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Teen Addiction

Jonathan Avery, M.D. reviews what parents should know about teen substance use and addiction. He discusses new developments and statistics, since his previous episode on "Teen Vaping and the Impact of Vaping on Public Health. " He also highlights the increase in teen depression and suicide rates and the correlation with addiction, especially since the COVID-19 pandemic. He also goes over his recent appointment as the Stephen P. Tobin and Dr. Arnold M. Cooper Associate Professor in Consultation Liaison Psychiatry and Vice Chair for Addiction Psychiatry, and the services offered at the Program for Substance Use and Stigma of Addiction.

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Teen Addiction
Featured Speaker:
Jonathan Avery, MD
Jonathan Avery, M.D. is the Vice Chair for Addiction Psychiatry, the Stephen P. Tobin and Dr. Arnold M. Cooper Associate Professor in Consultation-Liaison Psychiatry, and the Program Director for the Addiction Psychiatry Fellowship. 

Learn more about Jonathan Avery, MD

Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast featuring world class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids' Health Cast by Weill Cornell Medicine. I'm Melanie Cole. We're talking about teen addiction today with Dr. Jonathan Avery. He's a Steven P Tobin and Dr. Arnold M Cooper associate professor in consultation, liaison psychiatry, and vice chair for addiction psychiatry at Weill Cornell Medicine.

Dr. Avery, it's such a pleasure to have you join us. You've been with us before and we did a previous podcast on vaping. Before we get into the topic of teen addiction, can you share any updates and where things stand now with vaping and our kids? There was a recent banning of Juul, can you give us a little update on that?

Dr Jonathan Avery: Of course. Yeah. And thanks for having me again, it's always great to be back and talk about, addiction, which I think, we all should be talking about all the time. I'm an addiction psychiatrist, so a bit of a bias, but there's definitely no escaping it. And for our kids, we can escape talking about vaping still. There's been a lot of changes in the last, couple years since I was on, one of the big changes. COVID 19 for the kids and adjusting to that. And, we saw some of the vaping numbers go down over the last couple years because we thought maybe because kids weren't around other kids, they weren't getting exposed to vaping, nicotine or vaping marijuana in the same way they were in 2019.

Also, there's been a lot more public knowledge of vaping and juuling and all those other devices back in 20 18, 19. A good percentage of folks didn't even know nicotine was in these vapes. Parents had no idea, about these cool little devices they were finding in their kids' room, but now we really know about it. Now, the government and the legislators are also aware and there's been a lot of good advocacy work and a lot of changes. And you mentioned one of them in terms of Juul and a lot of other devices that contain nicotine, have been banned or going to be banned from the market.

They're also gonna regulate nicotine in cigarettes going forward. And so the sum of all of that seems like it's gonna be positive, less exposure to nicotine and vapes, more awareness. And then hopefully these laws will result in less sort of access and availability of these devices. That being said, the numbers are still pretty high. By the end of high school, a significant minority of folks may have had some exposure to them. So it's something that we should still be talking about asking our kids about. And none of this means we can turn a blind eye to it. but hopefully it's in a positive direction.

Melanie Cole (Host): Well, thank you for sharing all that information. And I agree with you. There's a lot going on and COVID certainly changed a lot of this. So what substances have you seen an increase in besides alcohol in the misuse or overuse of? Have you seen an doctor about anxiety, anxiety related disorders and as a result, are teens are using alcohol and drugs to kind of medicate some of that away?

Dr Jonathan Avery: Sure. And the adults, I think COVID 19 has been stressful for families, for kids, their parents, it's sort of a perfect storm from a mental health and substance use perspective. You have stress, you have isolation, you have changing rules in terms of how you interact with folks. Parents are stressed. They're going through the same restritions as, kids and everyone's at home and, hopefully that's lessening and we're getting through that. Although I've been saying that for years now, seemingly, but it was a big stress on everyone. And so we saw the uptick in mental health issues.

