The Overlap Between Mental Health and Substance Use in Teens

Episode Notes

-The two often go hand in hand—do you treat one first?

-Why social media can be particularly damaging to an adolescent’s psyche

-Do long-term consequences matter to them?

-The power in simply letting them know you care

-Why peer therapy can be powerful 

Transcript

This is On Your Radar, a podcast series produced at WGN Radio with the doctors and staff at Rosecrance. I'm John Williams from WGN Radio. And in this episode, as we deal with the mental health challenges that adults and kids are facing, we're going to talk about how does mental illness overlap with substance use and addiction, particularly amongst young people. With us today are Joe Kreul, Rosecrance Vice President of Child and Adolescent Services, and LaShonda Walker, who is an assistant administrator of the Rosecrance Harrison Campus. So, Joe, what is it that you do at Rosecrance, or what does Rosecrance do via you?

The vice president role basically allows me to oversee all of our youth programming across the entire state, and try to make sure that we're, you know, like leading the industry with evidence -based practices and making sure that our services are linking clients to all the services they may need from like a wraparound care perspective. So, I oversee the programming in the Rockford area, Chicagoland, as well as the Central Illinois area as well. 

So what, are there new ideas emerging and you make sure everybody is aware of either new drugs or new therapies, that sort of thing?

Yeah, it's an ever-changing field, especially when you're talking about youth. There's new forms of treatment coming out, new things to have on your radar, new grant opportunities. There's a lot of exciting opportunities from the state and federal level regarding youth mental health treatment services. So it's my job to make sure that we're getting our clients, or our youth that we work with, plugged into the services they need, and that we're, you know, Rosecrance is able to kind of be at the forefront of implementing some of these great ideas. 

And LaShonda, just tell me a little bit about what you do. Who have you been interacting with? I understand that your job has changed a little bit, but for several years you were actually working with youth. Is that right? 

Correct. 

You work with adults now? 

I do work with adults. For the past 16 and a half, almost 17 years, I've worked with the adolescent population, primarily young women, and they're always very fun.

I suspect they are, but I think that was a double-edged comment on your part. 

But now I get the opportunity to work with adults, working back toward recovery. 

Recovery from what?

Substance use. But a lot of our clients who we work with definitely have mental health associated with their substance use. 

So does one exacerbate the other? Just talk a little bit about that.

I think it is a huge part of what we do. I think our adults have struggled with substances maybe initially, but then mental health has come along. So, sometimes they're really kind of intertwined and matched, and so we do our best to treat what our clients would like to have treated. So we let them direct treatment for us. 

If I have a mental health disorder, maybe I'm abusing alcohol, so how do I tackle that? Do I need to stop drinking in order to get well, or do I need to get well before I can imagine stop drinking? 

Both.

 Yeah. Like at the same time?  You know, we say on the radio sometimes, Rosecrance helps peel back the layers of dual disorders, and I get that when I read it, but I still don't know exactly what that means or how you would begin to do that. 

It really is directed by our clients. So some of our clients come in and they only want to focus on substance. But then as we're working with them, we learn more about... family and mental health and just different things that are impacting their substance use, or just their lives in general. Our goal is to help them get back to what normalcy is for them. So some clients, yes, we jump in right away, focusing on alcohol or whatever the substance is that they're trying to kick. But as they go along in the process and in the experience, we learn more, we grow more with them, and we get to direct their treatment the way it needs to be for them. 

So, Joe, there's not a set path when the kid walks, or the adult walks in the door. Maybe a young person where we got to do this first.  It's not like that?

I mean, I'd say I agree with everything LaShonda said. A lot of it is client driven. I mean, there are some exceptions where if they need to go through like a detox program or something along those lines. But quite frequently, even if somebody comes in seeking…If you had an adolescent coming in for depression issues, maybe not right out the gate, the first session, they're going to admit, especially with their parents in the room during the assessment process, they may not going to admit the experimentation they've done with drugs or alcohol. But then the course of treatment, as they get to trust you, as you build that relationship and rapport, they'll start to disclose how they've been coping in unhealthy ways. And then you can start to work with them on relapse prevention and more healthy coping skills to work with. You know, it's very similar to what LaShonda was talking about. A lot of it is client-driven because very frequently, as the clinician, you have an idea of what the client needs, but you need to start where they're at, or where they are at. Sorry. I can't, like, force you to do something you're not ready to do. I can suggest it, but it ultimately. Therapy works a lot better when the client is able to come up with their own epiphanies through treatment as opposed to me just handing them to you. 

