Talking to Teens about Alcohol, Drugs, and Other Dangerous Behaviors: Four Keys, Six Goals, and A MESS

A couple of parents came into therapy complaining about their sixteen-year-old son doing poorly in school, drinking, smoking pot (“He’s addicted!”), and hanging with knuckleheads. He sulked, eyes downcast, as they described how poorly he was doing in almost all parts of his life. They expressed how much they loved and cared for him, but that they were not getting through to him. That was not surprising, as they had made A MESS out of their communication and connection with him.

Adults—parents, teachers, and professionals in particular—try to have conversations with young people about alcohol, drugs, and other behaviors that can be dangerous, but unfortunately often mess up. How they mess up these conversations tends to follow certain recognizable patterns. Identifying those patterns improves the likelihood of useful and productive conversations, and hopefully helps develop preteen and teen resistance to adopting problematic and/or actually dangerous behavior. This article is both a reminder to professionals and possibly new information and approaches for parents about such conversations.

How not to make A MESS out of conversations with teens starts with identifying the four keys for parent confidence. These four S’s refer to areas parents and other adults can start to relax about in their developing children: sex, school, social groups, and substances. They are very much interrelated and also related to the other issues discussed in this article.

Sex

If parents in particular are able to gain confidence that children are unlikely to engage in premature sexual activity, they will relax and be more willing to let children explore and experiment as needed developmentally from childhood through adolescence. This also asserts that although preteens and teenagers may be sexually abstinent, they can still get involved in problematic, exploitive, toxic, or abusive interpersonal relationships. Well before puberty and before the possibility of any sexual activity, children need to learn how to recognize and avoid people who are emotionally, psychologically, socially, and spiritually unhealthy. Sex, in that sense, would likely be not just premature developmentally by cultural or social standards (or parental hopes), but caused by or coexisting with problematic intimate relationships that are significantly harmful to young people’s immediate and future well-being.

School

If adults are able to trust that children refrain from problematic distractible activities that harm their school performance and endanger their academic and vocational futures, they will relax and be more willing to let children explore and experiment as needed developmentally. For some children, staying academically focused is relatively easy because they have academic and/or cognitive capacity, natural aptitude, and sufficient self-esteem, motivation, and stability in order to do well—they are the “good” students. However, others might lack significant academic competencies, have learning differences or disabilities, negative self-identity, little drive, and chaotic circumstances that challenge their ability to be “good” students. Some, with sufficient support, can do well, resulting in fulfilling academic experiences, which allows parents to relax. Some will not do well, especially if parents are extremely demanding and/or unrealistic about their children’s capacities and/or perfectionism. This may manifest as performance never being “good enough.”

Social Groups

If adults experience children not associating with wayward or toxic peers who will distract them and/or introduce them to harmful behaviors and compromising situations, these adults will relax and be more willing to let children explore and experiment as needed developmentally. If children instead associate with “good people”—that is, well-behaved, respectful, hard-working individuals with high aspirations—adults assume or hope that these individuals will model, encourage, and even police their children’s success behavior. Otherwise, adults fear that by associating with negative peers children will develop the same negative attitudes, values, beliefs, and worst of all, behaviors.

Substances

If adults, in particular parents, are secure that children will not experiment with alcohol and other drugs or engage in self-harming behavior, they will relax and be more willing to let children explore and experiment as needed developmentally. Modern society and culture show images of the use and abuse of alcohol/drugs as well as other compulsive risky behaviors. Sometimes use is glorified as cool or an essential rite of passage. At the same time, alcohol and now marijuana are legal—as much as eating, gambling, surfing the Internet, spending, and so forth are legal—and their use is often considered benign or acceptable, at least within some boundaries.

