One Choice | Reducing Adult Addiction Must Begin with Youth Prevention [#25]
Most addiction is rooted in the teenage years: 9 in 10 all adults with substance use disorders began using one or more drugs like alcohol, nicotine, and marijuana before the age of 18. A key reason for this is the unique vulnerability of the still-developing teen brain to substance use. The earlier substance use is initiated, the more likely an individual is to develop a substance use disorder. And if teens use one substance, they are far more likely to use others as well.
My guests today are bringing a new context to youth prevention messaging. There’s just One Choice. Youth substance use prevention efforts are often focused on individual substances, specific settings (e.g., impaired driving), and even specific amounts (e.g., binge drinking). While specific prevention messages are useful, they lack the context of the common patterns of substance use reported by youth. Nationally representative data from the National Survey on Drug Use and Health show that for young people, all substance use (and non-use) is closely related: among youth aged 12-17, the use of any one substance – alcohol, cigarettes, or marijuana – significantly increases the likelihood of using the other two substances and other illicit drugs. Similarly, not using any one substance significantly reduces the likelihood of using any other substances.
Rooted in the science of the vulnerable developing brain, the goal of youth prevention can be reframed as, One Choice: no use of any alcohol, nicotine, marijuana. or other drugs by youth under age 21 for reasons of health.
One Choice is a message of hope and science.
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Transcript
Dave: In prevention. We are all leaders, whether you're leading a nationwide prevention initiative, facilitating statewide prevention, community, or coalition coordinator, or a one person shop, you are a prevention leader. How we show up and how we engage with others to create positive change, takes all types of things.
So sit back and enjoy these conversations with your fellow prevention leaders from across the globe are sharing their lessons, learned best practices and strategies for success.
Reducing adult addiction must begin with youth prevention. Most addiction is rooted in the teenage years, nine and 10 of all, adults with substance use disorders began using one or more drugs like alcohol, nicotine, and marijuana.
Before the age of 18. The earlier the substance use is initiated. The more likely an individual is to develop a substance use disorder. And if teens use one substance, they are far more likely to use others as well.
My guests today, oh, they are bringing a new context to youth prevention messaging. There's just one choice. Youth substance use prevention efforts are often focused on individual substances, specific settings, like impaired driving and even specific amounts like binge drinking. While specific prevention messages are useful, they lack the context of the common patterns of substance use reported by youth. Nationally representative data from the national survey on drug use and health show that for young people, all substance use and non-use is closely related similarly not using any one substance significantly reduces the likelihood of using any other substance.
Now rooted in the science of the vulnerable developing brain. The goal of youth prevention can be reframed as one choice. No use of any alcohol, nicotine, marijuana, or other drugs by youth under the age of 21, for reasons of health. One choice is a message of hope and a message of science. So without further ado, I am so very pleased to welcome Dr.
Caroline DuPont and Nancy Pasquale to the show. Oh, welcome. Welcome. Welcome.
Caroline: Thank you so much for having us.
Dave: Yes. I am looking forward to this conversation today to learn about IBH, which we'll get into that acronym and one choice. But before we really get into the nitty-gritty would love to, to share a little bit more about sort of your backgrounds, your bio, and what has brought you to where you are today, working in prevention. Can you share with us.
Caroline: Sure. This is Caroline DuPont. I am a board certified psychiatrist and also board certified in addiction medicine. And I have been working with IBH, which is the Institute for behavior and health ever since I finished my residency program many years ago. And I've been the vice president of the organization since 2014.
I work in private practice with people with all sorts of adult mental health issues and certainly with substance use disorders. But I have to say my passion is primary prevention and working with IBH and with our one choice, community, I get to really dive into that prevention, passion of mine.
And so I'm super excited to share that with you.
Nancy: And I'm Nancy Pasquale. I am the co-founder and coalition coordinator of Ryeact coalition. We're a DFC funded youth prevention coalition in in the New York city Metro area. I've been doing that work for about seven years now since 2014. I came to that work initially as as a trustee of our board of education, my background is in curriculum design.
My professional background is in curriculum design and I was a teacher of sorts, just a teacher for people who wore suits and worked in a business setting at the time, not so much you think classrooms. So it's very exciting for me in the work that I get to do now that I am also the co-advisor of our youth coalition.
So I get to work directly with youth thinking about how we apply the ideas behind one choice to our boots on the ground prevention work, both for adults in the community and directly peer to peer
Dave: wonderful ohh Nancy. I'd love to hear, and I'm sure we'll get to some of those stories from working with youth.
First Caroline had just briefly touch. IBH but there is a whole lot behind what IBH is, who it is and what it does.
Caroline: IBH is stands for the Institute for behavior and health, and it's an organization that is physically located outside the Washington DC metropolitan area. And it was founded in 1978.
So it's been around for a long time. And it was founded actually by my father. So this is a full disclosure here. My, my father is Dr. Robert DuPont and he has been a leader in the drug abuse and prevention and treatment his whole career. He was the first director of the NIH. National Institute on drug abuse, which is called NIDA.
