Jessica Lahey had a lot of questions about substance abuse. As a writer, a parent, an alcoholic, and even an educator of adolescents in a drug and alcohol rehab facility, she wanted answers about addiction.
“Experts out there in the world say, ‘substance abuse is preventable.’ As a parent, I want to know, well, what do you mean? How? I understand that there's substance abuse prevention programs at schools. I don't know if they are any good. Does anyone know if there are any good? I need to find that out,” she says. “As a parent, what works? What doesn't work? How do I talk to my kids?”
The answers she discovered turned into her latest book, The Addiction Inoculation. On this episode of the Harvard EdCast, Lahey shares what she learned about substance abuse risks and how parents can keep their children safe from addiction.
- Communication is key. Start these conversations when children are young and make it part of the talk about keeping your bodies healthy. Help children understand early on about what you do and don’t put into your body and why.
- Get to know the why. Inform children with age-appropriate statistics and information so they understand brain development and other vital aspects of what drugs and alcohol do to their bodies.
- Understand genetics doesn’t mean no hope. While a history of substance abuse in the family does put children at a higher risk, it also provides a foundation for parents to focus their communication.
Jill Anderson: I'm Jill Anderson. This is the Harvard EdCast.
Jessica Lahey knows parents worry about how to keep their kids safe from drugs and alcohol. She's an educator who spent years teaching in an inpatient drug and alcohol rehab for adolescents. She's also a parent and alcoholic who knows preventing substance abuse isn't cut and dry. In her new book, The Addiction Inoculation, she explores substance abuse risks, and hopes to empower parents with information to get beyond just fear. First, I wanted to know more about what's going on with kids and substance abuse today and how COVID might impact that.
Jessica Lahey: For about the past decade, we've been in a decline for just about all substances with the exception of vaping. And of course there's a newness factor there. There's also the legalization question. Will legalizing marijuana make it so that suddenly more kids are picking it up? But generally speaking, we've been in a decline across all substances, which is great. The decline sort of leveled out a little bit at the beginning of COVID. So that's a little worrisome and then COVID hit. And the worst part from a researcher's perspective is that suddenly people are further away from each other, while child checks maybe are not happening with the same frequency, it's harder to survey kids in the same way that we used to. And, there's a report that comes out once a year called Monitoring The Future that comes out of University of Michigan. And in order to get good data, you need to talk to a lot of kids and that's been, in some ways more difficult, in some ways less difficult, depends on how you're reaching those kids.
People in general are drinking more, we've also been eating more and gaining weight and all that sort of stuff, compensating for all of this stress and all of this lack of control and the anxiety that that brings. There were lots of jokes at the beginning of the pandemic about rushing off to the weed store before it shuts down so that you could get enough weed to get you through. That kind of thing. But I don't think we're going to see the real impact of COVID and what it's sort of done to kids' mental health for a little while. I think there's going to be a period of time where we're sort of kind of getting a snapshot of what's happening now, but I think there's going to be after effects in terms of just mental health stuff that's going on with kids right now, and that perception of lack of control. I think it's going to be really interesting to look at over the next two years or so to see where we are.
I'm hoping that that leveling out thing does head in the other direction, but I think we're going to have to sort of wait and see on that one. Many of the risk factors associated with, when kids are most likely to pick up substances, have to do with things like transitions, periods of time when they feel really low levels of self-efficacy or autonomy or control of their environment. And you can see that a lot of COVID has been a transition, because we're like, oh we'll just wait and see for another six months. We'll just wait and see. If you can just make it until six months from now, we'll have a vaccine and maybe you can go out. This whole period has been a big transition period for kids.
Jill Anderson: When I think about trying to sort of predict whether your own kid is going to become an addict, there's no easy way to do this. I mean, you can't. There's no one size fits all. Like education, there's no one size fits all answer. What compelled you as an educator, as an alcoholic and as a parent to sort of dig into this topic of, hey, what can we do?
