Dr. Bonnie Halpern-Felsher: Vaping, Alcohol Use & Other Risky Youth Behaviors

Welcome to the huberman Lab podcast where we discuss science and science-based tools for everyday [Music] life I'm Andrew huberman and I'm a professor of neurobiology and Opthalmology at Stanford School of Medicine my guest today is Dr Bonnie helper felsher Dr Bonnie helper felsher is a professor of Pediatrics and Adolescent Medicine at Stanford University School of Medicine a developmental psychologist by training Dr Halper felshire is a world expert in the risk behaviors that adolescents teens and young adults participate in today we discuss nicotine use both by way of smoking as well as vaping and ecigarette use

we also discuss cannabis and some of the correlative as well as possibly causal data linking cannabis use to psychosis in young adults and we discussed some of the other common risky Behaviors that adolescence teens and young adults participate in including risky driving behavior alcohol consumption and risky sexual behavior we discussed the various factors that impact whether or not a young person will participate in Risky behaviors including the family and home as well as peer group and social media and as we discuss social media we get into a deep discussion about how marketing is combining with

peer pressure in order to Drive youth toward particular risky behaviors by the end of today's conversation you will have learned from Dr Halper felshire the latest research on risk-taking behavior in adolescence teens and young adults and what we can each and all do to ensure that they either avoid these behaviors or if they are already engaging in these behaviors that we can mitigate some of the potential harms and potentially get them to eliminate these behaviors toward Having a life of enhanced mental and physical health before we begin I'd like to emphasize that this podcast is

separate from my teaching and research roles at Stanford it is however part of my desire and effort to bring zero cost to Consumer information about science and science related tools to the general public in keeping with that theme I'd like to thank the sponsors of today's podcast our first sponsor is eight sleep eight sleep makes Smart mattress covers With cooling Heating and sleep tracking capacity now I've spoken many times before in this podcast about the critical need to get sleep both enough sleep and enough quality sleep when we do that everything our mental health our

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if I've sweat a lot during that exercise I often will drink a third element packet dissolved in About 32 ounces of water after I exercise if you'd like to try element you can go to drink element spelled elm.com huberman to try a free sample pack again that's drink element.com huberman and now for my discussion with Dr Bonnie helper felshire Dr Helper felshire welcome thank you so much for having me we're going to talk about a very important and sometimes troubling period of life not always troubling but I think for everyone adolescence and the teen years

youth essentially is a tricky landscape yes it is it can be yeah as our brain and bodies mature we have more autonomy in where we take them but that means also more exposure to the ideas suggestions actions pure pressure of others and um that's sometimes where the the problems arise and who knows probably also where the solutions come from too from time to time but I think as conscientious people um who mind the Well-being of others of our species we'd all like to know sort of like what are the key features that Mark this stage

of development maybe we'll just start off by talking about this through the lens of um your expertise as a developmental psychologist you know what is adolescence in the teen years like what's going on um what sorts of things are being worked out psychologically um that we might not be aware of and then we can talk about some Of the common pitfalls and the risk-taking Behavior everything from smoking vaping drug use um sexual behavior uh addictive behaviors as it relates to social media bullying risky driving there's so much there but uh maybe we could just look

at this stage of Youth through the lens of a developmental psychologist and share with us anything you feel is worth worth knowing sure so first of all ages adolescence uh can be Anywhere from start starting roughly around age 10 some people would say ending around age 18 maybe 21 if you want to go into young adulthood then maybe mid2 and really adolescence is a wonderful time of as you said exploration it's a time when first of all marked by pubal changes on set amenes for girls um and and really the pubal and physical development SE

secondary sexual characteristics are coming out we also Have a lot of emotional development going on during this time height changes are occurring during this time but we're getting a lot of social changes as well as you said peer pressures so one misn is parents think that they don't matter during adolescence they still really matter but peers also come in and matter quite a bit and then teens are really trying to figure out who they are you get a lot of questions who am I where am I going in life what do I want to do

When I grow up what's important to me how do other people feel about me and then how do I feel about other people so a lot of the social and psycho Social Development is happening as well and you get asynchronous development too if a young person for example starts puberty at a younger age say 10 where they're physically looking older more mature but emotionally in psychosocially they still might be young versus the late matures Physical matures who may be not having and looking like in a older teener an adult till 16 17 18 but they're

more mature emotionally than others then you might have some confusion to that young person I look older but I don't feel older and stuff like that but it's really this wonderful time of exploration for an adolescent and a time of really wanting autonomy and wanting to make a lot of decisions that we should like them make but there are some Risks that we have to be careful about at the same time I often heard this word autonomy as it relates to this uh stage of you know puberty and the teen years you mentioned that kids

of the that age still really need their parents um you know in the last gosh 20 30 years in this country there's been a market increase in the frequency of divorce um is there any direct evidence that single parent homes or homes where I don't know people are Remarried or just basically divorced homes are somehow um creating more challenges in terms of risk-taking behavior in adolescence and teens or um or not because I know plenty of people who had you know grew up in single parent homes um sometimes parents remarried and sometimes didn't and I

by my mind I can't seem to come up with any direct correlation you know plenty of uh those kids did fine and plenty of kids in two parent homes that I know had had Challenges and and vice versa yeah I haven't contributed actually that was some my earlier dissertation work and I haven't really contributed to that literature for a while but what you're saying is is pretty accurate to what I've seen which is really the literature would say it's not the divorce per se it's the conflict that is happening so if parents actually get divorced

usually if the conflict resumes teenagers and children generally do well and Particularly within about two years if the conflict uh resolves if the conflict resolves right so you can have two parents who are married and living in the same home and may or may not be a good relationship but living in the same home if there's no conflict or that then generally teens will do well or as you're saying there's not necessarily a direct correlation the problem comes in whether parents are living at home together or separated or divorced is if There's conflict and then

that conflict tends to result in social issues emotional issues a lot of social anxiety a lot of feeling like I need to do better so that way my parents like me more and we see that with children too that's not just adolescence a lot of depression and with depression can come self-medication and uh self-medicating around other drugs and so on but that generally is resolved if the conflict resolves but as you're saying we're Seeing adolescent angst regardless of parenting uh what we really need though it's not a matter of just the divorce or not divorce

or the relationship between the parents it's parenting that's important so parents being good monitors being involved in their kids' lives not this oh you're 16 you have a car you can go wherever you want and we're not going to keep an eye on you we still need parents to monitor to pay attention to find out their kids' friends where are They going after school that discretionary time when parents are working and teenagers come home between 3 and 5 or 3 and six tends to be the most risky couple of hours they're it's called discretionary hours

where there's no parent around and we don't always know where those teenagers are hanging out so that's more important knowing where their children are and what they're doing and that there's some adult presence some monitoring then Whether or not they're still in a relationship my sense is that smartphones have allowed more communication and monitoring between parents and kids but also more interactions between kids and other kids and kids and adults more broadly so is there any evidence that uh the Advent of smartphones is directly creating problems for kids that um has to do with just

so much more PE PE to peer interaction or peer to-peer exposure Like when I was growing up we didn't have smartphones uh if you did something stupid like that meaning that kids would laugh at it might get told to a small group of people maybe a larger group of people but um in general it just kind of didn't go anywhere you're like a I screwed up and then You' get teased a bit and then it would kind of dissipate but now of course that can propagate very very far very fast is there any evidence that

that mere fact is creating Issues for for kids so I would say it's not a blanket statement I think it depends on the behavior that we're talking about bullying no doubt the example that you gave no doubt that if you mess up if you do something stupid it's getting filmed and it's going to go viral it will go on social media and then it will perpetuate and escalate amongst the peers um that we definitely know is happening and certainly in terms of drug use and marketing there there's Def some peer-to-peer interaction look how cool I

am look at the Smoke Ring I did look at other things that I've been doing there there is no doubt but in general there are also some good things about it parent communication they can monitor where their children are they can put a tracker on the phone uh I know with my own kids sometimes it was the best way to say you seem a little sad when face-to-face communication wasn't happening I could use the the phone to Have that conversation so yes there is some evidence that overall phones and smartphones have increased risk behavior but

it's more the access to the behavior and then the viral of really getting that information out like you said if somebody screws up um somebody dresses wrong if somebody kisses somebody that that could go pretty viral I wouldn't say that smartphones and social media as a whole is the problem I think it's situation specific and behavior specific That we're seeing and particularly around marketing for example that teenagers have more access now to YouTube to marketing that they're promoting not only are Industries promoting for example ecigarettes or cannabis promoting to young people but teens are promoting

to each other and that we didn't see before smartphones right we didn't see I took a picture or Instagram look at me smoking or look at me dressing sexy or look at me looking Cool or anything like that that did happen before it was more just word of mouth so that is definitely where we're a lot more concerned about social media um but more my concern about social media is the outside world targeting young people and that's where where I've been the the biggest concern about it teenagers targeting each other with bullying no doubt big

issue but in other ways there's more support there's more social Interaction the other time I get concerned though around teenagers is is more the social piece of sitting around together at a table and they're not talking they're on the phones so what we really don't know enough is how is the not getting out and playing and instead playing on a game not going to the park and and instead communicating through phones how is that changing their social and physical development is where I'm also very Concerned yeah I uh have family relatives with um who are

in their teens and it's interesting to see them interact um where they're on their phones a lot of the time but I've also noticed that there's a cohort of kids that are really trying to put their phones away and just spend time together and that was actually directly stated to me that oh yeah we hang out and we make it a point not to be on our phones when we hang out and then but then of course They'll text or be on the iPad with one another in the evening when they're apart so they're sort

of never apart right um but I do think there seems to be at least a sub movement of um kids and teens that are trying to do more face Toof face interaction with devices at least put aside I answer a really good point I've talked to some teens who say that they all they get together and they will deliberately put the phones face down in the middle no phones and Have dinner have a conversation so I I think you're right I definitely think that that that has been a movement and I really appreciate that and

