We Can Prevent Substance Abuse in Childhood and Beyond

I got so very, very lucky. My boys were young enough that they claim to have no memory of my drinking. My older son slept through my dry heaving in the bathroom right outside of his bedroom door. My younger son did not catch me the day he wandered into the garage just as I was stealing a nip from my hiding place. They are safe from my alcoholic past, so my worry has shifted to their futures. Now that I’m sober, with clarity to spare, all I can see is their inherited risk, hanging overhead like a sword of Damocles. 

I am a teacher and researcher at heart, so I read everything I could find on the subject of substance abuse and child development—textbooks, how-tos, memoirs, and academic papers. As I read and took notes in the margins, I peeked over the top of the books, watching my kids for signs such as aggression, excessive sensation-seeking, and a craving for risk. I scored my kids like I scored that “Am I an Alcoholic?” quiz. Add one point for a love of roller coasters; take one away when they both answer no, roller coasters aren’t their thing. 

I scored their friends, watching for signs of potential addictive behavior, because I’d heard substance use among peers is a big risk factor for substance use. My older son, Ben, had one friend who was lovely but disconcertingly attracted to risk, constantly pulling boneheaded stunts like riding his bike off cliffs and constructing elaborate luge tracks through the woods behind his house. Those steeply banked chutes and hairpin turns gave me nightmares all winter long. 

When my younger son fell in love with crystal healing, Pink Floyd, and psychedelic posters, Ben took me aside and said, “You know who else loves crystals and Pink Floyd and psychedelic posters? Potheads.” The observation was unnecessary, as I’d spent the past year sniffing beneath the wafting incense smoke for the skunky stink of pot. Can a love of crystals and Dark Side of the Moon cause substance use disorder? 

Between lessons in my drug rehab classroom, I conducted a fact-finding mission. I adored my students, even with all their challenges and button-pushing, and I looked to them for some kind of formula for predicting childhood substance abuse, maybe an algorithm I could use at home, one that, given enough variables, would spit out a probability figure. My students taught me so much about educating people whose emotional needs often eclipse all else, people who carry adult-sized burdens before their age of majority. They also explained how the dark web functions in the drug trade and which New England towns supply the best drugs. According to a note I intercepted as it was being passed across the classroom aisle, “Montpelier has lots of weed, coke, Molly, LSD, shrooms, but no dope. Barre, though . . . so much dope, crack, pills, etc.” I keep that note in a folder with the lesson plan for that day and a grammar unit on adverbs. 

All kids are at some level of risk for substance abuse, but research shows that we can not only predict which kids are at higher risk due to biological or environmental factors, we can also prevent those kids from taking their first drink or drug. 

When we lived in New Hampshire, and I watched the states around us decriminalize marijuana, I was politically and socially supportive while parentally freaking out and adding points to my kids’ risk scores. In the years since states started legalizing, marijuana use among kids 12–17 and 18–25 has continued to climb. Sure, there’s a predictable bump for novelty that might wear off in a few years, but now is when my kids’ brains are more vulnerable to the damage pot does to memory and learning. Last year, when we moved from New Hampshire to Vermont, where recreational marijuana use is legal, I added another point to their scores. 

Given all of these genetic and environmental risk factors for substance abuse, my best approach as a parent is to cop to our family history without shame or guilt, talk openly about my own substance abuse, and do my best to counter whatever other risk factors arise with as many protections as I can muster. We talk. We support. We offer their friends a comfortable and accessible place to hang out, and most of all, we listen. 

After all my research, interviewing, attending substance abuse and mental health conferences, and teaching hundreds of addicted kids, here’s what I have learned about preventing substance abuse in childhood and beyond: 

Humans Have Used Mind-altering Substances for Thousands of Years to Erase our Angst. If we can help kids manage their emotions and moods without having to resort to self-medication, we can increase their chances of making it to adulthood substance-free. 

Children’s Brains Are Cellularly, Cognitively, and Functionally Different from Adult Brains. They respond differently to drugs and alcohol, and addictive substances do more damage in a child or adolescent brain that is still developing than in an adult brain. 

The Younger Kids Are When They Start Using Drugs and Alcohol, the More Damage They Do to Those Brains.  Drugs and alcohol do both short- and long-term damage to the areas of the brain responsible for learning and memory. 

The Younger Kids Are When They Start Using Drugs and Alcohol, the More Likely They Are To Develop Substance Abuse Disorders As Adults. Adolescents who start drinking at twelve or younger are nearly four times as likely to develop substance use disorder as people who start drinking after eighteen. 

Adolescents Are Biologically Wired to Seek Out Novelty and Risk. Effective substance abuse prevention tools take these neurological and cognitive realities into account and capitalize on them. 

Effective Substance Abuse Prevention Reduces Risk Factors While Amplifying Protective Factors. The best risk-reduction measures and protections are applied early and are tailored to the whole child, taking their age, gender, developmental stage, ethnicity, socioeconomic status, family, and community into account. 

No Demographic Is Safe From Substance Abuse Disorder. Over the years, the media and popular culture create stereotypes about what type of people are addicted to certain drugs, but the reality is that substance dependence doesn’t care about media stereotypes. Addiction happens in every community, at every socioeconomic level, and every demographic. 

Genetics Matter, But They Are Not Destiny. Genetics are about 60 percent of the picture, and the rest comes down to environmental factors. While we can’t do much about genetics, we do have the power to prevent, intervene, and treat kids for the environmental risks. 

Prevention Works. Current data shows a continuing decline in substance use, abuse, and dependence among children and adolescents, and those declines are correlated with the rise of evidence-based prevention programs. 

Before I got sober, I read addiction memoirs to give me hope and show me a way forward. Now that I’m sober, I continue to read them because they remind me of all I stand to lose if I start drinking again. But the one book I wanted most was the one I could not find, a memoir of substance use disorder and long-term recovery paired with research-backed parenting and teaching advice. 

Once I’d faced my own addictions, I was desperate to learn more about my children’s risk and understand the steps I could take to inoculate them against substance use disorder. I am so very, very lucky; I got sober before my life imploded, and I’d do just about anything to protect my children from the pain, anxiety, and sadness that come with this disorder. All kids are at some level of risk for substance abuse, but research shows that we can not only predict which kids are at higher risk due to biological or environmental factors, we can also prevent those kids from taking their first drink or drug.

Editor's Note: This essay is excerpted from Jessica Lahey's new book, The Addiction Inoculation: Raising Healthy Kids in a Culture of Dependence (Harper Collins, April 2021) and has been reprinted here with permission.