Jessica Lahey: I got sober in 2013, and then in 2014, went to work in a drug and alcohol rehab for adolescents. So for five years, I worked in this rehab with kids who were just endlessly interesting, and fascinating, and entertaining and frustrating. But also kids that had so many things going on in their lives that if they just had some intervention early on, things could have been different for them. So when the experts out there in the world say, "substance abuse is preventable" as a parent, I want to know, well, what do you mean? How? I understand that there's substance abuse prevention programs at schools. I don't know if they are any good. Does anyone know if there are any good? I need to find that out. As a parent, what works? What doesn't work? How do I talk to my kids? Like I've learned a lot about effective communication with teenagers through 20 years as a teacher and through writing Gift of Failure and through luckily, lots of friends who happen to work with children and are experts in that kind of thing.
But what works for communication around this? What makes it so the kids will listen? I needed answers to all those questions. And frankly, I have the most amazing job in the world, which is to have lots and lots of questions, research for a couple of years, find answers to those questions all over the place and bring them all together and translate them into something that sort of a popular audience who doesn't want to go as deep into the muck and mire of the research as I do, will understand.
So of course that means I have to talk about cognitive development and adolescent cognitive development in particular, and think a lot about yes, but. You say, this is the answer to this question. You say, this protects us from possibly becoming addicted to drugs and alcohol, but why? Or okay, genetics are a factor. How much of a factor? And is there one gene? Well, no. Okay. Well what does that mean then? And how is that related to personality type and what are epigenetics and how is that related? So essentially I had tons and tons of questions that I couldn't find answers to in one spot. And as a parent and an educator, that's my happy place is at the nexus of education and parenting.
Jill Anderson: What did you discover about parents and families, what they were doing or not doing that could significantly alter outcomes?
Jessica Lahey: In substance abuse and in recovery circles, there's this horrible analogy that unfortunately is incredibly apt, which is that genetics, which really make up about 50 to 60% of the risk, and then epigenetics is mixed in there too, but sort of straddles the line between genetics and environment is the bullets that goes into the gun. And then trauma is the trigger. So trauma, whether big T or little T, like trauma as defined for example, adverse childhood experiences, we lump under those. And I encourage people to go and Google adverse childhood experiences and quiz and take the little quiz and see where your number is.
The kids in my classroom, if I were to give all the students in my classroom, a quiz, most of them would fall between like 6 and 10 at any given time. There was hardly anyone in that room that didn't have some sort of pretty serious adverse childhood experience, whether that's taking care of a parent, who's also using substances or having grown up in foster care and moved from group home to group home. And sometimes it's a little T trauma, it's separation or divorce, it's adoption, Nadine Burke Harris in her book, The Deepest Well takes those categories of adverse childhood experiences originally outlined by CDC and Kaiser Permanente. And she also breaks those out into further categories that she saw in her pediatrics clinic that also affect lifelong mental health and physical health. So adverse childhood experiences are part of the picture.
And then on top of that, you have other things that obviously can be influenced by adverse childhood experiences, can be influenced by epigenetics and genetics, such as aggression towards other children is a risk factor for substance abuse. Academic failure is a risk factor for substance abuse. Social ostracism is a risk factor for substance abuse, but the problem is, is without early intervention for some of those problems, they get so tangled up and interconnected that it can be really difficult to untangle them and say, okay, well, which came first, the chicken or the egg? Were you aggressive towards other children, and that's why you've been ostracized? Or what's happening here?
So early intervention is a big part of these conversations about what we can do to make sure that kids are not feeling such huge emotions that they can't name, that they don't have any allies to help support them around, that aren't being supported and aren't being treated. And then they go out and they have to try to deal with those emotions somehow and manage life. And sometimes substances help with that. And the unfortunate reality is that in the short term, many addictive substances are fantastic at alleviating anxiety, at alleviating depression, at alleviating toxic stress, that kind of thing. So the problem of course is in the long term. What we end up with is kids who don't get their social, emotional and mental health needs met are kids who are continuing to use these substances and unhealthy behaviors and unhealthy risk-taking as ways to sort of self-medicate, isn't a great phrase. I'll use it here though, to self-medicate some of that pain in order just to make their way through the world.
