Watch this video about adolescent drug use and addiction with Dr. Matt Klein, DO, the psychiatric consultant for The Pathway Program, and is board certified in psychiatry and adolescent psychiatry.

If you would prefer to read, rather than watch the video, scroll down to find a transcript of the interview. Also, timestamps are provided directly below the video if you would like to skip to a specific question.

Timestamps

• 0:20 – Can you give us a brief overview of who you are and what your role is at the pathway program?
• 2:25 – What type of patients do you typically work with at the pathway program?
• 3:19 – What do you think the young people you meet with drug problems typically struggle with the most?
• 5:57 – Many parents struggle to determine which came first, the drug use or the mental health symptoms. What would you say to parents in this sort of “chicken and egg” debate?
• 9:04 – What trends have you noticed among the young people you have seen over the past few years?
• 10:58 – If you could give a single piece of advice to a parent who finds themself trying to help their drug or alcohol abusing son or daughter, what would it be?

Q: Can you give us a brief overview of who you are and what your role is at the pathway program?

A: I’m Dr. Matt Klein; I’m a psychiatrist here in Arizona. I am a DO, and I’m board certified in psychiatry, as well as child and adolescent psychiatry. I’m also a psychiatric consultant for Pathway. My role at Pathway includes providing input in a general sense for certain situations, or if someone needs more specific psychiatric help, they will see me for evaluation and further management. What that has often incorporated is young people who were abusing drugs, they weren’t telling their family, and they look like they have all kinds of disorders as a result of that. The family did what was reasonable and took them to a professional. Because this young person doesn’t want to stop using drugs, they lie about that, and end up with diagnoses and prescriptions and oftentimes that may not be the case because of the drug use causing a lot of emotional lability and depression and anxiety, especially anxiety, when they are not on drugs. Many of these things can resolve and we’ve seen many cases where they just resolve naturally through the treatment at Pathway. My role is often to take a reevaluation, especially when the person in treatment has become more honest about what has been going on, and really reevaluating what is appropriate or needed and working with someone through that process.

Q: What type of patients do you typically work with at the pathway program?

A: The people I usually see at Pathway are people who are in the Pathway program – adolescents and young adults with drug problems. Most typically I’m just reevaluating the patient because they have become honest about their drug use and prior to that may have appeared to have other problems because they weren’t honest about drug use and showing a lot of emotional lability or depression or anxiety or all these other things which could be a part of their drug abuse. Reevaluating that, and reevaluating their medications and helping support them through that process, especially while they are in outpatient [treatment for drugs].

Q: What do you think the young people you meet with drug problems typically struggle with the most?

A: A common problem when people are abusing drugs, especially young people, is that adolescents are at a time in life where they are getting out in the world, socializing, and learning how to navigate these situations, and often don’t have a lot of skills. It’s a time in life where they are developing these skills. The natural thing would be, if you make a mistake, to feel bad about it, go back, and amend the situation or learn to not do that again. Whatever the situation is, the consequences of life will help guide someone through that process and learn how to form and maintain relationships. If you say something that hurts someone’s feelings, you should probably feel some guilt; that’s a natural consequence of that. When people start using drugs, they abort that process. If a mistake is made, well, it’s OK because tonight, I’m getting high. That’s the process they begin to develop, and as a result, that whole natural developmental process of socializing and learning how to have emotions and respond to emotions really gets arrested because there’s a quick fix. That’s probably the most common theme I see among people I work with at Pathway. They have a reason to come off drugs, but then they feel totally inadequate because they don’t have any skills, and it’s really intimidating. It creates some extra anxiety because I’m losing the one thing that helped me through all this, and on top of that don’t have any other options, and so it leaves people really anxious. That, across the board, really does resolve throughout treatment at Pathway as people begin to go back and go through that process of developing skills and things that they are missing.

Q: Many parents struggle to determine which came first, the drug use or the mental health symptoms. What would you say to parents in this sort of “chicken and egg” debate?

A: In the substance use treatment world, or mental health world, there has been a lot of talk about this term “dual-diagnosis”. That typically has meant that someone has a drug problem, and another psychiatric problem. These can be viewed in a lot of different ways. Some people see that someone was depressed or anxious and they used drugs to deal with it, and really the problem is that they are depressed and anxious. Through our experience here, that we’ve seen, when the drug problem isn’t addressed, those other problems don’t get addressed anyway. So, regardless of if it’s dual-diagnosis or not, if the drug problem is not addressed, the underlying issues or the other problems, even if those other problems didn’t contribute to the drug problem, they still won’t get addressed very well, if at all, while using drugs. On the flip side, sometimes people start using drugs first, especially young people. They love to start using drugs because it’s fun and their friends are doing it. Throughout that process, they become dependent and it becomes their coping tool. These patients will often develop depression as a result of their drug use, or become anxious because a lot of drugs, when you’re not using them, create anxiety as more of a withdrawal effect or prolonged withdrawal effect. If someone’s dependent on drugs, and they don’t have drugs coming in or they’re not sure where they’re coming from, those people get very anxious at that time. It can be sometimes very difficult to tell, especially at the very beginning of treatment if someone had an underlying issue that contributed to the drug use or if their drug use created other issues that then become their own separate issues. The bottom line is you’ve got to take care of the drug use before you can proceed successfully in any other of those areas, at least from our experience and what we’ve seen. You’ll often find that when you address the drug problem to help someone keep from returning to the drug problem, they will have to begin working out how to cope with these other things.

