By Drew Pinsky
WebMD Live Events Transcript
In this special audiocast event, Dr. Drew Pinsky, co-host of the radio show 'Loveline,' will be discussing how relationships affect the health of young adults.
The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Welcome to WebMD Live. Today we will be discussing Young Adults: Relationships and Health with Drew Pinsky, M.D.
Co-host of the popular late-night radio show "Loveline," Dr. Drew Pinsky attended Amherst College and earned his M.D. from the University of Southern California School of Medicine. Drew completed his residency in Internal Medicine at USC County Hospital and was awarded the position of Chief Resident at Huntington Hospital in Pasadena. As a Board Certified Internist and addictionologist, Drew is the Medical Director for the Department of Chemical Dependency Services at Las Encinas Hospital in Pasadena and the Chief of Service in the Department of Medicine. He also runs a private clinical medicine practice. Dr. Drew and his Loveline partner, Adam Carolla, published their advice on a myriad of subjects in their first book entitled The Dr. Drew and Adam Book: A Survival Guide to Life and Love. For more information go to http://www.drdrew.com.
Dr. Drew: Hi! Glad to be here. You have questions?
Moderator: What are some of the most common issues facing young adults as they begin to explore their sexuality?
Dr. Drew: Well, it's interesting. I was just reviewing a book on how this country has dealt with sex education and how the country heats up at the time of sexual disease crisis. It gains momentum around headlines that are designed to scare young people. I haven't seen it more important until now ... it's about interpersonal conduct, the way we treat each other and intimacy, particularly now when people are in troubled families that set up circumstances for abuse and dysfunction ... the culture doesn't help us ... it supports the pathology that exists in our country today. So, the issue is surviving bad parenting and abuse, and learning to achieve intimacy again. People aren't taught that both men and women create happiness and fulfillment and health. And, they need to get back to that.
Moderator: So what's the most important lesson? Is there a simple answer?
Dr. Drew: I think first of all acknowledging the problem. I've learned that each five years or so, we go through a wave of specific nuances that are of concern to me. A lot of kids are getting involved now in intimate contact that s inappropriate for that age, and older kids are acknowledging that intercourse and such carry with it more important things.
Moderator: Do you feel that young people are exploring their sexuality at a younger age these days?
Dr. Drew: They are. They're using their mouth at a very young age. Whenever I've talked to groups at any socioeconomic area on the scale, particularly 13-16 year olds, they consider petting or oral copulation a part of petting. And the decision for a girl to make out is a decision to do that with a young male. And, they see me flabbergasted and don't understand the big deal. But, by the same token they're holding back and abstaining from going beyond that .. there's a greater awareness of the bond that occurs beyond that. So, that's good. There's an awareness that you could hurt or be using someone ... the level of intimacy that you may not be ready for at that time.
Moderator: Are there inherent risks in that?
Dr. Drew: Well, there's a study about to be published about oral copulation as a risk for HIV, and it's shown that in a group it was the only risk factor and it's obvious to me ... I'm concerned about the young women ... it seems to be demeaning. It's almost diabolical that young women can take the genital contact out of the arena of this ... but also that they are doing it at all. Remember, I'm just the messenger, not judging or condoning, it boils down to the disturbing relationships with primary caretakers and a culture that reinforces the pathology.
Moderator: How important is communication in a relationship?
Dr. Drew: I'm not sure there's anything more. I try to point out empathy, mutuality, respect, they're important so that communcation can go forward ... you have to be able to stop and listen to the other person without interjecting your own issues.
Moderator: Are there timeless concerns young adults face in their relationships?
Dr. Drew: Yeah. The timeless concern is managing the changing biological milieu they find themselves in. Kids enter adolescence with unfinished business of childhood and have to manage it with changing biology, and tend to try to solve them in personal spheres and they're barely if not poorly equipped to do so.
Moderator: Have relationships amongst young adults changed over time, or pretty much remained the same as always?
Dr. Drew: No, it's changed dramatically! We didn't have adolescence at the turn of the century, there was no such concept. Romeo and Juliet were 14. You were expected to live until you were 30.
Moderator: How have times changed since you were a "young adult"?