He was the first director of NIDA and he was also the second white house drug chief, which is what we call the drugs czar so he, when he founded this organization, he was bringing all this knowledge and experience in national policy, but also in terms of treatment of people with substance use disorders and what IBH does, it's a non-for-profit that is collects data and ideas, and then shares it broadly with the people who are, as Nancy said, boots on the ground.
And so our goal is to develop messaging. Research that can support the people who are out there in the world doing the great work that they do. And in this case, we're really talking about prevention. So IBH developed prevention messaging based on science and data that we'll discuss that we call one choice.
And that one choice prevention is really my baby. That's what I love and where I've put a lot of my effort and passion. And so we're super excited to share it with you.
Dave: Oh, just thinking about the wisdom, the knowledge that. Y'all have gained over the past, what? 50 or so years. I don't like doing math, so we'll just ballpark it at 50.
Caroline: I haven't been there the whole time, but yes, absolutely. That organization has been doing it for literally 50 years, which is pretty.
And I think it's really relevant to S to share that to Caroline's point I got involved with IBH on one choice because I attended a professional conference for prevention leaders.
And I heard Dr. Bob DuPont was a was one of the keynote speakers there. And immediately after hearing him speak, I made a beeline to say, Do you ever come and talk in communities and I need you to come and talk in mind now, like yesterday. Because the research, he was sharing that at the time didn't even have that branded name of one choice, but it was all the ideas.
It was all those concepts in that way of framing and thinking about and I think that's a really important thing to say, right? That, that a lot of what one choice is when we think about what is one choice, it's a way of thinking about prevention. And it's a way of looking at an analyzing data that is available to us to show some trends and highlight information in a way that at least for me was like an aha moment.
It made me completely rethink how I was thinking about what the right messages were to be putting out in front of parents in front of youth. And how to think about. Moving the dial in terms of reducing use in our community. That relationship started because of the mission of IBH, which is get it out there, put it in front of people who, and get it in their hands.
And then that collaboration has grown over time to the one choice community, which we're so excited. And then when choice toolkit, which we're super excited to talk with folks about. So
we're like each other's greatest fans. So Nancy just explained how listening to Dr. DuPont speak, inspired her and then watching her take our like data and science and graphs and run with it and make it really accessible to her teen audience and to the parents and her community at large was so inspiring to us.
And so that synergy working together is really what one choice is all about.
Dave: Oh, you both may not know my tagline just yet, but probably by the end of this podcast episode, you'll have it memorized. But it's that prevention is better together and together we are stronger.
Caroline: That's it that's, it we're a hundred percent on board so we can fan club U2.
Dave: All right. Together is better. It is. But Nancy, you mentioned the aha moment that was fueled by ignited by sparked by one Joyce. So let's talk about that. What is one choice?
Nancy: So one choice is really based on three kind of big ideas about prevention and the first one really starts. And I may actually kick this one to Caroline first because the first one really starts in an understanding about.
The unique vulnerability of the adolescent brain to substances. And that's a really important distinction, I think, to make in all sorts of ways, but especially when we're out in community and talking to folks, and we're talking about things like alcohol, which is something that for adults is legal for adults, is something that they use.
And so making that really clear distinction that when we're talking in terms of one choice, this really is a primary prevention message. And it's really focused on that unique vulnerability of the adolescent brain. The second piece of one choice, that second big idea is that fourteens we know from data that, that all substance use is related, that we can't. And we shouldn't just be talking about alcohol. When we're talking about youth, we need to be talking about alcohol and its connection to the use of things like marijuana and things like nicotine and other drugs. And then th that last big idea, and this is the most exciting one. And the most to me, the one that just really lights all of us up is that the trend for youth of non-use has been growing year over year for the last 40 years.
And that is a piece of information that many people do not know. And don't believe when you tell them. And so talking about the why's around that. So we'll get into each of those three big ideas but that, that aha moment to say that makes sense to me. So and so in truth, when I first.
Her doctor DuPont speak at that big conference back in 2017 our past 30 day use of a lot of substances and in particular alcohol marijuana work high, they were high, they were higher than national averages. They were a big concern, but they were, but we were talking about those in a context in my community where we had lost in a two year period in a relatively small community six young people to overdose related deaths.
And so people in my community wanted to talk about the quote unquote, other drugs, right? Because that was the thing that made them feel concerned. But when we looked at our D. Our data was saying, yes, there are young people using those drugs and yes, that is true. But what they're really using a lot of is alcohol and marijuana and nicotine and how to frame a conversation in a sensitive way in that context to say, but if you wanna talk about though those losses, and if you want to talk about how we prevent those, we need to be talking about alcohol and marijuana and nicotine and how those all go together.
Dave: Yes. We'll come back to that, but I want to spend a little time on the developing brain, the brain science stuff. What yeah. Unpack that for me, please.
Yeah. So the big brain stuff that's the part that isn't us, that's not from us, but it's super important to have as a foundation.
Why are we talking about prevention and why are we talking about prevention in this age group? So the simple thing is to say all of these things are illegal under the age of 21 and that's important. That's really important. It's true. I find that often people have gotten confused about the legalization of marijuana where they think, oh, it's legal.
