Parents' worries never stop. But sometimes, Mom and Dad need reminders that seemingly innocuous items -- cough syrup bottles, cans of computer keyboard cleaners, even incense made from herbs and spices, can provide clues that their children are toying with danger.
Increasingly, curious teens in search of inexpensive highs -- especially good kids who aren't drinking or using illegal drugs -- experiment with things they're sure will fall below their parents' radar screens. Some of the most potent drugs of abuse are stored inside the bathroom cabinet or below the kitchen sink, stashed on a shelf in the garage or basement, or tucked into a desk drawer.
Nadine J. Kaslow, chief psychologist at Emory University in Atlanta, warns parents to be on the lookout for changes in their child's functioning, such as a sudden drop in grades, sudden loss of friends, sleeping much more -- or much less, losing their appetite, becoming unusually secretive, or lying.
She also warns about kids who withdraw from family life and become "disconnected from people in a real way." Some may spend increasing hours texting or on the Internet, where Google searches for phrases like "cheap way to get high" can steer them to how-to sites written by other teens -- a danger cited by other experts as well.
"Most parents are concerned about pornography and online pedophiles. What they don't realize is the preponderance of pro-drug use information on the Internet," warns Steve Pasierb, president and CEO of The Partnership for a Drug-Free America in New York. "It's not on their radar screen, because no one did it when they were growing up."
The following pages showcase a handful of ways your child could be endangering his or her life, along with some tips on what to look for and what you can do.
Teenagers seeking a quick buzz need go no further than the family medicine cabinet. A common item in many households is over-the-counter liquid cough and cold medicine containing dextromethorphan (DXM), the most widely used cough suppressant.
Safe at recommended doses, DXM can prove deadly when chugged by the bottleful in a practice teens call "Robo tripping" -- a nod to Robitussin, one of the most popular cough syrups with DXM. Not only can it create blurred vision, sweating, fever, high blood pressure, elevated heart rate and elevated body temperature, it also can produce hallucinations, loss of motor control, coma and even death. DXM-containing cough preparations, which include pills, tablets, capsules and powders, constitute a hazard parents can easily overlook, says Pasierb.
Other product names include "robo," "tussin," "dex," "rojo," and "red velvet." DXM-containing Coricidin HBP Cough & Cold, often called triple-C because of the lettering on the red pills, contains some of the highest DXM doses of OTC products.
Things You Can Do
Parents may learn their children have been abusing this medicine by finding it in inappropriate amounts in their child's personal space, particularly if the child has obtained it on his or her own. If abuse is suspected:
Throw away the unused portion of the product after you've recovered.
If you don't want to throw it away, remove it from the medicine cabinet or storage area beneath the bathroom sink, and secure it, out of your child's reach.
An estimated 1 million adolescents ages 12 to 17 used an inhalant in the past year, according to a March 25 report from the National Survey on Drug Use and Health.
Today, getting high from chemical fumes goes way beyond sniffing model airplane glue in the 1950s and 1960s. A variety of liquids, aerosols and gases found throughout the house -- or purchased on the Internet -- can be inhaled or sniffed, traveling quickly from the lungs into the bloodstream and overloading a child's organs.
"It can be deadly the very first time they do it," says Pasierb, noting that it can lead to Sudden Sniffing Death Syndrome, which "basically shuts down all the body systems. That's why you see so many high-profile deaths around sniffing." Among recent entries into these chemicals of abuse are computer dusters and octane boosters from auto parts stores.
Products to Look Out For:
Volatile solvents: gasoline, paint thinner, correction fluid, felt-tip markers, nail polish, nail polish remover, glue.
Aerosols: propellants found in spray cans containing paint, deodorant, hair sprays.
Gases: Used in butane cigarette lighters, air conditioners and propane tanks. Nitrous oxide in medical anesthetics, also found in balloons and small containers called whippets.
Nitrites: Used to intensify sexual experiences. These include room deodorizers containing cyclohexyl nitrite. Other nitrites easily purchased from adult bookstores or over the Internet are amyl nitrite, which comes in tiny capsules or packs and butyl nitrite, which comes in tiny bottles. Both are popped or snapped open -- giving them the nicknames "poppers" or "snappers."
Signs and symptoms of inhalant abuse from The National Inhalant Prevention Coalition in Chattanooga, Tenn.:
Paint stains on clothing or body, especially face and hands.
Presence of chemical-soaked rags, plastic or paper bags, socks or clothing or latex balloons.
Drunk, dazed, dizzy or drowsy appearance that cannot be explained.
Anxiety, irritability, excitability.
Red or runny eyes or nose.
Spots, sores or rash around the mouth or nose.
The smell of chemicals on the breath.
Nausea, loss of appetite, drooling.
Home medicine cabinets, which often store powerful prescription painkillers, sedatives and antidepressants, are "the No. 1 source of supply when it comes to prescription drug abuse," says Pasierb.
Parents may inadvertently be setting their children up for trouble with casual attitudes about handling those drugs. Moms and Dads who use each other's prescription drugs, as well as parents who give their children their own prescription drugs for particular health problems, are modeling bad behavior for their children.
"It's setting up this relationship that using somebody else's prescription drugs is perfectly fine," Pasierb warns. "We're treating our prescription drugs like over-the-counter drugs."
Nadine J. Kaslow, chief psychologist at Emory University in Atlanta, says parents should be aware if things like medications are missing, and address that right away. "I think you need to be pretty direct in these conversations," she said.
