Category Archives: Adolescent and Young Adult Substance Use

Should You Drug Test Your Teenager?

It can be extremely confusing, scary, and frustrating to discover that your child may be using drugs. What’s more, it’s usually unclear whether or not your child is being honest with you. During this time, it’s common for parents to wonder: should I drug test my teenager at home?

At face value, it seems like a good idea. The aim would be to gain a more accurate picture of what’s really going on. That being said, I’ve found that this has a tendency to backfire more often than not.

While the intention behind drug testing may be to protect children from substance abuse, it can actually have limited effectiveness in its application for teenagers. The reason is that they are extremely easy to fake and tend to do more harm than good when it comes to the relationship with your teen.

I’ve been working in the teen substance abuse field for many years now, and in this article, I’d like to address some of the common pitfalls associated with home drug testing your teenager, as well as discuss some of the pros and cons.

3 Potential Drawbacks of Drug Testing Your Teen

I have been a substance abuse counselor working with young people for 6 years, and of the parents that I have met with, many of them have either considered home drug testing or have already applied this tool to attempt to prevent their kids from using illicit drugs. However, drug testing comes with a host of possible drawbacks.

A clinical report by the American Academy of Pediatrics (AAP) states:

“However, drug testing also has a number of drawbacks; it can be invasive, it yields only limited information, and results are easily misinterpreted.”

Having seen these issues first hand, I tend to agree. Let’s discuss the drawbacks one-by-one:

Drawback #1: Limited effectiveness

It’s extremely common when working with young people to hear stories of teens and young people successfully tricking drug tests administered by their parents. There are numerous ways to accomplish this, some of which can be bought at smoke shops and some of which simply require resourcefulness on the part of the teen:

Fake pee,
Vitamin concoctions to detox the body, or
Secretly squeezing a water bottle taped to their leg with a hose attached.

Compounding this problem is the fact that drug testing can’t test for every drug. It will always leave potential loopholes. LSD, for example, isn’t typical on most drug tests, though we know it’s currently one of the top five drugs used by teens.

According to the Medical University of South Carolina, urine screens can test for alcohol up to 48 hours, and sometimes up to 72 hours if the drinking is heavier. These limitations undermine the effectiveness of drug testing as an effective preventative or intervention measure.

Drawback #2: False Sense of Security

Another problem families face is reconciling the false sense of security that drug tests can create. Since drug tests are unreliable and easily circumvented, families should avoid placing trust in the result of a drug test.

The reasons for avoiding it are that over-trusting drugs tests may lead to questionable situations where their child may:

Use the drug test to manipulate the family, and/or
The drug test will falsely state they are passing, despite showing signs of drug use and other at-risk behavior

It’s common for families to feel as bewildered after the drug test as they did before. In other words, it tends to not actually solve anything because you still don’t know if your teen is using drugs or not.

This can place families in a difficult position because even though they may be observing using behaviors and causes for concern, they have to rely on their teen testing positive on a drug test in order to catch their kid and administer a consequence.

Drawback #3: Cause Distrust

This leads to another issue which is that administering a drug test may be construed by their children as a sign of distrust from the parents. Even though young adults abusing drugs often take actions that jeopardize trust, parents may further alienate their kids by feeding the culture of distrust.

A successful response from parents is taking the stance of “You trust, you win.” There are two outcomes:

1. They abstain from drug abuse: For this outcome, everyone is happy. The teenager is staying sober, allowing their brain time to develop, and parents can nurture trust in their child and help promote their further growth.
2. They continue abusing drugs: If parents rely on the young person’s actions reflecting their behavior. In most cases, something happens that creates cause for concern or directly catching the young person using drugs. In this case, it can be the child who faces the consequences of breaking trust.

By allowing your teen’s actions to take the lead in these scenarios, it allows the parent to be on the side of their son or daughter while still utilizing logical consequences for the action. This can include losing their phone, car, weekly allowance, hanging out with friends, and in more severe cases seeking substance abuse treatment centers.

Parents can even lovingly say, “We made a decision to trust you, and you broke that trust and there are consequences to our actions.” Any teenager may argue or try to manipulate but the statement displays simple love and logic.

Alternative approaches to determining if your teen is using drugs

I believe there are far more reliable ways to determine whether or not you should be concerned your child is taking drugs.

Our recommendation is to help parents take a holistic approach to be able to address a range of issues affecting their child:

How are their grades in school?
Do they have a good peer group?
Do they isolate often?
Have there been any recent changes in behavior?
Are they an active part of the family?
Are they argumentative at home?

In this way, parents can observe their kids’ progress more objectively and recognize when digress is happening. This is preferred over leaning on drug tests to confirm drug use.

What to do if you do decide to drug test

While I’ve painted a fairly bleak picture of the efficacy of home drug testing, I do acknowledge that it is sometimes the right thing to do. If, for instance, you are working with a professional substance abuse counselor or physician on an intervention process that involves a drug test, here are some general guidelines for the best outcome:

Utilize professional drug testing services, if possible
Combine your drug test with some type of substance abuse evaluation
Learn the signs of teen drug use and evaluate your experience with your teen based on them
Don’t discount what your gut is telling you
Ask for Help

Don’t forget to ask for help

Responding to teenagers who might be abusing substances is a scary proposition – one that many of the parents we work with never saw themselves having to face.

If you’re concerned that your teen may be using drugs, it’s worth it to consider a professional opinion. Having a simple discussion on the phone with a substance abuse counselor can go a long way towards helping you decide what to do next (regardless of whether or not you seek any further services).

If you’re in this position, don’t hesitate to contact us, even if you’re not close in proximity to one of our two substance abuse programs. We’d be happy to help you develop a game plan and make any necessary referrals.

You are not alone!

How Does Social Media Influence Drug Use?

By Bob Hicks, CRADC, CRPS on July 20th, 2023 in Addiction, Adolescent and Young Adult Substance Use, Substance Abuse Recovery Tools

Social media plays an ever-growing role in our lives on a daily basis. For many of us, we use social media every day, but understand very little of how it affects us.

Social media and drug use are closely related issues for teenagers. This is because substances and social media affect the brain in similar ways. They can both cause of release of high levels of dopamine which can lead to produce addictive behaviors.

Social media has a huge impact on how we interpret others, ourselves, and the world around us. For this article, we are going to focus on social media’s relationship with dopamine and the brain’s reward system.

What is Dopamine?

Dopamine is a neurotransmitter that can be released in the brain and is commonly associated with pleasure, satisfaction, enjoyment, and reward. This system is in place to reward us when we take positive healthy actions in order to ensure we keep taking those actions, and it’s also one of the primary ways that drug use affects the teen brain.

Drug Use and Social Media

The greater the reward, the greater the chance we become addicted. For most of human history, this risk has been mitigated by the fact that high-reward activities took hard work and long periods of time to achieve.

