The Addiction Inoculation

A CONVERSATION WITH JESSICA LAHEY

We turned to addiction-prevention expert Jessica Lahey, whose latest book, The Addiction Inoculation: Raising Healthy Kids in a Culture of Dependence, gives some hopeful answers to just those questions …

GRAPEVINE: Why was it important to you to write this book? 

JESSICA LAHEY: I grew up in a home with an alcoholic, and my husband and I both have lots of substance use disorder (which is what we’re now supposed to call ‘addiction’) in our family tree. We have two kids, and I realised that this was very much a genetic issue … So when I got sober in June of 2013, I began wondering how to put an end to the cycle. I started researching addiction prevention, and what I found was that substance use disorder is indeed preventable.

The tricky thing was, that word ‘preventable’ was never broken down for me in a way that helped me understand what I should be doing as a parent or an educator. I was teaching adolescents in a drug and alcohol rehab at the time, and I was constantly looking at my students and trying to figure out what we could have done differently, so they didn’t have to land in this place. Luckily for me, I have the coolest job in the world: to get curious about something and then get paid to write about it! So that’s what I did.

It was a long journey. It took me a year of research even to feel confident enough to write the proposal for The Addiction Inoculation. It was clear from my research that good prevention science for kids really does work; but I discovered that it’s about how we deploy this information that makes the difference.

There’s a former player for the Boston Celtics, Chris Herron, who does a lot of substance use prevention work here in the US. He has substance use disorder himself, and he nearly died from opiate use. He says we tend to pay a lot of attention to the stories and the ‘just how bad it got’ kind of stuff – how you reached ‘rock bottom’. But we don’t tend to look at why a kid picks up a drink or drugs for the first time. And understanding the ‘backstory’ is especially important in addiction prevention.

GRAPEVINE: How so?

JESS: The backstory is the catalyst for what starts kids off on a path towards addiction – whether it’s that they have specific trauma or it’s the way they’ve been parented. It’s about them not feeling worthy or loved or known or supported. I never ever blame parents; I’ve made plenty of mistakes, myself … sometimes we love our kids conditionally, or we love some imaginary version of them! Whatever the case, that’s the backstory that leads them to that first drink. It’s really become the focus of my work – looking at how to help kids feel seen and heard, and like they’re worthy of taking up space in this world for who they are and not who they were.

GRAPEVINE: And from that first drink or use, is there a progression parents can look out for?

JESS: The most important thing we can do is look for a sudden change in our kids and adolescents – whether that’s a change in appetite … mood … sleep … whatever. Sudden changes are a great indicator for a range of things, from general mood issues, to eating disorders … to drug and alcohol use. We know our kids, and it’s important to take notice when they’re not acting like themselves. The hard part for parents is that even if it’s a positive change – like if your kid’s been really depressed, and suddenly they’re elated and have more energy – you have to be concerned about that too. 

You’ve got to figure out if it’s coming from a good or unhealthy place.

GRAPEVINE: What’s the title of your book about – ‘The Addiction Inoculation’?

JESS: With inoculation, we generally mean vaccinations and that kind of thing. There’s a school of thought in sociology known as ‘inoculation messaging’, and it’s the idea that giving kids good and age-appropriate information helps protect them from making damaging or destructive decisions. For example, giving kids what we call ‘refusal skills’ in everyday contexts means that, when someone approaches them with alcohol and says, “Come on – just have some!”, it’s no big deal for them to say no.

If we’ve had some good prevention talks at home and someone offers them alcohol and tells them, “Everybody’s doing it!” – they have the power to refuse that because they know the facts; they know what that person is saying isn’t true. It can also help to do some role-playing with them. Ask your kids, “What if a kid were to say to you, ‘Come on, it’s no big deal’, or ‘Everybody does it!’ How could you respond?”

So, if your kid is strong in their ability to say no to getting in the car with a drunk driver, they’re also going to be stronger about standing up for themselves and saying no to someone who’s pressuring them to have sex before they’re ready.

It’s about having that strength and resilience and trusting their instincts in those moments. It really is just about following the science and making sure that kids are adequately prepared for the world and not just going to shut down when they encounter difficult decisions.

GRAPEVINE: What are some barriers you’ve faced in getting this information out there?

JESS: I do a ton of speaking, and I don’t have any problem getting people to come out to talk about things like helping increase your kids’ learning engagement … but the minute I start talking about substance use, it scares people. That’s why I started making videos to share – so that if people want to learn about substance prevention, they can do it privately from their Instagram or TikTok account on their phone.

I’m willing to get ears however I can! But I think we’ve got to stop feeling shame and guilt around substance use disorder. I’m grateful for all the people who are willing to come out and say this is not something to be ashamed of. This is something that many people face, and it’ll only get better when we stop keeping secrets about it. And if that means I’m out there shouting about it on any platform possible, that’s how I’m going to do it. 

