Battling Addiction in 2023: Alcohol, Drug Abuse, Fentanyl, Vaping, Cannabis, Off-label Rx
By Melanie Wells
September 28, 2023
NYC-Parents in Action kicked off its popular Parent Lifelines: Online Seminar Series, 2023-24, with a conversation between Geoffrey Golia, LCSW, Director of New York Center for Living; and Laurie B. Freeman, PhD, NYC-PIA’s Director of Facilitation.
Dr. Laurie Freeman posed questions, spurring the substantive dialog. Geoffrey Golia shared solid advice, strategies and tips, demonstrating his genuine passion for helping young people meet their potential and move toward connected, engaged lives.
The drug scene has changed over the years, Golia said: the high potency THC products we see have a cannabis percentage much higher than years ago. Further, he noted there can be a link between substance abuse, cannabis schizophrenia and substance abuse-induced psychosis.
Dr. Laurie Freeman: “The idea of psychosis coming from cannabis use is very scary” to parents. How do we deal with the dangers? What should we say to teens, in order to help?
Geoffrey Golia: Tell them to delay use as long as possible. If a person can get to age 26, chance of psychosis emerging becomes almost zero. But for high school kids, still adolescent and still with developing brains, the danger is real.
The relationship between parent and child is important here. The first question we ask parents is, how is your relationship with your child? Are you spending time together? Is communication open between you?
The relationship between parent and child is important here. The first question we ask parents is, how is your relationship with your child? Are you spending time together? Is communication open between you? We know teens want to pull away and individuate, so parents should adjust how they relate to kids on the road to “becoming young adults.” However, this does not mean backing away from the parenting role, but rather meeting it with flexibility, to adjust to the growing adolescent.
“We like authoritative parenting – not permissive, not authoritarian,” Golia said, noting that the sweet spot for good parenting strategy lies between two extremes. On the one hand is simply abandoning parental duty (permissiveness); on the other, coming down too hard (authoritarian). Instead, choose the middle, or authoritative approach, by “setting clear boundaries, co-parenting effectively, letting kids know what the rules are and enforcing them lovingly but FIRMLY.” He urged parents not to hesitate about stating “what is not allowed in our house.” Tell kids you’re happy to have a conversation around this if they’re feeling peer pressure. But do find that “sweet spot” and be consistent. (A caveat: Have this talk when everyone is sober – NOT at a time when your child comes home high.)
Setting boundaries and limits ahead of time creates a safe space for our kids to come to us.
Setting boundaries and limits ahead of time creates a safe space for our kids to come to us.
LF: Let’s say you have good relationship with your teen but he comes home intoxicated, so you know there is some use. You’d like abstinence, but there isn’t. What does the conversation look like in that instance?
GG: FIRST, make sure they’re okay. Hold off on the lecture. They may need to sleep it off.
Once you’ve made sure they’re safe the next step will be to talk. Next morning, sit down with your child and express your worries. If you had an expectation of no use, ask about it. Demonstrate your care and concern but be clear that it’s “a violation of your expectation.” Or, if you haven’t yet set clear expectations, set them, now. Ask about context of use – has it been occurring for a while or is it new? And ask, what made you want to use? The success of the conversation will depend on your child’s openness, but you can start by expressing your curiosity and asking questions.
LF: Do you also want to set a consequence, say, if the child does it again?
GG: Consequence should come when it’s been mentioned beforehand. If it comes out of “left field,” that moves into authoritarian territory. Setting expectations “clearly and beforehand is the path we want to take.” Framework should be set ahead of time, “so the consequence, when it comes, is NOT a surprise.”
If you haven’t set expectations, then do so when the issue comes up. Going forward, stick to them. Expectations should be clear, and should be set “with warmth and love, but also with firmness.” For consequences: taking away a phone, or forbidding parties where you know there’ll be substance use, can work.