And I'm like, yeah, but some places, and it's not legal for anyone under the age of 21 for recreational use. And that's really important. So all of these substances are not legal under 21, but the other thing is that. The science of the brain really gives us important information on why why those laws are in place or why those walls should be in place.
So I, I don't know if most of you can probably picture some of the wonderful brain images that have come out that are multicolored brains that show that as our brains develop they don't develop evenly. It's not like boom, when you're born, your brain is a completed thing. Or when you hit a certain age now it's boom, it's done parts of the brain finish at different times.
But when you look at that progression, you can see that significant areas of the brain are continuing to develop all the way through the mid twenties. So it's really is more like 25 or so even further than that 21 timeframe when that brain is developing and the reason that's. Key is that means that anything that happens to that brain during that period of development can have a really big impact, not only on that person's present, but on their future, on how that brain continues to develop.
And some of the ways we see this commonly in our society is for example, concussion protocols. So when I was a kid, people that concussions weren't taking that seriously it almost. Joked about, I think oh, we got knocked out, on the sports field or whatever, it was not considered that big a deal.
And now, there's really a sophisticated concussion protocols because we've shown that yeah, wow, early concussions are a problem and repeat concussions are really a problem. And not just a problem again, in the short run, but in terms of that person long-term. And so that's one area that we see it commonly in our society where you're like, oh, protecting your brain is important.
Another thing is in terms of trauma informed care we've come to be much more aware that traumas that people have during their developmental years when that brain is developing, again, can lead to really significant downstream problems in terms of mental and physical health. So brain protection is super important, not just in the substance use world, but when it comes to substance use.
We have, again, some pretty compelling data that shows that the earlier a person is exposed to drugs. And the more significantly it's exposed to those drugs, the higher their risk is for developing substance use disorders in the future, and a whole host of other types of issues less educational attainment or poor income over the years.
So there's real kind of, again, data that supports that early initiation of substance is bad for your brain development. We have stuck with the 21 because that's the law, but if you're really going to protect your brain, you want to protect it till you're 25. And just to add as an aside, when I tell kids.
They love this. They love this. They love that my brain is not changing and growing at all. It's, I'm stuck with what I've got, or maybe it's not it's going downhill from here, but the kids' brains, they're just going up. And even when I talk to college students about this stuff, they get it.
They get that concept that they want to protect their brain. And they're excited to know that there's more to come from that brain power and that they can do things to foster, healthy brain development and do things to protect from detrimental things.
you probably saw me nodding along quite a bit.
I know listeners. You can't see us. Yes, but I'm just reflecting back to God. I was a wrestler in high school, even as a youth program before high school and then played ice hockey. And then I was deployed to Iraq as a junior in college and was blown up and didn't know that I had suffered a traumatic brain injury.
And I had to go back out on patrol that very next day. And it was years later where folks started actually talking about TBIs, but I went and got screened oh yeah, you definitely will. So that explains a lot. Yeah. So this is fascinating. Fascinating to me. Yes. So let's continue with build on that, what that second point that all youth substance use is related.
Caroline: Yeah. I'm going to jump in first before that. I think the one other brain thing I wanted to say, and that is what are drugs, what are they doing? How are they different than other things that we do and drugs or chemicals. Act in the brain in a way that kind of hijacks the pleasure centers of our brain.
And so there's all sorts of animal studies and things like that to show that not just humans, but animals will work harder for drugs than they were will for other basic biologic needs like eating and sex. Water and things that are hardwired into the brain to have that kind of pleasurable response or companionship another great one.
And so they're, they are often, naturally occurring, but then have been manipulated by humans. Another big conversational topic for us. Maybe we'll get to later on what we call commercialized, recreational pharmacology, where for literally centuries, but really sped up in the past couple of decades.
Humans have gotten very sophisticated at creating new and higher potency products that go right to that pleasure center of the brain. And again, high jacket from its normal purpose.
Dave: That sounds like that would be a wonderful just standalone episode as well. My goodness. Yes. Yeah,
Nancy: I think it's also important to note with regard to this.
And you touched on it a little as you were talking Caroline, is that when we talk about this to youth in this way, right? Talk about what's happening with their brain. They, there is a lot right now happening for youth in terms of all sorts of health messages around mental health, around whole person wellness, and around self agency. And self-advocacy like, in other words, oh, there are things that I can do and actively do or not do. But I like to think of them in terms of the active thing that you're doing. Because when you write. Use drugs that is an active choice, right? You're actively doing something.
You're making a decision. You're saying no, when it's offered it to you or your avoiding situations where it might be offered to you, it to you. So I think it's really important that whole piece around youth right now are very interested in topics related to their health in particular to their mental, emotional behavioral health.
And so they're very energized by thinking about it in that way, right? Because it feels very it feels very self the idea of self agency for them is really important, especially for teens. Who start to, who are at the greatest risk are also knowing that they have agency is incredible gift to give them.
Dave: They feel empowered.
Caroline: absolutely. And the reality is, in the end, it's up to that team, what they do, you can give them all the information, but at some point that individual is going to make a choice. And that's, that is going lead us into this next section, I think. But I think that it's really important to remember that if you don't, if you don't really explain to people why.
