The future of substance abuse in youth
Developmental psychologist Bonnie Halpern-Felsher specializes in teenage health-related decision-making, especially in their use of tobacco, alcohol, cannabis, and other substances.
Young people, she says, value immediate social benefits over long-term risks. In response, she supports bans on flavored nicotine products and has developed nationally and internationally used evidence-based substance use prevention and intervention programs, including some that are culturally targeted, such as her vaping prevention curriculum in Hawaii zeroing in on popular flavors like mango and poi. The reward, she says, is reduced substance use and better mental health. “Talk to your kids. Don’t lecture. Have a conversation,” Halpern-Felsher tells host Russ Altman of the best way to break through on this episode of Stanford Engineering’s The Future of Everything podcast.
Transcript
[00:00:00] Russ Altman: This is Stanford Engineering's The Future of Everything, and I'm your host Russ Altman. I thought it would be good to revisit the original intent of this show. In 2017 when we started, we wanted to create a forum to dive into and discuss the motivations and the research that my colleagues do across the campus in science, technology, engineering, medicine, and other topics. Stanford University and all universities, for the most part, have a long history of doing important work that impacts the world. And it's a joy to share with you how this work is motivated by humans who are working hard to create a better future for everybody. In that spirit, I hope you will walk away from every episode with a deeper understanding of the work that's in progress here and that you'll share it with your friends, family, neighbors, coworkers as well.
[00:00:48] Bonnie Halpern-Felsher: I don't think we're exaggerating the mental health issues, if anything, we are underplaying those right now, and really not working with young people. I see a lot of, not parents directly, or, or, or educators directly, but just society who's sort of blaming and shaming young people. Why are you depressed? Why are you on drugs? Things like that. When, if you step back and think about how the last few years have been, it's been really challenging. And so we really need to support young people and realize that the mental health crisis is real.
[00:01:24] Russ Altman: This is Stanford Engineering's The Future of Everything, and I'm your host, Russ Altman. We're about to have a great show and I want to encourage you that if during the show someone you think of or somebody pops into your head, that's your cue to tell them about the show. Word of mouth is a great way to spread news about the show and to expand our listenership and also to impact more people. So if you think of somebody during the show, send them this message. Today, Bonnie Halpern-Felsher will tell us that the way adolescents and youth make health related decisions, and this is not that surprising, is very different from how adults make these decisions. That can lead to misunderstandings about why they're doing things like substance abuse with nicotine products, alcohol, and cannabis.
[00:02:10] She'll tell us, however, that understanding their ways of thinking can lead to interventions to help improve their decision making. It's the future of substance abuse in youth. Today we're continuing our feature called the Future In a Minute, after my conversation with Bonnie, I'll ask her a few rapid questions and she'll give us a few rapid answers. And also before we get started, a reminder that if during this show you think of somebody, send them a message about the podcast, that'll help grow our listenership. When we think about youth and their health, there's some good news. We've all heard that teenage pregnancies are down. We've also heard that drunk driving deaths are down among teenagers. However, there's also been bad news. Mental health and stress and anxiety for the youth is up.
[00:03:02] And this unfortunately can lead to substance abuse. I'm talking about nicotine in cigarettes or vaping, alcohol and cannabis use. So we'd like to get that under control because the way youth think about these decisions, we will learn, is not about the future bad impacts. It's what about the here and now. What are my friends doing? What's gonna help me fit in? Well, Bonnie Halpern-Felsher is a professor of pediatrics, epidemiology, and psychiatry at Stanford University, and she's an expert on adolescent psychology and adolescent health decision making. She'll tell us that the way adolescents make decisions about using substances is not what you might expect, and understanding that is gonna be key to helping them make better decisions.
[00:03:52] So Bonnie, why have you decided to focus your work on adolescent issues, especially related to tobacco, alcohol, marijuana, and other substance uses?
