you so my name is jason boyle i was a senior clinician at the mass general hospital addiction recovery management service my responsibilities there were many fold evaluation individual therapy group therapy as well as supervision and training for other clinicians i'm now at my private practice but i still primarily focus on working with individuals with substance use disorders and really specialize in working with concern significant others i see parents siblings partners you name it i probably work with someone who has a loved one with a substance use disorder i'm a resident my wife and i have lived here for four years now we have two kids one of whom is in first grade at butler elementary so i really wanted to to be here as part of the community it was important to me to have the opportunity not just to do some some of the work that i do during the day but  also come here and share with you some of my knowledge around prevention which is something i don't normally get to spend a whole lot of time talking about right off the bat i don't really have any financial disclosures i am in private practice referrals all come through networking and word of mouth but otherwise everything else in here is just primarily from my work at m g h and just because i think it's actually information folks to have i have four i spent some time on recognizing the problem i'm going to try to focus more most of my time on prevention because i don't think enough is is really done and in fact if you look at federal spending on prevention for every dollar that's spent on substance  use disorders only about two cents is spent on treatment and prevention so it's something that we need to be focusing more on certainly but i will spend time on recognizing the problem because i'm assuming folks here probably have kids who are already teens  actually helpful for me to get a sense if people just raise their hand how many kids have folks have kids in elementary school and middle school and then in high school ok so pretty even split and as will talk about unfortunately the the years that kids are getting exposed to substance use it's getting younger and younger so having conversations about substance use and earlier an earlier age is becoming more and more important and i'm going to spend a little time about talking about how to get get help them what to expect if you feel someone that you love does need help and we have  lisa here as well he's going to be able to provide some other local resources at the end of the discussion tonight ok so the problem if you take a look at the top right graphic here part of the problem is that our perception as parents of what our kids are using is way off and we have a tencent tendency to think that our kids are not using when they're self reporting that they are in greater numbers also pretty concerning to see the variety of substances being used by kids at a pretty young age if you look down here in the lower left we're seeing all sorts of different over the counter medications and  doesn't include alcohol by the way and then the bottom line is that the vast majority of people who have substance use problems started using prior to the age of eighteen so having prevention recognizing the impact of substance use not only on getting through the teen years but just on the lifespan of an individual is incredibly important some specific as i'm sure you know especially got teens at home there are the kind of wired to have a lot of go a lot of gas and not a whole lot of breaks so when you want them to be thinking rationally and logically they're being driven by what their peers are doing by what society is sort of set telling them they're supposed to be like and that puts them at great risk if we then look at college age and what we sort of normally think as a normal college kids and i see it all the time in the in the clients i work with they say well i want to be a normal college kid and that idea includes drinking and partying when in fact almost a quarter of college students which is terrifying access has changed dramatically in terms of what's available to kids today compared to even when i was in high school and when it was helpful in terms of having parents as an audience is that so much of this and just our society's general belief of medication as a front line intervention puts us at risk it's teaching kids when you feel something not so great you can take something and not necessarily pushing toward some of the behavioral mechanisms that might also provide some coping this is up to fifty percent of individuals but it's really higher than that said least fifty percent of individuals with a substance use disorder have a genetic genetic predisposition some s as high as over seventy percent right when you factor that into the key vulnerabilities we have identified for teens relating to substance use disorders of sensation seeking anxiety depression impulsivity if you have see these things in teens and we're seeing it more and more with the increase of social media and technology we start to get a picture of just how vulnerable this each group really is program we oftentimes be referring back and forth to each other so it's great to recognize these vulnerabilities and be speaking to them dependently but also as they can together so   my work of working with parents specifically in understanding the impact of parenting style on developing substance used feel pretty comfortable saying that if you're here or if you're watching this  later point you're probably not in this first group of parents which are more the sort of neglectful or i'd say probably an involved as is perhaps a kinder word the style of parenting is is characterized by little emotional connection that doesn't mean that they don't love their kid it may mean that they're dealing with their own mental health or substance use problem that makes it hard for them to be emotionally available emotionally connected to their child and generally there's low to no limit setting and this obviously has a significantly negative impact and this age group oftentimes really struggles that the children of these parents oftentimes really struggles with substance use as a result the next type of parent is a more passive parent and passive doesn't mean uninvolved passive means actually more in some ways interested in being friends with your kid this is the parent who has high emotional connection