Dr. Drew: With the advent of a longer education, the family of origin, the transition into the workplace, the adolescence developed and in that period, people showed the tendency to solve the problems of childhood through adolescence. I was born in 1958 and I have the sensibilities of the baby boomers, but was socializing too with Gen X, and Gen Y is changing things again. There was a distinct change and I knew what they were up to, and talked to them on the radio which was by happenstance. And, no one was acknowledging any of it and we were a far cry from teaching them what they need to know .... AIDS was on the horizon and I felt someone needed to talk to them. So there was the change in the increasing laxity of their behavior ... in using drugs and alcohol and using interpersonal experience as a way of feeling better in the moment as opposed to growing out of a healthy intimacy ... it became "fun." And, the culture of course again pushed it into the direction it's gone. It's gone more and more in that direction, but things have turned around a little bit, there's a trend towards abstinence and delaying first intercourse ... but it's barely acknowledged.
Moderator: How do you feel about some of the problems kids are voicing to you on Love Line? How have your feeling changed over the run of the show?
Dr. Drew: Again, I'd say that my concern initially was so much focused on infectious diseases that it took getting that under control before you could turn your attention to difficult issues of dealing with dysfunctions of the interpersonal experiences. My feelings haven't changed that much. I do a radio show five nights a week, a television show. The basic content is similar night to night, but I'm amazed that I don't get frustrated or burned out ... it's the fact that it's a young person in need having an important experience that you can relate to. So, it's making a contact with a person in need that I find so fulfilling. So my fundamental feeling about the experience of all this really hasn't changed all that much.
Moderator: Statistics lately have suggested that a larger number of young adults, adolescents really, are experimenting sexually. Why do you think that is?
Dr. Drew: I think that number is getting better. I don't understand the question. The average age of first intercourse is 16 and it's been that way for some time. The general culture, not the prevailing culture, but they have an increasing understanding that this is an important thing and that's good. The reason there's been so much sexual acting out over the years is fundamentally the breakdown of the family and then a culture at large, which is telling kids that this is a good thing without giving any thought to what they're putting out to young people. And, then the kids do this as an affect as opposed to expressing intimacy ... and it's unhealthy to use sex as a drug, and they should use emotional resources to regulate affected states. The society can help with that as opposed to pushing it in the direction it's been going. It's difficult to change young persons' behavior. You can't do it by educating them, they have a fantastic knowledge base, but behavior changes very little. Use of humor and music has been shown to be effective in reaching them, they have to have relatable cases. Young people do the same thing.... they accept it and assimilate it when they trust it, and they only trust it when they hear the consequences of their peers' actions. We have to go into their culture and deliver on their terms or they ain't gonna get it! We may not like doing that, but we have to think in terms of stealth and not health, and that's how you get the message across.
Moderator: How influential is the media in contributing to the sexual identity and maturation of young adults?
Dr. Drew: Well, the age of puberty is declining. Does the media contribute to that by inappropriately stimulating them? I don't think it does. I think it does by traumatizing them with material they aren't equipped to handle, or putting out things that may be normative but are not normative or may be normative but is not healthy. And, they tend to get followed.
Moderator: What advice would you give to a young adult who is exploring feelings of homosexuality?
Dr. Drew: The most important thing is to talk to young adults who've been through it. The thing they need the most of is support. You have to remember that depression and suicide is the highest in the young homosexual male, and they need to be dealt with with care and diligently. It's important that they be treated. And, if they're struggling with identity issues, there's lots of gay and lesbian centers out there. And, then having a network of peers who are gay to support you ... some place you can retreat, in case the prevailing peer group doesn't support you the way you wish they would.
Moderator: How would you convince parents who think otherwise?
Dr. Drew: It depends what their issue is. Is there some policy at the school that separate groups are not allowed to organize on campus? I can't argue with policy, but if it's about being gay, I suggest you bring clinicians in and explain what happens to these kids if you don't give them the necessary resources. The other kids are just scared and they don't understand.
Moderator: Exactly what age are you referring to when you say "young adult"? Is it the same as "teenager"?
Dr. Drew: No. Well, it's funny, when I say adolescents, I'm talking about 12-40, it's become a chronic state in a lot of individuals. But, young adults, I'm usually talking about 19-25 year olds.
Moderator: Would you say the majority of young adults feel detached from society? Why or why not?