[00:04:02] Bonnie Halpern-Felsher: Well, hi everyone and hi Russ. It's great to be here. So really, uh, one of the things, I'm a huge advocate of adolescents. And adolescents people think cannot make decisions. They do, but the decisions they make sometimes may not be what we adults want them to do. So my job and my goal has always been to help understand adolescent decision making around all areas of health related risk behaviors, sex, drugs, rock and roll, but then also to help them become empowered to make better decisions for themselves. So why substances in particular? You know, we hope adolescents grow up to a healthy sexual relationship, for example, in any area, you know, way that they may have.
[00:04:46] Even alcohol, in moderation as an adult, but there are some areas of substance use, tobacco, marijuana, fentanyl that really no use is okay for an adolescent unless prescribed and stuff like that, but that we're really, really concerned about it. I'm really worried about brains and brain development, lungs and lung development, so that's why I really focused on adolescent substance use. The other reason, quite frankly, is. We're seeing so many ads and marketing and deception from the tobacco and cannabis industry that I just feel like that is a perfect area for advocacy, for really helping to change the environment for young people. So that's why I focus on those areas.
[00:05:32] Russ Altman: Great. And I want to get into the details of that work 'cause it's very exciting. But you said a bunch of things here that kind of lays the groundwork and the, and the two things I want to kind of talk about a little bit is the current status. A lot of us have heard that things are changing, like that driving deaths for teens are down and, but, uh, and that even, um, even unexpected pregnancies and stuff like that are down. And so there's a sense that, oh, maybe things are getting better. But then we also hear about internet usage and phones and, um, feelings of isolation. So I would, uh, the first thing I wanted to ask is what is the general state of adolescent health, uh, mental health, and obviously these related issues of substance abuse. And, and, and as, especially since you've watched it for a couple of decades, and so you have kind of a sense of how things may have changed. And in particular, are people overstating the changes or are these real changes that you're noticing um, in shifts?
[00:06:26] Bonnie Halpern-Felsher: So it depends on what behavior we're talking about and what health issue. So let's start with mental health. You're right. I mean, mental health has taken a huge toll right now, even before the pandemic. But with the COVID Pandemic, we're seeing so many young people who are depressed, who are even suicidal and, and really committing suicide. And we're seeing that increase more and more. You know, adults are depressed and anxious. But we have more coping skills. Young people don't. So what they do is they turn to the internet, they turn to social isolation, they turn to substances, to self-medicate. So I don't think we're exaggerating the mental health issues. If anything, we are underplaying those right now and really not working with young people.
[00:07:12] I see a lot of, not parents directly or, or, or educators directly, but just society who's sort of blaming and shaming young people. Why are you depressed? Why are you on drugs? Things like that. When, if you step back and think about how the last few years have been, it's been really challenging. And so we really need to support young people and realize that the mental health crisis is real in terms of substance, I mean, you're right. Um, unprotected sexual behaviors has gone down, which is great. Drunk driving and impaired driving has gone down, which is great. Young people have gotten the message about sober sitters or making sure that you're not driving drunk or we have Uber now and other.
[00:07:52] Russ Altman: Right, right. And soon it'll be Waymo so there's no humans involved.
[00:07:55] Bonnie Halpern-Felsher: And soon is Waymo, which apparently is increasing now everywhere. So, absolutely right. So, you know, I think they've gotten the message about that. But they've also heard, unfortunately, from people from the industry that tobacco and nicotine can help them feel better, or cannabis can help them feel better, or take a pill and you'll feel better. And I think they're hearing those messages and they're hearing the misperceptions of those rather than the real messages that they need to be hearing. And so we are seeing increases in substance use. Now, overall substance use has gone down. But cannabis, fentanyl, and I would argue nicotine, vaping, even though we see the national levels going down, I'm in schools, thousands of schools across the country, and I'm hearing 50, 60% of students vaping. So, a lot of concern there.