Sex, school, social groups, and substances are interrelated as the likelihood of excessive or problematic boundaries. Experimentation, use, and/or abuse can be tied to similar issues around self-esteem, identity, family and community support, and social and cultural models and expectations. Excessive or problematic use of substances beyond the casual social use of alcohol, for example, is often intrinsically intertwined with problematic sexual activity and/or toxic intimacy, unmotivated or poor academic performance, and negative social groups. Problems in these first three areas can make people, not just teenagers, more prone to many types of excessive behaviors. Anxiety-provoking, if not terrifying to parents in particular, basic reassurances come from these four key areas. However, adults often make A MESS of trying to talk children into desirable behavior, especially when aging into and through adolescence and young adulthood. These parents are trying to seek reassurance to lower their anxiety. “A MESS” refers to four problematic perspectives and consequential approaches as well as one that makes sense.

A MESS: Addiction, Moral, Education, Social, and Self-Soothe/Self-Medication

Addiction

If preteens or teenagers have imbibed alcohol and/or used recreational drugs (e.g., marijuana) and do so perhaps often or regularly, then the adult-child conversation is probably overdue. However, do not start hollering “Addiction!” and do not start the conversation by accusing the young people of being addicts. That is an adult or parental fear, but often not realistic. In addition, it is often very distracting. Addiction is a very sensational and scary label. While alcohol, drug use, and certain behaviors do have the potential to become addictive, the terms “addiction” or “addict” are often sloppily applied, creating a mess out of good intentions. It is important for parents to know there are specific characteristics described in professional literature about what constitutes addiction. Substance abuse and other professionals are aware that there is a continuum of use, which is conceptualized as the following (Stanford University, n.d.):

No use
Experimental use
Social use
Abuse
Dependency

Not everyone experiments with alcohol, drugs, or other risky behaviors, while others do experiment and never do it again. Still others will experiment as their peer group uses; for example, drinking beer and eating pizza while watching football, drinking wine with dinner or socializing, having a shot or two of whiskey at the bar to wind down after work, or smoking pot before (and perhaps during and after) going to a concert. They may adopt and maintain use only when socializing. Some people do not use when socializing, perhaps finding use not acceptable, and they may stop socializing with those peers. Some use socially and only socially. Some people stop use as it does not work for them anymore. A key issue is in the difference between typical adult versus teenage social use. Arguably appropriate or benign adult use, particularly in relation to alcohol, is to relax—excessive intoxication is looked down upon and purposely avoided. However, adolescent drinking is sometimes not just to get a light buzz, but to get extremely wasted to the point of stumbling about, throwing up, and passing out. Rather than being frowned upon, losing control may be the goal of drinking socially for some teenagers. This is specifically dangerous because of numbers three and four of the six ways to kill yourself with alcohol, discussed later in this article. Preteen or teen experimentation of social drinking (or drug use), although disturbing to adults, may be developmentally normal and not necessarily dangerous. When adults, especially parents, accuse young people engaged in experimental or social use of being addicted, they lose credibility. Moreover, whatever they have to say subsequently is likely to be dismissed as further nonsense, being out of touch, or being uptight. Conversations are highly recommended—preferably when children are younger—but from more accurate and relevant perspectives.

Although some children experiment and stop, others engage in social use but forgo future use, and others continue appropriate social use with developmental evolutions, use can morph into problematic use. Whereas initial use may occur without significant problems in functioning for many, others may develop major problems. Potential problems can be categorized as the four problem areas of substance use:

Physical or medical problems
Emotional or psychological problems
Intimacy/relationship or social problems
Academic or vocational problems

A physical or medical problem might be as simple as having a hangover or being tired from a night of indulgence and being sleepy, lethargic, or inattentive the next day at school or work. The continuum of severity extends to mortal danger from cirrhosis and pancreatitis. Emotional or psychological problems could be moodiness or minor to very significant anxiety, depression, or paranoia. Intimacy and/or relationship problems with romantic partners, friends, family members, and work associates may result from the first two sets of problems. Physical/medical and emotional/psychological affecting interactions and dynamics can cause academic or vocational problems. Furthermore, social problems can arise such as arguments, fights, and people disassociating from romantic partnerships, friendships, and/or community inclusion.

