hello. i'm ivette torres and welcome to another edition of the road to recovery . today, we'll be talking about youth and young adults in recovery. joining us in our panel today are tami bahr, assistant director, connections counseling, board member of recovery foundation, madison, wisconsin; jonathan katz, director, rita j. kaplan jewish community services, jewish board of family and children services, new york, new york; justin riley, at-large board member, faces and voices of recovery, seattle, washington; bridget ruiz, technical expert lead, division of systems improvement, jbs international, bethesda, maryland.

bridget, 21.5 percent of 18- to 25-year-olds have an issue with illicit drugs. talk to me a little bit about that and what kind of drugs are they using. it is quite different than it was even 2 or 3 years ago. we see a huge increase in pharmaceutical drug use, not using it as prescribed. we also see an increase in alcohol use, and binge drinking is a serious problem, as well as some of the more legal types of drugs labeled as incense or those types of things in different smoke shops. and jonathan, does that hold true for what you are seeing in new york city? absolutely. we are seeing the use or the misuse of drugs such as ritalin, adderall, inderal being used for specific purposes to help kids stay up late and study, to calm kids down. we're also seeing a lot of binge drinking and we're seeing a

disturbing kind of resurgence in the amount of nicotine smoking. i think kids are resorting to cigarettes because they're legal. they are not super cheap, but compared to other kinds of drugs they're certainly cheaper and readily available, and that is quite disturbing. and tami, let's talk about underage drinking a little bit more that jonathan brought up. talk to us about what is underage drinking. well, you know, the drinking age is 21. so there's a lot of kids who start drinking at 13, 14, or 15 and don't really have experience or understand how to drink responsibly, and so they end up drinking in very high-risk situations. they usually have a limited amount of time that they can use, so they are drinking in large quantities and binge drinking and then becoming really intoxicated and

having kind of all of the risk factors that go along with that. well, to be exact, there are about 10 million 12- to 20-year-olds that are engaged in underage drinking, which is a staggering-from 18 to 20, you've got 48.9 percent, justin, of those cohorts are using alcohol. talk to us about what you see in your practice and in the work that you've done in terms of how do kids get a hold of these substances and what are we looking at. that's a great question. i think oftentimes kids and young adults, if you will, find the alcohol in their own home, in their parents' home. i've had several great conversations with families who weren't even aware that that was happening. that they kept alcohol in their home, moderate amounts of alcohol for regular social events, and the children simply had access to it, and that was my experience personally growing up. my parents had alcohol and that's where i got it from and

then met people who were old enough to purchase it for me and it became just kind of a cycle and that is how we went about getting alcohol. and i see that true today. how old were you at the time when it started? when i first started drinking, i was 14 years old and i found the alcohol-my friend and i found the alcohol in our parent's cupboard. your friend had never experimented? or he had already? i think he had drank before, but that night was really about us figuring out what this alcohol thing was about. and we had watched so many other people do it, whether that was through media or just through our family. one of the things the audience needs to understand is that just that one experiment can become lethal if the level-right, jonathan? if the level is quite high? and then one is not tolerating it. sure, we actually use a film in some of our prevention work called death in the er about

someone who is near death because of alcohol poisoning. so all of these substances essentially are among the many that they use. we also have another issue, which is depression and some mental health problems, correct bridget? absolutely. oftentimes, especially in substance abuse treatment samples, we find that at least, anywhere-percentages range from 30 to 90 percent have some type of co-occurring issue from depression to trauma symptoms, those types of issues. so it is a really significant issue that we all have to really take-assess for and then be able to provide the treatment that young people need. and jonathan, how does a parent understand when there is a problem? what should parents be on the lookout for? parents should be on the lookout for changes in behavior, and

i think that's kind of the key sign post that we tell people to look for. a change in who your child is hanging out with, how they're doing in school, their involvement with activities. but i do want to emphasize also that there are many young people who are very high achievers who nonetheless get caught up in drugs as a way of dealing with the stress that they're under. i also want to highlight something that bridget said which is very important, the issue of trauma. because we've seen many young people who have experienced physical, emotional, sexual abuse and are significantly traumatized by that and that's a very frequent co-occurring factor. and i think a lot of kids are looking for a way to feel better, and so when they drink and the first experience

that they have feels good and they don't feel as sad or they don't feel as depressed or not as worried about what happened yesterday, that becomes part of the cycle that they kind of continue with. it kind of has a life of its own. so, it takes over after that. tami, you make up a very good point. they self-medicate to lower the threshold of pain that they are experiencing. so parents really need to know, as well as the kids themselves, when they go through one of these episodes, is it wise for them just to stop and say, "why am i doing this?" and for the parents, when they're confronted, as justin was noting, "i need immediately to go to counseling and start getting some help for this child." i think early intervention is really, really important, so whether that's parents being able to pay attention and to ask questions if they notice something. if it's the school system or somebody else that the child is coming into contact with because the sooner that

