Talking To Teens: Expert Tips for Parenting Teenagers

Andy:
Tell me about these books. I've got two books from you here, The Addicted Child, A Parent's Guide to Adolescent Substance Abuse, and also a workbook which walks through a bunch of different exercises, step-by-step for figuring out what kind of problems your team might be having, what kind of substances they might be using, and putting together a plan for how you can address it. What inspired you to create these books? And how did these come about?

Richard:
Well, I was really inspired to write these books as a result of my working at Menninger Clinic in Houston, Texas. Menninger Clinic is a psychiatric hospital that serves adults and adolescents. And I was hired there about 12 years ago as an addictions' counselor. So I worked on both the adolescent unit and the adult unit. In working with adolescents, I worked a lot with the parents and with the families of adolescents.

Richard:
I would conduct the assessment, I would give the diagnosis, I'd meet with the families and really tell them about their child's substance use history. And one of the most common responses I got from parents after telling them their child's history of using alcohol or drugs, was something like, I had no idea this was going on.

Andy:
Didn't realize, yeah.

Richard:
They didn't realize. Or if they did, they would say, well, I knew this was going on, but I didn't know it was this bad.

Andy:
Was that bad, exactly. Yup.

Richard:
So, and then I began to see that a lot of parents really don't have the resources to know what warning signs to look at. If they suspect there's a problem, where do they go? What kind of tests or assessments do they need? And then just a basic understanding of how alcohol and drugs work within their child's brain to both change the brain, and influence their child's behaviors. And one of the important messages that I wanted to communicate was that, you just can't look at the child's use of alcohol or drugs.

Richard:
If you look just at that, and you don't look at the underlying issues, you may be missing the reason why your child is using marijuana or drinking alcohol. Because there's almost always an underlying issue as to why a child is self-medicating. A lot of the kids that I worked with who were smoking a lot of marijuana multiple times a day, when I asked them to help me understand why they were smoking so much marijuana, the number one answer was anxiety.

Richard:
It helps me with my anxiety. So if a parent just treats for the marijuana and doesn't treat for the anxiety, chances are their child is going to relapse and continue using. So I wanted to help parents. Not every parent has the resources to send their child to a place like Menninger Clinic. Not every parent can afford extensive assessments and treatments. So I wanted to provide this resource for parents to help them.

Andy:
Well, I think you've done it. It covers all the different substances, it has statistics, it has science. And I like that it doesn't go too deep in the weeds. It just gives you the kind of a brief overview of everything. So then you can really get a good high level look at what might be happening with your teenager. And then you can dive in deeper from there to specific problem areas.

Richard:
I'm glad to hear that because that's exactly what I wanted it to do. I wanted it to be a resource that was not bogged down with a lot of technicalities, a lot of jargon, a lot of scientific information. Because this really is geared towards the average parent who just wants a basic understanding of how drugs and alcohol work. What are the warning signs? What do I do? And that's basically what that tries to do. The workbook is more directed towards the parents. It's to help them. It gives them exercises to basically work through some of the emotions that they're feeling.

Andy:
So talk to me about the drug danger zone. What is that? And why do we need to be aware of it?

Richard:
Well, I mean, parents need to be aware that the adolescent substance abuse is a big problem out there. The kids are turning to marijuana, they're turning to alcohol, they're turning to prescription drugs. And more recently, there's been an explosion in what's called vaping. And vaping nicotine has replaced cigarette smoking by teens, and also vaping marijuana.

Richard:
So parents just need to be aware of what's going on. A lot of these drugs are not aware of. A lot of the warning signs that they're not aware of. So this danger zone is very real out there. And most parents I don't think are attuned to what they should be looking for. They learn after the fact. They learn after some crisis develops. They learn after something has happened, where they've noticed a change.

Andy:
Yeah. You have a graph here in your book showing the ages when illicit drug use begins. And it's almost the vast majority is between the ages of 14 and 20. So really important time period in terms of getting teens on the right trajectory for all kinds of risk behaviors.

