What We Know About Preventing Adolescent Substance Abuse

There's a wealth of information available online about substance abuse.  The results of massive, government funded studies are available at places like SAMHSA.gov.  The results of these studies are available for free, which makes my job a lot easier.  The tricky part is interpreting the results.  When we collect data for studies, we try to do so impartially as possible, removing all human bias.  However, when we look at that hard data and try to make sense of it, human bias comes back into play and it's easy to lose track of what's really going on.  So let's look at the results of the National Survey on Drug Use and Health (NSUDH) and try to make sense of some of it.

The results of the 2013 NSUDH mostly cover prevalence, ie. how many kids of each age group are using which drugs. But one section of the study is devoted to "Youth Related Prevention Measures."  The study had questions which measured the correlation between kids answers to questions like, "do your parents help you with your homework" and "have you used marijuana in the last 30 days."  And they found some interesting correlations that let us know specific things we can do to help adolescents avoid falling into substance abuse!

Now, there are a couple caveats here before we dive into what the findings.  First caveat: correlation doesn't imply causation. If a kid is less likely to report marijuana use when he reports his parents frequently help him with his homework it doesn't mean those two things are directly related. It's possible they are indirectly related through a third factors like a feeling of connectedness that comes from having good family relationships.  Second caveat: we only know the connections that this particular study asked specific questions about.  If the study did not ask (or did not analyze) questions about exercise or number of close friends then we cannot use its results to examine the relationship between those factors and substance abuse.  Science is hard: sometimes we miss out on the most important connections because they're difficult ones to measure.

So what prevents youths from abusing substances? Here's the short list from the 2013 NSUDH:

• Perceived Risk of Substance Use

• Perceived Availability

• Perceived Parental Disapproval of Substance Use

• Attitudes toward Peer Substance Use

• Fighting and Delinquent Behavior

• Religious Involvement and Beliefs

• Exposure to Substance Use Prevention Messages and Programs

• Parental Involvement

Seems to make sense. If a kid believes drugs are bad, mom and dad would be mad if you did them, and drugs are hard to get, then that kid wouldn't do them.  Kids with high perceived risk, perceived parental disapproval, religious involvement, parental involvement, and exposure to substance use prevention messages were less likely to report substance use in the past month.  Kids with negative perception of drug users and lower engagement in fighting and delinquent behavior were less likely to report substance use in the past month as well. 

Let me focus on a few areas of the findings: Perceived Risk of Substance Abuse, Perceived Parental Disapproval of Substance Use, and Parental Involvement.  I think these are the most important aspects of youth prevention for parents because they highlight specific things that parents can work on.

It can be hard for parents to communicate specific and accurate information on the risks of substance abuse to their teens because there can sometimes be conflicting information. And some of the best information is relatively new. Dr Frances E. Jensen released a book called The Teenage Brain last month. You can listen to hear speaking about the findings in her book on NPR here. In The Teenage Brain, Dr Jensen discusses recent studies in neuroscience that demonstrate the long-term risks of drug use on the developing teenage brain.  She strongly encourages parents to use her book to gather accurate information about the risks of adolescent drug use and then discuss them with their teenagers.  She also speaks at length about the planning part of the brain that anticipates risk and consequences, the prefrontal cortex, and how it isn't fully connected in the teenage brain.  She encourages parents to help teenagers plan for and weigh risks because their brains aren't yet fully able to do so.

How should parents talk to their teens and tell them they would disapprove if they found out they were using drugs? Calmly and directly.  If a parent is emotionally overwhelmed by the idea of drug use it's likely the message might get lost in all the emotional charge.  If mom screams, "Don't ever let me find out you're using drugs!" then she'll get what she asks for. If her kids use, they will hide it.  It's important to leave the communication lines open with a calm and direct statement like, "I know there are going to be kids drinking, smoking pot, and using other drugs at your high school and I know there's a chance you might end up trying these things as well. I really hope you don't.  At this age your mental development can really be thrown off by even a little drug use, so even if you think you might try it, I hope you choose to put it off for now." Being able to make that statement without an emotional charge leaves your kids with the nonverbal message, "If I am ever in trouble with drugs, I know my parents won't just freak out on me. I know they'll be there to help me."

Being involved in your kids life is a huge factor in preventing substance abuse.  The NSUDH study looked at specific things like whether the kids reported that their parents helped them with their homework, whether they had a curfew on school nights, and whether their parents let them know when they did a good job.  In kids who reported parental supporting and monitoring, tobacco, alcohol and drug use rates were cut in half.  And that relationship gets at an incredibly important and very new idea in the realm of addiction treatment.  Connectedness is a key factor in preventing substance abuse and addiction.  Old studies that seemed to that cocaine was universally addictive in lab rats are being challenged by new studies that show rats living in communities will only become addicted in the absence of healthy social interaction.  You can read an excellent description of recent studies on this in this recent article in The Huffington Post. But the takeaway message is to communicate, connect, participate and be involved with your kids if you want them to lead lives free from substance abuse issues.