Good afternoon. Happy children's mental health awareness week. Welcome to helping teens understanding the connection between mental health and substance use. My name is Donna Amarall and I am both a
psychiatric mental health nurse and a member of the town of Westport Board of Health. During mental health awareness month, the board of health provides programs that focus on mental health as an important public health issue because to us there is no health without mental
health. Today's presentation focuses on one of our vulnerable populations, adolescence. Today's teens may struggle with the complexities of our world as well as the inherent challenges experienced during adolescent years.
These challenges may lead to mental health issues as well as substance use and substance use disorders. Here is some sobering data. According to the CDC, 15% of American high school students reported using
illicit or injection drugs. 14% reported misusing prescription opioids. and fentinel deaths have spiked among children in the US and teens. In 2021, more than500 youth under
the age of 20 died from fentinel use. According to the 2025 report of the National Center for Drug Abuse Statistics, 50% of teens have misused a drug at least once.
6.9% of 12th graders use marijuana daily. In Massachusetts, 11% of teens use drugs. And Massachusetts teens aged 12 to 17 are 33% more likely to have
used drugs than the average American teen. Of this group, almost 87% report using marijuana. Alcohol and marijuana remain the most abused substances by teens. The question I ask myself is why?
Why do our teens use substances? Are they just trying to fit in or are they masking and medicating difficult emotions and situations that they are struggling through? And if they use substances, how
does that impact their mental health? Today, our speakers will address these questions and provide us with scientific and clinical evidence that will increase our understanding of the connection between mental health issues and
substance use. And in the process, it may help us help teens. Our first speaker is Dr. Sarah Thomas. She is a licensed psychologist and assistant professor at the department of psychiatry and human behavior at the Albert Medical School of
Brown University. We are very fortunate to have her here to speak in Westport. For the past nine years, her research has focused on adolescent cannabis use and how it intersects with the development of worsening of mental health symptoms, how it impacts
adolescent brain development and neurobiology, and how sleep problems may be a predictor and consequence for adolescent cannabis use. Her recent work has focused on the connection between cannabis vaping and adolescent suicidality.
She has also given talks to teens on myths and facts about substance use and to parents about vaping. The presentation she's about to give us is what she recently provided at Brown University Grand Rounds. Our spec second speaker is Dean
Blackburn. He is a veteran of the United States Army and has extensive experience helping teens and adult adults in a crisis. Before he worked in mental health, he spent 20 years in the construction industry as a project manager in Boston. After graduating from
Wentworth, Dean then worked to become a paramedic. He pursued emergency medicine and worked on both an ambulance and in a local emergency room. It was during this time that he began to develop a desire to work with people in mental health and
substance use. He received his second master's degree in counseling, pursued his LAC, and then began working in criminal justice and a woman's treatment center. Following those two opportunities, he worked in medicationass assisted treatment and
community mental health. Currently, he is the substance use clinical supervisor at Children and Families in New Bedford and provides outpatient, one-to-one, and group counseling. Dean will also address the impact and connection between mental
health issues and substance use as well as identify ways we can help when a teen is struggling. So uh join me in welcoming uh our first speaker Dr. Sarah Thomas. Should I move this to here? Yeah. Yeah,
you can do that. All right. Uh, can everyone hear me? Okay. Um, well, thank you for the invitation to speak today. Um, so I will be talking about the research that I've been conducting the past few years. Um, and I would say probably my uh villain origin story was that when I first got
this grant, they wanted me to not enroll people who had depression and anxiety, but who had cannabis use. And we discovered that that was really hard to find anybody who um who didn't have mental health symptoms, but who used cannabis regularly. And um that kind of
generated a lot of interest for me in terms of figuring out why those things over overlapped a lot and how we could make sure that rather than kind of remove people from a study that have these symptoms, how we can actually figure out why they overlap a lot and figure out better treatments for them in
return. So um this research is funded by the National Institutes of Health um as well as um a private foundation of the Brain and Behavior Research Foundation. And so what I'll be talking about today is um why adolescence is a vulnerable
period um to initiate substances and for mental health. What are some of the predictors of substance use um and some of the consequences of substance use with regard to mental health. So one thing to just sort of caution is that it's really hard to
disentangle substance use and mental health to the extent possible. I'll be talking about um kind of separating them out of what are mental health related predictors of substance use initiation and then what are some of the consequences that may come about. But
the two kind of are are go hand in hand. Um so it is sometimes hard to figure out which one comes first. So first um we'll start off with why adolescence really matters in terms of why this is a vulnerable time period. Um, and part of that is because the
brain is rapidly developing during this period of time. I think a lot of us have heard about the fact that it takes until about age 25 until the prefrontal cortex is developed. Um, and this is called the imbalance model of adolescent brain development. Um and this really means
that uh the earlier adolescent period so ages 13 14 15 regions of the brain that are responsible for reward so regions like the basil ganglia those are developing much quicker than the regions of the brain that are responsible for
regulatory decision-m judgment um which develop much later. So you wind up with teens who are kind of so to speak all gas and no break. And it takes longer for the prefrontal cortex to kick in and kind of put the brakes on things. And this is true for both adolescent humans