Richard:
Absolutely. Almost all addiction starts during the adolescent years. Very few people get addicted to a substance after say age 21 or 25. Most of it starts during adolescence in those teen years. That's when people are more vulnerable to it. And that's when adolescents are more vulnerable to it. And the big danger with adolescents is, and I address this in the book, is that their brain is still developing. So you take a 15, a 16, a 17 year old, young man or woman, and you start pushing drugs or alcohol into a developing brain.

Richard:
You risk not only that person becoming addicted, so to speak, but also some severe consequences in terms of their cognitive abilities, their short-term memory and the processing speed of their brain. I saw a lot of that with kids who were using marijuana and the test results would come back, the processing speed in their brain was below average. Their short-term memory was imposed. And almost all of them said that it pretty well significantly curtailed their motivation.

Andy:
Right, yeah.

Richard:
But those adolescent years are very vulnerable years for any child. The brain is still developing. And as that chart indicates that you saw, it is a very vulnerable time for young men and women to be experimenting with drugs.

Andy:
So what are some of the signs that would tip you off to the fact that there might be substance use problem going on?

Richard:
What I recommend to parents, Andy, is that they pay attention to any changes that they notice in their child. Because those might be signals that something's going on. That might not always be related to drug use. There could be some other issues going on like depression, or anxiety, or some other emotional issues going on. But it's important that parents pay attention to changes in their child. For example, a child who may have been getting very good grades all of a sudden starts to perform poorly in school and the grades drop.

Richard:
A child who used to participate and enjoy sports no longer is interested in the sports. A child who took pride in their physical appearance no longer cares what they look like. A child who used to have a lot of friends, and introduce the family to their friends, and all of a sudden becomes very secretive about their friends. So parents need to be aware of these changes in their child's attitude, behavior, or appearance.

Richard:
Not take them for granted, but look at them as cues, or signals, that may be something's going on that they need to investigate. It might be alcohol, drugs, it might be some other emotional issue. But those are signals that something's going on that parents should not ignore.

Andy:
So then when you notice those kinds of things happening, what's the next step? Or how do you start to look a little deeper and diagnose what might be going on?

Richard:
The next step is to get an assessment done. And more likely than not the child's going to resist.

Andy:
I like that idea.

Richard:
They're not going to like that idea. They're going to say, "Hell no, I'm not doing that." But parents need to hold the line firm. Because it really is critical to get an assessment. And by an assessment, I talk in the book about a comprehensive assessment. We can't just focus on the alcohol or drugs because we might be missing some other issues. So the book talks about what's involved in a comprehensive assessment. For example, you want to get a complete medical workup, that's blood work, EGS, AKGs, MRIs, the whole good, solid physical examination.

Richard:
And you also want to get an addictions' assessment because there may be alcohol and drugs involved. And you want to get a psychological assessment, either from a psychologist or a neuropsychologist. Where you can look really deeply into what emotional or psychological issues might be going on with your child. Then you can take all those pieces and put the puzzle together to come up with a treatment plan and a diagnosis. So bottom line, if you suspect something's going on with your child, you need to get a comprehensive assessment done as soon as possible.

Andy:
So then that means you're going to a lot of different professionals and asking them all to run different tests and stuff? So then how do you kind of integrate all that information together or keep track of it all?

Richard:
Well, I would say the first person you go to is your family physician if you have one.

Andy:
Okay.

Richard:
Because that's the person that's going to probably make some good referrals for you.

Andy:
Yeah.

Richard:
I would not necessarily say that you need a psychiatrist right away, a lot's going to depend on the outcome of the assessment. But you probably want to deal with a psychologist to do a good comprehensive assessment. Many psychologists can also do a good addictions' assessment. So you might be able to get both a psychological assessment and an addictions' assessment from the same psychologist. You'll want an MD to do the physical exam. So you might only need your regular MD to do a good comprehensive physical, and then recommend a psychologist.