In today’s world of fast food, door dash, and internet food channels, we can access more food in an hour than our ancestors could access in a lifetime. The same is true for most other resources, and social media provides a convenient shortcut to receiving that reward.

Unearned Highs

As we discussed above, our brain’s reward system is in place to motivate us to take healthy actions. We have two routes to achieving these rewards;

We can earn these highs through action and actually putting in the work required, or
We can cheat the system and trick our brain into experiencing unearned highs.

For as long as the brain’s reward systems have been in place, humans have been finding ways to cheat the system, so to speak. Lying, stealing, cheating, fantasy, overconsumption, and manipulation are just a few of the tools we can use to try to cheat the system and experience rewards we did not earn.

The big tradeoff to our mental health becomes short-term pleasure for long-term pain (unearned highs), or short-term pain for long-term pleasure (earned highs).

Social media platforms play into this balance by offering an endless source of unearned highs, capable of tricking the brain into more dopamine “hits” than would normally be possible.

The Disadvantages

Through the internet and social media, people now have access to more information in an hour than what was available in a lifetime for previous generations.

There are many obvious advantages to this, but there are also some serious disadvantages. Social media plays a large part in a bigger cultural dilemma today which is dopamine saturation and immediate gratification by:

Using likes, subscribes, comments, and many other measures of approval to feed our desire for attention and human connection. Each “like” gives us a little hit of dopamine, each subscriber gives us a little more.
On top of that, we can live vicariously through others and get a taste of what it’s like to climb Mount Everest, be a millionaire, and get the love interest of our dreams all in a 15-minute window.

It’s no wonder so many people are glued to their phones. There are very few things in life that can provide that many quick fixes in short succession.

Dopamine: Social Media and Drug Use

This is where the connection between drug use and social media comes into play. In a world where quick fixes drive our daily lives and drugs are more available than ever before, the quick fix of drugs isn’t a huge jump from all the other quick fixes we access daily. The most common drugs used by teens all operate the same way on the brain.

Drugs affect the brain in the same way social media does, tricking our brains into huge releases of dopamine. Obviously, drugs are much more detrimental, but the payout is also significantly higher.

Effect of Social Media on Recovery

The connection that we consistently see at The Pathway Program between social media and substance use disorders is that both feed into the negative cycle of addiction in the brain, giving us quick fixes and demanding more and more as time goes on.

It is very common to see a person in recovery completely addicted to popular social media. Many of the teens and young adults we work with, come into addiction treatment with a drug abuse problem; along with an unhealthy obsession with social media.

In recovery, the young people who continue to feed into social media addiction are rarely capable of long-term recovery. The addictive cycle demands more reward, and always leads to relapse, if not broken.

What’s the Solution?

So, how does social media influence drug use? They both involve seeking unearned highs, which is a behavior that only results in further addictive behavior and mental health problems.

The solution for both issues involves finding ways to achieve self-worth, approval, positive relationships with friends and families, and positive experiences through earned highs, and to limit the negative behavior patterns of addiction and rush-seeking behavior.

Top 5 Most Common Drugs Used by Teens: Real world data

By Cassidy Culley on May 25th, 2023 in Addiction, Adolescent and Young Adult Substance Use

As a substance abuse treatment program specializing in working with teens and young adults who struggle with substance use disorders, we are often asked questions about commonly used drugs. Though the data is clear that marijuana is the number one drug used by teens, in this article we’ll discuss the other most popular drugs that teens are using.

The data used in this article was gathered from 281 drug treatment charts between 2020 and 2022 that outline the top five drugs used by teens, and make observations regarding the data that will help with understanding these trends.

Out of the 281 charts from young people admitted into our Arizona Substance Abuse Program, we found that the top 5 drugs that were used overall between 2020-2022 were:

Cannabis – 100%
Alcohol – 90%
LSD – 63%
Xanax – 59%
Cocaine – 44%

Many of the young people were also using other drugs among these top five, but these were the most common.

What are the Top 5 Drugs Used by Teens

Below is a graph of the top 5 drugs that were commonly used by teens. Among the top five were some unsurprising results, but there were also some unexpected appearances mixed in with the usual suspects.

#1: Cannabis

Cannabis ranks as the number one drug used by teens. Out of the 281 people admitted into the program, 100% of the teens we worked with used cannabis.

Though the number isn’t a surprise, we found it interesting that the number was a clean 100%. Additionally, almost every teen we worked with (74%) used cannabis first before they tried any other drugs.

This makes sense as most of the teens we work with report that cannabis is easier for them to obtain than alcohol, and the perception of risk for cannabis use has dropped significantly among teenagers.

#2: Alcohol

Alcohol is the second most widely used substance among teens and young adults. Between 2020 and 2022, 90% of teens admitted into the program were using alcohol.

We also noticed a drop in alcohol use year-to-year. In 2020, 92% of young people admitted were using alcohol; compared to 85% in 2022.

As a substance abuse counselor, I have made a few thoughts as to why this may have occurred:

As more teens label THC as their drug of choice, fewer people have claimed alcohol to be.
As Cannabis becomes more accessible and more potent, decreases in other substances such as alcohol occur, as those substances are less accessible, despite the potency of other substances.

#3: LSD

The third most common drug used by teens currently is LSD, edging out Xanax as the teens’ most preferred drug aside from alcohol and THC.

Over the past few years, we’ve seen teens’ interest in hallucinogens rise; the most common hallucinogen used by teens currently is LSD.

LSD is a hallucinogenic drug that comes in the form of paper tabs, gels, or liquids and has major effects on the function of the teen brain. LSD was one of the most widely used substances in the 60’s and 70’s, as a result of the counterculture hippie movement.

#4: Xanax

Benzodiazepines are a type of prescription drug and the most common of these is Xanax. Xanax is a depressant that suppresses central nervous system activity and helps users to calm down. Individuals who abuse Xanax will often feel a high similar to being drunk.

Between 2020 and 2022, 59% of teens we worked with had used Xanax.

We did note that Xanax abuse dropped from 2020-2022 by 9%.

In our experience, out of all the top five drugs used by teens, Xanax is most widely paired with cannabis. However, it is commonly also paired with Alcohol, a particularly dangerous combination that is infamous for leading to overdoses.

Also, it is important to note that the withdrawal from Xanax is also very similar to the withdrawal from alcohol. It is one of the only drugs of abuse that can lead to seizures and death upon withdrawal.

#5: Cocaine

One drug that has made a comeback in recent years is cocaine. According to our data, cocaine use amongst teens and young adults ranks fifth on the list with 43% having used cocaine.

Teenagers are drawn to cocaine’s ability to provide a euphoric high and increase energy and confidence. Its popularity among this age group is a cause for concern due to its addictive nature and detrimental effects on physical and mental health.

Teen drug abuse overview

The top five commonly used illegal drugs among teenage and young adult populations include marijuana, alcohol, LSD, Xanax, and cocaine.

Runner-ups included cough syrups, synthetic marijuana, psylocybin (mushrooms), and the ever-popular stimulant adderall.

