Transcription:
Signs Your Teen is Struggling With Substance Abuse

Scott Webb: Welcome to Children's Health Checkup. I'm Scott Webb and today we're discussing teen substance abuse and how we can care for our teens who are struggling with substances. And I'm joined today by Dr. David Atkinson, pediatric psychiatrist and medical director of the teen recovery program at Children's Health and Associate Professor at UT Southwestern.

And I'm also joined by Stacy Goran teen recovery program manager at Children's Health. And doctor, I'd like to start by having you share some statistics on teenage substance abuse.

Dr. David Atkinson: I think that teenage substance use is a bit more common than most parents realize. We know that a lot of the teenagers who use substances are not telling their parents about them. So when we look at use of marijuana, for instance, we know that 6% of 12th graders and over 4% of 10th graders are using marijuana daily. And that's very concerning because daily marijuana use is associated with far more harm than other types of substances.

When you look at drugs other than marijuana, in the past year, about 11.5% of 12th graders have used, 9% of 10th graders, and 6.5% of 8th graders, that's for illegal drugs apart from marijuana.

One thing a lot of parents tell me is that, "Oh, of course my kid is going to drink." What we know from the statistics is actually that there are plenty of kids out there not drinking, and this is more than ever before. So we see that while in the past year, 50% of 12th graders have used alcohol, it's equally true that 50% have not. And while 33% of 12th graders have been drunk in the past year, two-thirds of 12th graders have not been drunk at all. And if we look at 10th graders, 20% have been drunk, which means 80% have not.

Scott Webb: Stacie, what are the most common substances used by teens?

Stacie Goran: So in our clinic, we do a pretty intensive intake where we gather all the information of all the drugs that they've ever used. And so of the kiddos that we've seen and what we've found just out in the community, a hundred percent of the kids that are seeking treatment are using cannabis. And so that is the number one substance used right now for teens followed by alcohol. And the other drugs that we see are Xanax, so anything in that benzo family, pain medications, LSD or acid, ecstasy, DXM, which is an over-the-counter cough syrup, and some others, but those are the most common ones that we see used in teens.

We've encountered some that are using cocaine or have tried cocaine or other drugs, but the most common ones are cannabis, alcohol, and then probably those benzos and pain meds that they're able to find in the medicine cabinet or maybe from a previous surgery or something like that.

Scott Webb: Stacie, what are the warning signs of substance abuse in our teens?

Stacie Goran: We tell people to look for any mood changes, something that has progressed quickly as far as a mood change or conduct issues. When you have a teen that has an inability to cope with even minor frustration, they have school absences or tardies that can't be explained. They have a notable decline in school performance. Maybe they began to change peer groups or avoid family. They have a lack of interest in activities that they previously really enjoyed. So we have a lot of kids where it was, "I played football for since I was six, but all of a sudden I'm 16 and I don't want to play anymore. I'm not interested." And so those are some signs.

Also a decline in hygiene or appearance, appearance of someone that's sad, depressed or withdrawn, or maybe you've found drugs or paraphernalia, or suspected that your teen came home under the influence of something. So those are things to watch out for sure.

Scott Webb: And, you know, as a parent of two teenagers, a lot of what you're describing there for parents might just seem like normal teenage stuff. I mean moodiness in a teen, that's pretty standard fair, right? So is it difficult for parents to know the difference between, "Well, my teen just doesn't like to shower and they're kind of moody," meaning that it could be something more significant like substance abuse.

Stacie Goran: Right. The first thing I usually tell parents if they're really just suspecting, but they don't have any evidence to show that there is substance use, I tell them, "Take them to your PCP or your pediatrician and have them drug tested," or you could even do an at-home drug test, but we prefer the ones where they go into the doctor, have those conversations to see if there's any indication of depression or anxiety or ADHD or something else going on. But get that drug screen at the doctor's office whether you have someone who's using substances or not.

Scott Webb: Yeah. That's good advice. When in doubt or if you have any questions as a parent, seek professional counsel, professional advice, go to the primary. That's great. And Dr. Atkinson, back to you here, how can we prevent teen substance abuse? How do we do that as parents?

Dr. David Atkinson: It's a great question. I think the number one answer is to strengthen families. It's been shown in studies that when we have a good family bond, when we have good parent-child bond, there's going to be less substance use. What this means is that parents need to be able to have a good, positive relationship with their child.

