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Jessica Lahey on Talking to Teens about Alcohol
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Jessica Lahey on Talking to Teens about Alcohol

Separating fact from fiction on substance use
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You can also listen to this episode on Spotify!

Did you know that all children, regardless of genetics, are at risk for substance abuse?

Jessica Lahey is a New York Times bestselling author, mother, and parent educator on teen substance use. Her most recent book, The Addiction Inoculation, is a practical guide to help children grow up to be healthy and addiction-free. 

On this episode, Jessica sits down with Dr. McBride to discuss her own path to sobriety, the myths about substance abuse in adolescents, and how to help kids feel comfortable setting healthy boundaries. 

This is a must listen if you’re looking for ways to talk with your kids, grandkids—or yourself—about alcohol. Feel free to share this episode with others who may be, too.

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Transcript of the podcast is here!

[00:00:00] Dr. McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor for over 20 years, I've realized that patients are much more than their cholesterol and their weight, that we are the integrated sum of complex parts.

[00:00:33] Our stories live in our bodies. I'm here to help people tell their story to find out are they okay, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my weekly newsletter at https://lucymcbride.substack.com/subscribe

and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So let's get into it and go beyond the prescription.

[00:01:01] My guest on the podcast today is Jessica Lahey. Jessica is a New York Times bestselling author, mother, longtime teacher and educator for parents and teens on the subject of substance use and overuse. Her most recent book, the Addiction Inoculation, is a crucial resource for anyone who plays a vital role in children's lives, from parents and teachers to coaches and pediatricians. Helping raise kids who will grow up healthy, happy, and addiction free. Jessica, welcome to the podcast.

[00:01:35] Jessica: You are so welcome. I'm so happy to be here.

[00:01:38] Dr. McBride: I'm really happy to be here too because you and I were talking before the show started recording about how medicine in the current landscape is failing people. It treats people like a set of boxes to check, like humans are a bag of organs. We cattle herd, we box check, we move people along the conveyor belt, when health to me, and I'm sure to your husband, who's also a doctor, is rooted in the relationship with a patient, is founded on trust. And particularly when we're talking about complex issues like substance use and overuse, it requires time to get to know the patient and then unlock those complicated stories.

[00:02:25] So, this is why I'm thrilled to have you here because it's clear to me that this is not just your job, but this is who you are. So I'd love to talk first about your story and how you became interested in substance use.

[00:02:39] Jessica: I couldn't avoid it because I was raised in a home with someone with substance use disorder. One of my parents and one of my parents was raised with a person with substance use disorder and so on and so on, and so on and so on. And when I first got sober, On June 7th, 2013. Not coincidentally, my mother's birthday, I got blackout drunk at her birthday party.

[00:03:03] My very first thought was, okay, well hold on. If I'm part of this long legacy, and by the way, my husband is part of a very long legacy of substance use disorder, how on earth do I make this stop for my kids? I mean am I just, are they just destined to carry? And I had so many questions about genetics and risk factors and all that stuff.

[00:03:27] And more than that, I had also been a teacher for 20 years. And after I got sober, I started teaching in an inpatient recovery center for adolescents. And I wanted to understand very specifically, how those kids ended up there, what could we could have done differently, both from a parenting, from a social, from an educational perspective, how those kids ended up there.

[00:03:50] And then looking at my own kids, I got sober when they were nine and 14. And I really just needed some answers. And I was hearing, most of the information I had in my head was myth. It was magical thinking. It was myth, it was rumor. I needed to understand, if we give kids sips when they're younger, does that do anything about helping them learn moderation or should we be aspiring to be like those European families that we talk about so much?

[00:04:19] And anyway, so all of that stuff, I needed answers. I have the coolest job in the world, which is to get curious about topics and then get paid to research the heck out of them, and then translate that research for people who don't wanna dive in and research for two years to get the answer to a topic.

[00:04:36] So my job is not just… I'm a writer, but I'm at heart, a teacher. I mean, not just to kids, but now I get to go out into the world and translate all of this stuff. And if there's nothing I love more, it's helping people think about topics that freak them out. Whether that's letting your kids fail with Gift of Failure, whether that's substance use prevention stuff.

[00:04:59] It's the reason that I've stuck with this substance use prevention stuff, because it’s just so hard to get people over the shame, the guilt, the fear, the denial in order to talk about this stuff. So that's one reason that I make daily videos about this stuff. I'm out there speaking to lots and lots of people, and sometimes it's an uphill battle, but it's really, really fun.

[00:05:23] Dr. McBride: I can tell you're enjoying it and you're so effective at communication. I'm the same way. I love complicated patients. I love the layered kind of kernels of people's interiority and how their thoughts, feelings, and behaviors are interrelated and then explaining it to people. I also love tackling topics that tend to freak people out, like death and dying, delivering bad news, like somehow that's like my Super Bowl. And I think one of the reasons is because, at least for me, I see the fear in people's eyes and I see the shame that they carry and then being able to kind of convey a message to people that is, that they can wrap their arms around is really gratifying. When it comes to substance use disorder, I think a lot of parents are freaked out.

[00:06:12] I think they read the headlines. They see how pre pandemic, we had an epidemic of diseases of despair, including substance use disorder that is only accelerated during the pandemic and they don’t know what to do. And they know their kids in their adolescent years are trying alcohol, drinking in kids' basements.

