Talking with – not at – young people about substance use

Teenagers with substances
It's important for parents and caregivers to be able to discuss substance use with their children in authentic and respectful ways. (Illustration: Adobe Stock/David Chrisom, Boston Children's)

Teens and young adults using drugs and alcohol is not new. Neither is the challenge of speaking with them about the dangers and implications.

However, what is changing are the substances young people are using and the ways they’re exposed to them. We’re also learning more about how drugs, alcohol, and nicotine affect growing bodies and brains.

Here, Amy McCarthy, LICSW, clinical social work director of the Adolescent Substance Use and Addiction Program (ASAP) at Boston Children’s Hospital, shares how parents and caregivers can effectively approach the subject with their children in authentic and respectful ways.

Know what to look for

McCarthy says the first step in talking with your child about substance use is knowing what to look for as signs of substance use and substance use disorders. These can include:

  • Mood changes — in either direction
    It’s important to notice if your normally happy child is suddenly withdrawn or sad, and it’s equally as important to notice if your typically irritable child is suddenly more upbeat.

“You may think a sudden improvement in your child’s mood means they’re feeling better or coping better,” McCarthy says, “but it may be that substance use is relieving them of some of their stresses or difficulties, so it’s not bad to be thinking of where did this sudden shift come from?”

  • New friends or social behavior
    McCarthy encourages parents and caregivers to pay close attention to who their child socializes with – both in-person and online. Social media platforms have become a big player in exposing young people to new social circles as well as substances and substance use.
  • A drop in performance
    If you see a dramatic change in your child’s grades or performance at school or a job, you may want to consider substance use as a factor.

McCarthy warns not to jump to conclusions. “Young people experience so many developmental, hormonal, and social changes just as part of growing up,” she says. “But if something feels off to you, trust your gut and seek support.”

Draw from your own experience, but recognize the differences

“I remind parents that the substances they may have been exposed to when they were younger are not the same potency as what we’re seeing today,” McCarthy says. “And we’re seeing a lot of mixing — or cutting — of substances with others, so people don’t always have a sense of what they’re ingesting.”

Still, McCarthy states the importance of drawing from your own experience when relating to your child about substance use.

“Being able to reflect on your own substance use when you were younger, and whether there was a particular trigger that caused you to start using, can help when trying to relate to your child,” McCarthy says.

However, McCarthy stresses understanding the uniqueness of your child’s experience.

“It’s important for parents and caregivers to appreciate that their child will have their own reasons for using, but at the same time not to dismiss the behavior.”

Be prepared

You have to be prepared that if you’re going to ask your kids questions about substance use, you may get answers that are difficult to hear.

– Amy McCarthy, LICSW

Spontaneously asking your child if they’re using drugs, alcohol, or tobacco/nicotine can make everyone defensive, McCarthy says, so she encourages framing conversations broadly and planning ahead.

For instance, you can mention a news story or local talk about students using a particular substance and then ask your child their thoughts about it.

McCarthy also suggests giving your child notice that you want to discuss something serious.

“Families get so little time together,” McCarthy says, “so if you hijack the little quality time you have to unexpectedly discuss a heavy topic, it could cause your child to pull away.”

“People thrive when they have choice,” McCarthy says. “So reinforce the idea that they don’t have to talk about it right away, but they do have to talk about it.”

These suggestions come with a warning:

“You have to be prepared that if you’re going to ask your kids questions about substance use, you may get answers that are difficult to hear,” McCarthy says.

“There’s an opportunity for parents to model for their children how to regulate emotions and stay calm. If you’re asking your child to speak openly and honestly and you then lose your temper and get upset at their response, you’re sending a message that your child can’t discuss these things with you.”

McCarthy also reminds parent not to villainize or apply stigma to their responses or experiences.

“You don’t need to have all the answers,” she says. “But it’s important that your child knows you are a safe space for them to go.”

The Adolescent Substance Use and Addiction Program (ASAP) at Boston Children’s helps patients and families deal with the underlying concerns that are often responsible for substance use. The team includes addiction medicine physicians, child psychiatrists and social workers trained to uncover and address the emotional and mental health issues that frequently contribute to young people’s problems with alcohol and drugs.
Learn more about ASAP.

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