A day in the life of a teen: decision at every turn: drugs? No, thanks.

HEADS UP:

The Way to Go

As a teen, you lead a life jampacked with a thousand things. All day long you may participate in activities and interactions in and out of school, including team sports, going to parties, going to the library, hanging out with friends at the mall, studying, surfing the Internet, group activities, and text-messaging. The list goes on and on. If you think about it, you make a lot of choices while you're doing these activities and during the rest of your day. Some are big and some are small, but everything you do and say involves making a decision.

While you may not ever be faced with this situation, someday you may be confronted by a friend or a stranger with an offer to take drugs. What would you do? This article discusses making tough decisions in social settings where drugs may be offered to you, as well as the harmful effects that those drugs cause. A big factor in deciding what to do is understanding what can happen--the outcome or consequence of your choices.

You'll find out the facts and dangers of drug abuse as you continue reading, and you'll learn what you can do--and say--to protect yourself and navigate through social situations. Making decisions that seem uncool in front of your peers can be hard. But making decisions that can harm you can lead to dangerous consequences--short-term and long-term.

HEADS UP:

You're Normal

As part of their public-health mission to research the health effects and impact of drugs, scientists at the National Institute on Drug Abuse (NIDA) study trends on the number of teens abusing drugs, the kinds of drugs they abuse, and teens' perceptions of drug availability and the harmfulness of using drugs.

NIDA's mission is scientific but also includes sharing its research findings with the public, so its scientists seek to educate young people on the damage that drug abuse and addiction can cause to their bodies and lives. Elizabeth

Robertson, NIDA's chief of prevention research, says that "teens tend to believe that other teens are using a lot more drugs, alcohol, and tobacco than they are." In fact, researchers from the annual NIDA-funded Monitoring the Future (MTF) study found that more than 70 percent of 10th-graders in 2005 had not used illicit drugs in the year prior to their being surveyed. This is important to know. When you don't abuse drugs, you are in the majority with other teens around the country. That's the good news. The reality is that one person using drugs is one too many: Drug abuse may destroy not only the life of the abuser, but the lives of those around him or her as well.

The MTF study also reveals the drugs that are most frequently abused by teens: prescription drugs, marijuana, alcohol, nicotine, methamphetamine, inhalants, and MDMA (ecstasy). While these may seem like harmless "party drugs," each carries serious side effects, both in the short and long term. Drug abuse can wreak havoc on your body, your current and future health, and your social circles, which most teens want to preserve.

HEADS UP:

It's All in Your Head

When you're with your friends, why does it seem so hard to say or do something other than what they're doing? A big reason has to do with the way your brain is wired. "The brain is built to learn by imitating," says Jay Giedd, MD, who has spent a lot of time researching teenagers' brains (see sidebar). "Young children imitate their parents; adolescents imitate their peers."

Dr. Giedd used brain-scanning techniques to determine that the prefrontal cortex--that's the part of the brain responsible for impulse control and decision making--does not fully develop in most people until around age 25.

Knowing this, picture yourself at a party watching friends abuse drugs. "Whatever else you might be reading or hearing, your brain is thinking, 'This is what my group does, and this is what I need to do to fit in,'" says Dr. Giedd. But is it?

Because a teen's prefrontal cortex is not fully developed, his or her brain relies on the limbic systems to make decisions. The limbic system is responsible for emotional reactions, especially those involving pleasure or excitement. But it also helps create feelings of drive and motivation, so that if you put your mind to something, you can accomplish it.

HEADS UP:

The Shape of Things

Research shows that when teens think things through, they make good choices about risk. That's important to know, because when you're a teenager, the pathways in your brain are strengthened each time you repeat an activity or skill. Your daily experiences--and decisions--actually shape your brain. As you grow, the brain trims away pathways that aren't used. Those nerve connections that are used frequently through repeating skills or experiences are made stronger. So, the key is to make your experiences as positive and safe as possible--and that means thinking about things beforehand. If someone offers you drugs, you'll be more likely to give the answer you want if you've planned it out in advance.

HEADS UP:

Make a Plan

How do you plan it out in advance? There are many different strategies and ways to say no to drugs. One person who has studied what influences kids to abuse drugs is NIDA-sponsored researcher Gilbert J. Botvin, Ph.D., professor at Weill Medical College of Cornell University and director of the school's Institute for Prevention Research. Dr. Botvin has developed successful prevention programs based on his research. He has proved that teaching kids to practice saying "no" in social settings is one of the best ways to help them avoid abusing drugs.