because you really want to hang out and have a good time with your kid but might have a hard time setting limits maybe you talk about limit setting but then you have a hard time following through or you try to set the limit but then will kind of give in when your kid begs you or gives all the reasons why it's style which has a lower a motional connection that's not to say again that these parents don't love their kids but they oftentimes will prioritize the outcomes they want for their kids over their kids actual needs id's are the parents who might say  some positive outcomes in terms of academics and isn't necessarily correlated to high use of substance use but the mental health impact can be pretty detrimental these are kids who generally have lower self esteem might be more prone to violent outbursts or aggression and then the last parenting style is authoritative and this has more of a high emotional connection but also a moderate limit limit setting that in the way that th lives that they know where their kids are going but they're also providing opportunities for their kids to build trust they know their kids friends are who the parents are and they're also setting limits and these are the kids who have curfews  and their parents are aware of where aware of where they are and when they come home they're also the ones that if the kid is late for the curfew are more likely to impose a consequence for that so parenting and parenting styles really go hand in hand with prevention and what i have found in my practice i'm oftentimes working with parents whose kids are maybe no longer teenagers they might be in their twenty's twenty's or even older and as i ask them about their parenting style i'll find that the same things that they're struggling with now they've been struggling with their kids since they were toddlers that they had difficulty setting limits there in cancer rooms they had difficulty with  talking to their kids about observations that were concerning to them because they were afraid the phrase their kid was going to get mad so establishing good parenting habits early on really pays off in the long run and the earlier you can establish parenting of that authoritative style i've really seen it in itself be a protective factor so when to start discussions and a very deliberate in saying discussions because this is not about having one talk this is not about talking about the dangers of of substances this is about having numerous talks with your kids over their entire developing life and into adulthood one of the things i want to get across pretty early on is it's really never too early to start talking about substance use and it doesn't actually start talking about the dangers of  it is a medication that's taken for very specific reasons and that mom and dad are the only ones that give it to him making sure that kids understand that it should be taken only as directed and making sure the medications are kept out of reach and setting limits and consequences for non substance related behavior starts at that early age so what i mean by that is like i said before if you're stablished ing very clear limits with your kid by the time that they're three four or five it becomes much easier to start setting limits or to keep setting limits with them by the time that they're in their teens they already have come to trust that what you say is what you mean and that's very hard to do later on if they've learned something different from the surly age by the time that you have a kid who's six to nine you're starting to have conversations that are a little bit more specific to drug and alcohol abuse kids or the sage it would not be uncommon for them to be at a holiday party where someone is drinking the other day my daughter and i were putting lights outside the house and our neighbor came up and our neighbor was smoking a cigarette and my daughter was talking just the nonsense usually talks to our neighbor because she's quite a spirit and i realize after the fact you know what i actually probably should have a conversation with her about what that smell was because i'm not sure she actually understands what a cigarette is yet but if our neighbor keeps coming around she's going to start understanding pretty quick the other piece here is kids get more involved in athletics they're going to start following sports heroes they're going to start following the news the scores and on dudley they're going to start hearing about steroid use and while it's not certainly not as common as some of the other substances that i see in my clients i've worked with a number of individuals who struggled with steroid use and really would meet clinical definition of a substance use disorder because of steroids use by nine to thirteen starting to have discussions about expectations and i'll talk a little bit about that later as well as what the rules and the consequences might be and then by thirteen one is start having conversations potentially about genetic risk as we talked about earlier if a minimum fifty percent of addiction is related to genetics  if you have it in your family you want your kids to know now this can be a little bit tricky addiction loves seek so if you have a family member who has a substance use problem they might not admit it they might not want people talking about  it in fact in families it's very common to have the elephant in the room that no one talks about but this is actually about your kids and keeping your kid safe so everyone needs to make a decision around what you're going to talk to your kids about in terms of their vulnerability i received an e mail earlier this week from a father that i work with and he forwarded a letter that his father had written to his kids and the letter essentially discussed the concern this grandfather had because he'd seen all of his grandchildren getting drunk at their thanksgiving party these are kids some of whom are still in their teens some of whom are in their mid twenty's and he wrote in this letter that was absolutely came from a place of love that talked about his own witnessing of addiction in his family from his parents and his siblings and then seeing it in his grandchildren terrified him and that's the kind of transparency that can really make a difference and i love to say that addiction loves secrecy and so transparency is an active way to work against it so more active parenting