Even before the stress and isolation of pandemic life, troubling mental health trends started to surface among America’s young people. Of all age sectors, emerging adults (ages 15-23) are experiencing the biggest upsurge in symptoms of depression and anxiety. What’s going on? How can parents best help? Listen in as host William C. Moyers talks with psychologist Tim Portinga, PsyD, about the influence of peers, technology, school and substance use—and the importance of face-to-face family time. Read the podcast transcript below or listen and subscribe on iTunes, Google Play or watch on YouTube. 0:00:13 William Moyers Hello! And welcome to another interview in our series of Let's Talk podcasts. From substance use prevention to quality research, treatment of addiction and recovery from it, these award-winning podcasts focus on the issues of importance to Hazelden Betty Ford, issues that we know matter to you, too. I'm your host, William C. Moyers, and yes, it looks a little different around here today. As we all know, a lot has changed in the world since our last round of podcast interviews back in the winter of 2020. Hazelden Betty Ford takes seriously the need to do everything possible to prevent the spread of coronavirus among our patients and our employees. Even here in the studio we are following public health guidelines. As a result, I can take off my mask because the production crew, the Executive Producer, and yes, even my guest are elsewhere in the building. Today we are joined by Dr. Tim Portinga, the Manager of Mental Health Services at Hazelden Betty Ford's youth center in suburban Minneapolis. Tim has been with our organization since 1999 and he brings vast experience to our topic, Mental Health Issues and Emerging Adults. Dr. Portinga, thank you for joining us today. 0:01:28 Dr. Tim Portinga Thanks for having me, this is fun! 0:01:30 William Moyers And you've been around a long time—tell me where does your interest come in terms of emerging adults and mental health issues? 0:01:37 Dr. Tim Portinga Yeah thanks for asking. So, there's an old joke out there in Psychology-land and that is that if you find a therapist if you scratch him, underneath you'll find a client. [Moyers laughs] And it's absolutely true in my case. The adolescent early adulthood years were characterized by an awful lot of up and down. And I have a soft spot in my heart—I hope that doesn't sound too trite—but a strong empathy for young men and women that are going through those developmental issues. And, truth is the truth, I really enjoy being able to see kids make quick turns-around. That's one of the fun things about working with young people. [Moyers nods, smiles.] Is when their motivation is intact and they're really interested in making a change you can really get a hold of 'em and you can do some excellent work. 0:02:28 William Moyers Well thanks Tim for your authenticity there and thanks for the good work that you're doing. 'Cause you are making a difference. Emerging adults, what does that mean? 0:02:37 Dr. Tim Portinga It's a newer term out there in Psychology-land, but essentially it's trying to put together the term adolescent and young adult. So technically, we're talking about roughly the 15 to 23, 24 range. Maybe more accurate to talk about adolescents and young adults but frankly they have more in common than they have differences. So I think it's a good way of describing those folks. 0:03:02 William Moyers Would you say Dr. Portinga that emerging adults today are experiencing increased mental health concerns compared to earlier generations? 0:03:11 Dr. Tim Portinga Yeah and it's difficult to describe to folks. I think just about everybody thinks about their own experiences, that's kind of the lens that they use when they think about mental health concerns. But research in the last actually the last couple years have been really strong indicators. APA, American Psychological Association, recently did a ten-year review survey looking at all ages across the spectrum and in terms of increase or decrease in mental health kinds of symptoms. And interestingly, the 15-23-year range had the highest increase in mental health concerns of any of the groups. And mostly around depressive and anxiety-based symptoms. Which of course is dramatic because that means also there was increased symptomology around suicidality. [Moyers nods.] But kids are really stressed. It's a real thing. 0:04:04 William Moyers And they were stressed even before these times. And by these times, here we are in the summer of 2020, we've had this pandemic now for several months that's turned the world upside down. And even in recent weeks, we've had the civic stresses of what's been happening in America. Would you say that those are going to probably lead to heightened awareness among emerging adults around those stresses, and actually will they be feeling those stresses due to what's been happening? 0:04:30 Dr. Tim Portinga Yeah and the research is still coming in of course but absolutely by seat of the pants experience [Moyers nods] we know that this is gonna be a very significant stressor for young adults. You know, this is a prime time for development. One of the biggest things that young adults use for their developmental experiences are their experiences with peers. Right now they're isolated! They're not having a chance to have those normal types of experiences. They can't compare and contrast where they are as easily as they used to be. It's such an important thing that not only the loss of peers in that positive sense, but just the isolation. 