As is true about the backstory, it’s essential to try to understand the history that some of us might have with our own families – to figure out our own way to work around that and not just follow old negative patterns. I try to reassure the people seeking help in rehab that we’re not just weak people who couldn’t control ourselves. There are components of genetics, of trauma … it’s so important for people to understand that this is not something to feel shame and guilt about. This is something that – like with mental health disorders, or diabetes, or heart disease – we can manage with prevention and proper care. 

I want people to understand that sometimes reaching for drugs and alcohol was the best decision they felt possible at the time … but by giving people more information, we can help them make better decisions. 

It’s not just that I’m a weak-willed human being (because, believe me, I’m perfectly willing to admit when I’m being weak-willed – but that has more to do with using Twitter too much!). It’s not why I’m an alcoholic. I’m an alcoholic because my brain works differently in the presence of alcohol.

GRAPEVINE: What’s the danger of avoiding the issue of substance use around our kids and within our families?

JESS: We have this culture of silence around mental health disorders and substance use disorder … and again, there’s so much shame and guilt around these issues. A lot of what I try to help parents do is to get their kids talking, because it’s vital to keep lines of communication open.

Remaining silent is a real trigger point for me. When I was a kid, it was so damaging to me to witness the substance abuse in our home and to know that something very unhealthy was happening, while being told that I wasn’t seeing what I was seeing. It was highly distressing to me that I wasn’t allowed to speak openly and honestly about the situation. It’s gaslighting children to tell them, ‘the perception that you have of our home and our lives and our family is wrong – I’d rather you saw it this way’… 

So if you’re saying that your kids’ Dad is ‘taking a nap’ when he’s actually passed out drunk, that’s really problematic …

GRAPEVINE: How should families dealing with substance abuse disorder in older family members approach the subject with their kids?

JESS: I’m really committed to giving children correct information about what’s happening around them. Certainly, we need to protect children from trauma and from learning too much before they need to … but if my kids are suffering because I have an alcohol use disorder and I’m sort of glossing over it and pretending that everything’s fine, that’s really damaging.

It’s also necessary to make kids aware of the very real risks associated with their own potential substance use while they’re young. Whether it’s alcohol or nicotine or cannabis, or other drugs – those chemicals react differently in an adolescent brain, which is still developing. Things that would be low to moderate risk in an adult brain can be moderate to high risk in adolescence.

There are very specific things that can happen to the brain with substance abuse; in chronic users of cannabis, for instance, the hippocampus is smaller than in the general population.

It’s only been in our lifetime that we can see inside the human brain to observe how it functions. So we’re learning so much, so quickly, about the ways that drugs and alcohol can hinder or arrest development during adolescence – a time when the brain really needs to be developing on an even trajectory. Drugs and alcohol take that away from kids. 

GRAPEVINE: What are some of the patterns, lifestyle factors, experiences, and character traits that are associated with a greater risk of substance abuse by adolescents? 

JESS: Genetics are about 50-60% of the risk picture when it comes to substance use disorder, and the other 40-50% is about adverse childhood experiences and other challenges. These can range from more easily-recognised traumas like the loss (or incarceration) of a parent, violence in the home, or sexual or physical abuse … to things like racism, bullying, social isolation, adoption, childhood
aggression, etc. Even things like undiagnosed learning issues and academic failure can put kids at risk of developing substance use disorder.

In that rehab for adolescents where I taught, I almost always had a kid with an undiagnosed learning issue – commonly dyslexia and/or ADHD. Many of those kids had just been told, ‘school’s not for you’ … ‘you’re not a good reader’ … ‘you’re academically challenged,’ or whatever. Gabor Maté deals specifically with the link between ADHD and addiction in his book Scattered Minds. According to the research, people who are well treated for their ADHD have a reduced risk of substance use disorder over their lifetime, whereas kids who are not well medicated or treated have an elevated risk.

With all these things, whether it’s trauma or other adverse experiences in childhood, early intervention is really the key – because the closer we are to a risk factor, the easier it is for us to deal with it. But if we wait too long, we’re then dealing with a whole spider web of risk factors, which can be much harder to untangle. It also raises the possibility that they’ll cope some other way, like by using drugs and alcohol.

GRAPEVINE: There can be a tendency by parents to maybe get a bit complacent and assume that their kids would never try drugs or would never struggle with drinking … What’s the danger of this sort of mindset?

JESS: I never want to blame parents – but I think they need to understand the risk factors and how majorly genetics (for example) can affect the picture. Very few people don’t have addiction somewhere in their family, and it’s important to talk about that.

Time and again, I see a willingness to turn a blind eye or gloss over an issue in their family – like, ‘oh, that’s just an individual situation’, or ‘that person’s just mentally ill’, or whatever. They don’t see that their kids may have a heightened risk according to their genetics. 

GRAPEVINE: For families that do recognise a genetic predisposition towards substance abuse disorder, how should they best approach the issue with their kids?

JESS: That’s the picture my kids grew up in, and we’ve always been honest with them about it. Even before I was ready to come to terms with my own issues, when my parent that is an alcoholic had a relapse once over a holiday, we didn’t keep that from our kids. We explained that the reason that the holiday was all messed up was because their grandparent relapsed, so it wasn’t safe for us to stay there. And so sorry about Christmas, but that’s what happens when you have someone with substance use disorder in your family. 

