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The Seattle Times
SEATTLE - If you're a parent of a teenager, take note: Your daughter is almost as likely as your son to drink alcohol, smoke and try drugs such as methamphetamines and inhalants.
While the percentage of girls using some drugs reached that of boys more than a decade ago, the perceptions of parents and physicians haven't necessarily caught up, experts say. In general, girls are less likely to get caught using drugs and may have been doing it longer before they receive treatment. They may also become addicted faster and be more susceptible to health consequences.
"Contrary to what some parents might still believe, the gender gap (in substance abuse) pretty much closed in the last 15 years," said Susan Foster, vice president and director of policy research at the National Center on Addiction and Substance Abuse (CASA) at Columbia University. "High-school girls are a little less likely to binge drink or smoke marijuana, but otherwise there's not an appreciable difference."
However, the reasons why and how teens use drugs often differ by gender. If parents are watching for typical signs associated with drug use - hanging out with peers more, skipping school - they may miss girls' more subtle signals, experts say.
"Substance abuse in girls tends to be more inward in terms of both symptoms and causes of use, whereas boys tend to be more outward," said Linda Penhallegon, substance-abuse program supervisor for Youth Eastside Services.
Boys generally experiment with drugs for sensation and thrill seeking, while girls often rely on them to relieve stress, cope with depression and lose weight. (Experts note general differences between boys and girls, but individual children may not follow the same patterns.)
"Frequently, girls' use is connected to emotional causes, and they self-medicate," Penhallegon said. "Depression is one of the major symptoms of drug use with girls."
High-school girls who smoke or drink are nearly twice as likely to report feeling sad or depressed as girls who never smoke or drink, according to a CASA report released in February.
Boys, on the other hand, are more likely to draw attention by getting into fights, for example, or smoking pot at school. They're also more likely to buy and sell drugs (girls, at least initially, often have drugs given to them). Thus, more boys end up in drug treatment or the juvenile-justice system than girls (though the number of girls in both is rising).
"Parents whose daughter is depressed might not connect that with substance abuse," Penhallegon noted. "But with a boy caught with alcohol in his car, that's a more obvious connection."
Indeed, it's often not until girls' use escalates and they start acting out like boys - mouthing off, breaking curfew - that parents realize, "Whoa, something unacceptable is going on here," Penhallegon said.
That means "more boys are referred to treatment early on in the progression of abuse," she said. "Fewer girls are referred to treatment, but those who come in (have) multiple problems in addition to substance abuse."
Many of these problems, including self-harm (such as cutting the skin with sharp objects), eating disorders and a history of being raped or sexually abused, are linked to higher uses of alcohol and drugs with girls.
Chris, a mom of six who asked that her full name not be used, discovered her oldest daughter was using drugs after having her hospitalized for self-inflicted cutting. "It was an inward cry," said Chris, who found out that her daughter, then 17, had been using since age 14.
"She was pretty sneaky about it - she would smoke marijuana in her room before school and sometimes drink," said Chris, a former dot-com manager now studying to become a chemical-dependency counselor. "Girls get away with it because they know how to play up to their parents better."
Even in the worst of her drug dependency, her daughter was never loud and obnoxious; she just wouldn't follow the rules or come home by curfew.
It was more obvious with her son: He drank a fifth of whiskey with friends and collapsed in their home's foyer, ending up in the hospital for alcohol poisoning.
"Alcohol and drugs got him pepped, made him feel tough," she said. Her children are now clean and sober, having been through treatment.
Puberty is a risky time for both sexes in terms of starting to drink and use other drugs, but that's especially true for girls who develop early. This may be because girls who look older hang out with older boys, putting them in a situation where drugs are more available, CASA's Foster said. Girls who go through puberty earlier - developing breasts and wider hips - are also more likely to develop eating disorders.
"The link between eating disorders and drug use is extremely important for parents to know," said Katherine Ketcham, the Walla Walla, Washington-based co-author of "Teens Under the Influence: The Truth about Kids, Alcohol and Other Drugs."
Girls trying to lose weight sometimes try stimulants such as amphetamine or methamphetamine, Ketcham said. One girl she spoke with first relied on over-the-counter weight-loss medications she bought at convenience stores. Then another girl told her to try "meth," because she'd lost a lot of weight fast.
"Like most kids, she thought she'd use it until she'd lost the weight and then stop," Ketcham said. "But meth is powerfully addictive."
Girls are also more likely to start smoking as a weight-loss technique. "Girls who smoke to suppress their appetite are the largest group of new nicotine addicts," Ketcham said.
Girls concerned about their weight were twice as likely to smoke and 1-1/2 times more likely to get drunk, according to a study of 10- to 15-year-olds published in a 2002 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
Issues for boys tend to be more focused on behavior, such as acting out and anger management, Penhallegon said.
Substance use for both sexes is associated with many negative effects - from increased risk for unprotected sex to car accidents to delinquent behavior - but the health impact may be especially harsh for girls.
Studies show girls become addicted to nicotine at lower levels of use, get drunk faster and are more susceptible to developing alcohol-related medical disorders such as liver disease and brain impairment. Youthful smoking and moderate to heavy alcohol consumption are also linked to higher risk for breast cancer.
While drug use is certainly not good for boys, "girls are more likely to get hooked faster and suffer more health consequences," Foster said. "There are still a lot of questions as to why that happens. It might be the drug interaction with estrogen or how the body metabolizes it."
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-Are much more likely than teen girls to use smokeless tobacco (15 percent versus 2 percent) and smoke cigars (22 percent versus 8.5 percent).
-Are more likely to use drugs, drink or smoke on school property.
-Are more likely to binge drink. A third of boys report episodic heavy drinking, compared with a fourth of girls. This isn't true for black teens, who are less likely than white and Hispanic teens (boys and girls) to have five or more drinks on one occasion.
-Are slightly more likely to abuse prescription drugs such as painkillers (9 percent versus 7 percent for boys) and stimulants (4.6 percent versus 3.4 percent for boys).
-Are less likely to smoke, drink or use drugs if they frequently attend religious services (which isn't as true for boys).
-Are more likely to have been abused in the past. Among adolescents in drug treatment, 57 percent of girls, versus 31 percent of boys, report experiencing sexual or physical abuse in their lifetimes.
Sources: Centers for Disease Control and Prevention, 2001 Youth Risk Behavior Survey; The National Center on Addiction and Substance Abuse at Columbia University.
(c) 2003, The Seattle Times. Distributed by Knight Ridder/Tribune News Service.