 Ben has been in the field of substance use disorder and mental health treatment for 48 years. He has been an educator in the field of addictive disorder since 1979, holding positions as a general professor at College of Cemetery, program coordinator and instructor for CSU East Bay. Ben held positions as executive director, program manager, clinical director as well as counselor in a number of substance abuse treatment programs in the Bay Area. Now without further ado, I'd like to pass it over to Ben. Ben, you may begin. Thank you, Lori. Thank you for coming. It's always my honor and thank you for honoring the Aloni people as a person that's from First Nation. This presentation is a little bit different than I usually present, mainly because I'm not always sure of the audience and who is here. So when I designed it, it was with the idea that there would maybe people who are concerned about some youth that may be having and suffering from a substance use disorder or mental health issues. So I sort of pointed my slides to those kinds of things. I want to move this out of the way so I can. So we're going to first talk about what sort of the issues are and the concerns about parents who may have children that are having problems. Ben, I'm sorry to interrupt you. We don't see your screen yet. Oh, so what am I doing here? What am I doing wrong? I'm not sharing your desktop. Okay. I can't, oops. All right, so now we're, I can't get to the, I can't get, for some reason, the bottom line. Let's see. I can't get to share. If you move your mouse to the bottom, you should see the toolbar. It's not there. I can share my screen. Let me pull up your presentation. Give me one moment to find your presentation. Share my screen. Just everybody see my screen. You know, I don't see your screen. You don't. All I see is my, let me see if I can get out of it. I'm going to end my show. Okay. There you are. I'm going to stop share. Then you can go ahead and share your screen. It still won't let me, why won't it let me do that? If you move your mouse to the bottom and zoom, the toolbar should reappear. I'm doing that is that. Okay. Yeah, it's not for some reason it's not doing that. Let me see. Nope. It's not like me. Would it help if I share my screen and you tell me to advance lights. Yeah, we, we, we got to do something like that. Yeah. Okay. Okay. So I will share my screen again. And you can just tell me to advance lights. Okay. You see your presentation now. Yes, I see. Yes. Okay. So you can begin your presentation. Okay. And just let me. So let's go to the next slide. Oh, now, now it shows up to share a screen. So do we just want to do. Okay. Here we go. One of the things that I've run three adolescent treatment programs. And a lot of the concerns are the, you know, the parenting dilemma on what is normal for a teenager going through your puberty and their teen years, et cetera. And like I said, if I have a spouse that has a drug or alcohol problem, I can get rid of them and find another one of them. And if it's your child, it's a whole different situation that you are faced with is, is this a normal situation that my child is going through that they will process it and get on the other side. I remember with my own daughters, I shared this story with Lori that one morning we got up and get ready for school. My oldest daughter was she was in her teens and she was just having a difficult day and life was miserable and everything is bad and et cetera. And so she went off to school and all day long, I was worried. Oh my God, you know, what's going on with her, et cetera. And then in the evening when I came home, I said, you know, how are you, how are you doing, Nicole? And she says, fine, why? What's the matter? And so, you know, these are, are, you know, the proceeds, perceived problems of parents. And what are we supposed to do about it? Some of the other questions are, you know, when does it become a problem to the point where I should intervene? And then where do I go for help? And, and, and is what you're observing with your child is, or what your child is, are they observing your own behavior and habits that may not be the healthiest in the world? How's your own mental health? And, and have you been, you know, clear about the realistic expectations and consequences to your child's behavior, the structure that most families need to have in order to bring up children? And then as we'll talk about, what are some of the major prevention for substance use and mental health is how much time we spend with our kids and over time. And then, and then how do I evaluate my own parenting? Do I over parent? Do I under parent? We often would get kids referred to a treatment program and their parents would come in and the kid, yes, he's been experimenting with drugs, but there was no indication that there was a substance use disorder or mental health problem. What it was is the kid was 16 and the parents were still parenting him like he was 13. There's not a big difference between someone who's 70 and someone who's 75. There's a big difference in terms of developmental issues between someone who's 13 and someone who's 16. So all these are sort of the dilemmas