Most teens start using drugs in social situations. The first thing to do is learn how to say "no, thanks" in a casual way. You might think that other kids will make a big deal of it, but that's unlikely. "Kids and adults have an exaggerated view of the extent to which people are likely to pressure them to use substances," Dr. Botvin says.

But if you feel that a simple "no" won't work, you have other choices. Dr. Botvin and his colleagues have developed some approaches that are presented in the chart below. These techniques have been tested with thousands of teens--and they work. Dr. Botvin says that kids who learn these techniques and use them are 50 to 60 percent less likely than others to abuse drugs.

HEADS UP:

The Choice Is Yours

Now that you have the facts about what drugs can do to you, it's time to give serious thought to how you'll handle social situations that may involve drugs. Talk about the techniques below with your friends and others close to you. Plan and practice what you will do in advance. And remember, the vast majority of teens make the smart choice for their bodies and their minds: They don't use drugs.

For help with a drug problem or to locate treatment centers, go to www.findtreatment.samhsa.gov, or call the national hotline at 1-800-662-HELP.

The Teen Brain: A Work in Progress

Jay Giedd, MD, and his colleagues at the National Institute of Mental Health spent 15 years using MRI (magnetic resonance imaging) to map teens brains. From early childhood through the teen years, participants came in every two years to have their brains scanned and studied.

This cutting-edge research gives the first-ever look inside the teen brain. It reveals that the teen brain is a work in progress. "The fact that your brain is still changing creates enormous abilities to learn, says Dr. Giedd, adding, "Following the living, growing brain in the same individuals over time really has been the key to understanding the path of development."

These images show 15 years of brain development for a healthy person, aged 5 to 20. The areas in red show parts of the brain that are still changing; the blue shows areas that are developed. The prefrontal cortex, indicated by the red circles, is the last part of the brain to develop. It is responsible for decision making and impulse control. As a person grows, his or her brain develops and matures, as the progression of the blue area shows.

[c] 2004 National Academy of Sciences, U.S.A. Gogtay, Nitin, Giedd, Jay N., et al. "Dynamic mapping of human cortical development during childhood through early adulthood." PNAS USA. 2004 May 25; 101(21): 8,174-8,179. Epub 2004 May 17, p. 8,178, fig. 3.

Symptoms of Drug Overdose: Why You Must Act Immediately

If you suspect a friend may be suffering from an overdose or a toxic reaction to a drug, you must act. Call 911 or get to a hospital. You or your friend might get in trouble when an adult finds out that you've been around drugs, but that's far better than your friend being dead, or in a coma.

It's not possible for someone to sleep off an overdose. Taking a cold shower or drinking coffee will not help either. Drug and alcohol overdoses can stop the heart from beating or the lungs from breathing.

Drug overdose symptoms vary widely depending on the specific drug(s) used, but may include:

* Abnormal pupil size (either too small or too large)

* Sweating

* Agitation (restlessness, increased tension, irritability)

* Tremors (involuntary shaking movements)

* Seizures

* Problems with walking

* Difficulty breathing

* Drowsiness

* Unconsciousness

* Hallucinations

* Delusional or paranoid behavior

* Violent or aggressive behavior

Remember, if you suspect a friend may be suffering from a drug overdose, get help immediately.

Ways to Give Drugs the Brush-Off

THE TECHNIQUE                               WHAT TO SAY

A Simple No                                 No, thanks.
Don't make it a big deal. Be polite.

Tell It Like It Is                          No, thanks. I don't drink
Be yourself and say it in a language that   or I don't do drugs.
you're comfortable with.

Give an Excuse                              I have to meet my friend or
People make excuses all the time.           I'll get kicked off the
                                            team.
Change the Subject                          No, thanks. Hey--did you
This can distract people.                   see that strange outfit
                                            Mary was wearing?

Walk Away or Leave the Situation            Say no, then walk to
It's common at parties to have a brief      another group.
interaction, then wander off or leave
entirely.

The Big Stall                               No, maybe later:
This works with escalating pressure. It
doesn't mean you will actually try it
later.

The Broken Record                           No, thanks--it makes me
Give one reason, then repeat the reason,    sick. Repeat it if a person
but don't get into a debate or              pressures you.
argument--it doesn't help.

Lesson Plans for Student Activities

PREPARATION: Before beginning the lessons, make these photocopies: Two copies for each student of Reproducible 1 for a pre-text and post-text quiz, and one copy for each student of Reproducible 2.

Lesson 1 Heads Up: What Do You Know About Drug Abuse in Social Settings?