We will continue to update this post year-to-year as new data becomes available to us.

Real World Data: What is the Number One Drug Used By Teens?

By Cassidy Culley on April 21st, 2023 in Addiction, Adolescent and Young Adult Substance Use, Marijuana

As substance abuse counselors who specialize in working with teens, we get a lot of questions about trends in teen drug use. In this article, we’ll dive into the actual drugs that teens are using based on data we have gathered from 281 patient charts between 2020 and 2022.

We gathered data from all the charts from our Arizona substance abuse program over the last three years (2020-2022), representing 281 individuals who have received substance abuse treatment in our program. We found that the number one drug used by teens is marijuana. Most of these young people were also using other drugs at the time of admission, but not all.

So, what is the number one drug used by teens?

Below, is a chart of the top 5 drugs used by teens. Among the top drugs are some of the usual suspects, marijuana, alcohol, xanax, etc. However, we found that 100% of the young people we worked with were using marijuana:

Most common drugs used by teens between 2020 and 2022:

Substance	2020	2021	2022	Average
Marijuana	100%	100%	100%	100%
Alcohol	92%	93%	83%	90%
LSD	64%	65%	57%	63%
Xanax	63%	58%	54%	59%
Cocaine	44%	45%	38%	43%

Shown another way:

What drugs cause the most problems (substance use disorders) for teens?

Astute readers may observe that the number of teens who have used marijuana being 100% doesn’t necessarily mean that 100% of the young people in our program had a specific problem with marijuana. We felt the same way, so we took a look at the specific substance use disorders treated.

We took a secondary look at the charts from our California substance abuse program to determine what percentage of each drug was responsible for specific substance use disorder diagnoses, and here’s what we found:

Top substance use disorders in teens between 2020 and 2022:

Substance Use Disorder	Percentage
Cannabis	100%
Alcohol	65%
Cocaine	16%
Benzodiazepines	16%
DXM	9%

Note that many of the individuals were admitted for more than one substance use disorder. Only 14% of the individuals were treated for cannabis use alone.

In graphic form:

At least in the case of our programs, it appears conclusive that marijuana is the top drug of choice among young people, and it’s also the drug that is responsible for the most substance use disorders, by a long shot.

Alcohol came in second, and we noted that 58% of the young people we treated had both a cannabis use disorder AND an alcohol use disorder.

Though other illicit substances, like prescription pain medications and opiates, are responsible for many of the tragic deaths, their frequency of use didn’t even crack the top five!

The top prescription drug used was benzodiazepines (most frequently Xanax).

What drugs do teens try first?

While the data above seems to be painting a picture, we also gathered the data from our California program on which drugs the teens used first. Taken from the same data set:

Drugs that teens tried first:

	Percentage
Cannabis Alone	37%
Cannabis & Alcohol	35%
Alcohol Alone	26%
All Other Illicit Drugs	0%

The most common answer to the question was cannabis (37%), followed by alcohol and cannabis (35%). Not a single drug other than cannabis or alcohol was mentioned as a “first drug” by any young person entering our program.

Though the “gateway effect” of marijuana is under constant debate, it seems clear at least that marijuana is the drug that teens most commonly try first.

What about alcohol?

In years past, it wasn’t uncommon for every young person we met to be using alcohol as well as marijuana.

In recent years, this number has declined. Most notably, the number of teens who used alcohol between 2021 and 2022 dropped from 93% to 83%.

In future updates of this article, we will continue to monitor this number to see if the trend continues.

Potential limitations of the data

One thing we want to acknowledge is that this data was collected from young people who entered our substance abuse program. It is, of course, possible that the data would be different if we looked at data for teens who did not require a drug abuse program, then the numbers could look different.

Why is Marijuana so Prevalent Among Teens?

There are several factors that make Marijuana so popular among adolescents, but there are 3 main reasons that stick out among the others:

1. The Perception of Marijuana

The most recent Arizona Youth Survey (2022) data points out that around 49.1% of students between grades 8-12 do not believe that smoking marijuana regularly poses a significant risk.

Marijuana is one of those substances that are often perceived as harmless, and according to an article by the NY Post, about 57% of Americans believe that Marijuana is harmless. Pro-marijuana messaging is everywhere. It can be seen on billboards, on our favorite shows, glorified in music, and it’s all over popular media.

Society, social media, and the Marijuana industry are asserting that marijuana use is safe.

2. Accessibility

Marijuana has become one of the most accessible substances on the market for teens since the rise in concentrated or synthetic marijuana also known as wax pens, carts, and THC vapes.

The legalization of recreational marijuana in many states has caused a rise in accessibility, and teens may find it easier to purchase than alcohol. However, even in states where marijuana is still illegal, teenagers can purchase it through their friends, dealers, and even through social media.

The rise of online sales has also opened up avenues for teens to purchase through social media, without much difficulty. With its social acceptance and easy accessibility, it is concerning how easily teens can obtain marijuana without any safety measures in place and the effect that it may be having on teen drug abuse.

3. Peer Pressure

Peer pressure is one of the biggest factors that contribute to the popularity of drug and alcohol use among teens and young adults. Many young people feel the need to fit in with their peers and may use THC or other illicit substances as a way to do so. Being part of a group that abuses drugs, especially marijuana can give teens a sense of belonging and can help them to feel accepted.

This kind of pressure can also be harmful, as it can lead to drug use becoming a regular part of their lives, even if they know it is not good for them.

Summary

Our data shows that marijuana is the most commonly used drug among teenagers in the United States. The prevalence of marijuana use among teenagers has been on the rise in recent years.

It is important to address substance use among teens through education, prevention, and early intervention programs. Parents, educators, and healthcare providers play key roles in helping teens make informed decisions about drug use and seeking treatment if necessary.

Young Adult Rehab vs Traditional Drug Treatment

By Jeremy Wachter, ICADC on March 25th, 2022 in Addiction, Adolescent and Young Adult Substance Use

Why Young Adults Need Age Specific Substance Abuse Treatment

The young adult, or 18-25 year old, is often forgotten in the greater drug / alcohol treatment world. They aren’t teenagers, they have some freedom, and society expects them to act like adults. However, they aren’t truly adults yet, either.

Parents and young people alike often report attempt after attempt at sobriety or treatment. Upon further investigation, we often find that these individuals have been in and out of adult treatment centers. Sometimes these programs work well for young adults, but more often than not they fall flat. While we do not wish to disparage adult treatment programs, they don’t tend to meet the 18-25 year-old’s needs very well.

Why is this? We hope to examine the reasons in this post, as well as offer a few viable solutions for parents, young adults, or mental health professionals seeking guidance on working with college-age individuals in a rehab or treatment setting.

Young Adults vs Adults in a Rehab Setting

Much has been written and said about the adult alcoholic or drug addict. For obvious reasons, the treatment and recovery world is designed around the older adult alcoholic. This typically refers to a 45-55 year old individual who has experienced serious consequences – divorces, DUI’s, legal battles, with serious career-related implications.

