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mr peabody

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How to lower your child’s risk of addiction

by Jessica Lahey | New York Times | 31 Mar 2021

A strong sense of self-efficacy is one of the most powerful protective factors parents can give their children.

In the decade that I was an active alcoholic, my focus was on protecting my right to drink the way I wanted to drink, and keeping my drinking a secret from my family. From the day I got sober in 2013, however, my focus shifted to protecting my two sons from the genetic and environmental risks of addiction I’d strewn in their path.

For five years, I felt great about my efforts. I was setting a good example by being sober, my husband modeled healthy moderation and we were raising our kids with the support of a proverbial village of families we’d known and trusted for years.

Then, in 2018, my husband had a job opportunity that required us to leave that community and move to another state: Vermont. Our older son was already in college, so the change didn’t affect him too much, but our younger son, Finn, who was about to transition from middle to high school, was devastated.

“You are ruining my life,” he said, when we told him about the move. There was no yelling, no wild gesticulations, just a calm statement of fact, which was much, much worse.

According to all the research on risk for substance use disorder, the move had the potential to be a disaster for Finn. We had voluntarily exposed our 14-year-old boy to a host of risk factors for substance abuse during a vulnerable period of cognitive development on top of the genetic risk he already faced. A stressful physical and emotional transition that was out of his control? Check. Living in a state with permissive marijuana laws? Check. Sever ties with a peer group we trust? Check. Replace those peers and their supportive, loving parents with families we have never met? Check.

Before we moved, Finn had plenty of protections heaped on the prevention side of his metaphorical substance abuse scale: physical, financial and emotional stability; lack of stress; and his friends’ parents looking out for him and providing healthy models for sobriety, support and coping. My job was to figure out what I could do to balance the weight of his risk by loading the other side of the scale with as much protection as possible.

I could not help him make new friends, let alone pick their parents, but I could help restore Finn’s sense of control, agency and hope by building his sense of self-efficacy.

Self-efficacy, as defined by the psychologist Albert Bandura, is one’s belief in one’s ability to succeed; to regulate one’s thoughts, emotions and life; and to cope with challenges in a positive way. Self-efficacy is also the foundation for so many other positive traits, including resilience, grit, fortitude and perseverance. Self-efficacy is what gives kids a sense of control, agency and hope, even when the world around them feels out of control.

People with a weak sense of self-efficacy, on the other hand, tend to be pessimistic, inflexible, quick to give up, have low self-esteem, exhibit learned helplessness, get depressed, and feel fatalistic and hopeless. Not coincidentally, people who exhibit these traits are more likely to turn to drugs and alcohol to alleviate these negative feelings.

I wanted Finn to be able to talk to me about all his fears and anxiety around the move, and I knew that self-efficacy could help with that, too. It promotes open parent-child communication while helping kids resist peer pressure both directly and indirectly. Research shows that when a child believes he has the ability to resist peer pressure, he will be a lot more likely to do so, and further, he will be more likely to talk to his parents about those episodes of peer pressure when they arise. On the other hand, kids who don’t feel as if they can resist peer pressure don’t tend to talk to their parents about the things they do outside the home.

Lack of self-efficacy is a risk factor for substance abuse and other negative health outcomes, but when converted into its opposite and equal force, a strong sense of self-efficacy, it can be one of the most powerful protective factors we can give our children. Here are some practical ways parents can boost kids’ perceptions of their own self-efficacy and help kids with low self-efficacy get back on the right path:

Start with yourself.

Model, model, model self-efficacy for your kids. Start questioning your own assertions of “I can’t” with “I can’t yet,” then turn that perspective outward, toward your children. That helps kids believe competence is not congenital, it is learned, and often hard-won.

Give kids skills.

Praise alone won’t give your child a sense of self-efficacy or competence; these things come from the actual experience of trying, doing, failing, trying again, and succeeding. Give kids age-appropriate tasks that help them stay engaged and challenged while granting opportunities to taste success. Teach them how to make dinner from start to finish and see what they create on their own. Encourage your teen to take the family car to the garage and have that rattle behind the dash fixed.

Project optimism.

Optimism is about more than seeing a glass as half full; it’s a mind-set that has a very real impact on physical and mental health. Optimistic children are better able to resist learned helplessness and depression, whereas pessimists are much more likely to give in to feelings of helplessness and are consequently at much higher risk of suffering from a wide range of negative mental and physical health outcomes. According to the psychologist Martin Seligman, author of “The Optimistic Child,” pessimistic kids see obstacles as permanent, pervasive, and their fault. Optimistic children, on the other hand, view setbacks as temporary, specific and attributable to behaviors that can be changed. As Dr. Seligman explains: “Children learn their pessimism, in part, from their parents and teachers, so it is very important that you model optimism for your children as a first step.”

