Talking To Teens: Expert Tips for Parenting Teenagers

Andy:
So okay, so just talk to me a little bit about what led you to write this book. It's called The Addiction Inoculation: Raising Healthy Kids in a Culture of Dependence. And your previous book was really about the importance of failure and giving kids space to make their own mistakes, and seemed to strike a chord with a lot of people. And so after that, then, you thought this was the direction that you wanted to go in. Why is that, and what led you here?

Jessica:
So The Gift of Failure, you have to know a little bit of the backstory. So I've been a teacher. I was a teacher for 20 years. I was teaching middle school when I started becoming a journalist on the national stage. I wrote an article in January of 2013 for The Atlantic, called Why Parents Need to Let Their Children Fail. That led to a book, and The Gift of Failure sold in a big, huge auction, like 14 different editors. It was a big, huge deal. And the problem with having a big fat hairy deal with your first book, especially when it hits the New York Times bestseller list, especially when there's just a lot of buzz around it, is that you have to write another book. I mean, as writers, we are only as good as the last thing we wrote, right?

Jessica:
So the minute The Gift of Failure came out in 2015, people start saying, what are you going to write next? I was feeling a lot of pressure to figure out what that next thing was going to be. Oh, and you also need to know that I'm an alcoholic, and I got sober in June of 2013, right after I sold The Gift of Failure, mainly because I knew I was going to blow this huge opportunity, my marriage was going to fall apart. And I'm one of those addicts, alcoholics, who had a lot of not yets, but all the really bad stuff was just about to go down. I was about to start day drinking. I was about to start driving when drunk. I was about to start all of these things that had been my lines in the sand, that said I would never, ever do. And I could see them. They were right there.

Jessica:
So I got really drunk and blacked out at my mom's birthday party on June 7th, 2013. And the next morning, my dad, basically it's in the book, what he said to me is, "I know what an alcoholic looks like, and you're an alcoholic and you need help." And he was in a really good position to say that because he was raised by an alcoholic, and I was raised by an alcoholic. So the minute I got my sobriety somewhat in hand, or at least had started to deal with it, immediately my thought goes to my kids.

Jessica:
And at the same point in time, I was teaching. I taught for five years in a drug and alcohol rehab for adolescents. So I was sort of a teacher of everything, but mostly writing, in this drug and alcohol rehab. And I was constantly thinking about how these kids end up here. What is it? These just look like regular old kids. They're poor kids. They're rich kids. They're kids that come out of the foster care system. They're kids that have two loving parents at home. Why are they here in my classroom in a rehab? And what could we have maybe done differently?

Jessica:
And so I'm thinking about my kids. I'm thinking about my students. And at the same time, I'm starting to learn about prevention, substance use prevention, and finding out a lot of stuff that I'd never heard before. And so that's sort of in that moment of I was driving down to a speaking gig in Massachusetts, and I was on route 93. I was at the Hooksett tolls, right outside of Concord, New Hampshire. And it all, bam, there it was, the title and everything. And I pulled off the side of the road and I texted my two best friends, who co-host the #AmWriting Podcast with me, this podcast about writing, and I said, I've got it. This is it. And as soon as I proposed it to my agent, she's like, "Ooh, addiction. That's a really tough shelf. That's a tough sell because it's scary, and no one really wants to talk about it, and getting parents to pick up and spend money on a book on something that scares them is tough."

Jessica:
So we went ahead with a full proposal to my editor because we were so nervous that my editor wouldn't want it, that I said, we'll have to just go out to other publishers at that point. So anyway, that's the very long story about how this book came to be. And really, from my perspective, what it was, was I needed to answer to the question of, if the experts say substance use and substance use disorder is preventable, what does that mean? What does it mean that it's preventable? What can we do? What can't we do? What are the myths? What works, what doesn't work? And so I didn't have my chips on any one player in this field. I get to come into this with completely open eyes and blank slate, and look through the research. And I'm married to a statistician, which helps. So the statistician half of our marriage helps me when I get stuck with P values and things like that.

