Kids and Chemicals

[Music]

Mike: Welcome everyone to Avoiding the Addiction Affliction series brought to you by the Kenosha County Substance Abuse Coalition. I'm Mike McGowan. You know, a diagnosis of substance use disorder is difficult for an individual to hear and to accept. That's never more true when the case is an adolescent and their family who are getting the message.

Mike: That's the topic of today's conversation with Dr. Michelle Maloney and Dr. Sean LeNoue. Dr. Maloney is Executive Director of Addiction Services for Roger's Behavioral Health System. And Dr. LeNoue is the Associate Medical Director for the Regional Division at Rogers Behavioral Health.

Mike: Well, welcome doctors. How are you?

Michelle: Doing well, Mike, thank you so much for having us today on such an important topic.

Mike: Well, no kidding. Uh, you know, I've spent my, literally my life working with adolescents and Dr. Maloney I'll start with you. You know, I can't believe I'm still having to answer this question, but I've had so many people over the years, including recently tell me, oh, kids are too young.

Mike: Teenagers are too young to develop a substance use disorder. What do you say when you hear stuff like.

Michelle: Well, the first thing I say is each individual's different, right? So some adolescents will experiment, right? We think of that as a rite of passage, almost, you know, for every adolescent and many of them will not go on to develop a substance use disorder.

Michelle: Well, there are others that definitely will. I mean, there are some key factors to take into consideration. You know, we hear about genetics, you know, we hear about the environment, right? The availability of certain substances, um, the environment, uh, what is their families, uh, beliefs and attitudes towards a substance.

Michelle: And then the substance itself right . You know, we're hearing all this about fentanyl right. Unfortunately, one use can be fatal, uh, you know, and some substances impact the brain and are much more addictive than others.

Mike: And Dr. LeNoue, I would think that it would also depend on when they first start using it.

Sean: You're so right, Mike and I totally agree with Dr. Maloney. I mean, just going back for a second, the reality is that to level set, none of us want, um, for, you know, anyone to obviously struggle with substance use or addiction. Um, certainly not a child or an adolescent, but the reality is that quite unfortunately, The truth is that it does happen. And typically where use will often begin with experimentation, pretty innocently is in.

Sean: Um, adolescents in particular and depending on the type of use, things could progress pretty rapidly. So certainly, um, you know, we can talk throughout the podcast here, but you know, adolescents in many ways and youth are primed for sort of risk taking and experimentation. And when you mix that with normal development with.

Sean: The, the drugs and substances that we're seeing on the, out there on the black market, you know, kind of on the streets today. Uh, not to mention the potency of fentanyl, carfentanil, other, um, drugs and substances. The risk is really, really high. So I just want to applaud you and your work, Mike. You know, continuing to bring this to the forefront of how important it is, because it's so important.

Sean: And, you know, I would say one of the best ways that we can combat, um, these issues and concerns is through really quality education. Discussion and prevention prevention is the best treatment that we have.

Mike: Well, right. I think we know what works, right. We've done it before drug usage goes up and down. Look at what we've done with, uh, nicotine, for crying out loud.

Mike: I should say cigarettes. Um, but you know, we, we, who would have thought. We would, when all of us started that we would be able to say that cigarette usage is almost non-existent among adolescents. You know, we would have never said that Dr. Maloney there must be, you know, working with adults is one thing.

Mike: Although adults with substance use disorders can act very much adolescent, but adolescents must present some unique challenges themselves.

Michelle: Yeah. I mean, you know, you mentioned adults, um, about 90% of the adults that we currently see in treatment, um, started their substance use in adolescence, you know? And so that certainly.

Michelle: Gives you an understanding of how, you know, it can unfortunately spiral, um, you know, with adolescents, I think as we think about adolescents and we think about their normal brain development and their executive functioning, their ability to make decisions, right? One of the key cornerstones of any adolescent is impulsivity.

Michelle: Right, their frontal part of their brain hasn't developed yet. Right. And we think about their impulsivity. We think about their crazy decision-making. Um, when we talk about substances or we put substances into that mix, it has an even more significant impact on that brain development and so can make impulsivity even greater or, or that crazy decision-making, you know, even, even much more crazy. Um, and so that certainly is a challenge, because like you said, every adolescent has impulsivity and it's trying to figure out how do we help them the best. Uh, to get them to the next steps.

Sean: And I think along with that too, when we think about how do we help them best to get to the next steps, um, oftentimes in working with adolescents and then families too, um, you know, people will say like, well, what can I do? What can I not do? Like, I didn't see this coming, or, you know, this isn't my child, the brain is hijacked and in many ways, That is true.