[00:06:30] They're kind of looking at what other parents are doing and not knowing who to trust. And so I'd love to hear from you what are the common myths that parents tend to hold in their minds about substance use disorder in adolescence?

[00:06:47] Jessica: Yeah, I think this is really important because it's also the myths that get translated to their children. And the big ones are things like, first of all it's a fait accompli—kids are going to drink anyway, so I might as well teach them how to do it responsibly, either because I have beer at my house and I take away everyone's keys, and at least they'll be safe.

[00:07:06] That sort of just fatalistic, it's going to happen anyway because that's simply not true. The numbers are so much lower than people understand, and I get into that. In the book, there's this thing called pluralistic ignorance, which is we tend to overestimate in the case of alcohol, for example, how much people tend to drink, the people around us and how invested they are in having alcohol around.

[00:07:28] And we all tend to overestimate that. So that sort of fatalistic thing, the whole, you know, I really want my kids to be like those European kids. So therefore if I let my kids have sips at home, let them have their own beer, a little bit of wine, that kind of thing, it'll somehow teach them to be moderate drinkers and not freak out when suddenly alcohol is available to them at college or whatever.

[00:07:51] And that's wrong for so many reasons. I mean, the European Union as a whole, based on data from the World Health Organization and specifically World Health Organization Europe has the highest level of alcohol consumption in the entire world, and the highest level of deaths and illness attributable to alcohol.

[00:08:10] Yes, there are exceptions, and that's a fantastic conversation to have as well, because that's about outliers based on the fact that those countries tend to have very particular community standards around public drunkenness. So the outliers tend to have to do with community pressures, and that leads to a great conversation of family culture, school culture, city culture, all those kinds of things.

[00:08:33] And then, the idea that our kids don't listen to us because that's just not true. Even as kids get into college, they report that their parents tend to be their preferred and most trusted source of information for especially health, personal health, that kind of stuff, that kind of information. And finally, I want to also, I think it's really important to remember that substance use disorder and substance use are two different things. Lots of kids can try substances and not go on to have a problem with substances over the long run. And it's important to understand from an objective perspective what those risk factors are so that you can say, oh, my kids are at higher risk, or this puts my kid at higher risk, so what do I do specifically to deal with that. And then finally, I think it's also important to remember that yes, substance use disorder, we're having a crisis right now with mental health and stuff like that. And substance use disorder or substance use can be one way to cope with that. But prevention works. Effective prevention works.

[00:09:31] And we're at, we've seen a 10 year decline really now 15 year decline in most aspects of substance use in adolescence. And that's because prevention works. And in order to do that really great prevention work, we have to be objective about risk factors, and we need to realize that adolescent brains are different from adult brains. I don't talk about adult substance use that often, except for when I talk about whether or not you should do it in front of your kids and what your messaging should be, because the adolescent brain is just different from the adult brain.

[00:10:06] Dr. McBride: Okay. I wanna talk a lot about the adolescent brain, having three of them in my own house. I welcome your insights. Actually, two are in college, but they do inhabit my house every now and then. But let's go back to the first myth for a second. The myth that parents, I think, believe quite often, and I have believed in some ways, which is that it's inevitable they're going to use alcohol, trying to stop them from drinking alcohol or experimenting with it in high school is kind of like stopping a 747. I think a lot of parents think, as long as we've had the conversation, then this is, this is the best we can do. What data is out there, Jess, to show that delaying your exposure helps prevent the likelihood of substance use disorder?

[00:10:56] Jessica: So first it's just important to remember that there are two periods of brain development that are the most important. They're just these massive periods of brain plasticity, and that's zero to two and puberty to around 25-ish, depending on the kid. So what we need to remember is that that development, that cognitive development that's going on, and that brain development that's going on from puberty to 25-ish, we don't fully understand all of it, it is massive. It's happening all over the brain. It's happening with lots of different centers. The executive function part of the brain, the upper brain is connecting to the lower brain, and anyway, that needs to happen as unimpeded as possible. What we do know is that the younger a kid is when they first initiate their substance use, the more likely they are to have substance use disorder during their lifetime.

[00:11:46] So for example, if a kid starts in eighth grade, it approaches a 50% chance of developing substance use disorder over their lifetime. If they start in 10th grade, it goes down to around 20%, a little bit less than 20%. And if you can get them to 18, we get so darn close to 10%. It’s important to delay, delay, delay. So that's one reason. Not only are we lowering their statistical risk of substance use disorder over their lifetime, and yes, there are some confounders in that data. There are confounders. I mean 90% of people who develop substance use as an adult report that they started before the age of 18.

[00:12:26] And of course there are issues in there that we can't control for—the social determinants and all that kind of stuff. Families that have more alcohol around are gonna have kids that are more likely. So there's all of that as well. But this is what I'm dealing with in terms of the statistics.

[00:12:42] Also remembering that the development, the longer a kid goes without ingesting anything that messes, whether it's with your dopamine cycle or fills up receptors in your brain that are, should otherwise have naturally occurring neurotransmitters in those receptors, because we're introducing them through drugs and alcohol. The brain just needs to develop as unimpeded as possible for as long as possible. So we're protecting their brains and we're lowering their risk of substance use disorder over their lifetime.

