Of Course Your Kid Doesn’t Want To Go To Treatment; Meeting Treatment-Resistant Youth With The CRAFT Approach, with Lara Okoloko

ABOUT THE EPISODE:

Lara Okoloko wants parents to understand something important:

The majority of treatment options were designed for older adults with severe substance use disorders. She says we shouldn’t be surprised that young people with mild to moderate disorders are not interested in identifying with a permanent label of “addict” or “alcoholic” and swearing lifelong abstinence.

The standardization of treatment for older adults has also led parents to believe that anyone with a substance use disorder is destined for jail, institutions and death unless they find sobriety. Lara says this just isn’t true for kids and young adults.

As a 15-year practitioner and teacher of the CRAFT approach, Lara should know. She has served as a licensed clinical social worker for kids who are at-risk, in foster care, and drug-dependent, and now works with parents and families as well.

In this episode, we discuss in more detail why teens can be resistant to treatment, how the TV show “Intervention” changed our entire concept of treatment, the enduring myth that most kids are using substances, and why, despite its proven track record, CRAFT still isn’t the standard approach recommended and used for helping a loved one.

EPISODE RESOURCES:

• Lara’s website
• List of CRAFT-trained therapists in WA State
• WA State healthy use survey

Find a CRAFT-trained provider or organization at the Helping Families Help website

This podcast is part of a nonprofit called Hopestream Community
Learn about The Stream, our private online community for moms
Learn about The Woods, our private online community for dads
Find us on Instagram: @hopestreamcommunity
Download a free e-book, Worried Sick: A Compassionate Guide For Parents When Your Teen or Young Adult Child Misuses Drugs and Alcohol

Hopestream Community is a registered 501(c)3 nonprofit organization and an Amazon Associate. We may make a small commission if you purchase from our links.

Transcript

Lara: 0:01

There's a message which comes from the 12 step tradition that all people who have a substance use problem at some part time in their life are destined for jails, institutions, and death. unless they find sobriety. And that message is probably way more accurate for older people with severe substance use disorders. It's actually not an accurate message for a younger teen with a developing substance use disorder. It's just not true.

Brenda: 0:42

You're listening to HopeStream. If you're parenting a young person who misuses substances, is in a treatment program, or finding their way to recovery. You're in the right place. This is your private space to learn from experts and gain encouragement and support from me, Brenda Zane, your host and follow mom to a child who struggled. This podcast is just one of the resources we offer for parents. So after the episode, head over to our website at hopestreamcommunity. org. I'm so glad you're here. Take a deep breath, exhale, and know that you have found your people. And now let's get into today's show. Hi, friend. It is good to be here with you today. As always. I love that we meet up here and we can exhale a little bit, and I'm hoping this is time that you are taking for yourself, maybe running errands or on a bike ride, or maybe you're on your commute, your run, whatever it is. It's really so incredible that you're here with everything you have going on. And I am honored. I'm going to let you get right into today's episode because it is so good. So, so good. I tapped into someone who in the field of craft, community reinforcement and family training is considered pretty OG. She has been practicing for over 14 years and she has a private therapy practice. But today she spends more of her time teaching other therapists and medical providers the craft approach. So if anyone knows the techniques and strategies that craft entails and how to use them effectively, it's Laura Okoloko. Laura's a licensed therapist and clinical social worker. She earned her master's degree in social work from the University of Washington in 2005 and is the past board president of the Washington State Society for Clinical Social Work and And an affiliate instructor at the university of Washington's school of social work, teaching masters of social work courses. Laura began her social work career with at risk youth. Those who are in foster care, living on the streets, drug dependent or court involved. She enjoyed working with these tough, vulnerable, messy, resilient, and quick thinking young people. And then she began working with parents and families in social services and medical settings. She has a special passion for working with family members who are concerned about someone's substance use in her private practice. Laura uses a variety of evidence based consulting methods to help people make positive change in their lives and family relationships, including CBT, motivational interviewing, solution focused, brief therapy, family systems, theory, feminist therapy, and of course, counseling. Community reinforcement in family training or craft. She's also very familiar with the 12 steps of Alcoholics Anonymous and advocates for any approach that helps people stay safe and recover, including harm reduction approaches. When I reached out to Laura, I specifically wanted to talk with her about meeting treatment resistance with the craft approach, because I know that is an issue that so many parents face. Especially with teens and young adults. I also tapped Laura's insights on why craft isn't the de facto approach that is recommended in the therapy and treatment world for someone who's trying to help their loved one get better. And she highlights the reason why many teens and young people who are experimenting with substances resist treatment and what you can do. If that sounds familiar, I was not disappointed with what Laura shared. I took a ton of notes. And you may want to as well. So without anything more, here's me and fellow Seattleite, Laura Okoloko. Enjoy. Laura, welcome to HopeStream. This is going to be a wonderful conversation. I love, love talking with craft practitioners because you are so steeped in this. You teach other professionals, which is awesome. And we'll talk about that. So thank you very much for joining me and taking the time.