We're saying don't use any of these substances under the age of 21. It just sounds like a random rule. And I don't want it to sound like a random rule. I want it to be something that you're able to internalize and say, oh, I've made this decision for myself because of what I want out of my life or how I want to protect my mental and physical health.
And so I think that's, again, that's why that foundational part is really important for us that it's not just like us lecturing and saying, because we said, so we're even because it's against the law, but no, wait, this is your brain. And at some point, you want to take care of it.
Nancy: And the, and it's not right.
It's not a morality thing. It's not a judgment thing. It's not a, it's really about a self, a, self-advocacy a self agency of protecting your own health and celebrating your own. Promoting,
Caroline: what we always talk about is this concept of no use of any alcohol, nicotine, marijuana, or other drugs, for reasons of health under the age of 21.
And we always spell out those different drugs. And the reason we do that is because there can be quite a lot of debate about what's the drug. So if someone's I'm, drug-free, that's awesome. I love drug-free wonderful. Fantastic. But what do you actually mean? Are we sure we're on the same page and what you find is that some people are uncertain is alcoholic drug.
And some people are uncertain as nicotine, a drug, and now we've got a lot of people who are uncertain. This is marijuana drug. And if you eat, if you use it in different delivery fashion, does that count as a drug? And so again, we want to be clear that all of these are working on those same pleasure centers of the brain in the same way and have all the same risks.
It's also IBH did this research and this is what was the foundation of our one choice messaging and really where that word, that concept of one choice comes from. We did this original research where we took data that already existed. It was not our research. It was big national data from the national survey on drug use and health.
And they survey 17,000 students between the ages of 12 and 17. And they have all this big national data, but we took that data and looked at it in a totally new way. And we asked this question that hadn't been asked before, and that was what's the relationship between using one drug and using another drug.
And we the one that kind of sticks in my mind first, but you can do it with other drugs and I'll explain that is marijuana. So you ask 12 to 17 year olds in the past month. Have you ever used any marijuana and this the youth who say no are in one category? Nope. They did not use any marijuana. And then the other category are youth who say yes, I did.
I used marijuana in the past month. And that's the only distinction between these two groups. That's how we've divided them. Yes, they used, no, they didn't use it. Doesn't say anything about quantity or how, or when or why or anything like that? Yes or no. And then we looked at the data for those two groups in terms of alcohol use binge drinking, heavy alcohol use nicotine use and Mary and other drugs, other types of drugs, which lumped in everything, whether that's opioids or.
Whatever, exactly, whatever else, anything else. And what we found is that those 12 to 17 year olds who said, Nope, I haven't, I didn't use any marijuana in this past, just this past month. I didn't use any in this past month, their use of all those other things was very low and across the board. And then if you look at that other group of people who were the students who said, yes, I did use marijuana in the past month.
Again, nothing about quantity or anything like that. Yep. I did use something in the past month of marijuana. Then you look at their alcohol, use their nicotine, use their other drug use it's way higher. So if I could show you the graph or if you look at our graphs and go to our website and look at those graphs, you'll see the no use have little teeny bars on one side.
And the, yes, your marijuana use have really high bars on the other side. So you can just look at it. It doesn't take, you don't have to sit and study it and understand it. It's like really visceral. You're like, oh, if they didn't use marijuana, they really weren't likely to be using anything else.
Exactly. It's super straightforward. So then the question is is that just true of marijuana is that's the story. So then we did the same thing, looking at alcohol as our first question and just dividing into those two camps again did those 12 to 17 year olds. We're talking about pretty young people here use any alcohol in the past month.
And if they said, no, that's one category. And if they said, yes, that's the other category. And what is that same thing, little bars, big bars, the group that did not use any alcohol. They also weren't using any to speak of. Obviously some people were but low numbers were using anything else, marijuana, nicotine, other drugs.
And if you looked at the group that did use those bars are much higher. Then we went even deeper into that. And we said what if, instead of just asking, did they use alcohol? We also looked at binge drinking and heavy use of binge drinking is five or more drinks in a setting and heavy alcohol use is then repeat binge drinking.
And what is that there a very clear relationship that the more alcohol they use, the more likely they are to be using other substances. And then just really quickly, we did the same thing asking about nicotine. Now I have to put in a caveat here. The study is based on cigarettes because when this data was collected was before vapes came out and it's a big topic of ours.
Want to talk about it? And I know this data does hold true for people who vape as well but this initial study really was cigarettes. And what that showed was the same thing. If you didn't smoke, you didn't do other things almost at all. And if you did smoke, you used much more of all of these substances.
And so this is when we looked at this data, we were like, oh, wait a second. This is really different. Most substance use programs are like substance specific where like against drinking and driving or were against cigarette use or something like that. But really all substance use in youth is related.
And there are very few youth who are just using one substance. Most youth are either not using at all or once they use something they're using other things as well. And this is, that was the key.
Nancy: This is important. I feel like in the, when you then start to think about in terms of strategy, right? When you're on the ground, thinking about strategy, that becomes a critical piece of information and the reason.