that parents oftentimes have to deal with. Next slide, please. Now, these are some of the highlights of the 2020 National Survey on Drug Use and Health. And when if a kid is smoking tobacco or vaping, there is a very high chance that that kid is also experimenting with alcohol and other drugs. And it says, listen, alcohol use, et cetera, you know, it's talking about binge drinking, which is one of the most dangerous things for kids because they're drinking lots of alcohol at one time. And we make a distinction between someone who ODs on a drug and someone who passes out from drinking too much. But the reality is that someone who is passed out have actually ODed on alcohol. When they die from too much alcohol because of binge drinking, they die from respiratory paralysis, which is the same thing you die of when you take too much heroin. So it's probably one of the most dangerous things. And also, some of the major fatalities with kids is their binge drinking and getting in a car and driving around. And then illicit drug use is marijuana. Now, marijuana is now ubiquitous. It's all over the place. You can get it pretty much anywhere. And so the use of marijuana is becoming a social drug like alcohol. And so the good news about the legalization of marijuana is that we're not putting people in prison for years because of use or possession. The bad news is that it's now becoming more available to people pretty easy. When I was a teenager to get marijuana, you had to know someone who knew someone who knew someone to get that. And here, you pretty much can ask anyone and they'll have some marijuana around. Next slide, please. So some of the facts are that 15% of high school students report having ever used illicit drug and injection drugs. Cocaine and Helens, heroin, methamphetamine, and hallucinogens or ecstasy, which ecstasy, in a lot of ways, is like a hallucinogen. Anyway, so 15% of the students have experimented with it. And 14% of those students report misusing prescription opium and where they get their prescription opioids are from parents or friends of parents. There was a study several years ago about when we first started becoming aware of Vicodin and Oxycontin being misused. Literally, the kids were going into their friends' parents or their own parents' houses and taking their prescription drugs and using them. Now, honestly, the problem with injection of drugs is the direct risk for HIV, although that's been reduced by needle exchange. But the biggest issue, especially with the fentanyl epidemic that's going on, is the risk of overdose. Youth opioid use is very linked to sexual risk behavior. And I should have sort of put a dot, dot, dot there because it's not just opioid use. Alcohol probably is the number one process of risky sexual behavior that teenagers are facing. And students who report using prescription drugs without a doctor's prescription are likely than other students to be victims of physical or sexual dating violence. And this is what I was talking about, not just with prescription drugs, but also with alcohol. And drug use is associated with sexual risk behavior, especially violence, mental health, and suicide risk. Those who have a typical scenario, usually a teenage girl will go to a party and whether it's simply she overdrank and ended up in a sexual situation she didn't want to be in, including what we would call date rape. And there's a question here, and I got this fast, sorry. Or they've actually been given a drug that will cause that. From there, when especially young women end up in that kind of trauma, the rates of continued high risk, substance use starts along with other mental health problems such as depression, anxiety, that often lead to suicide attempt. Next slide, please. So primary causes of death in adolescence is motor field crisis, suicides, and homicides. The bigger issue is the issue around deferred qualification and impulse control. And we'll talk a little bit about that as we go along. But obviously these are all related, sort of cognitive problems that when you're under the influence, you don't think correctly. And they're exacerbated by substance use. Next slide, please. So high risk, age of adolescents experimenting with drugs or alcohol before adulthood. The earlier an adolescent begins to use psychoactive drugs at a higher risk of developing an addictive disorder. We call this early onset. And we only have to look at the records treatment programs over the last 25 years, where the average person coming into a treatment program or diagnosed with a substance use disorder were in their early 30s on. Now we have kids that are 12 and 13 years old that have a substance use disorder. I should have said this earlier. When we talk about adolescence and substance use disorder, it should always be with a slash mental health disorder. Because usually adolescents who are experimenting with drugs who continue to experiment in an abusive way also are suffering from some level of a mental health problem which has usually depression and anxiety. And the bigger picture is also PTSD. And they changed this last DSM, when they went to the DSM pilot, I think they made PTSD outside of the anxiety