[00:08:46] Russ Altman: Great. Uh, great, thank you. That really sets the stage. And then the other thing, the other general comments that I wanna, um, address is, um, you study, and you mentioned it right up front, health related decision making, perceptions of risk and like communications about health. What should we, who are not experts, know about adolescents and how they do those things, how they think about health? Uh, because it might inform the rest of our discussion, and I think a lot of us don't have a good feeling for what's going inside those heads.
[00:09:16] Bonnie Halpern-Felsher: Absolutely. So adolescents, when they're thinking about and making decisions, they're more attuned to the here and now, and they're more attuned to social issues. But when we talk about, you know, as physicians or psychologists or healthcare folks, or, or health communication, we tend to focus on the risks. In 30 years, you're gonna get lung cancer. In 20 years, you're gonna have heart issues, whatever it might be. Kids don't care about that. They care about today, they care about, you know, I, I used to, when I was talking more about cigarettes, which aren't an issue, thankfully with teens, but with cigarettes, I'd look at a middle school boy and just go point and say, it's harder to have sex if you smoke.
[00:09:56] And, and immediately that, you can see the light go, I'm never gonna smoke. Never. Or it's gonna be harder to kiss your, your partner or something kids care about today. So talking to them about, you know that, that you might have bad breath or talking to them about. It's harder to do sports. It's harder to run if you vape, or you might think that it's easier to concentrate with cannabis, but it's actually harder to concentrate. It's harder to sleep. And also realize that we harp on the physical aspects. Kids care about the social aspects, the positive, the benefits. So when we say, you know, I always say, you know, the lung cancer, or you're gonna turn green and, and grow a horn.
[00:10:42] And teens are saying, but wait a second. That didn't happen to me. I smoked the other day and I was the life of the party and I didn't crash and all these things. We look like idiots as adults, and we, they tell us we don't trust you when you're hyperbolic, when you're talking about things we don't care about. So as communicators, we need to hone in on what they care about today. And it's the social aspects, the physical and emotional and, and the social benefits, not the risks as much.
[00:11:16] Russ Altman: Great. Well, thank you. So that really is a great tutorial on how to think about this. And now let's go into your work, which is why you're here and, and, and you've really been an advocate and you've been out there. So people think about professors sometimes as up, up in an ivory tower. We're not in touch with the real world. This is not a claim that I'm guessing you're accused of very frequently. So, so tell me how you've taken your academic interests and turned it into kind of an action plan.
[00:11:42] Bonnie Halpern-Felsher: Absolutely. So two areas that we have action. Well, three, if you think about, we also try to train the next generation to do this work, 'cause I'm not gonna be doing it forever. Um, although I hope I will. Um, so one is translating to advocacy. So I've taken the research showing, for example, that teens are using nicotine e-cigarettes and cannabis because the flavors, you know, they come in. Unicorn poop and honey doo doo and banana butt, and all these crazy flavors, that's why teens are using. So I've taken that to testify at the city, county, and state levels across the country to really help advocate for banning e-cigarettes and tobacco that have flavors and, um, you know, claim the fame of, of really helping with that bill in time.
[00:12:28] Russ Altman: And those flavors are pretty much entirely there for the youth, um, audience, is that true or, or do we have a lot of 30 and 40 year olds who love the flavors or?
[00:12:38] Bonnie Halpern-Felsher: Yeah. I mean, 30 and 40 year olds might like the flavors, but you know, think about it for us, like, I don't like the syrup flavors anymore. They really are for kids and, and they originally, the e-cigarette companies, for example, claim that those, that adults needed the flavors to help adults quit smoking cigarettes and turn to e-cigarettes, which there really isn't evidence that adults quit smoking through e-cigarettes. We've got other ways to help adults, but more importantly, adults don't need those flavors. Kids do. And kids tell us that that's why they're vaping.