The advent of problems is the point that adults, particularly parents, are on solid grounds to confront and intervene. If their use is not causing any problems, young people can argue nothing is wrong and/or that they are just being kids. “Just being kids” is at least arguable as a developmental stage involving exploration and experimentation with alcohol, drugs, and other behaviors. However, when problems do develop, further discussion and examination is logical. Problems that are concretely identifiable—like being unable to make it to a first-period class, dropping grades, arguments, missed meetings, or lost or hurt relationships—are more than sufficient to confront supposed “harmless” use. Bringing up that young people are “abusing” drugs or are “addicted” can be completely distracting. It gives users an excuse to argue and distract from their problematic use, as they exclaim with indignation that they are not addicts and that “Everyone drinks!” They can further flip the focus by accusing their parents or other adults of hypocrisy, saying, “You drink! You’re the alcoholic!” or “Just because you were an addict and couldn’t control yourself, you’re going to call me an addict?” Suddenly, adults or parents are arguing about what constitutes being an alcoholic or addict, whether everyone drinks, what is bad enough or not bad enough, or how sensitive, hypersensitive, and/or paranoid they are because they used when they were younger. Completely distracting, completely not useful, and completely unnecessary. Furthermore, it is relatively easy to avoid, if the conversation sticks to identifying concrete problems.

Substance use and/or destructive behavior may be caused by or lead to addiction. This could imply a genetic vulnerability to addiction, or physical and/or cognitive weaknesses that lead individuals to use substances or engage in self-destructive behavior. Regardless, addiction is also a highly stigmatizing label. Requiring individuals—particularly young people, who are often riddled with insecurities already—to take on this label can be highly problematic, as the implied negativity is so strong. Individuals may adamantly resist this label and consequentially preclude any acknowledgement of issues and problem solving. While valuable conceptually, boundaries between experimental, social, and problematic use and dependence are not concrete and certainly not worth losing focus over. Trying to force young people to accept the negative connotations of the “addiction” label waylays the interaction and potentially precludes initiating support. If the young people are justifiably, medically, and functionally addicts, that can be addressed through intervention and support activities. However, pushing and using the “addict” or “addiction” (or “alcoholic” or “alcoholism”) label or terminology can prevent ever getting them to accept support or get into the intervention process. Save saying it out loud for later, if ever!

Moral

The “Just Say No” campaign launched in the 1980s and spearheaded by President Reagan’s wife, Nancy Reagan, “encouraged children to reject experimenting with or using drugs by simply saying the word ‘no’” (“Just Say,” 2018). In 1983, in Los Angeles, the Drug Abuse Resistance Education (DARE) program began, which sent police officers to classrooms to teach children about the dangers of drug use, gang membership, and violence. However, several studies have shown that participating in the program had little impact on future drug use (“Just Say,” 2018). It is arguable that the tone of this and similar approaches is that using alcohol or drugs constitutes a moral failure, and strongly suggesting substance use or certain behaviors are caused by people’s immorality. This implies a moral vulnerability to addiction; that a lack of personal values, willpower, and/or character as well as personal deficits leads to substance use or risky behavior. Labeling individuals, particularly emotionally insecure young people, as morally deficient as indicated by substance use or behaviors constitutes a humiliating insult—teenagers are not the only ones who would resist it. This becomes another approach that effectively precludes ownership of problems or problem solving; denying the insult thus denies ownership and change. To start or maintain a relationship with the premise and assertion that the other people are “bad” automatically damages rapport. The discussion often begins and ends with this insult, and if young people do not resist and accept the “immoral” label, their shame complicates stabilization, abstinence, and recovery.