disorders. But the symptoms of PTSD also include anxiety and depression. Next slide, please. So early onset. Early use of psychopathology and deficits in social and occupational functioning. And I think there's some slides there to talk about. I'll talk about now. One of the major issues is the developing brain. So science has said the brain isn't fully developed in people until they're in sort of like their mid-20s. And when the use of drugs are started, especially in very young teens, that developmental process can get stunted. And the ability to use executive functioning for a low decision making starts to be minimized. And so the decisions then start being made based on what the drug is demanding from them. So the other part of it is, especially now with the internet and some of the other things, is the development of behavioral disorders. Gambling, sex addiction, being able to watch pornography, and even to the point of gaming and other kinds of internet, things that kids can get involved with. And that also speak to a lot of the other problems kids are having when they may not be using substances, et cetera, but they are now involved in other kinds of addictive behavior that associated with, like I said, the internet usually. Next slide, please. So who's at risk? And this has a lot to do with the neurobiology of addiction. And we don't have time to get into it in terms of where it is. What we know, what science shows now is that in the midbrain around something called the VTA and the nucleus accumbens, basically where some of the neurotransmitters that are associated with addiction, such as the big one is dopamine, dopamine 2 to be specific, that one of the things we said about drugs is, drugs don't get you high. What drugs do is they trigger highs in the body. Every drug that's out there has a connection with a neurotransmitter in our body that when the drugs are introduced, they start to trigger these neurotransmitters. Most of them, the big ones are dopamine, norepinephrine, cocholine, and GABA. GABA is usually associated with alcohol. And additionally, you understand that from a neurobiologic basis of addiction that the developmental process starts to slow down. So their ability to get through the developmental processes that you would normally, a teenager you're supposed to get through, are starting to get hampered. I'll talk a little bit about what we used to call the 515 rule. Next slide, please. So navigating childhood and all the pitfalls that go along with it. The original slide deck here, I put a whole bunch of stuff on attachment and attachment disorders, but I decided that if you're interested, you can Google attachment disorders. But they have a major issue, they're a major process by which the type of attachment that a child develops when they're young follows them through the rest of their life. Next slide, please. So if health and secure attachments are not there as a child goes up, a person looks for ways to fill that need. So this is one of the psychological theories that we talk about that leads to addictive disorders. So if I didn't get what I was supposed to get from my childhood, and this is not to blame mothers, but usually the mother, then as I grow older, if that need wasn't met, we seek it out. We try to find ways for that feeling secure and that secure attachment that we didn't get as children. And the result is when we find substances that fulfill that need. And so in attachment theory, there are five or six different attachment styles. Another way of sort of looking at it is that when we're growing up, we develop self-defense mechanisms. This is our way of being able to function in the world by the development of these self-defense mechanisms. They're normal, et cetera. And they tend to be pretty permanent for our entire life. It's how we cope with our world. And if we did not develop healthy self-defense mechanisms, then those are often ones that are connected with our addiction. In fact, people who are trying to find recovery in addiction have to almost deconstruct those ego-defense mechanisms and build ones that are helping. Next slide, please. So adolescents, as we know, is marked by all kinds of biological, psychological, behavioral changes. There's physical maturation and puberty, just getting through that, which means that at some point all our hormones are changing and causing us to have all kinds of different feelings and urges, et cetera. And we're also in the middle of that trying to figure out who we are. How do we individuate from our families, but still feel connected to them. There is a book that came out when my kids were in their teens back in the 90s, and I think the name of the book was, I Hate You, I Hate You, I Hate You. Now take me to the mall because I need new shoes, kind of thing. It's sort of this push and pull that often happens in adolescents. It's also the time where we're trying to figure out part of that individuation is learning independence and taking personal responsibility. And when we get to this issue around the 515 rule or develop middle stage, you'll see where this becomes problematic. It's also the change between parental authority to peer