[00:13:11] So yeah, one of the claims to fame is really helping to pass bills and, and at the city and state levels to be able to get flavors off the market, to reduce the nicotine levels is another thing I'm trying to do to change the marketing and so on. So my lab really does a lot of work in the advocacy or, or action there. And the other that I'm probably most known for are, are substance use prevention and intervention curriculums. We're in thousands of schools. We've reached 5 million kids across the country and globe. We're used in 12 countries as well. So we've got free, I'm not selling anybody anything, free substance use prevention, school-based curriculums. Um, and we do free trainings and teach people how to use these. So, so that's,
[00:13:54] Russ Altman: What, what, what age groups are, are we talking about multiple programs for different age groups? Of course, I remember as a parent of kids in the, in the nineties, there was this thing called dare and my kids still remember their DARE classes and with mixed reviews, to be honest. But, um, tell me what are the target, uh, demographics of these programs?
[00:14:13] Bonnie Halpern-Felsher: Yeah, and, and it's funny, we say that we're the new DARE and people look at me and say, no, no, better, better. But, but in terms of sort of, uh, becoming a household name, I've had parents who've emailed me the permission slip from their schools, Bonnie, they're using your curriculum. I'm like, oh. So cool. Um, so we have elementary, middle, and high school programs, separate programs, and we have cannabis, nicotine, e-cigarettes, fentanyl, all drugs, alcohol and so on, and all demographics. We even have a set of curriculum specifically for our trans and queer youth as well. So, because they're facing particular stressors right now and using substances. Um, we've got, uh, specific curriculums for Hawaii, for example, and, and other cultures. And we do have Spanish as well. Uh, so we reach every youth who is out there as much as possible.
[00:15:04] Russ Altman: And how do you measure the success? Uh, uh, um, yeah, how do you measure the success? Because it's, it's a tough one, and you can look at societal trends, but you would literally like to know in that school where my curriculum was used, do I have better outcomes than if my curriculum hadn't been used?
[00:15:20] Bonnie Halpern-Felsher: Absolutely. So we, we do that a few ways. In brief, one is we have embedded pre-post curriculum, uh, excuse me, embedded pre-post surveys in the curriculums that, um, that classes can just register. They don't have to, but they can register, uh, on our data dashboard for the curriculums. And then in doing that, they get a pre and a post-survey, and then they can see, and we can see that they've changed the needle on knowledge, attitudes, and intentions, but we also do formal pre-post evaluations. Thankfully we've been funded by the NIH and other funders to do randomized control trials. It's hard because we've had the problem with schools saying, I don't want to be part of the randomized control trial because I don't wanna risk being the control group. We'll use the curriculum, uh, which is, I joke with my program officers, isn't that enough to show that it works?
[00:16:12] Russ Altman: Right, right.
[00:16:13] Bonnie Halpern-Felsher: Classes wanna use it, teachers. But thankfully we've said, because teachers say, how do I know it's effective? And I say, well, help me evaluate it. And so we've had some success. So we, we are, um, evidence-based. We are seeing changes in knowledge, attitudes, intentions, and behaviors, which is wonderful. Uh, and we also are seeing changes in, in, with our cessation curriculum, Healthy Futures, in young people quitting, which is really ultimately what we are hoping to do.
[00:16:41] Russ Altman: Yeah. On that note, I wanted to ask before, um, do, do kids realize that they're addicted and do they say, I wanna quit? Or is that just a thing that happens when you're an older adult?
[00:16:52] Bonnie Halpern-Felsher: Yeah, it's a great question. I was just thinking about that. So, teens don't always realize that they're addicted. But there's been some change where teens are now starting to recognize that they're addicted and parents are starting to recognize. When I first started this work, particularly around cannabis and e-cigarettes, nicotine, e-cigarettes, I got, uh, even colleagues who said, oh, you can't become addicted to those. You can, and we have science to prove it, and we have just kids telling us. So the hardest part though, Russ, to be honest, is helping young people to quit. We don't have nicotine replacement therapy, the patch, for example, approved for anybody under 18, a big area for advocacy.
[00:17:33] Russ Altman: Oh, I didn't realize that.