Q: What trends have you noticed among the young people you have seen over the past few years?

A: Some of the trends I’ve seen… One that’s particularly interesting to me is that in the past few years people’s first drug use, at least that we’re seeing at Pathway has not been alcohol. Years ago, almost everyone’s first experience of drug abuse was alcohol, because it was so accessible. A common situation was being at a big wedding and there was alcohol easily accessible and that would be someone’s first experience using – alcohol or getting drunk before any other drug use. Today it’s much different. Very commonly the first use we are seeing is marijuana, which makes me wonder if marijuana is more accessible than alcohol to young people. That’s unfortunate, because there’s a lot of negative effects of marijuana on adolescent brain development, and that’s pretty well researched. The other trend I see is pill abuse starting really young. Sometimes that’s someone’s first introduction to drug use, even before alcohol, is getting Xanax from a friend. Benzodiazepines are a huge issue. There’s a lot of talk about the opioid epidemic and that’s a big issue as well, but we’re seeing a lot of people using benzodiazepines early or before other substances that they are abusing. These are dangerous substances. People can become addicted and have very serious consequences from withdrawal from them.

Q: If you could give a single piece of advice to a parent who finds themself trying to help their drug or alcohol abusing son or daughter, what would it be?

A: If I had some brief advice to parents in general, if you find out your child is using drugs, seek professional help or get a professional opinion, especially from people in the substance use field. A lot of people think, maybe this is just a phase, or it was just a phase for me and I’m OK now, but what if it’s not? Do you want to take that risk? If you find that your child is using drugs or alcohol, I’d say take it seriously. Get an evaluation or help from someone – a professional in the field of addiction and don’t take that risk.

The following is an interview with Kim Miller, LCSW, LISAC, and Pathway’s Chief Clinical Officer. We asked her 11 questions about the recovery process, the family’s role in the recovery process, the Aftercare process, and her thoughts on clients seeking outside therapy.

If you would prefer to read, rather than watch, just scroll down past the video. The entire transcript will be provided there. If you would like to skip to a certain question, timestamps will be included below the embedded video and above the transcript.

Timestamps

• 0:21 – Can you briefly discuss who you are? What are your credentials?
• 1:09 – What type of people do you typically work with at the Pathway Program?
• 2:23 – What do you think young people you meet typically struggle with the most?
• 3:55 – What do you find the parents struggling with the most?
• 5:36 – At what point should someone in drug or alcohol treatment seek outside therapy or help?
• 7:02 – Do you think it’s important to set up aftercare before leaving treatment? How do you think families should go about this?
• 8:31 – You’ve said you believe that connecting young people into a community is important for their recovery. Why do you think it’s such a big deal?
• 10:34 – I just found out my son or daughter is using drugs or alcohol. Where should I start?
• 12:15 – Drug and alcohol addiction can be devastating on a family. What do you think are the best ways for a family to begin healing?
• 14:14 – You mentioned the family having their own recovery plan. What would be some key components of a family member’s recovery plan?
• 15:45 – In closing, is there anything in particular you would like parents who are going through these tough decisions to know?

Interview Transcript

Q: Can you briefly discuss who you are and tell us your credentials?

A: My name is Kim Miller, and I’m a licensed clinical social worker, a licensed independent substance abuse counselor, and a certified somatic experiencing practitioner. [I am] an EMDR clinician, and I do brain spotting, and I’m also a certified sex addiction therapist candidate. My role at the Pathway program is Chief Clinical Officer, and what I bring to Pathway is I have a lot of specialty in mental health, addiction, and trauma, as well as the interplay between all three. Also, I have the ability to really take a look at what’s going on for someone from all those different angles, really bringing in a three-dimensional approach.

Q: What type of people do you typically work with at The Pathway Program?

A: The clients that I work with at Pathway are adolescents age 13-17 or young adults age 18-25. I really enjoy spending time with young people and just watching them come from, maybe, a “failure to launch” kind of scenario or difficulty finding their way and then watching them become very joyful and full of life. It’s just one of my absolute passions. I love working with young people for that reason. I also really feel like, you know, the piece that I can bring is if you have young people coming in for substance issues, and then other things are arising, there’s an opportunity there to see what we can do to create a plan and that’s frequently the type of people that I end up being able to really work with on a deeper level. So if there’s trauma, or if they have some other outside issues or addictions that arise in their process, it’s an opportunity for me to be able to assess them or help create a plan for them to be successful.

