Welcome to the April edition, which is the start of my 22nd year of publishing Tips and Topics.

In SAVVY, guest writer Dr. DuPont shares about his prevention work with youth and how to combat misconceptions that alcohol and other drug use is a normal rite of passage and inevitable for most, if not all, teens.

In SKILLS, Dr. DuPont offers tips on what parents, families, schools and health care providers can do to change attitudes and behaviors around substance use.

In SOUL, I’ve shared before my five S’s - areas of life critical to have thought through ahead of time, not in the heat of the moment. Impulsive, unprepared behavior can result in irreversible and profoundly life-changing consequences. In this edition, I share a sixth “S”.

For 50 years, Robert L. DuPont, MD has been a leader in substance use disorder treatment and prevention. He was the first Director of the U.S. National Institute on Drug Abuse (1973-1978) and the second White House Drug Chief (1973-1977). Earlier this month, he was telling me the good news about adolescent substance use that I had glimpsed but didn’t know much about.

So I asked him to guest write this month’s Tips and Topics. I have edited his content into Tips and Topics format, but the words are Dr. DuPont’s.

Tip 1: Adolescent substance use is actually dropping not rising.

The substance use landscape has vastly changed in the last few decades, with the global drug market shifting from primarily agriculturally-based products to increasingly synthetic products that can be made in clandestine laboratories. The emergence of illicit fentanyl has expanded the national overdose crisis across all age groups. But importantly, in terms of youth substance use, the “big 3” are still:

• alcohol,

• marijuana, and

• nicotine because they are legal (or increasingly legal for adults 21 and older) and are widely accessible.

However, the ways in which these drugs are used and delivered has changed:

• About 90% of the alcohol consumed by underage teens is consumed in the form of binge drinking (consuming 4-5 drinks in a short period of time).

• Moreover, high-potency alcohol products are essentially “binge in a can” offering 4 alcoholic servings in a single container.

• Marijuana used to only exist as flower/bud for smoking, with a generally low THC content of 3-4%.

• Now it’s nearly impossible to find low potency THC marijuana (meaning less than 10%) – waxes and dabs boast up to 95% THC.

• Even nicotine, which had primarily been delivered through cigarettes, is now more often delivered via vaping/e-cigarette devices.

Despite these high-potency and high-intensity streams of use, there is GREAT and largely overlooked news about adolescent substance use: For over four decades an increasing percentage of American youth have not used ANY alcohol, marijuana, cigarettes, or other illicit drugs.

• In 1983, only 3% of high school seniors reported never having used substance use in their lifetime, and only 16% had not used in the past month.

• In 2021, those numbers reached 37% and 64%, respectively.

• Rates of substance non-use are even greater among 10th and 8th graders, underscoring the need to start conversations about prevention early to bolster these trends.

Tip 2: What worked to achieve the more hopeful statistics on adolescent substance use?

We know behaviors are greatly impacted by policies – for example:

• Implementing a national drinking age of 21 for alcohol coincided with declines in underage alcohol use.

• The Truth Initiative® funded through the Tobacco Master Settlement Agreement was immensely effective in reducing cigarette use, and the recent addition in 2022 of increasing the purchase age to 21 for all tobacco products was an important public health policy.

But it’s not just about policy and access to substances; it’s also about cultural norms. The Parents’ Movement worked in the 1970s at the peak of adolescent drug use and focused on marijuana.

• Marijuana use declined dramatically through the early 1990s when it began an upturn, coinciding with the marijuana legalization movement.

• While adolescent use of alcohol, cigarettes, and illicit drugs have reached new lows on a downward trajectory, marijuana use is the outlier and is holding steady.

National investments in community-based prevention efforts like the Drug Free Communities (DFC) Support Program have been powerful tools to reduce youth substance use.

Tip 3: What are some of the misconceptions about adolescent use and how can we change those attitudes and misconceptions?

One of the common misconceptions is that alcohol and other drug use is a normal rite of passage and inevitable for most, if not all, teens.

• But that doesn’t fit with our understanding of addiction and brain reward. Drugs super-stimulate the brain’s reward system, far more powerfully than natural rewards.

• Because the adolescent brain is undergoing rapid development, it is uniquely vulnerable to drugs. The earlier a person uses substances and the more intense that use, the greater the risk of subsequent problems, including addiction (9 in 10 adults with a substance use disorder began using substances before age 18).

• If we can help youth refrain from substance use until 21, the risk for addiction dramatically decreases.

Another related misconception among parents and caregivers is that when a young person uses, it’s just “a little weed” or “a few beers.”

• We know youth who do use substances do so more intensely (with higher potency products)

• But we also know that when a young person uses any one substance – alcohol, marijuana, or nicotine – their risk of using the other two and other illicit drugs dramatically increases.

• Put another way, for teens, all substance use is closely connected.

Many people do not know that there is a bidirectional relationship between substance use and mental health challenges – where one can contribute to the emergence of the other and/or worsen it. Focusing on substance use prevention can be a critical tool in supporting youth mental health.