Richard:
If the psychologist completes the assessment and decides, okay, this is what I think's going on. He or she may refer you to a psychiatrist, a child psychiatrist, or may refer you to a neuropsychologist to look a little bit more in terms of what's going on inside the brain. But I would start with my family physician and probably a psychologist. And that'll get you the baseline. And that will also determine if more people need to be involved in this assessment process.

Andy:
For one thing, I'm interested in, you mentioned that the kid is probably not going to like this assessment happening. So how do you recommend parents handle that? What do you say? How you get them? Are you just dragging them kicking and screaming into the doctor's office to get them looked at? Or is there a way to discuss this with them and get a little bit of buy-in from them that you're doing this? Or does it totally vary?

Richard:
It totally varies. I think a lot's going to be based on the kind of relationship you've developed with your child. I once had a person ask me, well, I don't have a child who's a teenager yet, but what can I do now to prepare for that? To lay the groundwork for my child doesn't start using alcohol or drugs. And my recommendation was, start developing that trust and that open communication.

Andy:
Strengthen the bond, yeah.

Richard:
Strengthen the bond so that later on, you may find that that's been a good investment for you. Generally, a child is going to kick and scream and fight about an assessment. So you may have to just literally insist that it be done. Sometimes an incentive will work, a reward, we do this. But bottom line is, one way or the other, you have to get that assessment done because without it, you don't know where you're going, you're in the dark.

Richard:
And some kids will just go along with it. Others will fight you along the way. Now if it's a really serious situation and the child obviously is overdosed, or taking drugs that have involved going to the hospital, then you may have to call 911. You might have to have an intervention, and the police come and the child is taken to a hospital where they can stabilize the child and then possibly admit them. But it is critically important that you get that assessment done.

Richard:
A lot of young men and women whose parents brought them to Menninger, they were at the end of their rope. They didn't know what to do. It become really a serious situation. And then they had to bring their child. Some of them come screaming and yelling. But they held the line and they forced them into the treatment. And they went through the assessment process. Which took about three weeks.

Andy:

And so if you're suspecting, but you're not positive about substance use issues, do you say that specifically to your teenager, "I'm worried about that drug and alcohol use, and I want to get a comprehensive assessment done. So I scheduled that for Thursday, we're going?" Or how do you approach that?

Richard:
I wouldn't necessarily jump to the conclusion that the child is using a substance.

Andy:
Yeah it could be something totally different.

Richard:
It could be. And so I would sort of go along the lines of, "Look I'm concerned about the behaviors that I'm seeing. Here are some examples of what I've seen, I'm really worried, I want to help you as much as I can. How about we start with having somebody give us a good assessment so that we can find out, not only what might be the cause, but also how we can help you feel better." In other words, sort of lay the foundation that what you're really trying to do is help your child.

Richard:
You're not accusing them of anything. You're not telling them anything. You're basically saying, "I'm concerned, let's together go find out what's going on, and then we can decide where we're going to go from there." Because you're right. It might not be alcohol and drugs. The child might be depressed. The child might be suffering from some type of stress, or some type of an emotional problem that they haven't talked about.

Andy:
And then so what if that doesn't go well? What if they say, no, I don't need that, this a stupid conversation ever.

Richard:
Well, it's at that point then you have to put the ultimatum down, you will do this, you don't have a choice. We're going to do it. I dealt with a lot of kids who that was their reaction to their parents, and their parents held the line and said, no, we were going to do it. And didn't really give them a choice. And ultimately they caved in, they can. They were mad. They were angry. They were upset. But that calmed down after a day or two. Some of them even being transported to Houston by their parents, up until the last minute we're trying to negotiate their way out. No, no, no.

Richard:
But the parents held firm. And I think a lot of that, Andy, is because they're just so emotionally exhausted with the struggle, that they've drawn the line and they said, I can't deal with this anymore. Regardless of what my kid is telling me, regardless of how much they're fighting me, I'm emotionally exhausted. I need to get this resolved. And so they bring the child, one way or the other, they get them into the assessment. Now that's in severe cases. That's where the child is really addicted to a substance and is using it extensively. For most people, I think the plan is just to get your child to your doctor and-

Andy:
Take them to the family physician, “We just want to get everything looked at. You don’t have to like it, but this is really important to me, and I love you so much that even if you hate me for it, we’re going to do it anyways."