These individuals may enter treatment on their own or at the behest of a loved one, but they are almost always seeking to alleviate consequences. The classic 30-45 day rehab program is very much designed to serve this type of individual, and the “young adult”, or college-age drug user is often lumped into this group.

It’s important to understand that young adults aren’t in treatment for the same reasons as an adult. They haven’t endured 15-20 years of hard drinking, they haven’t lost businesses, they haven’t been through divorces. They aren’t “fed up” with getting high, even if their lives have been miserable for a few years.

These individuals are over 18, but they haven’t totally started their lives yet. Their brains aren’t fully developed, they are almost always single, and in many ways they think and act like adolescents (more on that later). Their experience is somewhere in between the adolescent and the adult.

They’ve often lived on their own, had jobs, or rented apartments. They may have owned (or wrecked) a car or three. They may have even experienced consequences, such as a DUI, a serious breakup, or expulsion from a college or university program. In many ways their “drug using careers” are just getting started.

Rehab for Young Adults vs Teens

Similarly, much has been written and talked about where adolescents and drug abuse is concerned. We all generally understand that an individual under 18 is a different animal than an adult alcoholic or drug addict. They are (typically) still under the guardianship of a parent, parents, or family members. They are required to go to school, and their drug and alcohol use is almost always motivated by a desire to have fun and obtain peer acceptance. They often haven’t totally crossed the “invisible line” into true addiction or alcoholism, and there are numerous treatment approaches tailored directly to the teen drug user.

Young adults can’t be treated as if they are teenagers, because they are in a different phase of life. Legally, they are adults. Parents don’t have the same leverage over their young adult that they would have over a teen.

Additionally, young adults’ have usually progressed further into their substance use disorders than teens have. They have often been using drugs for more than just a couple years. They’ve progressed into harder drugs and often experience withdrawal symptoms upon cessation of use. When presented with facts about addiction, they usually nod their heads in agreement, rather than glaze over like an adolescent would.

Considerations for Young Adult Specific Drug Treatment

Because young adults often get lumped in with adults, they end up in treatment programs that aren’t designed for them. They usually don’t feel that they relate to their peers in treatment, and upon discharge, they are handed off into various 12-step programs where they continue to struggle to relate.

Consider a few generalizations about the 18-25 year old phase of life:

Young adults have a high social need

Being single and young means these individuals still have a high social need – programs need to incorporate fun, opportunities for social connection with a new peer group, and a clean hand-off into a high quality long-term Aftercare program.

Delayed emotional growth still applies

Parents are often frustrated as to why their 23 year old acts and responds like a 16 year old. We often think of delayed emotional growth with teens, but this applies to young adults as well. Young adults who used drugs through high school and college haven’t experienced the emotional lessons during these years. They often present as “23 going on 16,” and retain the black-and-white logic of a teenager.

Parental involvement is important for this age group

They are often still financially and emotionally intertwined with their parents. It is important that parents of this age group have support as their young person goes through the young adult addiction treatment process.

Parents and young people alike benefit from the parents having tools to manage the high emotions involved in the early recovery process. Parents of young adult drug users often also need family therapy, coaching, and support as they decide when and how to financially disconnect from their young adult.

They feel that they are behind in life

Being college-age means these individuals will be thinking about starting their lives after they sober up. Young adult programs need to consider helping individuals sort through what their goals are, and what steps they can take towards the lives they want to create.

Young adults have also likely gotten in more legal trouble than teens, and may need some coaching and support through the process of cleaning up their past.

A 12-step program with depth is usually necessary

Young adults often have crossed the “invisible line” into being dependent on alcohol or drugs. A strong personal 12-step program will be necessary earlier in the recovery process than it will be for teens.

Is there hope for a young adult alcoholic or drug addict?

Absolutely, yes. We see young adults sober up all the time. They are some of the most fun-loving, smart, funny, and energetic individuals we get to work with.

Though we often say there are no guarantees in the substance use disorder treatment world, we believe that seeking age-appropriate young adult rehab programming is just as important for young adults as it is for teens. Their odds of success improve dramatically when the treatment is age-appropriate, their social needs are met through support groups, and their parents are involved.

If you have any questions about the treatment process for young adults, or would like to inquire regarding a substance abuse evaluation, please reach out to us. We are always happy to answer any questions and assist in developing a plan of action for your family or your young adult.

Is Marijuana A Gateway Drug?

By Jeremy Wachter, ICADC on November 19th, 2021 in Addiction, Adolescent and Young Adult Substance Use, Marijuana

Obviously, the landscape of attitudes toward the use of marijuana has changed dramatically in recent years. One of the pieces of conventional wisdom in the drug world was always that marijuana was the most common “gateway” drug. With the widespread acceptance of THC and CBD products for medicinal and recreational use in various portions of the country, this has become a point of contention in recent years.

Those who argue against the so-called “gateway” theory of marijuana point out that there are no documented marijuana-specific properties that “cause” an individual to use other drugs down the road. While this claim is only partially true (we’ll briefly examine the science later in this post), the argument is fundamentally missing the point.

As an aside, in a recent survey of our patient charts, we found that marijuana is the most common “first drug” used by teens with substance use disorders.

To illustrate what we mean:

We surveyed our opiate users about marijuana use

Our (adolescent and young adult specific) substance abuse program did a year-long quick survey of all the opiate and heroin addicts who went through treatment in our facility.

We asked a simple question – did you start with opiates? The answer, a resounding no. Then we asked the obvious follow up question – which drug did you use first? Almost every response was … marijuana.

Surprised? Neither were we.

Rather than getting into the weeds (pun intended) about the clinical properties of marijuana, we prefer a common sense approach to the question. Is it true that marijuana is often the drug that opens the door to further drug use down the road, and if so, why?

A personal anecdote about marijuana

In other portions of this website, we’ve presented some stories about the teenage experience with drug use. I’ll add a portion of my own story:

As a young teenager, I was decidedly anti-drug. My family did a great job of discouraging me from using drugs as well as providing me with suitable alternatives such as hobbies and sports. Not only that, I went through the now defunct D.A.R.E. program as a kid.

I remember the D.A.R.E. officer talking about how people who used marijuana would inevitably experience serious consequences. Despite having some drug-using friends at school, I stayed clean, mostly because I didn’t want to compromise athletics. Then a curious thing happened:

One summer, I smoked weed for the first time. I took a few puffs of a joint at a concert and enjoyed the light, heady feeling I got from it. I didn’t get very high, but the experiment went so well that I decided to do it again – this time I would make sure to get good and high!

A week or two later, I smoked weed from a bong for the first time with some friends and … I had a great time! That’s right – I didn’t commit any crimes, steal from my grandma, join a gang, or try to jump from a high window. That was the day I realized:

Adults are jerks.

They had lied to me.

Drugs were awesome.