I think that's fantastic I've also seen circumstances where two teens are trying to help each other with homework and they're texting each other which is fine but I've often said why don't you just pick up the phone and call the person and in five minutes you can figure out the math assignment instead of 20 30 Minutes of back and forth it's just not as efficient unless you're literally copying and showing the picture but is that having a change on their social or physical development or emotional development probably not it's just a different world the way

that they communicate and that's why I say I'm less worried in some ways as long as they're still getting out and they're playing and they're being creative I'm less worried about that kind of social Interaction on on phones and social media it's a different way we don't have a lot of evidence to say when we're the other but if they're still doing the things that they should be doing as young people my concern is that outside world the the um concern of predatory behaviors the concern of Industry the concern of mass media and marketing to

teens that's the part that gets me particularly worried yeah well we know for sure that this is the first time in Human evolution that um humans have essentially written with their thumbs there's got to be a massive expansion of the brain's representation of the thumbs relative to you know 20 30 years ago but maybe now would be a good time to talk about risky behaviors uh or even just behaviors that are known to have some detriment to health smoking and vaping and e cigarettes um primarily and we should be probably distinguishing between nicotine And cannabis

um maybe let's just start with nicotine what what are the statistics on um smoking vaping and ecigarettes just rough statistics I I um saw a talk that you did online decided some pretty outrageous increases in um or shocking increases in smoking and vaping in the last couple of years just staggering so maybe if you give us the top Contour of those sure absolutely so the good news is smoking rates conventional cigarette Smoking rates has gone down pretty dramatically in the last couple of decades with teenagers with all people in the US which is wonderful by

teenagers to um well below 10% if not really well below 5% of teenagers that's the good news in terms of ecigarette use which I prefer the term ecigarette use than vaping because they're they're not Vapes they're aerosols uh but ecigarette use has gone up pretty dramatically so ecigarettes came on the market in the US In 200 seven and they were slow to to for uptick amongst teenagers they look like cigarettes when they first came on the market they weren't very popular with teenagers they didn't have they had some flavors not a lot didn't have a

lot of nicotine it was probably around 2011 to 2014 we started seeing an uptick but then it was really in 2017 to 19 that we saw a dramatic increase and that was the the statistics there we saw upwards of 27 to 29% of teens using ecigarettes During th those couple years daily use past 30 days so any use in the past 30 days okay uh was and in daily use it'll be some smaller percentage of that it was something like a 78% increase in high school student use and a 48% increase in middle school use

over those couple of years so a very dramatic increase in use since 2019 it's gone down but I'm going to give a caveat it's gone down in 2020 to the numbers are showing uh they went to around 20% and Now around 10% part of that was in 2020 we had covid and initiation of ecigarette use really occurs socially and going back to socialization it's a lot of teens getting together and it's not pure pressure of you have to try come on try this it's more like my friends are using I'm at a party I feel

like using yeah I'll try it well during the pandemic and the shutdown teens were not at school they weren't with their friends so initiation went down teens Who were addicted and we can certainly talk about levels of nicotine and eats but teens who were addicted continues to use some tried to quit which was great but we still saw a fair amount of use so part of the decrease in those 2020 to 2021 have to do with just access and socialization had changed and so rates went down since then even we publish a paper showing relationships

between Co and vaping we saw evali ecigarette and vaping Associated lung illness so that That we think was part of why we also saw further drops around 2021 but people were concerned about their lung health and teens as well and that's great the latest data show that their rates are under 10% the National Data I actually don't think it's true and the reason I don't think it's true is I'm in the schools doing curriculum presentations all the time where I teach and educate teachers to use our tobacco and cannabis prevention Curriculums and we've never been

busier than we are right now with schools just crying for help we have an another group of teenagers using ecigarettes nicotine or cannabis or whatever it's way more than 10% I would say schools are telling me it's 40 to 60% of their students are using ecigarettes so for with for we don't know or canis it's very hard to know it's very hard to know what's in there uh but 40 to 60% that's what the schools are saying at some point in the Last 30 days at some point in the last 30 days they're catching just

exorbitant numbers of students using right now and so from a science perspective is it 10% 20% 30 we don't know I can just tell you that the national CDC data would say 10% and maybe it's a problem with the surveys or the questions or teens aren't being honest but from a school's perspective it's much higher and then we have some National Data suggesting it's more in the 20 to 30 to 40% range as Well whatever it is it's too many it's too many teens who are inhaling nicotine and and cannabis as well wow a lot

to unpack there first of all um nicotine I did an episode of the podcast about nicotine um and a little bit of that got um confused in the way it landed um so I'll just quickly State nicotine known cognitive enhancer also known to dramatically increased blood pressure and vasil constriction not healthy for the body just to be clear It's not healthy for the body so when people hear that it's a cognitive enhancer increases focus and alertness that's true um in the short term highly addictive highly highly addictive um and habit forming since sometimes those are

separated maybe we um delve into that distinction but by my observation very few people can use nicotine occasionally people who try it seem to um like it um at least in the short run and keep using it um so Presumably kids are using I should say youth are using nicotine either by vape ecigarette and they quote unquote like the way it makes them feel who knows maybe it'll allows them to focus on their studies better I don't know uh but it is known to improve certain forms of cognition but only transiently and it's highly addictive

and it's bad for their health for anyone's health so that puts us in kind of a tricky situation when Evaluating in the statistics that you just uh laid out because uh one wonders you know are they taking it and then continuing to take it because of peer pressure because of lack of peer pressure to not do it because it helps them with their schoolwork um because they're naturally a little bit depressed and it provides a kind of um anti-depressant signal I mean what what do we know about why they're actually starting and why they're continuing

and Why they are reluctant to quit maybe we just parse those so why does a teenager try nicotine so there are a few reasons why they start um based on the the literature scientific literature and just talking to teens one has to do with the marketing no doubt if you look at the marketing it is targeting young people uh it's targeting them with first of all the devices themselves they are cool looking uh they're easy to hide They look like USB devices they look like highlighters in fact there's a new brand out called highlight that

is a highlighter that's a working highlighter but it's actually a nicotine ecigarette so a highlighter pen to to study highlighter pen to study and then but it's actually you take the cover off and it's actually a nicotine ecigarette device clearly marketed toward students clearly marketed towards students wow you have what's it called Boba uh you Know um teas drinks oh yeah the tea with the yeah a little mimicking that drink that's actually a that the straw is actually The Vaping inhaling there little pieces you have um Star Wars shapes you know it goes on and

on just the cartoon shapes that are clearly being targeted to not just teenagers children that we're sing CH children like young children children like young children so wait so I'm I'm I'm um shocked so kids younger than 10 are Are having these products push their way they are and actually I didn't tell you in the statistics the statistics I was citing I should go back and clarify a couple there to that are even more shocking so those are the numbers for middle and high school we don't have data from elementary but again the other part

of in addition to the science I contribute to the interventions I do I am getting Elementary School teachers calling us for help they are catching Second and third graders using nicotin cigarettes I'm not kidding and not just one or two quite a bit we said we would never develop an elementary school version of a vaping prevention curriculum that's what we call our uh you and me together vaperee we would never we have a middle school and a high school we were never going to do elementary we've had so many schools across the country call us

and say we need something for elementary so we Actually created a curriculum so we're having there there was a story of an 8-year-old uh back East who was caught and using and and the teachers and police didn't know what to do and of course I said it's not a police matter why aren't we helping this young person so we are we're we're seeing younger now sometimes they're starting because they're siblings older siblings uh it's being marketed to it they don't realize that it's a nicotine ecigarette or Cannabis ecigarette they just don't realize what it is

but the number of these products that are being targeted to young people is absolutely ridiculous ous what they look like uh the pictures are endless and the problem is they're coming out with new products every few months that are targeting kids so marketing the other is flavors and flavors and marketing go hand in hand you know if it if it looks bad looks Like or and smells like and tastes like nicotine or tobacco teens know that that's gross that's why we don't have cigarette use anymore teens we've socialized our country to say if you smell

tobacco it's it's nothing that we want to smell we walk away from it you walk across the street whatever we've done a really good job in Tobacco Control getting the word out around that these products e cigarettes smell and taste like sugar like sweets like Dessert like candy so you've got and and the names are things like unicorn poop and sugar booger and honey dooo that's not for adults those names are squarely for kids it's kids who are using chocolate it's kids who are using these flavors that are on the market and then the marketing

around it are these I mean they're beautiful they're these you know Pizzazz of pineapple dancing around or of you know um strawberries dancing or whatever it is that are very animated They're a juice box style that uh that have come out juice boox style vaping devices that are marketed looking like juice boxes again that's that's not targeting you and me that's targeting a kid interesting and uh scary uh to hear all this I'd like to take a brief break and acknowledge our sponsor ag1 by now most of you have heard me tell my story about

