Youth at Risk: A Convergence of Concerning Trends

0:00:15 William Moyers
Hello and welcome to Let's Talk, a series of podcasts produced by the Hazelden Betty Ford Foundation on the issues that matter to us, the issues that we know matter to you, too. Substance use prevention, research, addiction treatment, recovery management, education, and advocacy. I'm your host, William Moyers, and today we're joined by my colleague, Dr. Joseph Lee. Dr. Lee, welcome.

0:00:40 Dr. Joe Lee
Good talking to you again, William.

0:00:42 William Moyers
Well it's great to have you on. I always learn something from you every time that we get to sit down to talk, I'm amazed at your depth and breadth of experience as our Medical Director on Youth and Family issues across our continuum, our mission, and this country. There's so many things that we could talk about. You're so well-versed in all of those. But I thought I would talk—start by talking about something serious which is the mental health of our youth today. What do you see as happening, given the proliferation of social media and all the other things that you know so well. Where is the mental health of our youth today?

0:01:16 Dr. Joe Lee
Well I see some concerning trends across our country actually. You know in the world of addiction, in treating young people with substance use disorders, you see a kind of psychology. Things are magnified. Stresses are magnified, stresses and conflicts in relationships are magnified. Loneliness and anger are magnified. You see a lot of young people who have substance use disorders who become what I call very fatalistic. That is, if their significant other breaks up with them, if they're met with some adversity, they go downhill very fast. They start to become suicidal. And we know this is the standard course in the world of addiction. But the scary thing is in recent terms, I'm seeing the same trend and the same kinda psychology in our general social dialogue.

0:01:58 William Moyers
Hmm.

0:01:58 Dr. Joe Lee
And I'm seeing it through social media. And I'm seeing signs that are concerning with increased mental health issues and suicides not just for young people but for older adults. It's almost like there's a part of society I don't wanna say has become addicted but the psychology of addiction, the loneliness, the anger, the magnification, the polarization that comes with addiction, is now upon us all. We just don't see it.

0:02:20 William Moyers
Do we blame that on social media?

0:02:21 Dr. Joe Lee
I don't think it's fair to just have a smoking gun and point it at one direction. I think they're all facets of society. What you'll find is that social media is a lot like substances. A lot of people will go on Facebook, Instagram, Snapchat, use it fine without any difficulties. But there's a certain subset of high-risk people that when they get sucked in, it really hurts them. Affects their mental health. And so, social media has this way of magnifying things. When you see a pretty picture of a kitten, everyone goes 'Aww' and Likes your picture, it's magnified. When you see a humane act and someone's helping someone else, everyone's tearing up, it's magnified. But when you see polarized discussions, when someone makes a—a comment that's politically incorrect or maybe discriminatory—and young people make mistakes, by the way. That also gets plastered and it's indelible. And there's a magnification in that that I think is very dangerous for high-risk people.

0:03:14 William Moyers
And then of course what exacerbates it are some of the substances that youth are using today. Substances that didn't exist in my using days of old. Can you talk to us about what you're seeing at our youth facility in suburban Minneapolis in terms of the dependencies that young people come in with?

0:03:31 Dr. Joe Lee
Yeah, you see a lot of the convergence between substance use and technology and social media. So they're celebrating some of their use, finding peers who are like-minded through social media and Instagram. Posting pictures. It's always pictures before the social event when everyone's happy and they look like they're having a good time using substances. They never post the pictures after the event. [chuckles] When people have, you know, vomited and there have been fights. But it's always the before. But there's a convergence in, you know, vaping, cocaine culture, other kinds of drug use promoting it through social media. Giving a false image to other people. But you also see the flip side of it.

0:04:06 William Moyers
Hmm.

0:04:06 Dr. Joe Lee
So a young person may have made a mistake. Maybe they got too intoxicated on something, embarrassed themselves at a social event. Well that also gets plastered on videos and messages. And that is very traumatic for those individuals. 'Cause then they get bullied, they get ostracized, they start looking at everybody's feeds and everybody seems to be going on vacation. Everybody else has a new significant other. Everyone else got a new car for their sixteenth birthday. And the more friends they have, the worse this becomes. And by comparison, their lives seem lonely and inadequate. And so, for young people who struggle with mental health and substance-related issues, sometimes social media and technology can be a bit of a curse.

0:04:44 William Moyers
How does it work at our youth facility? You see it day in and day out. Because they can't have their phones when the young people come in for treatment. Do they have withdrawal?

0:04:55 Dr. Joe Lee
They don't have withdrawal. In fact, you'd be surprised with how many people actually like to unplug a bit.

0:05:01 William Moyers
Even young people?

