Drinking alcohol on top of taking prescribed medication: Have you discussed this issue with your teen?

An article in a recent edition of the Daily Telegraph highlights the current "nationwide shortage of child psychologists", which was an issue pre-COVID but one that's become far more significant since the pandemic began. It discusses "massive waiting lists" and, provides results from the Australian Association of Psychologists' (AAPi) latest national survey of 600 private psychologists that found "nearly half of practices were unable to accept new clients - an increase of 10 per cent on 2020."

Anxiety and depression were on the rise prior to the pandemic but COVID and all that goes with it, including lockdowns and restrictions, have certainly not made things easier. In 2012, 18.6% of young Australians aged 15-19 years reported 'psychological distress' (a predictor of mental health problems, including anxiety, depression and suicidal behaviour). In 2020, that had risen to over one quarter (26.6%), with young women being at greater risk (34.1%) when compared to their male peers (15.3%).

In response, parents have had to rely on already overwhelmed GPs to help assist their children. According to the AMA, some doctors, aware of the cost of specialist care and long waiting lists have resorted to medications, particularly antidepressants. The figures in this area are staggering and they don't even include what's been happening for the past couple of years. In 2013, 87,062 Australians aged 15-19 years were prescribed antidepressants. By 2019 that had risen to 125,515. In addition, there were another 50,134 children aged 14 or younger prescribed these drugs. That was in 2019, so you can pretty safely say there at least 175,000 young Australians prescribed antidepressants each year ..

I'm not a doctor and whether or not a young person should or shouldn't be prescribed a medication is not my area of expertise. It needs to be remembered, however, that many of these teens are also regularly drinking alcohol.

I've written about the mixing of medications and alcohol a number of times and those articles have some of my lowest readership rates. For some reason this is an issue that many parents simply don't want to acknowledge. If your child is on medication and they're going to parties on a Saturday night, a conversation about drinking alcohol on top of whatever prescription drugs they're taking is important. Yet, it would appear that those conversations rarely, if ever, happen ...

Every year I meet students living with a wide range of medical conditions including diabetes, peanut allergies, epilepsy, depression, ADHD and cystic fibrosis. All of them have the same query - how should they deal with the issue of drinking and did I know anything about the interaction between their medication and alcohol? 

As I make very clear to any young person who asks me this type of question - I'm not a doctor and I usually know next to nothing about their actual health condition and even less about the interaction between their medication and alcohol. There is really only one person who can help them and that's their doctor or specialist - the person who prescribed the medication. When I ask them whether they'd discussed the issue of alcohol with their doctor they often respond by saying "My parents were in the room, how could I?"

This is the problem that many teens with medical conditions face around the age of 15-16. Some have lived with their condition for many years, often having the same specialist they had when they were first diagnosed and although they're now becoming young adults, their doctors don't recognise 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's unlikely to be raised at all and then they're left grappling in the dark about how to deal with the issue, many of them relying on friends or the Internet for information.

If your teen is on medication for any condition and 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. 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 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 give them the following advice:

• How long have you had your specialist (or GP if it's for conditions 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, make sure you ask the question the next time you see your doctor
• If they are present and you don't feel comfortable, you're 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 hopefully they'll 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, be honest and 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

Some teens may simply want to know more about the impact alcohol could potentially 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'd be surprised how many students have been told absolutely nothing about the impact alcohol could have on their health condition. Once again, this is a discussion best had with a medical professional and not a parent. 

Of course, the best way to avoid any risk 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 provide 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!

References

Brennan, N., Beames, J.R., Kos, A., Reilly, N., Connell, C., Hall, S., Yip, D., Hudson, J., O'Dea, B., Di Nicola, K., & Christie, R. (2021). Psychological distress in young people in Australia Fifth Biennial Youth Mental Health Report: 2012-2020. Mission Australia: Sydney, NSW.

Therapeutic Goods Administration (2021). Antidepressant utilisation and risk of suicide in young people: Safety investigation. TGA, Australian Government Department of Health.