Dr. Drew: No. Here's what I hear most commonly from adolescents in general, "you're not hearing me." And I've seen this happen over and over. I was asked to speak at a media conference with producers trying to figure out helpful content for adolescents and the kids got up to tell them what was going on. And, the people said, "okay, well, now let's figure out what's going on with kids." They have difficulty opening up and listening. Do they feel disenfranchised? No. I felt I heard a lot more about that in the 80's. But, they do feel exploited, they are exquisitely sensitive to that. They know they are being sold things, they are the most amazingly media savvy generation we've had. They just want information, reality .. they don't want it processed for them or delivered to them, they don't want to be exploited. They felt exploited by their parents or the caretakers ... they had parents acting out through the kids or were abusive. And now that becomes a sensitivity to anybody attempting to exploit them in any way. It's a fine sensitivity to the prevailing culture trying to sell them anything .. a TV show, product, or sports team, they're sick of it.
Moderator: Would you recommend a "preferred" method of birth control for a monogamous young adult couple?
Dr. Drew: Well, obviously, I'm presuming they're not smoking, don't have medical conditions, there are advantages to the pill, less PID [pelvic inflammatory disease], less cancers. Multiple reasons are accumulating to suggest the pill - it adds a level of safety now beyond contraception ... and, of course, condoms become important for STD's and safe sex. I want people to know about emergency contraception, too. It's taking your pill in a slightly higher dose after a sexual encounter. You take two pills within 24 hours of an unprotected sexual encounter, and then two more in the next 12 hours and it helps to prevent pregnancy. It works by preventing ovulation just by the oral contraceptive pill. There is some information out there from various groups and I'm against abortion, so I wouldn't get behind this if I thought it prevented implantation, but there is some information that shows conclusively that this prevents ovulation ... it works the same way as the birth control pill. Is there a finite possibility that somewhere, some time it could prevent implantation? Yes. Just like there is with the oral contraceptive pill taken the way you usually take it. So, there are multiple medications out there that have the same probability and no one talks about having them taken off the shelves. So, I'm extremely disturbed about this, since that has the highest probability of cutting down on the abortion rate out there. The Right-to-Lifers are probably not using their brains, they have to read the literature.
Moderator: Who is at greater risk of health problems as a young adult, males or females? Why?
Dr. Drew: Males are higher risk for accidents and that's, I believe, the most frequent cause of death in that age group. So the reproductive issues are slightly more impactful in women, I'd need to look the current data up.
Moderator: How has the state of sexually transmitted diseases changed over the last 10-15 years?
Dr. Drew: Syphilis has gone way down. We used to see small epidemics of cases when I was in training. Hepatitis C is becoming an increasing issue. HIV has plateaued, as well as herpes and HPV has risen. The other thing is penicillin and multi-drug resistant gonorrhea ... that was threatening for a while.
Moderator: How prevalent is smoking amongst young adults?
Dr. Drew: I don't have that number in my head but it's surprisingly high. This is part of the denial that the kids maintain between their actions and consequences, they don't think it'll happen to them. They understand it but it doesn't change their behavior given what is out there about cigarettes today.
Moderator: Are illicit drugs a problem amongst young adults?
Dr. Drew: It's massive right now. Not only that, but the drugs they're choosing to abuse, (not addiction) are amongst the scariest ... Xtacy or "E" .. some of it is amphetamine or heroin, but Xtacy has been shown to clearly be a neurotoxin. The symptoms that I see are kids getting a locked-in syndrome of becoming completely rigid, or engaging in very bizarre behaviors, taking their clothes off, jumping off of high things, mood disturbance and panic attacks. LSD does this more frequently, long standing chronic panic and depression that don't begin until ten years after the exposure, and they abuse this with increasing frequency. And, when I ask them what their culture is like, they want you all to know that they reserve the right to smoke pot. It's incredibly woven into their culture, why is it okay to drink alcohol and not smoke pot? They see this as a sign of them being exploited, that their drug can't be legalized. We went through a period, the 'just say no' era worked. People make fun of it, but the perceived harm is way down right now, and they don't trust what is being put out there about them and they want to draw their own conclusions. But, the consequences of these drugs don't show up until 10 years later.