[00:17:34] Bonnie Halpern-Felsher: Yeah, it's, now plenty of healthcare providers prescribe it. They just prescribe it off label, which is fine to use, but we don't have any science telling us how many patches, how often.
[00:17:47] Russ Altman: Right. Right.
[00:17:48] Bonnie Halpern-Felsher: These e-cigarettes have as much as one to multiple packs of cigarettes worth of nicotine in there. And we don't have much way, many ways to help adult, or, excuse me, we don't have many ways to help kids quit cannabis either. So that is a need, uh, an area that we really need to work on. And again, that's why we can't blame or shame these young people. They start because of the ads and the flavors, and then they are hooked pretty quickly because of the amount of nicotine or THC.
[00:18:18] Russ Altman: Now another thing that you said in, in a, in a previous comment was, I think you referred to Hawaii. I know you referred to Hawaii. And that led me to wonder, is there a geographic differences, uh, even in the United States or even globally? Like how, um, exportable are these methods? And do you have to, um, I guess you do because you refer to the Spanish language. Do you have to refine them for different subcultures even within the United States?
[00:18:42] Bonnie Halpern-Felsher: Yeah. So yes and no. The pedagogy, no scare tactics. We really talk about, instead of just saying no and no, which is what DARE did, to just say KNOW. And to really meet young people where they're at, no matter where they are on the spectrum of use, no use to substance use disorders, um, not talking down to young people. The thing we started at the beginning talking about, balancing the perceptions of benefits and risks and, and addressing those. That is uniform across the globe. But things like Hawaii, we built for them because they have different links of classes and the flavors, for example. It's more mango and poi and other different flavors.
[00:19:25] The marketing is different there and the products they have available are a little bit different. So we didn't do a huge 180 on the curriculums, but we did revise them. We're doing a little bit of differences in New York, for example, little shorter classes. Uh, making sure that the images are relevant across the globe or across the country. We have a Northern Ireland curriculum, and that was very different, for example, because their marketing is different and their policies are different. Uh, Vietnam did one, uh, but they just changed the language. Same thing with Spanish. It's just the language. So it's kind of a yes no, uh, on that, um, on that question.
[00:20:06] Russ Altman: This is The Future of Everything. I'm Russ Altman, and we'll have more with Bonnie Halpern-Felsher, next. Welcome back to The Future of Everything. I'm Russ Altman and I'm speaking with Bonnie Halpern-Felsher from Stanford University. In the last segment, we got a great introduction to how adolescents think about health decisions, why they're using these substances that we talked about, and what are some of the methods that Bonnie and her colleagues have developed to intervene. In this segment I want to ask about the marketing of both vaping products and also cannabis products. What kind of extreme reactions are we seeing in cannabis use? And finally, what are things that you can do if you're worried about an adolescent or a youth in your life?
[00:21:00] Bonnie, you made reference to, um, flavors, especially for flavors in vaping, but basically there is this industry behind nicotine. It's either cigarettes or vaping products, and, and they have marketing strategies. Uh, what are those strategies and how do you manage all of that as part of your research and your um, uh, interventions?
[00:21:20] Bonnie Halpern-Felsher: Absolutely. One of them is what we talked about, which is flavors, you know, clearly those flavors are there to attract young people. Unicorn poop, sugar booger, uh, honey doo doo, those are not attracting people, um, our age. Whatever age you are. Um, certainly not attracting my age. Uh, those are squarely attracting our young people. So, but, but also the ads. The, the ads show those flavors. The ads talk about freedom, which is something that teens wanna have, right? Freedom. Do what you want, use where you want, use under your circumstances.
[00:21:54] They show a lot of skateboards or bling or dancing models that look young, whether they are underage or not, they look young. The other is, um, that we really worry about are the actual products themselves that we haven't really talked about. You know, e-cigarettes or vapes look like USBs. They look like, uh, pens. They look like highlighters. In fact, we're starting to see some, what happened for a while, one is a highlighter. That's a, a highlighter, writes like one, actually writes like one, but it's a vape device. So if you're a parent or a healthcare provider, you wouldn't look,
[00:22:33] Russ Altman: It looks like the kid's studying.
