Cheryl Martin (Host): This is Children's Health Checkup where we answer parents' most common questions about raising healthy and happy kids. I'm Cheryl Martin. One of those questions for parents of teenagers may be: How do I talk to my teen about THC and marijuana use? Well, here to help guide you in that conversation and answer some of your questions is Dr. David Atkinson. He's a pediatric psychiatrist and Medical Director of the Teen Recovery Program at Children's Health. He's also an Associate Professor of Psychiatry at UT Southwestern Medical Center. Dr. Atkinson, thanks for coming on.

David Atkinson, MD: Thank you so much for having me.

Host: First, talk about the risk of marijuana use for teenagers.

David Atkinson, MD: Yeah. The risk for marijuana use in teenagers is a combination of some of the things that are risky for everyone, adults included, and a special risk during the adolescent years.

I think the first risk that psychiatrists are concerned about is a very well established link between using marijuana during adolescent years and the development of psychosis or schizophrenia. And this doesn't depend on whether it is this natural plant marijuana which is the plant containing components such as THC or delta-9 THC and components like cannabidiol, or the things that come out of vape dots, the electronic cigarette-delivered THC, whether it's ,delta-9 concentrate, either exposure, either chemical will lead to an increased risk of developing schizophrenia in an early-onset of that condition.

Now, of course, it is not every adolescent that is going to develop schizophrenia when they used high potency marijuana regularly. But one of the very interesting studies out of Europe, I believe it was Marta Di Forti's study in 2019, showed that the risk of developing psychosis, which is a more general term that encompasses schizophrenia, may affect ten percent of daily users of high potency THC marijuana products.

The second risk to adolescents that is different than the risk of adults is that adolescents have been known for a long time to be more susceptible to developing bad habits. They oftentimes are more responsive to rewards and they have less inhibition. Particularly marijuana and THC will actually activate the reward centers of adolescent much more strongly than of adult.

So, adults sometimes will think, "Well, Uncle Charlie is 46 and he's used this stuff and hasn't had any problems." The adolescent brain may be getting a much more powerful high from the drug as well as not having the brakes, not having the ability to stop oneself when that higher potency reward is available.

Host: Now, Doctor, you mentioned before that a teen could say, "Well, this particular uncle, he's in his 40s and he seems to be okay." So, can marijuana use be harmful for adults as well, or those who've been using it for a long time?

David Atkinson, MD: Yes, I think there are problems. When you asked about are there problems for adults with THC, and I would say that yes, and the problems that adults see are also seen in teens. For everyone who's using THC, it's well-known that there is a lack of motivation that occurs when using the drug. There is also a very well documented effect on memory, what we call short term memory. Remembering things that were said to you or happened three to four days ago is extremely impaired. It's not like you forget your childhood with THC. But when we talk about laying down a little bit more permanent memory trace, things of events happening three to four days ago or things that were told to you three or four days ago, marijuana is pretty bad at that.

Also, when it comes to schooling, you could see that marijuana use really might not be much of a helper when it comes to studying for tests and being tested on content that you were taught earlier in the week. That memory impairment even with pretty low level use is very consistently found in both adolescents and adult.

I think the motivational aspect of THC use can hurt adults and adolescents. For adolescents, it's been a little bit more clear that what we have seen is that when the adolescent starts using THC, they start dropping out of things like sports, dance, band, any extracurriculars, AP classes. The drug is on the one hand maybe monopolizing motivation a little bit. Like, you want the drugs so much, it's hard to make room for other things.

Host: So, are there any other things that you want to add regarding why teens are particularly vulnerable to the effects of marijuana and THC?

David Atkinson, MD: Yeah, I would say that for teens and the effects of marijuana and THC another vulnerability is the fact that they don't have to make rent. They don't have to show up every day at work, or show up in a way that is presentable. They often can slide through the school. And if they don't really make a giant ruckus, or they don't make it obvious that they are impaired or under the influence, it may just kind of be brushed aside so that adolescents have an opportunity to develop regular use patterns without the same consequences than adult life.

And I think that adolescents also in the modern school setting, is that it is extremely difficult for administrators to entirely control the problem of THC use in schools because back in my day, you had to burn up a marijuana plant, which is like stinky, you were never going to get away with that in the restroom. Today, in the schools, a lot of teens are very tempted because of all of the THC vape that are in the school, and they're used in private in the restrooms and often shared or offered to friends in the restroom. So, your teen doesn't even have to buy the vape to be vulnerable and be at risk. It's just been extremely difficult for school administrators officials, resource officers to control this problem.