We saw the uptick and anxiety, and then, it's not surprising that substance use followed and the dominant hypothesis on why people get into trouble with substances is self medication. And I think there was even a little bit of like a it's okay for a minute during COVID to sort of drink or medicate, cuz things were so stressful. Parents are doing that. Kids were doing that. And the result is that, we are seeing more using alcohol.

We're seeing opiate overdoses at record levels for kids and young adults. And we're seeing parents, especially women, and mothers, increasingly in trouble with alcohol. And so it's, sort of permeating all aspects of family life. And that has a big impact on our kids, for sure.

Melanie Cole (Host): Well, I saw it too. And I even felt it in myself and had to really kick myself into gear. Because like you said, during the lockdown, it felt like, okay, if you make a drink at nine in the morning, who really cares, but it does lead to that feeling of, let's keep doing it. It's really scary. So let's talk about those warning signs, Dr. Avery, what do you want us to know as we're looking for signs in both our teens and ourselves, as we are thinking about these red flags signs and symptoms? Tell us what we're looking for?

Dr Jonathan Avery: Well, the first thing I would recommend always to start by having sort of honest and frequent conversations with ourselves, with our kids, with our families about substance use and mental health issues. And there's a bit of a news stir, when they said, start talking to your kids about mental health issues as early as eight, maybe younger and for substance use we're right behind them. We recommend really starting having the conversations with kids at age nine, about what they notice about substance use in the family, among their peer group, what they know about alcohol, what they know about vaping.

And sometimes families think if you don't talk about it, that's the way to avoid it happening. Like if you mention it, suddenly it's gonna manifest, then everyone's gonna be, drinking and drugging. But the opposite is true. Having the space to have open conversations about it and to really talk about it seems to lead to less substance use in families. and so hopefully that frame is there so that you're not just responding in crisis moments, but it's sort of an ongoing dialogue, that you're having with yourself and with your kids or your doctor.

And then when you start getting in trouble, it can be a little tricky, because it's slippery. You know, you start having that drink, smoking a little bit. And one thing that happens when you start getting into trouble is that it starts getting in the way of your function. And so it worsens anxiety, depression, you start to choose it over other healthy behaviors. For kids, that's doing your homework, interacting with friends, parents, you start becoming more moody and irritable as the mental health stuff evolves.

And the same thing happens for us as sometimes we drink at first to be social or connect, but, eventually it sort of becomes the answer to every question and starts dominating all aspects of one's life. And so hopefully we're having these conversations with ourselves family, with our clinicians about what our substance use looks like, so we can modify it beforehand. And then, one thing COVID did is it got rid of the menu of options we have for dealing with things. We can go to the gym, we couldn't socialize. And so, part of rebounding from these sort of things is getting those things in the mix again.

Melanie Cole (Host): One of the things I noticed is while we've got this epidemic of mental health crisis, especially in our kids, but also in ourselves, in the country in such a lack of mental health professionals, such as yourself, but with the advent of telehealth, we've been able, I see a counselor in Arizona. And we've been able to do this. What would you like to tell the listeners Dr. Avery, about what they should do if they suspect a family member or a friend or someone that they love, their child is suffering from addiction? Who do they call first? Do they call their pediatrician? You mentioned speaking to that person and communication and the importance of that, but to whom do we turn professionally?

Dr Jonathan Avery: Right. Two great questions. And there are one about telehealth and one, who we turn to, I'll start with, who we should turn to. I would start with the person you have the relationship with. And so for kids, that's often your pediatrician to start to approach them as a family or as a kid to sort of talk about what's going on, in your life. And, sometimes that's sufficient to get the knowledge out, about what's going on to share it with someone else. often people can modify their behavior just from that. And in fact, most people who get into trouble with vaping or alcohol it's self-resolve.