[00:13:11] Dr. McBride: It makes sense in a lot of ways. The way I think about it is that the longer you give adolescent brains to ripen on the vine, and the longer you give kids who are dealing with a lot of complex thoughts, feelings and emotions and genetic predispositions, the more chance you give them to find and practice coping with hard thoughts and feelings. You just give them more opportunities to realize that they like drawing, they like being outside to play sports, they like laughing with their friends, they've realized who their intimate friendships are and where they can go to put a lot of thoughts and feelings instead of the default mode to alcohol, which for some kids, as we both know, is a occupational hazard for our kids who are in distress.

[00:14:02] Jessica: And that's really apparent when you see what happens to a kid who has substance use disorder. They come to rehab. We remove the substance they're using as their coping mechanism. Suddenly you have kids with unresolved trauma. I mean so much. When we talk risk factors, you know, trauma is a big part of it.

[00:14:21] So suddenly we have these kids that have been using this one and only coping mechanism for so long that they. Not only don't have coping mechanisms for that trauma, but they don't have coping mechanisms for interpersonal disputes, for just feeling anxious. All of their coping has been through using the substance instead of actually learning a real coping mechanism, which is why we often talk about kids in recovery as having been—in some ways not always—having had their development arrested at the age at which they started using the substance and. I don't agree with that fully, but what I do [00:15:00] know is that it does arrest their ability to learn prosocial behaviors, to learn coping mechanisms, to learn how to as we often hear from, for example, Dr. Dan Siegel, integrate their upper and lower brain, and figure out how to be slightly outside of their emotions as opposed to living completely inside of their emotion and reacting from their limbic system, from their lower brain and not engaging that upper sort of more rational part of their brain. Yeah, it's tough.

[00:15:31] Dr. McBride: I just had Lisa Damour on my podcast.

[00:15:33] Jessica: She's fantastic.

[00:15:34] Dr. McBride: I love her too. And we talked, as you would imagine, about the rainbow of emotions that adolescents have and how complex they are and how they don't have necessarily in their teenage years, the vocabulary with which to discuss feelings. They don't have the interest always in talking about their feelings, and they don't even know they're having them sometimes.

[00:15:55] I have this poster in my office. That's the periodic table of emotions. I have a version at home too. It's like the periodic table of the elements, but it's emotion. So instead of believing that we have happy, sad, mad, we have rage, we have jealousy, we have envy, we have fear, we have this whole rainbow.

[00:16:19] So my kids tease me about it because they're like, oh my God, there's mom with the rainbow of emotions again. But then I see them when I'm not looking like my son and his girlfriend kind of being like, “hmm, I'm feeling kind of vulnerable today.” So what is my point? That it is a natural human instinct, whether you're a teenager or an adult who's experiencing complex emotions that are uncomfortable and maybe not even named to seek out places and ways to soothe, and I think adults do this. This is why I have a job. But teenagers, without the vocabulary, without the tools, without the insight that you are helping them grow and that I see older teenagers myself, it can be a very complex landscape and they're… Alcohol in our culture is socially acceptable and legal, and so it seems natural that they would experiment with it, and then you're off to the races.

[00:17:11] If you have a kid who all of a sudden feels, wait a minute, my social anxiety has been quieted, my uncomfortable thought has been muted, my fear is less loud. And they don't even necessarily articulate it that way, but it makes so much sense that this is an occupational hazard of being an adolescent.

[00:17:29] Jessica: Yeah, there's definitely a camp—in any field there are camps—these little camps of people who believe various things. And there's the trauma camp, that substance use disorder response to trauma. There's also the developmental camp, and I think that's really important. I think the reason that I and you and Lisa love adolescents so much is because, we tend to have a deeper understanding of how their brains work, which is why I tell parents that the more you understand about your adolescent's brain, the better you can be at stepping back and not just reacting to some of the buttons that are being pushed.

[00:18:06] And I think that whenever I—in fact, I tell parents, whenever you're most frustrated with your teenagers, just look between their eyes at that spot, right between their eyes. And remember, that's the part of the brain that's not fully connected yet, and that what they're doing in terms of their adolescence is designed to make kids want to push out and to individuate, but also to try new things.

[00:18:30] What's so cool about that? In trying new things in seeking out novelty and yes, sometimes novelty comes with risk. When they succeed at those things that they're trying out, when they build new skills, they're actually boosting their dopamine and boosting dopamine through… Kids are constantly craving dopamine. They want, we all want to feel good, we all want to have that feeling of mastery, inhalation, and all that sort of stuff. But if we want our kids to seek that out in healthy ways and healthy places, we can push them towards positive risk on to skill building and building competence, and then they can sort of get that dopamine cycle going in productive ways.

[00:19:13] But I think the minute that you just sort of shut down and say teenagers are difficult, they're moody. I heard one time on a podcast on—it might have even been This American Life—it was definitely on NPR a long time ago when I was a middle school teacher, I heard a middle school teacher say, sometimes I let myself just think that we should send these kids away to some holding place until they're ready to listen and able to learn again.

[00:19:43] And it makes me bananas because the exact opposite is true, that for people that really love and appreciate and understand adolescence and especially early adolescence, the more we understand what an incredible opportunity there is for learning, and how much learning is actually going on during that period, and enjoy it more, the more we understand it, the more we have the potential to enjoy it.

[00:20:08] Dr. McBride: So talk to me about what do you see as a major differences between the adolescent brain and the fully formed adult brain as it pertains to substance use disorder and dopamine, et cetera.