Andy:
One thing that you talk about that I thought was really interesting is this idea of the gateway or initiation sequence, or stepping stone drugs, because I think this is something that a lot of people have heard of, this idea that cigarettes are a gateway to smoking weed or something.

Jessica:
Yeah. Anyone listening to this podcast right now that's in the addiction field is now rolling their eyes and saying, oh, here is where Lahey shows that she really doesn't know what she's talking about, but the gateway hypothesis is really controversial, actually, and it has been used in the past in a really racist way to really perpetuate some racist stereotypes. So the basic idea is that there were some researchers who found that there is kind of a trajectory, and is there one gateway drug? Not really.

Jessica:
You could say, well, now it looks like if a kid vapes nicotine, then yes, they are going to be more likely to move on to cigarettes. And if they're more likely to move on to cigarettes, then probably they might, may or may not, depending on the kid, be more likely to move on to beer, to like a low ABV, alcohol by volume, beverage. And if they move on to that, then they maybe are more likely to move on to whiskey or whatever higher, vodka or whatever. And then there's a cannabis side to it, as well.

Jessica:
The problem is, is that there's no formula. There isn't one reliable model. And it turns out, within certain groups, certain ethnic groups, certain racial groups, the gateway hypothesis can look a little different. And just because a kid is using one does not automatically mean they're going to move on to the next. In fact, there are some studies that show that for example, Black boys, and I hope I got this right, it's either Black boys or Black girls, are a lot more likely, if they use cannabis, are more likely just to stay there and not progress, than white boys, whereas white boys, if they try cannabis, may be more likely to move on to some other quote unquote harder.

Jessica:
And this is the other problem, is that usually it's based on not that bad things, moving up to bad things. But alcohol is extremely dangerous. It's the one drug that during withdrawal that you can die. So having this sort of socially cultural idea of what's a bad drug and what's a not as bad drug and how one leads to the other can be problematic. So I do my best, the best I can there, to break it down, and I break down ideas like, you know, during the eighties, that crack was so addictive, it broke the gateway hypothesis.

Jessica:
Well, that was something that we actually saw during the George Floyd trial. During the George Floyd trial, there was talk of the fact that he had drugs in his system and that they turned this normal, mild-mannered Black man into a superhuman impenetrable by bullets force, that of course extra force had to be taken in order to subdue him. And during the crack epidemic, we saw that, as well, in the news, that like if Black men take crack, they turn into these superheroes, you can shoot them and it won't take them out. So there's a whole worrisome aspect to the gateway hypothesis, as well, and what breaks it, and blah, blah, blah, all that kind of stuff.

Jessica:
So as with everything in this topic, there are so many caveats. And in order to talk about substance abuse prevention, you have to be a little comfortable with the gray area. And I happen to love the gray area. And I love my job of making other people be more comfortable with the gray area, because most often parents are like, "Just tell me. Just give me the answer, give me the formula that I can plug into my calculator so that I can make this thing not happen." And it just doesn't work like that.

Andy:
And if it was black and white, then we wouldn't need a whole.

Jessica:
We wouldn't need that book. We'd just need a formula or a flow chart.

Andy:
So even given all of this gray area, you still write in here that if we can help our children understand the reasons they may be tempted to drink or do drugs on their first day, they may never end up having to recount the story of their worst day.

Jessica:
And that's not me. I have to make sure credit goes where credit is due. I'm quoting Chris Herren there, Chris Herren, who used to be with the Boston Celtics. He's amazing. The Herren Project is a really important prevention organization, nonprofit. And his theory is we spend so much talking about the last day, like when I blacked out at my mom's birthday party, it was so bad that we tend to not talk about the first day. And that first day is really at the crux of this book.

Andy:
It does seem that way. You focus a lot on that, on what are the reasons why kids start using substances. And if we can understand those better and we can talk to kids about them in the right way, then we can sort of set them up for success later in life.