No lies – just the honest truth. I think that honesty translates in a positive way to kids. Not only do they not feel lied to, but it helps them understand that if they have a genetic predisposition for substance use, then at the very least, they’re going to have to think about it more than their friends do.

Good substance use disorder prevention is about giving good, solid, accurate information to kids and trusting them (to a degree) to make good decisions for themselves based on that information. So the more honest information we give them … the more we teach them about their genetics and how drugs and alcohol can really mess with the developing adolescent brain … the better their decision-making can be.

Another aspect of risk prevention I talk about in the book is the importance of helping kids develop a sense of competence and self-efficacy.

GRAPEVINE: What role does that play in preventing addiction?

JESS: Well, self-efficacy is the ability to feel like (by making a decision and taking action) you can affect change. I remember one kid in my rehab classroom telling me that there was no point in him having any big aspirations in life, because all the men in his family went to prison. That’s an incredibly low sense of self-efficacy – the expectation that even if he did his best at school, even if he went to rehab and stayed sober, even if he made all the right decisions … he’d still end up in prison. 

On the other hand, someone who understands that they can advocate for themselves and make good decisions – that if they want to change the world around them or the circumstances in which they live, they can take action and change will occur. That’s someone with high self-efficacy.

Self-efficacy means that kids start to feel like they have some power, and they have control – and that helps them create a sense of competence in themselves. Competence is about building skills and knowing how to do things in different contexts. It’s really important for kids; the more competent they feel, the higher their self-esteem.

Adolescence is designed to push kids towards novelty and risk, so they can develop competence and become capable adults who can contribute to the world. As parents, we can help foster a sense of competence by increasing our kids’ sense of autonomy – by allowing them to make decisions when it’s not life and death, and giving them more control over their own lives as they grow and mature.

GRAPEVINE: Some parents subscribe to a school of thought that it’s better to allow kids to drink at home so that they can be supervised, and to prevent them from going out and getting drunk in unsafe places … What does research say about this kind of practice?

JESS: The research is extremely clear on this. When parents have a consistent and clear message of ‘no underage drinking’, that is associated with better outcomes for kids. I suggest that parents explain that this is about healthy brain development, not just the legality of it – because the drinking age differs from place to place, so that part’s a bit arbitrary. What I really care about is helping protect kids’ brains while they’re still developing. 

Another thing I hear is, “Well, I just want my kid to be like one of those European kids who don’t go crazy with alcohol when they hit legal age because they’ve always been allowed small amounts at home, and it’s never been forbidden”. The European Union has the highest level of alcohol consumption in the world and the highest per capita number of deaths attributable to alcohol use! 

So it’s the last place we should be holding up as a paragon of responsible alcohol use. Those stats are never discussed in that whole romantic version of ‘French kids get to drink wine at the dinner table’. I’ve spent time in Europe – I lived in England and Italy for a while – and I was totally sucked into that, too – that’s how I raised my older kid! But when I did the research for this book – despite how challenging it was – we changed the rules of our household around alcohol.

GRAPEVINE: How do you suggest parents begin talking about substance use and abuse with their young kids?

JESS: Just like the sex talk, it’s not just one talk. It’s about having a lot of developmentally appropriate talks throughout their lifetime. I know that in the beginning, these conversations can feel intimidating. But it gets easier, I promise. As I say in the book, substance use prevention starts young, with really little kids. It’s just talking about why we put some medicines on the outsides of our body and some on the insides of our body. And why we don’t swallow the toothpaste or why we don’t take medications that are meant for other people. That sort of conversation. It’s starting with young kids of preschool and kindergarten age, leading to more complicated and adult conversations as they get older and older.

They’re never freak-out, ‘sit you down’ lectures – they’re just regular, everyday conversations. I still talk about substance use with my young adult kids all the time; if they were to use substances, they can talk to me about that – we haven’t just left it at, ‘Don’t use substances’. They have an elevated genetic risk for substance use disorder, so I say, if you’re starting to move from wanting to just have a drink socially here and there to, ‘oh my gosh, I can’t wait to get home so that I can start drinking’ – that’s a huge red flag! The switch from healthy or social use to unhealthy use can happen in a really sneaky way. And I want my kids to have as much information around that as possible.

Good quality substance use prevention is like a hundred-piece puzzle. For me, the hundredth piece was on June 13th, 2013, when my Dad said to me, “I know what an alcoholic looks like and you’re an alcoholic and you need help.” 

I went to my first recovery meeting that day. Sharing information and observations, and having these conversations, is about putting those puzzle pieces down. Really good quality prevention information is part of that puzzle.  

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THE ADDICTION INOCULATION CAN BE FOUND ONLINE OR AT ALL GOOD BOOK RETAILERS.
YOU CAN FIND OUT MORE ABOUT JESSICA LAHEY’S WORK AT JESSICALAHEY.COM