Empower Parents

Introductory Paragraph

Nobody is free from the risk of drug use. While parents tend to think of children as innocent and safely removed from the risk of drug use, the fact remains that they are highly susceptible to experimenting with and becoming addicted to a wide array of drugs. One motivating statistic to keep in mind is: 90% of people with substance use disorder started using substances in their teen years. Whether they obtain them at home, at school, from friends, or elsewhere, it is all too easy for adolescents to fall into drug use and to impair their future. Parents have a significant influence on whether or not their children choose to use drugs. A basic understanding of the need to reduce risk factors and increase protective factors helps parents to balance the messages that they send to their children. There are a wide variety of resources and programs that are available to assist parents in building developmental assets and reducing the likelihood of children using substances.

Having children can be physically, financially, and emotionally challenging for many parents, especially when trying to ensure a drug-free future. Utilizing resources may assist parents in providing a hopeful future and eliminate risks which are detrimental to kids' overall health and wellness. Parents can inadvertently send messages to their children that may confuse them about the family stance on drug use. For example, not having clear communication about drug use, using substances with or around children, and watching television shows or movies that depict drug use can sometimes detrimentally impact children and put them at a greater risk of using substances in the future. Parents can empower themselves and set clear expectations regarding drug use by engaging in programs and becoming proactive in their parenting approach. They can also support school prevention programs which need the backing of families and the entire community. When the consistent message is sent throughout the socio-ecological domains (family, school, community) that drug use is not tolerated, it has a powerful effect on young people.

The Key Information section of this article includes information on the signs of drug use. In addition, the Relevant Research section of this article includes statistical data on common drugs, so that parents can be informed about the current status of national patterns.

Key Information

Perhaps the single and most important thing which can advance parental understanding of drug use is that substance use disorder is a disease. There is a social stigma surrounding drug use, a notion that one can “just quit” if they really wanted to. While there are people who’ve been able to leave substance abuse behind “cold turkey,” this is not as easy as it seems. Parents and guardians must come to recognize substance use disorder as a disease that alters the brain and should be treated without judgment and with much care. The American Medical Association, the American Society of Addiction Medicine, and the DSM-V recognize substance use disorder as a medical and mental health condition that requires positive intervention. The cognitive alterations caused by substance use rewire the brain and body to reward continued use, making cessation increasingly difficult based on duration and the type of drug used.

Parent's Role in Prevention and Recovery

Parental influence is one of the most important factors of a child’s development. Youth who believe their parents would strongly disapprove of substance use are far less likely to experiment with or regularly use substances than those youth who do not receive such messages from their parents. Parents have the ability to instill powerful values, create positive safety nets, and lessen the risk factors that youth face every day. Studies have found that increased parental involvement can greatly impact the life-course outcomes of children by providing a solid foundation for positive behaviors, limiting mental health issues, and preventing the onset of substance use. Substantial research has highlighted the importance of self-control, mental health, school readiness skills, and secure attachment during the most vulnerable periods of development in childhood. While substance use usually begins in adolescence, there are known biological, psychological, social, and environmental risk factors that can begin even before birth. Parents can combat these risk factors by providing a stable home environment, adequate nutrition, physical and cognitive stimulation, and supportive parenting techniques in order to positively impact their children’s overall mental and physical health.

Parental involvement is also a key factor in the lives of youth going through the recovery process. An article by Recovery First, an American Addiction Center treatment facility, states “Parents play an instrumental part in the drug addiction treatment or alcohol rehabilitation of their dependent child. In fact, most rehab centers report that it is often the mother or father who initiates treatment for their minor.” The parent’s support and involvement in treatment are potentially life-saving in the recovery process.

Parents Can Influence Use of Prescription Opioids

In many cases, doctors, dentists, and oral surgeons are still prescribing opioids to teens. Many parents, especially parents of student-athletes, may not realize the risks. One way to mitigate this issue is for doctors and pharmacists to educate parents on the risks of prescription opioids and encourage parents to work with their medical providers to reduce the possibility of their children misusing prescription pain medications. Research shows that youth who are prescribed opioids before graduating from high school are 33 percent more likely to misuse prescription opioids after graduation. Parents and caregivers can drastically reduce the risk of opioid misuse by having a strong, open, and honest relationship with their children.