we can intervene with somebody the less likely its going to be a problem later on. so being able to identify that and seek support is really important. and kids struggle. they don't know how to deal with being adolescents and they need support from parents and from the community to help them through that period. absolutely, and i think, tami, that many times parents actually do see something that concerns them and because they're afraid or they don't know the answer, they are overwhelmed by it and too anxious about it. they don't take action and that, as you say, you know, leads to increasing problems. and by default, adolescents and transitional aged youth is just a huge period of risk taking. and so parents may have not a good idea of when to intervene. is this normal adolescent developmental behavior? or is this a real problem that we need to address? justin, what are the consequences of

all that we talked about? of the issues that are facing youth and young adults? what are the potential consequences to society? i would have to say to begin with the consequences -they could be fatal. it isn't just "i got in trouble" or "i got kicked off the tennis team" or something of that nature. to tie it back to what jonathan had mentioned, i was a captain of the tennis team. i was on the rotary. i had scholarships for leadership. i was in student council. and not only were those going to be consequences of my behavior but also the loss of family. i mean, i had been to seven programs by the time i was 19 years old and was homeless, living in downtown denver. well, when we come back we'll take a look further into the issues of youth and young adults. we'll be right back. [music playing]

the prevention field has really changed in the last 20 years since samhsa has been in existence. we understand much more about prevention science. we also understand that, frankly, children who begin having problems before age 14 are much more likely to have problems as adults. and children who use alcohol before age 21 are much more likely to have problems as adults. so we've also learned that there are risk factors and protective factors. it is not just what happens to a young person that may lead to substance abuse or suicidal thoughts or depression or anxiety but it's also the kinds of protections they have in their family and their community and in their social-in their school and others. it involves multiple parts of the community and all of those things have to come together to assist kids in getting the kind of assistance they need to be the best decisionmakers and be able to manage issues as they go through

adolescence and into adulthood. when we look at young people today, we understand that they have an advantage over people in earlier generations. they have access to modern technology. they have social networking. they have smart phones. they have the internet and the use of technology then allows them to access questionnaires about their substance use, to participate in social networking support groups, and to link up with electronic health records or their counselors and to have online counseling if they're reluctant to go to face-to-face counseling. so technology offers a great deal of promise that young people are more comfortable with and use on a regular basis. so this is a revolutionary time for our youth and we hope to

take advantage of the technological advances to promote recovery. [music playing] where's mom? did she forget me? i wonder what happened to her. what if i get left here? drugs and alcohol may make you forget your problems for a moment, but that's not all you forget. my mother worked hard to be in recovery and i love her for that. for drug and alcohol treatment for you or someone you love, call 1-800-662-help. brought to you by the u.s. department of health and human services. i think one of the keystones or the next steps in moving forward for treatment programs and organizations and prevention services is to remove stigma around young people in recovery. i've now grown up, for about 5 years now, in recovery and have no qualms about sharing that with people.

i think the openness of the younger generations can really be used to reduce that stigma, and if done strategically can really break this trend of people being bashful about talking about that, "hey, yeah, i used to be both, drug addict, alcoholic, mental health. i did it all, and today i don't, and this is how." there is, i think, solution and hope in that. jonathan, why is age of first use of any substance an issue in preventing both the illicit drug and alcohol abuse in later life? that's very important because of the developmental growth of young people and children. the younger a child is when they start to get involved in some type of compulsive behavior, the more it takes over and interferes with their ability to develop skills

for dealing with issues: how to deal with frustration, how to solve problems, how to be resilient. and so they substitute-i think, tami, you had mentioned that earlier, that they begin to substitute these behaviors, the drinking and the drugging, the cutting, eating issues, and that helps them feel good in the short run, so they neglect or they are not able to develop the more constructive skills. justin, in your case did it not escalate into other more dangerous activity and drug taking. it most certainly escalated, and it escalated very quickly. my first drink at 14 years old and by the time i was 16 and 17, i started using cocaine, speed, really taking any prescription pill or anything that could alter my state of being. i think you hit on a really key point, jonathan, when you mentioned how to cope with different things.