but also animals. It's meant to actually be kind of adaptive to help propel them into independence. But it means that adolescence is a riskier time period. So the adolescent brain development is also facilitated by our body's own internal endockinabonoid
system. This helps to build the brain, but it's also responsible throughout the lifespan for helping us to manage stress, reward, and sleep um across all ages. And those receptors are concentrated in areas that are developing during adolescence. And it's
thought that by introducing cannabis during the time that the brain is developing that it kind of throws off the homeostasis of brain development, it may kind of change the trajectory of how that develops. And that's thought to be the reason why starting cannabis in adolescence is related to um kind of
worse outcomes like failure to complete high school, a higher risk of developing addiction compared to adult onset. So when we think about when do mental health conditions start to develop um this can help us to figure
out the ordering of which one comes first, mental health um symptoms or substance use. So looking at a meta analysis, which is a study of studies that had over 700,000 people, the study found that peak onset of mental health
symptoms starts around age 14 and a half. The median age is around 18 and the broader range is around 11 um to 34. And obviously as someone who works in a psychiatric hospital um for kids and teens, I can say that these disorders
can really start at any time. So this is only generally speaking but kind of going in order. The earliest ones that tend to start around ages 8 to 13 are anxiety disorders. So things like anxiety, um phobias, separation, social anxiety, then autism spectrum disorders
and then ADHD. Then later on ages 17 to 22 tends to be eating disorders, obsessivecompulsive disorders, uh cannabis use disorder. After that, in the late 20s, schizophrenia, personality, panic, and alcohol use disorders. And later in the 30s,
post-traumatic stress disorder, depressive disorders, generalized anxiety, bipolar disorder, and other psychotic disorders. So, I think this quote really helps to think through this as well, showing that the results of this work show that mental disorders have onset
when dramatic biological changes in the brain occur from childhood through adolescence. So it's thought that these are coming online um kind of in conjunction with how the brain is developing through late childhood um into adulthood. So that was mental health. So
when mental health tends to um appear in terms of symptoms and disorders generally speaking, what about substance use? Um so in the US we have this really great study called monitoring the future. Um this is also funded by the National Institutes of Health and they
collect data every year and have been collecting data every year since 1975 um in a representative US sample. So that way we know kind of what's going on yearbyear. So this started um in 1975 through the most recent year was last
year. And they survey 8th, 10th, and 12th graders, usually around over 25,000 of them from high schools across the US. Um and so we know from this past year that um rates of substance use in 2024 have continued to show declines since the
pandemic. So when we start off with alcohol, which is the um the highest use substance, we can see that the trend has gone down um over the decades that this data has been collected. And for example, 10th graders have about 26% of them report having past year alcohol
use. If you can see the pink asterisk, those indicate that um there was a substantial decrease um this year prior to uh compared to the previous year. In terms of marijuana, um 16% of um 10th graders reported past
uh 12-month use and 12th graders had a significant decrease in 2024 compared to 2023. And then in terms of vaping nicotine, um, ecigarettes, 15% of 10th graders reported past year use. Um, and 10th
graders also had a significant decline in 2024 compared to the previous year. This only started to be evaluated around 2017 because this is a a sort of newer method of substance use. And I'll just point out that the rates in the 2024
have not declined to the point that it was when it was being initially assessed. So it's still higher than when they first started evaluating it in 2017. So there's a theory called the great decline um that explains why these
curves are kind of going down and that is thought to be because there was such a successful campaign in the 1990s when I was a kid to eliminate tobacco smoking and so from the years 2000 to 2018 every year they had a decline in tobacco
cigarette smoking in youth. it never again increased between that time period. And they theorized that by eliminating a whole generation of tobacco smokers that they would also then eliminate um people progressing from tobacco to other substances. And that isn't what they found is that they
um did not progress to things like tranquilizers, opiate use. Um and that's probably because their brain wasn't being primed like starting with tobacco use. You know, your brain being your reward center is being primed to try other things. Um, so this is really great news that that was such a
successful campaign. Um, it does raise some questions for me as to, you know, now that teens are using ecigarette vaping, what are we going to see in the next few decades in terms of rates of substance use? Um, and then also when we look at these graphs that show us um the
whole population, this is um kind of obscuring some of the more vulnerable subpopuls like individuals who have mental health symptoms. So transitioning now to mental health predictors of adolescent substance use.
Um so there are certain um personality characteristics like impulsivity, anxiety sensitivity, um thrillseeking and hopelessness that predict different types of substance use um as a means to potentially kind of self-medicate those symptoms which I'll speak about in a few
minutes. We know that there are certain behaviors called um externalizing like rulebreaking and stealing that predict early onset cannabis use. Um by definition ADHD um needs to be identified or the symptoms have to be present by age 12. So we do know that
ADHD does tend to be a predictor of um substance use initiation. There's also environmental factors such as caregiver um beliefs or perceptions or behaviors related to substance use. um as well as peer influences and then also neurobiology.
So people's different kind of brain structures and function may make them more vulnerable to early onset substance use and may also be related to their mental health. Something that I'm researching right now is whether sleep problems in childhood are also a risk factor for substance use in adolescence.