strategies first and foremost be a role model your kids see what you do they take it all in so if you are someone who drinks or uses other substances make sure you're doing in moderation and ideally not doing it around your children model healthy relationships this is something that is so important in terms of if they feel like you're willing to go to people and talk about your problems that you're able to open up and talk about your mistakes that they're learning from you that if they have concerns that they can talk to you about it and then engaging in non substance related activities so many kids probably see their parents on the weekends at the end of the day you know wind down with a drink totally normal but if that's what they see every day you might still be drinking within what the national institute for alcohol abuse and alcoholism considers safe drinking but if that's how your kid equates unwinding they're going to learn from that however if they also see you engaging in exercise and other activities hobbies things that really build a sense of satisfaction th they incorporate that in their in their sense of self as well as set expectations i'm in my guideline for parents is ultimately to have a clear no use policy for your family  if you don't have a no use policy you are in some ways condoning substance use and this is a challenge and i hear parents all the time say it's not realistic to say don't use my kids probably going to use them when they go to college they're definitely going to use the army just kind of setting them up and setting up a conflict with them by saying you know no use the bottom line is that each of us need to decide to parent away that's right for us and we need to recognise that that what we say to our kids matters that even if you can't control your kid because you can't you can still set an expectation with them and you can still follow up on those expiation expectations in ways that can help your kids learn  consequences that us parents can actually impose one of the things that i that the phrases i like to use in my work with parents is a parents have the opportunity to provide a pinch before the kid experience a punch you get to potentially make that phone contingent on sober behavior make sure that at the car use is contingent upon sober behavior and those things might go away if the kid is engaging in concerning behavior at the same time i would also want to make sure that the child knows how they can earn back privileges to that this is not about being just punitive it's also about helping them understand the kind of behavior you want and ways in which they can move towards those behaviors i mentioned earlier access is a huge issue so limiting access to substances in the home is a huge part of of just reducing the risk ideally if you just don't keep alcohol in your home and i know that might be might be tough because i too enjoy beer at the end of the day sometimes but the bottom line is if it's not there your kid has a hard time getting access to it and so a very clear way to have a positive impact is just not to have it home if you do you keep it locked keep it monitored it is not uncommon for a kid to figure out how to break into the liquor cabinet even if it's locked and then you know fill it up with water or any number of  strategies to make sure that you're aware of what's in there how much and the same for medications and i'm not just talking about prescription medication is becoming a bigger problem we have made some some progress in terms of making sure the lot of these medications are now behind the counter at the pharmacy however it's still an issue and if you have it in your home there's access they don't need to go to the pharmacy to get it this one is a little bit less common to think about but don't share medications what i mean by that is ultimately you could have a couple  family members who are on the same medication and so if one person runs out it's not unreasonable to say well we'll take some of your brothers and or take some of your father's it in a d h d medication or some other medication like that even if it's  depressant or something that seems more benign and doesn't have the potential for abuse the problem is that this perpetuates a culture that it's ok to share these medications that are actually intended for the individual they should learn that their medication is for them that it's not for other people it's not to be shared with their friends and their friends medication should be shared with them either so so work on having that that culture that medication is only for the individual it's intended for  as well as disposing of a needed medication the huge problem that we have is the over prescription of medication pain medications of particular often times you'll get someone who maybe needs a week's dose and they might get enough for thirty days oftentimes i'm finding that there is providers are becoming more sponsible that this is situation we cannot ignore as society prescribers are becoming more aware of their role in this and yet at the same time we still have a problem if people aren't using medications but they're just keeping them at home i would then hear parents say ok well you know what if i needed to get in the future what if something comes up and i say well you know it's it's good that i held onto it the bottom line if there's a reason that you need this medication there's a prescriber who will prescribe it for you when you need it but keeping it around just increases the likelihood that someone who doesn't need it will get their hands on it transparency and consistency are probably my first two favorite words in doing this work transparency like i said because it actively works against secrecy and consistency because it actively works against the chaos that substance use disorders like to brin so having clear rules in advance is important this isn't about waiting until there seems to be a problem and then communicating with the consequences going to be it's about before the fact having an understanding within your family of what what the rules are and what the consequences are it also means providing opportunities to build trust and reward good behavior and in i'm seeing this in my daughter who's seven and what we try to do is is if she makes a mistake and she comes to us and she tells it to us we really try to positively reinforce her willingness