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20% depending on the statistic I actually haven't looked at the latest data on on adults um but but the majority of adults who are using are it's a little bit different to think about it adults are using generally they're not initiating Tobacco through ecigarettes they're generally and I'm talking 30 and up they generally have been smoking cigarettes and then maybe they're trying to use ecigarettes to quit which is a whole another uh set of literature that it's not say as effective as we're hoping that it is there isn't good literature on a popul ation level

that ecigarettes help adults quit uh cigarettes the difference with teenagers is they're initiating with ecigarettes And they're not saying huh here's a cigarette here's an ecigarette which one do I choose it's not that they're substituting or replacing they're not using cigarettes some are now because they're switching back and forth but they're initiating with these cigarettes they're initiating because of the marketing they're initiating because of the flavors and the products and the ability to hide it parents don't know what these products look like so the Landscape is very different so you were telling us Why teens

and Adolescent start vaping and marketing is clearly oriented toward them there are a number of reinforcing factors that at least to my mind as you're describing all this make it sound like the stuff is supposed to be quote unquote playful that it's it's not um it's not a drug that sort of thing reminds me a little bit of sugary cereals when I was a kid you'd buy this the cereal cuz you wanted the taste but You also wanted the colorful box you had the you know the cartoons that it related to on TV and there's

usually a toy inside that you wanted some surprise that you could then collect across boxes so there was a lot of levels of incentiv foration why do they keep smoking or vaping are they addicted to nicotine yeah absolutely so so the other reason why they start is they like like the taste and they like the rush so I've talked to so that's the other piece as So a few more reasons why they start and then and then certainly answer your question around the nicotine um teens have told me outright that they like the taste they

like the rush they like the buzz and we could talk about how much nicotine is in there it's astonishing and I can explain that but they like the buzz they they another reason by the way is stress and coping right now teens are so stressed out they' they've been stressed out for years but they're Particularly stressed with the pandemic and even though we're a couple years out of the lockdown teens are still they're having socialization issues social emotional learning issues they're still confused uh they missed a couple of years particularly high school students may have

missed part of middle school where you're learning to socialize with other people so they're very stressed and we know that there's a pretty strong relationship between stress not being Able to cope and using any drug but incl Nico tee so there's a lot of different reasons why young people and certainly the peers and again it's not peer pressure it's more like a lot of friends are using it I've talked to teens who say I wasn't intending on but I tried it and wow I really like the taste I like the flavor and then there's the

amount of nicotine that's in there in 2015 when the newer products came on the Market it was a salt-based nicotine so cigarettes and then earlier ecigarettes have a freebased nicotine freebased nicotine uses ammonia and sugar to bind to the nicotine and the other chemicals there's hundreds of chemicals in there to go through the body lungs into the brain and give you that Rush the free based nicotine is very costic if you think the litmus test it's very much on the basic side of the Litmus test there and if you're a nicotine naive youth which again

Most teens starting with nicotine ecigarettes have not used nicotine before when you start you don't want that costic throat hit feeling that's how it's described teens will say they don't like it they cough it tasted bad well to an adult who's been using cigarettes they don't mind that they're used to it but a teen is not well I will mention juel here because it's relevant juel Came on the market in 2015 with a salt-based nicotine which essentially uh for those who aren't familiar with CTIC and um litmus tests and things like that the salt-based nicotine

as I understand is quote unquote smoother it's um it causes less U sort of coughing um static contraction of the the muscles in the mouth and throat you know and so it's basically more palpable and more of a of a kind of gradual on-ramp which is exactly what a company wants um if you Want somebody to start using something you don't want to hit them Square in the face that's exactly right that's exactly right so salt-based nicotine generally uses benzoic acid to move that Li Mist test needle from the CTIC towards acidic because it's it's

an acid but really towards neutral so exactly so when you use it it's smooth it's easy to use you don't have that throat hit you don't cough you don't feel sick from it so teens will say and I I've talked to Teens and young adults who tried earlier ecigarettes and didn't like it and then tried the salt Bas style and said oo I like it couple with the flavors it's also more absorbent so there's some suggestion and some early evidence that it's also more addictive so when those products first came on the market before earlier

ecigarettes had say 0 to 36 milligram of nicotine suddenly we jumped up to 59 Mig per mil which is about generally about a 40 41 milligram uh because it's about a 7 mil uh sorry little chemistry and math that we a lot here but you're looking at basically it's anywhere from the nicotine that you see in either one to two packs of cigarettes per per device per pod per ecigarette device and how long does a pod typically last a let's say like a 15 or 16 year old kid who's um you know taking a hit

off The Vape Pen um I don't know what five times a day so I've asked teens in some of the Early earlier Publications we did now not with the newer devices but the older devices and they would say that they were using a pot a week which is about two or three cigarettes a day to one to four pods a day one to four pods a day one to four now these are highly addicted teenagers that is one to eight packs of cigarettes depending on the debates on how much nicotine is in there but you're

looking at several packs of cigarettes worth of nicotine okay so Just to backtrack a little bit because we got a little bit um technical um which is great but I want to make sure everyone's on board the amount of nicotine in one of these pods that goes into the vape pen or EIG is significantly greater than the amount of nicotine in one pack of cigarettes in many cases in many cases and there are many youth so adolescence and teens you said before between ages of 10 and 21 roughly 10 to 18 10 to 21 that

Are going through as many as four pods per day which has to be at least the equivalent of four packs of cigarettes but could be as much as eight packs of cigarettes per day correct in terms of nicotine concentration correct now I I guess to be fair they are not smoking in the traditional sense so that presumably there's some tars and other contaminants that are not going into their system but we know that there are a lot of chemicals in these pods besides just Nicotine and I think that's where a big source of the um

debate and interest is now is you know how dangerous are those those other chemicals is really an interesting question so um a lot of things that you said are really important to highlight U absolutely now not all teenagers are using four pods a day these are extreme very highly addicted teens uh and and unfortunately teens we've seen with lung collapses and and other pretty significant health Issues typically teens are using maybe a pod a day the newer ecigarettes by the way have probably four times that they're bigger volume so you're looking at 60 70 Mig

of nicotine some of them are equivalent to about 3 to 500 cigarettes worth of nicotine now are they using them in a day probably not we haven't done the studies on that but it's really the first nicotine product we've had that you can use 247 when I've talked to Teens you know I wake up in the middle of the night I may check my phone and check my email teens are waking up in the middle of the night to take a hit and they're they're hiding them under their pillows in their nightstands whatever and they're

telling me that they're just using them all the time and they could just suck on them all the time are they using when you say all the time that's interesting forgive me for interrupting but no no no are they using It specifically to wake up to study to um or just to maintain Baseline I mean that's the that's the problem with any addictive substance or habit forming substance is that what starts off as a rush becomes less of a rush and then um when one doesn't use they feel below basic Baseline I've done a lot

of discussions about dopamine and Baseline versus you know um non-baseline peaks in dopamine and some of that is smooth out for General discussion uh dopamine does Many things besides set up reward systems and um incentives in the brain but it's at least one of the things it does so are kids starting off taking nicotine and then and feeling like whoa that makes them feel really elevated in terms of mood focus and alertness and then finding that without it they're just depressed is that is that the general them I'm not trying to lead the the the

witness here I just want to know what what's what's going on internally Absolutely no no no all all great um questions there so what we're what we're finding when we talk to teens is that pretty rapidly they're going from I like it to I need it so you know your your multi-art question which is great what makes them start and what makes them continue they start because of the flavors and and the marketing and they like the The Taste and all that they continue because of that high level of nicotine and we are seeing that

teens Are addicted and we're seeing we actually published a couple of studies showing that teens who have been using ecigarettes in the past 30 days that the majority are showing signs of addiction pretty rapidly too within a few weeks it's such high levels of nicotine and there are some people who don't believe that teens are becoming addicted to nicotine and that you the levels of nicotine are not the same as what we're seeing in cigarettes that's actually not The case and we've seen more and more studies and to the question of using it as soon

as they wake up there's a study by colleague of mine that showed in the last few years the the data are showing that teens a greater percentage of teens who use ecigarettes are doing so in the first five minutes a waking that is a sign of addiction so you wake up maybe go to the bathroom maybe not and you take that hit and so and all the National Data are showing even though Initi ition may go down the percentage of teens who we're using daily has gone up and I attribute that a lot to the

type of nicotine the salt-based nicotine and to the huge amount of nicotine that's been on the market so yes teens are definitely feeling it they're definitely going through withdrawal symptoms that that feeling uh shaking the the sweats all the feelings that they need lack of concentration the problem is when you Talk to teens they they think that ecigarettes are helping with school and and by the way I've not heard a teen tell me that they started because of school reasons or concentration maybe they're continuing for that reason but teens have said that taking the hit

makes them feel good what they don't understand is it's that it makes them feel not bad right the withdrawal is making them feel bad and they don't realize that that hit and That that doping room Rush that they now need it that they're going through a withdrawal either way I'm wondering where they're getting the money to pay for all this uh nicotine when I was a kid I worked um I like mode Lawns I had a newspaper out for a little while but mostly um started working when I I think I was about 14 or

so coffee shop skateboard shop um bus tables did that kind of thing so I made money and I was able to use that money on the things That were important music skateboarding and bus passes and stuff that that's what it was back then food um Etc where are 12-year-olds getting the money to buy four or even one Vape cartridge pod as you called it um per day I mean someone's got to pay for this stuff um I mean unless they're stealing it and I can't imagine that they're all stealing it where are they getting it

how are they getting it yeah it's a Great question so there's not one way uh in terms of money I think there's questions around money and questions around access right and they're not necessarily the the same thing money babysitting the problem is when some of the newer products came on the market some of them the the say 2020 2021 products were about a dollar or two per pod compare that with a pack of cigarettes which is $10 to $15 depending on the state you live in so they are Cheap they're easy to get now newer

ones and older ones are a few dollars more but they're not that expensive they started off very expensive when they first came on the market Market but they haven't been the other is the sharing and we used to hear about pod parties where somebody buys the device which is more expensive buys the device and then you bring your own not beer bring your own pod which is a few dollars then you pop it in and then you share it Around um we've also heard stories of a few teenagers buying them and then selling for a

few cents or a few dollars a puff so meet me in the bathroom for 50 cents or a dollar you can have a couple of Puffs so I think teens are getting very very creative we've also seen unfortunately parents buying e cigarettes for their teens well at least they're not smoking cigarettes that's not the right comparison um so I think they're very Creative they're getting into many many different ways I've heard students say I'm not using my lunch money to buy lunch I'm going to use it to buy Vapes um there's no one way uh

there's not and unfortunately access is easier than it should by the way one thing I think is incredibly important for people to understand is across the US in 2019 December 2019 the legal age to be allowed to purchase or to sell nicotine products across the US is is become 21 So many people think it's so 18 so you go into a vape shop or a tobacco shop and if the shop owner doesn't realize it's 21 they'll sell it to somebody who's 18 and even if they know it's 21 they're still selling it because there's not

enforcement right now going on so we really do need our the public we need all the parents listening we need Educators police officers to really enforce the and regulate this age Restriction because teens are getting them from vape shops really easily they're getting it online really easily um they're buying them for each other somebody's going and buying 10 and and then reselling them if the looks older there's not a lot of carding going on or fake cards ID cards is pretty easy still to get so unfortunately we have a product that is appealing to teens

in a very unregulated market right now the FDA is not regulating it local shops are Not regulating it that it's just it it is the wild west out there so setting aside the issue of whether or not vaping is quote unquote better for us than smoking cigarettes because that argument is um a complicated one uh to say the least what do we know about the health hazards of vaping per se um does it increase um lung disease does it increase cancer rates I mean um my understanding is that nicotine the chemical is not what causes