Jill Anderson: So in the case of like what parents, and maybe even extends to educators and even beyond, it's just maybe not tapping into that early intervention that kids might need.
Jessica Lahey: Not just early intervention, but when it comes to schools, for example, only 57% of the schools in this country are using implementing any substance abuse prevention program. And of that 57%, only 10% of them are evidence-based. And what's interesting is we have programs that we know work. The really great news for those programs and for us, is that right now, it is all the rage. Not so much during COVID because so many things have gotten pushed out, but it is all the rage to have social, emotional learning programs in schools, which is great. And social, emotional learning programs are at the heart of the really successful substance abuse prevention programs. And substance abuse prevention programs that have a really great health side to them, so that starting at a very young age, we're helping kids understand things you put in the body, things you don't put in the body, things that are dangerous, ways that we protect our health and then moving all the way through, in a developmentally appropriate way through tobacco and vaping and into the more difficult stuff in high school.
But that kind of program that goes from very young all the way through high school and gives kids refusal skills and helps use a bit of inoculation theory and helps kids understand the data on when someone says to you, everybody does it. If an eighth grader can come back and say, well, actually the research shows that only 24% of kids in eighth grade report, that they've tasted more than a sip of alcohol by the end of eighth grade. That's not everybody. That's only 24%. That sort of actual real information is really helpful in combating the misperceptions we tend to have as humans about how much other people care about substances.
Jill Anderson: I think arming with information is a really interesting way to think about it and an interesting approach, because there are so many risk factors, and you've mentioned some of them, especially this idea of being predisposed to addiction, which kind of feels just so self-defeating like, there's no hope in a way when you hear that.
Jessica Lahey: It's actually really powerful because to me, I'm in this place with my kids where I know my kids are at higher risk for substance abuse, but that means that our conversations are very focused on that line between use and abuse, because I know my kids are probably going to dance on that line. We have to have a lot of conversations about it. I can't afford to not talk about it. If there were no risk in my family and everyone in my family were teetotalers, I might be able to just ignore it and hope it goes away. I can't though. And to me that's incredibly freeing. It's like, sweetie, I wouldn't be a good parent if I wasn't talking about this stuff.
My kid even joked last year, one of his teachers, I think it was in human biology, took a poll in class and said, do any of your parents talk about substance abuse at home? And my kid was like, when does my parent not talk about substance abuse at home? But it's like the sex talks. Those are hard at the beginning too, but the more you talk about it and the more it's a part of family conversation, the easier it gets.
Jill Anderson: I wanted to talk a little bit about protective factors. It almost sounds like even though being predisposed is a "risk factor." In some ways you're flipping it and making it almost a protective factor. What are protective factors?
Jessica Lahey: Protective factors, obviously for me anyway, start with us looking at our own habits. I don't think we can be effective in helping our kids deal with their use unless we're being really frank about our own use and really coming to terms with our own use. I was raised in a family where I knew one of my parents was an alcoholic and my sister and I would call them out on it. And the other parent would say, no, that's not what's happening. They're just tired. They're taking a nap. That kind of thing. And that is gaslighting and was telling me that my perception of the world was incorrect. And I got to the point where I could tell from 20 paces from behind when this parent was drunk and it was really insulting, emotionally damaging to be told that that's not what was happening.
And this is one of the things that sort of is going to be the toughest thing to deal with because it's super easy to talk in the abstract about this stuff. But if someone in the family does have substance abuse and it's a lot more loaded. But that elephant in the room of it's here, but we're not talking about it is really damaging. So starting there is really important. Having really good communication is really important. The research shows that having a family dinner lowers the risk of substance abuse in a kid. But I don't actually think it's really just ... Family dinner is sort of more emblematic of rituals that your family creates where you're all together and you have to look each other in the eye. And you're talking about things, whether it's game night, whether it's movie night, whether it's eating together, whether it's the things you do on car trips to hockey games, that kind of thing. It doesn't have to be family dinner in general. It's a really tough time to sort of get everyone sitting down all at the same time.