Signs of Substance Use

Parents know their children and their behaviors best. Watching for changes, whether abrupt or gradual, can give an indication that there may be a problem. There are signs to look out for that may indicate substance use:

• Loss of interest in enjoyed activities
• Sudden change in friend groups
• Sleeping more than usual or sudden hyperactivity
• Exhibiting aggressive, angry, rude behavior
• Rule-breaking
• Cutting classes or missing work
• Irresponsible behavior
• Isolating and avoidance of eye contact
• Making excuses for behaviors or lying
• Ignoring or resisting discipline
• Sudden weight loss/gain
• Watery eyes
• Shakes
• Nosebleeds
• Poor hygiene
• Sudden change in appearance
• Paranoid or anxious
• Change in mood, mood swings
• Dilated eyes

Relevant Research

The National Institute on Drug Abuse (NIDA) has published research which addresses how significantly the actions, choices, and lifestyle of parents impacts their children. Although much of the prevention discourse focuses on adolescence, the benefits of empowering parents begins with the birth of their children. A child’s temperament can make parenting easier or harder. Children with easier temperaments are more responsive to parent interaction, adjust well to routine, and may lead to a strong parent-child relationship. However, highly reactive infants can increase parental stress, frustration, impatience, and may be more susceptible to neglect abuse, and negative family dynamics. Early interventions for parents can aid in assisting parents to develop appropriate expectations of infants, strengthen parenting skills, and help parents learn skills to cope with frustrating situations.

This literature review overviews the evolution of adolescent substance use, the influencing factors, risk and resiliency factors, and the results of previous intervention efforts.

This article documents the benefits of programs that focus on training to promote positive development and proper parenting skills which encourage healthy attachment, love, effective discipline techniques, and healthy communication. These protective factors have proven to yield positive outcomes such as reducing teen pregnancy, decreasing school failure, and preventing substance use. Aside from offering effective prevention, family interventions also lead to positive impacts in adulthood by improving job performance, mental health, and goal attainment.

This study provides clinical reassurance of the impact of discussions on substance use between primary caregivers and the children in their care. . Their results showed that scenario-based and learning talks created more comfort responses surrounding the topic and reduced the likelihood of substance use, while talks that only centered on rules or criticism/negative parenting increased the child’s stress responses and showed a greater likelihood of substance use.

This paper addresses the impacts of substance use on the adolescent brain, cultural factors influencing teenage use (parental, social, media, etc), the social cost, and health care practices that may mitigate the issue.

Parent-child discussions on substance use, especially those that are open and frequent, along with clear and firm rules, are regarded as a primary defense against teenage substance use.

Important Statistics and Types of Drugs Being Used The National Center for Drug Abuse Statistics has the most current and comprehensive data involving youth substance use by grade, substance type, and state. The Center reports that 21.3% of 8th graders and 46.6% of 12th graders have used an illicit drug, with teenagers being responsible for 11.2% of overdose deaths. Additional substance-specific statistics follow:

Alcohol:

• ⅔ of students have tried alcohol by their senior year
• Over 40% report binge drinking
• 72% of teenagers get alcohol at home, from a friend's house, at parties, or directly from an adult

Cigarettes

• ⅖ students have used cigarettes by age 18
• 13.4% high school students use tobacco frequently
• Most frequent form is e-cigarettes (11.3%)
• 4% of middle school students currently use tobacco

Marijuana

• 43.7% of teenagers have used marijuana at least once
• 22% of teenagers have used marijuana in the past month
• 6.9% of 17-18-year-olds use it daily

Prescriptions

• ⅕ of teenagers have taken prescribed medicine that wasn’t their own
• 2.52% misuse pain relievers
• Prescription medication is more likely to be abused than non-prescription opioids
• Legitimate youth opioid prescription use increases adult misuse by 33%
• These substances are easier to access than one might think, with prescription pills being sought out more by teenagers, whether they are obtained in the home or from peers.