authority, which is normal. You're just hoping that your kid's peer group is healthy and they, for the most part, make fairly healthy decisions. And that peer group then becomes more instrumental in their decision making than the parents are. In fact, oftentimes with adolescent treatment, we find that the parents really have lost most of their, not connection, but their ability to influence their kid as opposed to their peers. And their belief system now are taking hold as a way that the young person is so respondent to life. There's also the normal increase exploratory behavior, wanting to reach out and experience new things. And then the whole process of the brain development that's still going on. Next slide, please. So this is a 515 rule. Now, let's start a real rule. When we first started developing adolescent treatment programs back in the 80s, there was what we basically did is we took the adult model and try to shove it over adolescents and it wasn't working. So we, in the Bay Area, we put together a consortium of adolescent treatment programs to sort of like, let's discuss what are some of the issues that are more relevant to adolescents than that we need to address that are not associated with how an adult gets into recovery. One of the main ones is the process of insight. So a lot of recovery is based on can you see or understand what your drug and alcohol use is doing to yourself and other people, et cetera. And oftentimes, adolescents don't. They're in that stage, developmental stage, that they'll be moving through. If you remember the other slide I talked about, the process of taking responsibility for your own actions. Oftentimes, they're not able to do that yet. So we started looking at why are adolescents in treatment programs oftentimes do not match their age, does not match their developmental stage as opposed to their, I'm 16, this is where I should be in terms of developmental issues. So we came up, this is not science by the way, this is our anecdotal way of sort of putting things in perspective. So we said it takes about five to 15 years for an adult to become, to develop a substance use disorder. And we say what an adult is is from early 20s plus. Then we say it takes five to 15 months for a teen to develop a substance use disorder. And that's from early teens, the early 20s. And then it takes five to 15 weeks for pre-teens to develop a substance use disorder. And that's up to your early teens. For teens and pre-teens, when they develop that, they cross the line, their developmental process stops. So you may have someone who's in treatment, who's 16 years old in terms of their biological age, but the developmental age is 13. And like I said, there's not that much difference between someone who's 17, someone who's five. There's a big difference between someone who's 13 and 16. So when we were dealing with an adolescent, we are looking more about where the developmental stages rather than their biological age. And it started explaining a lot of the behavior we were seeing in the treatment programs. It's interesting that we also, if you take that a little bit farther, if a teenager, let's say someone, let's say in their middle teens, ends up with a substance use disorder that goes undiagnosed or untreated, then that moves right into adulthood. And so I can't tell you how many times I sat with a 35-year-old man, and I swear I'm talking to a 16-year-old boy. And so their ability to do just normal adult things are being hampered because they're sort of stuck in this stage, the development stage that they never was able to get out of or get through. Next slide, please. I'm going to go quick through this. You'll have this slide pack. So again, kids trying to navigate adolescence, they have to figure out what their basic tasks are, which is what do they want to be when they grow? What do I believe is important? What is my sexual identity or my gender identity? How do I deal with authority in terms of realness, learning to be authentic and learning how to develop intimacy and how to be spontaneous and be aware of the people around me? In terms of relationships, understanding how to be empathetic and a risk in terms of relationships, we all know that in relationships, by bonding with other people, we run the risk of being hurt. And then learning how to accept ourselves and the people around us. And then connections. And this is why it's important. So connections to self, to others, to your spirituality, however you define that, and to the community. That also gets stopped when someone has a substance use disorder. Going back to attachment, what it means is that I moved my attachment to a substance. And so that becomes the focal point of who I am as a person. So in terms of people trying to get into recovery, it's then trying to figure out how to go back and make relationships with myself, with others, understanding what spirituality is, and to the community in large, how do I fit into that place? Next slide, please. We already talked about behavioral addictions, but we're seeing this more and more. I did some consulting over in Amsterdam, and it was really interesting that about a third of the people were there were