i started to notice that not only i drank and used drugs when i was happy or sad or celebrating or lonely or afraid. it started becoming my go to for any situation. i'm too tired. i need help with a test. that doesn't even make sense, but it became my solution for life. let's talk a little about perceived risk. obviously, a young adolescent or child for that matter- how does one then begin to interject perceived risk in that behavior that you just mentioned? is that a factor in prevention for the parents to get through to that child that there is a risk in this type of behavior? i think it's important to communicate to children and to young adults about the risks associated with that behavior. but as a young person who was participating in those behaviors, i didn't take that into consideration. i didn't have any immediate negative consequences of what

i was doing because i was still a-as we talked about earlier- i was still a young achiever and i wasn't seeing those negative results yet, but it caught up with me very quickly. were your parents sending you messages about substances? did they sit down with you? did they speak to you about it? i remember hearing messages from dare and great programs, not only at home but also in the classroom. my mother was a teacher and my mom and dad both advocated to not use drugs and alcohol. my sister, just as a quick example, had no problem with drugs and alcohol and to this day still doesn't. which is a much larger discussion of why me and not her, but i did receive anti-drug messages at home. tami, how do we then begin to develop approaches so that we can get to the youth and young adults at an earlier phase of their experimentation and prevent some of these problems?

yeah, i think one of the most important things is to be able to find issues that are relevant for that person. so teenagers and young adults are risk takers by nature. they're not going to listen to authority. they're individuating and they are trying to figure out how to make decisions on their own, and so at least we find that when we're able to find something that's important to them, that motivates them, that that is a way to start talking about the risks that they might be experiencing, the changes that they might need to make in order to be successful to reach the goals that they might have. and to really focus on personalized feedback, giving them information that is relevant to them instead of information that might be relevant to an adult or somebody who is older. like, it makes sense to us that we shouldn't drink that much and throw up. but for kids, sometimes that's fun. so being able to give them feedback that really relates to them, i think, is really important. so, jonathan, let's talk now about-that's for

alcohol and drug issues. children, you know, as we mentioned, also face depression and severe mental illness. and how-what kinds of things can we begin to do to prevent the child from going into a-or a young adult- going into a downward spiral? that's a very crucial goal. the most recent research has shown, as you mentioned, tami, that early intervention is really critical even with very severe types of mental illness. schizophrenia, for instance, or other psychoses, early intervention and helping people both behaviorally, learning skills to cope and sometimes psycho-pharmacologically giving them medication can really be extremely effective in helping young people avoid falling into a destructive pattern of behavior.

in terms of-if the parent really-there is a lot of literature coming in about whether to medicate/not medicate. what can a parent be doing? can they be doing anything to really help that child become better adjusted? i think that's crucial. you know, as has been discussed in some of the earlier questions, we have moved away, and certainly over my career, from dumping everything on the parents and blaming the parents. at the same time, parents can play a critical role, at the very least, in observing, being aware of what their children are going through and being willing to intervene and get some help for them. we need to-and i think some of the work that you're doing is really helpful in diminishing the stigma and the shame attached to seeking help because so many young people

really can benefit from help. the question of whether to use medication or not is very complicated-so many factors-and i think has to be addressed on an individual basis. but parents should not be afraid of it. tami, it calls to question not only what the parents can do but what whole entire communities can do. what is really the concept of a prevention prepared community? i think a prevention prepared community is willing to talk about some of these tough issues, willing to work together to have collations, to have groups that come together to try to support adolescents, children, their families. there is a number of those that are going on in various communities around the country and i think that's important to be able to feel like there's an impact that we can have. we can accomplish a lot more together in terms of supporting young people than we can if we try to work individually.

so a prevention prepared community, to me, is one that's willing to talk about it, willing to put it on the table, willing to work together for solutions and to be able to support our families. absolutely. justin, when you-and again, i want to go back to your example. at what point did your parents say, "enough?" or were you just, on your own, decided "i am not going to live at home anymore," or "i am going to walk away"? i did not miraculously, if you will, decide to change that lifestyle. my parents really tried any tool that they could come across. whether that was recovery communities, doctors, psychiatrists, i mean anybody, they literally took me to my childhood physician to see what they could do to help. i do think about what tami had mentioned about the community, that may have been something that would have been potentially profound because if-in my house, it wasn't acceptable.

my mom and dad stepped in immediately when i consumed alcohol or drugs and there was an immediate consequence. however, i could just go to the house across the street or in the next neighborhood and those parents had a different viewpoint. so, i do think that that would have been exceptionally powerful to have a community that would have banded together and said that "we aren't going to allow our kids to have access to these things." i remember-just a very short example of that is my parents had called another parent to let them know that myself and a couple of my friends were drinking at my parent's house. i mean, that is not allowed. we clearly decided to do it anyway. but upon calling those other parents, those parents came over and they were upset: "why are you involving us with these things? we know what our kid is doing and we don't care." and i think it would have been profound if those parents would have also said let's band together and see what we can do to make a difference. bridget, this is the whole concept of screening and brief interventions is it not to really intervene at an earlier stage?