And we know that sleep problems really cut across different mental health disorders like depression or anxiety. So the self-medication hypothesis is a major theory explaining why um some people may use substances and why it's linked to mental health. It proposes
that individuals use drugs to address emotion related symptoms and that the drug of choice is meant to reduce negative emotions in a specific way. And so there this has been researched um to see if people choose substances to kind of address their particular mental
health profile. Um, another way we can think about this is using substances to cope um with negative feelings. But we know from the research that when people say that they use substances to cope with negative feelings that they have a greater risk of de developing a substance use
disorder. So um we wanted to investigate this in Bradley Hospital where I work. Um so during COVID we were able to put in a survey um to the research assessments that adolescents complete when they're hospitalized um because we
were trying to understand what behaviors they were engaging in to kind of manage um their feelings around a lot of the changes and the stress that was coming about because of all the changes with COVID. So I had previously mentioned that um you know the charts that show us the
rates of substance use they're sort of missing these more vulnerable populations. When we look at the substance use rates during COVID from that same monitoring the future study this combines 8th 10th and 12th graders. This shows that there were no changes in
substance use on the whole during the pandemic and that even some rates of substance use went down which is great. This is a population level though. We wanted to know whether this would be the case for kind of subopuls. So what we
did was um as I mentioned we had the survey that we asked teens what they were doing to cope. Um so we had 491 youth who were hospitalized prior to CO and during COVID. They were between 11 to 18 years old um and 61% female. And
when they were admitted, they um all of them get questions about how many um cannabis use stays they had in the past year and how many alcohol use stays they had in the past year. And we created kind of a comparison of teens who had been hospitalized from August of 2019 to
mid-March of 2020 was considered pre-COVID and then mid-March of 2020 to April of 2021 was considered COVID. And what we found was that teens who were hospitalized during COVID reported significantly greater alcohol use days and cannabis use days compared to teens
who were uh hospitalized before COVID. We also found that adolescence reported that they used alcohol, cannabis, and ecigarettes to cope with CO 19. If they endorsed using that to cope, then they had significantly higher use days of that same substance. And
then we also found that ecigarette use was associated with lifetime suicide attempts. Um so again, you know, we don't know if these youth were initiating substance use for the first time or if they were continuing, but this does kind of illustrate the self-medication hypothesis using to
cope. Um and it also does kind of reiterate that population level estimates can sometimes miss more vulnerable segments of the population. So this is really hard to measure. Um, it's hard to measure predictors and consequences because of
timing of studies. Um, we really need them to be long-term, but that can be expensive and hard to run. Um, sometimes there's a common influence that affects both substance use and mental health, like genetics. Um, the best type of research study would be an experimental design where we'd randomize people to
either receive a substance or not. We can't do that with um with people who are under 18 because that wouldn't be ethical, but we can do it with rats. And so we do know that in animal studies um that there is something special about adolescence of like exposure to substances during that time that's
related to worse outcomes than being exposed to their equivalent of adulthood. And then another challenge is that people who use one substance often also use other substances. So it can make it difficult to disentangle the effects. So another um feature that may
be related to why people start using substances is sleep. So I previously mentioned the endockinabonoid system which helps to build our brain but it's also responsible for helping us to regulate sleep and when we're tired and in adolescence there's a lot
of changes happening with sleep. So they kind of take longer to get tired their um their sleep preferences shift to later on in the evening. So sometimes teens and adults report using cannabis to help them fall asleep faster. Um, the problem with that is over time, even
though it might help initially, over time it may take them even longer to fall asleep when using cannabis. And then when trying to stop using, they may find that it takes them longer to fall asleep or that they have kind of weird dreams and nightmares, which may lead people to start using cannabis again to
um, stop having those symptoms. Um, so I'll talk a little bit more about the research study that I'm doing right now later. Um but we did put two questionnaires into my study asking about sleep problems and um sleep impairment. So any kind of like next day
issues with feeling sleepy. And we found that teens who report using cannabis regularly um have significantly more um sleep disturbance problems. Not necessarily impairment, which was not what we expected, but they report more problems
falling asleep. We also asked for the teens who use marijuana whether they use it to help them sleep. So the questions were, you know, thinking of all the times you've used marijuana, how often would you say that you use um for each of the following reasons to help you
sleep? Because you're having problems sleeping because it helps make napping easier and more enjoyable. And we did find that um that teens who use cannabis report sleep uh as a motive. So problem sleeping. 60% of
the sample said that they use cannabis because of problem sleeping. And 74% said um to help them sleep. Then more hours that they reported being high daily was related to more sleep problems and more impairment. and a greater motive um to use cannabis to help them
sleep was related to more problems sleeping as well as um greater severity in cannabis use disorder symptoms. So, we really don't know which one comes first in this case, but my next research study, which should be funded soon, is going to be able to look at this and
have teens um wear an EEG cap and a watch overnight to be able to figure out what aspects of their sleep may be affected by cannabis use. So those were some of the predictors of um why cannabis may be related or sorry why substance use may be related in
mental health. Um now we're going to think about what are some of the mental health related consequences of adolescent substance use. Um so once once people initiate substances in adolescence um what can happen to mental
health again um they are kind of a cycle and I think um Dean is going to talk about this as well but the very reason that someone might start using a substance to manage their anxiety or to manage sleep might actually wind up worsening it and then they may take more
to kind of help that symptom and then it becomes a cycle such that instead of using it for a positive reason they are now using it to avoid um symptoms that they don't like. Um so they can kind of get stuck in this. So some of the consequences of adolescent substance