I imagine when adults, well, adults I guess are the objects of intervention too, but in the case of a teenager, they're not going to volunteer it. They almost have to be coerced or dragged or forced into some sort of treatment. Am I right about that, LaShonda? 

You'd be surprised. Some clients that we have, they come in just because they've had the experience. They're ready. They know. But the beauty of the therapeutic alliance with the client is you get to build with them. You get to have fun with them. You get to build a relationship and teach them that all adults aren't the same, and you can trust me if you really want to. And so that can kind of give you an opportunity to breathe life into their treatment experience, and it's not this thing that their parents made them go to. It gets to be their experience that they get to guide and be in control of. 

Are we talking outpatient here, mostly? 

For me, it's residential. 

Really? So these are kids who have committed to a program and are at a Rosecrance facility, maybe in Rockford, for how long? 45 days? 30 days? How long? 

About six weeks, I believe, is what we have right now. I mean, for a full treatment experience is about six weeks. Because the first three to four weeks, it's that push and pull, begging mom and dad to go home. Do I really like this person? They're siding with my parents. So once we get past some of those barriers, we really get to dive in for those clients that really want to. 

Yeah. And in these cases, what has the parent noticed? Is it, hey, I can tell you're using drugs and alcohol, so we're sending you off? Or is it some more aberrant behavior that makes me think, oh, there's a mental health issue here that we need to diagnose and treat? 
 
 

I think it's a variety of things, honestly. Some parents, they noticed right away Susie is not hanging out with the same group of kids, or they're being secretive. Or for some kids, they just walk up to the parents and say, hey, I need this. Help me figure it out. So it really does kind of change. But once we get them into treatment, we get to help them figure out the rest of it. Because sometimes they're just trying to check off a box, some of the kids. With the parents, it kind of depends. School is different. Grades are failing.

So, Joe, would you say then there is no definitive answer to what comes first? Mental health begets substance and alcohol abuse, or alcohol abuse leads you down the road of such extraordinary anxiety that it triggers mental health issues? 

I think it's too hard to say what comes first, to be honest with you. 

Maybe that doesn't even matter. 

It usually doesn't because what you want to do is give the client the treatment that they need because at the end of the day, if they're experiencing struggles with both, then you need to treat both at the end of the day. So a lot of times, trying to figure out what happened first is kind of irrelevant. You want to start where the client's willing to start, and then you make progress as you go through the recovery process together. 

And you can't dry out from a mental health disorder, though, right? I mean, I think in some of our minds, if we just remove the substance from the substance abuser, you know, and then correct the behavior that, you know, manage the behavior that led them down that path, but at least now you're not drunk, you're not high. But if you have a mental health illness, I don't know how you would physically distance the person from their illness, right? So it would almost strike me as much more complicated to get past a mental health disorder. What do you make of my analysis there? 

I think that's a fair analysis because even if a client goes through, let's say, detox, for example, and they are clean, if one of the things that was causing them to use was an inability to manage their emotional state, then they're much more likely to pursue that as an unhealthy coping mechanism again unless you kind of work with them on managing those symptoms. But at the same time, you also need to work with them on relapse prevention techniques from a substance abuse perspective. So they go hand in hand. Even the treatment, there's a lot of overlap from treatment modalities and styles. 

I would imagine it would be terribly frustrating to get somebody sober, and whatever it is that's causing them to drink in the past, if we don't tend to that, it's going to come right back. They'll start using or abusing again. Do you see that, LaShonda? 

We definitely have clients that do come back to treatment because they are still struggling with something, or maybe some new things have developed over time. I think one of the things that, for me, that is important with any client that I'm working with, that just because they have a mental health issue, it is what it is. Sometimes there's medications. Sometimes there's different treatments that'll work. But for some of our clients, this is their experience, and they may have it. And learning to help them live and have a normal life despite of their symptoms, and being able to not use substances or any other unhealthy thing, is what's going to be the most important to help them find some normality for them. Mental health is here. It's a part of every aspect of what we do. It sneaks up on you. It sneaks up on these teenagers. It impacts their households. It's everywhere.