So I don't want anyone to feel like that's a hurdle they can't reach. So communication, having rituals around things like a family dinner really important. Again, the early intervention, if your kid has mental health issues, obviously any mental health disorder, most mental health disorders, but especially things like bipolar and schizophrenia, those things you're going to have to really keep an eye out for and get early intervention for stuff like that. Because those are huge risk factors for substance abuse, the dual diagnosis situation.
And on top of that, there's all kinds of little protective factors that I got to play around with in the book that we don't know for sure that these things are really useful. But in our case, for example, we have lots of pets. Petting an animal reduces blood pressure and increases oxytocin and reduces anxiety. And why the heck not? We happen to love our animals. I'm talking to you in a room with three dogs, and one of the two cats is here. And there's a bunch of things like that, that I talk about regular health care and using your pediatrician as a resource for screening, that kind of stuff.
Jill Anderson: Right. And keeping those protective factors up above the risk factors.
Jessica Lahey: If your risk factor side is really, really heavy, you're just going to have to have more protective factors on the other side. And whether that means there are extra adults that your kid can talk to in their life, whether that means that you're seeking out resources in the community and using, for example, the school nurse, the school counselor.
Jill Anderson: I want to hear more about zero tolerance before 21, because I think that is probably a tough thing for a lot of parents with teenagers. I'm guessing. I don't have a teenager. Full disclosure. A lot of people who maybe can't imagine endorsing zero tolerance for teenagers who will likely experiment. We know that there are parents out there in the world who are inviting alcohol into their home and giving it to their kids, thinking that's somehow safer.
Jessica Lahey: I actually found it to be quite hopeless when I started thinking in terms of zero tolerance. But if you think of it this way, it really makes sense. Okay. So a bunch of health organizations have said there is no safe amount of alcohol for a pregnant woman, for the fetus. We don't give alcohol to kids zero to age two because A, that would be insane. And B we can't really do tests on it. But that zero to age two is one of the two periods in a child's life when their brain is developing the fastest, in the most ways, is most vulnerable to the environment. And just as we would never ever give a zero to two year old alcohol, because it will really mess with the brain development. We also have to think of adolescents as being similar in terms of their development, in terms of their cognitive development, they have so much going on in their brains. They're growing synapses at an insane rate, they're myelinating, the fatty sheath is going on all the neurons.
Besides zero to two, there is no other period during life when the brain is more vulnerable to outside forces for good and for bad, obviously. So there are things that drugs and alcohol do to the adolescent brain in terms of damage that it can do, that it simply either doesn't do or does to a much lesser degree once you're a full on adult, once your brain is finished developing after your early to mid 20s. So for all the people writing about safe drug use in adulthood, like Dr. Carl Hart has a new book out about it. Michael Pollan writes about psychedelic use in adults. Have at it. Adult brains, they're done developing. If you want to take on that risk, that is your business.
But the problem is, is that adolescent brains can suffer real short term, and in some cases longterm damage to the places in their brains that are most vulnerable. Like for example, the hippocampus with marijuana use, the hippocampus is the area that is uniquely affected by cannabis and it affects memory and it affects the ability to store emotional memories. And it's just such an important part of not just of adolescents, but of life in general. And then here's the problem. Once that brain development door shuts in the early to mid 20s, it's not like you can go back. You can't go back and myelinate, you can't go back and do some more synaptogenesis. It's just, you either have that cognitive development or you don't. And if you mess with it while it's going on with drugs and alcohol. And then on top of that, the adolescent brain is just trying to stay in some sort of normal state with the hormones and the neurotransmitters that are in the brain and introducing substances into that, throws it way out of whack.
