“Two issues drive teen substance use: drug availability and perception of risk.

Availability: Today’s teens know that obtaining substances is far too easy. For example, 70 percent of high school seniors say marijuana is either “fairly easy” or “very easy” to obtain. Seventy-seven percent say getting their hands on alcohol is very easy and twenty-one percent of seniors believe it is easy to find MDMA (ecstasy). Thirty percent say getting their hands on amphetamines is also very easy.

Perhaps more alarming, 27 percent of eighth-graders said getting ahold of a drug like marijuana is either fairly easy or very easy to do. And nearly 50 percent said alcohol is easy to find.”

Richard Capriola is a counselor and author of The Addicted Child: A Parent’s Guide to Adolescent Substance Abuse.

He shares his story and discusses his KevinMD article, “The pandemic drives a decline in teen substance abuse.”

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Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at kevinmd.com/rate. Subscribe at kevinmd.com/follow. Today on the show, we have Richard Capriola. He’s a counselor, and he’s the author of the book The Addicted Child: A Parent’s Guide to Adolescent Substance Abuse. He wrote the KevinMD article “The pandemic drives a decline in teen substance abuse.” Richard, welcome to the show.

Richard Capriola: Thank you, Kevin. It’s a pleasure to be here to talk about this topic of adolescent substance abuse and how the pandemic affected both adolescent substance abuse and mental health as well.

Kevin Pho: All right. So before we get into that, just briefly share your story and journey to where you are today.

Richard Capriola: I started out in education as a school administrator for the state of Illinois and worked there for about 30-some years. Then I transitioned over into working in mental health, starting at a crisis center and then transitioning over to the Menninger Clinic in Houston, Texas, where I worked for over a decade treating both adolescents and adults diagnosed with mental health and substance abuse disorders.

Then after I left Menninger, when I retired from Menninger, I wrote this book, which I wanted to be a resource for parents and anyone interested in adolescent substance abuse. So many times, when the parents I met with learned about their child’s substance abuse, their reaction was, “I had no idea this was going on,” or, “I knew something was going on, but I didn’t know it was this severe or this bad.”

Kevin Pho: So I’m just looking at the Washington Post, and just recently the CDC gave some studies and data in terms of teen mental health. So tell me some of the data and what you’re seeing in terms of how the pandemic affected teen mental health.

Richard Capriola: Well, prior to the pandemic, we’d already been experiencing a significant increase in teen mental health issues. For example, from 2009 to 2019, we’d seen a 40 percent increase in high school students who were reporting symptoms like feeling sad and feeling hopeless, and a 36 percent increase in teenagers seriously considering suicide. This was all before the pandemic.

Then the pandemic came along, and it sort of ignited all of these mental health issues. Teens were pulled away from their social environment and their schools. Families were under a tremendous amount of pressure. Some people lost their jobs. People worried about their health and their employment and so on, and this affected the children too. It affected all of the adolescents who were isolating at home, many of them doing an online type of schooling.

So during the pandemic, we saw an increase in things like depression and anxiety. Anxiety and depression actually doubled among teenagers during this time, and the number of visits to emergency rooms for suspected suicide increased by 51 percent for girls and 4 percent for boys. What we saw across the board was kids reporting feeling more anxious, more angry, and more annoyed. They also reported feeling bored, sad, and lonely, and many reported having sleep problems, and these were reported across pretty much all grade levels.

So the mental health crisis that we’d been seeing for 10 years before the pandemic increased dramatically during the pandemic years, I think a lot because kids were isolated from their social environment, and families were under a lot of stress, and kids felt that stress.

Kevin Pho: All right. So you talk more about that, plus teen substance abuse, in your KevinMD article, which was written back in January. So for those of you who get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Richard Capriola: Sure. What we noticed was that while the mental health crisis was increasing during the pandemic, adolescent substance abuse actually went down. It went down dramatically. The percentage of teenagers who were using substances like alcohol, marijuana, and nicotine vaping, which are the common substances most used by teenagers, all went down during the pandemic.

For example, the percentage of high school seniors who were drinking alcohol went from 55 to 47 percent. The percentage of high school seniors smoking marijuana went from 35 to 31 percent. Even nicotine vaping had been on a dramatic increase prior to the pandemic. We had seen vaping of nicotine and marijuana increasing significantly among those high school kids before the pandemic, and that went down during the pandemic too. So the pandemic had the effect of really suppressing, reducing, the high school kids using substances.

Even though it went down, we still found one in three high school seniors were using some type of illicit substance, primarily marijuana, and still around 30 percent of high school seniors report being drunk from alcohol at some time during the year. So overall, the percentages went down, but they’re still pretty high.

Kevin Pho: What were some of the reasons that could explain that decrease in substance abuse?

Richard Capriola: I think kids were pulled away from their social environment, from their peer influences. They were pretty much isolated at home. Many of them were not attending classes; they weren’t online. So I think a lot of it has to do with the fact that they just were more isolated and away from their peers and their peer influences.