0:05:02 Dr. Joe Lee
That's right! [Moyers chuckles] In fact, we'll have conversations where they're like, 'You know, you have some friends that are maybe not the healthiest for you. They may be good people. But, they're not gonna encourage you to be in recovery or to live a healthy lifestyle.' And they know that. And they actually dread going to the rolodex of their contacts list. They wonder if they should change their cell phone numbers. They actually like the time that they have away from that. Because I think that's a lot of temptation for them. And it's a draw. It's almost like some people describe it as being on a leash. They feel like they can't get away when they wanna get away. So, I actually hear more dialogue that they don't know how to navigate being plugged into technology and being in recovery. And we have to teach 'em new skills to do that.

0:05:42 William Moyers
Hmm. What has been the impact that the legalization of marijuana is having across this country with our youth?

0:05:49 Dr. Joe Lee
The important thing to remember about legalization is that the sky's not gonna fall. Okay? So society's not gonna fall apart because of the legalization of any one substance. What it does create though is—is does create a regressive economy. And what that means is that most people drink alcohol fine, but ten percent of Americans consume half the alcohol in the entire country. So there's a Pareto distribution, an 80/20 role. Which means if you legalize a substance, if you legalize lottery tickets, if you legalize gambling at a casino, the curve you see for consumption is not a Bell Curve. It's not the average American's gonna gamble a couple of times and then only the people on the tippy tip will have problems. What you actually see is a distribution where most Americans do fine and so they have no issue with legalization. But there's ten to twenty percent of a population that might really struggle. And they consume too much. They go to the casino too many times. They buy too many cigarettes. They buy too many vape pens. They drink too much. And so we have this debate about are we okay with simply a utilitarian principle, where half of America won't really care, and some people are gonna make money and maybe we will generate taxes—or do we also have a dialogue where we look at the minority population? The people that might be affected. Who will also try to sing the same tune as everybody else. 'I can smoke just as much, I can drink just as much, I'm just like everybody else.' But they're not. And do we have a special dialogue and conversation inclusive of everyone, or do we just run amuck with capitalism?

0:07:13 William Moyers
Hmm.

0:07:13 Dr. Joe Lee
And I think that's the concern I see is not necessarily do we legalize or not, but how is it done? And how do we cater for the marginalized? Because if you're a company selling a vape pen, if you're a company selling marijuana or alcohol, you have to make the margin off the people who consume too much. You have to. And they know that. They know their own data. And are we okay with that as a democracy? So is it just simply majority rules? Or, do we have special conversations to say we also have to protect those people who are vulnerable? And that includes young people.

0:07:43 William Moyers
On social media, on vaping, on the legalization of marijuana, what's your counsel to parents? And how they talk about these issues with their children or grandchildren?

0:07:53 Dr. Joe Lee
Well, I think people know their families the best. And I ask them to kind of look in their mirrors, look at the families, look what their risk factors are. And if they're somebody who there's a lot of addiction in the family, they should message differently. It's definitely not a "one size fits all." There will be plenty of people in America who will smoke marijuana or drink alcohol or use different substances and be okay. They will not develop a substance use disorder. But their children will also try to replicate that. But their genes are different, their environment is different, maybe they face different adversity. Maybe they have different mental health issues. And can we have the dialogue in our country that is nuanced and mature enough to be inclusive of those people? And right now, we don't have that dialogue. We have a polarization and a shutting down of anything that goes against majority rule. And there's capitalism that's behind it which I think is a bit sinister. And it victimizes certain people. So, our organization is not against any drug. People are surprised by that, you know. And I let 'em know we're not anti-marijuana, we're not anti-alcohol. We are advocates for the minority. We speak for the minority population a significant minority of people who will not react the same. As other people when they use substances. 'Cause they need to have a voice. 'Cause other people won't understand.

0:09:07 William Moyers
Is there any hope? [chuckles] I mean I know you're the father of two young children who are suddenly—seems like they're growing up rather quickly now. But do you get worried as a parent about parenting in the 21st century?

0:09:20 Dr. Joe Lee
Absolutely. There's so many pressures upon children and parents. Everything from all the activities. It's almost like what we've done is we have taken away some of the nurturing connectedness that we know makes young people thrive—

0:09:37 William Moyers
Mmm.

0:09:38 Dr. Joe Lee
—And we've created amalgams through activities and sequences and manuals and somehow when you add it together, it's not as holistic. The sum is not reflective of its parts. And I think we lose something in that. And so, whether it's sports or academics, we're almost training to a metric almost. Instead of understanding the big picture of how young people developed. And kind of the love and nurturing that they need. And so, young people then feel incredibly pressured. And then they hear all these distorted images on social media, on the Internet, when they play video games, when they talk to their friends. No wonder they have so many mental health issues.