Did the coronavirus pandemic make it more difficult for these kids? 

I definitely think it created some challenges for them, whether it be in their social environment or just how they feel or just being alone all the time. I think those things definitely had an impact, but I think those things were already present, too. It just kind of blew up. 

I'm sorry, what things were already present, too? 

Mental health, some of those emotional feelings that they weren't necessarily coping with in the best way. Maybe they were using substances. Maybe they were hiding in their friend group. Who knows how they were coping with it, but when they were at home and it was just them along with their own thoughts, a lot of things got a little bit larger, a little more out of control. 

Yeah, it wasn't like we didn't have these issues before March of 2020. They've been there all along. But I wonder if it brings it to a faster boil or if there are more people in the pot now because of the pandemic. 

I think we're all more aware. I think we can see it. I think it's not pretty. And it's very much out there. And I think whether you're on TikTok or Facebook or whatever, it's out there. Like people are experiencing it. I think TikTok has been a huge driver in these kids seeing themselves and other people, you know. So I think it was always there. I think because we were at home, because we were doing these little TikTok videos, we were seeing more of ourselves and seeing more people who are struggling with what I’m struggling with and they're okay. And so…

Oh, I'm sorry. So say a TikTok video gives me the feeling that everybody else is fine  but I'm not because I don't feel that way. 

For some, and for other people, this person has exactly what I have. They're talking about it. 

It could be a positive in that case.

I think it could be. I think we can't hide from mental health. It is there. We have to be a part of it. We have to acknowledge it. We have to treat it. We have to support the people who are struggling with it. And our kids are struggling with it. As young as, I think we were talking about this earlier, five years old. We have a lot of people, a lot of kids who are struggling with it. And we as adults, it's important for us to support our kids by not ignoring their symptoms.

But are you describing a scenario where somebody on TikTok would post something that acknowledges mental health issues and is being positive and proactive? 

Yeah, there's a lot of adults out there. 

But I think most people point to social platforms these days as instruments for distraction and feelings of being left out and inferiority and bullying. What I hear from a lot of parents is that the platforms are more negative than positive. You're not saying that right now.

I am saying that it definitely can do both. And it depends on where our kids are and what kind of support they have in their homes that will either lift it in one direction or the other. Some kids will bounce back and be super resilient. Other kids may struggle and drown and kind of get wrapped up in some of that chaos so that they don't have to deal. I think it can be a good thing. And I also agree it does have its challenges and it can be a bad thing. 

What are you thinking, Joe?

In my experiences working with clients, it seems to be more of a negative because it's… I equate it like, you know. Facebook and stuff like that, it's kind of somebody's highlight reel of their life because, and some people do, but most people don't post the mundane day-to-day things that they go through. You know, they're only posting the highlights of their life. And when you're inundated with that, I see a lot of adolescents in particular who are particularly vulnerable to comparing themselves to peers, trying to figure out who they are. They start to compare themselves negatively because these other people make their life seem great. Because it's easy to do that in a picture. It's harder to live it day to day. So when you start comparing your day-to-day performance as a person to somebody's highlight reel of their life, you fall short. 

It's funny, though, because anytime you see somebody posing for a picture or taking a little video at a park or in some setting, you can see how staged it is, how hard they work at creating the perfect face and setting. And if it's not right, they'll do it again and again and again and again. And then finally they post it.  Well, we've all seen or done that drill. I guess on one level we know that it's kind of an artificial world that we see on these platforms. But I guess we're not immune to the impact that they levy on us. We still feel like, oh, look at that. They're having a great time, and maybe I'm not. 

Well, you've got to keep in mind, too, like us as adults, we're much more able to do critical thinking and abstract thought processes versus somebody who's 13, 14, you know, that middle adolescent years where they're not really developmentally able to really realize, oh, this picture is probably Photoshopped and it was probably the 300th photo that this person did. They just see the photo, make a comparison, and move on. 