Jessica:
So first we have to talk about what the risks are, like what risk looks like for substance abuse or substance ... We're supposed to be, just from a linguistic perspective, it's important to know that we're supposed to be using the term substance use disorder and not addiction. We're supposed to be using person first language, a person who used opioids, not junkie, that kind of stuff. I happen to call myself an alcoholic. I do use the word addiction interchangeably with substance use disorder and substance abuse, which, whatever, pisses some people off, but there we are.

Jessica:
So some of the risks for substance abuse are, for example, the reason I had to look at my kids really carefully is that I was raised by an alcoholic. I was raised by a parent who was also raised by an alcoholic, and so on and so on. It turns out that genetics are about 50 to 60% of the risk picture. So when you're looking at a kid being at risk for substance use disorder, genetics are 50 to 60% of that. And that comes from Mark at University of Southern California.

Jessica:
And then on top of that is this thing called epigenetics, which is kind of where nurture and nature meet. It turns out that our genes can be turned on or turned off, based on the things we go through in our lives, like for example, trauma, which is where we get into the next big picture. So after genetics, we have to go into environment, and that includes things like so-called adverse childhood experiences, as defined by the Centers for Disease Control and Kaiser Permanente, and as expanded by an incredible book called The Deepest Well. Nadine Burke Harris, who's now the surgeon general of California, she found that yes, there are these like 10ish things on the CDC's list, but let's expand that a little, because they don't include things like systemic racism. They don't include things like adoption. So the CDC's list is a great starting place.

Jessica:
And if you want to know what your so-called ACE score, your adverse childhood experience score, is you can Google CDC and ACE quiz. And it's a number from one to 10, and the higher your number, the higher the bad things you've gone through as a kid, the higher your likelihood of ending up having substance use disorder during your lifetime. Although, there are some bigger issues inside of that, like for example, sexual abuse is just one that is like the big flashing light one that trumps a lot of other adverse childhood experiences.

Jessica:
And then on top of that, we have just trauma that may or may not fall on those lists. And I have to say, going through a pandemic, especially as the mother of two young adults, going through this pandemic has inflicted a certain amount of either big T or little T trauma, at the very least stress, toxic stress on kids. So whether or not this ends up being classified by the powers that be as an adverse childhood experience, we'll see.

Jessica:
On top of that, then, we have things like phases of life, like summers. It turns out the transitional periods, like summers, or for example, between middle school and high school, those are highly risky times. If you notice early aggression in a kid or aggression towards other children or undiagnosed learning issues, academic failure, all of these things are risk factors for substance use disorder. So if we think of substance use disorder risk and prevention like one of those old-timey scales, the heavier your risk side, the heavier your prevention side is going to have to be to outweigh all of that risk.

Jessica:
So I have kids with a fair amount of risk on their risk side. Like, yes, they grew up in a home with two parents without violence, that we could afford to put food on the table. But I'm an alcoholic. My husband comes from a long line of alcoholics and drug addicts in his side of the family, as well. So that's a lot of risk right there. There's 50 to 60%. And then there are little things that happen. We moved my kid to a place where he knew no one between middle school and high school. So I added some risk to his side there. Couldn't do much about it.

Andy:
Yeah, it's already a hard transition and that kind of exacerbates it.

Jessica:
So in order to know what preventions to use, you have to be pretty clear eyed about what your kid's risk factors are. And unfortunately, some of those risk factors, people don't like to hear. Separation and divorce is a real big one. So is adoption. I'm not saying that you should feel bad about those things. Of course not.

Jessica:
But let's think about them in terms of risk factors so that we can more accurately gauge what kind of preventions we need to heap on our kids in order to outweigh the risk. But that's the general picture for risk there. And some of that's hard to see, and it's especially hard to look at and come to terms with if you yourself haven't dealt with your issues. So I couldn't deal with it for a super long time because I was too busy protecting my right to drink.