Other Illicit Drugs

• 7.5% of teens have used hallucinogens
• 7.0% abuse tranquilizers
• 5.9% used LSD
• 0.42% used cocaine
• 0.17% used methamphetamines
• 0.02% used heroin

Impactful Federal, State, and Local Policies

Adolescent substance use places a large burden on parents, communities, criminal justice systems, medical facilities, and the economy. Physical and behavioral health care costs are substantially higher in individuals who have a substance use disorder. In the mid-1990s and early 2000s, the economic cost of substance abuse was over $360 billion in the United States. The large amount of federal budget requests for substance use programs, law enforcement, drug interdiction, and other related costs has led lawmakers to consider incorporating alternative prevention strategies aimed at assisting parents with the skills necessary to prevent child maltreatment and enhance parent-child relationships.

However, it is difficult to formulate policy for affairs considered to be under familial jurisdiction. Most state and federal efforts in this domain are less oriented to prevention than to intervention, such as truancy within an educational system or a level of neglect or abuse requiring intervention through social services. Thus, prevention policies have focused more upon reduction of risk factors than policy oriented towards enhancement of protective factors. Statistical correlation of the involvement of substance use with social services intervention has made prevention an increasingly attractive investment on the part of county commissioners who have seen a skyrocketing in their annual budgets associated with the costs of foster care. There is potential to implement policy at this local community scale, such as incentivizing participation in the development of parenting skills. Likewise, any state-wide policies which require counties to provide explicit channels for increasing family programming would be an example of this type of policy formulation. A current example resides in the allocation of funds from opioid settlements.

Policy variations and gaps. Policies regarding adolescent use of substance use treatment centers vary state by state. Kerwin, et al. (2015) provide a table that shows each state’s policy regarding minor or parental consent for substance and mental health treatment. It is important to know local policies which protect the privacy of the adolescent seeking treatment, whether the parent needs to provide consent, and areas where adolescents can be forcibly put into treatment. As of this paper, only Virginia requires the consent of both the parent and child for inpatient substance abuse and mental health treatment. While adults are charged with the care of their children, not all youth have access to safe, caring grown-ups. They are less likely to have an adult who will educate them on the dangers of substance use and abuse. Interventions for such youth should be considered a policy priority.

The American Academy of Pediatric Dentistry has published a national policy regarding the oral care of adolescents with substance use. It addresses the need for awareness and implementation of special treatment approaches.

The American Academy of Pediatrics provides its national policy on screening, brief intervention, and treatment referral for pediatric substance use. It provides recommendations for pediatricians and health insurance providers regarding best practice information for adolescents using substances.

Available Tools and Resources

SAMHSA provides a quick sheet on the 5 conversation goals for parents when discussing substance use with their kids. The SAMHSA National Hotline is a confidential information service that is free, available 24 hours a day and365 days a year. It provides services in English and Spanish for individuals and family members facing mental and/or substance use disorders. They also provide many links with helpful information to help families and individuals answer important questions about drug abuse and recovery.

SAFE Project:

• SAFE Choices is a program within SAFE Project that focuses on fostering resiliency in youth development through collaborative and diversified approaches that reduce risk of substance addiction and mental health challenges while empowering SAFE Choices in all stages of youth development.
• "Medication Fact Sheet: Opioids and Pain Management" is a one-pager discussing common opioids, their street names, and the risks surrounding the use of opioids for pain management.
• "Pharmacists and Your Safety" is a one-pager discussing the role of your pharmacist in your healthcare team and questions to ask your pharmacist so you can be more informed regarding prescription medications.
• "SAFE Project Online Courses" are SAFE Project original online trainings that focus on harm reduction techniques such as: Narcan administration and navigating Fentanyl use safely.
• "Why You Need to Ask if Your Kid’s College Has a Recovery Program (Even if They Don’t Use Drugs)." This article from SAFE Project focuses on the importance of substance use treatment programs in the higher education setting. The article explores the fact that substance use can affect anyone, especially youth exploring new chapters of their lives, and it's important to know what resources are available in the case they are needed.
• "Lessons Learned: Talking to Young Children about a Loved One’s Substance Use." This article from SAFE Project discusses the importance of talking with children regarding their loved one's substance use, how these conversations can create better dialogue around substance use, and how these conversations can begin the process of breaking the addiction cycle.
• See the wiki titled "Expand School-Based Prevention Programs" for more detailed information on how the school setting for children/adolescents can be used as protective factor from the adverse effects of substance use, misuse, and abuse. See the wiki titled "Build Education and Raise Awareness" for more detailed information on the stigma surrounding substance use that the school/work environments create and how we as a society can better raise awareness.

