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Melanie Cole (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. Together, we can keep kids happy and healthy.

I'm Melanie Cole, and I invite you to join us as we discuss substance use in kids and teens. Joining me is Dr. Rebecca Ba’Gah. She's a pediatric psychiatrist with Children's Health of Orange County. Dr. Ba’Gah, what a great topic we're discussing today. Thank you so much for joining us. As we get going, can you tell us a little bit about your background and expertise in this topic? And tell us a little also about the work that you're doing as it relates to addiction and substance use disorder in our kids and teens.

Dr Rebecca Ba'Gah: Absolutely. Well, thank you so much for having me here to take this opportunity to talk about such an important topic that is really unfortunately plaguing our children right now. I did my training at the University of Kentucky in what we call the Triple Board Pediatrics, General Psychiatry and Child and Adolescent Psychiatry. And there, I had the opportunity to see firsthand how substance use disorders can affect from birth all the way through the end of life. And it was there that I had some mentors who were pioneers in the field, who really gave me this sort of hunger to learn more, if you will. Through that, I was able to join some committees on the national level, through the American Academy of Child and Adolescent Psychiatrist. I am on their substance use committee, and act as a liaison to the American Academy of Pediatrics for their Committee on Substance Use and Prevention, and so really having the opportunity to work with some of the leaders in the field who are doing cutting edge research and also advocating on the federal state, city, county levels to bring more education, more supports, resources and accommodations for children and families struggling with substance use disorders.

So here at CHOC Children's, I work in the inpatient mental health unit where we're doing what we call as acute crisis stabilization, helping children come in, get them set up for success so that they can continue their treatment on an outpatient basis. We also work in the community here with the Department of Education, with our local pediatricians and outpatient clinics to help further educate and understand substance use disorders and then again, getting these children the necessary resources to help them when they're struggling.

Melanie Cole (Host): Well, it's a huge problem in the country. As a parent of a 19 and 21-year-old, almost 22, I understand the scare that this is for parents. So tell us a little bit about what's going on today. Back when I was growing up in the '70s, you know, it was pretty easy to identify. There weren't so many things, but now there's a lot, right? So what are our children using? I know, you know, certainly marijuana, which is being legalized, which must be confusing for kids. But there are other drugs and certainly even prescription medications that kids are sharing on campuses and at schools. Speak about what you're seeing in the field right now.

Dr Rebecca Ba'Gah: Absolutely. I think the first step is always getting an idea of what is out there, because like you said, definitely the landscape has definitely been changing over the last several years. First of all, there's been a dramatic shift in the way that kids are getting tobacco. Very few children are actually using cigarettes now. And about 50% of high school students in 2019 had vaped in the past, and so we're seeing quite a rise of that. And then additionally, like you had mentioned, marijuana. In 2019, 36.8% of high school students had tried marijuana and 5% actually before 13 years old, so we're seeing it also starting earlier as well.

The difference between the marijuana before and now is the potency of it it's a lot more potent and through that can cause a lot more deleterious effects. You had mentioned the non-medical use of prescription medication. And that's where you take somebody else's, for example, Adderall or pain pills or something like that. We're seeing that on the rise too, especially with the younger children. And we're seeing a lot of synthetic forms of marijuana that are at the root sort of a cannabis, but that's been manufactured in the lab that is even more potent that, again, we can see a lot worse side effects from these drugs. And I think just your point about marijuana being legalized, it is very confusing for children because it's like, "I can use it in a couple of years, but why can't I use it now?" And so it's again getting back to having a lot of conversations with children, educating them, understanding how these things can affect the developing brain quite profoundly.

Melanie Cole (Host): Well, we've learned more and more about the developing teenage brain in the last bunch of years. So one thing we didn't mention was alcohol. And certainly, when we're discussing signs and symptoms, which is what I would like you to discuss next here of those illicit substance use or prescription over-the-counter medication misuse, and certainly alcohol problems for parents. Alcohol seems to be maybe a little bit easier to identify as we could smell it or if a child is drunk, you can see it, but kids get good at hiding things. And so for parents, what are we looking for? Whether it's alcohol or marijuana or vaping, which doesn't tend to smell as much if they're doing it in their room, what are we looking for, Dr. Ba'Gah?

Dr Rebecca Ba'Gah: So the one thing that I try to always start with is one understanding that substance use can affect any aspect of a person's life. With use over time, you could see changes to somebody's appearance, their behaviors, school performance, relationships, and their mood. But to really try to get at how the substance is going to affect somebody, I try to think about what does the substance do.

So for example, if we think about something that is a depressant and an example of a depressant would be alcohol, as you mentioned, marijuana, a class of prescription medication called benzodiazepines, the trade names would be like a Xanax or an Ativan or a Valium or even opioids, which I think we all are quite familiar with, unfortunately, but pain pills, heroin, pain pills, like the trade name of Vicodin or Norco. So when we think about people using depressants, what those do is they would kind of slow the breathing down on somebody. They could induce sleep. Potentially something like marijuana, you could see an increased appetite. And then if we go to sort of the other big class of illicit substances, and we think of stimulants. Actually nicotine is a stimulant, cocaine, methamphetamine, or certain prescription medications like Ritalin or Adderall, those are commonly to treat ADHD. Those stimulant medications, you would see somebody who maybe is a little bit elevated in their mood. Their appetite has gone away. Maybe the heart rate is up. They're jittery, and you notice, "Why is my kid not sleeping much?" for example, or "Wow, they've lost weight." So I think starting back at sort of the function of the substance, and then from there can tease out a little bit some of the effects.