use, one that I think is really underrecognized is that um there's a physical consequence of vaping in that it may reduce um oxygen. So there may be some oxygen deprivation that happens because of vaping and this has been shown to result in impulsivity. Um, and
I'll talk about that in a little bit because impulsivity is a really big risk factor for suicide. So, impulsivity meaning kind of acting without thinking. Another consequence of substance use may be potential brain changes. Um, so this is such a um important time of brain
developing. So, using it at a certain time, especially when the reward regions of the brain are developing, might result in permanent changes. Um, there may be behavioral and mental health changes. um someone might do something under the influence that they wouldn't have done otherwise. And then um as I'll
talk about in a moment, there is a cycle um of different processes that may one put one at risk for addiction. This may speed up um when someone is an adolescent. So this um image can kind of help us to think about the process of addiction. Um this is kind of how we
think about it in NIH research studies. So the blue says binge intoxication and that's thought to be supported by the basil ganglia part of the brain. Um the red says um negative affect and withdrawal meaning like negative
emotions and withdrawal symptoms and that's related to a part of the brain called the amydala. And then preoccupation anticipation is in the green and that's related to the prefrontal cortex. I think that this image kind of um doesn't quite capture the dynamic aspect of brain development.
So if we were to think about how these different brain regions are developing during adolescence and earlier on we have the basil ganglia developing and then later on we have the prefrontal cortex developing. If someone were to initiate
substances early may maybe age 15 then they may be affecting several regions of their brain um that while they're developing. So I think it's really important to consider um delaying because these areas of the brain are not only responsible for you know elements
of substance use they also support aspects of mental health decision-m um lots of other functions. Um so one way that I kind of think about it is you know similar to sort of like if you put your handprint in sand and every six hours the tide comes and washes that away versus you
put your handprints in concrete. We really don't know which of those is the case for um some of these potential brain changes that happen with a as a result of substance use. We don't know if those are temporary. Um are adolescence kind of resilient to these
changes or will this create permanent changes in how the brain um is structured and segmented to the point that these changes might be permanent. And that's something that I'm trying to find out with my research, but we really just don't know. Um, so when we think specifically, if
we've we zero in on cannabis, because this is what I focus on in my research, um, the way that I think about it is almost like an equation. We're taking cannabis at a time of brain development, what is it resulting in? Um, if it is affecting the regions of the brain that
are responsible for reward, for feeling pleasure, then we may be less interested and motivated to seek a reward that's not a drug. Um, we might have lo loss of interest or pleasure in things we used to enjoy doing, which is also a symptom of depression. We might have more
consistent depressive symptoms if those go along with cannabis use and someone is continuously using cannabis. And there may be changes in the brain that support all of those different symptoms. So that's kind of the lens through which I see a lot of my research.
Um so thinking about mental health related consequences of cannabis um we know that teens who use cannabis regularly um it's associated with depression. Depression tends to come after cannabis onset rather than before.
It's also associated with psychosis um which is defined as things like hallucinations um seeing things that aren't there there hearing things that aren't there and delusions such as strange thoughts. Um, the risk factors for for developing psychosis with
cannabis use are starting early, using really strong versions of cannabis and being male. There's also sleep problems that can come about, um, changes in how people think and make decisions and then changes in the brain that may be the
reason for um, mental health conditions. So, these are some of the consequences um, related to mental health with using cannabis. Um now I'm going to focus on one particular study we did related to this. So recently there's been a recognition
that um adolescent cannabis use is linked to adult depression and suicidality. But these studies were conducted when um cannabis was a lot less potent. So right now you can get cannabis products that are up to 95% potency whereas back about a few decades
ago it was anywhere between you know maybe 4 to 20% potency at the at the greatest now it's just a lot um stronger um and vaping has been linked to oxygen deprivation as I mentioned before so back around the time of co we started
integrating more questions about substance use into our research battery for adolescence who were hospitalized at Bradley because we really wanted to make sure that we were understanding if any substance use was potentially causing their hospitalization. Um, and so keeping up
on the research and seeing that there were links between cannabis and uh suicide, I was curious whether um we would find a link especially for vaping. So we conducted the analyses looking at um cannabis methods. So
smoking, vaping or edibles. We found that teens don't really tend to use edibles. Um, and we adjusted for any sort of other variables that we think could explain the relationship between cannabis use and suicide attempts and thoughts. Um, and so we found that
adolescent cannabis vaping but not smoking was significantly associated with greater odds of having made a suicide attempt 30 days prior to hospitalization and with greater suicidal thoughts. when we adjusted for these other variables that we thought might explain the relationship, um it
still remained significant for suicide attempts and then became slightly less significant for suicidal thoughts. Um so again, this potentially comes back to we're not really sure what the mechanism is, but it is possible that vaping it's either delivering such a high potency
that it's really affecting um teens brain development and their mental health and or it's resulting in oxygen deprivation. So that is what my research is focused on right now is to brain changes explain the link between adolescent cannabis use and mental health. And I'm doing that by
enrolling teens who have um a range of cannabis use from none to a lot to try to understand how it may change reward regions of the brain and whether that gives rise to um mental health symptoms. And then I was able to get grant funding to have a third group of teens in the study who have um cannabis use and
depression so that we can understand how this looks um when that occurs together. So we make sure that teens fit um our inclusion and exclusion criteria. They mainly just have to have only cannabis use. They have to um be okay to have an MRI. Um and then we have them
come into our office in Providence. We go over the consent process with them. They do some mental health surveys. We do an IQ test. We ask them all kinds of questions about their substance use. And those questions include things like how many times a day they're using, what sort of products that they use, how much