[00:20:21] Jessica: Yeah, so I rely heavily on the Dan Siegels and the Frances Jensens and the Laurence Steinberg's to help me see—as Laurence Steinberg refers to—adolescence as an age of opportunity. And I love that because so many other people are talking about this a terrible time, but what you have to understand about the adolescent brain, and varying people describe it in varying ways, but there's sort of a mismatch between the part of the brain, the early developing part of the brain, the lower brain, the reacting part of the brain that is just like, you know, go, go, go, emotions, emotions, emotions and the part of the brain that's still getting connected that handles executive function and prioritizing of resources and time and all that stuff. And that mismatch seems to persist until just about the time that we want to freak out and give up on them. And then suddenly, and it's so cool being a teacher because you get to bear witness to these moments, and eighth grade is a great time for this. 

[00:21:20] For example, I taught English, and so I taught a lot of literature that had metaphor and symbolism in it, and many middle school kids, not because they're dumb, not because they're smart, not because they're lacking anything, can't understand metaphor in a way that some, maybe some of their classmates can. But you don't stop talking about it just because they don't understand it yet. You just keep offering it. You just keep offering it in ways that are obvious so that the day that those neurons connect, you can see their eyes just go wide and they go, “oh. That's what she's been talking about.” And that same thing can happen with strategies for organization.

[00:22:03] I talk in the Gift of Failure about when my daughter finally connected this strategy for helping her remember things and actually remembering things and being able to go to school with her stuff. And had we been arguing about it for months? Oh yeah, of course. But it wasn't until for whatever reason, those neurons finally, finally decided to connect.

[00:22:26] And there have been times as a middle school advisor where, you know, I had a family once beg me to be their kid's middle school advisor, because I had been his brother's middle school advisor and his brother had made leaps and bounds during middle school. And I'm like, that's really sweet that you wanna attribute any of that to me and being his advisor. But it's just that his lower brain and his upper brain finally connected, and I was lucky enough to be there when it happened and capitalize on some of those moments. And that's what's amazing to know about the adolescent brain is that all of these things that we're being asked, we’re asking them to do that they may not be ready for.

[00:23:03] All of that creates stress, anxiety, a need for some kind of control over their world, and if we give them the autonomy and we give them the competence that they need, what ends up happening in their brain is they feel this, as I mentioned, the dopamine cycle lets them have this great burst of dopamine. If you wanna read more about that, please read Anna Lembke's Dopamine Nation.

[00:23:26] It's such a fantastic book. And on the other side, the less kids get to feel that feeling of self-efficacy, of competence, of skill building, the more helpless they feel, the lower their feelings of self-efficacy become, and the more they turn to things other than their own abilities in order to help themselves cope. And it's the reason I quote Chris Herren. Chris Herren, former Boston Celtic, ended up addicted to opiates. It's a fantastic story. Basketball junkie, if you ever wanna read it. And he goes out and speaks to kids a lot and he, I quote him in the addiction inoculation as talking about the fact that we tend to spend so much time talking about the last day of substance use.

[00:24:07] How far we fell, how disgusting it was on my mom's birthday on June 7th, 2013, and how ugly it got. But what we need to be talking about, especially when it comes to kids, is the first day, and he talks about that moment when a kid is at a party in a friend's basement, and why they don't feel like they are enough. They deserve to be loved. They don't deserve to take up space. They don't deserve to be here. What is it that makes them turn to substances? And I'm really lucky in that I get to talk to a lot of kids and hear what those moments sound like for them. And we need to help them feel like they're enough in those moments so they don't have to turn to something else.

[00:24:49] Dr. McBride: I wanna break that down and I first wanna just comment that. You know, I think a lot of substance abuse programs in schools focus on this on the last day, right? Like, they focus, they, they bring people in and try to scare the pants off of kids. They show images of drunk driving accidents and kids are supposed to go away thinking, “oh, I don't wanna be in a car accident. I don't wanna die.” But in my experience with teenagers, myself, as a physician and as a mother, that doesn't really work. And then we know the data are clear that scaring people doesn't work. We have to meet people where they are. And it's clear that, as you talk about so beautifully, the roots of a healthy program to educate kids and on substance use is social emotional learning. So can you talk a bit about that and how that relates to the prevention as individual parents who may be listening?

[00:25:45] Jessica: Yeah, so backing up, for example, in this country, only 57% of high schools in this country, and by the way, high school is too late to be starting this. Anyway, we need to be starting these programs very, very young, and I talk about that in Addiction Inoculation. Only 57% of high schools in this country have any substance use prevention program.

[00:26:02] And of that 57%, only 10% are based on evidence. On any kind of evidence of efficacy, that kind of stuff. So what we know about the best available substance use prevention programs is that they start very young, pre-k, k, and continue all the way through the end of high school. They are rooted in social emotional learning, refusal skills, building self-efficacy and self-advocacy, and essentially giving kids from a very early age, pro-social skills and coping skills, coping mechanisms.

[00:26:37] It's the reason that some have mindfulness programs attached to them and unfortunately, we're in this horrible position right now where we know these programs work. Oh, and also life skills, by the way. Life skills are a very important part of these programs as well. We know that social-emotional programs that contain health modules—making sure your bodily autonomy and safety and self-advocacy and stuff like that. We know those work. And yet, right now, For the first time ever, social-emotional learning is under attack because there's a faction of society that sees social-emotional learning as something that it's absolutely not, which is either indoctrination or identity and whatever. And it's really, really upsetting to me because without social emotional learning programs, which are just about building pro-social skills and skills that help us be a part of society and get along with other people and advocate for ourselves and all of this stuff that we know is so important.