Lara: 5:15

Yeah, thank you for having me and for talking about this thing we both like so much.

Brenda: 5:20

I know, right? It's, uh, people probably tire of me constantly talking about this, but my thought is, what's the alternative, right? Yelling and screaming and shaming and blaming and it just doesn't work. I can just like let everybody know I did the research on that and can verify wholeheartedly that it does not work. Why don't you just give us a little bit of background on you and how did you come to be a therapist? How did you come to find craft just so we get a little bit of context for who you are?

Lara: 5:55

Yeah, well, I'm a clinical social worker and when I went to college, I wasn't I'm quite sure I didn't really know what social work was, but I knew I wanted to work with people and I was very interested in people and so I took psychology classes, sociology classes, anthropology classes, and thought, those aren't quite it. And then I took a social work class and thought, oh, this is the thing that I get to both help people directly, but also be just curious about people and understand people better. And also social work has a great advocacy component, uh, to it that I also really like. And so I didn't first intend to work in the addiction field. I was a medical social worker. I worked with homeless folks. I worked you know, in doing all different kinds of social work. And then I kind of stumbled into, Co facilitating a CRAFT support group for parents of adolescents, and I loved it. I really, really liked it. I didn't really know what I was getting into. I, I had some experience in addiction. The addiction world was not new to me, but, but CRAFT certainly was. It was new to everyone back then. That was 14 years ago. Years later, I became a private practice therapist. I continued that work that I had done for another agency developing Basically a family counseling program that was craft focused. And so when I had the opportunity to work in private practice doing anything I want with anybody, uh, this is what I wanted to do and have continued doing ever since then.

Brenda: 7:33

Amazing. What was it about that first experience that you had with craft in adolescence that had you hooked? Like what were you seeing that maybe you hadn't seen before?

Lara: 7:43

I. There's a few things that we're just really reinforcing about it. One is that it worked well. So that's nice when you see something actually working for people. And it felt intuitive to me and there's a quote by, Bill Miller, who is one of the people who wrote Motivational Interviewing, which is an approach to, you know, how to, how to talk to people in a way that's not confrontational in a counseling setting. And he says that Motivational Interviewing probably works best for people who recognize it when they first see it. Like for people who are being trained in it. And I think it's true for craft too. Like if as a provider, I think it works best with people who first see it, learn it and feel like they should, there's just a recognition. So I feel like there was that for me of like, Oh yeah, of course. Like, of course this is a better way. And I think. to be able to see that families could do what they so desperately wanted to do, which is to help their loved one, and that they could do that without the risk of all the cutoff and detachment and confrontation, all the approaches that risk the relationship. And I think seeing that, like, oh, that's not actually necessary. We don't have to introduce harms potentially in the, in an effort to help people. We could. Get rid of that part and still be more effective. I mean, that's just, that's a good, that's a good sell.

Brenda: 9:16

Yeah. And at the same time, and this just baffles me constantly is that it, it doesn't yet seem to be the default approach.

Lara: 9:26

Not yet.

