Psychiatrist and author Joseph Lee, MD, medical director of the Hazelden Betty Ford Foundation's Youth Continuum, joins host William C. Moyers to discuss what puts young people at risk for substance use and what parents can do to minimize the probability of addiction. By modeling certain values in the home, parents can create a culture that encourages children to develop the communication, relationship and resiliency skills they need to make healthy choices in adolescence and beyond. Read the podcast transcript below, listen and subscribe on iTunes, Google Play or watch on YouTube. 0:00:16 William Moyers Hello and welcome to Let's Talk, a series of podcasts produced by the Hazelden Betty Ford Foundation on the issues related to addiction, treatment and recovery. I'm your host William Moyers, I'm the Vice President of Public Affairs and Community Relations for the organization. My esteemed guest today is none other than Dr. Joe Lee. Dr. Joe Lee is the medical director of our youth services at Hazelden Betty Ford. His resume is too extensive for me to get into today and besides I don't wanna waste a few extra minutes when we can hear directly from you on what our topic of today is which is youth and risk trajectory. What does that mean, Joe? 0:01:09 Dr. Joe Lee Well, what that means is that we talk about addiction being a chronic health condition. And most chronic health conditions have risk factors. Before the disease comes on, before the symptoms manifest, there are risk factors. So there are risk factors for diabetes, there are risk factors for heart disease, and believe it or not there are risk factors for substance use disorders. 0:01:30 William Moyers Such as? 0:01:31 Dr. Joe Lee There are a lot of them. It's an extensive conversation just on the risk factors themselves. But believe it or not, you can identify some of the highest risk kids who might develop substance use disorders later on in grade school. Years before they actually touch any kind of substance. So when I talk about risk and trajectory, what I'm telling America is let's not wait until they cross a tripwire and start using substances to filter out whether they're really addicted or not. Or whether they have mild, medium or severe substance use disorder. Let's put our focus on prevention. And identifying these high-risk populations early on so that some of them we can head off at the pass and get them help before they start using substances. 0:02:09 William Moyers So, we always talk about the genetic predisposition as being a marker or a red flag. Certainly that's one, right? 0:02:18 Dr. Joe Lee Yes, genetic predisposition, a family history is definitely a big risk factor. It's not the only risk factor but it's a big one. A lot of families feel guilty when their loved ones or their young children become addicted through adolescence. And they kick themselves. And they wonder about their parenting strategies and whether they've done the right thing or not. And I often remind them that sometimes a genetic gradient is so strong that despite all their good parenting they're gonna manifest that risk. That said, there are other risk factors that parents can modify. You know certain kind of behavioral tip-offs, environmental stressors, certain kind of adversities and trauma, communication and bonding and relationships between family members—these are things that are malleable and can be adjusted to reduce some of that genetic risk. 0:03:09 William Moyers Every time you and I get together we talk about this and I marvel when I hear your presentation about the role that social media is playing in the conversation. Is social media putting our young people at more risk for addiction? 0:03:26 Dr. Joe Lee I think so. Before I get there, I got caught up in the marvel because I keep wanting my wife to hear these segments and then she will also marvel that people actually do say good things about me. [both laugh] And I'm not just mistake-prone like I am in the household, so that's where I got stuck on. But yes, with the social media thing, it—it well the social media and electronics and technology, if you bundle them together, definitely a reward. I think it's maybe a bit of a stretch to just use the term addictive all the way around. I think that that's a bit of hipsterism there. But it's definitely rewarding, it can definitely become compulsive. And I think the pockets of young people who are prone to addiction are also prone to getting sucked into dating apps, Instagram, lots of other social media, Snapchat. They—they seem to get some of them more sucked into it than maybe some of their other peers. And it's because of that reward. How many times have I—they liked something or what kinda conversations can they get in? They really seem to enjoy it and sometimes that can be a problem. 0:04:25 William Moyers What do you see as it relates to well you've been at Hazelden now I can't remember when you joined our organization? 0:04:31 Dr. Joe Lee No, I'm just kidding, 2008. 0:04:34 William Moyers You weren't even hardly born then. 2008. So you've been here for ten years now. In your position as a doctor, seeing patients every day, being out and—and lecturing and representing our organization, what has been the biggest change you've seen in adolescence as it relates to substances in the last ten years? 0:04:54 Dr. Joe Lee Boy, you've seen the opioid epidemic. You know. As a country we started caring about the opioid epidemic when white kids in suburbs starting to die. And that was a big thing. And you know as an organization we've always cared about heroin and opioids. We've always advocated for people who were—had addiction. And—and I think as a country though it was a wake-up call. The prescription drug crisis brought that fire to the suburbs. And because of stigma, people thought of addiction as something that happens in dark, danky parts of town. And—and not their children. So, there was a gestalt shift with the American public and people. And now you see that a lot of people in suburbs they're concerned about substance use disorders just as much they are about affordable housing or other things. They—they worry about addiction in their neighbors and their backyards. And that gestalt shift has given our discipline an opportunity to again advocate and much in like a civil rights kind of way for people who are underserved and marginalized consistently. So I think that's been one big change. 