Where have you been? What were you doing? Who were you with? Even though these questions come from a place of love and concern, parents who suspect their teen is drinking or using drugs could actually push their child further away with this approach. Listen in as host William C. Moyers talks with psychologist Tim Portinga, PsyD, about adolescence, substance use and family issues. The good news? Addiction treatment works for young people and, with time and effort, families can rebuild trust. Read the podcast transcript below or listen and subscribe on iTunes, Google Play or watch on YouTube. 0:00:14 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 matter to you, too. I'm your host, William C. Moyers, and yes, it does look a little bit different in here today. If you're a fan of these podcasts, then you'll note that this time around we've had to do things a little bit differently. 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 for this interview because the production crew, the Executive Producer, and yes, even my guest, are elsewhere in the building. Today we are joined by Doctor Tim Portinga, Manager of Mental Health Services at Hazelden Betty Ford's Youth Center in suburban Minneapolis. Tim has been with our organization since 1999. Today we take up a very challenging topic: teenagers, substance use, and family issues. Tim, this sounds like a recipe for stress and anxiety. 0:01:37 Dr. Tim Portinga [laughs] Yes, absolutely so. I think one of the hardest things that families ever go through is the experience of watching a son or daughter start to have problems with substance use. So many parents feel just a lack of power and understanding. Their reactions are often not useful, to be blunt. 0:01:59 William Moyers What do you mean by not useful? 0:02:01 Dr. Tim Portinga So usually when kids start to have problems with substance use, parents start to understand that something's wrong. And usually it's subtle. They'll start to see the kids are deteriorating in their grades, in their school, their work, their relationships are starting to come apart. They'll notice that their kid doesn't always tell the truth. And—frankly this is one of the biggest signs that parents see first of all—is that one plus one doesn't always equal two anymore. And parents start to understand one plus one is sometimes three of four. Their radar's going off but they can't understand what's happening. The nature of substance use of course is to keep it secret. 0:02:44 William Moyers Mmm. 0:02:45 Dr. Tim Portinga Particularly with younger adults. Because of all the reasons that are obvious around disciplinary issues and all that. Usually, parents will respond by getting critical. 'Where were you, what were you doing, where'd that money go, what happened to the car?' And those kinds of questions will tend to drive their son or daughter even further away. Essentially one of the biggest things that come when kids start having problems with substance use first of all is a lack of trust. Families will still love each other of course, but the trust starts to become problematic. And once trust starts to break down, you inevitably see much more conflict within the family in terms of communication styles, relationships. It's a natural thing when you don't understand what's going on with somebody to start asking questions, to start knocking on that door to try to figure out what's going on. But often that serves to push the young person away. 0:03:46 William Moyers So Dr. Portinga, what should a parent do? I mean as you said it's only a natural reaction. There's probably some fear and anxiety in there on the part of the parent. They want their child not to go down that road, they want their child to be healthy. What do you tell a parent? 0:04:01 Dr. Tim Portinga [smiles] Yes. So you start with communication stuff. Often, people are communicating like I was saying in critical kinds of ways. 'You did this, you did that, where is this,' declarative, accusatory types of statements. You wanna morph over to statements that take responsibility for their own emotions. And are direct and accurate about the questions. When I see that you're home late, I feel nervous. [Moyers nods.] Asking questions that are more about their own individual issues. And trying to make sure that empathy and compassion bond stays intact. Instead of pushing them away. 0:04:41 William Moyers It's not easy. 0:04:43 Dr. Tim Portinga No, it's not. And one of the biggest pieces that goes along with that of course too is an understanding of how the person themselves are affected. One of the things that we know with people that live with folks that are having substance abuse issues is that they doubt—start to doubt themselves. They wonder about their own ability to parent. They start to isolate themselves. These are not the types of issues that parents want to talk to their other family members about. [Moyers nods.] It's certainly not what you talk to your neighbor about. You know, how they found a bunch of empty bottles in the backseat of their car for instance. So, typically what parents will do is start to isolate, they'll start to lose communication with family members and co-workers and they start to have their own issues. They feel sad, worried, scared. The other side of that often is anger. 0:05:32 William Moyers Mmm-hmm. 0:05:32 Dr. Tim Portinga When people get sad and worried, they tend to become aggressive as well. Further compounds the problem. So it's really important for parents to understand that they need to take care of themselves as well. They have to focus on the things that keep them healthy. 0:05:45 William Moyers Yeah. And we know that substances affect all the organs of a young person's body but the irony of it is the one that it has a profound effect on is the organ in the body that tends to develop last. Correct? 0:06:00 Dr. Tim Portinga [smiles] Yes. 0:06:00 William Moyers Can you talk more about the developmental pathway that is affected by substance use? 0:06:07 Dr. Tim Portinga Yeah, this is one of the most interesting pieces of it I think. Adolescence, young adulthood, is an absolutely fascinating stage in life because what we know about brains at that point is that they are probably at their peak of their ability to do abstract reasoning, straight-up memory work, learn new skills, take a crazy situation make sense of it and move forward. They can do trigonometry and calculus for God's sakes, right? [smiles, Moyers nods] I'm lost there now. 0:06:37 William Moyers Yeah. [laughs] 0:06:37 Dr. Tim Portinga Yeah. And, interestingly enough, the last part of their brain to develop is this prefrontal cortex [points to forehead] here right behind their forehead. And that's the part of the brain that's in charge of executive functioning, long-term decision-making, to some degree sort of ethical and values types of judgements. That's unfortunately the last part of our brain to develop. So, a big part of that is also delay of gratification. How do I make myself do my homework on Wednesday for a good grade at the end of the week? 0:07:11 William Moyers Mmm-hmm. 