It goes back to what I was talking about before with just as one example, adults in my community, lots and lots of well, intending, caring parents, caregivers, grandparents, community leaders who truly get to spend hours and hours of their lives, caring about what happens to youth would say things like at least they're just having a little beer.
And so helping them understand the science of addiction, the science of the developing brain and how it works and how those chemicals work. All of those chemicals, including the ones in alcohol and marijuana and nicotine, not just the ones in, again, I use those air quotes, the scary drugs, helping parents really understand if you really want.
To do that, that, that primary prevention, you need to understand those connections that there is no such thing. If you're a teenager, there's no such thing as just a little, it's just a little beer. It's just not rooted in reality. And that was an important bit of science to share and it and is really different than that.
When I, again, when I talk about those aha moments, that was an aha moment for me to say that's the information that parents need to understand, because if we want to get at those downstream effects, we need to look at the upstream causes and alcohol use and in particular, in my community, and by the way, in most communities, right?
When we talk about the substances of abuse or misuse among teens, There that there are three big ones and everything else is significantly less. It doesn't mean they don't exist. It doesn't mean that they're not important and that we shouldn't worry about them. But what it does mean is that if we stop looking at those ones that are just so commonplace now in part because they're legal.
And so our thought process about them and thinking about them as drugs has changed because of their legality, among other things and their, and they're easy access. And they're common used by adults. Because of those things, we've lost sight of the fact that those are drugs, they're chemicals that have an impact on the brain and in particular, on the developing brain.
And so shifting that conversation was really like a revolution. And in fact, my students call it their little revolution when they talk to parents about that revolutionaries.
Dave: Oh, that, that is a great sound bite right there to pull that one out. You'd said that first question use within the past 30 days, what does that non-use group look like?
What are the trends? What is that.
Caroline: What's really great about this data that we used is that it's big national data. So it isn't oh, this is true in this community. This is looking at communities across the country. And when we have looked at data like this, and also many of our organizations that have joined with us have looked at their local data, they have found that this really holds true that it's really consistent.
And that's again, really important. And that's where we got this concept of the one choice. So it wasn't like we thought of that concept and then looked for the data to support it. We were talking about this data as Nancy said long before we coined that term because the data came first and then we're like, wait a second.
So really ultimately it's boiling down to an individual who is making this choice and I'm, I really want to think about it as an individual, because many people who are what we call one choice kids they fly under the radar. They're not really super vocal about it. They don't proselytize their their decisions not to use.
They're just doing their thing. And they have a whole lot of reasons of why they has an individual have made that choice. And what we've done is uncover this connection. And then are supporting the people who are in fact already doing this. We didn't create people who are one choice we might have labeled them that way.
The other thing I think is really important is to think about this. And we've talking about this as primary prevention and primary prevention is super important, but this one choice message holds true for anyone. And that's why we talk about this as being a health standard. So a health standard is something like wear your seatbelt and it's a really clear standard.
It isn't wear your seat belt when you're on the highway or wear your seatbelt if you're in the passenger seat. It's wear your seatbelt anytime you're in a vehicle. And the health standard doesn't change, even though some individuals don't wear their seatbelt So another thing would be like wear bike helmets.
And I like this one because when I was a kid, no one wear bike helmets, we didn't know that you were supposed to be wearing bike helmets, but again, that brain protection thing, we've gotten much more sophisticated about it. So now kids are growing up, always wearing their bike helmets. It's just normal to them.
And then we had something changed. And what changed to what I saw is that those rental scooters and e-scooters and stuff like that came out, and all of a sudden people were on wheeled things that don't have no helmets and it's normalizing, not helmet use again. And you're like, oh my gosh, how did that happen?
I thought we'd discussed this. But the reality is that the health standard hasn't changed the behavior might've changed, but the health standard and the brain protection hasn't changed. So when we talk about one choice, I'd want to make sure that we're not excluding people who have used.
It's not like a purity pledge. No, I'm sorry. You already drank your, you can't be part of us know who's doing that. That's ridiculous. That's you didn't wear your seatbelt yesterday. I guess you can't put it on today. Ridiculous.
Nancy: And that really speaks to, especially as a person who comes out of a sort of education background, that there's a lot, there's so much right now in, in education talking about things like the growth mindset, right? Like the idea that just because I'm not doing something now, doesn't mean I can't do it tomorrow. If, as I learn new things, as I gather in more information and better, and perhaps better or more accurate or more complete information, I can make different choices.
And a big part of our work is to try to remind and encourage folks who work in prevention that this isn't about picking, going and finding the kids who haven't used. And making it only about them. We also want to encourage youth who maybe have used in the past, who are, who have, who are recognizing, maybe that's not the best choice for me.
Maybe I can make a different one that would be better for my health, better for the protection of my brain. Better for fill in the blank of any number of reasons why. So one of the big things we talk about with youth all the time, when we talk about making these choices is what's your reason why and whatever it is for you.
Is what it is for you. And one of the activities that we do to share one choice is that we have youth talk about what's my reason, why what's your reason why? And it can range from I've had students say things like I'm a person of faith. And because of my faith, I believe I shouldn't be doing that.