Well, let's talk a little bit about why adolescents are maybe more vulnerable to some of the things we're discussing. As you referenced, their brains aren't fully developed. I like to say the clay is still soft. But that's true, isn't it? And I think we say that, but maybe we will never appreciate how, you know, fungible the brain is and how, I don't know, is there an age by which we would expect somebody to have achieved full maturity or cognitive ability?  It's not 13. It's not 16. 

I mean, the science says it's around 18 or 19, but I feel like I've worked with a lot of 30-year-olds who still aren't quite there yet. 

I beg to differ.  No kidding. 

40-year-olds? 

What is your thought about that? You just said what, especially girls? 

I did not say especially girls. 

I thought I heard you say that. 

No, I said I was just agreeing with them. I think 40-year-olds, too. 40-year-olds, you said. I mean, I think, I don't know. I think maturity is abstract. I think our life experiences kind of dictate that for some people.

 Are females more susceptible to this than males? Are minorities more susceptible to this than people who aren't minorities? Or if you're a minority in a situation, regardless of your gender or race or orientation, are you then more vulnerable to some of these things, do you think? 

I think the simple answer is yes, but I also think it is very complicated, too. I think you're right. Minorities and women, we tend to, definitely with women, you definitely see it a little more often. I think we're talking about it more, we're seeing it more, it's happening more, but I do still think everybody goes through it, whether you're a man, a woman, a child, a member of the LGBTQ community, I think, plus community, I think we're all impacted by it on some level certain genders and certain races. 

But if we were going to just kind of list some of the vulnerabilities that adolescents have to substance abuse, alcohol abuse, or mental health disorders, or the overlap of the two, the fact that their brains are not fully developed or their maturity is not, that they're maybe more susceptible to peer pressure, right?  That's no revelation here. Are they therefore more easily addicted, would we say, or is there any science on that? If they're more susceptible and their brain is not fully developed, is it more likely that they would develop a mental health illness or a substance abuse disorder? 

Joe, you're the science man.

To be honest, I know... Like at that age, it does have a great impact on the developing brain. I don't know off the top of my head statistics if you're more likely to become addicted, like chemically dependent and addicted to a substance as an adolescent versus an adult. But I do know it does have a very profound impact as youth enter, like, young adulthood if they are abusing substances during those teenage years. I don't know if it causes them to be more chemically addicted, though, I'm sorry. 

Yeah, right.  Although it does seem to be like young people who use alcohol, for instance, behave more dangerously or inappropriately than older people. If I think about that, I may retract that statement, but maybe that's just a function of youth, just being younger and more immature people, too. 

Yeah, it's actually a common developmental period of life, like in the early or mid-adolescence, which is around 13 to 17 years old. It's very common for adolescents to go through this period of invincibility where they feel like nothing bad is going to happen to me, and things that happen to other people happen because they did something wrong. You know, like, okay, my friend, you know, drank and something bad happened, but it's because they drank this substance, and I'm only going to drink this substance so I'm going to be okay. It's a common thing that they go through, and that's when you see a lot of adolescents engaging in incredibly risky situations and incredibly risky behaviors because they lack that concept of, like, almost like a concept of mortality.  And I know it's... Not that simple, but it's a concept of something actually bad can happen to you for engaging in this behavior. They just haven't put that together yet, which is a scary thought. But if you think about people that you knew at that age, yeah, I can see that. 

I wonder how you convey that. I wonder what the best strategies are to, if we're just talking about drugs and alcohol here, conveying to a young person this, you're going to be sorry. How do you get that message across?

It's very difficultly. I don't know if that's a word. But it's because at that age, you're also just kind of living day to day. You know, that's the age where when you ask somebody, what do you want to do when they grow up? And they just throw something very generic at you. And they're like, you know, it's whatever. They're more focused on what they're doing tomorrow. So a lot of the conversation has to be about how these decisions are impacting them in the moment because having a discussion with a 16-year-old about, oh, if you start doing this now, you're going to regret it when you're in your 30s, and you can't buy a house and stuff. And I see a lot of parents try to go through that line of logic. But to that youth and that life developmental stage, they're not seeing past this weekend. So stuff that's conversations or ways it's impacting them more in the moment, like with their friend group or how it's impacting their ability to do extracurricular sports, how it might be impacting their relationships. Things that are more in the moment to them is going to be more effective than trying to have a discussion about down the road in their life. 