Brenda: 9:27

And like you just said, I've been doing this for 14 years and I just wonder how long is it going to take. Till this is the default and maybe you have insight to that because you do train practitioners now in craft. What is your thought about that? Why isn't this, why hasn't this been adopted really as the default gold standard in, in helping people?

Lara: 9:52

Oh, I have a lot of thoughts about that.

Brenda: 9:55

It's probably, we need another hour for that, but maybe a top line.

Lara: 9:59

I'll give you the short version of what I think is. I think at first blush, it seems like, well, if there's like in psychology or the helping professions, like if there's an effective practice that comes along and works better than the standard. And we certainly have Lots of research that shows that that you'd think kind of like maybe in a medical other medical settings where you'd think well, of course, it's going to get adopted and of course, it'll take the place of what was being done before. And that's what progress is. And it seems really obvious like that. That's maybe how it would work. But I think that's not how it works. I think that when Okay. A practice comes along that, that challenges the paradigm that's in place, effectiveness is not enough to make it take over as the standard. I think it's really an uphill push when you have something that goes against what's seen as the standard. Acceptable or the knowledge base that we all have. It's kind of like the first doctor who realized that they needed to wash their hands to minimize their patients dying. Right? And people were like, what? That's crazy.. They were, people were offended. Uh, he was ostracized. Like it doesn't, didn't matter that he was having less patient death or that he had discovered something useful because it. Went against the paradigm of, and was really a challenge to, to have that be accepted. And now we look back and think, well, of course, like that's how, how are people not, how are people doing a, a autopsy and then going to a birth and not washing their hands?

Brenda: 11:42

Right?

Lara: 11:43

And so I think similarly, I think craft challenges. A lot of things that have been in place for a long time without challenge, and I think some of that's related to stigma. When we have, when a population is stigmatized, then the way we communicate hate. Stigma is a way of communicating social disapproval. And the way that we do that for people we stigmatize is to ostracize them, is to push them out. And so the standard approaches that are very focused on cutting people off, having them hit rock bottom kicking them out of the house, detaching, all of those old methods, they're in line with stigma that says push them aside. So I think when this approach comes along and says, we can actually help protect family relationships we don't have to do it that way. I think it, it's tough to get that social shift and that cultural shift you know, and work. You know, craft is competing with a couple of decades of TV shows like Intervention that have have trained everybody to believe that that is the way that you do it, that that is what needs to be done. And it's, you know, Coming along after 75 years of Al Anon shaping our cultural understanding of the need to prioritize self care and detachment, which itself is not bad. Self care is great, but the idea that that needs to be the only approach that we need to, to push self care forward and, and detach from the person that's suffering. Especially for parents, I think it's a good reminder that Al Anon was not developed as a parenting program.

Brenda: 13:40

Right.

Lara: 13:41

Al Anon was developed for the wives of AA members. And so if parents especially are feeling like it's not a great fit as a parenting approach, that's not what it ever was meant to be.

Brenda: 13:55

Such good insight. I was talking to somebody in the harm reduction world about this, who's a huge craft person And she said, well, you know, you couldn't make a TV show with a family implementing craft because it wouldn't be very exciting because there wouldn't be any yelling and screaming. There wouldn't be any. Well, I shouldn't say any, there would be much less drama and the yes, the yelling and you're kicked out of the house and we're not talking to you until you clean up your life. It's just, you know, A little more low key.

Lara: 14:31

Yes, and it's a process versus an event. Yeah. An event can be filmed and exploited. Yes. And I think a process is more difficult to show over time. You'd have to follow somebody over time and, and try to capture that, those things that are shifting. I think you're right. It's less dramatic. It's harder to demonstrate. And I think another thing that the TV show Intervention did, is it convinced everybody that treatment is rehab. Right. And that's actually not the way most people get treatment for a substance use disorder. And so I think there's also my more kind of skeptical self thinks that there's also something here around the for profit industry of addiction treatment, that the idea that we You confront people, you kind of force them that day into rehab, which for most people is not affordable and that they're going to get, you know, 28 days of care, kind of an acute care model for a chronic problem, which is not a great fit either. And then they're going to be better and it's going to be great. I mean, I really think we can't underestimate how much that TV show has created an idea in popular thought about, like, not only what the family should do, but what treatment should look like. And that's just, that's really a really small sliver of what treatment is.