[00:22:34] Bonnie Halpern-Felsher: It looks like the kid’s studying.
[00:22:35] Russ Altman: They're highlighting their history book.
[00:22:37] Bonnie Halpern-Felsher: Exactly. And then taking a hit. There are some that look like McDonald's Happy Meal toys. And then more recently we've seen these that are video game vapes. And if you don't inhale, you lose the game.
[00:22:50] Russ Altman: Oh my goodness.
[00:22:51] Bonnie Halpern-Felsher: There's one like when we were kids, the Tamagotchi idea, the one that we would have, if you don't take a hit off of the vape, your Tamagotchi character dies. This is really,
[00:23:01] Russ Altman: I had no idea. I had no idea the level that, that this reaches.
[00:23:06] Bonnie Halpern-Felsher: It is awful. And with, with cannabis, we're seeing similar things. We're seeing, you know, gummies that yes, adults are using, but kids are, and kids don't realize that maybe a dose or a, a serving size is one gummy. So they take, you know, how many times have you been able to eat one candy. They eat multiple, and they're getting really sick. So we're very worried about the marketing of cannabis as well. The flavors, the bling, the styles, and none of this is regulated or it is, but not enforced.
[00:23:38] Russ Altman: Yeah. So I wanted to get to cannabis. 'Cause that seems to me to be like a newer market. Like we've been having cigarettes of course, forever, uh, and then vaping. But the, the legalized cannabis market is relatively new. And I'm sure that that creates a dynamic situation for you in your research and in your interventions because you're like, it's a very rapidly evolving thing. So tell me, um, what are the specific risks and what are the specific things you're seeing in cannabis use that people may not be aware of?
[00:24:04] Bonnie Halpern-Felsher: Yeah, so one of the things that people may not be aware of is the amount of THC that's in these cannabis products. When I was a kid, they were more like 5% THC. Today they're upwards of 15 to 20.
[00:24:16] Russ Altman: So just to be clear, THC is one of the active ingredients in cannabis that give, gives you all of the symptoms associated with cannabis use or, or many of those symptoms.
[00:24:25] Bonnie Halpern-Felsher: Right, right. It's the psychoactive component. It makes you high, gives you that buzz. Absolutely. Thank you for clarifying that. Absolutely. And so it used to be about 5%, so yeah, it would still give you the buzz, high, but was not gonna cause some of the problems we're seeing today. Today we're seeing upwards of 20%. So just to explain that, today's one joint, which is like a cigarette style of a cannabis, one joint that you burn and inhale is equivalent to 10 joints when I was a kid.
[00:24:56] Russ Altman: Wow.
[00:24:57] Bonnie Halpern-Felsher: So at least tenfold, plus.
[00:24:59] Russ Altman: Is this through like, um, basically bioengineering the, uh, the cannabis to have higher levels of making these chemicals inside the plant?
[00:25:06] Bonnie Halpern-Felsher: Correct. Correct. And, and then we have something called dabbing that's about 80 to 90%. And what they're doing there is they're taking all the plant material out and just keeping the psychoactive component and enhancing that component within the bud, within the flower of that cannabis. So you're getting highly concentrated amounts of THC, so this is causing young people to wind up in the emergency room. We're seeing cannabis hyperemesis, so vomiting, cyclical, but the most concerning thing that I'm worried about is psychosis and depression and suicidality. We're seeing an increase of that. More data are showing that it's causing not associated. So you take a hit or multiple hits off of a 20 to 80% THC cannabis product, and you are more likely to have a psychotic episode, um, and more.
[00:26:03] Russ Altman: This is so important because you know, there's also the possibility that you would be depressed and then that's why you're using the drug. And so there's this cyclical thing where it can make it, the whole situation worse, um, much like alcohol does with depression.
[00:26:16] Bonnie Halpern-Felsher: Absolutely.