So when you go up and you have a great high on cocaine. Unfortunately you're not only going to come back down, you're going to come back down to a lower state you were in before you took the cocaine. And adolescents have at baseline, a lower level of dopamine than young children and adults. So when kids are complaining about being bored and finding everything is just so boring, they're not exaggerating. It's true. They have these low levels of dopamine and dopamine is about drive and motivation and things, the world being in technicolor. And, and when that level is really, really low, they're just meh. And so they're looking for things to color outside the lines, to get the world all in technicolor, to mix metaphors and drugs, and alcohol can do that, but in a way that really hijacks those neurotransmitters. So, unfortunately for us parents, the research is really, really clear.
Kids who do not start taking drugs or drinking alcohol until after age 21. Well, if you look at the research, actually, kids who start in 8th grade or 10th, greater 12th grade, the risk falls just precipitously with each passing year. So it's delay, delay, delay is the name of the game with kids. And if we can get them to their early 20s, really to 21, let's say without having consumed drugs or alcohol, especially in any sort of chronic way then we've protected their brains. And yeah, it's a pain. I'm really sorry to say this, but moderation doesn't work. 90% of people who have a substance use disorder during their lifetime say they started before age 18. And if you start taking drugs or drinking, when you're in 8th grade, you've got like somewhere near like a 50% chance of having substance use disorder during your lifetime. I think it's actually higher than that. But if you just make it to like 18 or 21, it falls to like 10%.
So, so if we can just push it off, just delay it. And if we can keep explaining to them why. Not just because I said so, but here's why, let me tell you about your brain. Let me tell you about the statistics. Let me tell you about what there is to protect and what the stakes are.
Jill Anderson: So did you have a family contract? Which is something that you do talk about as an important thing to have.
Jessica Lahey: We never wrote it all out because I learned about this stuff sort of after, midway through. We never wrote it all up, but we always did have the understanding, the same understanding I had with my parents, which was if I am ever feeling unsafe, if I need an exit strategy, if I need a ride that the parents will be there, no questions asked, and we will talk about it later. That exit strategy thing is a really important part of my sobriety now.
I go to every party, every dinner with an exit strategy in case I start to feel uncomfortable about drinking, or I want to have a drink or I'm getting tired. And then that's when I'm more vulnerable to drinking. So we articulate it that way in terms of like all of us need an exit strategy and need to have that permission to leave, even if it makes us look like a doofus in front of our friends. Those sorts of pacts are really important for us to have not just for our children, but for all of us. And when we model that for them, then we're also showing them that this isn't something we're doing arbitrarily because they're kids. This is something we do because it helps us take care of ourselves and prevent us from getting into situations that we're uncomfortable with. So we have talked about all the different aspects of what would be in a really good contract, family contract, but we've never actually put them down to paper.
So I think the question of preventing substance abuse in our kids is one of those things that we know we're supposed to do. The vast majority of parents when polled know that the first place teens tend to get their hands on opiates is in our own medicine cabinets or in someone else's medicine cabinets. And yet only 10% of parents actually talk to their kids about that stuff. And that is so important to think about because we shouldn't be, I don't think starting with a conversation about opiates in the medicine cabinet. I think what we should be doing is starting with a conversation with our little, little kids about things like can you spell out the letters on this label that make up mommy's name or make up your name?
And why do you think daddy's name is not on this bottle too? Why is it only your name? Why do you think it would be a bad idea for you to take medications that are prescribed for daddy? Oh, because daddy is much bigger than you and you're little and you don't have the same body and why do we not swallow the toothpaste when we brush her teeth? Why do we spit it out? These are all issues that have to do with what we put in our bodies, how we keep ourselves safe and healthy. And when you have those conversations early on, a conversation about opiates in the medicine cabinet is a natural outgrowth of those conversations. And so being mindful of starting early and continuing to have these conversations as we go along and then just making sure that our kids' schools have a substance abuse prevention program that's actually worth its salt.
Jill Anderson: Jessica Lahey is an educator, writer and parent. She is the author of The Addiction Inoculation: Raising Healthy Kids in a Culture of Dependence. I'm Jill Anderson. This is the Harvard EdCast, produced by the Harvard Graduate School of Education. Thanks for listening.