Andy:
You talked a little bit about some of the effects of marijuana earlier, but you point out on page 26, that actually only a small percentage of high school seniors believe smoking marijuana involves any great risk at all. 15% say maybe it occasionally poses a risk, and 30% believe that doing it regularly is a risk. So it's hard to have a conversation and saying, hey, this is not a good thing to do when you're a teenager maybe has these strong beliefs that it's really not a big deal. Why is that? Where do you think those kinds of beliefs come from?

Richard:
First of all, I think that they're seeing that more and more states are legalizing marijuana.

Andy:
“How big of a deal could it be? Come on. Everyone else is doing it.”

Richard:
That's it's got to be cool. It's got to be okay. What's the big deal?

Andy:
I'm only a few years really away from 21 anyways, and then it's totally legal. So what.

Richard:
Yeah, so what's the big deal? And they really don't perceive a lot of danger to it. I mean, some of them, their friends are smoking marijuana. They're smoking marijuana. They're chilling out. They're having a good time. What's the big deal? And they say to parents, you're overreacting, you're making a big deal out of this. What I found worked with these kids more than anything else because telling them it's illegal meant nothing to them. Telling them it was bad for them meant nothing to them.

Richard:
So what did capture their attention, was the neuroscience. When I talked to them about how marijuana worked in the brain, and I would show them a picture of a diagram of a brain, and I would show them where marijuana attached to different parts of the brain, I had their attention. Because they were interested in the neuroscience. They were interested in how marijuana affected their brain. And if I had a test and I had the testing done, I could show them, okay, you've been smoking a boatload of marijuana, here's what's going on in your brain.

Richard:
The processing speed of your brain is below average. Okay. We know that because we tested it. We know that your short-term memory is impaired. We know that because we tested for it. So you tell me, you're smoking marijuana. You now see what it's doing to your brain. Your short-term memory is impaired. The processing speed of your brain is below average. And you tell me that your motivation has been sapped. So there you go. Now you got to decide what you want to do. And I would never tell them to just quit. That's a decision they have to make.

Richard:
But I would encourage them to suspend their use. So I would say to the young man or young woman, okay, the processing speed of your brains below average, we know that. Your short-term memory is not as sharp as you would like for it to be. And your motivation is not so great. So how about we agree to stay off marijuana for three to six months, you pick it. And then stay off the drug for three to six months and get retested.

Andy:
Take some new tests.

Richard:
Take some new test because I'm betting that, that processing speed of the brain will come back up to average. Your motivation will be better. And your short-term memory will be sharper. And then you can decide for yourself what you want to do. But check it out. So that seemed to capture their interest. Learning about how it was affecting their brain, because these kids are pretty bright.

Richard:
They do care about their brain. But I think that is one road into helping them understand the consequences of marijuana as an adolescent. My concern with using anything as an adolescent, again, goes back to the brain developing. It's just not a good idea to push things into a developing brain.

Andy:
You also mentioned vaping, and jeweling, and nicotine, which is another huge thing right now that teenagers are doing. So what do we need to know about that? And what kind of strategies can parents use to communicate about that, and make sure teens know that we don't approve of it?

Richard:
Well, almost half of seniors in high school are vaping some type of substance. Primarily nicotine and marijuana. It is exploding. If you look at the statistics over the last few years, vaping of nicotine and vaping of marijuana is just off the charts. It's rapidly increasing. And I think a lot of it is because of the availability of the substance. There's also a perception among young people that vaping somehow is safer than smoking cigarettes.

Richard:
The bottom line is whether you smoke a cigarette, or you vaped the nicotine through a Juul or some other device, you're still putting something into your lungs. One way or the other. But it is becoming a major problem in the adolescent community and one that parents need to be aware of, and even teachers. Because I'm sure you've seen these vaping instruments that look like USB drives. So teachers don't know. They think is just a USB drive. Kids are clever, they know how to fly under the radar.