not there for substance use disorder. They were there because of gambling, video gaming, internet usage in general. And they're two to four-fold higher in adolescence, where their brain is still forming, and it's a lot easier for this addictive behavior to start to happen. Next slide, please. So there's a film out there called The Hygiac Brain, and what happens is that over time, the addictive behaviors may be hijacked, the brain's natural reward system. So because we have dopamine and serotonin and norepinephrine and those in balance in a homeostasis kind of situation, they give us, we get rewards from doing certain things, or eating certain foods, or being with certain people, which is normal. When you start using drugs, you're pumping so much more dopamine and serotonin and norepinephrine into your body that it becomes, then becomes normal. So if you're not in that state, you feel like you're not normal. And so natural reinforcers are not working. And so the sense of connection to family or friends or things you like to do, sports or other things, stop becoming reinforcing, because the only thing that becomes reinforcing is putting the drug in your body to get that quote unquote high. So the brain becomes hijacked, starts up in the, like I said, in the midbrain. And then if you see slides, you'll see where these neurotransferers go, and menus from the dopamine area in the VTA go right to the frontal lobes. So that means you're basically an executive function, you're willing to make good, rational decisions based on evidence in front of you, goes away. And it's only interest then is to get a drug and or be involved with the behavior that's going to give you that feeling. Next slide, please. So there's a, we talk about the biopsychosocial model of addiction. We're saying part of it is biochemicals slash genetic, then there's the psychology associated with addiction and then the sociology associated with addiction. So in the biology, there's the genetic vulnerability, brain susceptibility, people with ADHD, ADHD, just with that oftentimes have a higher rate of that. And there's always this misnomer that we give, rightly so, parents are a little resistant about wanting to give their children most of the medications associated with ADD, which are stimulant drugs. They're basically speed. But they're being given therapeutic doses of that. What we're seeing is that kids that either didn't get diagnosed with ADD or got diagnosed and took medication for a while and then stopped. What happens is that years later or sometimes later, they will start experimenting with other drugs. Marijuana can help with the ADD. Alcohol can help with ADD. And then they'll find something like cocaine or myth and epitome. The problem is, is now they're not taking therapeutic doses of that drug. And then complications happen. We also know about genetic vulnerability. Depending on who you read, 50%, I'll just say 50% of people who have an addictive disorder had one or both parents, sometimes grandparents that had addictive disorder. So there seems to be a real connection from a genetic point of view. This also is those individuals that have a genetic predisposition that often times are those early onset. So as soon as they start experimenting with drugs, it goes from zero to 100. In other words, there isn't a slow progression into addiction, like often happens with someone who didn't end up with an addiction disorder until they were like adults. But as adolescents, it goes very quickly into a severe addiction very quickly. Some of the other issues in psychology are the issues around impulse control, self-management, how they are able to do mood management, and if they have appropriate self-esteem and how our ability to adapt to change. So things happen. Sometimes a couple decides that they no longer want to be together and they get a divorce. So they may not be made a parent anymore, but they're still parents. And so that often happens how well the parents are able to continue to parent during times when there is divorce and how well the kids are able to adapt to that change. And then again, social, peer-to-peer relationships and their engagement in social activities. If you have a kid that tends to be pretty shy or has social, we don't use the word shy as much as we use social anxiety. And I'm going to answer questions when we get done. So otherwise, my brain gets too distracted. OK, next slide, please. So as we said, the impact on the brain and the prefrontal lobes and then the cognitive control and deferred gratification starts to be affected. And then I already talked about the 515 lobe. Next slide, please. So warning signs. And this is where I talked about earlier. How do you know the difference between normal kid development issues and it's usually that if it's really ongoing, it's been going on for a while, if it's been going since they were little. One of them is mood changes. And ability to learn how to cope with those mood changes. Temper flare ups, irritability, defensiveness. One of the major ones is academic problems. In other words, they're cutting school. They're disciplinary action at school. They're low grades. And this usually happens, or