Well, then LaShonda, a lot of us have been doing it wrong because we do that. You know, if you want to have a fruitful life, kid, you got to behave all along the way. And they're not thinking about the long term, are they? 

Well, I mean, if it worked, I mean, we would all have made the different decisions our parents told us to make. It didn't. But I think I know you're right.  We have to be in the moment with our kids. We have to be very present. Like, this is impacting the right now and how it is, and how we can't talk about 30 years or when you want to buy a house or a car, or you have to be in the moment with them.

Well, so I'm just looking at some of my notes here. How do you know if a young person is in fact experiencing a mental challenge or is abusing drugs or alcohol? Because they are also naturally going to be sullen, and their mood is naturally going to be all over the map. They're naturally going to experiment and try things. So how do you know that they're going through something that really requires your interdiction? Any red flags or any signs, or what are you thinking, LaShonda? 

I think for mental health and substance abuse, it kind of all looks the same. But I think for any parent, you know your child for the most part. So if your child is behaving oddly or they're doing things that are completely out of their norm, I think you have that conversation. I think it's important to listen to and trust your gut. It's okay. Even if you go up and you say, hey, I'm worried about you, and they're like, oh, mom, you're... at least you had the conversation. It's about opening the door and keeping that dialogue and that communication going. 

What do you say? 

I agree with that wholeheartedly because even behavior changes. A lot of people think that, oh, my kids, if they're doing something abnormal and it's bad, then that's a red flag. But sometimes it can be something abnormal that's positive in a weird way, can also be something. So any significant change in behavior, friend groups, things like that, I think as a parent should warrant just the question of, is everything okay in your life? And just because an adolescent has a change of mood, like you said, moods are all over the place at that age anyways, and that's completely appropriate. It doesn't always mean there's a mental health issue, but it should trigger just that conversation from the parent, and that can make all the difference in the world because if it is a mental health issue and they are throwing out these warning signs and the people who should care about them the most, i.e. their parents, aren't even asking if they're okay, that can really exacerbate symptoms in the long term. 

Well, what's a mental health issue? Like, what are we talking about? 

Well, when I just use that phrase, a lot of people think it's going to be a full-blown mental health diagnosable disorder, but it doesn't necessarily have to be. Just because you're going through something rough in your life and maybe you're just kind of down and out, doesn't mean you have a diagnosable condition. But it also means that maybe you need support. To answer your question, it can be anything from excessive worrying, just kind of feeling down and out, feeling overly energetic or hyper, just kind of any change.

Yeah, but I wonder like, okay, so how would I know if my kid is developing or has bipolar, and he's just up and down because he's a teenager and we're living in a pandemic and that's what happens when you're 16? I don't know that that's a fair comparison or contrast, but I wonder how a parent knows how aggressively to get involved.

Sure. I think it comes down to the impact it's having on their life. If a kid's up and down, like you said, but their grades are doing well, they're still engaging in activities, they're still completing tests around the house, things like that, it's not negatively impacting them as much. That can be a simple conversation. Hey, let me make myself available with somebody who cares for and loves you to provide support should you want it. But then if it's to the point where it's negatively impacting them in terms of, maybe they're truant from school, getting failing grades, stealing things from the house, if it's having more of a detrimental impact on their functioning, then that's where I would say to get a little more aggressively involved. You know, seek a professional counsel,  or an assessment. or something along those lines. 

It's funny, though, because of late, one of the criticisms of parenting techniques has been that we hover over them too much. We helicopter over the kids. We try and smooth the path for them so that they don't have, you know, any hardship. And, in fact, that's part of growing up, right, is struggling. Am I making that up? 

No. I think it's important to struggle. It builds character. I think parents who hover, as you say, create this bubble, and sometimes it's hard for our kids to get out of, and they're stuck in it, and they develop these unhealthy ways to manage, and then they become adults who can't keep a job, who have additional relationship issues. I think we as parents, and I mentioned this earlier, we need to create a safe place for them to land. It's okay if they struggle. Like, they can come back, and they can talk to me about it, and we can work through some of those challenges. 