Melanie Cole (Host): Well, also, the kids are using alcohol and drugs right now to sort of self-medicate. As you say, the symptoms of this mental health epidemic that we've really encountered lately, right? including those caused by the pandemic.

Dr Rebecca Ba'Gah: Absolutely. I was actually just having a conversation with a colleague yesterday about that these use disorders, they don't exist in a vacuum. There's something going on with the child that they're feeling they need to escape. And you're right. This last year, or actually a couple of years now, has been really difficult for the children and the isolation leading to a low mood, leading to anxiety, hopelessness, despair, and trying so hard to do whatever they can to get out of that. And a lot of them are turning to substances to dull those very powerful, uncomfortable feelings.

Melanie Cole (Host): Well, I certainly agree. And so now, what can parents do? If we are worried about our kids, what are the first things you'd like us to do? Give us some ways that we can help our child. Who do we turn to? What's the next step? What do we do?

Dr Rebecca Ba'Gah: I think the first thing as a parent, being aware that these unfortunately exist, right? I mean, of course, the adage that I always kind of start with is we don't know what we don't know. And so taking this time right now to educate yourself that this does exist in as youngest kids that are 10, 11 years old. We are seeing substance use in the little ones, it's not just a high school issue. So number one, educating yourself that the problem is there.

Number two, if you believe that your child is struggling with anything in general, not just substance use, really taking the time to talk to them about this. And it is hard having difficult conversations with your children. But I think some of the things that you can do, for example, set the stage for it, if you will. And so schedule a time to talk to your kid, because this is important and it's not just like off the cuff, "I'm driving home from school. And oh, by the way, I can see that you're losing weight. Are you using drugs?" No, right? So, take the time to sit with your child and be open about it and try your best to come from a nonjudgmental standpoint. If you feel that have the ability or the comfort level to talk to them, a really great place to start is actually with their pediatrician. Pediatricians a lot of times see children from birth to 18 and so have already a good established relationship with the child. And perhaps you could take them to the pediatrician, tell the pediatrician your concerns, and then they could start that conversation there.

The American Academy of Pediatrics is working very hard to educate all of its members so that when kids come into the office and there are substance use disorder or just even substance use concerns, to give those pediatricians the tools to be able to screen these children, but then also to help get them to further treatment.

Melanie Cole (Host): So, this is all really great advice and certainly our pediatricians are a great first place to start. They're the gold standard, helping us to raise our children healthy and safely. And the AAP is, as you say, really helping them along in this regard. So how do families get involved? Because if you have more than one child, maybe a couple in college or in high school, and one of them is abusing substances, sometimes it takes that whole family to get involved. As a psychiatrist, what do you tell families about working together to sort of un-normal binge drinking and the use of these substances in society, which they're seeing everywhere?

Dr Rebecca Ba'Gah: Yes. absolutely. And I think obviously the huge thing is modeling behavior, right? I mean, I think it's very difficult anytime to tell your child not to do something when you're doing it, right? Don't drink a bottle of wine every single night and expect that your child may not be watching what you're doing. And so I think looking at yourself and sort of seeing are you possibly showing them some behaviors that may not be the best for them?

There are actually great support groups out there. If you have a child with a profound use disorder and needs support, there's a wonderful organization called Al-Anon that was born out of Alcoholics Anonymous that is there for family members, loved ones, spouses, parents who have somebody with a use disorder and can offer great support in understanding how to support this person with this use disorder, but also to create healthy boundaries with them as well.

Melanie Cole (Host): So as we get ready to wrap up, I'd love for you to offer us your best advice, warning signs that our child really needs to see a specialist. What you want parents to know about that importance of communication? Because if we start discussing these things with our kids when they're very young and keep those lines of communication open, I think we have a better chance of either staving this off or helping them if it becomes an issue. Please give us your best advice.

Dr Rebecca Ba'Gah: Absolutely. So I think, number one is being honest with children. Children are quite smart, very astute and intelligent beings, if you will. And I think being honest with them that these things do exist and talking to them about, "If somebody does come up to you and they offer you something, what are you going to say?" So you're basically giving them some defense, because just ignoring the problem and not believing that it will ever come to your child because they're a good kid leaves them defenseless. And so I think starting the conversation early, especially about nicotine, because that seems to be the earliest start, and alcohol and marijuana that though these things are legal, these are for adults and not children, and that like we've mentioned before, "Your brain is still developing and we want it to give a chance to do what it's going to do without compounding on top of it."

I think again talking to your kids as the base of all of this. If you notice that there's something different, their appearance changes, their sleep pattern changes, their friend group changes, it doesn't necessarily mean that there's something wrong. But talking to them so that you have an idea of what's happening. "You know, I noticed you have this new group. What is it about this new group that you like?" And just, again, getting more information, because this starts off as subtle changes that eventually becomes a big deal. But if we can intervene early and offer them supports, then we're not chasing our tails.

And I think challenge about seeing the specialist is that you had mentioned the mental health crisis right now, mental health services are just so impacted. So I think that it's always wonderful to have an opportunity for your child to see a therapist if you think they're struggling. If there's concerns for significant mood, anxiety, or substance use issues, to try and see a board-certified child and adolescent psychiatrist. And so even if the problem may not be at full fruition, parents working to get their child in to see somebody just because unfortunately it is taking time right now, but there's always that bridge to go see the pediatrician and at least start the intervention there.

Melanie Cole (Host): Great advice and information for parents. And parents, be sure to share these shows with your friends and family on your social channels. We're all learning from the experts at CHOC together. And for more pediatric health and wellness tips, please visit choc.org. Thank you so much for listening to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. Together, we can keep kids happy and healthy. I'm Melanie Cole.