Episode 9

  • What reduces the risk of addiction?

  • Will changing environmental factors help or is it just up to genetics?

  • Is prevention only for kids?

This episode looks at the protective factors for addiction. Genetics isn’t the only factor and much can be done to help improve people’s chances of avoiding addiction. Addicts can tell you what they didn’t get that they needed and perhaps unsurprisingly it’s reinforced by research.

 In this Podcast 

  • Environment plays a key role in raising or lowering a person’s risk for developing an addiction
  • The biggest protective factor is the presence of a secure attachment to the primary caregiver as evidenced by the child feeling supported, loved and having involved parental figures. 
  • School success (aided by parental involvement) is also a key protective factor
  • Positive peer groups and involvement in pro-social activities reduce risk
  • Additional caring adults are also helpful in reducing risk of addiction
  • Adults are at risk too and peer groups also influence their use habits greatly
  • Strong relational connections are important for all people


Helpful Links:

6 Ways Your Environment Is Influencing Your Addiction | Psychology Today https://www.psychologytoday.com/us/blog/all-about-addiction/201808/6-ways-your-environment-is-influencing-your-addiction

Chapter 3 Prevention Programs and Policies, The Surgeon General’s Report on Alcohol, Drugs, and Health https://addiction.surgeongeneral.gov/sites/default/files/chapter-3-prevention.pdf

Risky Substance Use Environments and Addiction: A New Frontier for Environmental Justice Research https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924064/

What are risk factors and protective factors? | National Institute on Drug Abuse (NIDA) https://www.drugabuse.gov/publications/preventing-drug-use-among-children-adolescents/chapter-1-risk-factors-protective-factors/what-are-risk-factors

Free Treatment Planning Tool  www.betsybyler.com/treatmenttool


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective. I’m your host, Betsy Byler, and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor. It is my mission to help my fellow therapists gain the skills and confidence needed to add substance use to their scope of practice. 

I take topics that are typically aimed at substance abuse counselors and share them with mental health therapists in a way that is relevant and tailored to meet our needs. By adding substance abuse to your scope, you can expand your ability to treat the whole person and better meet your client’s needs. Bringing more hope, healing and freedom to the people you serve.

Doing therapy is hard work. Made harder when addiction is thrown into the mix. Many of us didn’t get the training we needed to deal with substance use and finding the knowledge that you need to fill that gap can be difficult. Each episode, I’ll bring you information on substance abuse, topics that impact our work, helping you gain knowledge and confidence in a relatable and practical way. So join me each week as we talk about All Things Substance.

Welcome back.  Last week we talked about genetics and heritability and how it accounts for about 50% of someone’s risk when it comes to becoming an addict or an alcoholic. We talked about how mental health disorders, that are also related to genetics, increase someone’s risk for developing an addiction. We talked about how the type of substance used plays on someone’s available receptors and the way their body metabolizes drugs can also increase their risk of becoming addicted. And we covered environmental factors that are also involved in whether or not someone becomes an addict or an alcoholic

I’ve been making the case that addiction is not a choice and at times some people have thought that that meant that they were fated or destined to become an addict or an alcoholic. And that’s not true. It’s risk, not fate.  Just like the risk each of us carry from different medical illnesses in our families. For some people it’s the risk of heart disease for others, the risk of breast cancer. Those aren’t fate either and there are things that we’re told that we can do to help reduce our risk for those sorts of medical illnesses. Well, addiction is no different. There are things that we can do to help reduce the risk.

For many of us, we have specific niches. And for some of you, you don’t see anyone under 18. And even for those people over 18, they’re still at risk for developing an addiction.  I’ll talk about protective factors and addiction in  adults a little bit later in today’s podcast. First though, we’re going to talk about protective factors  when it comes to kids and their development.

At the end of last week’s podcast, I brought up a story. And the story was about a young man who was in a substance abuse group that I was leading.  His girlfriend was pregnant at the time and was to have a little girl.  He and his girlfriend both struggled with mental health disorders and with substance abuse. And their use wasn’t just dabbling in it. They were using pretty heavily  and they had family systems that had a lot of addiction in them. And so the risk was pretty high for this little girl.

 The group members felt that somehow this was super unfair of the universe to slap this little girl with so much risk  before she even got to take her first breath. When I asked them, okay, so what does she need in order to not become an addict or an alcoholic? And they had a ton of answers, and I’m going to share those with you today.

