Quick Clips with Dr. Kilmer: 09. Why “Teaching My Kid to Drink” is Not a Thing and Understanding Situational Tolerance

In this series we talk with Dr. Jason Kilmer, professor of psychiatry and behavioral sciences at the University of Washington School of Medicine. He specializes in the development, implementation, and evaluation of substance use prevention and intervention efforts on college campuses and among 18–25 year olds.   

While Dr. Kilmer focuses on college campuses, his insights are universal and particularly helpful for parents with teenagers of any age. Share these recordings with your parenting peers as you all navigate this exciting time in human development (ages 14–25) and work to help your kids navigate away from alcohol and other drugs.

The video mentioned in this episode that further explains situational tolerance can be found at https://gordie.studenthealth.virginia.edu/learn/alcohol-education/situational-tolerance (created by Dr. Susie Bruce and her team at the Gordie Center). 

This podcast is brought to you by the Substance Abuse and Mental Health Services Administration (SAMHSA). The views expressed here are not necessarily those of SAMHSA or the U.S. Department of Health and Human Services. For questions or comments about this podcast, please contact WhatParentsAreSaying@gmail.com. 

Transcript

Quick Clips with Dr. Kilmer: 09. Why “Teaching My Kid to Drink” is Not a Thing and Understanding Situational Tolerance

[00:00:00] Debbie: Welcome to Quick Clips with Dr. Kilmer today. We wanna talk about teaching kids to drink and why that is not a thing. Dr. Kilmer has done some groundbreaking work in situational tolerance, and there's a video. Have you explaining this, that will be linked into the description of this clip, but why don't you talk to us, Dr.

[00:00:33] Kilmer, about what that term means. Situational tolerance. 

[00:00:38] Dr. Kilmer: We're very complimentary, and I'll be quick to say that. It's, it's, it's, my job has been to try to disseminate this work. A lot of times we publish in journals that we may never see in the real world. But this work was really championed by Dr.

[00:00:50] Shepherd Siegel. There's a, a famous Siegel and Ramos paper that, in my career, has been one of the most influential, and so certainly not my work and more my job. And how do we get this out there for people to do something with? The very, the CliffNotes version of this cliff was one of my favorite authors when I was younger, so shout out to Cliff.

[00:01:09] But the CliffNotes version of this is that, you know, for years people have viewed tolerance. The ability to, in quotes, hold your liquor as being very physical. You know, I used to get a buzz after two drinks. Now it takes me three or four. For years, I think there have been misunderstandings of tolerance.

[00:01:25] People say, well, my blood alcohol level is this, but now I have tolerance, so what would my blood alcohol level be? Now, the same tolerance does not mean we get less intoxicated. It means it takes more of a substance to show the expected effect. What Siegel and Ramos showed is that there is a huge environmental or situational component to tolerance and to its development.

[00:01:48] If you go back to Intro to Psych, we learned about Pavlov and Pavlov's dog. Pavlov put food in front of a dog. Dog. Salivates. Now put food in front of a dog. Ring a bell. Dog looks at you Funny, but if you keep doing food in a bell, food in a bell, food in a bell in time. Ring the bell with no food. The dog salivates The bell becomes a condition stimulus that can elicit salivation as a conditioned response, jump forward to human beings and drinking.

[00:02:13] If the summer before someone goes to college. And a fill in the blank about wherever the setting might be. Someone's place on a lake, someone's basement, someone's backyard, people drink. If you walk into that backyard and you drink, you walk into that backyard, you drink, you do it again, you do it again.

[00:02:31] What are you doing? You're pairing that backyard with drinking. No different than that bell. The Pavlov's dog. That setting, that group of friends, wherever you are and whoever you're with, are cues associated with the presentation of alcohol to the body. Why does that matter? In physiology, we know about something called the opponent process theory that's used to explain the concept of homeostasis.

[00:02:55] We maintain a set point temperature 98.6, and the opponent process theory says if you shove the body one way, the body shoves back the other turn up the heat. We sweat, make it cold. We shiver as a depressant to the central nervous system. Alcohol slows down the body. So if you go into that backyard drink slows the body down, drink slows the body down, drink slows the body down in time, you walk into that backyard, all those things slowed by alcohol now ever so slightly will speed up.

[00:03:28] They are cues that signal to the body, we're about to receive alcohol and the body will make an anticipatory response in the direction opposite the way the drug acts. Scientists call us a conditioned because it's brought on by cues compensatory, the body's literally trying to compensate response. If they now drink the exact same amount they've always drank, they might not feel it in the same way because while that depressant is there, there's now this offset anticipatory response.

[00:03:56] It's speeding the body up so objectively they'll be at the same blood alcohol level, but subjectively they won't feel it the same way. So what do they do? Maybe have one additional drink. And you can use this over time to literally explain how tolerance can develop, jump forward to when that student goes to college.

[00:04:14] The term that Seagull suggested we use is the term fail tolerance fails to fall someone to a new environment, to a new set of cues, that tolerance that they may have in those three months leading up to going to college because they drank in a backyard during the summer. In college, they're now in a new city, a new residence hall, a new fraternity, or in a new group of friends.

[00:04:37] All of those familiar cues aren't there. If they drink the same amount, they drank 48 hours earlier, it could hit them devastatingly harder because that condition compensatory response won't be there, and the full blown depressant impact of what they consumed could hit them really, really hard. You mentioned that you'll make available in the link, the, the, the video that Suzy Bruce and her team.

[00:04:59] Uh, at the Gordy Center at the University of Virginia had me narrate, um, they made a really scary animated version of me that frankly freaks me out a little bit, but it graphically includes an explanation of what I just described here. But what it highlights, Debbie, is the importance of realizing that trying to kind of like get someone ready for college in quotes by having them drink could actually, unfortunately set them up for a pretty hard fall.

[00:05:28] Because if that student develops tolerance, it will not follow them to college. And if they drink the same amount they were drinking in high school in, in that summer before college, that same amount could hit them in a much more pronounced way, which could lead to a range of not so good things happening.

[00:05:46] Debbie: Thank you so much. Seriously recommend people check out this video. It is really well done, and I think your caricature is great. 

[00:05:56] Dr. Kilmer: They worked, it took a little while to get to the caricature. They, they, they landed on, it definitely evolved. There were versions of it that was scarier in the past.