0:05:09 William Moyers Yeah. 0:05:09 Dr. Tim Portinga Very difficult thing for young people to endure. 0:05:13 William Moyers And then of course technology, we as parents we were concerned about technology taking over for peers of filling that void before we all had to go virtual! 0:05:23 Dr. Tim Portinga Yeah. [chuckles] Yeah. And technology has its own pluses and minuses also. There's an awful lot of research out there that ties social media work to increased levels of anxiety and depression. And you know if you can just bare with me for a minute— 0:05:38 William Moyers Please. [nods] 0:05:38 Dr. Tim Portinga —If you can imagine yourself as an adolescent sitting in your dark bedroom 11, 12 o'clock, 1 in the morning, scrolling through Facebook or other sorts of social media pages, what you're seeing is your friends having their best times ever. They're on vacations, they're having wonderful experiences, they're with their pals, they're partying, whatever that situation might be. And the strong temptation of course is to compare it to your own experience. And here you are sitting by yourself in this dark little room, right? [Moyers nods.] Bored. So, whenever we compare ourselves to other people, we almost always misinterpret how those situations compare up. And we usually feel slighted and that's an experience that an awful lot of kids are having right now. 0:06:22 William Moyers So let's talk just a little bit—we could talk forever on what you just mentioned, but how important are peers to emerging adults? 0:06:32 Dr. Tim Portinga That's the—I date myself a little bit here—that's the 74,000 dollar question right there. So, one of the things that parents will often struggle with is the fact that as kids go through this developmental process, at some point peers become almost more important than they do. Their allegiance to their peers, the way they take their peers' interactions, the feedback from the peers, becomes one of the biggest factors. Often that's a hard thing for parents to let go of or to accept. 0:07:03 William Moyers That's very very interesting. What should parents be watching for in their teenagers or their emerging adults, young adults? 0:07:13 Dr. Tim Portinga So one of the first things that will usually happen if young people are starting to struggle with mental health symptoms is if they'll start to isolate. They'll spend less time with family members, less time in school-related kinds of activities, extracurricular kinds of activities. Of course there's just the simple symptom but kids will start to look sad. They'll have less fun, they'll be less engaged with formerly pleasurable activities, they'll start to let go of things that they used to enjoy. And then you sometimes will get some irritability mixed into the fray. Sometimes that seems kind of paradoxical but often anxious or depressed young folks with start to express that in increased irritability, anger, frustration. Much lower tolerance for day-to-day kinds of problems. Which again, classic in relationships, right? 0:08:09 William Moyers Mmm-hmm. Mmm-hmm. 0:08:09 Dr. Tim Portinga Because in relationships there are always ups and downs. 0:08:14 William Moyers And then of course we have substance use. 0:08:16 Dr. Tim Portinga Yes. 0:08:16 William Moyers And that's always known to be a red flag. How does substance use figure into the mental health condition of an emerging adult? 0:08:26 Dr. Tim Portinga That's been one of the big things that Hazelden Betty Ford has really focused on. Over the last ten, fifteen years, and that's really been captivating for me as a professional in the field. We always—you had the big "silo" thing going on. We had this idea that if people would just get sober, their mental health issues would go away. Or coming from the other side of the fence, if people just were to deal with their depression and anxiety symptoms, they wouldn't need to medicate their emotions anymore, they wouldn't use so much. Or maybe their substances use issues would go away. But the truth is, it's never been either/or. It's always been both/and. And best practice for treating young people particularly is to address the depressed and anxiety symptoms. Those are kind of the predominant types of concerns that we have. Right alongside the substance use disorders. And typically what we see in a treatment setting is that from day to day, the issues can change. Some days it's about relationships, maybe it's a phone call from a peer back home. Some days it's gonna be about anxiety, about what's gonna happen to me after I get out of treatment. And that anxiety can be overwhelming and it can cause them to thing about using. And they start heading for the door, they wanna get out of treatment, right? To deal with this anxiety stuff. Often times it's thinking about using. Which tends to make them nervous. So you have to deal with both. Simultaneously as much as you can. 0:09:48 William Moyers Are teenagers using more substances today—today being the summer of 2020—than they were when you started in this field back in '99 at Hazelden Betty Ford? 0:09:58 Dr. Tim Portinga From a big standpoint the answer is sort of a qualified no. Substances in terms of the sheer number of people that are using substances have stayed relatively constant. Some changes percentage points up and down over the national spectrum over the last years. But what they are using has changed dramatically. [Moyers nods.] Just to go from my own experience, when I started in the field, the majority of my patients were abusing cannabis and alcohol and they were playing with other drugs from time to time as opportunities would provide—with the younger crowd. 