Golia also noted that parents should model “emotion regulation.” If your child sees you regulating your emotions around sensitive subjects, it’s a model for him to use in his own emotional regulation. If a child can regulate well, it’s less tempting to use drugs to help.
LF: What about kids going to parties where friends are getting high, so they do it to fit in? Or, the situation when using substances helps the child manage uncomfortable feelings?
Parents should model “emotion regulation.” If your child sees you regulating your emotions around sensitive subjects, it’s a model for him to use in his own emotional regulation. If a child can regulate well, it’s less tempting to use drugs to help.
GG: “These two things are linked, even for the kid who uses because he’s following friends,” as he may be “avoiding painful feelings of being ‘other’ or left out.” There is an emotional paradigm here, even if it’s just in the moment.
Young people are just developing their social and emotional skills. What we do is help kids develop good coping skills so they’re can do other things to cope than just reach for drug use.
We want young people to develop a toolbox of coping skills. We see predispositions for substance abuse as early as toddlerhood, and also in latency (ages 5-10). Signs of emotional regulation difficulties appear early. By ages 12-14, coping via cannabis use emerges, and later on, use of other substances too.
LF: So, we need to look out for that early, and help kids learn to manage their emotions as they are growing, so they don’t reach the point of having to use.
GG: Yes, because at 12, 13, 14, it may start with cannabis and alcohol. The percentage of users then rises steadily, up to twelfth grade. He noted potential for a parallel rise in emotional regulation challenges: “From ages two to ten, we see emotional regulation difficulties begin. Teachers see and report it. If they do, pay attention.” As parents, we can “help our kids in advance.”
LF: A question er asks: Is it so bad if kids are smoking weed sometimes? We sometimes use it. How do we talk to them about appropriate use?
GG: This is a valid question for adults who use alcohol or cannabis sensibly. But research suggests kids should not use any substances before the frontal cortex is developed (in their mid-20s). Before this time, cannabis and alcohol use can affect that development negatively.
Golia stressed that parents CAN say no. “You can say no to something that you use appropriately, but that is NOT appropriate for your child,” due to age. The context (age, maturation and development) is different. IT IS OKAY TO SAY THAT.
Research suggests kids should not use any substances before the frontal cortex is developed (in their mid-20s). Before this time, cannabis and alcohol use can affect that development negatively.
Golia added, “We need to get over the idea that this difference is hypocrisy. The context is the difference. Use by a fully mature adult is different than use by an adolescent with incomplete brain development.
However, we should “look critically at our own use and think about what we’re putting in our bodies.” Sometimes when families come in for treatment, parents begin to see they may be using more than they should. Do differentiate between your use and theirs, but if your child needs treatment, practice some “solidarity” and remove the substances from the house.
LF: Similarly, if you drink moderately, it’s important to distinguish between what’s safe for you and what’s safe for them, based on data around the effects of age difference.
GG: Right, don’t take a defensive position – it actually is different for young people. There are areas still in need of growth development, so for them to use before their 20s is different than use by a mature adult.
Strengthen family and community ties, too. Young people should grow up with a good sense of connectedness and empathy with family and community, because feeling disconnected works against the ability to resist substance use at too early an age.
LF: You can say to your child, if having a drink takes you out of the moment, that won’t serve you well in becoming an engaged and connected person.
GG: Yes and help them approach things with gratitude. See what is beautiful around you. It can really undergird a sense of hope. Yes, there are dangers, but help kids learn to see and dream about the amazing things they can accomplish: “Make your life a masterpiece.”
LF: What are signs kids show if they are really in danger? And what about Fentanyl lacing?
GG: If you have real concerns about the condition your child comes home in, it’s never the wrong move to get medical attention – you can go to the ER or urgent care (if there’s a lot of vomiting, for instance). Out of abundance of caution, always ensure your child is safe.
As to Fentanyl: This is deeply concerning. Opioids are now often laced with Fentanyl. One positive piece: we’re fans of providing Narcan nasal spray to reverse risks from opioid use.