one of the signs is a B student all of a sudden over a course of a semester, they end up being a D student. And so something's going on. Now it may not be substances. It could be depression. It could be anxiety. It could be a variety of things. And so it's a clear indication of substance use. Changing friends very quickly, especially when they change a peer group and parents don't know who those are. And you're seeing sort of a change in their attitude about things and not wanting the child, not wanting their parents to sort of meet these new people. Or what I call them sort of the existential angst, nothing matters attitude and low energy, et cetera. And especially if the kid was really into a sport or some kind of activity that they really enjoyed and did a lot of, and all of a sudden they don't want to do it anymore. That could have a lot of indicates for a variety of things, but it's definitely an indicator that there may be substances going on. And then, you know, physical or mental changes. And, you know, basically you're seeing your kid when they're under the influence is happening. So next slide, please. Okay, we're getting a little bit through this. So I want to just quickly talk about these are the risk factors. They're all very typical ones. You know, there's an attachment in the family. There's an effect of parity going on. But the protective factors is that if you know that you have a strong bond with your child and they still come and talk to you, you know, they still will ask you questions about stuff and that you are supportive of what they're trying to do in their life. And there are clear limits and consistent enforcement of discipline. When my oldest daughter turned 13, I put a list of the rules and their consequences on the refrigerator and said, these are the rules that are going to guide you through your adolescence, through your teens. And these are the consequences. So you know what they are. And so if those things happen, you know, you know what the consequences are. Next slide, please. Outside the family, it's sort of the ones that we talked about before. Your child doesn't seem to have good coping skills. There's academic failure going on. There's aggression and impulsivity. But protective factors are, you know, that you're bothering the child. You know who their friends are, where they're going, where they're coming from. Success in academics or extracurricular activities. And they sort of, they tend to follow the rules, not blindly, but they tend to follow the rules. They stay within the lane. And they typically have conventional norms against, you know, abuse. And that also happens because of what they've been told about drugs, alcohol, what's appropriate, what's not appropriate, et cetera. Next slide, please. Co-occurring disorder. So this is what I said earlier that there's co-occurring disorders basically means that a person meets the criteria for a substance use disorder and a mental health disorder. And they have both. One's not caused by the other, originally they may be, but that now, at the time you diagnose them, is that they have both. And so estimate rates of co-occurring, mental illness among adolescents, and substance use disorder range from 60 to 75%. So it's very high. Other commonly doc-made co-occurring mental disorders include conduct disorders, oppositional defined disorders, ADD, anxiety disorders, and PTSD. Those are the big ones that we see with kids. Like polo sometimes in there, but not as often as these here. And then the major depressive disorder, they start to arise. And we don't know. This is when you don't know if the depressive disorder is started out as a depressive disorder, but then was exacerbated by the use of drugs and alcohol. Next slide, please. So genetics, you know, environmental contributions. So again, there's studies, animal studies that point to this. There are twin studies and adoption studies that all point to a direct connection between genetics and substance use disorders. Epigenetics is simply saying that our DNA doesn't change, but it can be influenced by an environment. And that's becoming a real hot issue in the addiction field in terms of what is the impact of epigenetics on individuals that may not have any historical familiar addiction, but they end up with it. Is there something to do with the epigenetics? Next slide, please. So we're going to talk a little bit about now some of the things to be done. There's new federal funding available, and these are sort of the priorities in schools. And, you know, this is one of my biases. Schools oftentimes tend to be in denial about the rate of mental health and substance use disorders. And sometimes they take the place of saying, you know, we're not here to raise your children. We're not here to educate them. But the reality is they see, oftentimes, see the kids as many hours a day as you do. And so they're really trying to, you know, build safer safety schools and train educators about addictive disorders and to identify kids with substance use disorders, mental health disorders, help with academic achievement, and then, you know, support education, and staff stability and well-being so they