The Partnership, along with Abbott Pharmaceutical, advises parents to take several steps to deter children's abuse of medications legitimately prescribed to other family members:
Things You Can Do
MONITOR: Become aware of how many pills you have. Track refills. Control your child's prescription dosages and refills. Make sure other relatives are aware of risks. Talk to heads of other households where your teen spends time to make sure they're aware of the importance of safeguarding medications.
SECURE: Take prescription medications out of the medicine cabinet and hide them. Keep all prescription and over-the-counter medications locked away. Have relatives and friends do the same.
DISPOSE: Properly discard expired or unused prescription drugs by mixing them with undesirable substances such as coffee grounds to keep teens from fishing them out of trash cans. Do not flush down the toilet. Remove identifiable information from prescription bottles and packages before disposing of them.
Slang Terms in Prescription Drug Abuse (From The Partnership for a Drug-free America)
Big boys, cotton, kicker -- prescription pain relievers.
Chill pills, French fries, tranqs -- prescription sedatives and tranquilizers.
Pharming -- getting high by raiding parents' medicine cabinets for prescription drugs.
Pharm parties -- parties where teens dump various prescription drugs into a huge bowl and grab a handful.
Recipe -- Prescription drugs mixed with alcoholic or other beverages.
Trail mix -- a mixture of prescription drugs served in a bag or bowl at pharm parties.
These blends of herbs and spices, sprayed with synthetic chemicals, are sold as herbal incense. They're legal in most states, even though the smoke they produce is chemically similar to smoke from marijuana, hashish or other forms of cannabis.
In 1995, John W. Huffman, an organic chemist at Clemson University in South Carolina, who had been researching cannabinoid receptors in the brain, created a synthetic cannabinoid in his laboratory, which was termed JWH 018. Huffman has said that biologically, it's similar to THC, the active ingredient in marijuana.
In 2008, researcher Volker Auwater and colleagues at University Hospital in Freiburg, Germany, tested Spice Gold and found it contained at least two synthetic cannabinoids.
The problem is, these compounds haven't been tested in humans, so users can't be sure how their bodies might react. These drugs can dangerously increase heart rate and blood pressure, lead to loss of consciousness, paranoia, hallucinations and trigger psychotic episodes.
Other Product Names
Red X Dawn
In the very risky practice termed "the choking game," youngsters use belts or ropes, or bare hands, to cut off blood flow to their brains. The action produces lightheadedness, followed by a rush as blood flow resumes. This effect also can be achieved by pushing the chest on a hard object to cut off breathing, or by hyperventilating.
The sensation can be addicting, but the practice can kill or cause brain damage. Although statistics are imprecise, a Web site devoted to the subject, called Games Adolescents Shouldn't Play (www.gaspinfo.com) says that as many as 250 to1,000 American youngsters die each year playing a variation of the game, although those deaths often are reported as suicides. Emory's Kaslow said she's worked with a family where a college-age child was accidentally asphyxiated this way.
"They went in the kid's closet and there was all sorts of paraphernalia," she said. "One of the things we say to parents, 'your kids' room should be your kids' room.' On the other hand, if you do see things like belts around or those plastic bags ... you need to address it right away."
Kaslow says parents can't live in denial, saying "my kid would never do this. I raised my child well. We come from a good family." But she sees that these parents, many of whom were Baby Boomers have no experience with this phenomenon.
"What they know about is alcohol and pot; they don't know from choking games."
Nicknames for the Choking Game
Blackout, fainting game, space monkey, dream game, suffocation, roulette, passout, flatliner, California high, airplaning, American dream, funky chicken, tingling and gasp.
Signs, according to GASP, that your child may be engaging in this practice
Any suspicious mark on the side of the neck, sometimes hidden by an upturned collar or turtleneck, or a scar.
Personality changes, such as aggression, agitation.
Presence of a strap, rope or belt lying near the child for no reason; with the child being elusive when asked about the object.
Headaches, loss of concentration, flushed face.
Hearing a thud coming from the child's bedroom, or a thud against a wall, which could indicate the child is doing this alone.
Showing an interest in the effects, sensations or dangers of strangulation.
About 80 to 90 percent of parents say they talk to their children about drugs, yet only 33 percent of kids say their parents talk to them about drugs, according to figures cited by Pasierb. Youngsters who report learning a lot about drugs in their own homes are "half as likely to use as kids who don't get that," he said.
Parents may think they have little power over willful and sometimes defiant teens, but weighing in on drug abuse and saying the family won't stand for drug abuse "does have an impact," Pasierb said. Trouble is, parents who report talking to their kids about drugs tend to focus on illegal drugs like cocaine, marijuana and heroin, often are missing the point. Prescription and over-the-counter drugs "are a much more immediate threat to your child than illegal street drugs."
Dr. Eugene V. Beresin, a child and adolescent psychiatrist and co-director of the Massachusetts General Hospital Center for Mental Health and Media, says parents need to open lines of communication long before adolescence, and "create an atmosphere at home where kids can actually be responsible for themselves, understand what risks there are to behavior, and have an open relationship with their parents so they can ask questions."
Parents should actively inquire about what's happening with other teens their sons and daughters know. They should initiate these conversations "in between the cracks," such as when they're watching television together. Beresin tells parents they should have frank discussions in which they tell their teenage sons and daughters that some things that may seem cool "could be dangerous or even deadly.
"The question kids have to think about is what's dangerous? What's safe? What am I willing to risk?" Beresin said. "Kids need to have an ongoing feeling both of experimentation and curiosity, but at the same time, there has to be a sense of self-preservation and protection."