Sean: That is the case. Um, but kind of going back to what we mentioned earlier, too, the more that we can bring these issues out into the forefront, the more that we can just bring it out, talk about it very transparently, directly, and clearly. And then do it in a way too, because adolescents don't like to be talked down to.

Sean: No one does especially adolescents, right. And, you know, scare tactics. We know don't work, um, in general and that when we can just really be real and be honest about concerns and, um, the devastating effects that these substances, um, can have on their brains and on their lives. It's not to say that, oh, problem solved it's as easy as that, but it really is that easy to begin those conversations and then get their perspective on, you know, what's cool. And, um, why these issues are such big issues.

Mike: Let me just ask you Dr. Maloney. You know, if that's, you know, if you mix impulsivity. With invulnerability, relapse has to be part of the deck of cards too. How do you prepare an adolescent and their family for that?

Michelle: Yeah, I mean, that is such a difficult conversation at times, because I think.

Michelle: Parents want to send their adolescent to treatment or counseling and, you know, they wanted to be cured or never happen again. Unfortunately, that's really not the case. I mean, if you think got a 15 year old who you're asking them never to have alcohol again in their entire life. Right.

Michelle: They can't even think about next week, let alone when they're 40. Right. Because they feel like they're immortal. So sometimes it's really taking it that one minute at a time, one day at a time. Helping them understand what are the red flags? How will, you know, if you're headed down the wrong path, um, what will be some of those, you know, key points in your life and really working with the adolescent and the family, not to think about, you know, next year, five years, but think about the next week. Think about the next day, the next month and not go beyond that and prepositional that we'll have our ups we'll have our downs and it's more important that we have an open conversation. So the adolescent has someone they can go to, to say I'm struggling, right? Because not only is it about the substance use, but all of the adolescents I see also have co-occurring mental health.

Michelle: Um, conditions, whether that be depression or ADHD or, you know, Asperger's, um, you know, there's some other, and we want to ensure that we're trying to treat them as a holistic person. And we know their friends are so important to them at this age, you know, their peer group and isolation, as we've seen through COVID has not been good for them.

Michelle: And, you know, we want them to be able to have that social life and be safe and healthy. At the same time.

Sean: Dr. Maloney, wouldn't you say to that? You mentioned co-occurring right. And wouldn't you say that really, when it comes to substance use issues and mental health that co-occurring in many respects is the rule, not the exception, right?

Sean: Where the, these issues typically sort of run together, if you will. Um, and thinking about. How we can support, as you've mentioned that individual as a whole, um, and thinking about those other factors that likely come into place when it, when you think about social pressures, peer pressure, but also mental health concerns and substance. So that's, I think that's pretty key when we think about treating. Well,

Mike: And you both just said it. And when you talk about alcohol, you know, I just had somebody the other day 21 years old, and I said, would you like to do a podcast with me? She's recovering. She says, I don't think I should my drug. The only one I've ever done is alcohol. And I just started laughing because I said, yeah, gosh, forbid that we should do the number one drug in the country, especially here in Wisconsin. But when you said can't drink again, it made me think. Well, how do both of you answer the question , and I'm sure you get it.

Mike: Okay. I'm going to stop doing this other stuff, but I want to keep smoking weed. Cause I like what that feels like. How do you answer that question for an adolescent?

Sean: I can start us off and just say, you know, to Dr. Maloney's point earlier. We try not to get into the realm of thinking about forever, right.

Sean: Or never again, or, or absolutes in the moment, because that's a lot for anyone to take in, particularly an adolescent. Now it's not kicking the can, it's not trying to mislead in any way. Um, but really thinking about, you know, the core of recovery achieving recovery and maintaining recovery. However one is wanting to define that of we have to be present focused in the here and now because we can't take care of tomorrow or next week or next year until we're doing okay and taking care of right here right now. The other thing we talk about as we were just real, um, as always, and then we just say, you know, this doesn't mix well for you and your brain. The reality is that it doesn't really mix well with anyone and their brain, but yours in particular. Doesn't seem to do well.

Sean: And so, you know, no shame, no shade. It's just, it's how it is. Like if someone had diabetes, right. Or they had asthma, that's something that they have to deal with. So everyone's kind of dealing with kind of their own things. What are you working on? And then also this isn't a death sentence. In fact, this could be, this could save your life, right?

Sean: Like there's so much more to life, frankly, and we're not here to tell you what those things are, but to go out and explore and find like, what are the things that bring value and meaning to you? And, you know, I guarantee there's so much more than vaping or smoking marijuana or alcohol. And if we dig a little deeper, sometimes we can find oftentimes many will find, find that those are sort of covering the surface of some things that may be deeper down.