Before we started this podcast, I think you used a phrase I hadn't heard before, fall forward or fail forward or something like that. I don't know if you just invented a new phrase. 

I did not. I know I read that somewhere. Please do not give me that credit. 

But it does make sense because I think falling backward, I get that. That's the wrong direction. But if the action goes, furthers me in some way, if I'm falling or failing forward, presumably there's some residual value to that. It was not all for naught. And probably we do. I know apps where you can track your kids everywhere about, you know. I don't know if you're  linking to their phone or something like that, but you know exactly where they are at all times, and then presumably who they're with and what they're doing. And maybe something like that is a good idea, but I see parents hovering over those things without relinquishing any responsibility or control to their kid. Maybe they need to go out in the world and make mistakes, suffer the consequences, and that's okay. I guess I'm asking you a parenting question more than I am a question about mental illness and abuse. But I think as you try and anticipate one, you're sort of navigating the other. How much, for instance, if when I ask them how school and they say it's okay and that's the end of it, I wonder what the next thing is that you say after that.

Well, I know that I'm an annoying parent. I always, how was this class? You started this class. Do you like a teacher? Have you made a new friend? I'm sure my daughter is over me asking those questions. But I do, I want to know. I want her to know that I care about those things. And I want her to know that this is a perfect place to share it. Tell me. You can't get it wrong. So you had a bad day. Why was it bad? What happened? Or you made a new friend. Who's your new friend? So for me, I like to get in their business. I want to know what's going on, but I also know that there has to be a space. So I'm not going to push her down the stairs if she doesn't give me all the information I want. This is her opportunity. If she doesn't want to share, okay. But that doesn't mean I'm not going to ask again tomorrow or the day after that. At some point in time, he or she is going to give me whatever they want to give me. 

And if rather than reaching out to you, they're now... experimenting with drugs or drinking alcohol at parties or something like that and really going down a bad path. I presume as a hands-on parent, you would notice that too.

I would like to believe that, but I also have worked with a lot of parents who didn't see it coming. I talk to my kid every day. They tell me everything, and it still happened. I don't think there's a perfect science with that. I think you make yourself available, and then you do the next right thing to help them move forward in the best direction for them. 

So the parent thinks they've failed now, right? 

I would never say that. 

I said, thinks. 

And maybe they do. And in those cases, when I've worked with parents who felt like they failed or they could have done it differently, if we hold our kid's hand through every class, through every bad relationship, like they don't learn how to feel uncomfortable. You should feel crappy if you... you and your girlfriend or boyfriend broke up, your heart is breaking. That's normal. You should have some discomfort with whatever you're experiencing, but you can still come back, and we can talk about it. We can still be a part of this together. I'm not going to hound you, but I want to open up a safe space for you to know that this, come, come. Let's hug. Let's talk, cry together if we need to. I want to be a support to my kid. 

Would you be completely candid with them if they asked you about your sexual life when you were young or your drug and alcohol use when you were young?

So right now, I have a 12 and a 17-year-old. My 12 year old, probably not. I don't know. I don't know. I think, I don't even think she would want to know that about me. I think she'd be grossed out. But I think if, I guess I would have to be presented with the information if she's curious because she's interested in some of those things, and I want her to learn from me. So I guess it would have to be, what are we talking about,  what is she saying? And again, she's 12, so please do not make my blood pressure rise. But I guess it would depend. I can't say for sure, because tomorrow she may have this terrible conversation with me, and I don't know. It would depend on what she's asking me about. 

What do you think about the level of candor that parents should have with their kids when discussing these things, Joe? 

I think it's important to not pretend that you didn't live life, too. I mean, there is such a thing as disclosing too much information. But at the same time, if it's something like maybe you yourself experimented with like substances or had struggles with mental health issues when you were their age, I think it's okay to share that as long as you're not...

Glorifying it? 

Yeah, thank you. 