My whole attitude toward drug use changed in an instant. I had believed that doing drugs was stupid, but at that point I “realized” that the joke was on me. Within a few weeks, I repeated the experiment with prescription painkillers, cocaine, and over-the-counter cough medications. I began stashing drugs in my room and I quickly fell in love with getting high.

Unsurprisingly, things did get really dark for me. A few years later I was strung out on heroin, homeless, and on the verge of losing ties to my family.

Turns out the joke was on me. I went through the process of getting sober kicking and screaming. But here’s the point:

It all started at that concert, with those first few puffs of marijuana. An “innocent” moment in time where I went from being a capable, athletic, suburban kid to someone open to the idea of doing drugs.

Lowering the barrier to drug use

The 2020 Arizona Youth Survey points out some telling facts about youth substance abuse:

41.3% of students surveyed have used marijuana by the time they are in the 12th grade.
35.8% of students have used marijuana concentrates by the 12th grade.
28.0% have taken marijuana edibles by 12th grade.

The number of 18 year olds who have used marijuana is approaching half.

We also know from this 2014 study that 44.7% of individuals with lifetime cannabis use progressed to other drugs later in life.

Why is this? Is it something “special” about marijuana? Doubtful – we could likely make the same argument about alcohol or vaping. We think it has more to do with perception of risk.

Luckily, the AYS gives us data on this topic as well:

Perception of Risk for Marijuana Use Among Youth

The Arizona Youth Survey goes on to say:

Only 23.3% of 12th graders perceive trying marijuana once or twice to be a moderate or great risk.
87.3% of 12th graders perceive trying illegal drugs other than marijuana to be a moderate or great risk.

There’s two conflicting facts here: while almost all students perceive trying other illegal drugs to be a great risk, almost half of marijuana users go on to use other drugs. That should tell us something – once someone tries their first drug, their perception of the risks of other drug use often gets lowered by default.

Some Common Sense Facts About Marijuana Use

We believe (and see in our drug abuse program every day) that the gateway effect is not referring to a scientific phenomenon – it’s referring to behavioral and social factors that open the door to drug use in general. Consider the following:

A teenager having fun using one drug is more likely to hear from another teenager that another drug is also fun.
As noted above, most teens view other illegal drugs as risky at first. Having a good time using one drug makes other, harder drugs seem less scary to try.
Starting to use drugs plugs teenagers into a social network of drug-using peers, some of whom have access to drugs other than marijuana.
Taking one drug regularly leads to tolerance. This leads to a natural inclination to try other drugs as time goes on.

An overview of the science on marijuana

Earlier we noted that the claim that marijuana doesn’t directly lead to other drug use is only partially true. Here’s an overview of what the science says:

Marijuana’s association with other drug use

This 2014 study found that 44.7% of individuals with lifetime cannabis use progressed to other drugs later in life.
The National Survey on Drug Use and Health found that marijuana users are three times more likely to become addicted to heroin.
A 2018 study found that cannabis use was associated with non-medical opioid use in adults.
This 2004 study found that early cannabis use is strongly associated with use, abuse, and dependence on other illicit drugs later in life.

Cross sensitization, or the “priming” effect

Early-use marijuana has been shown to “prime” the brain, setting the person up for substance use disorders later in life. The term cross-sensitization is used to describe the effect of exposure to one drug leading to hypersensitivity to another drug. It has been shown that marijuana use early in life does lead to cross-sensitization for other drugs, which may help explain the high number of users who switch to other drugs later on.

In their article on cross-sensitization, the Addiction Policy Forum had this to say: “Marijuana is an undeniably powerful drug, like alcohol and tobacco, changing the brain and accelerating drug-reward learning.”
This study from 2004 found that an enduring change to the dopamine system takes place in those who use cannabis early in life. This adaptation led to a long-lasting cross tolerance for drugs like cocaine, morphine, and amphetamine.
A more recent study from 2020 performed on rats found that exposure to marijuana during adolescence led to cross-sensitization for cocaine, but adulthood exposure did not. They also reversed the experiment, finding that cocaine use did not lead to cross-sensitization for marijuana.

What about Alcohol and Tobacco?

As compelling as all of this may seem, it turns out that other drugs may have the same effect. For instance, the cross sensitization effect has also been shown in the literature to take place in those who use alcohol or nicotine.

It appears that it may not matter which drug a person does first. As we’ve already stated, it’s likely just the simple fact that someone tries a drug that helps predispose them to other illicit drug use later in life. In their resource on the “gateway effect” of marijuana, the National Institute on Drug Abuse had the following to say:

“An alternative to the gateway-drug hypothesis is that people who are more vulnerable to drug-taking are simply more likely to start with readily available substances such as marijuana, tobacco, or alcohol, and their subsequent social interactions with others who use drugs increases their chances of trying other drugs.”

So … is marijuana a gateway drug?

Hopefully this article has painted a clear enough picture. As stated in the beginning, we’ve hardly ever met a drug abuser who didn’t start with marijuana. We believe practical experience speaks louder than words.

There is massive pressure to be dismissive of some of the common sense wisdom concerning marijuana use. The fact remains that marijuana is almost always the first drug kids try.

Even if it weren’t for the well documented physical health and mental health risks of marijuana, it would still be true that using marijuana early in life sets in motion the social, behavioral, and emotional wheels in motion for other drug use later in life.

Marijuana Potency Testing Shows the THC Percentage in Weed Has Gone Up

By Jeremy Wachter, ICADC on November 4th, 2021 in Adolescent and Young Adult Substance Use, Marijuana

Many parents (and even grandparents) we work with assume that marijuana is the same as it ever was – weed is weed, right? Not so fast. If you assume that the marijuana your child has access to is the same weed you and your peers had access to back in high school, think again.

The federal government has been testing marijuana potency since around 1972 in something called the Potency Monitoring Program (due to technological constraints in cannabis testing labs, it wasn’t possible to test marijuana potency prior to the 60’s). It has shown a definite increase in the strength of marijuana over the decades.

While the Potency Monitoring Program has admitted its own limitations in testing methods from decades past (outdated testing methods, small sample sizes, and sampling of months-old samples likely limited the accuracy of potency figures through the 70’s and 80’s), it is true that marijuana potency has increased.

This is especially true in the past 20-25 years, as testing techniques have improved and sample sizes have reached into the 1000’s per year.

Marijuana potency testing shows we have the highest THC Weed in history

A two-decades long study (1995-2014) of the potency of samples confiscated by the DEA showed a clear trend upward from the mid-90’s. This study includes over 38,000 samples of marijuana plants over the two decades. We’ll let the study’s results speak for themselves:

The potency of illicit cannabis plant materials has risen consistently since 1995.
THC content in 1995 was approximately 4%, whereas by 2014 it had risen to around 12%.
CBD content in cannabis plants has fallen on average. The THC to CBD ratio has therefore gone from 14 times in 1995 to 80 times in 2014.

Alternatively, here is the included graph from the Potency Monitoring Program’s quarterly report #146.

