Safety First Episode 2

Resources from the Episode

College Parents Matter

*The views and opinions expressed in this episode are those of the guest alone, and do not necessarily reflect the views of the host, the Safety First team or any affiliated organizations.

Transcript of Safety First Episode 2

[Intro Music Plays]

Dr. Amanda Giordano: You're listening to Safety First. Tackling Tough Topics with Teens. Our goal is to provide useful information about issues that affect today's teenagers. To help support parents and professionals who work with youth.

Hello, everyone, and thank you for joining us today on the Safety First podcast.I'm excited to introduce our guest, Dr. Amelia Arria. Amelia is a professor in the Department of Behavioral and Community Health, the director of the Center on Young Adult Health and Development and Associate Dean for Strategic Initiatives at the University of Maryland School of Public Health.

She is a widely published researcher in the area of substance use among young people, and her primary focus is to ensure science is translated into action by parents, educators and policymakers. She earned a Bachelor of Science from Cornell University, followed by a Ph.D. in epidemiology from the University of Pittsburgh and then completed postdoctoral training at Johns Hopkins.

So, Amelia, thank you so much for being here today.

Dr. Amelia Arria: Good to be here. Thank you.

Dr. Amanda Giordano: Well, we're very excited to have this conversation with you. So why don't you tell us a little bit about your work and your professional journey up to now?

Dr. Amelia Arria: Well, I started off in sort of the developmental psychology realm and moved into public health. And for a long time have been studying the multiple influences on people's behavior, especially adolescents and young adults. And public health really gives you the opportunity to study the causes and the consequences of risk behaviors. It keeps me interested and keeps me from getting bored in any one particular area. You can switch from biology to policy pretty easily. So it's a great field. And I think that the impact you can have is quite substantial through translation of some of these findings.

Dr. Amanda Giordano: Yeah. And how did you get into substance use among young people specifically?

Dr. Amelia Arria: It's sort of a long story. When I was first out of college, I got a job at the University of Pittsburgh Liver Transplant Center, and a lot of the people who had liver diseases had quite a substantial history of alcohol and drug use. And my job was to interview them about how those behaviors played out in their lives. And how it led to a very serious health consequence. And I was always more on the prevention side. So instead of becoming an M.D. and a clinician on the liver disease side, I decided to focus on how we can prevent these things from getting out of control before those health consequences arise.

Dr. Amanda Giordano: Yeah. So makes sense then, that your work kind of went to the field of substance use among young people in that preventative vein.

So tell us a little bit about the prevalence of substance use among young people. Specifically today, we're talking about cannabis use, but feel free to share about other substances if they're pertinent to your work.

Dr. Amelia Arria: Well, one of the things that we know is that the prevalence of alcohol use and binge drinking has gone down quite dramatically in recent years, which is a real plus. But what we have seen is more steady prevalence for cannabis use and an increase among young adult cannabis use, that age between 18 and 25.

So the most recent statistics can be found on websites like Monitoring the Future and the National Household Survey, but I think it runs around 15% have been using cannabis in the last year among 12 to 17 year olds, and that prevalence can vary based on age. And then among the young adult population, it's a bit higher.

But I think it's surprising to people that not everyone is using cannabis. And that's one of the major messages, that it is not a normative behavior, even though we're concerned about it. It often gets overestimated by people. And then if you break that prevalence estimate down into how frequently people are using it, not very many people are using it every day. But it is a serious problem when people use it every day. So it's important for people to know that it is not normative.

Dr. Amanda Giordano: Yeah, I appreciate that really nuanced perspective.

And looking at those things, I'm curious if you have ideas about what has contributed to the increase in prevalence over recent years.

Dr. Amelia Arria: Well, definitely ease of accessibility, right? We know that policies are the most potent preventative solution that we have. Right. So making things less accessible in the area of alcohol seem to really matter. Right?

Parental permissiveness is another one, making sure that parents have the tools and the resources that they need to intervene and to disapprove of use. Those are really powerful indicators.