Cancer in cigarettes it's the tars and other things that um are consumed or brought into the lungs and therefore blood stream when one smokes um that's not to say nicotine is safe I have to be careful here sometimes Clips get cut and people run wild and I I'm not saying nicotine is safe but um what are the problems with vaping nicotine um even let's just say one or two hits per day um especially in kids you know do we do are there known Challenges for brain development are there known challenges for cognitive development are there

known challenges for um lung function is it I mean nicotine is a vasoconstrictor and it raises blood pressure so that's basically stress on the system chronic stress uh but yeah what do we know about what um vaping and ecigarettes are doing to malign Health yeah so first of all start with the brain and and nicotine uh absolutely These high levels of nicotine and really any nicotine is harmful to the developing brain and our brains continue to develop until we're around 25 24 or 26 depending but to around 25 so in that process of of your

brain developing of your brain changing if you introduce nicotine you're changing your brain you're changing the brain chemistry and you're so much more likely to become addicted as an adolescent and young a young adult the tobacco industry Knows this I mean they that's why they target teens we've no this with cigarettes if we target a teen then we're going to have have them for life so significantly more likely to become addicted because it actually rewires your brain and there's plenty of evidence for that the the other pieces that we're worried about is now you're right

nicotine in terms of cancer although I will tell you having talking to some oncologist they would say the Vast amount of nicotine still worries them in terms of cancer we just haven't had enough research on ecigarettes to really know now you're right ecigarettes do not have tar but ecigarettes have alahh tides and alahh have been L linked to cancer so there's still some concern there there's some early anecdotal evidence and probably some of my colleagues out there would say no no there's pretty good evidence around cancer I we just don't have enough body A resarch

but again it took 50 years to figure out cancer and cigarettes we've not had the amount of ecigarette use or or that we saw with cigarettes for that long for that many people to really know it's still pretty new I just might want to just interject the alahh tides um like parap from alahh from Malahide these are the same chemicals that we use in Laboratories to um fix as it's called tissues to make those tissues firm so That then they can be cut and analyzed under the microscope um alahh highes cross-link proteins um basically change

the configuration of proteins and turn what would otherwise be appliable tissue into kind of a hard rubbery think of like a dense eraser like um consistency and in other words not the configuration most conducive for those cells to live and Thrive actually quite the opposite um which is why um that's for sake of doing anatomy on well any body part you Use param alahh glut alahh um and for Malahide to cross-link proteins it basically kills tissue by cross-linking proteins taking a nice you know pliable configuration that's uh amendable to life and twisting the the U

or shearing the proteins more or less um relative cross-linking them and making them nice and rigid so if that's happening in the living child that can't be good that can't be good they can't be good lugs bloodstream everything and all the Alhida cancer right right and so that's why there's a lot of concern there and when I talk to teens uh and in our curriculum we we often say uh because when you just say and you gave a beautiful explanation of the alahh tides but for a teenager what I generally say is is if you

ever dissected a had biology and you dissect a frog yes how did it smell it was gross well that's what you're putting into your body when you're vaping uh because that that's Exactly the point and and that kind of helps them understand it a little bit more but there's a lot of concern around the alahh highes uh there's lead there's cadmium there's propylene glycol and glycerin so there's a lot of other chemicals so no we may not have the thousands of chemicals that we have in cigarettes but we certainly have hundreds of chemicals in an

ecigarette that's very concerning so there are a lot of studies now really showing pretty Significant effects of ecigarette use on heart and lungs a lot um not only all the chemicals we've mentioned but also the flavorants there's cinnamon alide another alahh there's vanilla there's um uh what is it the The Buttery flavor um that's in there is also a lot of concern so that you're inhaling these flavors and I have often explain you can take flavors you can take butter and heat it to several hundred degrees and eat it if you don't Burn your tongue

but you then take it and really inhale the resulting aerosol and then we're seeing the the lesions on the lungs we're seeing young people who have been using ecigarettes having lung collapses pneumonia asthma amongst people who have not had seizures uh one of the teens I know who was using four pods a day was having seizures uh so makes sense because nicotine is a stimulant yes it can cause runaway excitability in the brain If too much is Taken um if 40 to 60% of kids are using ecigarettes um and it's destructive to the lungs uh

and it sounds like the brain as well where are all the young athletes are they the the remaining um uh are they the remaining fraction yeah and and I should say 40 to 60 is what schools are telling me and that might just be using once in a while we don't really know but even kids just like I had to do PE class when I was in high school yeah yeah we had to run a few Laps I can't imagine doing that if your um if your lungs don't function properly no it is actually much

harder and teens will say that and adults I know I actually know an adult who said that when he went from smoking cigarettes to eat cigarettes it actually was harder for him to exercise and to ride his Bic and and and exercise and do other things on the ecigarette compared to the cigarettes that the the impact on the lungs is so strong so you're right it is Probably hurting um Athletics right now where actually there are some curriculums on athletes and and vaping and we're building one as well because there's a lot of concern when

you tell a teen you know I'm worried about lung cancer in 20 years years H I don't care about 20 years from now but you would tell a teen it's harder to run they're more likely to listen to you I'd like to take a brief break and acknowledge one of our sponsors waking up waking up is a Meditation app that offers hundreds of guided meditations mindfulness trainings yoga needer sessions and more I started meditating over three decades ago and what I found in the ensuing years is that sometimes it was very easy for me to

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that's waking up.com huberman we haven't talked too much about peer pressure or just Social pressure um I remember when I was a kid it was in the just say not drugs era and um remember seeing the television commercials with the eggs like two like really beautiful raw eggs and say this is your brain and then was this your brain on drugs and it was frying and you know Nancy Reagan was the big like was everywhere those in that in that time you know just say no just saying no in any case um there must be

a lot of data indicating that what Messages kids respond to I was told and I don't know if this is true but I was told by a researcher um that the anti-smoking campaign that was effective in kids was not one that convinced them that smoking was bad for their health but was one that um convinced them that it was um their purchasing and use of cigarettes that was making uh other people rich and then um kind of demonizing those people that was effective kind of like show uh the Commercials of of these guys um you

know kind of cackling behind closed doors you know making fun of the the people that were um in their words um you know not bright enough to know that that they were being taken advantage of and then that set a kind of a psychological warfare between teens and these people that they perceived as I'm taking advantage of them for money right and that that was effective in getting them to smoke less as opposed to telling them Hey listen smoking is really bad for your health right absolutely so first of all the just say no not

effective say just having saying just say no around any Behavior to a teenager whether it's tobacco cannabis cigarettes um and sex does not work it does not work and for many reasons first of all te are curious and when you say just say no why well because it's bad for you well wait a second exactly what you're saying just telling me that it's bad for me if you Tell me I'm going to get lung cancer or I'm going to have lung disease or anything and I tried the ecigarette and I didn't have lung problems and

instead I actually liked it then we look bad we look like we're lying to teenagers and instead what we were talking about earlier the the feeling the rush the flavor The Taste the perceived in real benefits outweigh the concerns over the risks as a teenager so when we say to a teen just say no don't And they say well why well your brain or your heart or your lungs or it's bad for you they don't believe us and and we absolutely Lo lose credibility so we talk to teens and this is based on decision-making research

that I've been doing for 25 years we have to help teens weigh the benefits and the risk now I don't mean that we say hey it's good for you or you're going to like it certainly not but if we only come from a risk model and a just say no model that never Works for teens we need to help them understand the balance and and teens know that there are good things about using some drugs real or perceived and we can't lie to them on that so that gets to then how do we have those

messages and you're right if we only harp on and and our research would show this too the long-term health risks the your brain on on drugs those kinds of things that's so far in the future or the tra you know you're going To have a tra if you smoke but they're showing the 80-year-old and no 16-year-old even looks at somebody at that age or cares about somebody that's so that other person that that's the problem so we need to talk about the social aspects that teens really care about you you may get wrinkles although we

don't know that so much with these cigarettes but um but the Athletics the things that are important to teens now the campaigns that you're Talking about are really effective as well particularly the mass Campaign which a level that we see social media Campaign which is do you realize that the industry ecigarettes tobacco nicotine cigarette whatever you want to call it is targeting you as a teenager on purpose they want you as a smoker I used to go to middle school students and say before eat cigarettes when cigarettes were of concern and I I love saying

to to young people 400,000 adults Are dying each year from a cigarette from cigarette use you're a replacement smoker and it was great cuz teen said we get really angry and say wait I this 12-year-old boy was so cute wait I don't want to be a replacement smoker Dr money was a big deal to him and I I don't want to give money to the industry and it's great channel that energy and get young people mad that's what really worked showing that the Seven Dwarfs we call it the seven CEOs of the to Big tobacco