I've had students say there's a history in my family of addiction and I'm worried about that. And so just I would want to protect myself from other types of illnesses. If I knew I had a history like heart disease or diabetes, for example, and I make choices, it's the same idea, right?
This is a health choice. So kids will say that kids will say I'm an athlete. And I don't like what it does to my body. And I want to be my best on my, on the field or. Th for my teammates. And for myself on the field so the reasons vary and what's great when you start to share those reasons.
Other young people can see themselves and that's me too. I'm that too.
Caroline: Because again, it's that fly under the radar thing? A lot of these people, it's not, it's something they've come to on their own decision, but they haven't necessarily, they don't realize other people are doing it. And that's where it, that's going to bring us to our next kind of major point, I think.
Do you want to do this one Nancy? Or do you want me to describe this too? Okay. I would say describe it and then we can chat. All right. All right. This is our other really big piece of IBH research. And this, we took data from the monitoring, the future, which is again, huge national data.
This is how the nation looks at youth substance use and there's tons of data and it's used for all sorts of different things. And
Nancy: I think it's worthwhile just to jump in and say that the reason. This is why, how our nation measures youth drug use is because of Dr. Robert DuPont and his work and the monitoring, the future data.
Caroline: He started that when he was the the director of NIDA and it's gone on ever since. And yes, absolutely. So you're right. This is a core of ours. But the data doesn't belong to us. It's it's a whole different entity at this point, but but you could use the data and you can look at the data in a lot of different ways.
And a lot of data is shown. Like what percentage of teens are using marijuana or what are using alcohol and at what grade level are they doing that? But it tends to be substance specific and looking at use, and we thought, wait a second. Just like you said about who are those non-users? And so we asked the data, it's a little funny way of saying it, but we asked the data how many students haven't used anything.
They haven't used any alcohol. They haven't used any nicotine. They haven't used any marijuana. They haven't used any other drugs. And so we went initially, to the heart of it, which is seniors in high school. And the kind of lore would be, or the kind of social norming would say, ah, yeah, everybody uses.
And, or at least everybody tries or everybody experiments. We have all these kinds of ways that we couch that as if it's okay. But we looked at this data and lo and behold, it's not true. Everybody does not use. And that. Again, one of these things that you look at and you're like, oh, why didn't I know that, so this data has been collected since the mid seventies and it, we have data up through 2019 at this point.
The pandemic may have mucked with our our is a little bit, but hopefully not too much. And what we've seen is a steady increase in the number of high school seniors that haven't used any of these substances. And we can look at it in two different kind of snapshots. One is lifetime never used.
So again, that primary prevention thing, and what we can see is that lifetime, no use has grown to just over 30% of high school seniors who have never used anything in their whole lifetime. And if you go to when was that? The lowest number. So that lowest number of non using in their lifetime seniors that was in the kind of mid eighties when it was like 3% of high school, seniors had never used anything in their lifetime.
And so that's a huge change again to 30%,
Nancy: 10 for the 10 that's. So I just I have to highlight that, that is a 10 for the exponential change in lifetime
Caroline: that was going on, but nobody knew it. Nobody was paying attention to that because people were concerned about use. They weren't thinking about non-use.
And so that's why this was like such important. And the other thing is I I'm going to just explain the other data point on this slide is. Probably more important to me is past month non-use and that's really important again, because I don't want there to be some purity test here. I don't want it to be like, oh, you don't pass ridiculous.
So if you look at past month use, you see again, this incredible change over time. So now it's up to just under 60%. It's 59 something and change percent of high school seniors have not used any substances in the past month. And again, if you go back to that eighties time, about
Nancy: 17, 16 or 17%, again, exponential increase and
Nancy: guess who was a teenager at that low point, we told them parents now parents of
Caroline: teenagers and healthcare providers.
Everybody, the lawmakers that's, who was a teenager during that period, that teen non-use was at its lowest. And so they don't know. So they think everybody uses, but it's not true there again, a whole third of high school seniors have never used a thing and. 60% haven't used in the past month.
So they're not, at all frequent users and that's who we're speaking to, in our first message here. And we want to give those people who are making those smart choices, their own voice. And that's the thing that Nancy has done that is just like amazing where she's taken this information that we had, that we're all really excited about, but she figured out how to translate that.
And so it could really be used. So Nancy, you've got to tell us about some of the activities and stuff like that, that
Nancy: you've done. We've used that, that information. And again, one of the reasons why it was so important for our community, especially early on is that we did have some numbers early on in our coalition days that were significantly higher than national averages and cause for great concern and.
It occurred it, I realized that by making that the only narrative that I was effectively rendering invisible, the flip side of that narrative, which was that there were lots of young people who weren't using, even in my community where our numbers on uncertain data points were quite high. And some of them are still high higher than national averages.
But I wanted to talk, I wanted to flip that narrative to say, let's talk about non-use, let's celebrate that and let's figure out how to grow it. Let's look at, let's look at supporting that so that more young people will a recognize themselves in that choice and their own ability to make that choice.