Brenda: 16:06

Yeah. Those are such good points. I hadn't really thought about that, filming a process versus an event because they're so different. The craft approach is so nuanced and it plays out in just the smallest. Interactions with each other in the home or, you know, wherever you happen to be in the car driving somewhere with your, with your person. So I think those are really, really salient points to remember when we scratch our heads sometimes and wonder, why isn't this more widespread? But you now are really focused on training providers. And tell me a little bit about what that's like when you go in to train folks who may have some of these old mindsets.

Lara: 16:51

Yeah, I, I do still see clients because I think I really love it. And also, I want to stay kind of relevant and sharp myself and, and what it is to provide this work. But I really take a lot of joy in training people. And I think for where I am in my practice with craft, I feel like I can make the biggest impact by, by doing that. helping it to spread in the provider community. And so that's really where my passion has been. And you know, there are people who come to craft trainings already really seeking out an alternative and they kind of know what it is. And and they come already. It's like, I can preach to the choir for the, for those group of people. And that's fun, you know, to be with people who, you know, have that mindset already. But I also really enjoy talking to providers who maybe. sometimes aren't even sure what they wandered into in the training or, you know, were recommended to come to it, but weren't quite sure what it was. I really enjoy engaging with my own community of providers because I've had to make, I had to make some of those shifts over time. I also like everybody else, was really influenced by 12 step thought about addiction and recovery and, you know, all the things that we all are influenced by. I certainly had watched many episodes of Intervention and had read books about codependency and things that I don't really believe in anymore, but, but I did. And so I really enjoy engaging with other people on those same things that I had to be on a journey for. And I remember a time many years ago, but I can still remember my own introduction to harm reduction and, and some of my questions about it. Initially, I remember having a period of time where I thought that harm reduction was just for people who didn't really believe in, in people. That could be in recovery and that it was a, it was a cop out and it was somehow harm reduction communicated something negative. Like I, if I really believed in you, I wouldn't take that approach. And I, so because I remember thinking things like that and I was willing to listen to other people and, and grow in my own thinking, I love doing that with other people. Because I get it. I, I thought some of those things too.

Brenda: 19:17

Yeah. And, and it's the exact same with parents, right? When we've seen these things. And I remember my son, I, I, I should have taken this as foreshadowing when he was in like middle school, he was obsessed with the show intervention. Like he would do marathons. Watching that show. Maybe I should have paid closer attention to that, but we've seen all the same things and we've heard the same messages if we've heard anything at all, because a lot of the time this, you know, when you, when your kiddo starts going off the rails, like this is your first introduction to substance use. Yes. To addiction to. This entire world. And so you really don't even necessarily have any grounding in like, what should I believe? Or what should I think? I think we all just look at it and go, it's scary. It's. It's not accepted by society. It's very stigmatized. It's very bad. And we got to get rid of it as soon as we can. And so I'm sure there's probably some of that carryover that parents are holding as well to wonder, what do I do with this? And what I really wanted to tap your brain for today is. To talk a little bit more about treatment resistance, because our community really reaches parents of adolescents and young adults. I would say, you know, the average is like 12 to late twenties. And I've found as they get older, I hear there's a little bit more willingness, but in those younger years, especially in the adolescent years. It's, I have seen in our community with hundreds of parents, like, it's pretty rare to have a kiddo go, yeah, I'll go to treatment. It does happen for sure. And I, I could name names if, if I needed to, but it's less common than, I'm not, you know, A, I don't need help. There's no problem. And there's no way I'm going to treatment. Like, you know, F you, that's not happening. And so I thought that maybe we could sort of get into that a little bit because it's so common and parents are just pulling their hair out when you see, especially today, high potency THC products. severely impacting these kids, mental health, the psychosis that's happening, you know, the natural consequences of fentanyl are death. And so I think there's this like, sense of heightened urgency of how can I, like, I'm on board with craft. I like this approach. I'm using it. I'm learning. And still my kids like got the hands up. Like, no, that's not happening. So spill all of the secrets that you have, Laura, because we need them.