lifetime use that they had, and then we have an MRI visit that happens at Brown. Um, we have them get used to being what or get used to what it's like being in an MRI with a simulator. We have them um spend half the time in the MRI playing a game and
half the time resting. And then I do an interview with them to diagnose cannabis use disorder. And what we found is that comparing teens who have very little or no substance use to teens who have um a lot of cannabis use, we find that um
pretty much every psychiatric uh profile is more significant in the group of teens who use cannabis. Everything except anxiety, which is kind of interesting. So teens who use cannabis report significantly more sleep disturbance um psychosis related uh
experiences, ADHD symptoms, depressive symptoms, and more functional impairment in their life. We also found that teens who have a lot of cannabis use are not incorporating reward amounts into how they make decisions. Um and we found
this both with the with the game that we had them play while they were in the MRI as well as a separate game. So they're just really not incorporating levels of reward. Um I think which is really important for helping us to understand why cannabis is related to lack of
motivation. And then another really interesting unexpected finding was that um something that I think is related to both substance use and mental health is dopamine. So we know that um dopamine is important for motivation. It's important for movement and Parkinson's disease. um
it's been implicated in addiction and um it's really hard to study because you need to use a certain type of imaging that we can't do with adolescence. So in adults they found that uh chronic cannabis use is related to lower levels of dopamine but nobody has looked at
this yet in adolescence and we were able to find a way to get this um information from data that we already had. So we have found that in pretty much all of the regions of the brain that one would expect there to be dopamine storage, teens who use cannabis regularly have
lower dopamine than control teens. And that really has implications for understanding why that may be related to other mental health disorders because disorders like depression and psychosis disorders are also related to abnormal levels of dopamine. So this kind of
opens up a whole new area of research that we can be doing. So to summarize um compared to control adolescence, adolescence who use cannabis report greater levels of mental health symptoms in all domains except anxiety. They have different ways of making decisions that don't really
incorporate reward into it. And they have lower um dopamine neurohysiology which suggests that they're not producing as much um dopamine as as other teens. And in conclusion, overall we find that substantial brain changes during adolescence might account for
increases in mental health symptoms that we see during this time as well as make adolescence more vulnerable to the effects of substance use during adolescence. Um some of the predictors may be externalizing symptoms, caregiver use and coping with negative affect as risk factors. And some of the
consequences could be that substance use may change the brain and behavior in a way that gives rise to mental health symptoms. um especially when it's occurring during these pivotal periods of development. Um but it's unclear yet whether or not these changes are permanent or whether they're
temporary. And to finish up, I would just like to say what are we doing here with these billboards? Um you know, if we want to think about why teens and kids may have the idea that cannabis is medicinal, well, all we have to see is what the, you know, advertising looks
like, especially around me. Mother Earth Wellness, um why wait for better health? heal. It's legal. So, I think we really have to wonder about some of the messaging that we're kind of sending with these advertisements about it would make sense to me that people might think, well, this would be good to help
me sleep because it's medicinal if if those are images that I'm seeing on a daily basis. Um, so I am conducting several research studies right now. So, if there's any interest in doing that, you can see me after and I can give you a flyer. Um, or you can Google teen decision-making study. And again, I'd
really like to thank all of my collaborators in the NIH for this funding. You know, it's a really tough time for funding right now. So, if this information is valuable to you, you know, please make sure that you're supporting the biomedical sciences and letting kind of people who are in charge of things like that know how important
it is to you. So, thank you very much. question me. Um, yeah. Did she ask you a question? She just asked about sharing slides. So, go ahead. Oh, okay. Good evening, ladies and gentlemen. Thank you so much for coming out this evening and spending your time
with us. Um, I appreciate your time. So, my name is Dean Blackburn. I'm a licensed alcohol drug counselor and problem gambl gambling specialist at Child and Family Services here in New Bedford. I act there as the substitutes clinical
supervisor and in education. So before we get started, I want you to kind of change the way that you think perhaps a little bit because everything that you see is focused on the substance, right? Everything you substance, substance, substance,
substance, get substance. But what I want you to understand is that substance use is a symptom of something greater going on in someone's life. and it serves a purpose and a need. Focus should be on understanding the why and the what, not the drug. So,
in other words, I don't treat drugs. I don't treat drug use because I could put Oreos in there. I could put anything in there and I'm going to get the same result. Does that make sense? So, I want you to suspend your judgment, your own personal rationale, values, etc. when you hear this. So, we're going to treat
the underlying cause, the mental health, not substance use. And we're going to seek healthier ways to meet the need, the what and the why. Now, one of the big questions that's always asked to me is it so different treating adults versus youth. What do you think the answer is? Show of hands. Is there a
difference? I got one. The first difference between working with adults and substance use and youth is nothing except youth addiction treatment focuses on emotional development, education, and family involvement. While adult rehab
emphasizes personal responsibility and independent recovery, but the process itself is the same. It's going to be word a little different, things of that nature. But when you look at the different programs like ACRA and SMART and some of these other programs, they've been modified
for teens. They haven't changed that much really. There must be an ongoing process of a self-desire to change to see a problem with the intention to reduce or solve it. They must have a value system from which the client makes his or her decisions, including substance use or the lack thereof. A
system or process of managing thoughts, feelings, emotions, and urges. A change plan with not only clear goals but objectives to obtain the goal, a method of resolving underlying and ongoing issues, stressors and an afterare plan to ensure
maintenance of recovery is possible. So I have a question um since it's not it's the same you said um and do you agree that substance use is more than just about substance about something that led them to do that? Absolutely.