And so we. Made a really concerted effort to do a number of things. One was to just change the way we talked about prevention every time, all the time. So even when I'm talking specifically because as in, in prevention work, and especially those of us who are funded by organizations like the DFC that have some really particular models about wanting us to look at data and do strategies that are geared directly toward places where our data is highest like alcohol.
We still talk about alcohol. We still do strategies that are aimed at alcohol, but every time I talk about alcohol, I talk about its connection to other use. And every time I talk about alcohol, I also talk about the growing trend of young people nationally and in our community. Now I'm super proud to say who are not, who are choosing not to not only use alcohol, but therefore also.
Choosing not to use other substances. So I'm always making those connections and I'm always talking about those three things. So we've used those in parent materials. We've done some infographics where we put together a whole parent university, for which Dr. Bob DuPont was the keynote speaker and talked about one choice before it was one choice.
And then we put together a set of parent workshops to talk about, okay. So if we're talking about this as a as a way of thinking and as a health standard, how do we connect that to the other kinds of health standards that you care about as parents? How do I make the connection between.
Prevention and what I'm doing when my kids are in kindergarten and first and second and third grade that the conversation about wearing a bike helmet is the same conversation which there's not a parent alive who has a second grader. Who's not, running after them in the street. If they don't have their bike helmet on, there's not, when I was a kid, not only did we not wear seat belts, we had cars that didn't even have seat belts yet.
I've now officially dated myself. Yes. I was a child in the seventies, maybe in the front seat, your car had a seatbelt that was a lap belt, but we certainly didn't have over shoulder seatbelts. We didn't have five point harness safety seats. We have those things because science taught us some stuff and we took that science and we used it to help do things that protect.
And see, and save lives and also protect people and vehicles. The same thing is true with this science. And we're trying to put those conversations on the same continuum. I have found it. And so we've done parenting materials and by the way, those materials are available and they help you think about how do I frame one choice within conversations about health, across the stages of development from the time that my children are very young to the time that my children are in 12th grade and beyond them preparing to go off to college.
And what does it look like? And the basic stay the same. They just develop as the child develops, right? The way we talk about it is different, but this, but the same things apply. We've done peer to peer messages. We've done a mosaic wall, which I shared with you, that students talked about sort of their reason why.
Like I'm one, I make one choice. The great thing about that. I am one campaign that mosaic wall is that we were trying to give a visual representation of the idea in our own community locally, that more and more youth every day are making the choice to be drug and alcohol free and why, and having that be about them in their voices, in their words, to adults in the community and decision-makers in the community, but also to their peers and one another.
Because one of the things we know is that youth who think right, that perception of your peers use sometimes affects your decision about your own use. If you think, quote unquote, everybody's doing it. And especially in those formative years, when being like other people is such an important part of natural and normal, youth development, I want to be like my peers.
So the more that kids think that other people are using, the more likely they are to use themselves. And so helping with those perceptions about use. And we literally grew that wall with individual tiles of young people, talking about their reasons for not using it was completely anonymous. So it didn't have to, it was perfect for the fly under the radar kid.
But what was great is each one of those individual tiles represented one individual making one choice, but then you start to watch that wall grew and it grew from 200 tiles. We installed it in our in our high school, it grew to over 300 tiles. We installed it in our middle school. It grew to over 800 tiles, individual young people talking about.
And yes, they're one. But when you look at the collective of 801. The power of that message, that more and more youth are choosing not to use it, not just philosophical, theoretical youth on a dataset, but real youth in our community who have scribbly handwriting and made little pictures on their tiles and put little hearts on the, for the dots on their eyes, your peers, your friends, your kids, our kids.
That it is an incredibly powerful message. We, our kids have done PSA's to share what one choice is and what it means and their reasons why we've created parent materials that explain what it is, but then also give parents tips and tools. So again, these are all those things that for those of us working in prevention, these are tools.
Others can use. And what's great about the toolkit which resides on our website. Of course, again, it's one choice prevention.org/toolkit. And if you just go to one choice prevention, you're going to find the toolkit. It comes up first and foremost, you can get there. All of those materials, we make them available to anyone who wants to use them.
You can brand them yourself, and in fact, members of our community from all over the country rural Montana, To suburban New York to urban California are using those tools in ways that make sense for their communities. We have folks who are presenting materials in Spanish, for example using them in their communities to share that message.
And we share those with each other, right? So we it's all about taking those three big ideas and finding how they fit and work within the programs and the prevention work that you're already doing in your communities. And that's, what's so powerful about it is that it doesn't matter that I'm from, suburban New York city.
And then I have a colleague who's from rural Montana or rural South Dakota. We were just online with a group in rural South Dakota. That's going to be doing some work with us. We all that message is powerful for all of our kids. And there are ways to incorporate it in and those ideas in to help youth make those healthy choices.
Caroline: I think Nancy, one of the, also the keys that you brought to us really early on is that this is a youth led movement. So we uncovered the data that this is already happening. But in fact, there are youth that are, have already been living this life. And what we're doing is finding them and helping give them a voice and giving them a platform if they want it to, if they want to stay under the radar.