Lara: 22:07

Well, I, I wish I had the secret. So then I could just see each family one time and tell it to them. Yes. Yes. Solve that problem. I think there's I think there's a few things I want to talk about on this question of treatment resistance for younger teens. So one, I want to talk about what treatment is more, but before that, I want to think about motivation for change. And one of the problems I think is that most teens, they are beginning to use, for those that are beginning to use substances, most of them don't yet have a substance use disorder. They have substance use and as a parent, I get, I get why that's really upsetting. I'm not saying that to say, therefore it's okay. It's not okay. It's not healthy for a younger teen to use substances at all. But the disorder part is the negative part of one's substance use. And so for a parent with a younger teen who's starting to use cannabis, tobacco, alcohol, other drugs, for the teenager, it's okay. Mostly all reward, no cost. And for the parent, it's all cost, no reward. So the parent is very distressed, which I would be too. And feeling very worried and maybe even angry or frustrated. And having a lot of fear, feeling out of control. Feeling helpless, feeling maybe disrespected. All the things, all of that's negative. And there's no benefit. There's nothing positive from having a teenager who's using drugs and alcohol. For the teenager, it's likely it feels good. They are meeting new friends. They feel popular. Maybe they feel less social anxiety. It's all benefit. So where's the motivation for change when you have a behavior that comes at high reward, low cost? So that's part of how I understand the treatment resistance. For more UN videos visit www. un. org Is to say, yeah, the, of course, later on, which this is the frustration of parenting a teenager later on when the inevitable problem becomes more severe and there, the change is harder to make. But then the motivation will appear because now they're having problems, right? So now the cost benefit analysis has shifted, and that is part of what addiction is, is that my substance use comes at more and more cost, and I'm not making a change. That makes sense. Right. Because lots of teenagers will use substances and will end up growing out of their problematic substance use. They won't develop a substance use disorder and they will be an adult who sometimes uses substances and doesn't have addiction. But some of those teens, and this is where, where, why this issue is so important and why parents naturally are very upset about it, is the younger people start using drugs and alcohol, the more likely they are going to develop a substance use disorder. So kids who start experimenting before the age of 15 are five times more likely to develop a substance use disorder than someone who doesn't start using until their later teens or early adult years.

Brenda: 25:56

Hi, I'm taking a quick break to let you know some exciting news. There are now two private online communities for supporting you through this experience with your child or children. The stream community for those who identify as moms and the woods for guys who identify as dads. Of course, this includes step parents and anyone who is caring for a young person who struggles with substance use and mental health. The stream and the woods exist completely outside of all social media, so you never have to worry about confidentiality. And they're also ad free. So when you're there, you'll be able to focus on learning the latest evidence based approaches to helping people change their relationship with drugs and alcohol. In both communities, we have a positive focus without triggering content or conversations. And we help you learn to be an active participant in helping your child move towards healthier choices. You'll also experience the relief of just being able to be real, connect with other parents who know fully what you're going through and have battle tested mentors alongside. You can check out both the stream and the woods for free before committing. So there's no risk. Go to hope stream community. org to get all the details and become a member. Okay. Let's get back to the show. Where do we go from there? It might take a while, right? For the, for consequences to, to happen. What are some things that, you know, like, what do we do while we're.