Take interest in what their child is doing. That's positive. Even if the child is disruptive or disrespectful, take the time to build a positive relationship. You have to understand that also preventing substance use starts at age 10 or earlier. It doesn't start when they're teens and they might be going out to parties or being offered.

It's important to have a strong family bond before for the first time they're put in a substance using situation. The parents need to have the confidence to set firm limits, but not arbitrary limits. This means that the teen knows what the limit is ahead of time and knows what the consequence will be. And also knows that the parent will follow through on that consequence. No matter how much they complain about it, how much they protest, their parent is going to stick to what they've said.

So it involves both a firmness and strength in the parent and the emotional investment in the child. So the child feels that they are appreciated and there's a positive relationship to build on for when the parent has to set those difficult limits.

Scott Webb: Yeah, that sounds great. Having that great family foundation before our teens find themselves in those tricky situations, having that, to build on having that to lean back on, that's really great advice. And Stacie, do you hear any common misconceptions about substance abuse by teens?

Stacie Goran: I think the biggest one, and I think it's gotten worse as there's been more legalization and decriminalization of marijuana in different states, it's just that marijuana is not harmful. The truth is that it is harmful. And the other thing is that we're seeing that kids are not just smoking marijuana the way that marijuana existed 20 years ago, 30, 40 years ago. The potency is so much higher. They're using the concentrated THC rather than just the plant, the marijuana plant. They're vaping, so it's less detectable. The parents can't smell it. So maybe they go into the bathroom at school. So they're just using more often and the potency is so much higher, and so we hear parents say sometimes, "Well, it's just weed. I just want to work on the other stuff, but I'm going to let them keep smoking weed because that's not harmful."

And so I think that's the biggest misconception is that marijuana is not harmful. And we see kids that become less motivated. If they have underlying mental health conditions like anxiety or depression, it actually makes these things worse long-term. So they may feel better in the moment when they're using, but when they come down, they feel terrible. And so just recognizing that it is really problematic for teens and also affects their brain in ways that it doesn't impact an adult. So I think just realizing that would be really important.

And the other thing I would add to what Dr. Atkinson was saying about preventing teen substance use is just being really involved in their friends. Knowing who their friends are. If your teen calls and says, "Hey, can I go spend the night at so-and-so's house? Or can I go out with so-and-so?" Meet that person, talk to their parents, build those relationships, so that you're connected to their friend group, because then you can really keep a good gauge on what's going on and what they're doing better than if you don't know who they're hanging out with.

Dr. David Atkinson: I think Stacie is absolutely right about knowing the friends and knowing their parents. There was a recent study that showed that parents who set limits have a lot lower substance use in their kid. But that effect is amplified when the friends' parents also are setting limits for them. And the parents' efforts are undercut in the reverse situation when the parents of their child's friends are not setting limits and not having consequences. So it's important to understand that children do not exist in isolated nuclear families and they don't exist just in isolated friend groups. These are groups of families that are interacting and need to cooperate together to prevent substance use,

Scott Webb: Doctor, drug and alcohol abuse are common concerns for parents, of course, but the rise in opioids isn't limited to just adults. So what are opioids and how can parents prevent opioid addiction in their child? That's a loaded question, but hopefully you can take us through this.

Dr. David Atkinson: I think it's such an important question because opioids are killing over 50,000 people a year. For the past three years, that's 150,000 deaths. And this year during the pandemic, there is indication that this number's even higher. So opioids traditionally just included codeine and morphine. Those drugs were bad enough. They caused an epidemic of their own in the 19th century. In the late 1800s, there were a lot of people getting addicted to morphine. But then you had modified forms such as heroin. You have many other synthetic opioids. You have drugs like oxycodone, which a company recently had to go bankrupt because they were marketing it as less addictive and in fact, it caused a lot of addiction. Then there's the new drug. The new player is fentanyl, which is a very powerful synthetic opioid. That's not natural and it's so potent that even a small amount that's accidentally ingested could kill somebody.

So the opioids are addictive because they give a lot of pleasure. The opioids are also addictive because when people stop using them, they feel terrible. They feel absolutely sick. And they sometimes use to just get rid of that feeling of sickness. The opioids are especially dangerous because they shut down the center of the brain, the medulla that drives respiration. You do not breathe when you take too many opioids.