And that's what I opened with is we don't focus on substance use. I don't come in and my focus is going to be on what are you using, what are you using, what are you using, right? I'm not going to talk. It's going to be why are you using that? You say that like a 35year-old has different reasons and reasoning for doing so than maybe a
12y old. I'm about to hit that. Okay. Okay. So this is something that you heard earlier whether whether treating adults or youth were complicated and you heard it in earlier the three greatest factors that influence our biology
environment experience. You heard this in the earlier presentation. Okay. So it's very personentric to what what that's going to be. And when you look at all these different factors well some hit different people at different ages
at different times. exposure. Twin studies have shown, you know, one person goes off to MIT and one ends up under a bridge. Why? Right? Almost all substance use begins during adolescence. Regular and heavy
use of addictive substances may alter normal brain activity and cause serious adverse medical, mental health, psychosocial, and cognitive consequences. Prevention and early interventions are key aspects for preventing the development of a substance use disorder. There are
several uh successful evidence-based approaches for prevention, early intervention and treatment of problem substance use and adolescence. This is something you heard earlier as well due to the prevalence of co-occurring disorders. Adolescence with problem substance use should be evaluated for mental health and
adolescence with mental health should be evaluated for substance use. So that's going to answer your question a little bit more. So why do teens use drugs? Number one, their appeal. The doctor closed with that. Right now, people think drugs are the
greatest thing. Cannabis is the greatest thing since sliced bread. Teens can be influenced by the power of persuasive marketing. There's little doubt. Alcohol advertisements, media images, and celebrity endorsements of alcohol play a role in youth drinking and cannabis use.
Likewise, drug use in the media can powerfully change the perception and attitude of teens. Studies have shown many teens who use drugs being used in the media begin to associate with as not being a big deal. So, media exposure and marketing
do have adverse effects on a teen's choice to use drugs. And this is what the doctor closed with. Number two, short-term escape. Many teens have to cope with family problems, friendship struggles, problems with social, and the list goes on and
on. These teens often lack healthy coping strategies to get through life's difficult times. Number three, relief and self-medication. Too many teens today struggle with emotional problems. Teens who struggle with emotional and mental
problems are especially vulnerable to becoming susceptible to the luring power of alcohol and drugs. Sadly, these youths will do anything to find relief, no matter how short-lived it is. Number four, acceptance. We all have
a desire to be accepted in life, and it's no different for a teen. In fact, the need to be accepted is probably more sought after in adolescence. Youth who lack confidence may feel drugs and alcohol help them to come out of their shell. They build their identity on who they are under
their influence. rather than who they really are. Number five, rebellion, control, and power. When teens feel trapped by parental pressures, it's not uncommon to rebel. It tells them to go ahead and do
what they want and not think about consequences. From seeking independence to finding a way to calm their intense emotions, teens who rebel have nothing to lose and everything to gain. or so they tell themselves. Their screw you attitude could quickly turn around to
screw them. Number six, curiosity. Sometimes the desire to try drugs is satisfied need excuse me. Sometimes the desire to try drugs is a satiated need to satisfy curiosity. They
feed themselves lies to justify their unhealthy behavior. There are so many statistics out there. There are so many sources of this information. I wanted to just show you a couple reasons for vaping among
adolescents. To relax or relieve tension, to experiment, to see what it's like because of boredom, nothing else to do because it tastes good. And you can look at those numbers. You look at the center of how it affects the brain.