0:10:17 William Moyers
But what is the balance? I mean we can't keep putting our fingers in the dyke because we only have ten fingers. Where is the balance between technology and helicopter parents and freedom and rules?

0:10:33 Dr. Joe Lee
I think the balance is tough. It's always going to be a bit of a pendulum and it's gonna swing back and forth. But we always have to understand the "why." So if the why of doing an activity or having a metric or having social media—if you don't understand the "why," then you have to question why am I letting my child do this? So you shouldn't be reactionary. This isn't about turning off video game systems, it's not about banning cell phone use for your teenagers. We live in a technological age. We should encourage it. We should be pro-technology. But we have to be thoughtful. We have to have the wisdom about how technology and modern society will affect our young people. And in that clairvoyance, we have to be able to guide them. And say that if this really isn't important for my child's development, it's not that they can't do social media or these different things. But we can't prioritize it.

0:11:17 William Moyers
Mmm.

0:11:18 Dr. Joe Lee
And sometimes if it gets in the way, we have to know when we can let it go.

0:11:22 William Moyers
What role does technology play in a positive way as it relates to the issues that we know so well at Hazelden Betty Ford? Whether it be prevention on the front end or education on the back end, and treatment and recovery in between?

0:11:33 Dr. Joe Lee
Well, we're learning the rules of engagement for technology and technology can also be beautiful. It rallies people together. So that magnification—

0:11:41 William Moyers
Yes. Yes.

0:11:41 Dr. Joe Lee
Right? Which it's not—there's not a great direction to it right now, but sometimes that magnification, sometimes you see the best of humanity come out when people share through technology. 'Cause it lowers the threshold for them to be vulnerable and to share stories—

0:11:54 William Moyers
Aahhh.

0:11:55 Dr. Joe Lee
—And to connect and open up. So there's a power to it. But it's very much a double-edged sword. And it depends on the context and who you are and what the message is. And I think in time, we will as a culture understand how this works. Just like we've become accustomed to other technologies and they're not, you know—

0:12:10 William Moyers
Mmm-hmm. Yeah.

0:12:11 Dr. Joe Lee
—And I'm sure people, when they invented the TV or something and I wasn't alive then [Moyers chuckles] but had similar scares about stuff. So there's no point in creating a hysteria about it. We just have to understand what the rules are, how it affects our psychology. But more importantly how it affects our souls.

0:12:25 William Moyers
So where is the interface between technology and recovery, for example?

0:12:30 Dr. Joe Lee
I'm not sure that technology can completely replace the interpersonal connectedness that happens from one-to-one meetings. I'm not sure that it will fully be able to replace the intimacy necessary. However, I think if it's used properly, it can increase the connectedness over distances, over miles. It can lower thresholds for people to be vulnerable. And I think it can augment the kind of connectedness that people feel if there's a solid foundation.

0:12:59 William Moyers
Let's talk quickly in the few minutes we have left about from your perspective as a medical doctor and a psychiatrist, with an expertise in child development and so on, what do you see as the strides that are being made in medicine and in science overall that is hopeful as it relates to addiction treatment and recovery?

0:13:21 Dr. Joe Lee
I think after the opioid crisis, people are starting to understand the value of prevention. I think people are also understanding that health care is not about treating people who are too sick. It's about intervening before. And if you look at a lot of our programs, you know our programs don't necessarily require you to have some CPT billable diagnosable code, we help because we know that people on a certain trajectory need that help. And I think science in medicine is showing that there's a lot of promise in investing in those people early on with various services. Services like prevention and early intervention. Services like our children's program. Services like our family programs. You know, these programs that I think can help people who don't necessarily meet criteria for a diagnosis, but certainly could use the help. So I see a lot of promise in the science becoming more holistic in that way. And I don't mean it in a cheesy way. I think there's actually a lot of truth, a lot of research behind it, and it's gonna get better. We're gonna think differently about how health care is done.

0:14:20 William Moyers
Mmm-hmm.

0:14:21 Dr. Joe Lee
It's not about you getting a heart attack and then you go to the hospital and you get this procedure done—we're gonna think differently about wellness. And I think the science is gonna guide us there. And I'm excited about that.

0:14:29 William Moyers
I think we'll end on that high note. Dr. Joseph Lee, the Medical Director of our National Youth and Family. Thank you so much for bringing your expertise, your incredible passion, and your articulation of these issues to our audience today, Dr. Lee. [turns to camera] And we wanna thank all of you for joining us for another edition of Let's Talk, a series of podcasts that bring to you the issues that matter to us and the issues that we know matter to you as well. On behalf of our Executive Producer, Lisa Stangl, I'm your host William Moyers. We'll see you again.