White Coat, Black Art·Q&A

Why Dr. Brian Goldman bought cigarettes for his underage son who has FASD

On Friday, Dr. Brian Goldman found himself making a difficult decision: buying his first pack of cigarettes — for his 17-year-old son. He tells Metro Morning host Matt Galloway why he sees it as a means of harm reduction.

White Coat, Black Art host says choice was about harm reduction

Dr. Brian Goldman is opening up about his decision to buy his son a pack of cigarettes as a means of harm reduction. 'I'm all about breaking barriers that lead to shame,' he says. (Sebastien Bozon/Getty Images)

On Friday, Dr. Brian Goldman found himself making a difficult decision.

In the interest of harm reduction, he wrote on Twitter, "I bought my first pack of cigarettes. Not for me. For my son." 

Goldman's son is 17, and he has fetal alcohol spectrum disorder (FASD).

The condition can make learning from past experiences tough, and hinders a person's ability to make good long-term choices, said Goldman, the host of White Coat, Black Art and an emergency room physician in Toronto. 

Goldman spoke with Metro Morning host Matt Galloway about what compelled him to buy those cigarettes for his son, and the challenges of raising a child with FASD. 

Here is part of their conversation.

Why did you buy cigarettes for your son?

It's complicated, for many reasons. My son, a couple years ago, was diagnosed with fetal alcohol spectrum disorder (FASD). We adopted both of our children from orphanages in Russia. It was a highly personal thing. There are many different kinds of harm reduction. I could have bought him a Juul. I could have bought him a vape. But I thought that it would be very easy to turn him into the equivalent of a three-pack-a-day smoker with the nicotine levels that you can acquire, and I didn't want him to get used to that and comfortable with that, so that if he received vape liquid from other people he would graduate onto other things. 

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The thing about a cigarette is that you smoke them, there's a finite amount of nicotine in it, and there's only so much he can afford. There's only so much that he's going to be able to acquire on his own. So there is some limit there. I suppose if he became the equivalent of a pack-and-a-half or a pack-a-day smoker, I might consider switching him, you know, buying him a vape. There are other harms. As an average teenager with fetal alcohol spectrum disorder, he's got the full range of issues that kids face.

We've talked about fetal alcohol spectrum disorder on this program before. But for people who don't know a lot about it, just quickly tell us a bit about it.

Fetal alcohol spectrum disorder is a brain-based neurodevelopmental disorder that's caused by prenatal exposure to alcohol. And we won't ever know about our son's history except to know that he was given up for adoption and in a country — in Russia — that has a high prevalence of alcohol use disorder, and it can cause facial features that are characteristic. But the most important aspect of fetal alcohol spectrum disorder is that it affects the brain, it causes poor executive function. So that means making choices is very difficult.

How is that exacerbated as a child gets older and becomes a teenager?

You can add to that all of the problems of adolescence, and those parts of the brain aren't well-developed in a 17-year-old anyway. But in somebody with FASD, they will find it very difficult to learn from experience, to make choices that are in their best long-term interest. They have a tendency to engage in high-risk behaviours — and they can be drugs, they can be sexual, smoking. So smoking and using marijuana and other drugs are often very common. They don't learn from consequences. You can shame them all you like. You can admonish, punish — whatever you say about what happened today, it can happen tomorrow, next week, bigger, you have no idea. You never know what's going to come next.

When did you learn that your son was smoking?

He had dabbled in cigarettes starting a couple of years ago. And we knew, for instance, that at the high school he goes to, he could go to the mall. So we knew because he smells of tobacco, you see some nicotine stains, you see some butts, and you ask him, 'Where'd you get them from?' And he'll say he found them on the ground, which is another aspect of FASD: tall tales. They're not lies; he often can't answer where he got them at that moment when you confront them. So we knew, starting two years ago. As parents, my partner Tamara and I, we're getting used to the idea of not being surprised.

So what led you to the point in which you felt it was the right time to buy him a pack of cigarettes?

One of the other aspects of FASD is fragmented sleep, and we knew for a while that he was having trouble falling asleep, staying asleep. And what happened in the last few months, we became aware that he would get up, and get dressed and initially, he would just step outside, and then he went to the garage to smoke cigarettes. And you could see the detritus of that there. And more recently, in the last few months, we learned that he would get up sometimes and walk the streets and be fairly far — not that far away — but far enough away that he could meet up with other people. And so now, you begin to understand where the harm reduction comes from. It's not the tobacco harm reduction, it's who he's getting it from.

The tobacco is the thing that people can't square. You're a doctor. You know all about the effects of smoking cigarettes, and you buy your son cigarettes.

I know.

Goldman is a Toronto physician and host of White Coat, Black Art on CBC Radio. (CBC Radio)

How difficult was that decision?

It was really difficult, especially for Tamara, because she's an ex-smoker. But the thing is that Tamara and I have both discovered that our relationship with our son has become dotted with disapproval and shame and anger and fear, and when you only have that, when do you have love? Where's the love? Where's the acceptance?

And buying that pack of cigarettes was a way of saying, 'I love you. I mean, I know you're not making right choices. We're going to try to limit this.' It's a way of saying, 'I don't approve of the fact that you smoke cigarettes. But I do approve of you, and I love you. And and I'm here. I'm going to stay here.'

He knows he's got parents who love him and they're not utterly disapproving of him at all times. That's something that happens when you parent a child with FASD. You see all the bad stuff. 

By the way, he's high-functioning. He can get a 90 in functions. I could never get a 90 in functions.

You didn't need to tweet this out and you certainly didn't need to come on the radio and talk about it this morning. And I know that it can't be easy. Why did you want to do that?

Two reasons. One of them is to give comfort and maybe some inspiration for other parents who have kids with FASD, because I find that the world, society, the educational system really doesn't get or understand it. The tendency [is] to assume that that child with FASD doesn't do something they're supposed to do because they won't, when in fact they can't. That's 'can't', not 'won't'. 

And the other reason is that I'm all about breaking barriers that lead to shame. Shame is about keeping silent — we'll just keep this to ourselves because we're so ashamed of it. I'm not ashamed of it. It's not his fault. It's not our fault. And I'm not perfect. There may be thousands of people who are listening to us right now who are gonna write in saying, 'Couldn't you have found another way?'

But the response overwhelmingly to your tweet was ... life is sticky. Life isn't black and white. And that there are complexities in everything and that you raise the complexities to your credit.

I know, and I'm heartened by that.

Q&A has been edited for length and clarity. Click 'Listen' above to hear the full conversation.