Make failures specific, but generalize success.

Guide children toward optimism by framing their success as generally as possible. If your daughter has a good day in math class, help her globalize that success. Instead of “I did well in math class because I paid attention,” move toward “School is going well because I am doing all my assignments on time.” Help her expand her success beyond the boundaries of one class or one day.

Be specific in your praise.

General praise, such as “Good job!” is useless when it comes to bolstering self-efficacy in kids because it has no real meaning. Aim for behavior-specific praise that reinforces practices you want to encourage, such as, “I’m so proud of you for sticking with that project even when you got frustrated.” Behavior-specific praise describes the desired behavior, is specific to the child, and offers a positive, clear, statement.

Don’t go overboard with your praise.

Experts on the use of behavior-specific praise in the classroom recommend a 3:1 or 4:1 ratio of praise to correction, a ratio I have tried to maintain with my own students and children. I teach and parent older teens, but this guideline is effective for kids of any age. Research shows it not only boosts good behavior, but also creates a sense of community and positivity that helps kids hear our constructive criticism when it inevitably comes.

A belief in self-efficacy, Dr. Bandura writes in his book “Self-Efficacy: The Exercise of Control,” is “the foundation of human motivation, well-being, and accomplishments.” That might have been what my son needed most to get started in a new school, and not just as a protection against substance abuse. It could help him set and achieve goals, view obstacles as surmountable, have a lower fear of failure and approach new challenges with the assumption that he could succeed.

While I can’t know which, if any, of the preventions I’ve heaped on Finn during his adolescence will inoculate him against developing a substance use disorder, I do know that boosting his self-efficacy has been essential to building up his sense of competence, well-being and happiness.

One year after the move, Finn and I hiked up to the top of the mountain behind our house to pick wild huckleberries. We’d spent an hour or so crawling around on our hands and knees talking about whatever drifted through our minds, when Finn sat back on his heels, dumped a handful of berries into his mouth and admitted to being happy. What’s more, he was looking forward to his second year of high school. As we sat together, eating huckleberries and looking out over the Vermont landscape, I felt the weight of his risk ease from my shoulders, at least for a while.

 
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mr peabody

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Firefighters and paramedics tended to a person who went into cardiac arrest after a drug overdose.

Overdose deaths have surged during the pandemic*

by Abby Goodnough | New York Times | 14 Apr 2021

The latest numbers surpass even the yearly tolls during the height of the opioid epidemic and mark a reversal of progress against addiction in recent years.

More than 87,000 Americans died of drug overdoses over the 12-month period that ended in September, according to preliminary federal data, eclipsing the toll from any year since the opioid epidemic began in the 1990s.

The surge represents an increasingly urgent public health crisis, one that has drawn less attention and fewer resources while the nation has battled the coronavirus pandemic.

Deaths from overdoses started rising again in the months leading up to the coronavirus pandemic — after dropping slightly in 2018 for the first time in decades — and it is hard to gauge just how closely the two phenomena are linked. But the pandemic unquestionably exacerbated the trend, which grew much worse last spring: The biggest jump in overdose deaths took place in April and May, when fear and stress were rampant, job losses were multiplying and the strictest lockdown measures were in effect.

Many treatment programs closed during that time, at least temporarily, and “drop-in centers” that provide support, clean syringes and naloxone, the lifesaving medication that reverses overdoses, cut back services that in many cases have yet to be fully restored.

The preliminary data released Wednesday by the Centers for Disease Control and Prevention show a 29 percent rise in overdose deaths from October 2019 through September 2020 — the most recent data available — compared with the previous 12-month period. Illicitly manufactured fentanyl and other synthetic opioids were the primary drivers, although many fatal overdoses have also involved stimulant drugs, particularly methamphetamine.

And unlike in the early years of the opioid epidemic, when deaths were largely among white Americans in rural and suburban areas, the current crisis is affecting Black Americans disproportionately.

“The highest increase in mortality from opioids, predominantly driven by fentanyl, is now among Black Americans,” Dr. Nora Volkow, the director of the National Institute on Drug Abuse, said at a national addiction conference last week. “And when you look at mortality from methamphetamine, it’s chilling to realize that the risk of dying from methamphetamine overdose is 12-fold higher among American Indians and Alaskan Natives than other groups.”

