Ask the Expert: Dr. Joseph Lee of Hazelden Betty Ford

We’ll feature an expert in the mental health and substance use disorder field to answer questions

Q: In terms of addiction, how does the adolescent or young adult brain differ from an adult’s?

The adolescent brain is still developing. Young people tend to have less physical effects from drug use (i.e. hangovers, withdrawal) but their brains are much more adversely affected. Their ability to limit risky decision making is also not on par with adults so they may need more help when trying to stop using.

Q: What are some key signs and symptoms that indicate an adolescent / young adult may need treatment for mental health and substance abuse?

What a parent should be looking for are changes in behavior. If a child’s interests change dramatically, they begin to associate with a different crowd, their grades plummet, their weight changes significantly, their eating and sleeping patterns change, they begin stepping outside the values you know them to have – those sorts of things are all worth noticing. It’s all about paying attention, and then having open, compassionate conversations—taking care of each other. We’re getting better about this when it comes to mental health. When, for instance, a boy gets dumped by his girlfriend, we now know to worry that he may get dejected. We’ve learned to keep an eye open, to check out if he is OK. We tend to the relationship. But we don’t often do that with the warning signs of substance use, we hope it’s just a phase and wish it away.

Q: If a parent / caregiver is in recovery, does that mean their child is at greater risk for addiction?

Family history of addiction is the greatest risk factor we know of, so the risk is indeed greater, which is important for families to understand. But having a family history of addiction doesn’t guarantee addiction or necessarily make it likely. There are many other factors as well, and a parent’s recovery can also be a protective factor in some ways. When talking to your kids about risk, think of it like the conversation you’re probably having about texting and driving. If your teen has a history of car accidents or has ADHD or exhibits risk-taking behavior, then your talk about the dangers of texting and driving would probably take on more urgency. As a parent, you also need to outline norms and expectations and model safe behavior for your kids. You can’t say, “Don’t text and drive” and then text and drive. Same with substance use.

Q: How can parents / caregivers maintain emotional objectivity and communicate effectively during times of crisis?

The key is to begin communicating effectively long before the crises come. As a parent, the relationship you have with your children is the most important investment you are going to make in your lifetime. Having conversations about drug and alcohol use is important, but it is not the most important part of building that parent-child relationship. This is a something you build every day, year after year.

Research shows that a positive relationship between parent and child is the most powerful protective factor for limiting future problems with substance use. So, it’s important – for example – to teach your kids how to communicate, how to problem solve, how to empathize, how to be resilient, how to be gracious to others, and how to come to you when they need assistance. If you teach them those skills, no matter what problems arise you will have a foundation that will enable you to eventually work things out together.

Q: What are some tips for setting appropriate boundaries?

Kids expect boundaries, unless they never hear about or see them. Again, as parents, we need to outline norms and expectations early on and be consistent—but also model everything we expect, including safe behavior. What’s most important is that the set of guides/ rewards/ boundaries in the home are positive in spirit. You want to guide and teach. You want to be consistent. You aren’t trying to be their probation officer.

Q: Can pharmaceuticals be helpful in some situations?

Absolutely. We use medications to treat withdrawal symptoms for addiction. For some specific addictions like opioids and alcohol, we also have FDA-approved medications that can help patients longer term. Medications aren’t a panacea though. Therapy, peer support, family involvement, school and job support – all are typically very important, too. There’s no one-size fits all. We have lots of tools, but it’s important to personalize care and support so that we can meet individual needs.

Right now, there is too much stigma about medications, especially for opioid use disorder. While it is noble that people want to get sober “on their own,” the science says that medications are very helpful and can be life-saving. So don’t discourage young people from getting medications from their physician.

Thank you to Jeremiah Gardner for helping to facilitate this Q&A. If you have a question for the experts, or you are an expert interested in being featured, please email phoenix@thephoenixspirit.com. Experts have not been compensated for their advice.


Joseph Lee, M.D., ABAM, is the Medical director for the Hazelden Betty Ford Foundation Youth Continuum and is based at the nonprofit’s center for adolescents and young adults in Plymouth, Minnesota. A triple-boarded physician, he completed his Adult Psychiatry residency at Duke University Hospital and his fellowship in Child and Adolescent Psychiatry from Johns Hopkins Hospital. He is a diplomate of the American Board of Addiction Medicine and a member of the American Academy of Child and Adolescent Psychiatry’s Substance Abuse Committee. Dr. Lee’s experience with families from across the country and abroad provide him with an unparalleled perspective on families, emerging drug trends, co-occurring mental health conditions, and the ever-changing culture of addiction. He is the author of Recovering My Kid: Parenting Young Adults in Treatment and Beyond, which provides a guide for parental leadership in times of crisis.

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