Companies at the time said nicotine's not addictive nicotine is not addictive there our cigarettes are not addictive and that clearly they were lying to teens you show that to a teen and explain how nicotine is addictive and they knew it but they're trying to get you works really well and and same thing with marketing we we have a whole lesson on marketing do you think that that that candy was for me as an middle-aged adult it's for you and that gets the mad Because they don't want to be duped they don't want to be targeted

that is a much better message now we still have to tell them about the health risks we absolutely do they still need the knowledge they still need to understand what they're doing is unhealthy but we can't do it in a lecturing way and we can't do it in a way that makes them feel stupid we can't tell them their brains are developing till 25 and therefore they're dumb our lessons on Talking about brain are more like it's really cool that you're developing it's why you can do dance that's why you can sing better you can

learn language there's so much that you could do that's really cool that I can't do right now but because of that that's why you're so much more likely to become addicted and the industry knew that that's why they're targeting you those are the messages that work a lot better for teens sounds like the the key is to Never undervalue the spirit of defiance in youth yeah and perhaps to um wager it um against these clearly destructive behaviors to be honest I'm shocked that um there's so much Vape use and ecigarette use I mean these numbers

are staggering yeah maybe we could weave in a discussion about cannabis sure uh I did an episode about can cannabis um the landscape around cannabis has changed so much since I was a kid it was highly illegal at least where I grew up um now I think it's um been decriminalized certain places still illegal elsewhere I don't want anyone getting in trouble um as a consequence of not understanding what you know the laws in their area uh and outright legal pretty easy to get in a lot of the country and um it's not clear that

at least with individual use that it's being um you know punished as fre nearly as frequently as it used to be so the you know 10-word summary of of the Cannabis thing is that the ratio of THC to CBD is important it is true that a lot of cannabis has much much higher levels of THC now than in the past although I'm told that high THC level cannabis always existed um but it seemed seem to be the concentration of THC that is of let's just say concern as it relates to the potential development of psychosis

um if there's a predisposition um as in terms of the uh how addictive the Cannabis is and so on and so forth which is not to say that CBD is totally innocuous but it seems to be like the THC concentration is the kind of the thing that to mainly focus on so what do we know about cannabis and here we're going to assume cannabis with a a reasonable to high level of THC in it so not pure CBD um what do we know about vaping and EIG use of cannabis specifically is it true that youth

that are taking um nicotine by way of Vape or ecigarette then transition into using cannabis is it sort of a Gateway into Cannabis use and how prevalent is cannabis use in kids age 10 to 21 first of all your right I mean THC levels we're seeing today's joint is about 10 joints when I was a te uh so the the dramatic increases in the potency right now that we're seeing around THC and then you get something like dabbing which is about 80% THC versus 20 to 30% of of the more mainstream products that we have

on the market when I say mainstream I mean like uh uh joints or Or ecigarettes so the potency has gone up dramatically and it is of concern so depending on the study you're going to see anywhere from 10 to 20% of teens saying that they're using some form of cannabis either smoked or in the form of a joint or a blunt and for those who don't know a blunt a lot of people don't realize is a combination of both tobacco and cannabis so it's it's a cigar leaf or some people buy a cigar and pull

out the tobacco and put in the Cannabis or They'll just get the cigar leaf and and roll the the cannabis flower then you're getting both the kind of the double whammy and the Chaser the high of both of nicotine and THC so we're seeing a fair number of it's interesting even though teens are not smoking cigarettes they're still using joints which is interesting uh but very quickly increasing is ecigarettes with cannabis in there you could buy a cannabis style ecigarettes and that's been around for a Long time with volcano vaporized and specific cannabis vaporizers that's

not new but it's become much much more popular but now we're also seeing teens buy a nicotine ecigarette inhale half of it and then add the the cannabis wax or oil to it and then basically get the combination I had one young young teenager probably 123 14year old young man who said yeah I I got a cherry nicotine vape and I inhaled half of it probably use the word Inhale but I used half of it and then I added in some cannabis oil and now I had a cherry flavored cannabis nicotine device so we're seeing

that more and more and even though you're not technically supposed to and the manufacturers of nicotin cigarettes will say don't open them and add stuff a simple YouTube video will teach you how to do it um and unfortunately the videos are not using gloves and bedz zoic acid is coming your skin and things like that But which is bad for which is does it go transdermally does it go through the skin it supposedly it does yeah yeah if the benzoic acid is going transdermally presumably when one inhales off one of these pods they're also bringing

benzoic acid into the lungs correct and um hopefully people realize this from our episodes on breathing but if not I'll just make it clear now that when you breathe in a substance you know a airborne substance into your lungs Because of the um interface between the vasculature the blood supply and the lungs I mean basically things pass from the lungs into the blood supply very very readily quickly and then if those things are able they'll cross the bloodb brain barrier correct correct and it only takes about 7 to 10 seconds to go through the whole

system and into the brain too so it's a very fast process so yes so teenagers are definitely uh vaping or using cannabis ecigarettes And the the problem is you know for one teasel think it's healthier than just like nicotina cigarettes they think it's healthier than combustible I mean yes you're not burning it but you're still inhaling and you still are inhaling there seems to be the purp and glycol the glycerin the flavorant all the alahh tides even if it's just just a an cannabis ecigarette so there's a lot of concern there and then addiction is

still huge it's a huge issue when you're Talking about cannabis the same reasons that we talked about with nicotine the brain development and so on psychosis just a lot a lot to think about here psychosis um there's actually some scientists now who are really strongly saying it's not associated as causal that if you are predetermined to have a mental health issue psychosis schizophrenia then it starting to use or using cannabis can actually trigger and cause you to become psychotic um I don't Totally understand the mechanism yet I don't think we totally do yet but that

there seems to be more than just it might happen and it seems to be right in that older adolescent young adult time frame that it is happening so around the same time that the brain's developing um and we're hardwiring the rest of our brain that that change is happening from from a neur neuronal connection perspective um my understanding sorry to interrupt but my understanding is that Indeed um the use of high THC cannabis in youth in particular male youth right predisposes and you're saying might even be causal toward the development of psychotic symptoms correct in

late teens early 20s correct and that some of those cases um are ones in which the psychosis is irreversible correct um is it sometimes the case that somebody exhibits psychotic symptoms as the consequence of using THC and The Psychotic symptoms resolve or is it you know some sort of circuit switch that is then permanent you know it's a good question I honestly don't really know the answer to that of what what percentage um the the few cases I know of and in talking to the psychiatrist uh would say that it that it's causal and it

may be permanent now it could be it could be managed it doesn't mean that somebody's going to be having psychotic episodes all the time I Mean certainly can be managed and certainly we say please don't continue to use uh would be very important but whether it's completely reversible is something that I'm not sure of uh somebody more versed in this but we you know what you do in in your research and what I know is you know changes to the to the neural circuitry is not changeable you know when we hurt our uh brain cells

that is not something that we could recover from so that is very Much concerning yeah as an as adults there are very few new neurons added to the brain um um there is significant plasticity and recovery of function in some cases both by virtue of traumatic brain injury um certainly people can get over uh certain behavioral patterns and that no doubt involves plasticity but it it takes work and um and when it comes to addiction uh there's evidence that some of the reward circuitry can adjust but um again it it takes um adherence to Specific

things in order to make that happen um I'm very concerned about this uh potentially causal relationship but certainly correlation between high THC containing cannabis and psychosis mostly because we already have a serious problem with psychosis on the planet a lot of people don't realize that you know approximately 1% of the world's population has schizophrenia and by the way I have to be careful with the language nowadays you know has Schizophrenia or is schizophrenic or all that that language gets murky but meet the diagnostic criteria for schizophrenia I think is a safe way to put it

um so if one is then adding to that number of people exhibiting or and suffering from psychotic symptoms that prevent them from having uh functional work lives Etc that that's that's an issue um how difficult is it for these Adolescent and teens to quit vaping and ecigarettes and cannabis I mean um can They quit just by deciding are there programs are they all going into um you know recovery programs are there recovery programs in schools I mean how successful are they in stopping it's really difficult and and maybe I'll talk about nicotine first and the

same would be true for cannabis but a little bit less extent I me both are addictive and interestingly not a lot of people realize that cannabis is addictive and about one in six teens or People who are using particularly under the age of 25 do become addicted so they don't realize that it's addictive they don't realize it's addictive the argument I often heard was it's not as bad as alcohol which is a um kind of a lame argument I understand why people default to that but I mean getting hit by a car might not be

as bad as getting hit by a train um but yeah I don't I wouldn't even look at that analogy as accurate there just different um levels Of destructive different types of destructive um yeah these not as bad as blank doesn't really seem to to work no no and and you know I often say people say well why' you start studying tobacco I mean there is no safe level of tobacco use period yes we have very few 30-year-olds who suddenly pick up a cigarette and become addicted you know at that point you you your development of

your brain now can if you use regular Le are you still going to hurt your lungs and and heart and stuff like that absolutely the brain changes may not be there in the same way but most people don't pick up a cigarette or a cigarette for the very first time in their 30s or 40s and and on so absolutely it's addictive and and it is probably the most difficult to quit uh drug that's out there whereas alcohol we don't see I mean yes we have alcoholism I'm not downplaying that it's a huge issue in This

country it's a huge issue on this planet but you're not going to have people in two weeks three weeks suddenly say I'm addicted to alcohol you are going to with nicotine and you are with cannabis to some extent as well so yes uh nicotine is incredibly addictive and we have so many teens who are addictive addicted to nicotine through ecigarettes and really struggling to get off of it I gave a talk recently to a group of parents and they said this is all great Information Bonnie but how do I help my kid and I just

felt awful because there's not a lot that we have so taking a few different things first of all we don't have there are some programs there are inpatient programs absolutely showing some some POS impatient program there are actually some impatient programs and but those are going to be expensive or require that people have insurance that will cover that absolutely and they take weeks and then You're taking a young person out of their natural environment out of their school out of their friends stigmatizing which hopefully we're not stigmatizing drug use anyway but you know you take

a young person at 12 14 16 you put him in another place that's very difficult on them and if part of why they're using in the first place is stress you're just enhancing that outpatient programs we have some things but the problem is we don't have The best recommendations because we don't have great research so for example nicotine replacement therapy the patch first of all it's not authorized for use by the FDA something it approved by the FDA for anybody under 18 and and yet we have a lot of teenagers who are addicted we just

don't have the right studies and they haven't gone to the FDA for that approval now a lot of doctors are using nicotine patches and prescribing them for somebody under 18 it's considered Off label but you still can do it and most people would recommend it the the problem is and and I don't mean problem with using them I have no problem with and I've often suggested to I don't treat I I want to make sure that I'm not misquoted there either I don't directly treat see patients myself but based on the evidence and the American

