Levi’s survival and recovery against the odds — three days in a coma followed by a regimen of antiseizure drugs that he still takes — have made him perhaps the first scared-straight, been-there-and-back spokesman against the choking game. And there is a growing audience for his message.  While asphyxiation games have been around for many years, a series of locally publicized deaths around the country over the last few years, coupled with a realization that teenagers are seeing the game on Internet sites like YouTube, and playing it in more threatening variations — more often, like Levi, alone with a rope — are sparking a vigorous and open discussion in schools and among parents’ groups, summer camp administrators and doctors.  “We ought not to be timid in addressing this, and there has been timidity in the past,” said Stephen Wallace, a psychologist and chief executive of Students Against Destructive Decisions, a nonprofit group based in Marlborough, Mass.  A group called the Dylan Blake Foundation, founded by a parent who lost an 11-year-old son in 2005, said there were at least 40 deaths and 5 serious injuries from the game in the United States alone last year.  But the exact number remains uncertain because there has been little real research, health professionals say, and because medical examiners have been quick in the past to rule suicide. Some adults might also dismiss the game as the slumber party goof it was in years past, when constriction to the point of death was virtually unheard of.  But attitudes are shifting. Some medical examiners and pediatricians are looking at the increased teenage suicide rate from suffocation over the last decade and questioning whether dozens of deaths listed as suicide might in fact have been accidental, the result of a choking game experience gone wrong.  In 2004, according to the most recent figures from the federal Centers for Disease Control and Prevention, 779 children between ages 10 and 19 committed suicide by suffocation, up from 400 to 450 per year from the early 1980s through the mid-1990s, when the numbers began to rise.  Suffocation, which includes hanging, overtook gunshot in 1997 as the No. 1 way 10- to 19- year olds take their own lives, according to the centers.  Greater awareness in the medical community is in turn leading to the first serious scientific research about the game’s prevalence. Dr. Mark Lapore, an assistant professor of counseling psychology at Chatham College in Pittsburgh, is working on a survey in the Pittsburgh public schools. The American Camp Association, which certifies summer camps, discussed the choking game at its annual meeting last year.  “Asphyxiation games have been with us for generations, but what makes the current generation’s execution of this game different is that more kids are willing to play it alone,” said Dr. Thomas Andrew, the chief medical examiner in New Hampshire, who has consulted on 20 cases around the country where the game was suspected.  Of those 20 cases, most of which were listed officially as suicide, Dr. Andrew said he became convinced that four were really accidental from the choking game, and two others were unclear enough that they should have been changed to an undetermined cause of death. But he said that none of the death certificates, to his knowledge, were changed.  Anxiety about sex is another entanglement in the discussion. In some older teenagers and adults, the game can become associated with autoerotic practices of masturbation or intercourse to intensify orgasms, though Dr. Andrew and other experts say they think sex is not a factor for younger teenagers — and there was also no sex or ejaculation in Levi’s case, his mother said.  For now, most of the new debate is driven by advocates like Scott S. Metheny, an intense police officer from Upper Moreland, Pa., a suburb of Philadelphia, who has done more than 140 antichoking game presentations in the past 18 months on his own time.  He flew to Texas to talk to the students at Navarro, about 40 miles northeast of San Antonio, and to introduce Levi.  “Bringing Levi in was a shock factor,” Kandi Knippa, 18, president of the Drug Awareness Council, a student group. “It was very intense. But if we can save one life, it was worth it.”  About three-quarters of Ms. Knippa’s classmates, girls as well as boys, raised their hands when asked if they had heard of the choking game, which Mr. Metheny said was typical.  But the new debate also coincides with a reassessment of how teenagers think about risk. Conventional wisdom said adolescents often flirted with the edges of danger because they felt invulnerable.  Newer studies have dismissed that notion. They say that most teenagers are quite cooled-headed in assessing risk and reward — and that is what sometimes gets them in trouble. Adults, by contrast, are more likely to rely on experience or gut feelings than rational calculation.  Asked whether it would ever make sense to play Russian roulette for a million dollars, for example, most adults immediately say no, said Valerie F. Reyna, a professor of human development and psychology at Cornell University.  But when Professor Reyna asks teenagers the same question in intervention sessions to teach smarter risk-taking behavior, they often stop to calculate or debate, she said — what exactly would the odds be of getting the chamber with the bullet?  “I use the example to try to get them to see that thinking rationally like that doesn’t always lead to rational choices,” she said.  Those findings are influencing the way the choking game is discussed.  One doctor in Canada, Andrew J. Macnab, who is working on a major survey of the choking game in American and Canadian schools, said, “The best way is to get teens to talk to teens.” Dr. Macnab, a professor of pediatrics at the University of British Columbia, added that whoever talked about the game should use visual, concrete imagery.  Mentioning specific, narrow risks from the game, he said, like brain damage, medication and physical disfigurement can be even more powerful disincentives to adolescents than the idea of dying, which can seem theoretical or abstract.  “It’s not going to work if adults just say it’s a bad idea,” he said. “That tends to make it all the more attractive.”  In the Draher family, the question is how to use the gift of life snatched from the abyss. Mrs. Draher said she had never heard of the game before the day she found her son. Now she has joined a national group called Games Adolescents Shouldn’t Play (www.gaspinfo.com), which includes information about the game and Mr. Metheny’s PowerPoint presentation..  Levi’s father, Steven, said he was worried for a while that Mrs. Draher was going too fast in her newfound zeal.  “I was really kind of against her going public with all this — I thought she was pushing Levi into the limelight before he was healed,” Mr. Draher said in an interview in the family’s apartment in San Antonio. “But I’ve changed my mind. It seems to be helping Levi deal with it himself and talk about it, and that’s what matters.”  Levi, who has vowed to his parents never to play the game again, was fielding text messages on the couch as his father spoke. Mr. Draher said his son had moved on these days to other interests — girls and cars.  “He’s smelling perfume and gasoline,” Mr. Draher said with a smile.  A version of this article appears in print on , on Page A1 of the New York edition with the headline: Back From the Dead, Teenager Casts Light on Shadowy Game. Order Reprints| Today's Paper|Subscribe
A Texas boy has become a scared-straight spokesman against a choking game after he nearly died playing it.