The Partnership for Drug-Free Kids provides resources on how to address medicine abuse and addiction, with a focus on kids and young people.

Teen Safe offers a variety of links to resources for adolescents, parents, and clinicians regarding data, toolkits, and resources.

This video is kid-friendly and shows the effects of drugs on the brain. Parents can use it as a visual aid during discussions.

Infographics are provided on this website regarding adolescent substance use data and impacts.

Drugfree.org is a hotline that allows parents to speak to other trained parents about substance abuse issues.

Drug Prevention Resources has an abundance of tools and resources to help parents to reduce the likelihood of their kids using drugs.

Family Life's Art of Parenting is a free online course that gives parents a simple vision and creative ways to make faith the core of their parenting.

Fathers' Uplift empowers fathers to overcome barriers and become positively engaged in their children's lives.

Get Smart About Drugs is a website federally funded by the U.S. Drug Enforcement Administration for parents, educators, and caregivers that provides resources and a database for information in both English and Spanish. The website provides valuable information about talking to children about substance use, guides to getting treatment, and provides culture-based prevention resources. The DEA has also produced two books, "Growing Up Drug Free: A Parent's Guide to Prevention" and "Prescription for Disaster: How Teens Abuse Medicine."

The National Academy for State Health Policy offers a toolkit titled "Youth Crisis Receiving and Stabilization Facilities which includes reports on positive cases from a variety of states.

Promising Practices

Safe Homes. A variety of local initiatives utilize an approach to improve parental responsibility for youth in their communities. These include an effort by the United Way of Rutherford NC regarding pledges to communicate with their children and to supervise drug-free social gatherings in their homes. The Safe Homes initiative in Georgia focuses on safe storage. The Upriver Youth Leadership Council in Idaho supports a network of parents who are committed to ensuring that social events in their homes are drug-free.

Parent Partners are known by a number of different titles, such as parent mentors, parents for parents, veteran parents, and parent allies. They are parents with previous direct experience in the child welfare system who assist parents currently involved or at risk of becoming involved with the child welfare system. Parent Partner Programs can be court-based, within child welfare agencies, part of law offices, or independent.

Gobi is an online prevention program designed by professionals and young adults for teens and their families. It is designed specifically for teens, using a tool they already have in hand. Every day for 21 days teens get an assignment on their smartphone which takes 5 minutes per day. Several times a week they get a supportive text message that is meant to be irreverent, humorous, cynical, and just offensive enough to keep them laughing (and engaged). Parents are involved and get their own series of emails on adolescent development and communication skills. Teens are asked three times to schedule a time to talk with their parents. Topics and guidelines are included to make the conversation as successful as possible. Teens that use Gobi report:

• Improved relationship with their parents
• A decrease in their use of drugs and alcohol
• Better ability to manage stress
• Increased awareness of their choices
• Signing up for Gobi is free to use by both parents and youth.
• More information on adopting the Gobi program

Guiding Good Choices is a family-centered competency training for parents to build skills to help reduce the risk of children using substances. It helps to:

• Identify risk and protective factors for use in family strategies
• Develop effective parenting practices
• Family conflict management
• Use “family meetings” for family management and positive involvement .

Incredible Years is offered to parents whose children have been screened for disruptive behaviors during toddler well visits. The program offered group parenting classes that reduced negative parenting styles and parent-child interactions. Prevention of negative parenting styles has a direct impact on social, emotional, and physiological functioning in children and reduces adolescent and adult substance use.

Parent SMART is an innovative technology-based parental intervention strategy. It increases parental involvement in adolescent substance use treatment, including questionnaires and behavioral intervention tasks following treatment. The intervention tasks showed significant improvement in positive parental involvement and parenting processes with the child undergoing treatment for substance use.

The Strengthening Families Program (SFP) is a seven-session, evidence-based program for families with adolescent children. This program is designed to provide at-risk parents with necessary parenting skills that may lead to a reduction in substance use later in life. The results of the program have been evaluated in multiple different studies that took place in 17 different countries. The program has proven to be effective at reducing risk factors for adolescent substance use, mental health problems, and delinquency. The program also showed a positive influence on parental stress and parenting skills that helped to reduce child maltreatment by educating parents on stress and anger management techniques.