Andy:
I think that's really interesting. And I just was interviewing Peter Lovenheim, who has a book about attachment, and he was talking really about how the experiences during the first year of life to three years of life really shaped your style of attachment, and whether you're securely attached or insecurely attached, and there's avoidant attachment and anxious attachment. And that a lot of times these kind of are not necessarily from being a bad parent, but just from if you're working a lot and your kid has changing caregivers during that first year, or is at a daycare where there's not one consistent person that they can connect with. There's lots of different caregivers coming and going. They don't get that secure attachment to one of them.

Andy:
And I noticed early childhood neglect is one of the adverse experiences, also. And so it's really gotten me thinking about how we think of it as like, oh no, my kid hasn't had any of these, these big, terrible things happen, but it's not necessarily big, terrible things. It's just there's certain things that if they happen, they really can have deep and lasting effects.

Jessica:
And the last thing I want any parent reading this book to do is to feel bad about that, because the more we understand that these are normal things, I can't think of anyone I know that doesn't have some trauma, adverse childhood experience, something they went through early on in life. And there's actually a fantastic book. Gabor Maté wrote a book called In the Realm of the Hungry Ghosts. And he works with people who are suffering from substance use disorder on the streets in Vancouver. And that entire book is about how trauma affects your risk for substance use disorder over your lifetime.

Jessica:
And he's all in on the trauma stuff. And that's the other thing about this whole field, is that there's the trauma camp and there's the brain disease camp and there's the developmental camp, that kids, adolescents in particular, are just wired for novelty. And that's a good thing, but that also makes them more vulnerable. And I think it's also really important to say that a lot of the prevention in this book, I'm not talking about, like, I'm not ever saying you can't drink in front of your kids. I'm not saying you can't ever have alcohol in the house. What I'm saying is, is that adolescent brains are different, child and adolescent brains are different from adult brains, and things that may be perfectly safe or close to safe, or at least of moderate risk in an adult brain, is of much higher risk in a child's brain and especially in an adolescent brain. And that it's the messages we send around why we drink.

Jessica:
So instead of like, if I'm drinking because I like to have a glass of wine with dinner, and it's about matching with the food and blah, blah, blah, all those sort of reasons that some people drink, and my kids aren't hearing me say things like, "Oh man, today at work just sucked. And I really, in order to just unwind, I need a glass of wine." Or, "We're going to Thanksgiving at grandma's house, and man, there better be a lot of wine around because I'm not going to make it through the day without it." That sort of messaging, I don't care if you drink in front of your kids or not, but if you're sending those messages about why you're drinking, then what you're teaching your kid is that alcohol is medicine for bad feelings, that alcohol is a way for us to not feel our bad feelings.

Andy:
Yeah, this is great. And I think all this stuff is so important, because as you point out, as a parent, you need to really know your stuff when you're trying to talk to your kids about this, because they're going to have questions, and they're going to have questions about, well, why, and isn't that hypocritical? And how about you when you were my age?

Jessica:
Yeah, that's the big one right there.

Andy:
Did you drink? Have you ever smoked pot? And all of these kinds of things. And so, well, how do you answer these without being hypocritical?

Jessica:
What I found out from Gift of Failure is the more detail I could give about what to say and how to say it when, especially when the conversations are scary, that's good. And I said to my editor, when I was writing Gift of Failure and even a little bit with this book, no one wants to be told what to do. No one wants scripts. And she's like, "Oh yeah, they do." So I tried to write as many scripts as possible for this book, especially around how to give kids the ammunition to save face while saying they don't want to drink, or to not be a big dork and not be humiliated and give them actual refusal skills that make sense and work, according to this thing called inoculation theory, so that they're actually useful, because obviously just say no doesn't work and scare tactics don't work and all that kind of stuff.

Jessica:
But that thing you said just now about that conversation, when you yourself know that you've used drugs and that you drink, so how are you going to not, that's one of the questions I get the most, because that's such a scary place to be. I don't want to lie, but I also don't want to promote it. And I don't want to sound like a total square, but I also don't want to romanticize. And they could say, "Look, you turned out fine. How come it's okay for you and not okay for me?" And that's a thorny conversation. Yeah, that was probably, even among experts, one of the hardest questions I had in my research questions when I was interviewing people.

