Let’s start with the obvious. Our nation is suffering from the scourge of an opioid epidemic—in the form of addiction to opioid-based painkillers and heroin — that is creating anxiety, fear, and hopelessness among families and communities, while representing the leading cause of natural death in our country.

Now, let’s discuss what is less obvious.

Although 1 in 4 individuals with chronic pain who are prescribed an opioid by their family health-care provider will develop an addiction, the path of substance use disorders (SUDs) typically begins at an earlier point in their lives —  in adolescence. Ninety percent of adults currently suffering from an SUD started using substances as children and teenagers.

While overprescribing of painkillers is rightfully understood as contributing to our nation’s “opioid epidemic,” the true driver is the under-diagnosed substance use disorder problem that provides the platform for opioid abuse, and which starts years before opioids are first used.

This speaks to the most important aspect of our national conversation about opioids, the aspect that we are unfortunately not discussing nearly enough. Any successful strategy to combat the opioid epidemic requires minimizing the exposure and consumption of children and adolescents to substances like nicotine, alcohol, and marijuana; as well as preventing the abuse of prescription medications, which include attention-deficit hyperactivity disorder medications like Ritalin and Adderall, as well as anti-anxiety medications like Xanax and Valium.

The natural question is what should we do to best minimize that exposure and consumption. The best answer falls into three different buckets.

The first bucket involves close and active parenting. Because so much of the focus has been on attacking opioid addiction, we have overlooked how important modeling is to countering the behaviors that lead to SUDs.

It is incumbent on parents not to drink or consume other substances as a coping mechanism for stress, or to not say “yes” every time a glass of wine or a beer is offered at a restaurant or party. Close parenting also means close monitoring of your children’s communications (yes, this is your job).

Check their phones to see who they are engaging with, check their school bags to make sure they do not have illicit substances and have frequent conversations about their friends and acquaintances. Finally, instead of relying on a single 60-minute conversation in your living room, rely on consistent, mini-conversations to highlight the negative consequences of substance use. That includes creating “teachable moments” that legacy and digital media provide: a scene on a television show, a billboard image, or an Instagram “story.”

The next bucket relates to a simple, yet often overlooked point — children who use alcohol and other drugs before the age of 15 are five-times more likely to be addicted as someone starting at 21. Delaying the first usage of drugs is an irreplaceable and powerful way we can prevent the onset of opioid addiction.

The human brain is developing until the age of 25 and the last portion of the brain that fully develops is the prefrontal cortex; the portion that directly drives judgment, decision making, and impulse control. When an adolescent uses drugs, those substances hijack the limbic system, the part of the prefrontal cortex that reinforces good or pleasurable behavior and discourages the opposite.

Once that hijacking takes place, the brain is altered to prefer the deadly reward of drugs, including opioids, over the healthy rewards of daily life — eating properly, good hygiene, academic and professional success, intimate relationships, and raising a family. So, if you suspect that your child is considering experimenting with alcohol or marijuana, “vaping” or “juuling,” do not view it as merely a rite of passage.

Remember that these experiments can easily descend into chronic use and “addiction,” and encourage them to delay that experience.

Finally, we need to defeat the stigma attached to substance-use disorders. When we consider the millions of Americans afflicted with type-II diabetes, the vocabulary we use never includes “you chose to do this” “you do not deserve treatment” or “I want you out of my life.” They are never labeled as “weak” “bad” or “criminals.”

But people use this vocabulary every day when it comes to substance use-disorders, even though SUDs and type II diabetes have the same prevalence rate, are both preventable, and both have the potential to be chronic based on genetic predisposition. Much more dangerous than the irrationality of this double-standard is the impact it has on adolescents.

Children and teens who are ready for help, who desperately need it, or who simply want to have a conversation about taking a substance for the first time are denying themselves this support because they fear hearing these harsh messages and experiencing the feelings attached to them. Parents can’t control society at large, but they can control their homes, so make sure that this cruel stigma has no place in your home. It could make all the difference between having that life-saving conversation and not.

Make no mistake. We need to continue to significantly decrease the amount of opioid prescriptions and significantly increase access to evidence-based treatment programs. But continuing to misdiagnose the current challenge as strictly an opioid epidemic means moving our country further away from addressing the real challenge, and jeopardizing our children along the way.

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