Academy Pediatrics recommendations we should be using a patch with those under 18 te but then the question is how much if a Nicotine patch is about 21 milligrams of nicotine and a teenager is using 40 milligrams in a day do you give two patches and I've had some doctors say wow that's a lot of nicotine I say Well they're using a lot of nicotine what I've heard some uh my adolescent medicine colleagues have suggested as one patch and then supplement with gums and suckers and La Anders not as a starting I don't mean like what

we're seeing with with some uh Pouches out there like Zen as a starter I don't mean that I mean as a uh a form of treatment as a way to wean them off so reducing the dosage over time correct correct and and now but then they also don't have the the hand to mouth piece that we see that is difficult so gum in this case I mean non- nicotine gum just chewing regular gum um I've heard teenagers say that they're that they're withdraw last three to four minutes so they have a one teenager said I

have a Playlist on my phone that's each song is three to four minutes and when I start to feel the withdrawal I pop the music in my ears and I go do something and I listen to the song and by then that uncomfortable feeling is over I've heard teens say that they'll run that there's many different things that they'll do um chewing on a toothpick not a nicotine toothpick but just a toothpick um other ways to really get their mind off of that feeling is really important but we Also have to know with adults and

cigarettes it can take 7 to 11 tries so we can't expect until they're fully off of a cigarette can't expect a teenager to quit overnight especially with the social pressure and again sorry to interrupt but I think the the 7 to1 tries um did an episode on on nicotine and I talked about smoking a bit and most people fail most people fail they relapse it's very very difficult to quit smoking people that do it and stick to It are real heroes of the process uh it's not not easy um but that's with a heavy incentive

you know immediate health issues sometimes it's Financial um Etc with kids it feels like all all the pressures are pushing in the opposite direction because it's socially rewarded they get that you know elevation of mood and focus and there's just oh so much um driving them to you know continue using absolutely right one of the things that we do in our program To help teens quit is we talk about social withdrawal and it was actually one of our we have a wonderful group of 40 youth who work with us we call our youth action board

our yab our reach lab yab uh our yabs say that we need to talk about social withdrawal not just physical because of exactly what you're talking about they may not be able to go to that party at on a Saturday night where they know their friends are vaping because it'll and we know the brain cues Up that they'll see or smell or or witness somebody using an ecigarette and those cues will happen and they'll want to use it so they actually have to isolate themselves from their friend group who was using so it's very difficult

so really setting up your social M you really setting up your friends who are not using really trying to talk uh and and have your family around you and I really tell parents it's not the time to get pissed off with Your kids for using it's the time to really help them let's be in this together and often I say the reason why they're using isn't their fault let's go back to the beginning of our conversation about marketing and and that they're being targeted and teens didn't even know what was hitting them what was going

on so let's not be mad at them let's be sympathetic and help so they need the combination of nicotine replacement they needed to change their Milu they need to have healthy snacks and water and and exercise and all kinds of things around them and they may also need cond behavioral therapy or some other therapy to really get them it's not going to be a one stop we need to work with them and that's the same with cannabis by the way this is just any drugs and just feel so bad it is such a problem right

now when we built our curriculums same thing I said I was doing middle and high school and never Thought I'd do elementary and we have an ele curriculum I thought I was only going to do prevention we now have intervention and moving towards sensation that's how many young people are just struggling right now when I was in high school there seemed to be a phenomenon of you know certain behaviors allowed kids to have some social clout um by virtue of I guess they used to call it holding like if someone had weed or if somebody

um yeah if they had weed Then sort of gave them a position in the social structure often times the um kids that you know I mean I was friendly and knew most people in my high school class um you know and a few of them were kind of like less socially engaged than others but then at some point Midway through High School one of them was like start showing up with weed at parties or something and suddenly like they had like a social clout um it was kind of interesting to see how you know having

Paraphernalia having nicotine or cannabis or whatever it is is sort of um I think has long been a kind of like an instant um sort of uh route to inserting oneself into a social structure which is obviously unhealthy I'm not I'm not promoting this yeah and then it is social right that there's a there's sort of an instant substrate for communication when I was growing up I worked at skateboard shop and on my break I would go behind the shop there's A little alley there we'd skateboard there's this little bump and but occasionally like um

employees would share a share a cigarette or you you'd ask someone for a cigarette this this was kind of a way of bridging social gaps um so again I I feel like it's so hard to be a teenager there's so much going on internally and externally and everything you're talking about you know in terms of the the negative health effects the paraphernalia the marketing The Taste the addictive qualities of it Etc um just start to pile on on all these these challenges to to staying away from it but a big one seems to be the

kind of instant um social cred that one gets when they participate in something that other people are participating in because for instance like a sport like if there's a pickup basketball game you have to play reasonably well to get into get into the game otherwise you're it's not going to Be easy or you have to be very bold yeah right um so unless you're engaged in a sport you're in theater or you're doing other things it it's sort of an instant route okay I think I've made my point um is there anything about that um

that by way of understanding you know can help you know create like replacement behaviors I mean it's going to be hard to take a kid who's you know entire life is hanging out with their friends and vaping Cannabis or nicotine after school and hanging around and playing on their phone and saying Hey listen you're going to quit vaping nicotine you're going to feel worse your friends are all going to be doing it and um you'll still be their friend but you're not really part of it it's almost like you have to create a culture of

quitting before this can really go the other direction you do and and what you're saying is is so correct and so relevant and why I feel so bad For teens right now and and and the social media right you put put that in there as well and it's all over the place right now with them they're bombarded by all of the different factors that you talked about and it was interesting we were talking about earlier around the social aspects too I was thinking there was a point where it was so cool particularly around Joel it

was so cool to jeel that I had teens come up to me and say Dr Bonnie do you Have a fake ecigarette and I said a fake ecigarette well yeah all my friends are using and I don't want to but I want to fake it and I just felt so bad and I said no I'm not going to get you a fake e cigarette but I will help you with refusal skills and teach you how to say no but in this case not just say no but teach you how to feel good about about saying

no to certain things that you don't want to be doing and during that time there was it Was very difficult for teens to come up and say I either want to quit or I don't want to be a user I just don't want to start because that was not cool I think we changed in the last couple years thankfully I think there are more teens who are not using who are open to it or who open to quitting a lot of teens want to quit right now so thankfully we're in a new era where this

yes the pressures to use are absolutely there but there's starting to be a tide change where we Getting more teens who are getting on the so-called bandwagon to either quit or not use I think the social supports are being there a lot more than we've ever seen before we have more youth groups who are getting on board of either trying to help quit or trying to make sure that it's okay not to use um it's still hard and what you're talking about so it's our job as adults and healthc care providers and Community Partners and

Educators to really talk to Young people to set up those social groups and say it's okay not to use it's okay to come on over to this group and yeah maybe you're not going to be with that same social group on Saturday night let's start a new social group for you I'm not saying it's easy this is not easy for young people and it's not easy parents are struggling too they're struggling to know what how to talk to their teenagers but this is what we have to work towards and setting up those Social networks of

it's cool not to use one of the other things by the way that we talk talk about is the environment when we talk to teens about not using and why why it's bad for them heart lungs Etc and all the things and being duped and being marketed to and and the money the environment piece has also been interesting you know teens right now may not care about their hearts their lungs 20 years from now they care about the environment and There are environmental aspects to these the Plastics the the pods don't disappear the benzoic acid

does not evaporate and and we've got secondhand Vapor secondhand smoke secondhand and third hand so what I mean by that is if I were to use any ecigarette near you you would actually get a lot of the volatile organic chemicals a lot of the nicotine is in the air actually some stays suggest covid might even be on those droplets there's a lot of issues There and then third hand is it just doesn't dissipate that Vapor aerosol it's not a vapor that Aeros so then settles into carpets and and clothes and so on and this is

toxic to pets to Children things like that so we talk to teens about that that's another way to get young people to be willing to either quit or to Rally around not using is the environment know I if I wash dishes for too long and my my younger was out of the house but when when she comes over I Get yelled across the room mom turn the water off the environment we have to save water that's what they care about so much that if we could at least get that into young people's hands say you

know what you may not care about yourself but what about your friends and what about the environment I think we can also shift some of the generation right now interesting yeah I think replacement behaviors concerned for the environment seem like good incentives And I'm hearing all this I feel really lucky that I was always obsessed with something growing up whether or not it was like birds and fish tanks or skateboard or prior to that soccer or you know um I mean certainly there were drugs and alcohol around but there was there were always activities that

kept us busy um and I guess I wonder whether or not the Advent of social media has created less interest in activities I you know after school activities I guess They used to call them but um I mean even if it's video games um if it's playing a sport if it's theater if it's um art if it's music uh presumably kids are still doing all that stuff but is it the case that the kids that are vaping let's say nicotine maybe cannabis as well are less likely to be engaged in other activities I mean is

this thing becoming just kind of a closed loop of reward I mean that that's to me the real danger of any substance that um Increases the dopamine system activation without a lot of effort right because the as you and I know that the the whole of dopamine circuitry as it relates to reward is all about effort reward reinforcement effort reward reinforcement um but the effort piece is key and drugs basically bypass the effort piece and then you get the reward reinforcement and then eventually the rewarding and reinforcing levels of of return on that drug nicotine

cannabis Etc diminishes and then you're just caught in a behavioral Loop right right right absolutely um so you know are kids doing less stuff are they are they studying less as a consequence of this are they are they playing fewer sports are they less engaged in youth theater and music and youth groups and things like that when we were talking about cigarettes when I first started my career up until probably 2014 I would say yes you're absolutely correct and it Was generally the teens who would say I'm bored and I didn't know what to do

with myself and that's why I picked up cigarettes or um or I'm not an athlete or or this was my social outlet I haven't seen that as a result as much with ecigarettes now as a result of ecigarettes yes but not as a cause of using because it's so ubiquitous ecigarettes we're seeing everywhere it doesn't matter if you're how old you are male female used to be more males using Because some of the earlier devices were more Tech and guys were using it and some of the females didn't want to put them in their person

