wants is peace of mind, negative tests might be reassuring. “I saw a patient yesterday—I spoke with the parents and the parents said they found some kind of vaping device under the pillow, and the kid said, ‘I have no idea what that is or where it came from,’” she said. “But the parents kept finding it there. So they’re not having an honest conversation. So you might ask yourself: Would a drug test be helpful?”

    But even then, “you need a medical professional.” she said. “The time when a drug test is helpful is when it’s part of an assessment.”  

    Levy also agreed with Goodhart about the danger of drug test results obscuring other important factors. “If it’s negative, do you ignore everything? Because you still need to figure out what’s going on.”

    Even DuPont, a psychiatrist strongly inclined to support the option of drug testing, cites the importance of trust.

    To find a truly conservative stance on drug testing, look no further than Dr. Robert L. DuPont, president for the Institute for Behavior and Health in Rockville, Maryland, and the first director of the National Institute on Drug Abuse in the 1970s. A frequent national commentator as the drug testing craze took hold in the 1980s, and author of books including Drug Testing in Schools (2005), DuPont is a highly controversial figure among those who support harm reduction. He described marijuana, as recently as 2014, as “the most dangerous drug.” 

    Yet even DuPont, a psychiatrist strongly inclined to support the option of drug testing, cites the importance of trust.

    “In general I favor drug testing as a way of encouraging drug use prevention and as a way of identifying youth in need to help to become and stay drug-free,” he told Filter in an email. “But there are endless different settings and relationships so it is hard to say ‘always’ or ‘never.’ It is a topic for parents and youth to discuss along with the underlying issues about youth drug use itself, especially family-by-family decisions about drug testing. That discussion includes a shared understanding of the roles of parents and youth and about their family relationships. Honesty and trust are a big part of that conversation.”

    Understandable as parental fears are, acting upon them in ways that undermine trust between parent and child is never likely to help. Rather than turning to a test, the urgent priority should be to provide support and open positive lines of communication.

    Photo by Bram. on Unsplash

    • Alison has written about substance use for more than 30 years. She has also written for many years about medical coding. A freelance writer, she is also the editor of Alcoholism & Drug Abuse Weekly, and managing editor of Child & Adolescent Psychopharmacology Update and Child & Adolescent Behavior Letter—all published by WILEY. She also writes for Addiction Treatment Forum.

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