can cope with these issues. So there's a chunk of money that's going into it. It's actually more than this. This is just the new federal funding on top of what is currently available. Next slide, please. So substance use prevention resources. Next slide, please. So we're going to talk about types of treatment that tends to work with individuals with a substance use disorder or mental health for the youth and their families. Next slide, please. So most of it has to be family-based. Where, as I said, one of the things I said was that, you know, 50% of people with a substance disorder came from families with their substance disorders. So when we get kids in their treatment program, we have to evaluate, in fact, does one or both their parents have a substance use disorder? If they do, then how are we going to address that? So most adolescent programs need to be family-based. That means that at some point, if I had, in a perfect world, I would have everyone, family, parents, and grandparents, if they're involved in the daily upbringing of their children, siblings all come to treatment all at the same time, because everyone's been affected by it. And so one of the methodologies is what they call multi-dimensional family therapy. And it basically addresses the family dynamic environmental factors. And could some of those be contributing to the substance use or the mental health problem? Next slide, please. Caught in behavioral therapy, CBT is used in most treatment specifically. And why I think it's, one of the other slides we'll see, I think it's even more important, is CBT really helps people learn how to examine what they think in ways to think differently about situations. There's also something called DDT, which is Dialectical Behavioral Therapy, which tends to work with people who have problems with emotional management. And to look at cognitive distortions that you may have, oftentimes youth have a lot, because they're still in that stage of blaming the world for the situation they're in. Next slide, please. And this has what they call the third wave, which is CBT, they call it Acceptance and Commitment Therapy. And it's a mindfulness-based cognitive therapy, and it involves accepting rather than avoiding feelings, using meditation techniques, and from a mindfulness, from a meditation perspective, the belief I have is that most of us, including me, have untrained minds, and that untrained mind is what gets us in trouble. It leads us to places that are not necessarily true. And so things like insight meditation where you can be able to really see how your mind works and learn how to... I don't like to work in control, but use it more effectively than is, I think, an important skill. Next slide, please. Multi-component psychotherapy. Basically, this is a hard spot. It's sort of like you combine the basic components of family therapy, cognitive behavioral therapy, and then motivational interviewing, and then contingency management. Consistency management. I know people who really believe in contingency management don't like what I would say, but contingency management basically means how do I bribe my kid to be compliant if nothing else? And so their behavior, the rewards that they're going to get is contingent on their behavior. Next slide, please. Motivational interviewing is basically a clinical technique that helps elicit behavioral change by targeting ambivalence. All change has some element of ambivalence. So instead of saying someone's in denial for their addiction, we say they're ambivalent. There are maybe right now more positive things to continue using drugs at alcohol than negative things, which is often the case with kids. They're having fun with it. They don't see any problem with it. You're seeing things like their attitude to changing, their grade slipping, and a lot of other things. And so basically what motivational interviewing and motivational enhancement therapy does is help resolve the ambivalence a person has about making change, healthy change. Next slide, please. Well-stop programs, we didn't mention this. I've been in personal recovery for 50 years, and I'm a member of Alcox Anonymous, et cetera, and it was effective for me to find my own recovery. Youth oftentimes do really well in well-stop programs, but it needs to be monitored in terms of how they gravitate to. And part of 12 Steps is having a sponsor. Do you want to make sure the person who is sponsoring your kid is a very healthy individual and can really help them get through the 12 Steps and the things that go along with it? The downside of that is oftentimes kids, the outside of it is that it supports, it's a group of people that support not using. And oftentimes kids have a dilemma because they're being told they have to sort of like not hang out with their old friends anymore that they used to use with, and then where did they go? And so this can be helpful in terms of having a peer group that socializes together. The downside is that 12 Steps of Recovery oftentimes takes insight. And if they're not there yet, basically what a youth does is they basically just act as if they go through the steps and it's more of the fact that because the