Moderator: What do you think about marijuana abuse?
Dr. Drew: I have mixed feelings about it (pot). From a clinician's perspective, I'm against it in the sense that whatever I can use to create structure to help addicts maintain sobriety. However, in a more pragmatic reality, I think we're fueling an agenda that prevents people from having a rational discussion about it. I think it's addictive for a small subset of alcoholics. It's hard to have a discussion about it rationally. I think we should almost legalize it and then have a rational discussion about it. General prohibition doesn't seem to work. The Harrison Act of 1919 needs to be revisited, based on our most current scientific understanding of addiction and abuse. There should be no moral issues infused in these, it should be based on the clinical realities.
Moderator: What are some effective ways to control addiction amongst young adults?
Dr. Drew: Well, again, you're talking about addiction and not abuse, which is a different process. Addiction is a separate topic, not everyone can become an addict, not everyone has the genetic makeup for it ... if after surgery, I string you out on morphine, you become addicted and then I stop you and you never think about it again. If you have a propensity for it, you be come addicted once you are exposed to the opiate. How do you stop this? Well, decrease the exposure. The fundamental reason that the person uses is to regulate feelings, they grow up not being able to do this, and drugs are touted as "the answer." In Children's Hospital of Los Angeles, they said the things that we see as their problems, we see as their solutions. I think we need to have zero tolerance is the only answer in all houses and campuses, and I think that includes alcohol. I was at the U of Iowa, and it was a wet campus, and a few died and they converted to a dry campus and the kids were appreciative! It was amazing! In my day it would have been perceived as controlling and intrusive. Maybe it was different, they were trying to cast off over-parenting, now they're trying to find the parenting, the limits and structure and they're somewhat relieved when they get it.
Moderator: What socio-economic factors contribute to the overall health of a young adult's relationships?
Dr. Drew: I'm not sure I understand that question. It comes to bear on all aspects of health. Let me just tell you in broadest strokes, not based on data, but my experience, that is that I go speak in high schools and colleges every week for years, and I'm impressed by what I see in high schools, particularly in private high schools, where it appears that the empowerment of the students and the relationships with parents and teachers is resulting in something good. But, there is a large segment of the population that is not being parented well, and that population is falling out of bed, and whether that risk will result in anything, I don't know. But, the dichotomy is palpable and has been developing in the last five years particularly.
Moderator: Are there health issues a young adult woman should be particularly concerned about? How about a young man?
Dr. Drew: Well, I can tell you what they're asking about. They're not so focused on health as much as relationships. In fact, we went out and did study groups on young people and asked them where they got their health information. And, about 50% of them asked "why would I want information on health? That's the body breaking down. I don't have those problems." Yet when you ask them about drugs or cigarettes or depression, they say 'oh yeah!' So, they don't perceive these things as health. So, the males are wondering 'am I adequate?' And, unfortunately, the women are concerned about the men, too! "How can he be that way? Why is he doing this?" It's very different between the males and females, and there's very little information out there to help the women cope with this. We are very different! And, we need to empower the women, and it's all backwards. Women are concerned with how to get a guy and keep them, as opposed to what are my concerns, what do I want and need before we go on with this.
AWaldo_WebMD My girl friend is 8 months pregnant, and I am not ready to be a father. She is 17, I'm 20. She is also strongly pushing for marriage, which I am not ready for. Also, she is willing to raise this child on her own if I were to decide to leave. I did try to convince her that adoption would be best, but she would not hear of it. I could not allow her to try to do this on her own, so I have stayed around, but this is really not what I am ready to do in this point of my life
Dr. Drew: Well, you need to do what's right. Not to sound harsh, but this is the consequence of your behavior, and you must live up to that, which means taking care of the child. God knows you don't have to get married. But, the child has a way of taking care of affects, too. So, at least this young man knows he's not ready for either, but he may be stuck living up to one, which is the rearing of the child. There should be a lot more support given to adoption in this society. There are a lot of people out there that would make great parents and we should be giving medals to women who elect to go through the discomfort and pain of giving up a child to take care of the child's needs. God knows this is not someone who is ready to take care of a family.
Moderator: How have recent instances of violence in American schools affected the collective psyche of our youth?