One of the kids said, “Parents who give a shit”.  And I said, “Alright, tell me about that”.  What he described was the kind of parenting that a kid would roll their eyes about such as calling another parent to make sure they’re going to be there when your kid’s going to be over there, having a curfew, checking to see that their homework is done instead of taking their word for it, showing up to conferences, asking about their day, having friends over and asking them about their lives and being involved.  It was interesting that this kid was describing normal parenting.  Not helicopter parenting, where the kid has no chance to make their own choices or freedom or whatever. He was talking about involvement.

This kid, he didn’t have any time for adults. Now, he and I did Okay. Because it’s sorta my specialty working with kids like that, but he didn’t need adults. He had figured out long before that adults weren’t trustworthy and so he had figured out how to do stuff on his own.  But when thinking about a new kid, a baby, and what she would need as she grew up, he knew what she needed.

He knew what he didn’t have. The research backs this up.  Parental monitoring and involvement in a positive way is highly correlated with good outcomes in terms of adolescent and early adult behavior.

Once this kid opened that door…stories poured out from the rest of the kids in the room.They talked about how their parents never showed up for this or that thing, whether it was a Christmas concert, a play that they were in a sports team that they were on.  They talked about getting promised things that the family was going to do, and then it not following through. They talked about not being able to get their parents attention because they were involved in something else. More recently, kids talk about their parents being on their phones. I’ve had parents sit in my office and tell me that they weren’t on their phone a lot and have the kid look at them like they just grew another head.  And incredulous that the parent thinks that they’re not on their phone a lot.  

What these kids knew that they needed was connection and care from the parents that brought them into the world. We have this unique thing that it doesn’t matter how shitty a parent is. Every kid wants their parents love and approval. Even if they’ve never met them. It’s built into us. Even as adults, all of you listening to this podcast today, have some varying degrees of wishing you could have a parent’s love and approval if you didn’t get enough of it. Even if you don’t want anything to do with that parent. There’s a part of you that knows it still would have been nice to have it anyway. And that was the message of all the things they talked about that day. That was the biggest one. And if you look in the research, it backs it up.

If parents aren’t available for whatever reason, having a primary caregiver that’s involved is instead what’s needed. Having someone who’s voluntarily choosing to be your parent person and be involved and care about the things in your life. It can be hard when you’re an already stressed out parent to listen for the umpteenth time to some string of information that is super not interesting to you and that you may have heard about numerous times. 

There are different things that my girls who were into over the years, that I know way more about than I ever expected to. And at times when I would be like, Oh my gosh, this, okay. Again, I would have to remind myself that what mattered was that they knew that I was listening and that I was wanting to be involved in the things that they were involved in. Even if some of them might have bored me a little bit. 

So something that’s interesting that I found over the years that I’ve worked with kids. I began working with kids in college,  through an organization called Young Life  and then I moved into working with kids as a therapist, and I found the same things to be true.

There were always kids whose parents had no boundaries, no rules, no real involvement and the kid was free to do what they wanted to do.   That kid’s friends loved it. They thought it was awesome that they were able to do what they wanted. They thought it was so much better than their parents. And that that kid was so lucky that he was able to do what he wanted to do.  That kid though, he was not grateful for that. Those kids who have really overly permissive parents are never grateful for it. When you talk to them, and they’re not in front of their peers, they’ll tell you that they feel like their parents didn’t care or love them enough to bother with setting rules and limits.  The lack of rules that they had wasn’t about freedom for them; it was a sign that their parents didn’t love them enough.

I know that during teenage years parents have a hard time trying to figure out how hard they should be, how lenient they should be. And it’s so tempting to want to be your kid’s friend, because it sucks when they’re mad at you. It’s terrible to have to punish your kids. I would much rather have had time to do fun things with the family then spend time doling out consequences for things.

And what I know from the kids I’ve seen is even though they hate it in the moment, even though they might think it’s unfair. When parenting has done fairly and consistently, it makes a world of difference for them. This is doubly true when I’ve had kids whose parents are also using with them.  In the moment, it makes their use much easier and their friends think it’s super awesome. Later on, though most of them see that  it’s what pushed them into the world of addiction.  Because they had access, they had permission, they had protection from getting in trouble. And so they were able to increase their use without the consequences or even having to hide it much.

The biggest thing that the kids said that day when I asked them what this little girl needed was involved parents. When talking about parental involvement, there were a few different areas that the kids talked about. One of them was school. 