Education

The original 1936 Reefer Madness movie (Diege, Esper, Hirliman, & Gasnier, 1936) exemplifies a supposed educational approach that essentially attempts to scare the heck out of everyone so they stop using marijuana. Numerous other horror stories about alcohol and drug use are common in the media and literature. Many are real-life stories or based on actual experiences, while others are sensationalized to scare and prevent children from ever experimenting with or using alcohol or drugs. Unfortunately, when use is depicted in highly provocative and devastatingly consequential ways that are not realistic but deterministic, and when people subsequently may experience little or otherwise benign consequences from drinking or using recreational drugs like marijuana, the so-called education and well-intended messengers lose credibility. Additionally, the real and potentially harmful consequences of substance use are dismissed or minimized along with sensationalized tragic consequences. Education about substance use and problematic behaviors needs to be honest and accurate versus exaggerated dramatizations, as “scared straight” strategies and stories become the object of adolescent derision and actual dangers are ignored. Simply put, substance use can be dangerous, but it needs to be realistically presented. I often ask teenagers if they have participated in the DARE program when younger, and whether they found it credible and/or whether it stopped them from alcohol or drug experimentation or use later. Then we share a good laugh! I then tell them about the six ways to kill yourself drinking, which they have never heard about. The six ways are as follows (Landmark Recovery, 2018):

An initial effect of alcohol is to depress the part of the brain that inhibits risky and bad choices. Disinhibited because of alcohol, individuals may do something stupid, if not outright dangerous, like taking a dare to jump off a third-floor balcony into the swimming pool or driving faster than is safe. They might engage in behaviors that a normally inhibited, sober brain would stop them from doing. And they die.
Another early effect of alcohol is depression of the part of the brain that controls motor coordination. As a result, individuals might fall or lose control driving a car, resulting in accidents. And they die.
Particularly dangerous for teenagers who purposely drink to unconsciousness, alcohol can depress the part of the brain that initiates the gag reflex (i.e., the automatic clearing of the throat if there is some obstruction). Having drunk so much to both pass out and depress the gag reflex, if regurgitation (i.e., vomit) gets in the throat, airflow is blocked. Without the gag reflex, people do not breathe. And they die.
Having passed out from excessive alcohol consumption, other parts of the brain get depressed that control autonomic essential body processes like those that tell the heart to beat and tell the lungs to breathe. The depressed brain functions do not tell the heart to beat and the lungs to breathe. And they die.
The first four ways happen within the period of excessive drinking, but the fifth way takes much longer. Long-term alcohol use is toxic, destroying various body tissues and potentially resulting in cirrhosis of the liver and pancreatitis. And they die.
The last way results not from personal drinking, but from being with the knuckleheads doing the drinking. People can be in the car or otherwise caught up in the stupid, disinhibited choices and actions of other drinkers—drunk drivers, for example. And they die.

No young person I met has heard about all six ways before. These items were omitted from their “education” while they were prompted to “Just Say No” over and over.

Moreover, effectively preventing substance use or risky behavior is often presented as about merely providing education about effects and consequences. This crudely implies that if individuals are informed about the effects and consequences, they will logically refrain from use or behavior. They would be scared or intimidated, including distortions to include scare tactics based on dubious “facts” or outright lies like Reefer Madness (Diege et al., 1936) or parental horror stories of people they “heard about.” As noted, scare tactics often backfire when young people discover that use does not automatically result in addiction, moral degradation, madness, and/or death . . . oh my! While education about substances, their effects, and the dynamics of abuse and addiction is important, knowledge does not in and of itself stop experimentation, use, abuse, or addiction. Many users, particularly addicts, are more knowledgeable about their drug of choice than even some professionals! Many young people, adults, and addicts use despite more than adequate education and knowledge. When they cannot or do not stop, even when they are properly educated, then the conclusion is that such individuals are really, really stupid! Yet most users, including teenagers, have at least normal intelligence and are even sometimes brilliant. A purely educational approach results in asserting people are intellectually deficient if they are using regardless of the information they have. As with the moral approach, insulting young people is not an effective way to start the discussion or intervention.