desire to want to be a participant in this group, they do so and over time the insight will start to happen. Again, because they're not using, the developmental stages start to then catch up over time. And so next slide. Just quickly, there's not a lot of medications that can be used for the treatment of substance use other than for the opioids, which is something called buprenorphine, which is a drug that stabilizes someone and it's both an agonist and an antagonist and it's being used by the American Medical Society of Addiction Medicine is definitely, this is their go-to drug, especially with the fentanyl crisis, et cetera. But there's not a lot of good medications. And again, I'm a little weary about putting these on medications to begin with other than if they're truly diagnosed with ADD. Next slide, please. So now what? If you're concerned about your child and you want to intervene, there are resources available to help guide you. I'm going to give you some of what those are to get more informed about what to do and how that would fit with your resources. Next slide, please. Oh, care for the caregivers. It is difficult for your parents to deal with the situation. They oftentimes blame themselves. What did I do to cause my child to be in this situation? But the reality is that most of what's happening is oftentimes beyond your control. It's not something you did necessarily. It may be brain-based. Most of the disorders like depression and anxiety et cetera are a change in the biochemistry. Well, it's your responsibility to help get the best care. It's not necessarily your fault. And oftentimes your kid's going to use that against you. So be honest with your family and child about the diagnosis and then give yourself a break every once in a while. And educate yourself about reliable sources about whatever diagnosis there is, whether it's a substance use disorder or a mental health disorder or both. And remember, not all mental illnesses are the same. Some are very treatable, very easily, and others are going to be something the person is going to have to live with for the rest of their lives. Like buying out your child has diabetes. And here are some tips for you, like most parents roll their eyes when I tell them, take brief walks, et cetera. But one of the main ones is find some support. There are local parent group. There's Eleanon, Naranon, National Alliance on Mental Illness, NAMI and National Mental Health America. These are groups that can give you support with other people, parents that are going through the same thing and to help you. Next slide. I'm not going to talk about this. These are a couple of manuals you can get to ones called Wellness Recovery Action Plan. And then there's something from the Icarus Project. So it gives you some guidelines to maybe help you with ideas that if you're stuck. Next slide, please. So these are publications. Now, Lori, how do I bring this up? Oh, OK. I was going to stop share and then share my desktop because I think I was sharing just the PowerPoint earlier. OK. So this is the link that I just clicked on. Are you doing it or am I doing it? I'm doing it. Do you see my browser? You see my browser. OK. There it is. OK. So this is just one here. It's a focus on prevention. These are a lot of information you can download for free to give you some ideas on prevention activities. And so let's go to the next one. This is another one. This is sort of a screening and treatment substance use disorders among adolescents. Again, you can read this. There's other links. There are two of them. It's down there. It's the tip 21, tip 31 and tip 32. Yeah, right here. Oh, here. OK. 31 and 32. Yeah. And the next slide. Oops. Sorry. Go back here. I think we are on this page now. Yeah. So this is a phone number to Mirwood team. It's an adolescent treatment program up in north, around, I think, Petaluma area. I've known about this program for a while. I've referred people to it. And they have both a residential and an outpatient program. So if you want to know more about residential treatment, this would be a good place to start with these people. And I usually don't recommend a treatment program unless I know the program. And I know this one pretty well. And so it's a good program. Next slide. And then these last three are, again, links that you can use in a variety of areas on substance use. The SAMHSA one has, if you go to their website, you'll just click on the one that says publications. And there are dozens and dozens of different publications on a variety of issues on mental health and substance abuse. And the same thing with NIDA. It's two of alcohol abuse and alcoholism. And then NIDA, National Institute of Drug Abuse. These are all good resources for you to investigate if you have more information. Next slide. So if you have any further questions, there's my email address. You'll feel free to email me and be happy to, if it's a quick question, I can maybe email back to you. If it's something you want to discuss in depth, we can always jump on Zoom and be happy to do that. And especially if you're definitely concerned about someone, I want to be able to be available to help as much as I can.