0:05:54 Dr. Joe Lee [continued] But the other one is the—is the thing that you elude to about technology. And social media. Young people are inherently fatalistic. What that means is they tend to be inherently and developmentally a bit more shortsighted than adults. If their significant other breaks up with them, my girlfriend broke up with me, I'll never fall in love again, and if you're a parent you hear this kinda dialogue and you—you kind of laugh at it but you also wanna support them 'cause we've been there before. Young people tend to be shortsighted and fatalistic. There's something about Facebook, social media, Snapchat, Instagram, that tends to accelerate that fatalism. It gives people the idea that other people really are living these highlight lives and that they're missing out. It makes arguments all the more painful. It makes mistakes in their life permanently etched in the social stratosphere online and it's indelible. And in that kind of environment, kids who are at risk who are already thinking a little more fatalistically than other kids 'cause they're prone to addiction so they're even more short-sighted, they're even more prone to instant gratification, they get onto social media and they get burned a lot. And—and they're exposed to cyber bullying or sometimes they engage in cyber bullying, they engage in all kinds of mistakes that—that create all kinds of ramifications in their life. And that social media piece, all the way from dating apps down to just social chat networks, I think are—are—they're things that we haven't learned the ground rules for, yet. The—the ethics, how it affects our psychology, how it affects our relationships, how it ironically brings us closer together but actually further apart than ever before. These are things that I think as a civilization we're just coming to understand. And—and so that change is still going on. 0:07:36 Dr. Joe Lee [continued] And then finally I'd say there's a societal change. You know you've seen now a third or 30 percent to a third of college graduates are coming back in to live with their parents after college and the rest of the world has been like that for a while because you know you have old civilizations, housing's expensive, they don't have a lot of land and so you have a multi-generational thing but we've had this Norman Rockwell Libertarian 18 years old go get your own plot of land and chickens idea for a while. We've been running with that for a while. And that's now on its head. Out of the recession you see a lot of young people who are technically adults and above 18 but need their parents at the least in a transactional view financially, to help them get started. And that creates a gap where when addiction's not treated, it becomes incredibly dangerous. And I say that because that hazard ratio of when people develop addiction and this kind of modified adulthood where you're dependent on your parents for longer, they all overlap between the ages of 18 to 25. So 18 to 25's when people get addicted, and 18 to 25 is when people are adults but don't have the resources are in that limbo. And that's something that's really changed in our culture. 0:08:47 William Moyers So what are parents to do in this day and age? I mean I know you're a father of two very young children and I'm the father of three adult children and I—I'm from a different generation. I've had to experience children who've struggled with substances even though I set a good example for them. What are parents to do these days? 0:09:07 Dr. Joe Lee Well you know, it—it gets scarier and I'll get to the solution. And I just talked and did a grand rounds in like synthetic marijuana and now kids are buying things online and that's a reality. It used to not be, but with crypto currency like Bitcoin, kids are buying all kinds of substances online. So it's even scarier than people imagine. You can't even keep up with the kinds of chemicals that are out there. So I see a lot of parents coming to me for answers. And what I tell them is don't worry so much about knowing every latest drug. Be informed if you can but there's no way you can keep up. You know? We have the privilege of keeping up 'cause we see kids from around the country. We know what the price of heroin is in Alaska and as in you know in some tropical part states that we have. We—we see price differences and cultures evolve so we see it coming on. We can't expect that from parents. But what we can expect parents to do is to model values in their home. And to develop a culture that fosters the kind of communication, relationships and resiliency skills necessary for young people. That still may not outweigh external risk factors like trauma or genetic loading for addiction. But that—those are the cards that parents have to play. And the science tells us that. So if you look at prevention science, early prevention in grade school kids has nothing to do with drugs. You're not talking to first graders about drugs or cocaine. You can't talk to 'em about that stuff. What you teach them in those preventive classes is you teach them how to cope, how to communicate, how to be empathic. You teach them how to get along with other people. How to be resilient. How to be good citizens. And those skills, believe it or not, later on, reduce recidivism of all kinds, you know. Better school grades, less behavioral disruptions, less substance use, even for our high-risk populations. The beauty of that take-away for parents is instead of getting lost in the drugs or no drugs dialogue, or should this chemical be legal or not and how is it gonna affect my family, if you have young kids especially the way you wanna start is in your family culture. You want to model those values and instill a culture that reflects those values. 