Social

As stated previously, one of the ways adults relax about social issues is if their children, especially teenagers, associate with generally positive people who have constructive ambitions and values. The assumption is that “good” people will be good influences. The complementary theory implies that values and behavioral contagion will be caught by being around problematic peers. In other words, individuals are weak and therefore vulnerable to absorb the standards of behavior and morality of their social peer group. Whether young people use substances or engage in behaviors then depends on avoiding “bad” individuals and groups and choosing to socializing only with “good” people. A mother kept insisting her son’s negative behavior was the result of hanging out with bad influences, particularly one boy, who she constantly criticized. I challenged her by asking how she knew the opposite was not true: how did she know her son was not the bad influence on the other boy? While relevant, there are many individuals (including teenagers) who neither use nor abuse drugs or alcohol, nor engage in negative behaviors, despite associating with those who do.

A complementary theory conceptualizes that the influence of media promoting and glorifying models of use and behavior cause negative use and behavior. This theory also ignores the many individuals exposed to the same media influences (e.g., video games) who do not succumb to such use and behaviors. What might be more relevant is that individuals with shared sensitivities, vulnerabilities, and needs as presented by such media would gravitate to it, not that media creates such people. Similarly, individuals with shared experiences and issues, creating vulnerability to substance use and risky behaviors, would naturally gravitate to each other. For example, potheads with academic challenges will find other potheads failing in school to hang out with, as opposed to hanging out with academic, high-achieving nonsmokers. Failure to recognize that social causation may be in the opposite direction, and accusations of hanging out with the “bad crowd,” would constitute pushing these young people away from the individuals they feel the most compatible with. Avoiding real peers with shared experience is not what kids needing social connections would consider. They would actively resist adult recommendations to break off from the people who are most like them and feel and think the most like them.

Self-Soothe/Self-Medication

As there are four keys to getting adults, especially parents, to relax about their young people, there are also four core parenting goals used to guide young people into healthy adulthood. The four core goals of parenting are for children to develop the following:

A positive sense of self
A sense of excellence/drive
A great work ethic
Care about others

These four core goals also serve to have adults relax significantly about children’s development into functional adults. If children have a positive sense of self, including healthy self-esteem; a sense of excellence and a strong drive do well; and a great work ethic (i.e., determination and consistent effort), young people would tend to become successful as adults. However, without the fourth goal, positive identity, a sense of excellence and drive, and a great work ethic can create an egocentric narcissist—a scourge upon others. The fourth goal of caring about others balances serving personal needs and being in mutually beneficial relationships. If all four of these goals are achieved during development, hopefully by adolescence, adults can relax a great deal, as it becomes likely that their teenagers make mistakes for the right reasons. Making mistakes for the wrong reasons would include thinking themselves special and feeling entitled to ignore the rules that apply to others, and thus hurting others; a demand for perfectionism that can be frustrating; workaholism and/or exhausting or depleting themselves; or violation of the rights of others. As all people, perhaps especially teenagers, make mistakes, making mistakes for the right reasons leads to growth and learning. Examples of this include being unrealistic about their capacities and overextending themselves; exhausting themselves to do a good job or striving to be perfect; and giving someone undeserving another chance. These mistakes show there remains significant work to do in supporting and guiding their processes, but that it would be productive and probably more collaborative. If the four goals are achieved or worked towards with significant progress, young people are less likely to experiment with substance use or risky behaviors, become harmful to themselves and others, or become abusive or addicted. Weaknesses or a lack of development in acquiring and solidifying these four goals not only stresses parents, but manifests in major self-esteem, confidence, and performance issues as well as potentially leading to substance use, abuse, and dependence or problematic behaviors.

