Before we talk about alcohol and the risk of drinking and the nature of alcoholism, lets remember some basic facts about Fetal Alcohol Spectrum Disorders (FASD).

1. FASD is brain damage. The frontal lobes don't work right. The executive functions are affected (inhibitions, planning, consequences, perceptions, motivation, judgment)

2. The nature of FASD is that the individual has memory lapses, lacks impulse control, and has poor judgment when it comes to making serious decisions.

3. The social development of a teenager with FASD is stunted at about the level of a six year old. They can act like adults, but inside many of them function like children. Social maturation takes much longer. Most individuals with FASD require close supervision until they reach about age 30.

4. The rate of substance abuse with FASD is 50% for men and 70% for women. The majority of the individuals who don't drink report that the reason they don't drink is they don't have access to alcohol (close supervision). The risk for individuals with FASD is complicated even further due to lack of impulse control and poor judgment.

5. The brain of the person with FASD functions similarly to the way the person who is inebriated functions. For a person with FASD to have one drink is like having one drink after having already had 3 drinks, and has a greater impact on judgment. One or two drinks for a person with FASD is the equivalent of a six-pack of beer or an entire bottle of wine.

Now we can talk about alcoholism. One of the most effective treatment strategies is the 12-step program of Alcoholics Anonymous. This works well for most people, but it might not be effective for the person with FASD unless he or she has a good mentor for a sponsor, someone who understands the nature of the FASD and is willing to provide close contact, monitoring, and guidance on a daily basis.

Now let's talk about Al-Anon. Those of us who have walked that journey have learned about the three C's: We didn't cause it, we can't cure it, and we can't control it. This is sound advice for coping with the typical alcoholic. When it comes to caring for a child who is FASD and has a drinking problem, the advice to "Let Go" is not the advice to follow. This could lead to the child's continuing self-destruction. Remember, the child (even an adult child) needs an external brain in order to function safely, and this is especially true for the child who may be abusing alcohol or other drugs. We can control it to a certain extent, and in many cases we should control it. Situations where we need to step in and do something are when the child is under legal age of adulthood or when the child is in our care (with legal or in facto guardianship).

Yes, we need to hold the child accountable for his or her actions. But we do that at the level of their ability to function (Vineland score indicates this is often at the level of a 5 to 10 year old). How would you hold an 8-year-old accountable for getting into the neighbor's liquor cabinet? How do you prevent that from happening again?

It has been said that the greatest protective factor for a child (of any age) with FASD is the parents. I would take this further and say the greatest risk factor for a child (of any age) with FASD is parents who do not fully accept the reality of the nature of FASD and allow themselves to be talked into "letting go" by well-meaning but totally ignorant friends and family, ignorant of the nature and needs of FASD.

When should a teenager with FASD drink? In my opinion, never. When should a teenager with FASD be allowed to go off on his or her own to make their own decisions about their life? When they have proven over time that they are responsible and mature enough to live life without placing themselves or others at grave risk. This would include getting a driver's license and/or car, going to parties, moving out of the family home, and other typical rites of passage enjoyed by non-affected teens and young adults. A small percentage of young adults with FASD can handle life on their own, and do quite well, usually with LOTS of support from friends and family who check in on a daily basis.  Most need more than this to succeed.

The key to success can be summed up in the three A's borrowed from the 12-step programs: Awareness, Acceptance, and Action. The awareness needs to be based on sound education with information from research. The acceptance needs to be reached by parents first, then by the teen or adult with FASD, and also by those who have any influence in the person's life. The action needs to be based on reality, weighing the freedoms with the risks, the privileges with the responsibility, and need to be healthy goal-oriented actions that will lead to the person's well-being and happiness.

It's hard to be happy in prison, in a mental institution, on the streets, or in a morgue.

Learn how to talk to your teen about alcohol here: http://www.alcoholfreechildren.org/

PDF brochure "Make a Difference": http://www.alcoholfreechildren.org/en/pubs/pdf/makeadifference.pdf