I think it is something that we need to address from every standpoint: legal, and parental,and education of the youth.

Host: So, Doctor, would you say that it's okay for teens to experiment with marijuana? What's your position on that, or never try it?

David Atkinson, MD: Yeah, this is a great question, because one of the fun things about the word experiment, you know, "Is it okay for teens to experiment with marijuana?" The problem with experimenting with marijuana is that some people repeat the 200 times. That's not very good science if you think about it, if you're doing the same experiment over and over.

And the reason for this is the addictive component make people want to use it more. When I have adult friends tell me that they want to try marijuana, and they're going to a legal state, and they're thinking about doing it, I tell them, "You know the actual worst thing that could happen to you is that you like it." When someone does the experiment of taking marijuana, if they get a really powerful high out of it, one that could eclipse the natural highs of getting straight A's or making the football team or going on an awesome date for prom, those rewards, they're a natural human reward, and they can't compete with marijuana. THC can activate the cells of the brain in a certain area of the brain called the nucleus accumbens shell, it's directly activated by marijuana. So, it's kind of like they're jailbreaking their reward system, and that makes it really hard to not want it in the future. . Even if you've never done drugs before, think about the best feeling of your life, and wouldn't you like to repeat that feeling if you could? It's very hard to resist for some people once they get this strong high.

Host: So, you were encouraging your adult friend not to try it the first time. So, is that what you would also say to teens? Don't try it. Don't experiment.

David Atkinson, MD: When you're talking about adults and teens, I would encourage them both not use marijuana, because there's very few benefits to this in reality when you also have these risks.

Host: What do you tell parents who think occasional use isn't a big deal?

David Atkinson, MD: I think that there are different levels of response that are appropriate for heavy regular use, which is immediate intervention, and experimental use of one or two times, and by experimental, I really mean it like one or two times, and occasional use, which is once a month.

When it comes to the harms of marijuana, it's really hard to study the harms of very low level use, but I have seen some studies that have shown even twice a month use of marijuana can cause them impairment to memory.

The biggest risk of occasionally using marijuana is that people like it, and they tend to escalate their use. Most of the users of marijuana that we see, they're starting for the first time between eleven and fifteen. It starts out occasionally, sometimes because it's only available occasionally. It's not quite like crack cocaine where you see people from first years go to a point of being entirely impaired by the desire and impulsive use within a month. It's a slower development. But we always need an occasional use at the start.

And when you're talking about occasional use of marijuana in teens, it really raises a difficult question, how on earth would you tell if it's really occasional use or it's rather compulsive use? I mean, it's well-known that with adults who have alcoholism or alcohol problems they often will say, "Well, I drink the occasional beer." And then, they leave out the part every two hours. It's very difficult to know how frequent the adolescent marijuana use is because they often hide it. I think all of us would want to think it's more casual than it is, that we love our kids, there's natural tendency to not want to think about the worst.

Host: So, Doctor, if a parent suspects that their teen is using marijuana, what is the best way for them to approach the conversation?

David Atkinson, MD: When you're asking about the best way for a parent to react to an adolescent who's using marijuana, I honestly feel ideally we need to get the response occurring even before that. And ideally, parents should be talking to their teens about marijuana and THC, and letting them know the risks even at ages like ten, eleven because we see a lot of kids initiating shortly after.

And it would be communicated as a parent that we expect you not to use drugs. We expect you not to use marijuana. And this is one of the things that, while parents don't have perfect control over their kid, we have seen that when parents communicate very clearly the expectation that their kids do not use marijuana or drink or have risky sexual encounters, that has a small effect at least on the young person's behavior.

I think that parents will do themselves a disservice if they say, "Well, we know everybody's going to try it" and " everybody's going to have fun when they're a teenager." Half of teens never do drugs or alcohol, and about half of them do. The various rates will change from year to year which sample you use.

But for the flip side of the coin, of course, 50% use, but there's about 50% of the teens who are not using. It's not as abnormal as parents think for adolescents to not use. Now within certain subcultures, certain cities, certain towns, certain high schools, that rate of use may be much higher.