0:10:34 William Moyers Mmm-hmm. [nods] 0:10:37 Dr. Tim Portinga I had—I saw the figures just the other day. I had about four percent of my patients in the early 2000's that would identify opiates, some form of opiates, as their primary issue. It was rare. 0:10:49 William Moyers Mmm. [shakes head] 0:10:50 Dr. Tim Portinga Now, I saw just a couple—a year ago now—it was at 37 percent. 37 percent of my patients identify opiates as their primary drug of choice. That's a dramatic difference. Not only in what they're using, but the lethality, the long-term consequences, the destruction that happens around them. It's a much more significant problem. 0:11:15 William Moyers And what about the legalization of marijuana across the country? What sort of message is that sending to emerging adults and what is the result of what they're seeing and hearing? 0:11:25 Dr. Tim Portinga Sure. So, the more cannabis is available, the more people will use cannabis. Research is showing that in very strong ways. And, the more it's available, the more it's legalized, the younger the people will be when they start using substances. So one of the trends that we've seen across the country is that as more states have legalized substances, we start to see the age of first use decrease. Now this is a significant problem because again, based on research stuff we know that the younger somebody starts to have problems with substance use, the much more likely they are to have problems long-term. The chronicity levels are much higher, the levels of long-term dependence are much higher. So, long-term, it's a political football of course— 0:12:19 William Moyers Mmm-hmm. 0:12:19 Dr. Tim Portinga —And it really bothers me because it should be a science problem. It should be a research and academic-based issue. But it has become a political football. 0:12:31 William Moyers Mmm-hmm. 0:12:32 Dr. Tim Portinga And that's unfortunate. It really is. 0:12:34 William Moyers We only have a couple of minutes, Dr. Portinga, I wanna bring it around to a message that helps our listeners and our viewers to have some hope and to know what to do next. I mean, we've got this pandemic, we've got the viral nature if you will of what's happening in the streets across the country. We've got students who are in school but not in school. We've got technology becoming even more ubiquitous if that's even possible. [Dr. Portinga nods.] The stress of the country is higher than it's probably been in a long, long time. What is a parent or a grandparent to do if they are worried about their emerging adult or their teenager? 0:13:25 Dr. Tim Portinga I think the starting point always has to be communication. The communication, empathy, compassion piece. I think parents need to understand that it's not only difficult for them, but it's doubly difficult for their young folks. And they have to be super careful about listening. In empathetic, compassionate kinds of ways and gathering information. I think the communication piece is something that we talk about so often. In so many different fields. But particularly in mental health. I think it's one of the most underutilized skills and it's a skill that's readily used. 0:14:02 William Moyers Mmm-hmm. [nods] 0:14:03 Dr. Tim Portinga And it's something that I always wanna emphasize with family systems. 0:14:08 William Moyers And in those family systems the communication that you're talking about is around the table or in the—on the boat or in the living room. It's not communication by text or by voicemail, it's face to face. 0:14:20 Dr. Tim Portinga Absolutely. So, and one of the things that's the hardest for me in the virtual world is trying to get those second and third and fourth level impression that you get from being face to face with someone. 0:14:29 William Moyers Mmm-hmm. [nods] 0:14:32 Dr. Tim Portinga I'm a professional, I've had some experience with this, I hopefully can do it a little bit better than other folks. But I would emphasize with family systems that it's completely important to have that face time. That that closeness that proximity is just irreplaceable in a family system. 0:14:49 William Moyers Well thank you Dr. Tim Portinga, the Manager of our Mental Health Services at our youth facility in Plymouth. Thank you for bringing not only your expertise but your articulateness to it and the passion for what you do. We really appreciate it. 0:15:03 Dr. Tim Portinga [smiles] Yeah you're welcome. 0:15:04 William Moyers [turns to camera] And thanks to all of you for joining us! Be sure to tune in again for another edition of our regular podcasts, Let's Talk. On behalf of our Executive Producer, Lisa Stangl, and our podcast team from Blue Moon Productions in the Twin Cities, we want to remind you to stay safe and stay healthy in these times and all the time.