According to statistics, teenagers in Spain start to drink alcohol at the age of 14, and start smoking at 14.1. For some youngsters, these legal drugs are a starting point for the use of toxic substances and, although not in every case, they can lead to the abuse of illegal drugs like cannabis (14.8 years), cocaine (15.1) and ecstasy (15.2).
All of these are known for their noxious effects and they are the basis upon which prevention policies are drawn up. However, there is another substance which teenagers are taking at an even earlier age (starting at 13.7 years old): hypnosedatives (or benzodiazepines), medication that is commonly found in household first aid cabinets to treat sleeplessness or anxiety disorders. Orfidal, Tranxilium, Valium and Trankimazin are part of this family of drugs which, used without controls, can create a serious problem.
Information about the use of these, with or without prescription, by 14- to 18 year-olds, is included in the most recent survey on the use of drugs in secondary schools in Spain (the Estudes report, produced by the Ministry of Health, Social Services and Equality), and its analysis for the years 2016-2017 places hypnosedatives at the top of the list of early use.
Beyond this first conclusion, the statistics show that the use of benzodiazepines among children has taken a quantitative leap in the past few years. In 1994 the figures showed that they were taken by 6.9 per cent of teenagers surveyed - a total of 35,369 students took part, 2,970 of them in Andalucía - but by last year 17.9 per cent of teenagers openly admitted having taken this medication at some point in their lives. This percentage drops significantly to 5.9 per cent when the question refers to use in the last 30 days (2017 figures), and although this does not sound alarming, it does show a need to look at the causes and the consequences of this phenomenon among this segment of the population.
Sales have increased
To analyse the statistics seriously and rigorously, a clear starting point is needed. "You have to differentiate clearly between therapeutic use by medical prescription and uncontrolled use or abuse, because that's where the problem lies, and the line that separates the two can be crossed at any moment," says Dr Carlos Sánchez Menéndez, a medical psychiatrist who specialises in neuropsychiatry, young people and addictions.
Every day in his consulting rooms in Malaga and Cordoba he sees young people with anxiety and depressive disorders which can need a specific "and combined" treatment with hynosedatives, different types of therapy and exhaustive monitoring by the specialist. That counts as use.
In cases of abuse, on the other hand, there is no control by professionals, and they warn that the effects of these substances on young people can be serious if they are not administered under the relevant supervision.
It is a fact that the sale of tranquillisers has increased tremendously in recent years, "but as we only talk about sales figures we don't know whether this is because more doctors are prescribing them or whether it is due to the black market for these substances," says Dr Sánchez Menéndez, who is also the medical director of the Triora Monte Alminara specialist addiction clinic.
"The data about the consumption of hypnosedatives by adults does show a considerable increase," agrees Dr Juan Aguilar, a medical psychiatrist and head of the Children and Adolescent Mental Health Unit at the regional hospital in Malaga (formerly the Carlos Haya). Both these professionals are concerned about the use of these drugs among young people and say there are two main warning signs: one is the "worrying increase in addictive behaviour", says Dr Sánchez Menéndez, and the other, says Dr Aguilar, is "the general increase in problems relating to changes in behaviour".
The risk of teenagers falling into abuse of toxic substances lies in the combination of both of these, including the use of hypnosedatives when not prescribed by a doctor.
"We need to be well"
With regard to the reasons, the specialists also say that these days "there are more cases of anxiety among children and teenagers, and that possibly results in more treatments".
They also say that responsibilities lie in different areas: firstly, with a society that "increasingly has less tolerance for frustration, so it is harder these days for people to deal with problems, anxiety and bad times, and we need to calm those conditions above all. We need to be well," says Dr Aguilar, who confirms that more and more people these days are turning to tablets to keep them calm.
This also applies to children and teenagers, he says: "We don't give them the chance to experience the essential part of growing-up which involves a natural ability to deal with certain problems without needing medication. If anything characterises the society of today, it is delegation: people think it's up to the hospital to solve the problem, or the school, or the police... there is a permanent battle within the family about who should sort things out," he says. "People should resist the temptation to anaesthetise teenagers against processes which sometimes are completely natural."