because they would leak we now are seeing more of an equal if not a little bit more female using um it's it's not your so-called bad or good kids it's not anything it's not the young people who are struggling with school it's everywhere right now independent of location race ethnicity things like that so I don't see so much What you're talking about in terms of a predictor in terms of a of a result absolutely I mean then we're seeing teens who become more isolated who are not engaged as much who are more bored because they're

sitting home and they're vaping um but I also see a lot of young people sitting around together vaping uh so I I do think that that landscape has changed um is it going to change back I don't know is hopefully we change the culture again uh but it it's an Interesting thought I mean as soon as you said that I was thinking yeah I mean they're certainly not out as much as they used to be in terms of and we're talking about this at the beginning we're not seeing them out in Parks as much we're

not seeing them playing pickup sports games as much as we used to but I don't think that's because of ecigarette use I think that's because of social media and just the whole change and honestly parents being afraid of Letting their kids out for some predatory behavior and in other ways um and you mean if kids are let out of the house they're more at risk to predatory behavior but of course they're also at risk when but just by use of the phone because the phone connects everywhere absolutely the phone connects everywhere and that's something we

try to teach teens as well but I think that that's been something that parents are worried about you know I have to you almost the Pendulum almost swung too much of now I have to keep my kid in because I don't want to let them out of the house and I don't want to let them alone driving and alone at the park and things like that but I think that we've reduced you were talking earlier about autonomy we've reduced teens just autonomy and they they have to get into a little bit of trouble they have

to jwalk they have to do I mean I'm not encouraging but you know but but we there's some natural Amount of getting together and hanging out and being crazy at the park and playing and playing games and things like that and I think that has stopped or or slowed down a lot uh I I see it with with some people in my own Community I don't see as much just hanging out in the front yard and shooting the breeze and instead they're they're inside and they're on their phones and and stuff like that so could

that be part of why we're seeing more Ecigarette use possibly I just don't haven't I haven't seen the studies on it yeah perhaps that's a good segue into risky behaviors when I was a kid I mean the dumb stuff that we did um meaning dumb because it was dangerous to ourselves I mean I am not suggesting people do this kids please don't do this just don't but just the dumb stuff of you know jumping off roofs or between roofs um I'm not going to give any other uh Any anecdotes just uh it's amazing that we

all survived um and and some didn't but that was largely the consequence of drugs alcohol mental health issues of kids I knew um but car accidents um actually I grew up in the uh in the mother's Against Drunk Driving era and there was a there real discouragement around drunk driving I was fortunate that at least in high school most of my friends didn't drink or didn't drink much um but you still Heard about fatalities kids happen um even one is is too many obviously um what's going on now in terms of risk-taking behavior um driving

fast driving drunk um doing what used to be just described as dumb stuff um that unfortunately sometimes is is fatal or you know results in paralysis people jumping off bridges into water without testing the water depth you know we've all heard the stories and sadly um they true stories of people becoming Paralyzed that kind of thing dumb stuff dangerous stuff teens do more of it um is it still true that males are doing more of that physical danger stuff than than um than females or is that not true that's what we used to hear but

then of course there's been this big push importantly really to um balance out the amount of research on on both sexes yeah it's a good point I mean some of it has to do with just the methods of our research to know you know what's Interesting I haven't seen more recent data in terms of differences by sex of of risk engagement and risk behavior I mean a lot of what I've seen is balanced out I think it's maybe different kinds of risk behaviors that that people do but we're still seeing it I we're still seeing

teens drinking we're still seeing teens going to parties and getting drunk we're still seeing teens out on the beach and getting drunk I think the big difference now is whether from Mothers Against now I think it's destructive driving is that what it's called I think it's now mothers destructive driving I think that's so that includes drunk driving and racing and racing and and driving under the influence of cannabis or anything else which can be harmful but at least in in a lot of the teens and young adults I've talked to at least we've gotten that

word out to teens so they're still drinking and they're still doing stupid stuff when they drink but They're not getting behind the wheel as much um much less and this idea of a designated driver or sober driver um Uber or Uber Uber's really I guess or lift or any R shair let's just say any ride share has certainly been uh a game Cher in in in the landscape of teenagers and young adults right now uh and in fact I've heard not just a designated driver but a designated partner or a sober a sober sitter so

this idea that you go to a part party and there may be Drinking going on but you make sure that there's one person who's sober not just for driving but to make sure you're not going home with somebody you don't want to go home with to make sure that you're not leaving drunk and falling downstairs to make sure that you're not falling out of that window so that message we've gotten across really well which I'm thrilled about are we still seeing drunk driving in accidents I certainly have among some people I know certainly we Are

but I think that the message overall is gten out there some people I've talked to said we just just don't get behind the wheel period what's also interesting is more and more teens are not driving they're delaying driving more and more whether that's because of uber lift I mean it's it's as a parent it's less expensive to pay for a ride share than to pay for insurance for somebody under 25 or to pay for a car so certainly that might be it um but but That is there doing other stupid stuff I mean in addition

to drugs jumping skateboarding certainly we're still seeing that well skateboarding is a good sport you got to don't exceed your skill level but jumping between buildings not smart um unless you're super skilled and know what you're doing I mean you know there are the parkour kids and the skateboard kids and in the BMX cuz we we don't want to take away what the incredible things that they can can do But but there's risk there right I was referring to people who lack the skill to to complete the to complete the maneuver and um and getting

badly hurt or or in some cases not getting badly hurt but you you just kind of shake your head and wonder why you why you ever engaged in that kind of stuff just so risky yeah yeah we're definitely still seeing risk behavior amongst teenagers and part of it has to do with impulsivity we know that teens's up Until around part of the development right of cognitive and social psychosocial and Social Development it's up until around 16 17 they're still very impulsive uh we know with the brain development right the back of the brain develops f

faster and first and that's our amydala our emotional Center our motor coordination versus the front of the brain which is our executive functioning our uh uh planning for the future our really slowing down and being Able to think of the risks and benefits and make those decisions a little slower and a little bit better more like we would as adults so we certainly see impulsive decision you know hey let's go teepee that house or let's go ride on that car or let's go do things that probably hopefully wouldn't get them killed or injured but may

get them busted in other ways we're still seeing that I think there have been more programs to help teens sort of rehearse In in situations so they're not more life skills training so they're not making some of those impulsive decisions but teens will teens are going to be teens which by the way is why we don't put things in front of them like you know sugar booger and unicorn kind of marketing that's going to get te attractive because that is buying into that knee-jerk impulsive it looks cool everyone's doing a kind of thing that they

can resist I don't mean that they Can't but just buys right into teens are going to be teens and that's what they're going to do um what about sexual behavior you mentioned that kids are driving less um or getting their driver's license less frequently um which by the way with respect to teens wanting to drive less that just like baffles my mind I mean one of the reasons I like skateboarding as a sport is you could do it anywhere it was also Transportation and I like the social milu I loved the social milu of it

um and but getting my driver's license was like one of the most important events of my life me too I could drive to yede in the summer I could do all sorts of things with that I'm so surprised that kids wouldn't want to do that um such autonomy there so much fun um oh I I agree but I've also heard that um rates of of sexual behavior are going down is that true yeah stabilizing and going Down um and certainly rates of risky sexual behavior has also gone down so we are getting the message across

around condom use around um STI testing around birth control things like that which is also really good but rates overall have gone down is teen pregnancy down I think it's down actually I haven't looked at the latest numbers I think it's down uh certainly I don't think has gone up but I'm I actually would need to look back at those numbers it's been a little While since I've looked at them and is what we're talking about um today mostly within the United States and the United States alone or is it carry over to other countries

as well so it it totally depends on the behavior that we're talking about let's say vaping um or E use of cannabis uh or nicotine so interestingly ecigarette nicotine ecigarette use has not been as high in a lot of other countries it depends on the country but for example the UK or Europe We haven't seen the rates as high in the last few years part of it was that a lot of other states have a nicotine standard so that means a minimum amount or maximum amount excuse me of nicotine that you're allowed to have so

for example the UK I think it's around 1.7% in the US we have no nicotine standard which is another major issue with regulation we don't have we have as I was saying 5% 10% nicotine s there is no regulation about how much nicotine That you could have so in certain countries if it's right around the addictive level or a little bit below it we're going to see fewer teens becoming addictive it's still bad at any amount but we're going to see fewer people becoming addicted the other is the marketing was not as big in other

countries and really was the marketing was ecigarettes if you're trying to stop smoking cigarettes not marketed to teens that has changed in the last year or two So in countries I've talked to for example the UK I've been interviewed by them many times in the last few years and they would say we don't have the same problem and now they're saying boy we are seeing a pretty significant increase in the number of teens who are using part of it is a different landscape of the kind of ecigarette that's out there the kind of marketing that's

out there whatever it is we are now seeing is it as high as we have in The US I don't think so but it's certainly increasing same thing in in other countries where they actually didn't allow certain ecigarettes to be on the market have now come in and and been on the market and infiltrated and even in this country certain ecigarettes are illegal and they're coming in um illegally through illicit trading is happening in and and crossing the borders so um so ecigarette we're still seeing cannabis depends on this on the Country right whether it's

legal or not now even in the US I should say even states that have legalized cannabis you have to be 21 uh but we're still seeing underage cannabis use of course just like we're seeing underage drinking and underage nicotin use in other states where it's just really difficult to get we're not seeing cannabis as much but we still are seeing it we didn't talk about um things like Zin pouches which are becoming more Popular with adults as well so no vaping no EIG no smoking nicotine but a little pouch um which is different than dipping

tobacco or snuffing tobacco um as far as I know uh Zin pouches and things similar deliver nicotine into the bloodstream which then crosses the bloodb brain barrier goes into the brain has this effect of creating focus and alertness kind of little High um but doesn't carry the same carcinogenic risk but Presumably there are other risks um which include of course the add and habit forming nature of it the blood pressure increase the Vaso constriction which is related to the blood pressure Etc but what do we know about Zen pouch use is it on the rise

or um is or is it that there's something so compelling about vaping and um eigs that you know people in particular kids want the the physical act of of vaping so um this is a case where I've seen this one other Time where actually the popular press is ahead of the scientific press and probably head of the science and teaching us scientists that we better hurry up and figure this out how was how was that um so the popular press has been talking about Zin a lot and and arguing that it's a very popular product

and that we're seeing now this is true we're seeing a very sharp increase in the market share of Zin compared to other nicotine products so we're seeing It on the rise what I mean by science hasn't caught up is we don't have a lot of surveillance data to show whether or not teens are actually using Zin we have some data we actually published this study a couple years ago showing around 20 to 25% of people in general adolescence and adults and about 11 to 15% of teens are using a pouch presumably Zin we didn't ask

we now we looking at our data around Zen use um but we don't have widescale studies we Do have studies of pouches more generally like the CDC showed that about I think it was a couple of percent one and a half percent and that it went up a little bit so I think I can't it was something like I think it went from one 1.1% to about 1.5% of teens seem to be admitting using pouches so not a huge increase but a few hundred thousand teens are using across the country as opposed to 2 and

