How do you deal with the alcohol issue if your teen is on medication?

In the past year I have met students who have had a wide range of medical conditions including diabetes, peanut allergies, epilepsy, depression, ADHD and cystic fibrosis. All of them approached me after my presentation with exactly the same query - how should they deal with the issue of drinking and did I know anything about the interaction between their medication (and boy, was there a wide assortment there!) and alcohol? The vast majority of these students made it very clear that they weren't drinking at the moment and didn't really think they were going to try anytime soon but thought they'd take the opportunity to ask me what they should do if they ever decided to have some alcohol at a party or the like.

A couple of weeks ago, however, I met one young man who was really struggling. He was a great kid and I felt so sorry for him as he was obviously having a difficult time dealing, not only with his medical condition, but also the potential impact his diagnosis could have on his social life.

Asher was 16 years-old and had recently been told he had epilepsy. Apparently it was a genetic condition, with two of his older cousins also being diagnosed, although he was the only one who had it in his immediate family. He had experienced a number of highly embarrassing seizures over the past year, one at school, and now was on medication to try to control his symptoms. His parents had told him that it was now too dangerous for him to go to parties at the moment and he wanted to know what my thoughts were on the issue. Did I know anything about epilepsy? His cousins had told him not to worry and that you can drink alcohol and not be at risk but his parents had come down on him hard and made it clear that parties were a 'no-go' for at least the next few months, particularly while they were trying to get the medication right. He got very upset, some of his friends already thought he was a 'freak' because of the epilepsy, if he wasn't allowed to go out to parties he was fearful he wouldn't have any friends left at all ...  

As I made very clear to Asher - I know little if anything about epilepsy and I couldn't tell him anything about the interaction between his medication and alcohol. There was really only one person who could help him and that was his specialist - the person who prescribed his medication. Even his cousins who supposedly had the same condition as him couldn't advise him in this area - they may also have epilepsy but they don't know what medication he's on (and even if they did, they may not know the exact dosage or how it is being used), why he was put on that particular one and, most importantly, they're not doctors! When I asked him whether he'd discussed the issue of alcohol with his specialist he looked blankly at me and said "My parents were in the room, how could I?"

This is the problem that many of these young people with medical conditions face around 16-17 years old. Unlike Asher, some of them have had these conditions for many years, many of them have the same specialist that they had when were diagnosed and although they're now becoming young adults, these doctors often do not recognize that they're growing up and could be facing a range of adult decisions including whether or not to drink alcohol. The family GP who prescribes antidepressants for a 14 year-old can also find themselves in the same situation. We live in a world of an 8-minute Medicare consultation and keeping up with young patients and their changing social life is almost impossible for doctors. If the issue isn't raised by the teen it isn't usually raised at all and the young people are then left grappling in the dark about how to deal with the issue, many of them relying on friends or the Internet for information.

The decision to allow your child to visit the GP by themselves (i.e., without you present in the room) is a big one! Of course you want to know what your teen is saying to the doctor and what the doctor says back to them, but as soon as they first enter that surgery by themselves, those days are pretty well gone. If your teen is on medication for any condition and they have hit that age when they are starting to go to parties regularly, it is vital that you raise the issue of mixing alcohol with that medication. In my experience this discussion has to be handled carefully - you certainly don't want your child to stop using their medication (a real risk if you try to scare them stupid about what mixing them will do) and to be honest you most probably don't really know what the effect will be (unless you're a doctor yourself and even then you may not know the whole story!) so you don't want to overstate the harms and lose what little credibility you have left!

This is why I suggest that parents hand this over to the GP or specialist ... When a young person asks me what to do I always say the following to them:

• How long have you had your specialist (or GP if it's for things like depression or anxiety) for? How do you get on with them?
• Do you see them by yourself or do your parents attend your appointments with you?
• If a parent is present, would you feel comfortable asking questions about the mix of your medication and alcohol in front of them? If you do, (and some of them do, particularly those that aren't planning on drinking anytime soon) make sure you ask the question the next time you see your doctor
• If they are present and you don't feel comfortable, you are now getting to the age when you can ask your Mum or Dad if you can see your doctor without them. You don't have to tell them why you want this to happen but they are bound to ask. Tell them that you want to ask some personal questions about your condition and ask them to respect your decision
• Before you see your doctor write down the questions you want to ask so you don't forget anything. If you are drinking alcohol, let your doctor know how regularly your drink and how much you usually consume and then ask them about mixing your medication with alcohol - what effect will it have?
• Most importantly, listen to what your doctor says - if they say don't mix the two, take that on board! Remember you can always ask if there are alternative medications that you can use that don't have the same effect - sometimes a doctor will change a teen's medication when they know they have started to drink regularly

It's also important to remember that the teen may simply want to know more about the impact alcohol may have on their medical condition, e.g., if you suffer from depression, does regular drinking make it worse? Does a teen with epilepsy have to be more careful about drinking alcohol? You would be surprised how many students I meet who know absolutely nothing about the impact of drinking on their health condition. Once again, this is a discussion best had with a medical professional and not a parent. Of course, parents should be aware of the consequences of drinking but spouting these off to a child is most probably not going to go down too well, particularly when it comes to 15-16 year-olds. They're just going to see it as you trying to 'ruin their lives'!

I always make sure I tell young people who approach me about this issue that the best way forward is not to mix alcohol and medications, but realistically for some of these teens that just isn't going to happen. They need to know the facts and the best person to go give them those is their doctor ... this conversation needs to happen and needs to happen early in a 'drinking career'! Make sure you give your teen the opportunity to have this discussion and if you don't believe they will initiate the conversation, have a chat to their doctor beforehand and ask if they could bring up the issue in as sensitive a way as possible ... it's really important!