[00:27:36] Ask kindergarten teachers, they repeatedly say those are the skills that if you were to look at kids and say, okay, that kid is probably gonna do really well, and that kid probably is not. It all comes down to pro-social skills and behaviors. If we do away with social emotional learning, there have been places I have spoken where I've been asked not to use that acronym because it's quote “problematic.” This is a disaster because this is what we know works for substance use prevention programs, and we abolish that at our peril. Any gains we've made in the reduction in substance use among adolescents, we're going to lose.

[00:28:15] Dr. McBride: I could not agree with you more. I mean, social emotional learning to me is about giving yourself permission to be human, to be flawed, and to have bodily autonomy, and as you said, the refusal skills and the ability to learn how to cope and function in the real world. 

[00:28:34] Jessica: Self-regulation, collaboration. Well, and then if you look at risk factors for substance use disorder, we know that 50 to 60% of the risk lies in genetics. That's Dr. Mark Shook at the University of California, San Diego. We know that the other 40 to 50% is adverse childhood experiences, trauma, stuff like that, and then set.

[00:28:53] And of course, the social emotional learning stuff can help kids with that. But then on the other hand, we also know that child on child aggression, academic failure, social ostracism, undiagnosed learning issues, all of these other things are risk factors as well. And if social emotional learning programs help with so many of the things that can counteract social ostracism and help identify academic failure early on and can help reduce aggression between children. This is such an important part of the substance use prevention picture, and because we also know that self-efficacy is one of the most important things we can give kids and self-efficacy comes from the ability to self-advocate and self-regulate. It's all this self-perpetuating cycle that if we throw a wrench in there, sorry to mix metaphors, that we, this whole thing grinds to a halt and we have a whole bunch of kids who not only can't get along with other people, but don't have any coping mechanisms within themselves to manage their own stress. All that stuff Lisa Damur talks about with girls and Yeah.

[00:29:58] Dr. McBride: When I was growing up, it was just say no. That was the mantra.

[00:30:01] Jessica: And we know that doesn't work

[00:30:02] Dr. McBride: and it would be really easy to say no if you had the social wherewithal, the confidence, the emotional skillset to manage that moment when a kid asks you if you want a beer and you're an eighth grader…

[00:30:14] Jessica: Well, and that's not even enough. That's not even enough. So what we need are, they're ultimately called refusal skills. I sometimes call them refusal skills. I call them in Addiction Inoculation—the inoculation. There's a school of sociology called Inoculation Theory. It's essentially if we give kids the information they need in order to counteract messaging that's coming from other places, whether that's from liquor companies advertising beer to kids during sports, or another kid in their class. So let's say for example, you have an eighth grader who gets offered a beer. And the rejoinder to “no thanks” is, “come on. It's no big deal. Everybody's doing it.” If your eighth grader knows, well, it is kind of a big deal because here's what's happening in my brain and, and blah, blah, blah, and they know that it's not true that everybody's doing it. That in eighth grade, by the end of eighth grade, only 24.7% of eighth graders admit to having had more than a sip of alcohol.

[00:31:16] So if they have that information, it makes them feel more confident in their stance and makes them more likely to continue to stick with their rejoinder of, “no thanks. I'm good.” And that those refusal skills, that inoculation messaging is so important and we have to start that early and continue it through.

[00:31:37] So it's not just about the wherewithal, the emotional wherewithal to say, no, we need to give them the actual information to back that up so that they can feel more confident in their stance and they can have a reasoning behind their stance. And it's the reason, by the way, that of the entire book. There's a lot of things I loved about writing this book, but my favorite part, I didn't necessarily write. I asked adolescents to give me excuses they could use in public at a party or whatever that would help them save face and yet allow them to get out of using if they didn't want to. And there's two and a half pages of those in the book, and I'm so grateful to all of the kids that sent those to me because so many of them are brilliant and I wouldn't have come up with them on my own.

[00:32:21] Dr. McBride: Give me some examples. I'd love to hear, and for any parent who's listening, I would love to like have you flip to that page because if we can arm our kids with like just the words to use and ideas, then that would be great.

[00:32:36] Jessica: they are things like, “I can't, I get migraines” because we know that, for example, wine, alcohol is a trigger for migraines. “I can't, I have a sleep disorder.” We also know that alcohol is a major component of sleep disorders—it exacerbates sleep disorders. “I can't. I'm taking an antibiotic.” “I can't. My parents drug test me. Aren't they horrible?!” or “I can't, my mom breathalyzes me when I get home.” or even just in their own head. My son, who's now 24, when he was in high school, he admitted to me that while he doesn't say this out loud in his own brain, he's like, “I know that I'm at increased risk for substance use disorder, and my mom had to work so hard to get away from the pit of despair that she reached in her alcoholism. I think I'm just gonna not risk that for now,” or “I have an early practice. I can't.” “I'm the designated driver,” which by the way, makes you more popular with other people because you can help them get home safely and not get in trouble and not get pulled over. There's all kinds of things that we don't even think about.