0:07:12 Dr. Tim Portinga So, we have this interesting situation for young men and young women are incredibly smart from a pure horsepower point of view. But have a really hard time thinking long-term in terms of what kind of effects they're gonna have from a behavior right now. Behavior in the moment is really hard for them to translate into a future reality. Developmentally we have a couple different things. [points to forehead] This part of our brain develops through ongoing organic response. You know, we used to think that that part of the brain was done 18, 19 years old. It's probably more like late twenties or 30 before that part of the brain is completely wired. But the other thing that we know is a lot of substance use tends to slow down the development of that part of the brain. Increasingly, we're aware that cannabis is one of the substances that tends to slow down the neural development of our prefrontal cortex. There are actual changes in the complexity and sophistication of the neural network in that part of the brain due to significant substance use. The evidence is good around neuroplasticity—that part of the brain can start to repair itself over time. But there are significant deficits from long-term and serious cannabis use at that point. 0:08:24 William Moyers So then we get to the point where the young person has substance use disorder and needs treatment. Our facility in suburban Minneapolis in Plymouth has been there for a long time. What do you see in terms of the demographics of substance use among the patients that we treat? 0:08:45 Dr. Tim Portinga So I think again given my own personal history, we used to get an awful lot of young men and women that were using primarily alcohol and cannabis. They would experiment with other substances sort of as a drug of opportunity. But in some ways they were similar to older adults. They would have a primary drug of choice, usually cannabis or alcohol. Now, what we see is more significant polysubstance use. It's rare that I have a patient now that just uses one substance and dabbles with something else. I often have kids that are using four or five substances. [Moyers nods.] That all qualify. For substance use disorder type of diagnosis. And the particularly scary thing has been the increase in opiate use. 0:09:37 Dr. Tim Portinga [continued] Fifteen years ago, last time I saw the numbers, I was looking at between four or five percent, six percent, of my kids—my patients—that were using opiates as their primary drug. Last time I saw the numbers a little over a year ago now is 37 percent. And this is so incredibly dangerous and I think our country is aware of the risks with this now. And it really heightens our need for accurate and significant care very quickly for these young men and women. 0:10:10 William Moyers Accurate and significant care for young men and women and of course, lots of young men and women do receive treatment— 0:10:17 Dr. Tim Portinga Yes. 0:10:17 William Moyers Does treatment work for young people? 0:10:19 Dr. Tim Portinga Yes. [chuckles] That's a good question. Yes! Treatment absolutely works. There's been a fair amount of long-term outcome research around young men and women going through treatment centers. It's very difficult to do. I'm gotta put a huge asterisk in there. But, you know looking for correlations in terms of what works or not, interestingly and I think this'll be one that you like, William—one of the most significant correlations for being sober one year, two years out the road, is how many meetings they're going to over the course of a week. [Both chuckle] 0:10:53 William Moyers Of course! Right? 0:10:55 Dr. Tim Portinga So the number is 3.75. 0:10:58 William Moyers Wow. 0:10:59 Dr. Tim Portinga The average person that's sober a year, two years down the road coming out of even an adolescent treatment center is 3.75 meetings per week. I've always loved that number for that reason— 0:11:07 William Moyers Yes. [smiles, nods] 0:11:08 Dr. Tim Portinga —There it is. [laughs] 0:11:09 William Moyers [chuckles] The .75 piece is interesting. So, Dr. Portinga, then the young people do get treatment, they do recover 0:11:16 Dr. Tim Portinga Yep. 0:11:17 William Moyers They've gotta go back into that family dynamic that was very different than what they were in when they—before they found recovery. 0:11:25 Dr. Tim Portinga Yes. 0:11:26 William Moyers Talk just a little bit with the few minutes that we have—how does a family reintegrate a teenager or young adult into the family after they've found recovery? 0:11:36 Dr. Tim Portinga It takes a very clear-headed, functional approach early on. Empathetic, compassion, tremendous amount of love. Usually that will be intact in the family system. But what we will know is that the trust is just plain not there. So we need to be very open and honest about the fact that the trust is broken down in the family system. Simple but not easy. Trust is always built by doing what you say you're gonna do, telling the truth, and the third thing which is the hardest of them all is admitting when you make a mistake. [Both laugh] But focusing on those three things and simple communication and understanding that the truth is ultimately going to be the thing that rebuilds trust. Understanding we love each other, but trust is not the same thing as love. We can't blackmail people who love us for trust. We have to earn trust over time. And essentially it—if I just wrap this up a little bit—what addiction teaches families to do is to shut up. To isolate, to stop talking, to avoid the topic, because it's painful to discuss these things. Recovery tries to set that on its head. It's much more important to start talking now, to be simple and clear and precise, about how these trust levels work and where we are and what our plan is. Ultimately it comes down to rebuilding trust. 0:13:01 William Moyers So no wonder then that recovery is not a destination, it's a journey. 0:13:05 Dr. Tim Portinga Yes. And often families need a coach. They sometimes will do better with a therapist or with the Connection Program. Some way to help them learn the communication skills early on. I never doubt a family's sincerity— 0:13:19 William Moyers Mmm. 0:13:20 Dr. Tim Portinga —They love each other, I've seen parents absolutely go for the wall to try to protect their kid. [Moyers chuckles] But this trust thing is a really delicate thing to build and it takes time. 0:13:31 William Moyers Well thank you, Dr. Tim Portinga, for emphasizing the fact that trust does take time. Thanks for filling in a lot of the information I'm sure that people were looking for today on this program. Dr. Tim Portinga is the Manager of our Mental Health Services at our youth facility in suburban Plymouth. And as we can from your time with us today, you have a deep and rich knowledge and a real empathy for young people who need to find recovery from mental health and substance use. Thank you Dr. Portinga for being with us today. 0:14:03 Dr. Tim Portinga Thank you. 0:14:04 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. We'll see ya again.