So in the case of cannabis, what we've seen is more accessibility, greater likelihood that people will perceive it as less harmful than it really is. A proliferation of misinformation about the risks of cannabis, that is definitely something that is happening recently that parallels the trend and increased use.

And I think that parental permissiveness right now, even though we don't have good data on cannabis use, we anecdotally hear all the time that parents have misguided perceptions of the safety and the risks associated with cannabis use.

Dr. Amanda Giordano: Well, and that's a great lead into the next question, especially if you're maybe talking to parents. What do you want them to know about the risks associated with adolescent cannabis use?

Dr. Amelia Arria: One of the most important and probably underrecognized things that I would want them to know is that substances in general are rewarding to an adolescent brain, right? No matter what you're using. So we can't play Whac-A-Mole and say, well, this drug versus this drug versus this drug and keep, you know, looking at drug specific strategies, we really need to just recognize that any substance is rewarding and that reward or that drug related reward tends to overtake natural rewards like academic pursuits, like family relationships, like trusted friendships, things that require a little bit of work but are incredibly rewarding.

So when you've got drug related reward hijacking those natural rewards, you actually change the way that someone will perceive reward perhaps for the rest of their lives in some people. And that is a really important message because exposure from a very early age is related to increased risk for addiction, where that compulsive use becomes a problem.

And that is why is because they are seeking that sort of biological reinforcement from that drug, because they have had exposure to it early on when those pathways are being developed in the brain and that's kind of a very simplistic way of talking about brain development. But it is a very, very important period of brain development where you just don't want the exposure to drug related reward.

And the other important risk is on academic engagement and academic potential. It becomes harder to learn and it becomes less motivating to learn if you have drugs on board.

And I guess the third thing is that one of the tasks or developmental milestones of adolescence and young adulthood is to learn how to cope with everyday stressors. And drugs enable you to forget about the stressors that you even have in your life. They're not a solution to that stress. And as a young person, you need the practice of going through those experiences and dealing with it in a way that is difficult sometimes, but it builds your resilience to future stresses and stress is inevitable, right? And you want to build those coping skills. So one of the risks of having drugs on board is that you don't really have the experiences to cope and practice with everyday stresses where it becomes a crutch.

Dr. Amanda Giordano: Yeah. Gosh, what a great answer, because you're making us think about the negative consequences that come from using cannabis, changes to the brain and interruptions to normal brain development, but also what's not happening when adolescents are using cannabis, which is learning how to deal with problems emotionally, regularly and cope.

Dr. Amelia Arria: Right, Right. And academic engagement.

So we call it an opportunity cost. Yeah, it's an academic opportunity costs because you're spending time doing this when you're not spending your time really working toward goals and academic pursuits.

Dr. Amanda Giordano: Yeah, I also heard you say, which I just want you to reiterate, but you mentioned addiction, and I think that there are still people who struggle with understanding the severity of cannabis use and maybe have some doubts about whether or not someone can be addicted to cannabis.

What are your thoughts on this?

Dr. Amelia Arria: Well, we know for all substances that you can develop dependence on cannabis just like you can any other drug. And the way that I sometimes describe it to people is it's like a different wattage light bulb, right?

So, sure, cocaine can be more addicting that it probably is going to be stronger and lead to addiction quicker. And with cannabis, the proportion of people that will develop an addiction related to cannabis might be lower than the proportion of people who've tried cocaine or tried nicotine who will develop dependence. But it is still very real.

And today we find that with the potency of cannabis being what it is, it is much more likely to develop an addiction to cannabis. There is cannabis use disorder, there is a withdrawal syndrome. So yes, it is very addictive. And one of the very negative things about cannabis use disorder is that people don't recognize it as such, whereas people sort of understand that you can become addicted to cocaine or heroin or nicotine. But that cannabis is sort of excuse that just becomes your lifestyle. The compulsive use becomes your lifestyle.