[00:26:17] Russ Altman: And, and we're already seeing this, evidently.
[00:26:19] Bonnie Halpern-Felsher: Yeah, not, and, and people don't realize that the link between cannabis and these mental health issues is real. And we're thinking causal, not just associated. So yes, there's that cycle, but that it's enhanced and caused by also the cannabis use. And, and we don't have a nicotine or cannabis standard in the US. You can buy as much as you want in other countries. You can't have endless amounts of nicotine and THC, like in the US.
[00:26:48] Russ Altman: So are, when the kids are using, uh, cannabis products, is it smoking mostly or are they putting it in the brownies or like what are the methods? And, and, and I don't even know if there's vaping yet. I hate, I hate to even say this, vaping for kind of cannabis, um, but is there?
[00:27:04] Bonnie Halpern-Felsher: Yes. So yes, yes, yes to all of what you said. Um, smoking joints interestingly, while kids are not smoking cigarettes, they are still smoking joints, but we're seeing an increase in the vaping. So you used to, vaping in the, like a volcano vaping device or, or um, is not that new. But the smaller more pen-like hideable vaping products for cannabis, yes, is very common. You can also just buy a nicotine, not trying to give suggestions here, you can buy a nicotine vaping device, inhale about half of it, and then add in cannabis oil and you get that double whammy. And we're seeing that.
[00:27:44] Russ Altman: So it's DIY stuff.
[00:27:46] Bonnie Halpern-Felsher: It's totally DIY. We're seeing that all the time. And then edibles, brownies, cookies, uh, you, you go into a vape shop and a cannabis shop, uh, you, marijuana shop, you can see these. And, and similar to what we worry about with the nicotine, they look like candy for kids. And I'm very worried. I hear, just pop a gummy and you'll be fine, without really realizing we're normalizing these behaviors.
[00:28:10] Russ Altman: So, so here's a, a question that I, I hate to ask, but how young are the, are you seeing kids who are being exposed? You know, I, I'm imagining just having had kids myself that, you know, if you are a younger child with older siblings, you might be exposed to things very early that might make us extremely concerned. So just give it to me like, when are you, what is the earliest that you're seeing these kinds of behaviors?
[00:28:34] Bonnie Halpern-Felsher: I'm gonna scare you, but it's second grade. I've been hearing about it.
[00:28:38] Russ Altman: These are seven year olds.
[00:28:39] Bonnie Halpern-Felsher: Seven year olds. Um, and you're right, they're getting from their older siblings, they look and taste like candy, whether we're talking about cannabis or nicotine. With our curriculums, you asked me earlier what age groups we have. I'm an adolescent developmental psychologist. I'm not a kid psychologist, and we built middle and high school curriculums and we were begged by educators to build it elementary because they're seeing it. We don't have national data, but we have a lot of anecdotal data showing that kids are using young kids.
[00:29:10] Russ Altman: So that leads perfectly, and we have about, we have about a minute and a half, two minutes left. I wanted to ask you for people who are listening, who think, who have adolescents in their life or even littler kids based on your last comment, um, and if they are seeing or worried about things, what are the kinds of approaches you would recommend? 'Cause I could imagine a parent or a teacher really being paralyzed, not knowing what to do. Um, what, what would be your advice to somebody who's worried about somebody in their life?
[00:29:37] Bonnie Halpern-Felsher: One thing I do want you all to know, um, and want people to know is that there is a tobacco 21 law as well as cannabis 21 law. So in states that have legalized cannabis, most people think it's still 18. So please be vigilant. Don't let stores sell to anybody under 21. We're seeing this all the time. So that's one thing to realize. The other is, what can you do? So look for signs and symptoms. Is your kid coughing? Is your kid having more headaches? Is your kid not able to sit at the dinner table because they have to go to the bathroom to take a hit? Does the room smell like strawberries, bananas, mango?
[00:30:18] Russ Altman: It's the flavors that might tip you off.