Dr. Drew: I don't know the answer to that. I know that young people feel highly scrutinized and sort of blamed for the violence. I think it's been absorbed into the fabric that's already there. But, it has been for quite some time, not because of isolated outbreaks, but in those kids that have to walk through metal detectors everyday, and be careful walking down the street, or who are afraid to walk down the streets. Those are the kids with whom this should be discussed.
Moderator: Has the overall maturity level of young adults changed much over the years?
Dr. Drew: All I can tell you is that the whole period of adolescence evolved over the last 100 years, and has become institutionalized over the last 30 -- now it's become a market and people study it!So, it's well-entrenched in the development of a human, I don't know that it's changed that much.
Moderator: Do you think that legitimate psychological concerns in young adults can be overlooked, or effectively written off as "teen angst"?
Dr. Drew: No, I don't think they should be at all. If there's any advance we've made in the last 20 years, we've understood more fully the developmental needs of the age group, the depression, the probability of accidents, and suicides, they are at higher risk for these things and don't all need to be treated, but they need to be evaluated as if they are important medical concerns. The choices and experiences and unhealthy behaviors that manifest during that period affect and set the stage for the rest of their life! It may affect your brain function or health status if you expose yourself to X and LSD. It's exquisitely sensitive (the brain) to traumatizing experiences and exposing yourself to chemicals or engaging in sex too early. These things need to be addressed early.
Moderator: Do you think schools are doing their job in educating teenagers about drugs and sex? What could they be doing better?
Dr. Drew: I think schools are really struggling with this. I think they know the nature of the problem and extent of it. I'd advocate dealing with the reality. Don't pretend the horse is not out of the barn or that it'll get better. I suggest they use more teen counseling type models, but the schools are struggling. Anywhere political issues enter into what kids need, it ill serves their health.
wkennedy_WebMD Is there any health concerns regarding anal sex?
Dr. Drew: Well, obviously the STD issues, you want to be sure you're wearing a condom ... it's the most efficient way to transmit a virus. You can induce the anal problems of hemorrhoids, etc. I have to say, though, that is one topic that has become suddenly routine in talking to young people. And, I don't know if it's them trying to up the ante or an expression of some innate aggression, it sounds like some very aggressive act that they're interested in engaging in without any concern for the partner.
Moderator: What do you think the dangers are - emotionally and physically regarding abortion?
Dr. Drew: Well, the physical dangers are small but obvious, like infection, bleeding, anesthesia. I think the psychological issues are not discussed enough. I talk to women all the time about this, they're led into like it's a procedure, it's no big deal, it's sold to them. Yet, on the other side of it, they feel awful. There's probably some biological event from going to the pregnant to the non-pregnant state .. some sense of loss, and the cognitive sense of a life was lost or removed, and then guilt and shame. And, most women are not given ways to deal with this. Talk to any woman who's had an abortion ten years later, they still tear up. It affects people much more than they're willing to talk about. Yes, I think too many women are having abortions these days. And, I think it's being looked at as birth control, which is atrocious.
Moderator: What, in your estimation, is the overall state of health of America's youth, both physically and emotionally?
Dr. Drew: I think I alluded to that earlier. There's a piece of the population for whom things look remarkably good, I'm completely impressed with these kids. But at the same time, there is a group that has a negative slope and that is the fractured family, the abandoned qualities, the abusive nature of their personal world, and if they want to solve that interpersonally, those same relationships form in their young adulthood.
Madief_WebMD What resources do you feel are available to young adults suffering from clinical depression?
Dr. Drew: Tons of resources! I wrote a book on depression called 'Restoring Intimacy' and the proceeds from that are going to NDMDA ... they are wonderful. They will help you find resources in your area if you have issues with payment. If you have resources, start with your physician, there is an army out there of people out there who are well equipped to help with depression. And, you can go to my website www.doctordrew.com. And, the National Depressive and Manic Depressive Association is a site we like. It's an area in Dr. Drew's Office on the site. We reference them.
Moderator: Dr. Drew, thank you for joining us. Please join us again next Friday at 9 p.m. EST here in the Sexual Health Auditorium when we discuss The Latest Advances In Testing For Cervical Cancer, with Dr. Juan Felix.
Dr. Drew: My pleasure! I would love to come back. 'Hope to see you soon.
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