They talked about that they needed their parents to be involved in school because at the time they didn’t care about school.  Because they’re kids and they didn’t think school was important and that they wish that their parents had been involved earlier. So that they wouldn’t have missed out on things and had gotten behind in their education.  Story after story was told about how they never learned how to do fractions and so now they’re terrible at math.  Or they faked their way through a certain class and now they don’t know what to do, or they missed a lot of classes and failed things and now they’re not on track to graduate or they were allowed to drop out.

Another thing that they wanted parental involvement for this girl was with her friends.  They believed that the parents need to know their kids’ friends and their kids’ friends’ parents.  For a lot of us, that’s kind of a no brainer.  One thing I’ve found over the years is that it’s not really a no brainer for everyone. I recall one of my staff working with a family and the staff person asked his client  how well she knew her kids’  friends’ parents. And she was really confused and she genuinely didn’t understand why he was asking her that question. Her response  was something close to the kids aren’t my friends, their parents aren’t my friends, why would I need to know their parents?  

And  the idea that she would have contact with her kids’ friends and with her kids friends parents just wasn’t on her mind. It’s not that she was unintelligent or didn’t care about her kid. She had brought her kid in for help and wanted help communicating better with her kid.  She just didn’t know that this was something that she probably should be doing. It was a great opportunity for education, but it’s one of those things that I think that those of us who are in a different world take for granted.

I want you to think about your parents whether or not they knew your friends and whether or not they knew your friend’s parents.  For a lot of us, the answer is yes. Some of you  didn’t have that. And instead, I want you to think about what that would have been like if your parents had known and been involved with your friends and your friend’s parents.

The third and related part for parental involvement had to do with sports and extracurricular activities. They wanted their parents to be involved in getting them to practice or “forcing them to practice” if it was an instrument and showing up for things where they’re going to be performing, or they’re going to be displaying their skill somehow.  Being involved if the parents are going to be involved, if it’s in bringing snacks or helping carpool or whatever.  

That was another area of parental involvement that the kids said was really important to them. And in some of these cases, these kids were remembered 10 years before a fellow team member whose parent was always there. And I know it doesn’t seem like a big deal that they’re remembering 10 years earlier when they’re only 17 years old. But remember they’re in my group because they’re using drugs a lot and they were paying attention when they were seven years old that there’s other kids had parents who really showed up for them.

We know that attachment is the strongest force; that there is nothing stronger when it comes to developing a confident and capable human. That there is nothing stronger than a solid and healthy attachment to a primary caregiver. And this was absolutely reflected in the things that the kids were saying to me.

 Another big thing that popped up during this discussion with the kids was getting help when they needed it. And by help, they were talking about help for mental health issues. For some kids it was about when they had something terrible happened in the family. Like one of the kids talked about when his brother died.  He didn’t get the help that he needed. And so drugs was an easy way to figure out how to cope with the loss of his brother. He talked about what things might have been like if he had gotten the help that he needed. For other kids, they felt like they expressed their need for help. And that their parent either said they were going to follow through and didn’t, or their parent basically said, well, I had to suffer when I was a kid so, so can you. 

Which is a weird thing.  And I hear that more often than one would think and I’m not sure what that is, That if we had to suffer with something that the logical thing is that other people have to suffer. When instead we can choose, I had to suffer so I’m going to make sure that my kid doesn’t have to suffer. It’s not that they don’t love their kids.  It’s an interesting response. And usually when I ask them about that, it’s like, they haven’t thought of it that way.

In this example, since this little girl had parents who both struggled with mental health issues and there was a strong influence of mental health issues on both sides of the family. It was something that they noticed that they were sure she was going to need that they wanted to know that this girl was going to have just in case. 

Another big thing that the kids pointed out was that they thought the kid should play sports.  And when I asked them about this they talked about the team aspect and having good exercise and working together with other people.  And being around other positive adults who cared about what was happening to them and being connected to peers who also liked the same things that they liked.  They admitted that yes, they knew people who were athletes who were using, and that was happening in high school. 

A number of them talked about how they stopped playing sports and had a bunch of time on their hands. And the other kids who weren’t involved in anything had a bunch of time on their hands and that it became really easy to fill that time with other kids  and get involved in things that they had no business being involved in.

So the things I heard from them about these extracurricular activities were contact with other positive adults, learning something new and getting better at it. Having chance to display and practice these skills, being involved in a connected way with other kids moving towards a positive goal, 

The main areas of protective factors are positive family connections, parental monitoring, and involvement, connected to school with an emphasis on academic success,  connection with other positive adults, connection with other peers  around a specific pro social activity and treatment for mental health issues that arise.