Andy:
One guy that you talked to who said he was honest with his son about that he drunk when he was younger, and then-

Jessica:
Oh, it wasn't just drunk. He'd used a lot of drugs and had a great time and loved it. Yeah.

Andy:
Yeah. And then his son, oh yeah, here it is. Page 172. When my son asked me and my wife about our drug and alcohol use when we were kids, I believed honesty was the best policy. That's something I think I would have handled differently with our son. Yeah, yeah. He told him about that.

Jessica:
Yeah. I mean, it's a matter of degrees, because I actually do believe honesty is the best policy, but his son came back and said, "Dad, you kind of messed that one up because you made it sound so fun and romantic." And he actually acknowledges also that there was an element of wanting to seem cool to his kids and to be a buddy with his friends, and our kids don't need buddies. They need someone that they can trust and look to and have reliable information from. And from his perspective, he liked being a buddy with his friends, and it went a little too far in that case. And his son came back and said, "I wanted to try those things because you made it sound like a lot of fun." So there is a line to be drawn between the two.

Jessica:
I am honest, though, about what we've tried. I think we've been honest with our kids, but we're also very honest about, and I'm allowed to tell this, but my husband, who is now a physician, he had a year just after college where he smoked a lot of pot. He lived in a house where they grew it in the basement, and he was underemployed, and he was bored, and he was feeling really bad about himself. And so he was just not dealing with that by smoking a lot of pot. And we explained to our kids that he came out okay on the other side, but it delayed him being able to take action because his motivation was down because he was high all the time.

Jessica:
And two, he ended up having to go back to undergraduate school and get pre-med stuff and then ended up going off to med school. And he really harmed his short-term memory. For a while there, he felt like he just didn't have the same short-term memory going into that year as he did coming out, which makes perfect sense since the receptors that are in, the reason cannabis works on our brain where the receptors are is they're right near our hippocampus and in our hippocampus, which is the seat of memory formation. So of course that high person who forgets what they were saying and can't finish their sentence is funny, but it's a perfect example of how it's messing with their memory formation in their hippocampus.

Jessica:
And in an adolescent, that damage can be permanent, whereas in an adult, that short term damage, with a joint here and there is not going to necessarily be permanent damage, but in an adolescent, it does have much more potential to be permanent damage because the fact that adolescents, the brain is not done developing until we're somewhere between 20 and 25. And during that period of cognitive development, the chemicals we put in our brains really affect the development itself.

Andy:
Yeah. And there's some studies in here that have some really specific examples of that. Like this, you talk about how the adolescent brain, alcohol kills off gray matter in the frontal lobe. In teenagers, that gray matter is really important. And there's a study showing that teens who admitted to drinking lost so much gray matter in their frontal lobe that the lead researcher of this study described the loss as striking.

Jessica:
Yeah. What's interesting about the adolescent brain is over time, gray matter is being converted into something called white matter. They're the same cells, but the gray matter doesn't have this coating of myelin, which for example, in someone who has multiple sclerosis, what's happening is their cells are being demyelinated. So that myelin is, I'm looking at the cord from my Mac right here, it has a white covering on the outside, which is akin to myelin. And it makes the messages, the electricity going through my Mac computer wire, more efficient. It keeps them from just firing all over the place and getting lost, and myelin does that in the brain.

Jessica:
And so you would think, okay, well that's good. You want gray matter to go down and white matter to go up, but what's happening is that part of the brain, that frontal lobe, hasn't been fully hooked up yet. And once it gets hooked up and as it gets myelinated, you want as much myelinated gray matter as possible to turn into as much white matter as possible.

Jessica:
And that area of the brain, you know when you get frustrated with adolescents for not, I don't know, thinking about consequences or putting two and two together, or being able to manage their time, that's all frontal lobe stuff. And we want as much of that to stay intact as possible. So losing gray matter, losing white matter, a failure of gray matter to convert to white matter, all of that shows problems with cognitive development, and alcohol has a really big impact on that.