You can see that THC levels have continued to climb since 2014, reaching into the 14-15% range.

Why is this happening? Especially since the onset of the medical marijuana movement and the push for recreational legalization, growers have been working to make higher and higher THC content strains in order to compete with one another.

A simple Google search for “highest THC content ever recorded” returns page after page of articles claiming that strains with names like “Bruce Banner” or “Ghost Train Haze” are the strongest in the world, with concentrations ranging form 27-44%!

High Potency THC Concentrates

The other elephant in the room in the marijuana game right now is the popularity of new cannabis products known as THC concentrates. Nicknamed, oil, shatter, wax, or dabs, these are generally different forms of the same thing: THC that has been extracted from the marijuana plant through various methods. In many ways, this is a new class of marijuana which draws more parallels to some of the traditional “hard” narcotics.

But how strong are they actually?

The National Institute on Drug Abuse compiled some data on this topic. They report that solvent-based marijuana concentrates can have an average THC level of about 54-69%, whereas non-solvent-based concentrates have a lower average of 39-60%. They even report that some of the samples can have upwards of 80% THC content.

Why it matters

In our experience, this has led to a new wave of marijuana related consequences for young adults and teens:

High THC cannabis is now the norm. New conditions such as marijuana hyperemesis and marijuana induced renal failure (kidney failure) have appeared on the horizon. Anecdotally, a higher percentage of our adolescent and young adult substance abuse program’s intakes have included complications from marijuana-induced psychosis.

Marijuana used to have the reputation as the drug that wouldn’t make you overdose. In 2021, this is no longer the case. This scholarly review on marijuana poisoning discusses that deaths have begun to pop up in relation to eating food products containing concentrated THC butter.

For young people, this new world of marijuana is opening doors to potential health, mental health, and social risks that weren’t present in the past. According to one 2019 study, 33% of 8th-, 10th-, and 12th-graders reported lifetime cannabis use and 24% reported lifetime concentrate use.

Ironically, many cannabis users debate whether marijuana potency testing is even a good measure of a marijuana strain. Some claim that super-high THC cannabis strains don’t get the user more “high” than low-THC strains. This begs the question – are the individuals who use these products needlessly opening themselves up to potential consequences without even knowing it?

In Conclusion

In short, the THC percentage in weed has gone up, with new high THC strains coming out each year. Perceived harm among young people has gone down, and legalization efforts have lowered the barrier to obtaining medical-grade marijuana for youth. Additionally, marijuana is decisively the most commonly used drug by teens. Elizabeth Stuyt, MD, an addiction psychiatrist, puts it perfectly in a 2018 article in Missouri Medicine:

“There is absolutely no research that indicates this level of THC is beneficial for any medical condition. The purpose of these products is to produce a high, and the increased potency makes them potentially more dangerous and more likely to result in addiction.”

We couldn’t have said it better.

Marijuana and Mental Health Risks

By Jeremy Wachter, ICADC on October 4th, 2021 in Adolescent and Young Adult Substance Use, Marijuana

As we’ve seen in our recent posts about marijuana-induced psychotic disorder, cannabinoid hyperemesis, and the physical effects of marijuana, it’s possible that recreational marijuana isn’t quite as harmless as we’ve been led to believe. In this post, we’d like to explore some of the literature relating to marijuana and mental health. As professional drug and alcohol counselors who work with young people every day, we see much of this first-hand.

Marijuana is a complex drug. Some people feel happy and relaxed when they smoke marijuana, and others feel anxious and paranoid. Still others develop more and more paranoia or feelings of anxiety in the long-term, leading to mood swings or manic symptoms.

This article is not intended to tell you what you should or shouldn’t do. We simply want you to be informed on some of the possible outcomes of marijuana use so you can make a decision on your own. We hope this information is helpful, as marijuana is decisively the drug most frequently abused by teenagers and young people.

Marijuana and bipolar disorder

Bipolar disorder, formerly called “manic depressive disorder”, is a mental health condition in which an individual has alternating periods of elation and depression. As mentioned above, one of the main effects of marijuana is the feeling of relaxation and happiness it provides under ideal circumstances. So, is there a link between marijuana and bipolar disorder?

There is actually a decent amount of literature on this topic. In particular, this 2015 study performed a systematic review and meta-analysis of six studies covering 2391 patients with bipolar disorder or manic episodes. The results of the study showed an association between cannabis use and “exacerbation of manic symptoms in those previously diagnosed with bipolar disorder.” Additionally, two studies from the analysis suggested that the risk of developing new manic symptoms is approximately three times higher among people with bipolar disorder who remain undiagnosed.

Marijuana and anxiety disorder

There is some debate in the industry and among the public as to whether marijuana causes anxiety disorder. In fact, the literature is conflicting on this topic at times. Some studies point out that anxiety symptoms get triggered by cannabis use, and others show that it can be beneficial in treating symptoms.

This 2014 systematic review noted in the “Adverse Effects” section that anxiety, psychosis, and dysphoria were all associated with higher concentrations of THC.

Marijuana and suicidal ideation, attempt, and self-harm

A 2021 study by the National Institute on Drug Abuse examined over 280,000 adult participants from the National Surveys on Drug Use and Health. They found that past-year cannabis use disorder, daily cannabis use, and nondaily cannabis use were associated with higher instances of past-year suicidal ideation, plans, and attempts across both sexes. They found that the associations were stronger in women.

Another 2021 study on over 204,000 adolescents found an association between adolescent cannabis use and self-harm among youth with mood disorders. The study states that, “Cannabis use disorder is a common comorbidity and risk marker for self-harm, all-cause mortality, and death by unintentional overdose and homicide among youths with mood disorders.”

Studies point out the need for more research in this area. It is unclear whether marijuana use causes suicidal ideation or whether individuals with depression are simply more likely to use marijuana to cope with an underlying mental illness.

Marijuana and Depression

One of the current areas of study is that of marijuana’s potential positive effects on depression. However, there is also evidence to suggest it may make things worse. The Mayo Clinic reports that marijuana users are diagnosed with depression more often than non-marijuana users. However, as stated above, there is a problem of determining causation.

The real trouble is that while marijuana use may provide temporary relief, there is also a good chance it will make symptoms worse. This 2018 study found that users of marijuana experienced stress, anxiety, and depression relief with as little as two puffs of marijuana. However, they noted that baseline symptoms of depression ended up being worse over time. This seems to fall in line with conventional wisdom on drug abuse in general – drugs provide temporary relief at the cost of more pain later.

What’s the Verdict?

From the resources linked above, it would appear that marijuana and mental illness go hand in hand. However, many of the sources repeat the same problem with determining causation. It is as of yet unclear whether marijuana increases risk of anxiety disorders, suicidal ideations, depressive episodes, etc, or whether individuals with mental health issues are simply more likely to use marijuana.

In our view, the question isn’t really about whether or not marijuana can cause mental health problems. The question is, how can we help address mental health issues in individuals so they don’t have to use marijuana to cope?