OBJECTIVE

To give students science-based facts about why the risk for drug abuse is higher in social settings such as parties; to show students that abusing drugs is not the norm among teens; to provide students with research-tested drugrefusal strategies; and to assess students' knowledge of the topics before and after reading the article.

NATIONAL SCIENCE EDUCATION STANDARDS

Life Science; Science in Personal and Social Perspective

LESSON STRATEGY

Introducing the Topic

* Before the lesson begins, hold a class discussion based on these questions: Where do you think most kids who abuse drugs have their first drug experience? Why is it sometimes difficult to say no in a social setting; for example, if someone offers you a slice of cake or a piece of candy after you have made up your mind to get healthier by avoiding refined carbs? Could those same reasons apply to turning down drugs? Why do some teens have a hard time saying no to drugs at parties--even when they don't really want them?

* Tell students that they are going to see how much they know about the latest research into teen drug abuse in social settings and drug-refusal strategies. Distribute copies of Reproducible 1. Tell students to write their names on the paper and label it No. 1. Then have them answer the questions. Collect and grade the papers.

READING, DISCUSSION, AND ASSESSMENT

* Have students read the article "A Day in the Life of a Teen." Next, hold a discussion based on these questions: Are you surprised to learn that most teens overestimate the amount of drug abuse among their peers? How might the media play a role (TV, movies, news programs, etc.)? Why is the urge to imitate so powerful among adolescents? How can you resist it? Should teens avoid social situations as a way of avoiding the temptation to use drugs? Why or why not?

* Next, tell students it's time to see how much they've increased their knowledge. Give them a second copy of Reproducible 1. Tell them to write their names on the paper and label it No. 2. When students have finished, collect the papers, score them, and compare the results before and after the lesson.

WRAP-UP

* Conclude the lesson by asking students what they think would be the best way to teach teens drug-refusal skills: giving them materials to read, or offering opportunities to role-play tough social situations? Discuss whether your school ought to offer classes, and whether they should be optional or mandatory.

Lesson 2 Heads-Up: Understanding Drug-Abuse Statistics

OBJECTIVE

To help students develop an understanding of statistics, find out how scientists collect and use statistics, and use their knowledge to interpret data from the 2005 Monitoring the Future survey (www.monitoringthefuture.org), an annual study of the behaviors, attitudes, and values of teens in America.

NATIONAL SCIENCE EDUCATION STANDARDS

Science as Inquiry; Science in Personal and Social Perspective

LESSON STRATEGY

Introducing the Topic

* Explain to students that statistics is a branch of math dedicated to answering questions by using numbers. Scientists use statistical methods to collect, analyze, and draw conclusions from data. Have students think of ways in which statistics are used to help people understand the world. (Examples may include baseball statistics and student-performance analyses, such as class rank.)

* Tell students that many types of scientists use statistics. One of the most common statistical tools is the survey or poll. In a survey to track drug use among teens, for example, a scientist might ask survey participants whether they have used a particular drug in the past 12 months. Scientists analyze the results to determine facts about drug use among teens. Have students recall surveys they have heard about lately. What do they think was the purpose of those surveys?

* Explain to students that, in general, the larger the number of people surveyed, the moreaccurate the survey results will be. Statisticians (mathematicians who study statistics) call the number of people surveyed the sample size. If you ask 10 teens the question, "Do you consider drug abuse to be dangerous?" you will not get a reliable snapshot of how teens nationwide feel about the dangers of drugs. But if you have a sample size of 50,000 teens from all 50 states, you are more likely to get an accurate picture.

* Hand out Reproducible 2. Tell students that they are about to examine and analyze parts of a real statistical study that provides facts about teen drug use.

* Wrap up the lesson by discussing the following questions: Why do scientists collect statistics? How do statistics help in the battle against drug abuse? Were you surprised by any of the data you examined in the reproducible? Why? What type of questions would you include in a Monitoring the Future-style survey in your school?

For more information about the Monitoring the Future study, refer students to www.monitoringthefuture.org.

Heads Up: Teens and Drug Abuse--Understanding the Statistics

Introduction: 2005 Monitoring the Future Survey

* One of scientists' main tools for understanding drug-abuse trends among teens is the annual Monitoring the Future survey. In this survey, approximately 50,000 8th-, 10th-, and 12th-grade students in public and private schools across the country answer questions that provide information about teen drug-abuse behaviors and attitudes. The Monitoring the Future survey has been done essentially the same way for more than 30 years, so scientists trust the trends that the data reveal.