to be honest with us she still gets a consequence but we also communicate to her the consequence would have been greater if we'd found out without her involvement without her telling us following through with consequences and upholding limits is essential and don't shelter your child from natural consequences so often parents that i work with continue to think of themselves as as their child's protector well into their teens and into their twenty's the problem is that our goal as parents on part is to protect but it's really to teach our kids how to protect themselves and if when your kid x engages in a behavior that causes a consequence and you shield them from that consequence what they're actually learning is that you will protect them but they don't actually have to learn how to protect them allowing for natural negative consequences allows them to actually learn from their behavior and ideally they won't repeat it being involved in and i know i think next is the next talk is going to be around technology i think and this is a way that's totally different than from when i was a kid communicating with your teen and listen to their perspective on know what they're watching what they're listening they enjoy the things that they enjoy it can be really challenging to to listen to some of the music choices that they might have been some of the music choices they have might actually be the laden with messages around substance  use or sex or or other topics that are are pretty concerning this is not about just saying the no you can't listen to that it's about understanding sort of why what they're getting from it having those conversations and certainly about what their they're engaging in terms of social media what apps they're on how they're communicating with their friends gone are the days that you had to go down to the corner to pick something up from your dealer they will make house calls they will text you without you texting them first it is one of the issues that my clients do with frequently is that even when they're trying to engage in recovery based behavior their dealers are businessmen and they've lost a client and they want that client back and so they will reach out so be aware of who your kids are talking to because even if they decide that they might want to stop they may be some of the trying to rope them back in the warming communication and office offer observations  i mean this this seems to go without saying and yet in moments where you might be angry it's important keep in mind that anger can be communicated in both constructive and destructive ways so being able to communicate in a warm way that parents and communicating with friends parents about plans or or activities and this is something that i hear constantly that parents know who their kid is hanging out with they haven't talked to their friend or the their friends parents and this is just setting things up potentially for really bad outcomes their friends parents may not have the same culture at home you may be dealing with a friend whose parents are much more permissive my wife and i you know our kids or are still quite young seven in three we've already decided our kids will not be having sleepovers and i've now that may sound like we're kind of a lame duck parents but as we chatted about our own history and the kinds of things that each of us engaged in in sleep overs it really wasn't a whole lot of positive going on that outweighed the risks and these were our first exposure to r rated movies and you can find a lot worse than an r rated movie these days some of our first experiences with substance use as well as just peer pressure happened during sleep overs so knowing who their kids are hanging out with what their parents are like like something that is unlikely to happen you say oh well i want them to i want them to know that they can contact me if they're fine that they can't drive home or if they're in an uncomfortable situation i don't know that they'll actually do it or not we have to communicated anyway parenting is not about controlling your kid so i'm making sure that at the end of the day us parent can say i did it in a way that i feel was was right even if my kid didn't follow through when i was probably thirteen or so i had an older cousin that invited me with a bunch of his friends out on a camping trip and then he told me that they were bringing a bunch of beer and i felt super on comfortable i was still well before the age where i felt like i was ready for this and i actually called my mom and i told her i'm pretty pretty worried i don't really feel good about this i don't know these people in my mom came down and she picked me up and she talked to my cousin and i avoided that situation it wasn't all that much longer before i had my first experiences with substance use but at that time it meant the world to me that my mom was willing to do that and i kind of felt a little uncomfortable as i got older that i had done that and now looking back as a parent i think wow did she do something right giving me the sense that i could contact her so you never know you never know when it might happen it might happen when they're thirteen when they're fifteen but but working to make sure your kid knows that you're available is so important despite everything we do we might not be able to prevent a problem so the next strategy is to intervene early if we can and that requires recognizing if a problem exists these are just some of the warning signs and there's a whole bunch i'm the first couple are pretty straightforward but there's a number on your them going to point out are actually kind of confusing you know why because they're pretty normal teen behaviors changes in dress and grooming change and choice of friends these things happen not necessarily because of a problem but because of the natural progression of a teen development their brain and that they're in the second most active period of brain  after infancy their brain is shutting down certain pathways in focusing on other pathways that doesn't necessarily mean that they're bad it just means that they're figuring out who they are as a person sometimes arguments mood changes these things to be part of individuation the process that's normal for all teens but then we start getting to things that are a little bit more more concerning violent actions changes in eating weight loss weight gain sleep