That seems like a worthwhile approach, while also conveniently side-stepping marijuana’s other inherent risks, and the documented negative effects of marijuana use on brain development in adolescents.

Is Relapse a Part of Recovery?

By Josh Azevedo, LISAC on October 1st, 2021 in Adolescent and Young Adult Substance Use, Family Support for Addiction, Parent Recovery

I would like to share some of the most common questions I receive about relapse. I will answer them from an overview perspective and in a general sense. Relapse is a big topic, with many variables that are case specific. I don’t think it can be covered thoroughly in a blog post, so my aim here is to cover some basics. I hope to help remove some fear about relapse and provide perspective for those parents who are trying to understand their addicted loved one’s behavior and support their recovery.

Here are four of the most common questions I receive:

1. Does everybody relapse? Should we expect our son/daughter to relapse?

No, not everybody has a relapse. Some people come into recovery truly ready to make a change and sobriety sticks right from the beginning. To address concerns you may have about your own child and the possibility of relapse, I suggest you respond by using your recovery in the same way that is suggested to the addict/alcoholic: take it one day at a time. It is incredibly hard to tell who will have a future bump in the road. Sometimes the toughest and least motivated person doesn’t relapse, and the recovery valedictorian does. Either way, if you work on yourself as a parent, you will be well-equipped to respond to either possibility. If there is a relapse and you have been working on your own recovery you will at least know that you did not contribute to the relapse. Being a part of the solution is something you can control. Whether or not they relapse, is not.

2. What are the most common reasons for relapse?

Reasons for a relapse can be very case specific, but here are some common issues that often lead to relapse:

A. Not accepting the severity of the problem – many alcoholics/addicts struggle to admit the severity of their problem and the full ramifications and effects that it has on themselves and others (this is particularly common with young people who have not experienced a lot of consequences yet). They often tell themselves that their using isn’t that bad, that it was circumstances that created their latest problems, that it was somebody else’s fault, or that it will be different this time. They have trouble accepting that the effect alcohol/drugs have on them is different from what they see in other people. They see others who use or drink with different outcomes and long to be like them. If they are aware of the disease concept of addiction, they may feel it is unfair that they have the disease. This failure to accept the full ramifications of the problem can lead to lack of effort in recovery or outright avoidance of needed changes, followed by continued use of old coping skills which can lead to a drink/drug.

B. Not finding a new and supportive social group – if a person in early recovery still spends time in the same places with the same people that they did while they were using, a relapse is likely. Remember the adage: “You are who you hang out with.”

C. Failure to clean up past behavior – recovering addicts can suffer from tremendous guilt, much of which is legitimately warranted due to their choices and behavior. It is critical that they begin to clean up their own past messes because it builds self-worth. There is not a specific timetable for this, but if avoided long enough relapse can ensue.

E. Replacing one addiction with another – sometimes addicts/alcoholics will justify using gambling, sex, work, etc. in an unhealthy way which continues the addictive mindset.

F. Failing to participate in aftercare programs following treatment – I hear stories all the time of people leaving treatment after thirty days and saying, “I’m feeling so much better. I have a lot to catch up on and I don’t have time for aftercare, sober living, meetings, or sponsorship.”

G. Simple pride – “I’ve got it all figured out now.”

3. Can we prevent our child from relapsing?

No. But parents can influence their child’s recovery one way or another. Building the relationship with your recovering child while they are sober goes a long way to help. You can learn to understand addiction and recovery and become your child’s greatest cheerleader. If you participate in your own recovery and learn about the family dynamics that contribute to your child’s stress, you can help reduce it. This does not mean removing the stress of “life on life’s terms,” it just means taking care of your own recovery to make sure you are not adding problems to the ones they already have.

4. What more can we do as parents?

Although you cannot decide how your child’s journey will go in recovery, there are plenty of things you can do to support them. Learn what you can about addiction and recovery by reading helpful literature and attending parent meetings. I strongly recommend to any parent of an adult alcoholic or addict that they read the book Alcoholics Anonymous if they wish to understand the alcoholic mind and behavior. Develop a support system for yourself that you can call on as you and your child go through ups and downs. Focus on building your relationship with them and do your best to let go of anger, guilt, and fear so you can focus on hope and love.

As I stated at the beginning, this is not a complete discussion on relapse. It is just a short overview. Relapse is common in recovery, and it may be a part of your family’s journey. If your child is currently sober, I think the best thing you can do instead of focusing on a possible relapse is to enjoy every day that you have a sober child. If they do relapse, it does not mean that they have learned nothing or that there has not been progress. For some people it is the needed lesson to build and strengthen their recovery.

This article was written by Josh Azevedo for Parents of Addicted Loved Ones and originally appeared on their blog for families of addicted loved ones here.

Modern Teens and Marijuana – A Talk With The Doc About Teenage Substance Abuse

By The Pathway Program on June 14th, 2021 in Adolescent and Young Adult Substance Use

We interviewed Dr. Scott Nelson, PhD to ask him some questions about teens, drug use, and information for parents. Dr. Scott Nelson is a native of Michigan, who came to Arizona in 1970 to attend college. He earned three degrees from Arizona State University: Bachelor of Science in Psychology, Masters of Counseling, and PhD in Educational Psychology. In spite of those three degrees, he never really got out of junior high school; spending the vast majority of his career with middle school students in the Tempe Elementary and Mesa Unified school districts. He is a retired licensed Psychologist, and holds a current certification as a school psychologist.

He has a passion for helping guide early adolescent’s in their journey to become positive, productive adults. The initial adolescent smoking cessation campaign in Arizona; Tobacco: “Tumor causing, teeth staining, smelly, puking habit,” was developed through interviews with students at Powell Junior High School, where Dr. Nelson facilitated a smoking cessation program.

Dr. Nelson has a long history of association with 12-step adolescent substance abuse programs, and firmly believes that such programs are crucial in providing young people positive alternatives to the many temptations confronting teenagers. He currently volunteers his services to the students, and community, of Willis Junior High School, in Chandler.

Q: In your experience, how does marijuana affect adolescents?

A: The use of marijuana in adolescence has the potential to stunt social-emotional growth, hamper the development of effective problem-solving, create doubt, diminish self-confidence, and foster negative parental and peer interactions.

While initial substance use may be experimental and “recreational,” continued use (and increasing use) tends to fill gaps in emotional development. So, the adolescent may become prone to choosing the substance in order to feel better, rather than engage in the sometimes complicated and arduous process of problem solving. Such reliance on “quick fixes” reduces the available repertoire of more effective, long-lasting solutions to the myriad of issues that confront the adolescent.

While the adolescent may feel accepted and relieved by the use of marijuana in the company of others, there develops the need to keep such behavior “secret” from parents, caregivers, and authority figures. The weight of such an emotional burden can wreak havoc with the adolescent’s self-concept and confidence. The lifting of such a weight is a nearly universal revelation of adolescents who have successfully been able to deal with their previous history of use. They report that there are other peer-based activities that provide the same dose of emotional satisfaction, as did the previous use of the substance, minus the emotional albatross.