Q: What do you think the young people you meet with drug problems typically struggle with the most?

A: I think young people with drug problems typically struggle the most with how to just grow up. I would say they are coming in and just struggling with … some of their failure to launch, they are struggling with, “How do I respond now to life? … for a long time now I’ve been using substances, or I’ve been very distracted by a substance-using type of lifestyle.” Sometimes the very basic things that they’re trying to do, they don’t know how to them, or they’ve never had the opportunity to do things that might be … age appropriate. I would say they are primarily struggling with, “How do I live on the planet? How do I get a job? How do I do a resume? How do I have interactions with other people? How do I have fun?”

The biggest thing that we are really working on with them is to have an enjoyable life, and have a life that’s fun and full of friendship and community. I really think that’s a piece that’s missing: if we just give people skills for progressing in life. But I think if we can give people the opportunity to also have fun and have a group of friends around them, I think that’s really valuable. 

Q: What do you find the parents struggling with the most?

A: I would say that parents who are struggling with young people that have drug problems are primarily struggling with how to parent their loved one according to the age that they actually are, knowing that they have a drug problem and their emotional growth is delayed. Watching them navigate … “How do we expect him or her to be an adult, or young adult, or adolescent,” while also keeping in mind that maybe some of their skills have been compromised. At the same time, “How do we hold them up to a high bar? How do we get them to be closer to where we’re hoping they can be at a certain age to be functional?”

I also notice for a lot of parents, what can really hold them back is just different fears, shame, or things that they feel like they’ve done wrong. Maybe sometimes they blame themselves. They think, “This is all my fault that my loved one has turned out this way.” That actually ends up being a really critical point in all of our sessions that we’re doing together – really working with the parents on how to take a look at their fear. How to take a look at things like resentments or anything that they have that they need to let go of emotionally – to just be able to dive into the present moment and see their young person for where they really are, and to get a really accurate picture of the reality of the situation, and then be able to respond to their young person from that standpoint.

Q: At what point would you recommend that someone in drug or alcohol treatment seek outside therapy or help from a professional such as yourself?

A: I would recommend, if a young person came in and we were trying to evaluate the situation, first and foremost, if somebody asks for help with some outside services or they are asking about some specifics around a certain situation, I’m all ears. That’s when I start really diving in and listening and seeing what we can do. There’s quite a few young people that will actually say, “I want to work a little deeper on this issue.” Then we get to evaluate. Is that something we would want to bring somebody into the treatment team to help with, or is this something where we can help them come up with more of a plan?

I also think that sometimes, if you see somebody in treatment and they’re getting stuck, and you’re also noticing in their assessment a significant history of grief, trauma, or mental health symptoms, you do want to catch those right away up front and be really mindful. I think it’s good to continue to evaluate people, and if you do notice that there’s different issues coming up or different situations coming up that do need further addressing, that’s a really good opportunity to take that to the treatment team and come up with a plan.

Q: A lot has been said about the lack of aftercare programs and resources available to drug and alcohol treatment patients and their families. Do you think it’s important to set up aftercare before leaving treatment? How do you think families should go about this?

A: Aftercare planning or discharge planning should happen from the moment your client hits the door. They are going to be at your facility with a really well guided staff – but what happens when they leave? This is … a really important thing to address. We know that a lot of steps back or relapses happen within just weeks of leaving a treatment center. Studies have shown over and over again the absolute importance of having plans from the moment they hit the door all the way through treatment and having those very solid and stable and in place so that the minute that they leave, they are literally walking right into the next phase of their treatment, which is part of their aftercare plan. Any program that you’re looking at that doesn’t have really strong aftercare planning, which might include social, spiritual, physical, meetings, opportunities for people to continue to grow in their trajectory. There should be opportunities for them to attend outside meetings, for them to come up and do alumni meetings, for them to hopefully be able to reach back somewhat sometimes to the staff for further support. I think all these things are really key in the process. 

Q: You’ve talked in the past about how you believe that connecting young people into a positive community is important for them to recover. Could you discuss that a little? Why do you think it’s such a big deal?

A: It’s so important that we have a community around us. Especially in a recovery community if you’re going in for help for substances or even mental health or trauma. It’s really important that we have those people around us for a sense of connection. I think a lot of people feel that the opposite of drug addiction is connection. I think that having a community is such an important part of … finding our way back to relationships. Maybe we’ve never had relationships before. I think if we don’t have a plan to include that as part of someone’s treatment or even part of them leaving treatment, I think we are missing out on a really big piece of the puzzle.