Well, did you have any friend relationships that were destroyed because? No, because all my friends use cannabis. Did you have any employment issues because of your use of cannabis? No, because I don't have a job. Right? Or because these things just don't even exist.

And your whole life revolves around getting, using, staying high. And that that's not something that typically happens with other forms of addiction where people just sort of don't even realize that it's possible.

Dr. Amanda Giordano: Yeah, that's fascinating that the continued, despite negative consequences might hide itself a little bit with cannabis use.

Dr. Amelia Arria: Right. Exactly.

Dr. Amanda Giordano: Yeah. Yeah.

You also mentioned potency, and I'd love to talk a little bit more about that. How is the THC potency different today than previous decades when it comes to cannabis?

Dr. Amelia Arria: Yeah, it's the potency of products available today is much, much higher than it used to be. The THC is the psychoactive component of cannabis.

Very simply, there's lots and lots of compounds in cannabis. But THC is the psychoactive component and the products available today can be up to 40% THC. There are some products that are even higher on average. I think it's hovering around 20% THC, whereas in the early 1990s it might have been around 3%. We have graphs showing all of this and I can share them with you. So I’m probably misstating some of the numbers. But the point to be made is that the potency has risen quite dramatically. The availability of high potency products is proliferating.

Dr. Amanda Giordano: Wow. And what are some of the negative consequences of high potency cannabis specifically? Is it different from low potency?

Dr. Amelia Arria: Certainly. I forgot to mention, I was remiss in not mentioning the mental health consequences and high potency products are associated with faster transition to addiction, faster transition to problematic situations like psychosis, mental health issues, panic attacks. And that's because of the strength of the THC concentration.

Dr. Amanda Giordano: Yeah, and I imagine when we're talking about adolescent use, too, they probably aren't  aware of the THC concentration in the products they're using.

Dr. Amelia Arria: Yeah, we asked college students if they know what the THC potency of the products that they're using. And I would say a little bit more than half don't even know what they're using. So it's very concerning.

Dr. Amanda Giordano: And, you know, you mentioned this increased prevalence use of cannabis with adolescents. And I imagine that also comes with vaping, which is vaping THC is becoming more prevalent.

Is that the most common form of cannabis use that you're seeing?

Dr. Amelia Arria: We're still seeing that smoking cannabis is the most prevalent, but also use of edibles and vaping has gone up quite dramatically. I'm not an expert in knowing what the prevalence of vaping is among users, but we hear it all the time that that is a very common way of using among people who use cannabis.

Dr. Amanda Giordano: And I did want to get your thoughts just briefly and then we'll kind of move into advice for parents and caregivers or some of the more preventative work.

But what about Delta-8 and CBD? I feel like parents see these things and might not know what they are and if they're harmful to youth.

Dr. Amelia Arria: Yeah, there's a lot of confusion over all these products that are available and honestly, it's hard to keep up with all of the products that are out there and what they are and what policy decisions can be made to keep our children and our population safe.

What I know about Delta-8 is that it's a less potent form of cannabis, but it still carries risks. So people just use more of it to get the same effect. And it's synthesized in such a way that people are concerned about what is used to synthesize it from CBD. But like I said, I'm not an expert on the synthesis of Delta-8 from CBD.

Dr. Amanda Giordano: But Delta-8 does have mood or mind altering properties, just to a lesser extent of Delta-9 THC.

Dr. Amelia Arria: Right. Right.

Dr. Amanda Giordano: Okay. Yeah. And CBD still comes from cannabis products but is not mind and mood altering?

Dr. Amelia Arria: It is not psychoactive in the sense that THC is that it doesn't. But it is very, when you look at the CBD potency, it's negligible in today's products.

Dr. Amanda Giordano: Okay.

Dr. Amelia Arria: So I have doubts about when people say that things are high potency CBD and have medicinal properties which it could have. Whether or not that's even true, because nobody is really watching this store on a lot of these products and what they actually contain.