Why at adolescence it's so critical when you look at the numbers of people that are using how it impacts academics long-term growth and the one on the right is most stunning to
me and I would encourage anybody to go and look up Johnny's Ambassadors. I won't get into that, but the link between marijuana and schizophrenia or psychosis is on the rise and it's really troubling to
see. Top 10 marijuana myths. There are a lot of myths. There are a lot of people that come to me with these belief systems that are founded on no truth, no science. Vaping again, it was originally came
out, it was orign, healthier, a way to quit. What we're finding is just the opposite. Signs of substance use, something to look for in both adults and young people. Mood, anxiety, and conduct
issues that have progressed quickly. Inability to cope with minor frustrations. Unexplained school absences or tardiness. A notable decline in school performance, avoiding family or previous peer group and/or change in peer group, decline in hygiene or
appearance. Your teen appears apathetic, sad or withdrawn. You have found drugs or paraphernalia or evidence of possible alcohol or drug use and signs of intoxication. Now I think in the last few slides that I'm going to present on this is probably
the most important and this is one of the major factors that differentiates between treating adults and young people. It starts at home with parenting. They need to be involved in the
process. Too many times mom drops old Johnny off and says Dean fix him. I'll be back, Dean. It's not getting better. I see this day in and day out. How to prevent teen drug and alcohol abuse.
Start early. Communicate clearly. Take a positive interest. Talk with your youth about the dangers of substance use. Get to know your youth's friends and their parents. Have a clear rule. Keep all prescription drugs out of easily
accessible places. And most of all, set a good example. I'm not going to go into these very much, but different types of counseling that and and care that you're going to see as individual and groups, certain modalities that are
highly effective, DBT, which is dialectical behavioral therapy, experiential therapy, EMDR, motivational interviewing, relapse prevention, and 12step facilitation.
The family treatment approach. Family treatment involvement is key to the resolution of any chronic health issue and addiction is no exception because everyone close to the patient experiences the harmful effects of substance use. The primary challenge
of rehabilitation is briding the treatment focus from the individual to the entire family. In family therapy, a counselor facilitates discussions and problem solving sessions with the entire group as well as select individuals or
subgroups. In many cases, an educational component is included so that spouses, siblings, parents, and youth better understand the disease model of addiction. To involve the family and youth substance use treatment considering the following
steps. Attend family therapy sessions. Participate in support groups. Educate yourself about addiction. Create a supportive environment while practicing good self-care boundaries and limits.
Encourage participation in recovery activities. For families, recognize your role. Depending on whether you're a spouse, a youth, or another family member, your role in the process is different. For a spouse or a patient, a parent, it
may be necessary to take legal steps if the individual is at risk of self harm in any way. Remove your enabling habits. Stop your enabling behavior. Here's what you could do to stop enabling your loved
one. Stop providing an excuse for their use. Don't give them money for groceries or other needs. Don't pay any bills for them. Stop providing the alcohol or the money for the drugs. Stop covering up their addictive behaviors. Don't do
their work for them. Establish and follow through on consequences. A parent of a teen using alcohol or drug may take away all driving and privileges. Remove all drug and alcohol from the home, requiring the individual to move out if they refuse
treatment in more drastic but sometimes necessary. Take away visitation rights and even contact the authorities. You set the boundaries, then stick with them. That's the best route to take. Protecting yourself and your loved one from
constant battles. Protecting yourself matters, too. Sometimes, unfortunately, there's little you, as a loved one, can do to ensure your loved one obtains the help he or she needs. Does anyone have any
questions? Thank you very much for your time. Thank you, G. So, um, we do I did want to open it up to see if anyone has any any questions, um, for either of the speakers. Um, one of the questions I have, um, is for Dr.
uh Thomas is that when Dean is talking about interventions that help in your practice, what do you see are some of the interventions that help our teens when um when they're struggling with either
mental health issues or um substance use? Is this on? No, it's on. Okay. Um I think you know if for me one of the challenges with adolescence versus adults is that some adolescence are
often not the ones calling in and saying hello I would like an appointment. Um so sometimes your initial hurdle is motivation. So, I think um as Dean had mentioned, there's something called motivational interviewing where you're really trying to validate um you know,
finding the pros and the cons of substance use for them and helping them see why they use it, but what are some of the things that they don't like about it? And then kind of what would all be the good things of quitting, what would be the bad things of quitting. helping them to realize that their use um the
benefits is short-term and all the problems that come with it like legal problems or fights with mom and dad take a lot longer. So I think the first step is like if there isn't motivation, you have to kind of work with them on getting that motivation and moving them at least into a gray area to recognize
that like okay this is maybe not a long-term solution. And then the next step again I would agree with Dean of like I think the family based treatment is so important. It is co-occurring disorders, meaning mental health and and substance use treatment is
underststudied and not like it's not super effective. Often we need much more money and support because it needs to be kind of wraparound meaning the family has to be involved probably the school has to be involved, the community has to be involved. Um so I I think it's like
yeah that would be ideal is having the family involved but also a third piece of it is um there's something called contingency management. That's a fancy way of saying rewarding people for not using. And that's where I kind of see my research going is where I find it really
troubling that especially cannabis use but any substance if it's used during this time that's really negatively impacting the reward regions of our brain. contingency management to pay people not to use substances. Is that not going to be valuable to them because
they don't value non-drug rewards because of what's happened to their to their brain? So, I think contingency management it can be controversial. People don't understand it. But I think, you know, we have to do what's effective and what's effective is rewarding people for not using and eventually they don't,
you know, you taper that off. But it is very successful. So, I think it's sort of a combination of those things. is their motivation. Then first we have to work on that of like helping them realize that it's negatively impacting their long-term goals. Making sure there's family buyin and the family
knows what they need to do to support them and then potentially really having a powerful intervention of of rewarding them, paying them to for not using. Okay. um when uh I think it was April 1st
actually um at this high school, middle high school, uh Chris Herren came to speak to the students and Chris Heron um is someone who's in recovery. However, he was a um high school um star in
basketball and then he went on to play basketball in college and then for the Celtics. Um his drug use started um he started with alcohol and then spiraled into using other substances um opiates.