These probably aren’t a surprise for us as these are the areas that we’re usually looking at when it comes to helping a kid do better in their life and in school. They’re also really important in prevention of substance abuse.

Now earlier I mentioned that we would be talking about  kid prevention and then I wanted to talk about adult prevention. That might sound a little unusual to be talking about.  For a long time Addiction was something that started in adolescence, moving into adulthood. That is the majority of how addicts and alcoholics start their use. It’s not the only way though. 

So , in the eighties and nineties with the incredible explosion of prescription pain medications, we saw something developing in the field that really wasn’t a huge problem before. There are people who did not use heavily or even consistently when they were kids or early adulthood, they hadn’t developed those patterns of addiction. And what happens is people find themselves having some kind of injury surgery,  something that involves pain and they’re given pain medications. 

Doctors were facing lawsuits for not treating pain effectively enough and so refusing to give someone pain medication was not something that they were encouraged to do.  And as many of us have read there were companies, specifically oxycontin,  who were intentionally misleading people and telling them that this was not addictive.

And so imagine that you’re a doctor and you do this because you want to help people feel better and you have a pain medication that’s not addictive and that you can give them to relieve their pain. We know now that those medications are extremely addictive and we know that tolerance means they’re going to have to take more.  It created this whole panel of people who are taking an incredible amount of pain medication, and it’s not effectively managing their pain anymore. The withdrawal from those pain medications is extremely painful. And so now they’re in this loop of, I can’t be without my pain medication because I can’t handle the pain and I can’t function, but the pain medication is making it so I’m drowsy and I’m still in pain and it’s just the cycle. And so we wound up having addicts who had never had a previous history of addiction and found themselves addicted to pills. And they had never before, even been in contact with drug dealers and they found themselves having to figure out how to get more pills.

In the addiction field we now had addicts who didn’t have this long history of addiction. They could have been leading very average lives and ended up addicted to pills and losing all sorts of  things and not even realizing what had happened. I have a friend who attended his buddy’s wedding and a year later was a pallbearer at his funeral. And it was all because he had an accident, got on pain medication  and ended up accidentally overdosing. It’s not that these people wanted to become addicted to pain medication; it’s that they were given this pain medication in a lot of ways  they weren’t warned. In some ways the doctors who gave it to them didn’t know to warn them. Or if they were warned, they didn’t really think it would happen to them. What they found is that the pain medication made life a little easier, that they were able to take it and it just softens the edges a little bit.

We’re going to talk far more in depth about the pain medication issue in an upcoming podcast. But this is what I was referring to when I was talking about adult prevention. If you have somebody who has had surgery or had injuries, multiple procedures, this is something that you’re going to want to be talking about asking them about their use of pain medication. How often are they taking it? Are they taking it more often than they’re prescribed? How many are they taking? Have they ever taken it when they didn’t quite need it, but knew it was going to affect their day and make it a little better?

And we’re not accusatory at all. We’re just wondering, because we want to make sure we’ve got the protective factors in place.  And for adults, the protective factors are going to be similar. They’re going to be connection to friends and family who care about them,  meaningful purpose in life whether it’s through their work or through their hobbies or through their family, sufficient coping skills to manage the stress of dealing with life and emotions and recovering from injuries  and good self care.

We have an interesting job. We encourage perfect strangers to come into our office. We build a relationship with them. We encourage them to tell us all of the things that they keep hidden. We challenge them, we speak into their lives. We help them towards success and our job is to make it so they don’t need us anymore. If you think about it, it’s kind of a weird job.  I love my job . And I think it’s amazing what we get to do. And we were trained to do this with mental health issues and to help people move to a place of greater function. I think we’re uniquely gifted to work with substance abuse too. What we’re doing by adding substance abuse to our scope of practice is addressing one more area of their life that will make the difference for them about whether they’re able to  recover from their addiction and effectively manage their mental health issues. And be able to live happy and healthy lives.

In the next podcast I’m going to be going over the stages of use.  We’ll talk about what differentiates one stage from another and what that might look like in a person’s life.

If you’re ready to take the next step in addressing your client’s substance use head on over to betsybyler.com/treatment tool. The treatment planning tool I created will help walk you through the process of evaluating your clients use and deciding how and when to intervene. The tool is completely free and will be delivered to your email so that you can use it right away.

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist, friends, and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know. Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast and until then have a great week.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal clinical or any other professional information.