Dr. Volkow added that more deaths than ever involved drug combinations, typically of fentanyl or heroin with stimulants.

“Dealers are lacing these non-opioid drugs with cheaper, yet potent, opioids to make a larger profit,” she said. “Someone who’s addicted to a stimulant drug like cocaine or methamphetamine is not tolerant to opioids, which means they are going to be at high risk of overdose if they get a stimulant drug that’s laced with an opioid like fentanyl.”

The surging death rate eclipses modest gains made during President Trump’s term against the nation’s entrenched addiction epidemic. During his administration, several billion dollars in grants to states allowed more drug users to get access to the three F.D.A.-approved medications for opioid addiction — methadone, buprenorphine and naltrexone — that work by suppressing cravings and symptoms of withdrawal. Naloxone, the overdose-reversing drug that has saved thousands of lives, also became widely distributed.



Brendan Saloner, an associate professor at the Johns Hopkins School of Public Health who studies access to addiction treatment, said surveys that he and a colleague, Susan Sherman, conducted of drug users and people in treatment in 11 states during the pandemic found that many had used drugs more often during that time — and used them alone more often, likely because of lockdowns and social distancing. Well over half the participants also said the drugs they used had been cut or mixed more than usual, another red flag.

“The data points corroborate something I believe, which is that people who were already using drugs started using in ways that were higher risk — especially using alone and from a less reliable supply,” Dr. Saloner said.

Although President Biden has yet to appoint a permanent “drug czar,” his Office of National Drug Control Policy released an outline last week of its priorities for addressing the addiction and overdose epidemic. They include measures the Trump administration also embraced, like expanding access to medication treatment for opioid addiction, but diverged from the Trump agenda by pledging to address “systemic inequities” in prevention, treatment and recovery.

And although the Biden plan embraced medications for addiction, shortly after his inauguration, Mr. Biden reversed a move by the Trump administration that would have made it easier for doctors to prescribe buprenorphine, a lifesaving anti-craving medication, for opioid addiction.

Members of the new administration said at the time that the plan was not legally sound, but one of the priorities listed in the new document is to “remove unnecessary barriers to prescribing buprenorphine.”

On Tuesday, several dozen organizations that work on addiction and other health issues asked Mr. Biden’s health and human services secretary, Xavier Becerra, to “act with urgency” and eliminate the rule that doctors go through a day of training before getting federal permission to prescribe buprenorphine. Many addiction experts are also calling for abolishing rules that had already been relaxed during the pandemic so that patients don’t have to come to clinics or doctors’ offices for addiction medications.

Although many programs offering treatment, naloxone and other services for drug users have reopened at least partly as the pandemic has dragged on, many others remain closed or severely curtailed, particularly if they operated on a shoestring budget to begin with.

Sara Glick, an assistant professor of medicine at the University of Washington, said a survey of about 30 syringe exchange programs that she conducted last spring found that many closed temporarily early in the pandemic. After reopening, she said, many programs cut back services or the number of people they could help.

“With health departments spending so much on Covid, some programs have really had to cut their budgets,” she said. “That can mean seeing fewer participants, or pausing their H.I.V. and hepatitis C testing.”

At the same time, increases in H.I.V. cases have been reported in several areas of the country with heavy injection drug use, including two cities in West Virginia, Charleston and Huntington, and Boston. West Virginia’s legislature passed a law last week placing new restrictions on syringe exchange programs, which advocates of the programs said would force many to close.

Mr. Biden’s American Rescue Plan Act includes $1.5 billion for the prevention and treatment of substance use disorders, as well as $30 million in funding for local services that benefit people with addiction, including syringe exchange programs. The latter is significant because while federal funds still largely cannot be spent on syringes for people who use drugs, the restriction does not apply to money from the stimulus package, according to the Office of Drug Control Policy. Last week, the administration announced that federal funding could now be used to buy rapid fentanyl test strips, which can be used to check whether drugs have been mixed or cut with fentanyl.

Fentanyl or its analogues have increasingly been detected in counterfeit pills being sold illegally as prescription opioids or benzodiazepines — sedatives like Xanax that are used as anti-anxiety medications — and particularly in meth.

Northeastern states that had been hit hardest by opioid deaths in recent years saw some of the smallest increases in deaths in the first half of the pandemic year, with the exception of Maine. The hardest-hit states included West Virginia and Kentucky, which have long ranked at the top in overdose deaths, but also western states like California and Arizona and southern ones like Louisiana, South Carolina and Tennessee.

 
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