And the availability to get the drugs too; it just wasn’t there the way it is. Even now, after the pandemic, these kids know that these drugs are readily available. When we ask high school seniors, for example, “How easy is it for you to get marijuana?” 85 percent of them tell us it’s no big deal. Ninety percent of them tell us alcohol is easy to get. So these drugs are widely available, and I think during the pandemic, because kids were isolated away, the availability went down significantly.

Kevin Pho: Now, for all those parents who are listening to this podcast and reading your article, what kind of warning signs or red flags should they be looking out for in their own household that may lead to a potential behavioral health issue in their teen?

Richard Capriola: That’s an excellent question, Kevin. In my book, The Addicted Child: A Parent’s Guide to Adolescent Substance Abuse, I list the warning signs for alcohol, marijuana, self-injury, and eating disorders, because those often accompany a child using a substance. But as a general rule, what I say is pay attention to the changes you see in your child. You know your child better than anyone. Pay attention to those changes. Don’t assume that they’re just normal adolescent acting-out behaviors. They may very well be that, but they could also be a sign that there’s something else going on underneath the surface that you need to pay attention to and perhaps investigate a little deeper.

Examples would be a child whose grades are declining; a child who used to participate in sports and enjoy sports and no longer shows any interest in participating in sports; or a child who used to introduce you to their friends and now becomes very secretive about who their friends are. Disciplinary problems at school can be another significant signpost. And then, of course, if you notice any strange odors coming from your child’s room, or you pick up any paraphernalia, those are obvious warning signs. So just be alert to these warning signs.

I think part of the problem is that many times, the parents that I worked with were caught off guard by their child’s substance use because nobody told them what the warning signs were. Nobody told them what to look for. So they were caught off guard by this, and then they began to question whether or not they’re a good parent. They’re good parents. They’re good parents doing the best job they can do. They missed the warning signs because nobody told them what to look for.

Kevin Pho: Now, let’s say that we have a suspected warning sign. What are some specific questions parents can ask their children? Because sometimes this could be a delicate subject, as you know, and parents don’t want to come across too strong. But what are some specific questions that you recommend parents ask their children if they suspect anything?

Richard Capriola: I think the first thing you should do is have a conversation with your child, and by that I mean don’t accuse your child, don’t threaten them, and don’t punish them. You want to come into the conversation with an inquiring point of view. In other words: “I’m seeing these behaviors. I’m noticing these things. Can you help me understand why I’m seeing them?” Or, “I’m afraid that you might be getting involved in these activities. Can you help me understand what’s going on?”

Have that conversation. Share how you’re feeling with your child, share what you’re observing, and give that child an opportunity to give you feedback, because you might not be seeing things or hearing things the same way they are. What you want to do is have that conversation from an inquiring point of view, give your child the opportunity to give you feedback, and then go from there.

Kevin Pho: We’re talking to Richard Capriola. He’s a counselor, and he’s the author of the book The Addicted Child: A Parent’s Guide to Adolescent Substance Abuse. He wrote the KevinMD article “The pandemic drives a decline in teen substance abuse.” So, Richard, how do you anticipate the next few months to years going? We already have such an increase in teen mental health issues. Now that things are relatively normalizing from the pandemic, what do you anticipate the next few months to bring?

Richard Capriola: That’s a good question, Kevin, because early next year, we will have new data, nationwide data, on adolescent substance abuse, and we’ll be able to see if the decline that we saw during the pandemic years has rebounded. In other words, will we see an increase in adolescent substance abuse now that kids are back into their more normal routine, back into the regular classroom, back with their peers? Are we going to see an increase in substance use above what we saw during the pandemic year? That’ll be an interesting study that will give us some insight as to whether kids have returned to higher levels of substance use.

This mental health crisis, I’m afraid that we’re just scratching the surface on that, for both adults and children. I think we’re going to see that continue for quite a while, and hopefully we’ll provide the resources for families and children as they continue to struggle with these various mental health issues that were heightened during the pandemic. But I suspect, both for adolescent substance abuse and mental health, we’re going to be dealing with this issue for quite some time.

Kevin Pho: And my final question: What are some of the take-home messages that you want to leave with the KevinMD audience?

Richard Capriola: My message, when it comes to adolescent substance abuse, is if you’re a parent out there, don’t become paranoid about this. Don’t become afraid of it. Knowledge is power. Learn as much as you can about it, learn the warning signs, and feel more confident that if you have to deal with this issue, you’ll be able to deal with it.

And if you’re a professional out there who works with adolescents or with families, there’s a lot that you can do to help these families and these kids get through this substance abuse and mental health crisis that we’re going through. You have the ability to make a difference in their lives. And it’s work. It’s hard work, but it’s work that, I think, it’s really, really a blessing to have people, psychiatrists, psychologists, and social workers, out there who are all trying to get on top of this substance abuse issue and this mental health issue. So if you’re one of those professionals, I applaud the work that you’re doing. I’ve worked with so many of them, and they put in hours of work trying to help kids and families.

Kevin Pho: Richard, thank you so much for sharing your time and insight, and thanks again for being on the show.

Richard Capriola: Thank you, Kevin. I appreciate you inviting me and spending time with me today.