* Students participating in the survey fill out questionnaires in school. (All answers are kept confidential.) Scientists then tally and analyze the answers. They compare the current year's results with those from previous years to see how drug abuse among teens is changing. Armed with these results, scientists can target research and drug abuse prevention efforts in areas that most need them.

v* Scientists must take precautions when interpreting the Monitoring the Future results. For example, an increase in the percentage of students saying they've used a particular drug doesn't necessarily mean use of that drug is on the rise. The rise has to be larger than the margin of error, which is an estimate of how a survey would vary if it were taken multiple times using a different group of people each time. Statisticians (mathematicians who study statistics) have devised formulas to determine the margin of error and whether a result is or isn't statistically significant, meaning it didn't happen by pure chance. The formulas take into account sample size (number of people surveyed), the number of possible answers, and the number of people giving each answer. Scientists use the formulas to help them analyze data from surveys such as Monitoring the Future.

Interpreting the Data: Findings From the 2005 Monitoring the Future Survey Now it's your turn to analyze and interpret statistics from the 2005 Monitoring the Future survey. The two bar graphs below chart 12th-graders' use of two drugs with very harmful health consequences: ecstasy and methamphetamine.

Percentage of 12th-grade students saying
they used methamphetamine at least once in 12 months
leading up to the survey

Ecstasy (MDMA):
A human-made drug
chemically similar
top both stimulants
and hallucinogens.
Research in animals
indicates it can
damage the brain.
In high doses, it
can lead to organ
damage, including
heart failure, and to
rare but potentially
lethal hyperthermia.

1999   5.6
2000   8.2
2001   9.2
2002   7.4
2003   4.5
2004   4.0
2005   3.0

Percentage of 12th-grade students saying
they used ecstasy at least once in 12 months
leading up to the survey

Methamphetamine:
A stimulant with high
potential for
addiction. Abuse also
can lead to psychotic
behaviors and stroke.

1999   4.7
2000   4.3
2001   3.9
2002   3.6
2003   3.2
2004   3.4
2005   2.5

Note: Table made from bar graph.

Heads Up: Drugs in Social Settings: A Quiz

See how much you learned from the article by answering the questions below.

1. What percentage of 10th-grade students say they've used illicit drugs in the last year?

a. 50 percent

b. nearly 30 percent

c. 15 percent

d. less than 5 percent

2. When teens guess how many of their peers use illicit drugs, the guess is usually

a. too high.

b. too low.

c. about right.

d. exactly right.

3. The part of the brain known as the prefrontal cortex is fully developed

a. around age 5.

b. around age 10.

c. around age 15.

d. around age 25.

4. The last part of the brain to develop is the area responsible for

a. emotions.

b. decision-making and impulse control.

c. understanding complex facts.

d. breathing.

5. When you see others use illicit drugs, it can be tempting because the brain is wired to learn first by

a. repetition.

b. rote.

c. imitation.

d. reading.

6. Most teens--the amount of pressure others will put on them to use illicit drugs.

a. underestimate

b. overestimate

c. don't care about

d. read about

7. As a teen, each time you repeat an activity or skill the pathways in your brain are

a. strengthened.

b. unchanged.

c. weakened.

d. not used.

8. Practicing saying "No, thanks" to drugs--teens' likelihood of abusing drugs.

a. raises

b. has no effect on

c. lowers

d. confuses

9. If you suspect a friend may be overdosing on drugs or alcohol, you should

a. let your friend try to sleep it off.

b. call 911 immediately.

c. wait 10 minutes, then decide what to do.

d. give your friend coffee.

10. Which of the following is a symptom of a drug overdose?

a. extreme confusion

b. seizures

c. loss of consciousness

d. all of the above

1. b; 2. a; 3. d; 4. b; 5. c; 6. b; 7. a; 8. c; 9. b; 10. d.

You're the Scientist

Write your answers on the back of this page.

1. How did ecstasy abuse among 12th-graders change between 1999 and 2005? When did it rise? When did it fall?

2. How did methamphetamine abuse among 12th-graders change between 1999 and 2005? What word best describes the overall trend?

3. What is the main difference between the ecstasy graph and the methamphetamine graph? (Don't look at the numbers; look at the general trends shown in the graphs.)

4. The Monitoring the Future survey has found a general decrease in drug abuse among teens since the late 1990s. Did ecstasy and methamphetamine follow this trend?

1. Rose sharply from 1999 to 2001; began to decline after 2001.2. Fell from 1999 to 2003. (Small rise in 2004 was not statistically significant.) Fell further between 2004 and 2005. Word: Decline. 3. Methamphetamine abuse showed steady decline; ecstasy abuse rose, then fell. 4. Ecstasy did after an initial increase and methamphetamine followed the trend.