I had the opportunity recently to interview Dr. Robert Benavides Jr., a clinical psychologist with a private practice in Santa Rosa, about his many years of experience counseling teenagers with substance abuse issues. Below are several topics covered in the interview.
UG: What is your history in working with teenagers and substance abuse?
RB: I’ve worked with adolescents in residential treatment since 1978. Substance abuse became a specialty of mine gradually. Early on, I worked with a lot of families, adolescents and couples. I noticed that substance use, abuse and dependence was something that would come up in the course of treatment. In my early training there were two therapists that specialized in alcoholism and they made a big deal out of doing in-service trainings on alcoholism. I got an opportunity to look at the AA model and alcoholism and I gradually became curious about the whole field. I started doing continuing education courses as well as attending workshops and conferences and I began to look at the bigger spectrum of addiction. I received a certificate as a Substance Abuse Professional from the National Association of Drug Abuse Counselors. I started to look at the effectiveness of abstinence models, which is what AA is, as opposed to the model that I am more comfortable with and that is the harm reduction model.
UG: How important has having specialized training in substance abuse been in your work with teenagers?
RB: Critical. I think that in working with adolescents the probability that they are not going to be exposed to alcohol or other drugs is zero. Suggesting that they are not going to be exposed is like suggesting that a kid is not going to be exposed to the Internet. That’s not going to happen. If a youngster is going to be exposed to alcohol or other drugs, the important question then becomes what prophylactic factors need to be in place so that this kid has emotional, cultural and social protection? That’s what you want to ask yourself. Kids by their very nature want to be accepted by their peers. By their very nature they are curious and adventurous and those are horrible factors to be in place when it comes to drugs and alcohol. Many times the kids don’t have a good sense of what can happen to them as they move from the spectrum of curiosity to experimentation to abuse and then in some instances dependence. If the parents don’t have a good sense of how their kids are functioning they can often believe that their kids are wonderful because they are playing soccer or are on the swim team. They may not pay attention to the fact that their kids are experimenting or that their kids are hanging out with peers that are using. They may find themselves shocked when the school calls them to say “We’ve got your kid here because he’s got a bong pipe in his pack” and of course the kid is going to deny that there is anything going on.
UG: There are a lot of high functioning kids in good families that fall into the same traps as other kids.
RB: No question. In many instances, parents get really good at denying their own use and they don’t see the impact that they are having on their kids. One of the typical mistakes that I see in family therapy is when parents will tell their kids, “Trust me, I know what I am talking about because I was your age once and I used.” As far as I’m concerned that’s an error, because the message that your kid gets is, “Dad did it and he’s ok. He’s an engineer. How bad can it be.” Their critical thinking is flawed. The parents completely unintentionally make that mistake with their kids. The other thing that I will hear is, “I will buy the drink, I will buy the alcohol and I think it is much safer for you to use here at home.” Well, what the parents are doing is they are not building a prophylactic system. What they are doing is presenting doors to their kids and then lecturing them about the perils of drugs and alcohol. The minute kids hear that tone, they flat line on you. They know it’s coming.
UG: Couldn’t that be part of a harm reduction system? Parents providing a safe environment for kids to experiment. Would that be consistent with a harm reduction approach?
RB: The short answer is yes, that is consistent with a harm reduction model. But, I’m going to suggest that it doesn’t reach that point. If you have a healthy kid, they are not going to be interested in risk taking. Risk taking has its place in life, but what we want with our kids is to reduce that risk as much as is possible.
RB: Well, the focus in harm reduction is just as it speaks and that is reducing the harm. So, if you have a young person that is curious, what you want to do is satisfy the curiosity. But, you don’t necessarily satisfy the curiosity by bringing home a line of cocaine and a line of speed and say, “Try all these and try them here rather than out on the street.” The harm reduction, in many instances is to help the kid make critical decisions so that their curiosity doesn’t harm them. Now you take it to the next level, you’ve got a kid that is using, the question you are going to ask yourself when you are using a harm reduction model is how can I still minimize the risk? Understanding that my daughter is using pot, likes pot and considers it a natural comfortable substance that is better than alcohol. How do I reduce the harm in a way that I can still maintain a relationship with my daughter? I don’t want her to feel like I am cutting her out of the formula, but I still want her to understand that the standards are clear. You are not going to bring the substances here, I am not going to let you use here and I am not going to approve of your friends who I know are using. So there is any one of a number of things that can happen while you are balancing having a positive relationship with your kids and that is the hard part.
UG: So it is not all or nothing. If you use drugs then I will cut you off.
RB: No. If you do that then you force your kids to go underground. If the kids go underground then the relationship with Mom and Dad is cut off. The availability of counseling and advice is cut off. There is tension within the home and your kid is using. Now you have two problems. I would much rather have one and that is that my kid is using and what I want to do is reduce the harm. Then you go to the next level, let’s say that someone is dependent. Now I have a son that is dependent on either alcohol or speed and I may want to consider an inpatient treatment program, because he’s not going to school, not functioning well, acting aggressive and I go into his room and find beer cans under the bed. At that point, this kid has gone from abuse to possibly dependence and I have missed several gates before, so harm reduction is going to take on a different face.