Lara: 27:37

Yes. So, I would say, one, we don't want to wait for anything. We can be active in lots of different ways when a problem is developing. And I think this is where craft is great because, It's not just about the treatment engagement skill, there's other things, other skills that it's giving to use in the meantime. So, using positive communication to make sure that you're communicating directly, clearly, calmly, firmly about substance use, especially with younger teens, that it is against the rules. And there's a good research basis for this communicating to younger teens about substance use, is teens who are more likely to be using substances are more likely to say that their parents either do not communicate to them about substance use, or that they perceive that their parents wouldn't care, meaning that they are not perceiving that their parents have strong disapproval. So this is different, obviously, for a 17 year old than a 13 year old, but for those that have younger teens, having parents communicate frequently and clearly that they do not approve of the substance use, that it's not allowed, it is against the rules, and that there will be consequences for breaking rules. That's a very appropriate way to deal with substance use in a younger teenager. And obviously as teens get older, your parenting skills have to shift because they're growing and changing and the relationship is changing and they're becoming more of an adult. So I just want to make that distinction between parenting a younger teen versus parenting an older teen. And so that's a good point. preventative stance is that the research is clear about the type of parenting that is most effective of younger teens, which is warm, highly communicative, and authoritative, which is not authoritarian. So we can think of authoritarian like, I'm in charge, you don't get to question me. You know, whatever I say goes like very coercive controlling. That's not what I mean. Authoritative is clear leadership. The parent is in charge.

Brenda: 29:54

Yes,

Lara: 29:55

if I say there's a rule and the rule gets broken, there will be a consequence that's more authoritative versus permissive parenting which is not great for preventing problems in teen years. So that combination warm. Which is affectionate, lots of communication and parental involvement and clear disapproval and consistency with follow through on breaking the rules. I would say that those are some of the things that are effective when teens are younger.

Brenda: 30:28

Yes, and that's probably counter to it a lot of, I know at least what I was doing, which was if I, in my mind, Well, if I talk about drugs, then they're going to want to do it, right? Or like I had this perception that if I talked about it with my son, with all my kids, then somehow that was going to make them really curious and they're going to want to do it. And what I've kind of realized now is. They were already curious. You needed somebody to speak up and say, this is not okay. This is what it does to your brain. Yes. It may be legal. I'm thinking weed in particular here, marijuana. Yes. It may be legal for adults. This is why it's not legal for kids because of what it does to the brain so that I like the idea of just having an ongoing conversation about it. What do you think about with older kids? Like maybe the 17 year old, I'm kind of a fan of like what you were saying about the upside downsides seem to be reasonable. And could we say to them, Hey, I get it. Like this is, you're getting a lot out of this. And I'm not getting anything out of this. So we're, we're in a battle about this and that makes sense that we're in a battle. Where do we go from there? Like what, how does that conversation play out?

Lara: 31:44

One thing that I think is useful is to think about that difference between maybe authoritative and authoritarian is More than just saying this is bad or you're not allowed is especially as kids get older is to share why you are worried about their substance use. What's the value that you have here that you want to communicate? And so for some people they may have a long family history of substance use problems and that that this would be an appropriate place to say because of this family history I really want something different for you, and that's why it's so important to me That you're not using substances right now, and one of the things that that I think is a valuable message is if you want your kids to be able to enjoy substance use as an adult, to be able to drink alcohol without having an alcohol problem, maybe enjoy cannabis use. Sometimes if you want that for them, then the best way for them to have that is not to use as a teenager.

Brenda: 32:44

Yeah.

Lara: 32:45

Because using as a teenager increases the risk so much that your substance use will be problematic for you. In your adult years, and so there's a lot, whatever, and maybe that what I just said doesn't appeal to you, but whatever it is, that is the value that you can say. Here's why I'm asking you to not do this thing that I know you enjoy. I know it's fun, and I know you're enjoying the connection with peers. Here's why I'm asking To make a different decision here, and I think communicating family values is part of that shift from having a young child in which you can say, here's my rule versus an older child who's becoming an adult who is making their own decisions and you have less control, but you do have a lot of influence. And I know that parents don't feel influential, but that doesn't mean that they are not actually influential.

Brenda: 33:37

Right. Yes, there is that misperception that we're sort of like, Oh, well, teenagers are never going to listen to us anyway. And that's really, I mean, I've seen the research that's really not true.

Lara: 33:49

It's really not true. And I think something else that This feels like maybe not as clear of a direction, but I think this, this is an important thing to consider about what we consider normal or not normal or what's typical. And one of the things that I've seen with parents of teens is that The parent can sometimes accidentally perceive their teenager's substance use as typical. And when we think something's normal or typical, we react differently than if we know that it's not. And so there's a couple reasons why people tend to mis evaluate whether substance use is typical in teenagers. One is because maybe you used too much. drugs and alcohol as a teenager, and so it seems normal to you. And so then you maybe underreact when it's your teenager doing it. Also, people tend to use substances like others in their social circle. And so we tend to take our own social circle and then extrapolate and think that that means it's typical for everybody. The truth is the majority of high school students did not use any drugs or alcohol in the last 30 days.