[00:33:42] A lot of Asians have something that's like a flushing disorder that is actually, it's sort of a… it's not really an allergy to alcohol, but it is something that makes drinking alcohol quite unpleasant. So you can go with that. There are a few studies, there's all kinds of ways that you can get at this.

[00:33:59] It’s just not the best thing for me right now. And I think the big overlooked answer is, “nah, that's okay. I'm good.” No is always an acceptable answer. And even in in sobriety, I have to value my sobriety and my safety more than maybe the worrying about upsetting my host, if I need to go home early from a dinner party where I'm just not feeling safe anymore and my husband and I have a signal and we've got all kinds of exit strategies and stuff like that, but helping kids know that they're worth it, that they are allowed to say no and that, obviously we have to make sure they know that in terms of unwanted touching and having sex before they're ready, all of that kind of stuff, we have to sort of empower them, give them the self-efficacy they need in order to feel like they're entitled to say no to whatever the heck they want to if it feels like it's going to endanger their safety.

[00:34:56] Dr. McBride: And I do think kids these days are feeling more empowered to say how they feel to put limits down, to set boundaries. But of course, without the vocabulary and tools and the social support and the emotional vocabulary, it can be more difficult.

[00:35:11] Jessica: Yeah. And that why that's part of the dovetail also with Gift of Failure, is that we know that parents who are highly controlling of their children tend to have kids that lie to them more often, and also that don't feel heard because if you are from that school of thought of do it because I said so or because I'm the parent without attaching any of the why to it, then it's like the difference between saying, I would prefer that you not drink until 21 because it's the law versus I would prefer that you not drink until you're 21 because of the potential damage it can do to your brain and because it can raise your risk of, of substance use disorder over your lifetime.

[00:35:48] I'm a why kind of person. I need to know the why. Otherwise, I am not invested as a learner and many kids are the same way. Just telling them, because I said so doesn't tend to be a winning strategy.

[00:36:02] Dr. McBride: To what extent are parents, quote unquote, “responsible” for their kids' relationship with alcohol? I'd love to talk to you about genetics versus experiences. The whole trauma argument that…I'm sure you know Gabor Mate and his system, I mean, he's wonderful. I also take a little bit of an issue with the idea that it's all rooted in trauma. I also believe on the other side that trauma is a, is a big word and can mean lots of different things. Feeling unloved and unsafe in your home for whatever reason can be traumatic. It's not just the. Experience of say, you know, breaking your leg and being ambulanced to the hospital. It can be an uncomfortable experience.

[00:36:54] It's the way that experience is handled from the individual standpoint, and that can then lead to a predisposition towards unhealthy coping strategies. So talk to me about what parents are responsible for. How much is genetic and how much is environmental, because I don't think we know the answer, but I'd love your thoughts.

[00:37:17] Jessica: Yeah, so like I said, the, the figure we have on the genetics is about 50 to 60%, but then you add on top of that this added layer called epigenetics, which is a crossover between environment and genetics. Also it’s not just one gene. We're not gonna ever have this CRISPR technology where we're like, oh, we can flick that one gene out. Look. And addiction is gone. It's not like that. It's tied into personality, it's tied into chemistry. It's tied into so many different aspects of our environment. And again, epigenetics determines how genes either do turn on or don't turn on, that kind of thing. So then on top of that,  the other 40 to 50% is yes trauma.

[00:37:56] Jessica: But there's all different kinds of trauma. If you read Lisa Damour’s Under Pressure, you understand the difference between stress, like there's little T trauma and there's Big T trauma. I think everyone on the planet should have to read Nadine Burke Harris's The Deepest Well, because average childhood experiences as originally defined by the CDC and Kaiser Permanente are really valuable, right?

[00:38:21] Because we know that people who have. People are more likely to have negative life outcomes in terms of health, mental health, all kinds of other stuff. If they've had various adverse childhood experiences and there's a really handy list, go google Adverse Childhood Experience and Quiz, and you can take the quiz yourself.

[00:38:38] However, it is not a complete list. The things that are on that quiz are a great starting place. For example, we know that physical and especially sexual abuse is a huge, huge glaring blinking neon sign risk for eventual substance use disorder. That's a huge, massive risk. So the adverse childhood experiences list of 10 things within categories comes close, but then there's also… it doesn't take into account Nadine Burke Harris's list, which can include things like systemic racism. Why on earth are we not counting that as a big T trauma because it absolutely is. There's a lot of debate right now around adoption, around all kinds of things that qualify as—can qualify as traumatic experiences for kids.

[00:39:24] So, and you should know about me that anytime someone says it is, All this or all that, I'm immediately suspicious as a journalist

[00:39:35] Dr. McBride: Well, I'm the same way. I mean, that's, that's it. I mean, everything is in the middle. It's not all nature. It's not all nurture. It's in the middle.

[00:39:40] Jessica: Well, and that's why, you know, there's an entire chapter essentially. What if I were to write about the peers chapter, you know, why did I include a chapter on the influence of peers in the book?

[00:39:49] Why bother? Because I could have just said, research shows that the more your kid's friends use drugs and alcohol, the more likely your kid is to use drugs and alcohol. Okay? Chapter over. But the problem is, it is a much more nuanced picture than that. And I tell the story in that chapter of. My son Ben had a friend who, Brian, that's his real name.