Great. But if they want a platform, we are prepared to literally hand them the microphone and the PSA's that she's exactly that, that Nancy references are so powerful because you get these teens just ordinary people standing up and saying, I am one, I make one choice because, and then you get this kind of.
Group of them. I am one and you think, oh my gosh, I'm not alone. And it's so powerful. So that is really exciting. And as Nancy is talking about, we do have this one choice community. That's part of our website. So you can go on our website, you can use any of our information. I think that's really important.
It's free to use. You're welcome to use it. We would love to have you use it and we'll help you use it and even personalize it. So if you want to do those mosaic tiles that Nancy was talking about, you can literally get us to put your work logo on it, your organization's logo on it and print them out.
You bred them out. We can't do that for you but we can work it out for you and then you print it out and you can do that exact thing in your prevention program already, all set for you. And that kind of. Availability of the materials is one of the things we're super proud of, but it's always growing.
So like another organization do you have a handout? And we're like, oh no, we don't have a handout. So we made one. No, we have a tri-fold handout that you can download and you can print and you've been handed out, oh wait, no, we have can't pay for the printing costs. We just want something. People can see, that's a link.
We can send them. Great. Here's a digital one-page version. We're constantly coming up with new things because. People who are actually using this request it or share with us what they're doing. And that is so exciting.
Nancy: And I would also just share that on the toolkit, which again, I think w we're really hoping that people would just go check out the toolkit, see what's on there, noodle around, call us.
If you're interested in finding out more, if you want to become part of that one choice community and join in those regular meetings and just hear what other people are doing, get ideas from one another I'm which always in this work is one of the most incredible and powerful things, right? Like we learn because we.
We meet one another, doing the same work in different places with coming at it from different backgrounds. And we can find those places where we have that common goal of helping youth. So the toolkit, I think it's important to note was. Developed by in collaboration, IBH and riots. We put that together. We coauthored that toolkit, but we worked with a youth advisory board that came from representative youth from about, we had a group of about 15 to 20 youth from all over the country.
Again, we tried really hard to make sure we weren't. Looking for partners in different, to have representation from different areas, different backgrounds urban, rural, suburban frontier, like all of it. And those youth were really part of developing, use those words.
We, we like to be referred to this way. Have you thought about this? I'm not sure that makes sense. So they were really a very integral part over a series of several meetings. Helping us develop the toolkit in what it should look like, and we continue to build it and grow it with input from youth. In fact, we have some meetings in the next two weeks coming up where we're going to be adding some new materials and we're getting youth involved in in helping us create those.
But we also do that with our adult member, coalition members, just getting them to give us input and say, Hey, I need a something. And then we say, great, let's make it together. And then let's make it available to everyone.
Dave: I love it. So listeners check the show notes, going to drop a link to both just the main website, the toolkit, and to the community where you can get involved and get connected with other folks from across the globe.
I'm guessing that are all coming together around one choice to close out this episode, though. I've got a question for both of you. If you were to have one, if you're going to remember one thing from this episode, remember this for our listeners, what would it be?
Caroline: I think it's a message of hope. I think I think that knowledge we have based on that data, that there are a growing number of teens and it's a large number who are. Choosing not to use any substances and who are prioritizing their mental and physical health and their futures. That is a great message of hope.
And it can get discouraged in this business. You can feel like we're just constantly fighting an up hill battle, with talking a little bit about that legalization of marijuana and the big commercialized enterprises that are trying to undermine our prevention messaging. And so you can get really lonely and discouraged.
And I think seeing those numbers and realizing that no, there are a lot of teams that are already making this healthy choice. And there are a lot of organizations that are working together and join us and be part of the solution. So
Nancy: it's funny when a home, when we were both taking that big, deep breath in and giving that its very serious thought to your question, literally, as you were saying it, Caroline, that same answer came to my head, which has.
Youth use is not inevitable. It's that bit like it's not inevitable. And in fact, that's not even something that's not about us, right? That's about them. They're already doing it. They didn't ask our permission. They're already doing it. And by the way, they're doing it in lots of places, right? Even in all sorts of settings and all sorts of youth, right?
This is not just about privileged white youth. It's not about urban use of color. It's not, it's all youth it's youth across a whole representative group. Youth use is not inevitable when it feels like that too, you go find the youth because. I have to tell you when I have my worst days, when this work gets me down, spending time with them and seeing what they're doing, how they're thinking, how they're empowered about this message of health for their peers and for themselves it changes everything.
So it's the message of hope. I completely agree and join us because we need as many good hands and good thoughts and good thinkers as we can get helping to spread that in and get it out there to as many people as possible.
Dave: Beautiful messages. And I am hooked. I am sold. I'm going to be pushing one choice, Sharon it far and wide listeners go to the website, get involved and also help spread that message of hope that it comes down to just one choice.
Thank you both so much. It's been an honor
Caroline: Thank you so much.
Nancy: Thank you.
Dave: That concludes this episode. Thanks for tuning in. Be sure to hit the subscribe button and share this episode with a friend before you leave. And we look forward to seeing you on social media, because prevention is better together. Together are stronger.