Brenda: 35:00

You always see the flip of that, right? You always see like 46 percent of teenagers did blah, blah, blah. And you're like, but wait a minute. That means that there's a majority that didn't.

Lara: 35:12

Yes. Yes, and so we can lose sight of that if we're only looking at, for example, if your teenager has started using drugs and alcohol, likely their friends do. They probably are not hanging out with kids who are not. And so then it's very easy to think, okay, so it's normal. Everybody I know is doing it. All of my, all of the kids that I know are doing it. And so just that perception, you will behave differently. If you think that's typical, so one thing that is a useful kind of intervention for parents is to just get accurate data. Yes, sometime over the course of teenage years, most teenagers will try some substances. That's not the same as saying all kids are using drugs and alcohol. For those of your listeners that are here locally, You can go on the website, Ask HYS, which is the Healthy Youth Survey data. That's done, I think, every other year. It's anonymous data collected from Washington State high schoolers. Anonymous self report of substance use is pretty accurate data, and you can look up your district, your county, your child's age, and you can get Up to date, accurate data to know is my teenager's behavior typical. It really does not going to vary that much state to state. And in fact, it may be even a little bit higher here in Washington if access is easier. I was just going to say that. So if they use our data, it's going to be pretty typical.

Brenda: 36:44

Yes, use Washington and use Colorado and if you're not in one of those two states, it'll probably be lower in your state.

Lara: 36:50

Yeah. And there's some good news too. Alcohol use is down with teenagers at least here locally. So I, I would encourage parents to look at that. especially if they are well, I would say though, that's probably not your audience. If they're underreacting, they're probably not listening to your podcast. They're probably more appropriately reacting. But I think that's something to consider. And then I wanted to go back to the other piece, which is the piece about what is treatment. And I think this is related to the question of treatment resistance for younger people. The majority of treatment options were designed for older adults. with severe substance use disorders. So, it's also not surprising that a younger teenager with a mild substance use disorder, or maybe a moderate substance use disorder, or maybe even substance use without a disorder, is not interested in participating in treatment that was not designed for them. And so, I do think we also have a lack of treatment options that that problem directly is related to treatment options. resistance. And there's a message which comes from the 12 step tradition that all people who have a substance use problem at some part time in their life are destined for jails, institutions, and death, Unless they find sobriety, and that message is probably way more accurate for older people with severe substance use disorders. It's actually not an accurate message for a younger teen with a developing substance use disorder. It's just not true. And so I also understand the resistance to needing to identify with a lifelong substance use disorder and commit to lifelong abstinence and to be squeezed into the shape of a child. The customer for something that was never really developed for them. And so I also just want to challenge this idea of what treatment is. And like we talked about earlier, that TV show intervention has made us all think that it's all one. One doorway into one type of help, and so for parents with younger teens, you know, but actually really any age teens family therapy, and I mean, specifically with a family therapist trained in systemic strategic approaches, family therapy can be at least as effective at send as sending a team to treatment. So if you can find. A family therapist who has specific training, so these things would be things like strategic family therapy, functional family therapy, multisystemic therapy, all of these are therapies in which the therapist is trained to see the family as an, as an interlocking system. in which everyone's behavior is influencing everybody else's behavior and is trained to help identify maladaptive, unuseful patterns and help the family to develop healthier patterns of interaction. That's what I mean by these systemic therapies. If you can find a family therapist trained in that, going to that therapist with your teenager is at least as good. As getting, sending them away for something or having them go do something alone with a therapist. So those, that's just one way that I want to think about challenging this idea of what treatment is and say, it doesn't have to look like what it looks like for somebody else or what it looks like for someone who's older.