Recognizing the vulnerability of the adolescent brain, the connectivity of substance use for youth, and the evidence that substance use is not inevitable, we must set a clear public health standard for youth substance use:

One Choice – no use of any alcohol, marijuana/THC, nicotine, or other drugs by youth under 21 for reasons of health.

• Analogous to other health standards like using seat belts, wearing bicycle helmets, and exercising, this is a public health standard we can all support.

SKILLS

Tip 1: What do families and schools or other people and organizations need to do to change attitudes and behavior of youth around substance use?

Education is key – we need parents/caregivers and adults who support youth to help establish as a health standard the One Choice of non-use for youth. We can amplify the voices of youth who have made One Choice not to use any substances for their health – offer them platforms talk with peers and their communities about their experiences.

Tip 2: What should parents, schools and others say/do when interacting with adolescents about substance use especially using marijuana, alcohol, tobacco and vaping also?

Know your influence! As SAMHSA states, “Over 80 percent of young people ages 10-18 say their parents are the leading influence on their decision whether to drink or not.

• Don’t assume they know how you feel about drinking and substance use.
  Send a clear and strong message that you disapprove of underage drinking and use or misuse of other drugs.”
  

If you’re a health care provider, know that you are viewed by youth as a trusted source of accurate information about substance use.

• But youth are most comfortable speaking with parents/caregivers and friends or peers.

• That means you have an opportunity to educate not only young patients but their families.

• The American Academy of Pediatrics (AAP) supports a goal of non-use for youth and offers guidance on screening, brief intervention, and referral to treatment (SBIRT).

Know that it’s never too late (or too early) to have a conversation about substance use prevention. Access conversation starters and tools to help you talk early and talk often with the young people in your life about their health.

Tip 3: How can people interested in this, help and get more information about what you are doing with One Choice?

Identify who is working in the prevention space in your community and share the One Choice Prevention website and resources with others. If you are a member of a community coalition, consider joining the One Choice Community, where we collaborate with prevention professionals across the country to develop resources and tools.

Bio/Contact Info:
Robert L. DuPont, MD was Director of Community Services for the District of Columbia Department of Corrections from 1968-1970. From 1970-1973, he served as Administrator of the District of Columbia Narcotics Treatment Administration. In 1978 he became the founding President of the Institute for Behavior and Health, Inc., a non-profit research and policy organization that identifies and promotes powerful new ideas to reduce drug use and addiction.

A graduate of Emory University, Dr. DuPont received an MD degree in 1963 from the Harvard Medical School. He completed his psychiatric training at Harvard and the National Institutes of Health in Bethesda, Maryland. Dr. DuPont recently retired from his private psychiatry practice where he specialized in addiction and anxiety disorders. He has been Clinical Professor of Psychiatry at the Georgetown University School of Medicine since 1980. His most recent book is Chemical Slavery: Understanding Addiction and Stopping the Drug Epidemic.

For more information about his work, visit www.IBHinc.org and www.OneChoicePrevention.org. DuPont
can be reached at the Institute for Behavior and Health at contactus@ibhinc.org.

SOUL

Since the focus is on youth and prevention this month, it reminded me of when my youngest daughter left for college, I reiterated my parting and ongoing advice to her that we had shared with her brother and sister: “Remember the five S’s.” These are the areas of life it is critical to have thought through ahead of time – to examine one’s values, practices and their consequences. It is too late to consider what to do in the heat
and immediacy of the moment – the results can be irreversible and profoundly life-changing.

I first wrote about the S’s in August 2004 and then I mentioned them again in October 2017. Since then, I have added a sixth S. Here are the five S’s, plus one:

1. Substances – Besides addiction which is treatable, there are consequences that can be irreversible: acute intoxication causing a fatal accident or overdose, or a head injury with permanent cognitive impairment.

2. Sex – In the midst of making out, it is not the time to examine your values and practices about abstinence, safer sex, pregnancy and abortion.

3. Speed – I don’t mean stimulants, I mean cars and driving fast. When the tire blows out and the car rolls, or the car upfront suddenly stops, or the road is wet and the
brakes don’t work well – that is too late to think about speeding.

4. Seat belts – When the car is rolling or you are heading for the windshield, it is too late to buckle up.

5. Sleepiness – A sleepy driver is as dangerous to self and others as a drunk driver. When my son sideswiped the median barrier dozing off for a split second after a late
date, sleepiness was added to the list.

And now for the added 6th S:
6. Skin – To get that golden tan, it may seem necessary to lie for hours in the sun. But skin cancer is no joke, so slap on the sunscreen. Also under “Skin” are impulsive tattoos, especially while drunk. When you wake up in the morning, you might have prevented that huge tattoo emblazoned across your chest, “Cindy, I love you”, the woman you met for the first time last night.

It is our family’s joke to mention now the six S’s. They will come in handy as my grandgirls keep growing. But hopefully it will prevent some pain with your family or loved ones and save lives.

UNTIL NEXT TIME

Thanks for joining us this month. See you in late May.

David