Having a community to laugh with, to share with, and to talk to is just so vital to who and what we are as human beings. We absolutely need that to help us [find] our way. I think it should be a big part of the recovery process and I think it absolutely has to be a part of the aftercare process for people to really build themselves into a support system and build themselves into a greater community and learn how to be back in with social engagement with other people. Being able to connect and be in connection and relationship with other people is so important. In my opinion, what drug use does is it separates us and it isolates us. So much of that recovery process is if we can come back into connecting with one another. It is such a big part of the healing process.

Q: I just found out my son or daughter is using drugs or alcohol. Where should I start?

A: I think one of the best ways for a family to start healing is for a young person to … get evaluated [and] for the family to treat it as if it is an issue. I think one of the biggest things we can’t do is underplay things. I think the sooner that we say to a loved one, family member, or young person in our life that’s struggling with substances, “We need to just go somewhere and talk to someone who’s a professional.” I think it’s OK to have someone come in and evaluate the situation other than a family member. I feel it’s very difficult with our own family members to get a read on if something is out of the norm or if there’s an issue. I think it’s better to not underdo something. I would rather have someone overdo it a little bit – maybe bring someone in to get an evaluation for them to decide it wasn’t as bad as they thought. One of my fears with substance use is sometimes we’re just seeing the tip of the iceberg. If we’re catching somebody in a pattern that we didn’t know was happening or we’re catching them using, there’s usually more than meets the eye. That’s why I usually tell people, one of your biggest moves is to take somebody in and get them evaluated, have them work with a professional, and ask a professional some questions.

Q: Drug and alcohol addiction can be devastating on a family. What do you think are the best ways for a family to begin healing?

As far as the family recovering, I have seen families do the best when the family members themselves are actually involved in the treatment process. I cannot reiterate enough how much having family there is probably the most critical part of the entire process. If I have a young person come in, I’m immediately looking – even if they’re over 18 – at what their family system looks like. Who can we bring into the process? [I start] getting the family members introduced to Al-Anon or other support meetings or support groups. [I start] getting a community for the family members. When I see a whole family all pulling on the same rope as best as possible, I have always seen the best outcomes. Having the whole family get involved in the process as much as possible is one of my primary goals in working with people.

I will say, just briefly, sometimes you don’t have that opportunity. You may have someone who can only bring in one family member. Then, I’m working with that person to say “bring in that one family member, bring in your sponsor, bring in a neighbor, [or] bring in somebody who’s supportive.” Bring more people into your community that we can really help be a part of the process with you. There’s something about building that sense of relationship and community … that comes into play with family members, too, whoever that young person deems as their family, like good supportive friends. I would say just bringing in the whole family as much as possible into the process, and having them have their own recovery plan, too. 

Q: You mentioned the family having their own recovery plan. Could you touch on that a little bit? What would be some of the key components of a family member’s recovery plan?

A: Oftentimes, if you have a young person who’s coming in for help, what I typically find is I have a family coming in with them who’s hurt. They’re scared. I even have family members who say, “I feel like I have symptoms of somebody who’s just lived through something that’s a really big tragedy or a big trauma. I feel so afraid or I feel so stressed out.” These are the kinds of reactions sometimes that I experience when family members come in. Sometimes [I work to help] family members get their own counselor, or help them be connected with their own support system or their own support group. I have family members who might get their own sponsors and work their own program in a 12 step program or other platform. To me, I think it’s evaluating a recovery plan for a family member to get their own support and their own services. I have them reading books. There’s a bunch of books out there that I think are a really helpful part of the plan for them. Sometimes they are doing their own writing and their own writing assignments, or doing work to let go of any fears or shame, resentments, or different things that are holding them back from responding as well as they would like to respond.

Q: In closing, is there anything in particular you would like parents who are going through the tough decisions of putting their loved one in treatment to know?

A: If you are considering putting your young person in treatment, and you’re like many parents or family members who’ve come and walked this road, just know that it’s hard, it’s difficult, there’s a lot of questions, but that more than likely if you’ve come to this point, there’s something going on that you’re concerned about. It’s not … easy to be validated throughout this process. A lot of people feel like they’re turned upside down, or they’re confused or they’re not sure which direction to take. I would absolutely encourage you just to come in and get some information. Get a little information about how to set up an evaluation to have somebody else take a look at the person that you’re concerned about. Especially if you’re not sure. It’s OK not to be the treatment center, or not to be their treatment counselor. A lot of families say that one of the most valuable things they’ve learned in a session is that they don’t have to have all the answers. They don’t have to be the ones creating a treatment center at home to try to help their young person. They can reach out to people who have experience on this to get input and help and resources, so that they can hopefully find that path back to relationship again with their family or their family member.