Host: I love the fact that you're saying parents should say, "This is our expectation." But here's a question that comes to mind. If the parent initiates this, what if the kid says, "I need guidance on how should I answer the question because peer pressure is so strong that friends are offering me drugs. What's a good answer for me to get out of it?"

David Atkinson, MD: sometimes with teens and I will tell them—for the ones at our program, they're all getting drug tested. That is a great out to say, "I can't use if I'm being tested." But the other thing you could tell the kid who say, "Look, my dad will go through the roof if he finds that I've used. I can't do it". And that way, the teen's able to kind of refuse the offer without it sounding judgmental, because I remember some drug education when I was teenager saying the kid should be like, "No drugs is bad for you and it's going to ruin your future!" And that is one of the things that her team, they often can get away with refusing drugs, but they're probably not going to get away with little beat afterwards.

Most people really don't care if you don't accept a drug that is offered to you, at least you're not "chiefing their weed." If somebody is really persistent on wanting you to use drugs with them, it's probably because they themselves have a drug problem. Most people who are not having a problem with drugs are really going to be very persistent. Sometimes you do get some teens that are very curious and they want to use and they really want a buddy to use with them And I think that if they want that buddy to use with them It might be because they themselves have some misgivings about it, whether it's A moral sense or a little bit of fear of what might happen?

But I think it's important just for teens to fully stand their grounds by knowing. And if the offers persist, it may be a good idea just to find a graceful way to exit the situation and "Hey, Im getting a call," "Oh, got to text somebody. Hold on a second," and just step out. Because I think that all of us tend to cave a little more under pressure when a sales man has you cornered. Its little bit harder and more stressful as they know. Sometimes it's better to be able to just leave the situation.

Host: So if a teen continues using marijuana, when is it time to seek professional help?

David Atkinson, MD: Well, I would say if you have somebody and they failed a couple drug screens or they've had a couple of incidents where they've been caught, getting caught using marijuana is like catching a mouse in your home. For every mouse you see, there's probably seven you don't. And it indicates that, yeah, they haven't been able to modify their behavior with negative consequences, with the problem being brought to light. And that's where programs like recovery program at Children's or other outpatient substance use program can help find their motivations to not use. And that's one of the biggest reasons why teens stop using is that they find their motivation to not use.

Oftentimes that motivation believe it or not is to improve the relationship with the parent. As the parent, you often see all the negativity, doesn't care about our relationship, but that its often one of their big motivations to not use.

I think that the thorough assessment, that professional help, working with someone who does substance abuse than mental health can help identify what other factors might be there, because certain kids with ADHD are more susceptible to regular marijuana use, causing problems. Some kid with other issues like major depression or anxiety may have a hard time stopping, because they don't feel good much of the time.

And I think that, also, the parents should be humble enough to see if there something there family interaction that could change to kind of bring the kid closer in a good way while still maintaining limit and the expectation of stop using.

Host: Thank you. As your final thought, what would you say is the most important thing you want parents to know about marijuana in their teen?

David Atkinson, MD: The most important thing I want parents to know about marijuana in teens is that this doesn't just become a problem in bad teens. Some of the nicest adolescents I know sometimes very brilliant, very intelligent, extremely social, talented, dutiful to their community, volunteering, doing the Boy Scouts Girl Scouts, can develop problems with marijuana. It often manifests by their other interests dropping out. It often comes along with some depression. Very important to understand this is not a problem that bad teens develop . It's important for the parents to understand that your good kid is just as susceptible as any other. The only difference we see with the kids who are "delinquent" in drug use is that they tend start at a little bit of an earlier age. They may tend to use substances that society disapproves of a little more. But it doesn't matter your background. It doesn't matter your economic class. It doesn't matter your religion your values, your goals, or the dreams that you and your child built up together. When the substance enters the brain, it can take over everything.

Host: Dr. David Atkinson, this has been a really informative discussion. Thank you so much for educating parents on THC and marijuana use.

David Atkinson, MD: All right. Thank you for having me. I appreciate the opportunity.

Host: If you are concerned about your teen’s THC use, mental health, or substance use, support is available. Children’s Health Teen Recovery provides specialized resources and care to help teens and families navigate substance use concerns. Learn more and find support at childrens.com/teenrecovery.

Thank you for listening to Children’s Health Checkup. If you found this podcast helpful, please rate and review it or share the episode. And please follow Children’s Health on your social channels.