Sean: Uh, you know, someone's trying to work through, or maybe trying to cover up because there could be trauma. There could be anxiety, there could be depression, there could be a multitude of factors. So going deeper,

Mike: You know, I think you just, you, you kind of led me to the next thing I wanted to talk about anyway. And that's, you know, at the risk of irritating people that listen to this, um, in AA, they talk about, you know, the steps, right? Powerlessness and higher power. Well, I always found when working with adolescents, staying concrete was pretty essential early on and making a list of people you would harm and how you harmed yourself.

Mike: So, Dr. LeNoue you already started talking about. Dr. Maloney, what are some of the other key concepts? An adolescent needs to grasp to give them the best shot at recovery.

Michelle: You know, I really focus on goal setting. What do they want to achieve? What's going to be important in their life. You know, and if they can set those goals, um, and achieve those goals, I mean, that's pretty concrete.

Michelle: Um, you know, even kind of rewarding yourself, you know, if I do this, I'm going to reward myself with that or, or involving the family in maybe providing some of those rewards, whatever, whatever they may be, you know? And I think. What's important is, you know, you mentioned earlier about, they want to give up everything, but marijuana, you know, I congratulate them and commend them because that's motivation, right.

Michelle: They're willing to open that door, have those conversations and really engage in that therapeutic process. Right. And you can use that motivation. To get to the next step, to get to the next level. Right. I found working with adolescents, if I'm there, like, yeah, but you have to do it this way or you have to do it that way.

Michelle: Right. They completely shut down. And then typically they're being, you know, forced into our session or forced into my office and. We'll just sit there and stare at one another versus, you know, let's truly have that conversation about what's going on.

Sean: That's right. That's right. And thinking about, you know, especially for folks who are really pushing back on, you know, that commitment or, you know, I think Mike your point is so true. You've got to stay concrete, um, in a lot of ways that you made earlier. So I'll just say it, like when, when we find that there's like resistance coming up, um, or pushback, I'll say things like, Hey, I'm not asking you to commit to forever right now. I'm just asking you to commit to right here right now.

Sean: And let's really just kind of focus on where we're at. And in many ways, if we are doing our jobs well there, and we're really helping you to find stability, happiness, contentment. A lot of those other things will figure themselves out. We need to be intentional. Right. But if we're really working hard right here right now, a lot of those other factors will start to become clear.

Sean: They'll kind of fall into place. So let's just focus on right here, right now.

Mike: You know, this is probably on an entirely separate podcast, but kids don't really have a choice where they live. Um, and so many of them, uh, in the recovery treatment process have to go back into an environment where their old buddies are using, their parents or relatives are using brother and sister are using.

Mike: I would think that there's a couple of things. Making new friends skills, refusal skills has got to be a part of the recovery process or, or you're pretty lonely.

Michelle: Yeah, definitely part of it, you know, in their goal setting is, you know, having them identify again, what are their values? Do they have any hobbies?

Michelle: Right? Did they used to play basketball and they stopped playing basketball and, you know, they want to go to a basketball camp to meet somebody over a shared hobby or shared sport. Sometimes just taking a break, you know, is it possible that they're homeschooled for a period of time, right? Just that, that break, you know, working with adolescents sometimes on deleting their social media.

Michelle: You know, and that in and of itself can be traumatic for some adolescents and for others, they really embrace it because it gives them a break, um, and allows them to regroup, rethink, you know, get to know who they are as well. Um, but then also, like you mentioned, the refusal skills. We do a lot of role plays on what's going to happen when somebody walks up to you and we have this thing, we call an exit plan.

Michelle: Right. And that exit plan could be that little white lie, you know? Well, my mom's going to blah, blah, blah. So I have to leave or, you know, what is their sort of pre-planned thing they're going to say when it comes up. And can they have that exit plan that they utilize, you know, and really that family work, right?

Michelle: If it's that brother or that sister, that's also using in the home, how do we do family work? So that, that one adolescent. You know, can stay in recovery or achieve their safety. Right. Cause that's what we're really looking at many times safety, unfortunately, you know, with substance use, we also see an increase in individuals who have attempted suicide.

Michelle: Um, and so we want to make sure they stay safe.

Mike: Dr. LeNoue. When I used to do inpatient and I would have kids leave treatment, I would make them call back the next day during group, just so people could hear from them. Right. I cannot think of an instance where they weren't offered a drug within the first 24 hours, some of them in the parking lot, by the person that was picking them up.

Mike: So how important is it to include the family in the process and work with the family and not keeping them in a box that they are in?