As much as the parents in the introductory example clearly wanted to support their son, they had been doing it poorly. They made A MESS out of the communication, as they focused on his behavior and what they wanted him to do instead: do better in school, participate in family activities, stop drinking and smoking pot, and stop hanging out with his “loser friends.”
Rather than starting in on their concerns (and adding to A MESS), I said to the kid, “This must really suck. Your parents are mad at you about grades and drinking and pot. They don’t even understand how much life sucks.” I continued to say, “You don’t like messing up in school, and you might even know that you’re drinking and smoking too much, and that really sucks too. Life sucks, school sucks, and parents not even knowing how much it sucks for you sucks even more! Lots of stress in your life, right?” He nodded almost imperceptibly. We talked a little bit about academic struggles, failing to make the football team after years of identifying as an athlete, and shifts in social and romantic relationships.
Then I said, “They don’t know that drinking and pot helps you chill from the stress, huh? And maybe video games help too?” There was more to the interactions between us and his parents watched in stunned silence. I eventually got him to admit that he had a lot of stress—life did suck—and that the drinking, pot, and video games (one can insert surfing the Internet, or gambling, or spending, or eating, or any number of behaviors here) helped him deal and self-soothe (or self-medicate).
After he agreed to my interpretation, I offered, “Would you like to learn other ways to deal with the stress and all the suckiness without the alcohol and drugs that get you into so much trouble with everyone?” He slowly nodded his head and we created a deal for working on his growth and change! The growth and change process began for the parents as well, seeing their son in his deeper emotional and psychological turmoil.

Substance use or self-destructive behavior may be best seen as being caused by the profound needs of individuals to self-medicate for severe emotional and psychological pain. This is often the most effective approach with any “user.” Rather than insulting or pathologizing possibly insecure young people with severe labels like being “morally deficient,” “stupid,” “ignorant,” “weak,” and/or “easily influenced by others,” self-soothing focuses on internal personal pain otherwise missed. It reveals and honors anxiety, depression, and loss while depathologizing the use or behavior as attempts to avoid and/or soothe overwhelming feelings. It especially acknowledges the challenges of moving through adolescence. Individuals may or may not be addicts. There might be use, problematic use, or worse. However, this goes beyond identifying problematic use to validating psychological turmoil. Rather than being about character flaws, use is about surviving overwhelming feelings. Education about dangers and risks shifts to education about self-medication for emotional pain, and the social peer group is identified as a supportive culture for self-soothing. Once the connection to self-soothing or self-medication to avoid suffering is made, then parents, other caring adults, and/or professionals (including interventionists) can help young people explore their feelings and subsequently explore alternative, healthier, and less destructive ways to deal with them.

The story about the sixteen-year-old pot smoker is an example of how not to make A MESS out of the conversation about alcohol and/or drugs or other problematic behaviors. It was not about addiction, not about moral failings or lack of education about the dangers of alcohol or drugs, and not about negative social influences. Rather, it was about young people’s instinctive, socially accessible, but problematic ways of self-soothing or self-medicating deep emotional and psychological stress. Understanding these principles significantly improves the likelihood of adult attempts at connection and communication versus A MESS that often waylays effective support and intervention.

About the Author
Ronald Mah, MA, PhD, LMFT, is an author of books on child behavior and psychotherapy (especially couples therapy) and a consultant trainer for organizations including Head Start, ECE, social services and substance abuse treatment organizations (e.g., CCAPP). He is the owner, director, and teacher at a childcare center, has elementary and secondary teaching credentials, is a college instructor, and was previously on the board of directors of the California Kindergarten Association and the California Association of Marriage and Family Therapists.

References

Diege, S., Esper, S., Hirliman, G. A., & Gasnier, L. J. (1936). Reefer madness [Motion picture]. United States: G. A. Hirliman Productions.
“Just say no.” (2018). Retrieved from https://www.history.com/topics/1980s/just-say-no
Landmark Recovery. (2018). Signs of alcohol poisoning. Retrieved from https://landmarkrecovery.com/signs-of-alcohol-poisoning/
Stanford University. (n.d.). Continuum of use. Retrieved from https://alcohol.stanford.edu/alcohol-drug-info/

Ronald Mah, PhD, LMFT

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Ronald Mah, PhD, LMFT, is the author of Difficult Behavior in Early Childhood (2006), The One-Minute Temper Tantrum Solution (2008), Getting Beyond Bullying and Exclusion (2013), and twenty e-books on therapy and couples’ therapy available at www.smashwords.com. He has developed DVDs on child development and behavior and has been a trainer for addiction treatment conferences with CCAPP, community mental health, severe emotional disturbance school programs, and vocational and welfare-to-work programs.