As long as you're not glorifying it. Like having an honest conversation about, you know, I struggled with this, and this is the impact it had on me, and this is what I did to get myself out of it. And you don't need to go into all the details. You don't want to turn your child into your own personal therapist by going too far into it. But I think just, you know, I've worked with a lot of parents who felt like they weren't… if they talked about their own experiences, they would make their kids worse. Or if they mention something, then it'll put the idea in their child's head and make it a thing. And it's like, no, that thought has been there. Like, it is okay for you to explain to them, like, yeah, you know, when I was younger, I did some stupid stuff. And this is the negative impact it had on me and why I... tried to find alternatives to that. And this was my process through that. So then they know that they can come to you, like LaShonda was saying. They can come back to you if they need that and have that dialogue with you. Otherwise, they're going to feel like they have to hide it, and it's secretive, and if I mention I'm struggling, then I'm going to get in trouble because I'm always met with punishment, or I'm met with being talked down to, or my parents had a perfect life so they wouldn't understand. You know, because you absolutely want to put yourself in a place where your child feels comfortable coming to you for support. 

Yeah, and that's where I start to tippy-toe with my own kids who are older now. But, I mean, I think that's, you know, if I could do some things differently, I think I wouldn't be so afraid of pursuing more deliberately, as you were saying, LaShonda, what's going on. Tell me. You don't want to tell me about it? Well, I'm going to ask you about it. We're going to have a little more open dialogue here. And I think my fear was always that I would make things worse. If life hadn't driven them to drugs and alcohol, I will because I'm trying to keep them from taking drugs and alcohol. So then you say, okay, oh, it's good. All right, all right. So I'm here if you need me. And then you really haven't done them anything at all. But I didn't want to be too, you know, I didn't want to intrude too much in their personal life because I was afraid I was going to make it worse, you know. 

I don't think you can do harm by really trying to get across to your child that you care about them and what they're going through. I mean, at the end of the day, that's what you're trying to achieve with this is just let them know, like, I care enough about your life and what you're going through to ask. And it may annoy you, and I'm sorry if it does, and I'm not going to, like, break into your diary or steal your phone or anything like that. But, like, I care enough to ask because I've worked with a lot of teenagers who have depression and suicidal thoughts and things like that. If they actually knew and believed that their parents legitimately cared about them, it would mean the world to them. And I know their parents do because I'm a parent myself, but the youth I was working with didn't believe that based on the actions shown by their parents.

It's a lot to lay on the parent. 

I'm not trying to blame the parent for everything. It's more about, as a parent, just making it apparent that you care about your child through your actions, your conversations. It's not that you're going to break them if you don't. 

Yeah. And it would seem to me like the distinction between a drug and alcohol problem or a mental health disorder, and again, I think underlying this conversation is that they overlap, is that the kid knows if they're drinking or taking drugs, but they may not know why it is. Maybe they're not, but they still... are tortured inside, and they don't know why or how, or is this normal, or I don't have anything to disclose per se. I'm not sneaking drugs or alcohol, but I really am out of sorts. You know, what do you need to know? You know, I don't, I don't, I don't got anything to tell you except I don't feel right. And maybe that's normal, or maybe I'm not comfortable talking about it, but there's no big reveal here. It would seem to me it's more insidious that way. It would be a harder thing to talk about if you were a parent, wouldn't it be?

Are you saying, like, if there is no seemingly underlying thing going on, or your child doesn't even know why? 

Well, sure. I mean, if I'm drunk a lot, I know it's because I'm drinking. But if I feel unbalanced and I'm not drinking or not drinking to excess, then what is that?  You know, the child doesn't have as much evidence to explain their feelings. And I would imagine that the parent's fishing in the dark. They don't know what they're looking for, and the kid doesn't know what to say. 

Sure. I would say the fact that they came to you to even talk about feeling dysregulated is a win. And that is proof that they felt safe and comfortable and believed that you cared enough about them to even bring it to your attention. 

Sure, but flip it and say, okay, you haven't come to me on that, but I'm sensing that something is wrong here, right? And it's not about drug or alcohol use. So what's going on here? And the kid throws up his hands and says, I don't know, I'm 16. What do I know, right? So I wonder what some flags are. I guess it would be some of the things, LaShonda, you were talking about, social distance from friends, poor grades, I don't know. How would you know that your child isn't having a substance abuse problem but is actually experiencing some sort of mental health disorder?