absolutely, and getting the entire community involved. so the educational system, the juvenile justice system, neighborhoods, everybody at the same table to come together and create ways to identify young people that need help or need intervention is key and screening, brief intervention, that is the whole basis for that initiative. and when we come back, we're going to be dealing with a lot more related to how we can help young people and get them into recovery. we'll be right back. [music playing] for more information on national recovery month and to find out how to get involved or to locate an event near you, visit the recovery month web site at recoverymonth.gov. before, addiction and depression kept me from living my life. now, every step i take in recovery benefits everyone. there are many options that make the road to recovery more accessible.

it begins with the first step. join the voices for recovery. for information and treatment referral for you or someone you love, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music playing] i work for a virtual program with preferred family health care and it provides services to young people. it is technology based. it is in a 3-d environment and it gives them the flexibility of having convenience. it addresses transportation difficulties from mainstream outpatient treatment and it gives them the opportunity to access resources for their recovery process anytime that they choose. our virtual world program is for the adolescent, age ranges from 18 to 28.

and it's online, virtual world counseling, so you can do individual sessions as well as group sessions at your accessibility. so anytime that you are available to do sessions, it's kind of at your fingertips. our premise has not ever been that virtual treatment would be better than traditional treatment. it has always been to be able to provide treatment to those people that have bahriers to getting traditional treatment. there's many clients that are unable to access traditional treatment, especially if they live in rural areas. maybe they live 40 or 60 miles away from the nearest treatment facility. maybe they have lost their license because of a dwi charge or maybe they don't have a vehicle or can't afford a vehicle, can't afford gas money. so we found a way using the virtual world to access those clients using computer technology to enter into a virtual world from their home through a computer, through the internet. as from our office, we are entering that same virtual

environment through our computers through the internet and then we can meet in that virtual space. this kind of gave people an opportunity to access treatments based on their needs. and so if they needed to do a session every day, then they could do a session every day instead of just one time a week for a couple of hours a week. it's really cool because i get to wake up in the morning. i get to get my cup of coffee in my own house and i get to go sit at my computer and i get to talk about my rehabilitation with a real person over lines. it is really easy because it works on my schedule. when we give them a laptop computer, we give them access to the internet. they now can plug in with us in a therapeutic way. it allows me to have treatment, you know, when i can't get around or, you know, i am busy. it allows me to access a counselor, you know, and it is as easy as logging on and choosing an avatar and going.

people are more open. they admit quicker when they have used, which is something that is very hard to do when you are sitting face to face with another human being, you know, your counselor. just the magic of that environment invites them to be more open and honest and not be afraid when they are sitting in front of someone else. i think the group components for the virtual world are very unique in the setting that we can create whatever environment that we prefer. instead of going into a group session where i am sitting on chairs and i am talking to people, i get to go online and go across the world. i get to be in this big meadow field where there's overlooking an ocean and you get to create your own houses and stuff if you want to. it is really interesting because you create the environment that you do your treatment in. as time goes on, as clients continue to engage in this world, it becomes more and more realistic. the more someone is immersed in this environment,

the more the technology starts to disappear. the results of our virtual programming or our portal programs has been by and large as good or better than traditional treatments when we compare the two. in the virtual programs, we have been able to maintain people in treatment longer. we have been able to assist them to increase their recovery activities, so that they're engaging more in recovery activities. i hope the future brings for me and my recovery, you know, that i stay sober. i can live my life like a normal person without having, you know, the crutch or the extra weight, i guess, to carry around. the virtual world is excellent for that because anytime i need support or things of that nature, i just hop on, talk to my counselor, you know, and it helps with whatever problem i may have. i think that young people in my age group really enjoy the virtual world program. it's kind of like a game actually.

i really enjoyed it. it was exciting for me when i started because, like, i change my avatar every single day just because it was something to do. i think it's just taking the next step into technology and treatment and integrating that into an effective way for young kids to approach treatment. this is a technology-based generation and, therefore, they're encountering technology on a daily basis whether it be social media, courses online, schoolwork, projects. so this addresses their treatment environment in a context that they are very familiar with. jonathan, when and how should a parent first intervene? we have heard from justin and his experience. but overall, what-we know the signs. we already talked about them. how should they intervene with a potentially problem situation?