Caitlin Whyte (Host): At least one in eight teenagers have misused an illicit substance in the last year, including opioids, heroin, cocaine, and more. So, how can we stop teens from experiencing high-risk substance use? And how do we treat and support those who are facing their addiction? At Bergen New Bridge Medical Center, the Teen THRIVE Program serves adolescents between the ages of 13 and 17, offering them the ability to focus on recovering from alcohol, drugs, abuse, and addiction.

And today, we are going to learn more about teen substance use and our THRIVE Program with Gianna Carinno. She is a counselor and the Manager of Adolescent Services at Bergen New Bridge Medical Center.

This is Wellness Waves, a Bergen New Bridge Medical Center podcast. I'm your host, Caitlin Whyte. Well, to start us off today, Gianna, can you tell us some of the risk factors for substance use disorders in teens?

Gianna Carrino: Of course, I'd be happy to answer that question. So, there are several factors that can contribute to the development of a substance use disorder, especially when we're talking about the adolescent population. I'll touch on a couple of different factors that we typically take a look at.

So, one that is really big is genetics. A family history of substance use or mental health disorders can increase the likelihood of developing substance use disorder down the line. So, there is a genetic factor that does play a role there. We also tend to take a look at environmental factors. So, if you grow up in an environment where substance use is normalized, or you have easy access, or it's readily available, or you see your parents drinking or using drugs, this can always influence an adolescent's behavior, and especially their decision-making in the future.

There's also some factors that we take into consideration, such as peer pressure, past diagnosis of mental health disorders. So, there's some conditions, just for example, like depression, anxiety, ADHD, or conduct disorder, that there is research to support that substance use is correlated to self-medication of those symptoms and used as a coping skill. We also want to take a look at socioeconomic status. So, sometimes individuals who come from lower socioeconomic status, and those types of backgrounds, they do tend to experience more stress and trauma and even have limited access to resources, which does increase their vulnerability to substance use.

Host: Thank you for that explanation. Well, what are some of the most common substances that you're seeing being used by teens these days?

Gianna Carrino: So, over the course of the past three years, we have seen an increase in marijuana use in the adolescent population. So, I do oversee a substance use program for teens ages 13 to 17. And I would say about 85-90% of the individuals who are enrolled in that program, their primary diagnosis for a substance use disorder is cannabis use disorder. It's become very accessible, and especially in the vape cartridges, it has become easier for them to conceal, hide, and use them as well with virtually no smell so they could go undetected. They could also now use them in places where normally it would have been a little bit harder for them to use marijuana, for example, in school, out in the community. A lot of the devices now are really small and they kind of look like office supplies so it's easier for them to hide.

We also do see a lot of alcohol use disorder or teenagers experimenting with alcohol. So, we do speak with them a lot about the risks of using alcohol. And we've also seen an influx of adolescents using hallucinogens as well. So, those are the most common substances that we see here. However, we do treat all substance use disorders.

Host: Of course, of course. Well, thank you for that. What are some challenges in treating teens that make them unique from other patients that you may see, maybe older patients or things like that?

Gianna Carrino: I'm so happy that you asked that question, because there really are a lot of unique challenges compared to treating adults when it comes to adolescents. So, something that is so important to understand is that the adolescents are at a different developmental stage. So, during your adolescence, this is a really critical period where your brain is developing. And we often categorize our adolescents by seeing increased impulsivity, so a little bit of difficulty with instant gratification of making decisions. There tends to be sometimes some risk-taking behaviors, and they also could become more susceptible to peer influence. So, this kind of makes it a little bit harder for teens to fully comprehend the consequences of their actions, including the choices to use substances and engage in substance misuse. If they continue to engage in the substance use, eventually down the line, that could lead to a formal diagnosis and create some negative consequences in their life.

Another thing we would like to take into consideration about our adolescent population is, during that age range, they have a lot of social and peer pressure. So, a lot of times, they could be easily influenced by their friends, by their peers, by individuals in school, and also by their social dynamics. So, this could really impact their decision-making when it comes to their choices to engage in substance use. We also want to take a look at the fact that family dynamics are a big part of their life. So, the family does play a crucial role in their development and also their recovery from substance abuse. So, however a family relationship may be strained or if there's some dysfunctional or chaotic behavior in the home, this could complicate the treatment process. So, we always tend to say addiction is a family disease, and we do want to treat it that way.

Another thing that I think is really important for us to note about treating adolescents is they're trying to figure out and establish their independence. They don't really have a unique form of identity right now, so they're in this period of time where they're trying to figure out who they are. Sometimes, they may engage in substance use and believe that that's a part of their identity. It could be a common part of their day-to-day routine. So, we do a lot of work with them in regards to emotional regulation and building new healthy routines.

Host: Gotcha. And I'd love to focus on the family aspect that you mentioned. Why is it important to involve the whole family and other loved ones in the treatment and recovery process?