There are some reports out there about Fentanyl and cannabis – however Fentanyl is more likely to turn up in powders or pressed pills, such as Xanax, or Ecstasy. There are test strips you can use to test for the presence of Fentanyl. But it is less prevalent with cannabis.
LF: If it’s Ecstasy – how dangerous is it for our kids?
GG: The big danger is in their feeling that they need this substance to manage their emotions – that they cannot do without this. You can never know for sure what’s in a hit of Ecstasy nor how you will react to it.
LF: We can talk to kids about why they feel they want to put themselves in danger, and tell them too that “even if you don’t use this stuff, it’s not the end of your fun forever.” We want to promote a culture of sobriety in young people but do it with facts. “Just say no” isn’t enough. And, we want to pivot to the incredible things they can do without the substances.
Finally, at what age should parents START talking to their kids about substances?
GG: I think you start appropriately building to it at a very young age. If someone dies in the family you try to address it carefully with your toddler in age appropriate ways. This is the same. Start angling toward it, so by age 10 or 12 you can discuss it openly and honestly. You don’t need “fearmongering,” just a “healthy dose of awareness of dangers,” but be sure to let kids feel “they can come back to you and talk to you.”
I like using the “call for help” in tricky situations. It’s a call that says, you need to come pick me up. With this, don’t lecture – just say “thank you” for calling me for help.
LF: What about vaping? Nicotine, cannabis?
GG: There’s a lot out there; cigarette use is lower but e-cigarettes and cannabis vaping have increased. Vaping is less undetectable, more discreet, so we see kids using without the adults noticing. Same with edibles – they can pass under the radar.
“There are no redeeming factors to nicotine use,” added Golia. He advised having a conversation using the authoritative parenting approach:
1) Ask questions: be curious about what is going on and what they’re thinking.
2) Be frank, if you’ve stopped smoking.
3) Offer help. Tell them about gum and patches to beat nicotine addiction.
4 Set expectations going forward. And stick to them.
LF: Suppose you offer help and your child doesn’t want help, is happy using, says “I function well and I’m doing my school work and I want to keep using.”
GG: Note negative consequences. Say firmly that “this is not the expectation in this family.” Provide your reasoning for why it’s not acceptable. Back it up, citing the addictive nature of nicotine, and health issues. Be clear about your expectations.
LF: Do you see parents with Rx opioids in the bathroom cabinet, and kids find and use it?
GG: Yes it happens, and is often an entry point for opioid use that can lead to heroin. It’s extremely addictive and can quickly lead to dependency. Don’t keep opioids in your medicine cabinet. Lock them up and keep them away from kids.
LF: Alcohol too?
GG: Yes, lock it up. Don’t leave it out for them to take and use.
LF: What about cannabis leading to psychosis or schizophrenia?
GG: It’s searchable on Google, but briefly, data has shown cannabis use has increased the potential for substance use psychosis and for the early development of schizophrenia. If there is a pre-disposition, the substance use may push that pre-disposition to the fore. The mistake is in thinking cannabis use is benign. It isn’t. It may push a predisposition to emerge.
LF: So parents need good solid conviction around saying, “This is not okay.”
GG: Yes, our inclination may be to waver, but we should be consistent and maintain conviction.
LF: What about psychedelics as a treatment? Can that be confusing or raise questions of when to say yes, when to say no?
GG: Yes, cannabis legalization, and medical psychedelic use can both create confusion on the safety of using. But we’re talking about young people (not adults) and it is not safe for them.
Laurie thanked Geoffrey on behalf of the audience, and noted some optimistic takeaways: that parents can help their kids have a more engaged and connected life if they’re NOT using; and that parents can help kids learn to deal thoughtfully with their problems, rather than seek to escape them through substance abuse.
GG: Yes, right – and let’s be happy warriors about this!!