DEAR DOCTOR K:

My teenage son seems different lately. He's lost interest in team sports, is more secretive and is hanging with a new crowd. I'm worried he may be abusing drugs or alcohol. I keep trying, but he won't really talk to me about it. What can I do?

DEAR READER:

Few things are more important to teenagers than being part of a group of their peers. It appears to be hard-wired in us: Teenagers in many different cultures tend to band together, and to suffer if they are not part of a group. When the group does drugs, they can be hard to resist.

When I was a teenager, abuse of illicit drugs wasn't widespread. But alcohol abuse was. There was a group I wanted to be a part of that was having a party. I went to the party and did what they did. I knew what would happen, yet I did it anyway. I still remember that night, and the next morning, like it was yesterday. Whenever I'm in a liquor store and see that particular brand of scotch whiskey, my stomach turns, even though I'm sure it's perfectly good scotch.

Teens are surrounded by images of alcohol and other drugs. They see them in movies and on TV. They hear about drugs and alcohol in song lyrics. Alcohol ads show drinkers as popular, beautiful or rich -- often all three.

It's common for teenagers to try alcohol or drugs. Why? Some teenagers use alcohol or drugs to feel good. Some do it to relax or to fit in with their peers. Some do it to make themselves feel older or more sophisticated. Some are just plain curious, and since they are teenagers, consider themselves immortal. They ask themselves what I asked myself that night: "How harmful can it be?"

You may feel that the last thing your son wants is your advice. The same "wiring" that makes teens vulnerable to peer pressure seems to make them resist parental advice. Still, talk to him -- just don't come down too heavy. Make an argument, not a judgment. It may not seem like he's listening to you, but he probably hears everything you're saying. And more important, he knows that you care.

Make sure your son understands that drinking or taking drugs can affect his plans for the future. It could ruin his chances of getting into college or getting a job after graduation. It can lead to addiction and possibly even death.

I would suggest asking your son directly if he is involved in any way with drugs or alcohol. If your teen tells you he is not drinking alcohol or doing drugs, but you still are concerned, talk with his pediatrician or guidance counselor at school for advice. It's also important to set a good example -- that's how kids learn.

We have more information on dealing with substance abuse in our Special Health Report, "Alcohol Use and Abuse." You can find out more about it at my website.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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