I think it goes back to what Joe said. If it's extreme, we're going to reach out and get some more supports. So for some people, it is going to maybe not be right down the street to Rosecrance, which we want you to, but maybe it is, you know, the pastor at your church, or maybe you're in a boys or girls club. Encouraging our kids to have relationships outside of ourselves is important. It gives them another doorway to reach for supports when they need it. So I think it is hard to say. Every kid is going to be very different in how they're displaying their discomfort or their distress. So if you as a parent instinctually think something is wrong, the best thing you can do is one, have the conversation, and then two, reach out to supports. So whether that is us down the street, please call us. And if it's not, then maybe it is the pastor, the youth pastor in your church, or maybe it is her favorite aunt or his favorite uncle or whatever. I think the point is having the door open. You noticed something was wrong. You asked about it. Maybe today they're not going to tell you about it, but maybe tomorrow when it's a little bit rougher, they will. Or maybe they'll reach out to that aunt, that uncle, that youth minister, or whomever their safe person is. And maybe because you said something, they decided maybe I need to talk to somebody. So I think you have to start there. You can't do it wrong because you're a parent. You get to ask. 

It would be logical or natural to hope that you would be that. in the storm for your kid, but maybe you've been their disciplinary and you've been their judge all their lives, and they're not going to feel as comfortable talking to you about this, right? I mean, some of these alternatives you're discussing make sense, don't they? Because some parents either haven't been perfect parents or they don't have that skill set themselves. I mean, I'm not going to blame somebody for being an imperfect parent, right? 

Yeah. No. 

Our kids also don't want to disappoint us. So that could be another reason why they don't want to come to us. Sure. I mean, it doesn't always have to be because it's something atrocious. Maybe it's just like, I don't want you to see me in this way right now. Or I'm not comfortable with it. Or maybe I'm personally just not comfortable with the way I feel about myself, and I don't want my parent to see me that way. And this person is a little bit safer for me to start that journey with. 

So last question. What type of help is out there for children who are struggling with mental health concerns and substance abuse? Is it counseling? Is it pharmacology? Is it breathing techniques? Maybe it's all of those, huh? 

I think it is all of those things. But it also depends on… you can't just jump to pharmacology. You can't just jump to…  I think you have to do the assessment. You have to do the legwork, the background. You have to start at the beginning with the question. And then, hopefully, if it is necessary, you are reaching out to a service like us because we had it all.

That's funny because, Joe, it does – LaShondra makes it sound like a process. It's not just a conversation or just we had a good session in the bedroom that night, and they told me everything. Maybe it is a more protracted process than we know. 

Yeah, absolutely. I mean, a lot of times, you know, somebody going through a substance abuse or mental health issue, it's a process to turn that ship around, especially when you get a little older because sometimes you're combating years worth of unhealthy coping skills that you're trying to undo and then replace with more healthy coping skills. So, you know, like LaShonda said, traditionally it starts with the assessment and a discussion of what the client's needs are and what their strengths are that we can build on, and what their needs are that we can help kind of bolster as well. And, you know, you asked about services. I mean, pharmacology is a very popular one. Outpatient therapy group is actually incredibly evidence-based, particularly for teens.

Really? That works? 

It can because it's different from a parent kind of talking at you than when you have a group of peers who can also share insight. There are a lot, I mean, especially when you think about an adolescent. The way peers view them and role model is way more important than what their parents do because we're old and we're out of touch and we don't know what's going on. But when you have a room full of teenagers who are talking about their problems and solutions thereof, and how they've managed, the message sinks in a lot better, and it's more normalized and less stigmatized for them to even be experiencing these things. Most kids are used to parents talking at them. So, no, a group is incredibly beneficial.

Well, I'm glad you two are talking at me. This has been very helpful. Joe Kreul is Rosecrance's Vice President of Child and Adolescent Services, and Lashonda Walker, Assistant Administrator of the Rosecrance Harrison Campus. Both of you, thanks for your time today. 

Thanks for having us.

This is On Your Radar, a podcast series produced by WGN Radio and the doctors and clinical staff at Rosecrance. With over 60 locations throughout Chicagoland, Northern and Central Illinois, Wisconsin and Iowa, help is just a click or call away. Click on rosecrance.org or call 866-330-8729 for more guidance and information. 

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