Along the same lines, Dr Sánchez Menéndez refers to a profile of parents who are "increasingly over-concerned about the wellbeing of their child, and as part of this hyperprotective mechanism they look for other resources to solve the problem. They place their trust in medication, teachers, doctors or therapists".
He also adds something which gives cause for thought: "Nowadays children are expected to be permanently active, with an overload of intellectual activity compared with the physical, but both aspects should be balanced. Otherwise, we find children who when they reach adolescence, have access to these noxious substances they consider them a means of escape".
Dr Sánchez Menéndez also gives another incontestable fact: "In recent years we have seen profound cultural, social and family changes," he says, and "these profound changes can have an acute effect on some children, to the point that they need professional help".
Within this complex scenario, real problems which do need to be treated with medication and specific monitoring also tend to be mixed up with other transitory ones which are part of the natural and necessary growing up process of the child or teenager.
In other words, serious anxiety or severe depression are not the same as a case of intermittent sleep disturbance or anxiety. "These days, however, there is a great deal of pressure for all problems to be resolved medically," says Dr Aguilar, who from experience says that there is a growing demand for medical assistance from parents or schools.
That is what happened to Blanca, a mother in Malaga who prefers not to be identified, but who still gets upset when she recalls a recent experience with one of her teenage sons.
Almost overnight, he became so badly affected by anxiety that he couldn't bring himself to go into the school and then began to suffer panic attacks in places in which he previously felt secure. Once it was confirmed that there was no external cause for this radical change in behaviour (for example bullying at school or consumption of drugs), Blanca decided to take her son to see the psychologist at the local health centre, who rapidly identified the problem and gave the lad the tools "to overcome it little by little", says his mother.
However, his anxiety continued for several weeks and at school it resulted in interruption of classes or anxiety attacks in the corridor, to the point that some teachers insisted that he needed medication and that "it would end the problem more quickly", says Blanca.
She admits that at that time she felt under extra pressure from the school but is happy that now her son has returned to being "the same as he was before, a brilliant student and sociable child" who doesn't need to take medication. The two specialists who were looking after him didn't think the medication had been at all necessary.
Why are they abused?
So what happens when teenagers themselves decide to start taking hypnosedatives? Why does this abuse start? Virginia Pérez Fernández, the head of the prevention programme at Proyecto Hombre (an association that supporters people with addictions), is used to tackling these questions with adolescents.
"These substances are easily available. The teenagers find them in the first aid boxes of their own homes, because their parents take them. So the first thing to bear in mind is that they are accessible, either at home or by other means," she says.
In many cases, there is a 'mirror effect'. "Parents are role models, and if I see them taking these tablets and they seem to be working, the time may come when I decide I need to take them as well," she explains.
Although there are no specific statistics about the consumption of these drugs among young people in each specific area, a few years ago Proyecto Hombre and the University of Huelva joined forces to carry out a study which involved talking to 4,000 secondary school pupils in the eight provinces of Andalucía. The conclusion was that most teenagers who took hypnosedatives did so "because others in their family took them". Also, so did their classmates.
"Teenagers copy each other; if one says they have taken a tablet, others will decide to do the same," says Dr Aguilar. Although when considering the abuse of drugs it is difficult to separate the consumption of hypnosedatives from others, one thing is clear: girls take them much more than boys (according to the Estudes report, the girls make up 62.2 per cent).
Apart from the urge to copy others, another aspect is that benzodiazepines have other characteristics which can make them attractive to teenagers, as Dr Sánchez Menéndez explains:
"They are very cheap. There is a black market which is easy to access, they are safe - they are rarely lethal even when taken in high doses - and they generate tolerance, so after you have been taking them for a while they become less effective and you need to increase the dose. That can lead to addiction," he says.
With regard to use without medical prescription, Dr Aguila warns that "abuse of hypnosedatives can also be associated with an excessive use of stimulatory substances, and that rebound effect is like a timebomb".
He believes the use of benzodiazepines should be limited to medical treatment and very specific cases; and even in these cases, they should only be taken for short periods.
"It is not advisable for teenagers to take them for more than six months," he says. He and Dr Sánchez Menéndez agree that this medication should be combined with individual therapy and, in the case of children, with therapies in conjunction with their parents.
Their final message is clear: "People need to talk to their doctor. It's no good just going to see him or her because you want to be prescribed tablets."