[00:30:20] Bonnie Halpern-Felsher: Yeah, that's probably not fruit salad. It's probably, uh, something like that that's going on. So think about that. Are, are their school grades going down? Are they kind of hiding big sweatshirts where they can hide the vapor within, it's really aerosol, but hide that in there. And then getting help if your young person's using. I mean, I'm a parent. My kids are much older as well. They're adults now. But I understand being angry, being hurt, being upset, but now's not the time for that. Go to your pediatrician, your adolescent medicine doctor, addiction medicine person, your school counselor, and get this young person some help, whether it's cognitive behavioral therapy, nicotine replacement, um, other therapies that they might need, and it may take a few times to help them quit. Like cigarettes, it's not gonna happen overnight.
[00:31:08] Russ Altman: So, but a general pediatrician is a good first. Uh, you don't necessarily need to go to a specialist. Your pediatrician will know the resources hopefully and be able to hook you up, so to speak. I don't really wanna use that phrase, hook you up with help.
[00:31:21] Bonnie Halpern-Felsher: Yeah. No pun intended there.
[00:31:23] Russ Altman: Okay, great. Well, this has been fantastic, and um, before we totally end our conversation, I wanted to ask you if you're ready for our new feature, which we're calling the Future In a Minute, where I ask you a few rapid questions and you give a, give me kind of short, rapid answers are. Are you ready to do that?
[00:31:39] Bonnie Halpern-Felsher: I'm ready. Let's go for it.
[00:31:40] Russ Altman: Great. Okay. First question, what is one thing that gives you the most hope about the future?
[00:31:47] Bonnie Halpern-Felsher: I think the thing that gives me the most hope about the future is that young people are admitting to needing some help and that there are more and more resources available that we need to have, have everybody be aware of right now.
[00:32:00] Russ Altman: What is one thing you want people to walk away from this episode remembering?
[00:32:04] Bonnie Halpern-Felsher: Talk to your kids. Just simply say, I listened to this podcast. Can I tell you what I learned? Don't lecture, have a conversation. Let's go on the Reach Lab website or some other website and let's learn together. But just talk.
[00:32:20] Russ Altman: Aside from money, what is the one thing you need to succeed in your research?
[00:32:25] Bonnie Halpern-Felsher: Schools to let me in to do my random control trials.
[00:32:30] Russ Altman: There you go.
[00:32:30] Bonnie Halpern-Felsher: Only the one thing.
[00:32:32] Russ Altman: If all goes well, what does the future look like?
[00:32:36] Bonnie Halpern-Felsher: I think the future looks like I, there are a lot of things I'd hope for, but in terms of this conversation, that we are really looking at more regulation around substance, substances, regulation around marketing, around flavors, around the nicotine and THC levels, and that when we have regulation, we have enforcement because we have a lot of people, lot of companies going through those loopholes and skirting regulation.
[00:33:03] Russ Altman: Yes. And finally, if you were starting over again and you needed to get your degree or your certification in a different discipline, what would it be?
[00:33:11] Bonnie Halpern-Felsher: Wow, that's a great question. I think, you know, I, having a PhD in developmental psychology allows me to pretty much do whatever I want. I love that. Maybe I would've been trained also as a clinical psychologist, but honestly I probably would go for a JD as well, a law degree, because so much of what I do is advocacy related and action related, and I work with lawyers, but I think having that would help me as well.
[00:33:37] Russ Altman: Thanks to Bonnie Halpern-Felsher, that was the future of substance abuse in youth. Thank you for listening to the show. Remember we have a huge archive of old back episodes that you can spend a lot of time listening to. It's more than 300 now. Also, remember to follow the show if you are enjoying it. Uh, that'll make sure that you get immediately notified of a new episode and can figure out if you wanna listen to it and when. You can connect with me on many social media, including LinkedIn, Mastodon, Bluesky, and Threads where I'm @RBAltman or @RussBAltman. You can follow Stanford Engineering @StanfordSchoolOfEngineering or @StanfordENG.