Gianna Carrino: Having family involvement in the recovery process is crucial. Like I just mentioned, addiction is a family disease and we like to treat it that way. So, family can bring a lot of support, especially to an adolescent who is struggling with substance abuse. One form of support, of course, is emotional support. We want to bring family in, because family and loved ones, they could provide a unique form of emotional support to that child that is invaluable during their times of challenges. That could be their safe space or someone they know who's looking out for their best interests that they could go to. If they have their family around them supporting them, they can also feel encouragement and it might boost their morale and motivation towards their recovery, especially if they're in a period where they are struggling in early recovery. In addition to that, having family involved does improve treatment outcomes. There is research that suggests that families involved in the treatment process leads to a better outcome for the adolescent in treatment.

Another thing I want to touch on when it comes to bringing the family in on treatment is they could de-stigmatize addiction for the adolescent. The adolescent may not even fully understand or know what addiction looks like. If you bring the family in to support them, they'll feel less shame, blame, and guilt on themselves and be willing to open up and have open and honest conversations

Host: I love that. That is so important. Thank you for reminding us. And what are some things that can be done to prevent teen high risk substance use then?

Gianna Carrino: I always like to tell my families and individuals working with adolescents to start early. You have to have that conversation early on with them. It's really important to have that talk before you suspect that there's any substance use. So, if you establish that open dialogue with them about the risk and consequences of substance use, you're going to create a really healthy environment and somewhere for them to feel safe and not judged to come to you with questions.

It's also important about choosing the right time and the right place to talk to the adolescent. You want to pick a quiet and calm environment. You don't want to come at them in an aggressive or an assertive manner. Typically, if you do that, they're going to close up and feel like maybe this isn't a subject that I could be truly honest about. I also like to say sit your kids down and ask them what they're seeing at school. Let them tell you from their experience with no judgment. Let them have a conversation about what they're seeing, what they're experiencing, to really have them know that they truly can come to you with anything and that they won't be judged or penalized for it.

I also like to talk about with our families discussing peer pressure and how to resist it. So there's a lot of myths out there for kids to believe. A lot of things we hear now from the adolescents that we treat is, "Hey, my friend told me that if I'm anxious, I can use this vape pen," "Hey, my friend told me if I'm feeling down or I'm sad about something, I could use this vape pen and it'll help me feel better." So, just talking about that with your kids and having them really understand what choices they're making and what they're doing to their brains, their bodies, and their mental health at that point if they choose to engage in substances.

Host: And wrapping up here, Gianna, can you tell us more about the Teen THRIVE Program that Bergen New Bridge Medical Center offers?

Gianna Carrino: Of course, I would be glad to tell you about the program that we offer here at Bergen New Bridge Medical Center. Our program is called Teen THRIVE. We are a substance misuse and abuse program for adolescents. We typically serve adolescents who are 13 to 17 years old. We do also treat 12 year olds as well. We have several levels of care.

The first level of care that we have in treatment program is called Early Intervention. This is an education-based program that educates adolescents on the dangers of engaging in substance misuse and what that may lead to down the line. We have a little bump up from our Early Intervention level of care, which is called Intensive Outpatient Programming, formerly known as an IOP. So, this is group therapy that occurs three times a week, as well as an individual component for the adolescent. Once they start making positive progress in the program, they're able to attend less days a week and eventually move towards graduation of that program. In both early intervention and in the IOP, we do include family. As we discussed, it's very important to have family involved in treatment for the adolescents as it often correlates to a better outcome for them.

Coming up in the fall, which we're really excited about, we are going to have a new program for our adolescents here, which is called a partial hospitalization program. It's going to be a program that runs five days a week from about 9:00 a.m. to 3:00 p.m. This will treat co-occurring disorders for both substance abuse and mental health conditions. This program will be used for adolescents who need a higher level of care or were not successful at the IOP level and need additional support, so we're going to have that as a resource as well.

Like I said, we're located in Paramus. However, we understand that there could be a lot of barriers for treatment for adolescents, so we try to remove all barriers to treatment. That way, they're able to come in here and get help. So, we accept 99.9% of commercial insurance plans, because we are a hospital. We also accept Medicaid at no charge to family for treatment here under Teen THRIVE. And in addition to that, if an adolescent does not have insurance, we have an option here at the hospital called Charity Care, in which we will connect them with our financial department. They will meet with a representative and they will help them complete that application to get Charity Care here at the hospital.

Another thing we have in our program that makes it accessible to patients and to families is that we provide transportation. So, the transportation will pick them up, bring them to treatment, and drop them off back home after. So, a lot of times we hear barriers of maybe like families are working, so they can't always drive the adolescents to treatment, especially after-school hours. So, having that transportation is really helpful for them as well. I'll provide you all with my contact number to call and to make appointments for new referrals or if anybody has any questions, you can reach me at the following number which is 201-967-4000, extension 25673.

Host: Wonderful. Well, thank you so much for joining us today, Gianna, and for all the work that you do.

Gianna Carrino: Thank you so much for having me and giving me the opportunity to share this information.

Host: To learn more about teen substance use and the THRIVE Program, please visit newbridgehealth.org. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.

Thanks for checking out this episode of Wellness Waves, a Bergen New Bridge Medical Center podcast. I'm your host, Caitlin Whyte.