Trust me

They were as far apart as two people could get in that cramped little exam room. The mother sat on a chair in the corner, clutching her purse in her lap, still wearing her winter coat. Eric lay on the exam table, iPod on, ear buds in, staring at the ceiling.

His mother barked at him as soon as I walked in. "Sit up. Take out those damned earphones."

After a long pause, he pulled himself up into a slouch and fixed his gaze at the floor. The chart said he was fifteen, but he was nearly as tall as I was.

"Hi Eric," I said. "How can I help you today?"

"Talk to the doctor," his mother said. She stood up and ripped the iPod out of his hands. They traded icy glares. "I want him tested," she said. "I want him to pee in a cup."

I've had a lot of appointments like this one. Exasperated parents. Silent teenagers. Tension so thick it sticks to your skin when you walk into the room. And my heart always aches for them. I know this is probably not going to end well.

As every parent is painfully aware, the stakes are high. On average, 5,000 teenagers die every year because of drugs or alcohol. If a natural disaster did that, we'd call out the National Guard. But for this kind of emergency, parents are on their own.

The problem is, our attitudes about alcohol and drugs are complicated. We tell our kids to just say no, but we have to have our glass of wine with dinner, or a beer when we get home from work. We keep our pain pills in the medicine cabinet, and our sleeping pills on the bedside table. And of course, we haven't forgotten the things we did when we were the same age as they are.

No wonder our kids are drowning in mixed messages. Every time they watch a football game, they see a dozen beer and liquor commercials, featuring hot, hip young people having the time of their lives. Last year two states legalized marijuana. But of course everything is off limits for kids, which makes all of this stuff the perfect forbidden fruit. To teenagers, drugs and alcohol are passports to adulthood. It's a border they're literally dying to cross.

So how do you know when your kid is sneaking across that border? If you search online, there's a handy-dandy list of the symptoms of substance abuse: moodiness, sleep disturbance, secretive behavior, unreliability, poor concentration – the list goes on and on. Unfortunately, it's the same list as the symptoms of adolescence. I'm not saying it's useless, but in the end there's only one thing you can really do. You have to ask them.

Okay, stop rolling your eyes. Hear me out.

First of all, they might actually tell you the truth. It depends. If you started talking about substance abuse early – when they were still in grade school – the lines of communication may still be open. But don't lecture, and don't accuse. Have a discussion. Ask them about drugs and alcohol in their school and among their friends. Ask them what they believe, and what's important to them. Then listen.

And what if they just shut you out as soon as you raise the subject? It's still worth doing. At least you've shown them that you care. That it matters. That you're there if they change their minds. And they might – that's what teenagers do. The fact that it's a hard conversation doesn't mean you shouldn't have it.

But when you do start talking about this stuff, be prepared for one particular question: "Why don't you trust me?" They ask it because it puts you on the defensive – but also because they really want to know. You have to admit, it's a good question.

How far can you trust a smart, responsible, resourceful, impulsive, self-absorbed, rebellious, irrational teenager? That's never an easy call. But it's a call you're going to have to make, again and again, in a thousand different ways. And it's a moving target. Someday soon, you're going to have to trust them whether you like it or not, because once they're out the door, you won't have any choice.

Do everything you can to build up the trust between you. Start early, and keep at it. Because one day, if you run out of trust, your options will be few, and none of them will be good.

A few days later, Eric and his mom came back to find out about his drug test. Doctors have a rule: never order a test if you don't know what to do with the results. She stared at the paper. He glared at her and clenched his jaw.

"What now?" he asked.

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