Andy:
And so the same sort of thing. Your teenager going to feel like, hey, this is not a big deal. Everyone does it. It's not smoke. Smoking causes cancer, but vaping is all good. Right? So is that a similar thing where you're going to start testing them and showing them that it's having effects on their brain? Or what? Is there a different approach that you kind of use for vaping?

Richard:
Well when people used to ask me, what's the danger with marijuana? My number one response was the biggest danger to marijuana is respiratory. And because you're sucking something like smoke into your lungs, it doesn't matter whether it's coming from a joint, or from a vaping pen, it's still substance going into your lungs. And that's just not a good thing to be doing.

Richard:
And again, I think it comes down to working with your child, developing a relationship, helping them understand the dangers involved, and setting an example. And letting your child know that “This is unacceptable behavior. And why? It's unacceptable because it's hurting you. And I care about you and I care about your long-term health. You may be thinking vaping, nicotine is cool now, but in 10 or 15 years, when you find out that the ramifications of that involve some type of respiratory disease, you're going to look back and say, well, maybe it really wasn't worth all that fun I was having. And as a parent, I want to keep that from happening for you.”

Andy:
Yeah. I think being informed about all these things so you know what the consequences are as important. And then some of these things like vaping, we don't know that much yet. And studies will have to keep coming out over the next 10 years and such.

Andy:
I've been reading a lot of books about aging and longevity recently. And I was reading something interesting that was talking about one of the strongest predictors of Alzheimer's particulates in the air. And people who live in areas with higher levels of particularly nanoparticles in the air, much more likely to develop cognitive decline as they get older, which I hadn't realized before. But really interesting starting to think about how these things sucking all those particles into your lungs from a vape pen, especially starting so early in life, we don't know. But what's going to happen later on, but could all be some really, really potentially serious consequences that we're just not aware of yet.

Richard:
I think that, that's an excellent point because as you mentioned, we do need to continue studying the long-term effects of a lot of the behavior that we're doing. Whether it's inhaling a substance like marijuana or vaping nicotine, or breathing polluted air. We don't know the long-term consequences. So what does that mean? That means, because we don't necessarily know the long-term consequences. Are you willing to gamble?

Richard:
Are you willing to gamble with your health? Because you're basically gambling that my behavior now, smoking marijuana, taking drugs is not going to affect me 10 or 15 years down the road. That's the bet you're placing. And the risk is your health. Because we really don't know. We really don't know. And may not know for years down the road, what the effects of a child taking some of these substances are now. Sometimes we do know.

Richard:
Sometimes through the testing we know, like the example I gave with marijuana that the short-term memory has been impaired, or the processing speeds been impaired. Those are fairly quick things that we can figure out. But in terms of the respiratory system, the longterm medical consequences may not show up for 5, 10, 15 years down the road. Especially for a young man and woman who might be heavily into say, vaping nicotine.

Andy:
Well, yeah, because also nicotine from what I've read is one of the actually substances that has the most evidence that it actually enhances neural functioning. So I don't know. I don't know if we want to run the tests on their brain we're going to show them well, actually, you're looking pretty good.

Richard:
That you might run into that from time to time. But again, it's the long-term consequences that may have an opposite effect.

Andy:
Yeah, exactly. We're here today with Richard. Capriola talking about what to do if you suspect your teenager might have a substance use issue. And we're not done yet. Here's a look at what's coming up in the second half of the show.

Richard:
Why are they using the drug? People don't always use drugs because they're stupid. Usually there's an underlying, emotional, psychological, psychiatric reason why somebody is using a substance. This usually starts to develop at very young age, even before high school. And I think the reasons for that is because the so-called inhalants are readily available.

Andy:
And around.

Richard:
A lot of them-

Andy:
In the garage.

Richard:
Exactly. They're household products.