Um he talked about the importance of the support he received um to get to help him get through that that struggle. Um, and one of the things he said which I
remember and I held on to is he said one of the things that scares him and he said it to the students is um marijuana psychosis. He said it's one of the scariest things he's ever seen. And I in working in clinical practice have also
seen um the effects of cannabis and causing psychosis, a break from reality, hearing voices, seeing things that aren't there, being very paranoid um that people are out to to hurt you. So it is a very frightening experience. And there are researchers that have said
that it's as if when someone uses when when they get diagnosed or have been diagnosed with schizophrenia that the use of cannabis is a trigger that there's a circuitry in the brain that when you use cannabis it causes a flipping of a switch in the brain that
may not get flipped back which causes a psychosis and they remain having psychotic symptoms. So, it's really frightening. But a a point I want to make about what you were saying uh Dean about the involvement of family. Um
sometimes it's really hard as a parent to not react to what your kids are doing, right? React in a way that then they close down. So, are there ways to um help your
your child, your teen um when these frightening behaviors are happening, when they're experiencing um or they're using substances or they're experiencing any kind of mental health issues? Is there um a way to approach
them that might have the teen open up more? The young person or the parent? the young person because parents so you know I speak from personal experience in that I was a foster parent and I had a um an adolescent who had a mental
illness. He didn't get into substance use but he was a gambler and that's one of your areas as well. Um the what I had to learn was to not react to him in a very highly emotional way but to listen
and to hear his experience so that I could help him and not put him on the defense. And this is if you remember in the earliest part of my slide what it talked about is we always focus on the gambling, we focus on the drug.
We get that response and we respond to it versus sitting back and asking, "What does this do for you? Why do you do this? What need is being met? How can I help you? What is it that you're looking for? What does
that Oreo, what is that drug, what is that porn? What is that alcohol? What does that do for you?" So helping a parent to step back, don't look at the symptom because that's what the drug is. That's a symptom of
something greater. We don't know what the underlying is. And that's the biggest thing for a parent to understand is they have to suspend. And that's why I put it. You have to suspend your judgment. Right, wrong, good, and bad. Take it off the table. Just look at it
objectively. There's a flower on the table. Yes, but I don't like the flower. That there's a flower on the table. Let's talk about it. And that's what you have to do with a parent. Okay. Um, one of the one of my favorite characters and a a TV show was Ted Lasso and he quoted
someone else who said this, but he said, "Be curious, not judgmental." You want to ask the questions as a parent rather than react to what you're hearing. Ask more questions to understand. um and not be always thinking about how
you're going to respond, but just listening. There is a program called mental health first aid. Um if you go online and just put that in, there are courses that parents can take, anyone can take really to learn how to respond
to um a teen who's struggling or another adult who's struggling. um it helps you identify the symptoms um and then look at how you can respond in a way that can get um the teen or the
adult in into uh professional help. So I encourage people that are in the audience to think about looking up um and learning about mental health first aid. It's free um if you want to take the course. Um you just have to register for it. Um, so that's um, and I and I
think, you know, when I hear the research is so important, the re the research for me reinforces me as a clinician, I've worked for over 40 years in mental health, you know, what I'm seeing and then researching it and saying, "Yeah, what you're seeing is is
it's supported by evidence, right? Evidence-based. Um, which is really important when you're operating and trying to help someone. you want to have the evidence that says this is the best course of action um or this is a problem
and in order to not have it be such a problem then this is what would be helpful. So in regards to teens and use of substances um it impacts their their brain and can negatively impact it in a way that
decreases their ability to function well um and also impacts I would say their relationships. Um are there are there any questions from the audience? Okay. Well, I want to thank um both uh
Dr. Sarah Thomas and Dean Blackburn for being here uh to to take their time, their valuable time to come and speak today and to provide um information for our Westport community. I just wanted to let people in Westport uh know that
there are going to be two other events. Um one is on the 16th. It's um called Loneliness, the Silent Epidemic. I will be running that program at the council on aging from 10 to 12 and it will be really a presentation and a discussion
and the following day at the library from 10 to 12 there'll be another presentation by uh Feather Windalker who is uh going to be talking about creating your best self and she uses neuro um biological uh base about um coping
strategies that one can use to change the path patterns in the brain that will bring calmness, um decrease anxiety. Um so, um I encourage people to um at least come to one of those other events as well. But again, thank you very much to
our speakers. [Applause]