patterns again these may not be necessarily related to substance use but they are concerning and they may be an indicator something else with the bullying or eating disorder finding  things online trying things out that their their peers are trying out that are having a negative impact technology keeping them too awake too late at night but when you start seeing more than a few of these signs substance use should definitely be on your list of possible concerns so first and foremost if you see them don't ignore them don't think that they're just going to go away or that they're going to get better on their own recognize that that if there is something that's specific to substance use with your kid that there's really nothing normal about kids using substances if we look at the changing culture around marijuana use when i was a kid it was in the years of of their drug abuse resistance education didn't really work research that came out a few years ago in new zealand that kids who started using cannabis in their teens and were chronic users to their twenty's into their thirty's had up to eight point reduction in their i q if you compare that to adults who started using marijuana in their twenty's and continued using chronically there was no change in their i q so there is a distinct impact of marijuana on the developing brain and that that  study is actually one that started back in the seventy's which was marijuana that was nowhere near the potency of the stuff that kids are using today so if three percent t h c marijuana chronic use can lead to a point in lots of different forms and it is in many ways a hobby in a way that it's never been a hobby before kids will find different methods different means so there's really nothing normal about this i go back to  that one of those first slides i showed you around college kids we think partying and drinking in colleges is normal it's not normal to have almost a quarter of your population meet the definition of  so when you respond to a concern make sure you're using i statements talk from the i respect if i'm concerned about what i'm seeing i'm concerned about this behavior as opposed to you have a problem or something's not right with you if you speak from the perspective it's very hard to argue as soon as you start saying that you you you you're more likely to get defensiveness and responding a lot of parents will think well you know i need for them to get bad before they're going to see a reason to get in treatment or get some help that they're not going to benefit if they don't want to and in fact this is completely contrary we know that people who are extremely motivated for treatment have just as good if not better outcomes than individuals who are motivated for treat and that may seem surprising but there's pretty good reasons behind it people who are internally motivated for treatment have def f typically been suffering for longer have more progressed illness and have usually experienced greater consequences from their use so if there's a problem than you're seeing it early on you don't have to wait you can do something right away have changed the way that we think about substance use disorders it used to be sort of a black and white type thing either you're addicted or you're not you know maybe you're using but it's but it's not not that that and that has thankfully shifted with  m five and we're now looking at substance use disorders on a spectrum from mild to moderate to severe a mild substance use disorder generally endorse a two to three symptoms moderate four to five and a severe six  now what's interesting about this is is a these all really have to do with functioning in individual social functioning their medical functioning interpersonal functioning necessarily about you know are they drinking alone or some of the things that we might classically think is as warning signs and i will see kids who are high school year or a little bit older who will meet first severe substance us while getting good grades but their emotional life might be a disaster or that or their social life might be really struggling substance use disorders can exacerbate or mimic mental health that they're being assessed by someone who will actually actually ask questions about substance labels generally have been pretty unhelpful and we're seeing the detrimental impact of stigma as the opioid epidemic grows calling people addicts or alcoholics typically not very helpful  and it has limits people's willingness to get treatment so so recognize that because things are being seen on the spectrum now you don't need to wait until things might have most of these places are going to provide a comprehensive assessment of an individual's needs and you don't need to meet a substance use disorder don't need to know you have a substance use disorder before you get assessed at some of these places just knowing that your kid has used this enough to get an assessment at mass general or children's hospital and it is important to make sure that if you're going to have your kid assessed they're being assessed by someone who truly has some training in treating substance use in mental health a recent study had psychologists reporting up to seventy five percent of lice and psychologists had received no formal training on treatment or prevention and if you look a lot of people say parents learned to cope with a program that was started by a woman named julian julian peterson down in the cell sure her son struggled with opiates for a long time and she did not feel like she found the help that she needed so she founded learn to cope it's parent facilitated group they have a strong online community and there's a tremendous number of resources on there including resources just like the site from what your kid is talking about when they say things like triple c or or  leaner or any number of the things that you might hear and just not know what they're talking about and then the recovery resorts institute is a program that's out of mass general hospital the founder of the arms program where i work for years is dr john kelly he's now the director of the research recovery research institute the vast majority of the statistics that i used in this presentation are from our eye they have number of resources for parents there about both understanding substance use disorders as well as the recovery process so it's a great resource for