It's a confusing landscape out there.

Dr. Amanda Giordano: And so especially for parents who are listening or professionals, you work with youth, what might be some warning signs that a teenager could be using cannabis?

Dr. Amelia Arria: I think that because of the drug related reward that I talked about before and how powerful that is, I think young people start to reprioritize what they feel is important. So just the reprioritization of things that they normally enjoyed and that they don't anymore. Being socially isolated, spending an inordinate amount of time, getting, using, getting over the effects of a drug.

But you as a parent might not, that might not be visible to you, right? It might be apparent to a friend. So it's important to point out those warning signs to peers, like what those warning signs could be to a friend or what is visible to a teacher, maybe academic disengagement or to a coach not showing up, missing practice, disengaging from things that they normally would have done.

And then, you know, mental health issues could be a warning sign. And I think the idea is really to be vigilant about what is going on in a child's life, who they're hanging out with. Being a nosey parent is a good parent and making sure that you take things seriously and that you follow your instincts, that something might be going on.

Dr. Amanda Giordano: And if a parent were to find out that a teen is using cannabis, what do you think is the best course of action?

Dr. Amelia Arria: Be sensible. Don't panic. Make sure that you get somebody involved who's a professional. Don't try to use Dr. Google to help you with a problem. There are lots of resources available in communities. We have a website called collegeparentsmatter.org that helps parents to guide them through what steps you probably need to take.

There are a lot of qualified professionals on the mental health side to help with  screening for what might be a problem or what could be a problem with a child. But I think it's really, really important to make sure that they're vigilant and that they take it seriously and that they disapprove from a preventative standpoint and set boundaries on their child's behavior, because that is the healthiest, according to the science that's going to keep their risk down.

There are no guarantees but the lowest risk is associated with high levels of parental disapproval and setting boundaries in an authoritative way and coming from a place of care and concern.

Dr. Amanda Giordano: I really like that you emphasize that because I think parents can sometimes believe that during adolescence, the role of peers and the roles of friends is so influential and parents don't really have a lot of influence anymore.

But you're saying that the science is telling us that parental influence still really matters.

Dr. Amelia Arria: Number one. Number one, and we have had multiple interviews with young people. And when you ask them what is the most important influence in your life, parents come out, number one.

Dr. Amanda Giordano: Wow. Great. My last question for you is, in your opinion, what are some ways that today's society can best support adolescents when it comes to things like substance use?

Dr. Amelia Arria: Listen to the science. I think that's one of the most important things. We have a lot of science that can help guide our decision making. To come at the science with an open mind and to make sure that we treat our young people with compassion and care and concern and make sure that we see them as people that have a lot of potential and that we don't want that potential to go away because of an issue like substance use or cannabis use or getting involved in substances.

To separate the drug from the potential that a kid has, I think to really make sure that we focus on the students.

Dr. Amanda Giordano: Yeah, fantastic. I like the idea of separating their potential from the use. And just in closing, do you have any advice or suggestions for parents who might be listening and maybe feel a little bit apprehensive about navigating the adolescent years, especially with vaping and alcohol use and all the ways of substance use out there?

Dr. Amelia Arria: It's tough. It's really tough. The website has very specific instructions, collegeparentsmatter.org, and scripts that you can use about how to communicate with young people. I think it's not having a conversation, right? It's not about having the talk. It's more like virus protection software that's constantly running in the background.

Dr. Amanda Giordano: Yeah.

Dr. Amelia Arria: Rather than just like the one time. So it's not like you can inoculate your child. And your child is going to change over time and you're going to make mistakes and you're going to, you know. Just be brave and know that you can handle it.

Dr. Amanda Giordano: Wow. Well, thank you so much. You have given us so much information. We are just so thrilled that you were able to be on the podcast.

And for our listeners, thank you so much for joining us on the Safety First Podcast, where we tackle tough topics affecting today's teens. I'm your host, Amanda Giordano, and we hope you'll join us for our next episode.