RB: One of the first things that will happen is that there is a shift in the relationships at home. You no longer find kids that look you in the eye, that are comfortable talking to you and you’re going to find some withdrawal and isolation in the home. Certainly, depending on the drug of choice, you’re going to see a shift in the grades. Grades become an easy barometer to use. You may find that a kid who is motivated, excited at school, having a wonderful time and really paying attention to the quality of work and all of a sudden that begins to wane. That’s the time to step in and say, “What’s going on buddy?” You are curious about why there is less interest in school, about why they are not hanging out with kids that are doing well academically and now something has shifted. They don’t want to play soccer, they just want to hang out with friends and you begin to see an indication that the social network has changed. Those are the things you want to look at early on. When there is a lack of respect in the home you will find that the kids become extraordinarily aggressive. They no longer treat their parents with respect and now their parents are just obstacle peers, no longer friend peers. You will typically find a 14 or 15 year old kid that cusses at his parents and challenges their authority with a tremendous amount of aggression, both physical and verbal. The kid is now hiding and what they are hiding is their drug use. They are not going to talk to Mom and Dad about it because they don’t have a good relationship. There is a change in priorities. When pot is the drug of choice, typically the motivation just drops off. You are going to find kids that love getting high, it feels good and if they are high food tastes better and responsibilities kind of drop off. So the basic question is, “Why should I work so hard in school?” When kids are motivated, the level of delayed gratification is much higher. When kids are not motivated the level of delayed gratification is really low.
UG: A common problem that I see is with kids who are using marijuana, mostly recreationally, where the parents are disapproving and the kids think it is not harmful or addictive. It is a big struggle.
RB: It is for the parents because, in many instances it cuts right into their values. If you get parents that have high levels of esteem, high levels of respect and a good sense of direction in life they are able to sit down with their kids and say, “No, I think that is the wrong direction for you to take.” But, other parents may have low self-esteem and feel like they have not done well professionally and they are not comfortable in their own skin. Those parents will often project their own inadequacies on their kids and they will say things like, “ I know exactly what you are doing. When I was your age, I was in Juvenile Hall twice for using and I have already told you which program I did.” They go right down their failure script. When you go down your failure script the respect and credibility as a parent is dropping. In many instances, the mistake in thinking is that if they can tell their kid how badly damaged they are as a result of their drug use that maybe their kid won’t go down that road. If you have really high credibility, when you say, “I don’t want you to do this because this is what I have learned,” the probability that the kid is not going to use will be high. But if you don’t have credibility and the kid is angry with you then you are going down a difficult road.
RB: My anecdotal experience is that the range of drugs has expanded dramatically. What you get today, as a result of the Internet are smarter drug users. If you present a kid today with Vicodin, that kid is going to go right online, take a look at the drug composition and they are going to make decisions based on that information. Kids today have a wider range of drugs that are available to them. It is not typical to find kids that are addicted to alcohol. That is the exception. The most common drug of choice is pot, because we grow it here locally. The typical kid is going to use opiate-based drugs, like Oxycontin, Oxycodone or Methadone. They are going to use those drugs because they are available and they can get them from their neighbor or their peers. The parents often have them in the medicine cabinet. Kids are a lot smarter and they have a wider range of drugs available to them. A lot of the drug use is a function of what one kid tells another kid. They use each other as expert advisors.
RB: There are several things that you look for in terms of resiliency factors in families. When you find parents that are aware and respectful of developmental stages with their kids then there is a much higher probability of family cohesiveness. When parents see their kids as human beings who are children, they are looking at the uniqueness within that individual. As I look at the uniqueness within that individual I have to constantly ask myself as a parent, “Who is this kid? What drives her? What is important to her?” You are going to find some kids that will immediately gravitate towards music, sports, social activities or patterns of isolation. You look at the uniqueness of your child and really help them discover it. When parents really acknowledge the uniqueness of their kid in relation to the other members of the family there is a much higher probability that the kid is going to feel valued, understood and respected. When my daughter, who is now a schoolteacher, was in the 7th grade, I asked her, “Who do you think is going to introduce you to drugs first?” She said, “Nobody” and I said, “Well, that’s impossible. Somebody is going to do it and I’m not going to be there with you. Who do you think of all your friends is going to do it?” She picked one of her friends and described her behavior as being avante garde, adventurous, risk taking and not caring about school. As it turns out, in high school this friend was the one to introduce her to drugs. What I was trying to do was to help her predict something that she was not even thinking about, but I was thinking about it because I was the Dad.
UG: So, basically teaching your kids to problem solve before the problem arrives?
RB: Absolutely, but the only way that kind of conversation takes place is if there is trust in the relationship.
Check out www.rbjpsy.com for more information on Dr. Benavides and his counseling practice.