everybody going to take me seriously because they just caught my kid smoking marijuana absolutely because treatment starts with a good assessment and sometimes when we do an assessment we find you know what there really isn't a substance use disorder for this individual but there might be some concern runnings i depression and then they can guide you to the right place even if you're not sure if your kid might need it it's good to schedule an appointment even if you're not sure and  and in fact it's just the office of parents changing their behavior to support their kids into recovery is significantly more effective than just getting your kid to go alone this is a process that the whole family the recovery process can take ten years for an adult to achieve their first year of sobriety so if you have someone who's who's meets for a severe substance use disorder this can be a long road however early treatment reduces the active  lifespan of it so we're talking about a ten year process for adults if you get your kid into treatment earlier you're likely shaving years off of that process so the earlier you intervene the better off they're going to be think it's a great great question and i can't necessarily cite anything but i can say regardless of what you're doing in your home the behaviors that are happening outside the home you are pretty concerning binge drinking significantly improves the likelihood of someone avoiding a substance and substance use could happen and so we recognize that you may be exposed that you may be tempted we're concerned enough to say that we don't want people using substances and we hope you'll talk to us if you're seeing it in your peer group or if you have concerns about it and then if you choose to use because we can't necessarily stop here that we will be able to have conversations about it even if we disagree different strains of marijuana at the home and see the different administration techniques and the these things are all factors that make it very complicated it's a complicated situation  so make sure that you're having a conversation kids about mr marijuana and also saying that no use policy it's important that it's your question your shirt and this is it it's incredibly difficult i mean we if we if we look at alcohol which is also a legal drug i mean this is this is a huge challenge for our society exactly exactly i mean alcohol is illegal for someone underage twenty one you can see it and so marijuana just because it's legalized doesn't mean that someone s it's tricky because i think a lot of people would say the very first time they had alcohol they disliked the taste and so one is taking the risk exposing because maybe they just like it but maybe they actually really like it i mean i've had clients that i've worked with who will say the first time that i had a drink i was  perhaps but if they like it they've now been introduced to it and they might start seeking it outside the home as well my sense is that the bottom line is everyone needs to decide how they want to parent in a way that's right for them but there isn't one right way i mean there are certain things that i might do that other parents might disagree with but if you go into a saying like this is what's right for our family this is what's worked for our family then by all means you can pursue that i think it's it's a significant risk to expose people early as we said did you know i said it early on nine out of ten people with a substance use disorder were exposed before very real especially for middle school and high schoolers and you know how to have that conversation as a parent about that experience that their child might feeling you know even if they do end up at a party or end up at some place with some assaulted her friends how to handle that anxious feeling of trying to fit in trying to you know make connections how to handle that in those moments because i think you know i i think a lot of young people are feel very lost in those moments and that's kind of where turned happened really showed my perception basher you know well and with social media now too i mean they're seeing being this window that's it's bottle of beer or you know or smoking a joint or something that there's even even more pressure i think i think one of the one of things i wish i got to do more of it's one of the reasons why i wanted to come talk to clinicians such as myself can do more preventative work at a decent amount of time can be spent on working with the kid on the refusal skills but that's not something that has an established problem that you don't need to wade into is a problem where you learn how to do that to understand the ways in which your body language your eye contact the words you choose and how you see them can have an impact on what other people will do in response i mean it is it's very different for you say you know if they want to say no and to predict situations that are potentially more  pretty significant amount of the training i do with kids is role play i work where i will i will peer pressure and often ask them tell me about your your most successful peer pressure tactics  ways that you've been able to pressure your friends to do stuff before and then we'll start talking about how they would actually manage those if they came back and and really work through it because you're right we're just hearing something  because somebody else doesn't like it if you have to have that conversation with your child about what it looks like in this person's home or what this person is doing i think you might miss it just thinking well this is you know everything's great here and not seeing sort of like how close they are to that peer pressure and that exposure just through other families or the other  right and when we think about the gateway drug to gateway drug typically we think of it in terms of like oh well once you use marijuana when you want to progress and use something more stronger or things like that when in fact for the challenges that having use up your brain is then trying to actually experience other substances with greater intensity so that the back of marijuana they have an impact on your brain if you use other substances that's so again if you're interested in being a part of that conversation honestly see me and you're more than welcome to end it all relates to mental health substance use it's all part of the same conversation