Brenda: 40:35

Right. I, I, I totally agree that, that that label of, A, I had to go to drug treatment, and also now I'm going to have to identify as a sober person or a person in recovery. For the rest of my life, and maybe I'm a ripe old 16 and a half years old, that's a big pile of baggage to carry around with you, especially if you're just experimenting and maybe even dependent, maybe even like you said, a mild or moderate substance use disorder, catching it early. And I love the idea of starting at home, starting with. Home based interventions using craft and then working with a therapist locally, because as soon as you pull the family apart and, and I had to do this, right? So I'm not saying that this is the wrong approach. I had to send my son away. If you can do, if you can avoid that, because you're taking the family unit, which is broken, you're further pulling it apart. Then you got to treat everybody in their own little container and then try to. bring everything back together. So that's right. It is absolutely necessary. Sometimes I had to do that. However, I wish that I had known some of this about other options before going to that extreme.

Lara: 41:55

Yes. And I think a lot of people have to do that because the other options are hard to find. They're hidden. No one even knows what they are. I mean, probably the majority of your audience hasn't heard those phrases before. Those are evidence based therapy modalities that are out there and well tested. We know they work, but they're hard to find, hard to access. If there were just easy 1 800 numbers that you called and someone linked you right to it, just the same way that they'll do for rehab. I think, you know, I, I'm really an advocate for more choice, better matching, not to limit choices, not to say no one should use rehab, but we need to challenge the idea that that is The treatment that is what treatment is and to say there's lots of different things and for those who might be listening who have a teenager who's opioid dependent, medication for opioid use disorder, that's treatment that's more effective treatment for an opioid use disorder than any rehab that's available. So just to expand the idea of what treatment is and and I think that's one thing is to expand it in our mind and then the advocacy piece is that we need the community. Of treatment providers to expand the options available and to design treatment that's a better fit for teenagers.

Brenda: 43:17

Yes. A hundred percent. It is so true. I know that the parents of kids who struggle are expert researchers for the most part. They're really good at doing research. So I would say, you know, rewind to all of those modalities of treatment that Lara just talked about for family therapy and just start digging, like call every single person at your insurance company, in your faith community, in your friend community, like find. The people and know that they may not be right next door. You may have to do maybe a virtual option or whatever, but they're out there and you do have to dig for them. So thank you so much. This is so enlightening. A lot of new perspectives and. Insights that I think are going to be incredibly helpful for our parents. And we just appreciate your time. And if you are lucky enough to live in Washington state, uh, in the show notes, you're going to be able to find Laura and she'll, if she can't help you, she'll probably be able to find somebody who can, and I'll put the link to the research site that you mentioned about self reported use. And yes, I would say Washington's probably going to be higher than a lot of states.

Lara: 44:31

This has been really good to talk to you. And. I know it's, it is a very, very scary time for parents when the person that you love so much is, uh, you know, taking a lot of risks and, and sometimes making some bad decisions. I have teenagers too. And man, teenagers can really be dumb sometimes,

Brenda: 44:54

and it's just the nature

Lara: 44:55

of being an adolescent. They're not risk averse enough. And it's a scary time. And we love our kids so fiercely. And. And so I, I really, I really get what a scary time that is when, when things look like they're taking a wrong turn.

Brenda: 45:09

Yeah. I appreciate that. There's nothing like from the heart of another teen parent. So thank you for, for relating and for giving us some really good things to think about. And we'll put all the links in the show notes and thank you so much. Yeah. Thank you. Okay. My friend, that's a wrap for today. Don't forget to download the new ebook, Worried Sick. It's totally free and will shed so much light on positive tools and strategies you can use right now to start creating conditions for change in your home and in your relationships. It's at hopestreamcommunity. org forward slash worried. And as always, you can find any resources mentioned during today's show at brendazine. com forward slash podcast. That is where every episode is listed and you can search by keywords, episode number or the guest name. Plus we've created playlists for you. Which make it easier to find episodes grouped by topic. And those are at brendazine. com forward slash playlists. Please be extraordinarily good to yourself today. Take a deep breath. You have got this. You are not doing it alone. And I will meet you right back here next week.