So how much is too much? Each individual is different. Young users may be especially prone to overdose because they have no tolerance, they have no experience, they do not know what they're buying. And this synthetic fentanyl that is coming in is oftentimes not manufactured in a pharmaceutical laboratory. Usually, this is a drug that is produced in clandestine laboratories whether inside or outside of the United States. And then sometimes it is sold as if it's another drug that doesn't have as bad of a reputation. And because it's cheap, it's going to replace heroin. It's going to replace oxycodone. And a lot of times kids are getting into fentanyl when they think they are getting another drug that may not be as potent or as deadly. So that is the big problem that we're facing now with the opioids.

Interestingly, just like prevention of substance use starts at ages 10, 11, 12, or earlier for our youth, the prevention of opioid overdose deaths has to start before they're using the opioids. We know that most of the people who overdose on the opioids are in that 18 to 30 range. However, they never start with the opioids. Usually, there's other drugs that are abused. And this is one of the big fears that we have about adolescent marijuana use is that when we follow marijuana users over time, those marijuana users who've hit it hard during adolescence, they are very likely to convert to opioids in young adulthood. And the marijuana and the opioids may have a little bit of a chemical, I guess, teaming up in that the opioid use can be proceeding much more rapidly after somebody has been using marijuana heavily during the adolescent years because of brain adaptations and chemical changes.

So we need to address substance use during the adolescent years, hopefully give them the skills to go without drugs, to give them the skills to live a sober lifestyle, so that when they are older, they are growing up, they're going out of the home, they're outside of the parents' control, they're not at risk for falling prey to this massive epidemic of drug overdose, which is just killing tens of thousands of people every year.

Scott Webb: When we talk about dealing with this, about facing substance abuse, Stacie, as we get close to wrapping up here, who should parents turn to for help if their child is facing the type of substance abuse that we're speaking of today?

Stacie Goran: I always recommend that their first stop be the pediatrician or PCP, because that person typically knows the child and has some history with them. So reaching out there, maybe reaching out to-- if you just feel like they've dabbled and you're concerned and you don't want it to progress and get any worse, then reaching out to a therapist that has some experience in this field, working with this population, would be a great next step.

If you feel that this has already become problematic, they've got behavior issues, maybe school problems, maybe even legal issues, then reaching out to a program, so that they can be engaged in a program that'll deal with mental health and substance use issues simultaneously and a little more intensive.

If their situation is dangerous, they're using drugs that are more dangerous or maybe their behaviors have become more dangerous, then even a substance use residential program might be the next step. But I would usually start with the pediatrician and see what their recommendation is and their referral would be for that. We tell people they can call us as well and we'll point them in the right direction. So just reach out. Don't ever hesitate to reach out and get help, even if you feel like it's just starting and maybe it's too soon. We always say it's never too soon to reach out and get help because we don't want to wait until things get to the point where it's really difficult to turn things around.

Scott Webb: Yeah, definitely. I don't think there is, for us parents, I don't think there is a too soon when it comes to substance abuse for sure. Doctor, as we wrap up here today, anything else we want to tell people about teenage substance abuse? Warning signs, treatment, just your best advice for all parents in the audience about how to tackle this really difficult subject when it comes to our teens.

Dr. David Atkinson: I think the thing that I want to emphasize most is that substance use problems don't happen just to bad kids. The thing about the drugs of abuse is that they hijack the brain and they hijack the brain motivation. They sometimes become a preoccupation for the young person and sometimes they're so emotionally overwhelming that it's very difficult to leave them.

So I believe that all parents should understand that this is a health issue. This is not a moral issue. Good kids can get wrapped up in substance use problems. Good kids can have problems of emotions that they do not deal with properly and good kids who are wrapped up in substance use will often do things like deceive, fail to follow through on obligations, say things they wouldn't and just thought to abandon some of those things that have made them so successful.

So when we're looking at this drug abuse problem, it's not a good idea to just think of it as this is something that is a moral failing when somebody uses or that this is something that's only used by moral failures. This is a health problem that can overcome even kids who have really good characters, really good families, and have really good intentions.

Scott Webb: This has been a really educational conversation today. Want to thank you both for joining me and thanks everybody for listening to Children's Health Checkup. For more information, go to childrens.com/teenrecovery. I'm Scott Webb, stay well.