[00:40:08] He was insistent—the two young adults I profile in the book, Brian, and Georgia insisted that I use their real names because they felt this was just too important. Brian and Ben became friends. Brian had been already kicked out of one high school, then got kicked outta my son's high school for substance use and behavioral stuff and my, my kids stuck by him and all their friends stuck by him and I'm like, look, my instinct as a parent is you cannot be friends with this kid because if he does substances, you are more likely to do substances. In the end, that relationship was much more complicated and the fact that my son, Ben, and his friends stuck by Brian actually led to the moment where Brian realized on the second time he got kicked out of that high school and my son and his friends took him running on the last day, he was allowed to be on campus. Brian realized in that moment that was his turning point. That was his 100th piece of his puzzle where he said, it all has clicked into place and I see what I stand to lose, and my son benefited from the object lesson. The real scared, straight sort of object lesson, real life learned experience of, oh, this is what happens when you rely on substances in order to manage these other things. 

[00:41:26] And here let's talk about those things. And PS the best part of that whole relationship was I said to my son, “Ben, look. I'm so pleased you want to support him and go visit him in rehab and all that stuff. Loyalty is great and a friendship, but if you're going to be friends with Ben, knowing what I know about the statistics, we're gonna have to talk about this a lot.”

[00:41:47] And that was something that became a standard conversation topic for us. How's Brian doing? How are you doing about Brian's… how do you think Brian's doing? How do you think…what are you seeing that works for Brian and what doesn't work for Brian? It gave us a proxy so that my son didn't have to talk about himself as much, which can be very difficult for teenagers. But it allowed us this proxy to talk about substance use and substance use disorder in the guise of Brian and gave Brian a launching off place for his, what became his recovery.

[00:42:19] Dr. McBride: It's so lovely and I really like the way you talk about Georgia and Brian in your videos and in your book, because it just helps parents, I think, hook into the realities of these kids' lives with empathy and compassion for their stories and great respect for their privacy. Obviously, that the fact that they wanted to share their stories means that they feel that this needs to be talked about more than it is.

[00:42:45] Jessica: Yeah, I can't count the number of times. I was like, no, really, let's do a pseudonym. You can choose the pseudonym. And even recently with Brian, I had to get in touch with Brian about something and I wanted to make sure that they were making that decision from a place—and they were [00:43:00] adults when they made this decision—but that they were truly making this decision from the perspective of, you know, I appreciate that. A lot of people have shame and guilt in that. There may be some persecution that I could face maybe in the workplace later if this got out, that this was me, but this is too important. It has brought some value out of everything I went through as a kid, as a child of an alcoholic, everything I went through as an alcoholic.

[00:43:25] And this education might help someone else. And I think that's really where Brian and Georgia are coming from, from this. And I talked to Georgia last week, talked to Brian two weeks ago, and yeah, they're doing great. They're doing so well.

[00:43:39] Dr. McBride: It's incredible. I'd love to now segue into talking more about you if I could because you are talking the talk and walking the walk. So had you tried to get sober in your life before that moment at your mother's birthday party?

[00:43:56] Jessica: I've had periods of sobriety because I was scared. Like, you know, I did that, I did that thing a lot of sober curious people do, and to make it clear, I'm so hopeful about where we are right now because I think a lot of people are realizing you don't have to rise to the level of completely out of control, homeless, DUI, all that stuff, getting fired from work. You can say to yourself, “man, I'm gonna try dry January and just see how it goes.” And then you realize, oh wow, this kind of feels better. And so I'm gonna keep going. You can stop drinking just because it's not working for you anyway. I was scared to death.

[00:44:30] I tried through the guise of long distance running like I used, running as a reason to stay sober, to not drink, and I would make all kinds of bargains with myself. When I was pregnant, I was sober. When I was training for big races, I was sober, but it just was starting to take over to a degree that I couldn't control it anymore on my own. And so the reason I talk about getting to a place where I know I needed help as a 100 piece puzzle is, you know, my dad on that morning, after my mom's birthday party was my 100th piece. But pieces one through 99 had to be there for all of that to click into place and form a big picture.

[00:45:13] And those early attempts at sobriety were pieces of that. And the beauty of all of this puzzle piece stuff is that I can't guarantee that my kids are not gonna develop substance use disorder, but all of this prevention stuff are pieces of that puzzle. So maybe they get to start at piece 65, where I started at piece 32.

[00:45:34] It builds those blocks. So I was able to get sober. I happened to get sober in 12 step and. There are lots of ways to get and stay sober. I happen to get sober in 12 Step, and my higher power is the people in those rooms and the people I work with at the rehab where I work now. I work as a prevention coach and sort of a recovery resource at Santa at Stowe.

[00:45:58] It's a recovery in Stowe, Vermont. It's medical detox and recovery, and they are my higher power. I can't show up for them. Unless I'm sober, I can't go do my speaking engagements. I can't do my daily videos unless I show up sober because then I'm being completely inauthentic and I would be hungover and miserable.

[00:46:18] But all of my stuff has been partially in service to getting control of my life back and being the parent that I know I need to be in order to raise two kids who might break the cycle of this. 

[00:46:36] Dr. McBride: What I'm hearing from you is that. Your sobriety is rooted in the 12 steps. It's also rooted in the ongoing process of helping other people, which is one of the tenets of AA is passing on your knowledge and wisdom to other people and, and making meaning out of an experience, and I think you really are making a difference.