Sean: Totally. I think it's absolutely essential. Um, and I would say that that is true actually, frankly, regardless of someone's age, um, it is particularly true with adolescents. Um, but, but for all that we work with and treat because these issues don't exist in silos and, um, you know, we can actually really lean into. And better support individuals. When we think about other people that are in their network and in their systems, because really when we think about recovery, one of the many core components is going to be about transparency, accountability, right? First and foremost, an individual being transparent and accountable to themselves.

Sean: Right. Um, because we don't want to create a situation where people feel like they're being policed or micromanaged or other things. Um, there were there there's just no trust. And so then they can feel like, well, what's the point? Like, you know, I'm just going to be policed at all times. So I'm going to do what I want.

Sean: We have to be able to help them to rebuild that trust and to regain the freedom. Um, but, but yeah, absolutely families are so important and I would also say. You know, biologic family versus sort of chosen family or other chosen individuals in someone's life. That, that is essential too, because when we think about LGBTQ, um, youth, adults, um, you know, when we think about those at risk for substance use, for mental health, for suicide, right?

Sean: Sometimes, you know, biologic family may or may not, um, be. Uh, you know, safe or, um, be the most helpful with all due respect to an individual in their recovery. Um, you know, maybe someone's working through, um, gender, sexuality, um, kind of identity and, and maybe they're not accepted in their home. Um, maybe there is substance use that's ongoing in the home. Maybe there's trauma, maybe there's abuse, right? So those are unfortunate realities. Um, but, but when we can try to identify early on, if those are factors and then think about folks, um, and people that will help to support individual, even if they're not necessarily their biologic family.

Sean: You know, chosen family is so important too. So something else I just wanted to point out.

Mike: Well, that that actually leads. You're doing a great job of leading me to my next questions. Um, which is a support system. I get worried sometimes as, uh, that young people have a more difficult time fitting into the support group structure because of the ages of the people there.

Mike: But that sense of sponsorship and mentorship that's available in support groups would seem to also be familial in a way.

Michelle: Yeah. I mean, you know, when you, when you think about, you know, one of the things I really encourage as they look at kind of creating that safety plan for themselves, right? Who are the supportive individuals in their life?

Michelle: Is that the next door neighbor? Is that a coach? Is that a favorite teacher? Like those individuals can be so critical in an adolescent's life and, you know, knowing what that is. Um, you know, when we think about, you know, we like to think of it as community-based groups, right? So it may be AA, you know, there are young people's AA.

Michelle: Um, it might be smart recovery. It might be their church, right? Who, who are those individuals? Who are those groups that can support this individual that truly give them a safe place to go and have those conversations.

Mike: That's a great point, you know, as a way to exit this conversation, to be sensitive to your time.

Mike: Um, I'd like both of you to just speak a little bit. It must be, it must just be so rewarding to watch the transition that takes place in recovery with an adolescent.

Sean: It most certainly is. Um, and one of the things, so I'm going to, I'm a child and adolescent and adult psychiatrist, I'm also an addiction psychiatrist. And so one of the many things that drew me to this field and this age group in particular is that. Sometimes you really got to work for it. Um, and that's true for all individuals in different ages, but this age group in particular, when they get it, they get it.

Sean: And you can just see that light bulb go off. And, and even when there's this reluctance or resistance, there's still the opportunity. As always, and especially in this age group to really make lasting change that can just affect individual's entire lives and entire developmental trajectories, um, and, and prognosis.

Sean: So, um, it's really rewarding. And again, I think. The opportunity to intervene early is something that I think is especially important here because you know, the best way to not get hooked to heroin or alcohol or anything else is to never start in the first place. Um, and, and even if someone has sort of.

Sean: Begun going down that road, there's always opportunity to walk it back. There's always opportunity to go in a new and different direction. I mean, whether someone is 16 or, you know, 65, it doesn't matter. Um, but, but that's something that's especially cool about, um, working with youth.

Michelle: Yeah. And for me, you know, I started my career 30 years ago as an adolescent therapist.

Michelle: And, um, I'm fortunate that I can remember my, uh, an adolescent I had in treatment who highly resistant, uh, went on to have a successful career and is now the father of an adolescent. And what really keeps me going in this field sometimes is, you know, just hearing from individuals like himself, who, you know, are proud of themselves for making some difficult decisions and choices.

Michelle: And now seeing him with his own adolescents, and even though his own adolescents are having struggles at the moment. He knows that there's hope he knows that there is. There's another way. And so that really does as a therapist, fuel my fire to allow me to continue to work day in and day out with a challenging population.

Mike: Well, that's outstanding. When a recovering parent can be the beacon of hope for their own kid. What a great story. I, you know, thank you both so much for joining us today, you know, for the listener, you know, that we put links to their information at the bottom of this podcast. And we hope that you listen in with us again next week, when we talk about substance use disorders until then stay safe and everybody can be a beacon of hope.