By talking about it, by getting the menu of options in and they actually don't need intervention. They just need to sort of address it, and many can. There's folks though that can't, and those can't sort of modify the behavior despite really wanting to. And those are folks with mental health struggles, with trauma, with the family history of addiction. And so for those folks, just talking to the pediatrician or school counselor, may not be enough, for those folks, we might want them to see a psychiatrist or someone with training, in addiction.

And then there's always that red light emergency in addiction, psychiatry, which is if things progress to harder substances like opioids or harder, drugs. And in that case, you definitely need to see an dedicated. Addiction professional because the risk of overdose becomes so much greater when you progress from alcohol and marijuana, to something like opioids. The good news about accessing that higher level of care and the one good thing, I'm sure there were more than one good thing to come out of. COVID 19, is that you can now access a menu of options via telehealth mechanisms.

Which, we were starting to think about that before the pandemic, but now they've really expanded and you really do have a menu of options in terms of getting intensive substance use, and mental healthcare. Yes. A lot still exists in person intensive rehabs or outpatient programs. but there are wonderful, apps and programming to address youth vaping. There are substance use intensive programs or unique ways to connect with psychiatrist or therapists. And so, you do have a choice and options now and I think that's certainly one positive that's come about.

Melanie Cole (Host): I agree with you. It's been interesting how that has evolved over the pandemic and Dr. Avery, just a little plug for yourself. Can you tell us about your recent appointment and the work of New York Presbyterian Wiell Cornell Medicine Program for substance use and the stigma of addiction? Tell us about the work that you're doing as it relates to addiction.

Dr Jonathan Avery: We've sort of been flirting with the topic today. My big academic focus is on the stigma of addiction. And the main finding is that our attitudes as a society, even attitudes among doctors, Are worse towards individuals with substance use with addiction, than towards any other medical or psychiatric condition. And so as big as all the epidemics are, and I really think it is stigma that gets in the way of us, really addressing it. And making gains just because it feels like such a heavy non-health topic, bad people doing bad things.

And we haven't quite wrapped our mind around that this ends up being a brain disease that needs empathy and care. And so our program for the stigma of addiction, we work on understanding stigma, and then we work on developing interventions so that our doctors, our lawyers, our family members, can understand what substance use disorders really are and not have finger wagging or, negative, views and approaches to those that are really, really struggling. No one wants to be in trouble with substances.

Everyone's at war with themselves is in trouble with addiction. And so we really need to approach them with empathy and care. And that's the primary focus of my work here. And it really should be the primary focus when we think about kids and addiction, we've gotta treat them with care and kindness as people that are struggling and not as sort of bad people doing bad things.

Melanie Cole (Host): What wonderful work you're doing. It is a struggle for so, so many, and it's really important that we have these discussions. I'd like your best advice, Dr. Avery, as we finish up this podcast and wrap up the program, how families can get involved in recovery and treatment for the mental health aspect of the patient, what we should be looking for and how we can help our teens with addiction?

Dr Jonathan Avery: No one recovers in isolation, you can't do this on your own. And so if it's my kids to my senior patients, They always have this impulse to do it on their own. And you really can't. The opposite of addiction really is connection. And your family is often the folks that need to be most involved to help you change. And so, my recommendation for patients and their families is to have as much family involvement in the process as possible. Sometimes we can be a little shy when approaching doctors or clinicians as family members in terms of getting involved but I recommend it.

Having family meetings with the pediatrician to the dedicated mental health or substance use professional, reading about addiction, they're wonderful free peer support groups that exist as well. To have ongoing conversations with our family, with our providers to make it a part of our community, that's so key if we're going to get through this, because there's no way that we can help folks by isolating them or isolating from folks that are struggling.

Melanie Cole (Host): Agreed. Thank you so much, Dr. Avery for joining us again and sharing your incredible expertise and passion for this topic. Thank you again. And Weill Cornell Medicine continues to see our patients in person, as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell. That concludes today's episode of Kids' HealthCast we'd like to invite our audience to download subscribe, rate, and review Kids' HealthCast on Apple podcast, Spotify and Google podcast.

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