[00:46:55] I see people reading your book. I hear p people reading your book. I've had my kids listen to your videos, and not that they necessarily wanted to, but I have heard some good feedback because I think what happens when we talk about alcohol to adolescents is it often comes across as a parent as just a, a moralistic, judgmental, do as I say, conversation

[00:47:22] Jessica: And not necessarily do as I do, because if…

[00:47:25] Dr. McBride: not necessarily right. And then we go, poor gin and tonic. And they're like, Hmm. It's funny, one of my most popular posts on substack, like by a mile was the post I wrote called “Is Dry January a good idea? And I put it out on January one.

[00:47:40] And I mean, the answer to the question in my mind was probably what you wouldn't be surprised to hear, which is that sure. It's only though scratching the surface of the curiosity and compassion and empathy we need to have about ourselves and about the why, because you can put a fence around a behavior for 30 days, 31, I guess, in January, and then on February 1 you can go to the pub and get plastered or just start drinking again.

[00:48:07] The question isn't, can you give it up because you can…

[00:48:10] Jessica: I gave it up for a year.

[00:48:12] Dr. McBride: And for some people that's very hard, but the harder question is mining that interior landscape that is driving you to drink when you don't want to, if you're remorseful the next day, [and] you wish you hadn't done it. That is hard work, and it's much easier to put a fence around it for 31 days. I'm not saying don't do it. I'm saying do it and get curious.

[00:48:34] Jessica: One of my favorite speaking gigs is, and don't hate me for this, but every six months or so I'm at Canyon Ranch, either in Tucson or Lennox, Massachusetts, and they put me up and give me a discount on spa stuff for me and my plus one, and I do my talks. But the cool thing about Canyon Ranch is that there's no alcohol served there.

[00:48:55] And some people bring their own because they just can't be without it for a couple days. But there are plenty of people who go there and realize that they hadn't anticipated how difficult it was going to be for them to not have it there as an option. And, and then every—because Canyon Ranch was founded by someone for whom recovery is part of their story—there is a meeting there every single day at five and the people that often, and I often run those meetings and the people that show up at those meetings are often people who are like, “I don't really know why I'm here. All I know is it really bums me out that there's no alcohol here and I don't know what that's about.”

[00:49:29] So, you know, it's a

[00:49:31] Dr. McBride: great starting point.

[00:49:32] Jessica: Well, and also a lot of people are there either by themselves or with a spouse and don't know anyone else there. So they feel like it's a super safe place to go to a first meeting anyway. Either way, it's a really cool place to get to do the kind of stuff that I do. Because it's opening the door for them in a way that maybe they hadn't anticipated.

[00:49:51] Dr. McBride: Yeah, I mean it's self-discovery. I think about health as not an outcome, but a process of laddering up from self-awareness to acceptance to agency. I mean, the serenity prayer… I'm not in recovery, but people ask me if I am all the time. I mean from alcohol, I'm, I'm in recovery from other shit that I do, but because I really understand and believe in the concept of the Serenity Prayer, which is accepting the things we cannot control, which is a lot, knowing ideally what we can control, and then understanding the difference and not spending so much time over here and shifting our energy and attention and curiosity to this spot.

[00:50:31] Jessica: You want to hear something ridiculous? This is so interesting. So two things. When the book first came out, it was first getting its reviews and stuff like that. I got one review where it said very specifically that I parroted AA stuff. So first of all, I did not use anything AA in the entire book except in one spot.

[00:50:52] I said, this is where something, for example, like the Serenity Prayer has been useful for me, and this is the restraints that we're dealing with when we talk about this stuff. Like that's why don't talk about AA because it is, the minute I refer to that, that is the only thing someone will hear. And then I'm just stuck.

[00:51:11] Dr. McBride: And they associate it with, oh, AA that's like my crazy Uncle Sal. I just drink a gin and tonic every night. What's it to you? So I think that your approach that is honest, empathetic, rooted in data, and that stems from your own experience of being perfectly imperfect is really valuable. And so I just want to say thank you for being here and thank you for doing what you're doing and God speed.

[00:51:38] Jessica: I am so grateful to you for just having this conversation. Every single time I have this conversation with someone, I get an email or a DM from someone saying, you know what? I'm scared too, and I don't know what to do. Or, I'm scared for my friend and I need to know how to help them. And so, you know, the more we talk about this, the more other people are gonna feel like they're allowed to talk about it too.

[00:52:02] Dr. McBride: Thank you all for listening to Beyond the Prescription. Please don't forget to subscribe, like, download and share the show on Apple Podcasts, Spotify, or wherever you catch your podcasts. I'd be thrilled if you like this episode to rate and review it. And if you have a comment or question, please drop us a line at info@lucymcbride.com. 

[00:52:24] The views expressed on this show are entirely my own and do not constitute medical advice for an individual. That should be obtained from your personal physician.

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Each week, Dr. Lucy McBride talks with her guests like she does her patients — pulling the curtain back on what it means to be healthy, connecting the dots between mental and physical health. To Dr. McBride, health is about more than the absence of disease. Health is a process, not an outcome. It's about having awareness of our medical facts, acceptance of the things we cannot control, and agency over what we can change. To learn more about Dr. McBride, visit: https://www.lucymcbride.substack.com/about To sign up for her weekly newsletter, visit www.lucymcbride.substack.com/welcome