0:11:05 Dr. Joe Lee [continued] And I had a conversation with my six-year-old in the car, driving him to school. Because one of his friends is leaving school at the end of this year. And he was hesitant about maybe doing a goodbye card for his friend. And it was our first conversation really about empathy. I actually used the word 'cause now he's old enough to understand what it is. And I said Gabriel, if you were the one leaving school at the end of the year, what would you like your friends to do? 0:11:32 William Moyers You've often emphasized the role that empathy plays. It's powerful to hear you share it in the context of your own experience with your oldest son. Are we not an empathetic society? 0:11:45 Dr. Joe Lee I think as people we are capable of empathy. But we are also as biological creatures prone to heuristic thinking. We're prone to heur—you know simple calculations that don't waste energy and that's stereotyping. So we tend to empathize and identify better with people who are more like us. And so we can be compassionate in a social justice realm for people who are suffering, but that's not exactly the same as empathy. I think social justice and compassion are incredibly important, so needed in our society. But that's been confused for empathy. Because it—empathy isn't just about helping people in need. Empathy's about can you walk in the shoes of somebody that you have opposing views with? When you're angry at them, can you pause and imagine what it might like be on the other side? Can you kind of as that Hamlet quote goes I'm gonna butcher that 'there's more in the stars and skies than in our dreams.' You know. And—and that people come from different walks. And to not judge prematurely. I just reviewed a book on empathy done by a Dr. Reiss I think I'm pronouncing her name right at Harvard. And she—she has this clinic on empathy and one of the things that I could add to that in my own experience is that as a prerequisite to empathy, one of the reasons I think that empathy isn't penetrating our culture well, because boy we talk about it a lot. We talk about it as a feel-good word. We see it all the self-help books. But one of the reasons I think it's not penetrating into our culture is we've kind of missed that it can't come on its own. And so, a lot of the kids I work with we're actually working on humility and we're working on having them accept grace. And when you have grace and humility, empathy is possible. When you don't have grace and humility, empathy is hard. And I explain it like this. If you don't think you're the same as other people. If I don't imagine and in my faith that I'm as broken as every other individual on Earth, how can I possibly walk in their shoes? If we are inherently different and I believe that? Right, in AA we call it terminal uniqueness, right? 0:13:49 Dr. Joe Lee [continued] And—and grace. Once you walk in enough people's lives, you understand we're all fallible. And that we all need unmerited forgiveness. And second chances. And third chances. And fifteenth chances. Because that is human nature. And—and accepting that grace allows us to pass that gift onto other people. So, empathy sometimes isn't where we start. Empathy is the gift we get for a lot of things that we do in life because we approach it through a certain sense of humility and grace. As a society we talk a lot about empathy. We seem to almost never talk about humility. Or grace. Unless some athlete wins a football game or something and then they talk about you know what I mean? How humble they are. But outside of those award proceedings, people aren't using that lexicon. People aren't using those words. And I think in some ways those words are the foundation. For empathy. 0:14:41 William Moyers We have to wrap it here—up in just a couple of moments but I wanna just return to your work down in the trenches working with young women and young men, adolescents, at our facility in suburban Minneapolis. Young people do recover don't they? 0:15:01 Dr. Joe Lee Yes, they do. 0:15:02 William Moyers How do you help them to recover? 0:15:05 Dr. Joe Lee I don't know. I think I—we just help them see their own truth. We—we emphasize their autonomy because at the end of their lives, it's their life. And it's their choice. And they have to choose to accept the burden of a chronic illness like addiction. And and a lot of what we do now and we've advanced a lot of things we've done compared to in the past, is we use evidence-based strategies like motivational interviewing. But we've never forsaken the value-driven spiritual component of recovery. And—and what that allows people to do is we believe in people. We are humanistic. We believe that they are good kids inside. And we speak to that person. And we have them lay their cards on the table and say is this what you see? And when they have the courage and the humility to do that, when they stop complaining or defending about their lives and accept the grace that their loved ones have given them, and embrace that love, then their perspective is different. And that's the transformation that we see in recovery. And so, there's a lot of hope. I—I a lot of people come to me and they're like oh you work in a field and that must be really hard. Well, there are hard parts of it. But last week I must have had four or five people reach out to me. And it's a typical week. Saying thank you, telling me how they're doing, sending me cookies. You know just all kinds of things that just show me that—that not only are people grateful but it's happening everywhere. That people can recover, they can start young, they don't have to be invincible or delusional. But you have to treat them with empathy, you have to model that empathy and grace and humility for them, and you have to waken that capacity within them for change. And I think we're starting to do that. 0:16:46 William Moyers Dr. Joe Lee, not just an expert on adolescents treatment and recovery from addiction, but also a healer. Thank you very much for taking the time to be with us today. And thank you all for tuning in, however you did it, to another edition of Let's Talk, a podcast produced by our executive producer Lisa Stangl and the great crew. On behalf of the Hazelden Betty Ford Foundation, I'm William Moyers. Make sure you tune in again for another episode of hope, help and healing. Thank you.