Q: Have you seen a rise in marijuana use in middle school aged students over the last 2 -3 years?

A: Yes, I’ve seen an increase in the use of marijuana by middle school students. Back in the mid 80s, when I began my long association with 12-step adolescent substance abuse programs, it was the students who came to me and asked for help with their use. Today, it seems like marijuana use among early adolescents has become normalized. No, not every teenager is getting high, however, whatever stigma that existed; causing some kids to seek help for their marijuana habit, seems largely to have vanished.

Q: Has the perception of harm caused my marijuana use changed throughout the course of your career?

A: No, the perception of harm has not really changed over the years. Just variations on the same theme. “It’s green. It’s natural. It’s organic. It grows in the ground. Sick people use it. It’s legal.” Most of the current perceptions miss the point, the point of my response to the first question. And frankly, it’s unrealistic to expect early adolescents to grasp the gist of my first answer. They just want to feel better, feel good, escape, be accepted. And, marijuana fills those needs well. Early adolescents, by and large, lack the emotional maturity to grasp the potential harm associated with their behavior. They just want to feel good, right now. Just Say No failed to inoculate kids against the use of substances because the focus was on harmful effects, not on filling “holes” associated with emotional deficits. What kid is likely to say “No” to an activity that makes them feel better quickly?

Yes, adolescents should be made aware of the negative consequences of substance use. We should never stop telling kids what to do, and what not to do. However, we need to realize that only providing such guidance is not enough for some teens.

Having said all that, I must comment on the latest “shiny bright thing” out there; vaping, wax pens. This is not our grandparents’ marijuana. The combination of highly concentrated THC, the lack of counteractive CBD, and whatever else is cut in, increases the potential for harmful effects exponentially. Everyone needs to know that, not just kids.

Q: Did you notice parental attitudes surrounding youth marijuana use change throughout your career? How?

A: I think there has been a general lessening of concern over the use of marijuana over the years, coinciding with the passing of medical marijuana use laws, and the legalization of possession and use of limited amounts of marijuana for recreational use. However, I have encountered very few parents, over the years, who openly advocate for, or approve of, such use by their own teenage children.

The concern here is how kids perceive societal norms. And, it appears that the use of marijuana is becoming more normalized. Therefore, the combination of the immature adolescent mind, and an apparent increase in cultural acceptance of marijuana use has the potential of leading some adolescents down a slippery slope.

Q: At what ages do you believe substance abuse prevention is best delivered in schools? Why?

A: The question here is: What constitutes substance abuse prevention education. There is no minimum age for providing children with the emotional tools necessary to confront the challenges of living. Kids do not initiate substance use wishing for such behavior to become substance abuse. Kids turn to things that make them feel better. The more confident, comfortable, and committed any child is, the less likely that child will turn outward for compensation of emotional deficits.

So from day one of kindergarten, students need to be supported, encouraged, accepted and loved. Specific education on the effects of substance use should take place at an age when children can comprehend, not just hear, such information. My rough guess is that is about in the fourth grade.

Q: How can parents help prevent substance use?

A: If there was one way to parent that would guarantee a trouble free adolescence, they would have written that book already. It hasn’t been written. Nor will it ever be written. The real danger in adhering to someone else’s idea of what you should do is that rarely does that person fully grasp the complexities of your situation. Having said that, there are some things that might help. To the extent that kids don’t have to wonder or worry, they may be less likely to turn outward to soothe whatever fears they have. Raising a successful adolescent begins way before the onset of adolescence. To the extent that one can provide structure, standards, and routines, children will have less to question or doubt. What such standards are will depend on the unique set of circumstances in each family, which is why that “book” hasn’t been written.

Adolescents crave attention and approval. Don’t be shy about encouragement, support, and love. Don’t be afraid to enforce standards, limits, and rules. Remember that it is the adolescent’s “job” to question, to bump up against your “fences.” Do not be surprised or upset when they do. Just make sure the “posts” are firmly set in the ground. Listening to a teenager’s wants, desires, complaints, concerns, does not give license to such behavior. On the contrary, it validates deeply held emotions. The nonjudgmental listening to such allows the release of pressure, thereby decreasing the potential for explosion.

Q: What can parents do to help teens build resilience?

A: Be there. Be at their “address.” Nonjudgmental listening will let you know where they reside. Love, encourage, support. Laugh. Plan. Dream. Show hope. Establish routines, things your kid can fall back on when their world, which often differs from your world, is falling apart, or shattered into pieces on the ground. Every day is a new day. Things take time. One thing at a time. One day at a time. Nothing good and lasting ever started quickly. Every journey begins with a first step – take it. Take it with them. There are no guarantees. What has happened has happened, what’s next, move forward. Help others. Encourage them to give of their time in service to others. Resilience is all about confidence, comfort, and resources. Be a resource. Be there.

Q: How can a parent best nurture a positive relationship with a teen?

A: Talk, listen, communicate. Communication Resolves All Problems. Have expectations for your children. Have standards. Set limits, and hold to them. Help your child to Properly Interpret Social Situations. Some behaviors are only acceptable in some situations. Being able to “read” emotional and societal situations is as important, or perhaps more important, than being able to read the written word.

Having a positive relationship with an adolescent starts way before adolescence. Put in the time early. All the things I mentioned in my previous response apply here.

I raised twin girls. Everyone told me, “Just you wait.” They are now 29 years old. I’m still “waiting.” One day at a time.

Q: Can you share some lessons you learned from working with adolescents?

A: My favorite therapeutic statement is: “So, what’s it like to be you?” My favorite therapeutic behavior is to shut up and listen. My favorite therapeutic plan starts with: “So, what’s next?” And, then I shut up and listen, again. What I learned from kids is that each child brings their own baggage to the train station, and that I’m not the engineer, despite all my formal education. I’m the porter. I’m just helping them see a path to get where they want to go. I may carry their bags a bit, but I will strive to always return them “lighter” than when we first met.

All kids want the same things: Love, acceptance, approval, attention. While their behavior might mask their emotions, feelings, desires, masks are temporary, sometimes protective, and, ultimately, to be taken off. I’ve learned to be extra kind, extra gentle.

Q: Is a peer support system critical to a teen staying off of drugs?

A: Yes. Birds of a feather flock together. You are who you hang with. No man is an island unto himself.

Q: If you could have teens hear one thing from you regarding substance use, what would it be?

A: Things take time. You matter. Help others.

Q: If you could have parents hear one thing from you regarding substance use, what would it be?

A: You were a kid once too. Things take time. That behavior you see that you don’t like: it’s a mask. Beneath lies confusion, fear, frustration, sadness, disappointment… just to name a few. Be a Porter, carry their baggage a bit. Return it lighter than when you first picked it up.