A5 million plus using ecigarettes But with all those qualifications aside yes we are seeing an increase in Zin use amongst teenagers what's most concerning is that it seems like it's teenagers who are not using it in addition to ecigarettes but new initiates so they're now just like I'm concerned about teens initiating tobacco or nicotine through ecigarettes now it seems like some are initiating through Zen so Zen is kind of the Gateway it may be an onramp um to using And and and the idea is that they're putting it in between their lip and their gum

and then each pouch of Zin is three or 6 milligram it comes in a 3 MGR pouch or a 6 MGR pouch now it is nicotine that yes it's originally D derived from tobacco but there's no tobacco in the pouch itself it's a white powdered nicotine and the I don't know what else is in there we are really lacking the research there but my concern is we've Seen this with smokeless tobacco for years is oral cancer and you're putting this in the mouth and at the mucosal line and are we going to start being concerned

about oral cancer which we've already been concerned about with other pouches how would you get oral cancer if there if there's no tobacco and it's just nicotine does nicot I I was under the impression and please tell me if I'm wrong that nicotine itself doesn't cause cancer the question is what else is in There is it just nicotine or is there aldhy and other chemicals that are cut with it so that's why I'm said we don't know enough about it my big concern is exactly what you're saying are we going to start seeing teens using

nicotine and then nicotine pouches and moving on but the the brain piece it doesn't matter what else is in there we are still concerned about the brain development and if you're using a 3 mgram or a 6 milligram pouch and we know That a lot of teens are using multiple pouches our study showed this as well multiple pouches throughout the day and actually some social media is showing teens putting in several pouches at the same time then you might be getting again as much as a pack of cigarettes of nicotine and that's very concerning so

the whole piece we talked about before about brain development and are we stuning or changing or or really rewiring the brain with nicotine doesn't Matter what form it's in it is not good and it's not good for teenagers yeah I get asked a lot of questions about Zen pouches and other nicotine pouches and one of the more common questions is um related to the fact that a lot of people start with one or two pouches a day quickly move to four to five and the typical ceiling for most people that at least ask me questions

about it uh is moving to quickly a canister a day yeah which is a Lot of pouches uh I think it's 15 to 20 pouches per can okay so 3 to six milligrams right you can do the math do the math what's that 60 to upwards of 60 milligrams that's that's and I'm thinking back three packs of cigarettes you got your step ahead of me two steps ahead of me two let's play it safe two I'll give you you know two packs of cigarettes day at least two packs of cigarettes worth of nicotine and it's

interesting in in the in the old days When we didn't have e cigarettes and we were talking about cigarettes and we were talking about adults we would talk pack cigarett years right how many packs of cigarettes and for how many years and that language kind of reduced for a while because adults and people weren't using cigarettes as much and so we weren't worrying about this concept of packs I'm worried about it again again we're getting so much nicotine now now yes not in the form of combusted not in The form of burning maybe it's in

the form of ecigarettes or pouches but it's still a huge amount of nicotine that we're seeing that young very young brains are using yeah can't be good in my opinion I spent years studying brain development still teach brain development every year can't be good the brain doesn't do well developing with high artificially high levels of any neuromodulator and then you go back to the 8-year-olds we were Talking about earlier and we have no studies right on what does a drug like nicotine do to not a teen brain but a child brain and clearly is not

good but what exactly is happening we don't have those studies but it's it's incredibly scary to to think about what's happening with young people um and getting addicted so young and then continuing that addiction of a lifetime of addiction that they might have seems like it would be appropriate Now to kind of take a step back um I think everyone agrees that these are major problems that are in our youth um and just evaluate messaging and tools to overcome uh these issues um right so obviously if you never try a substance or behavior you can't

get addicted to it um but given the prevalence of this stuff what sorts of messaging work earlier we talked about set you know accessing the the rebellious spirit that is youth as a Way to get um youth to engage in healthier behaviors and abandon unhealthy behaviors but there's quitting there's just saying no and then there's harm reduction um there's convincing people that some substance is bad for them and scaring them to the point where they quit there's incentivized in them to be healthy there's um replacement behaviors there's just so much in that landscape I Know

you just um held a conference on cannabis and tobacco recently I'm sorry I wasn't able to attend it sounds super interesting but whether or not we're talking about social media or cannabis or risky driving behavior or um you know Reckless Behavior of any kind I mean what works and when I say this I don't necessarily just mean at the level of Public Health discourse but also parent to child um peer to peer yeah um sibling to Sibling what works I mean how should One approach a kid or an adult for that matter who's vaping cannabis

or is vaping nicotine at uh and it's just clearly going to be a bad trajectory what can one do I mean we all also understand personal accountability and neuroplasticity generally emerges best when it comes from within as opposed to from the outside but what can we do the most important is and I've said this for years have a conversation and some people think that Having a conversation about name your name your risk behavior drugs uh of any sort Alcohol Tobacco other drugs having a conversation about sex having a conversation about risky driving get young people

curious that is not at all the case there's nothing we can talk to a young person about that they don't already know you know we're kidding ourselves to say oh we can't mention drugs to a 16-year-old because we're going to get them curious they've known About drugs since they were 8 years old they we're not and and I often say to parents start that conversation Young when you're when your kids are really young four or five maybe the conversation is having a cookie or having some grapes and and make or going to bed now or

going to bed in five minutes I used to say that with my own kids you want to go to bed now or in five minutes so they felt like they were making the decision I didn't really care Which decision they were making it was not a fight we need to start having conversations around decision making and healthy decision making and not having a confrontation but a conversation very young now I'm not saying that we talk about drugs or sex when they're very young although to be honest I did I talked about cigarettes and and um

and pubal development with my kids when they were very young but it but just starting that conversation so That when you move into more sensitive topics more difficult topics as a child ages and becomes an old older child and into adolescence it's not shocking that you're having those conversations and this is whether you're a parent an educator or whatever so just talking a conversation and not scheduling it by the way not on Saturday at 3:00 we're going to sit down and talk about sex or 3 o' we're going to talk about drugs that does not

work you need to I I joke That was like the queen of organic conversation you know I'd see something on TV oh you know oh let's have a conversation about that just making it a natural part and you were asking about differences in cultures and and countries we don't normalize those conversations other countries do and we need to be doing that so that's it sounds like we don't normalize them or formalize them correct we don't so that's one thing the other is we're Kidding ourselves if we just talk about the just say no as we're

saying before of course we want no use of course we want teens to wait I mean and say we hope and expect that most people if not all will grow up into a healthy sexual relationship whatever that might look like even a healthy alcohol relationship a glass of wine or half a glass of wine at night with dinner again no safe use of a lot of the other drugs including nicotine certainly fentanyl illicit Fentanyl um want to make clear not all fanol mid elicit fentanyl but to just simply say no and don't do and it's

bad for for you is setting up again that failure of your conversation because okay well you're telling me it's bad but I liked it or my friend liked it and it's not so bad so you've lost credibility the most important part of harm reduction is not to do it absolutely of course not to use not to have risky sex maybe not to have sex at All until you're older not to use tobacco not to use any drugs but how do we do that with a young person who you go into a classroom and 10% 20%

have already started using or having sex or whatever the conversation is you shut them down well they don't understand me so why should I listen to them they're not talking to me and so that no use conversation doesn't work there's a Continuum or spectrum of use everything from no use to once in a while to Regular use all the way up to addicted years when we're talking about drugs so to go in and assume that nobody's ever used or nobody wants to use you're setting yourself up for failure that's the expectation that's the hope but

what we really also need to talk about is best if you don't use but if you do let's if you are using Let's help you cut back or quit and if you are continuing to use let's keep you safe let's make sure that you're not going to Die and what I'm talking about here is you know when when most parents if their kids are going to go to a party well I shouldn't say most parents but a conversation often is hey I hope you're not drinking but if you are pick up the phone and I

will come get you that's harm reduction and people oh I didn't think about that well that's putting Safety First that is a harm reduction message o or saying I you know you're pretty young to start having sex but Here's a condom just in case why do we schools have condoms and because they know that as much as we say it's best to delay are going to that's harm reduction let's at least reduce risk of sti's pregnancy and so on and what did the data say is um the consequence of harm reduction versus the um kind

of like thick black line don't don't go anywhere near this behavior all the research or pretty much all the research that I've read and hopefully will contribute to Shows that that those messages the harm reduction messages um or what I would say comprehensive really the harm reduction unfortunately harm reduction has gotten a bad WP um part because of cigarettes versus ecigarettes and this reduction or harm Continuum with tobacco so maybe we don't say harm reduction we say comprehensive conversations comprehensive education from no use all the way up to what do we do if you are

using and all the research is really Saying that those messages are way more effective than not using it all than that if we tell teens don't use and we see this a lot in sexual behavior we say do not have sex period sign a contract that you're not going to have sex and then they're in a situation and we don't arm them with the understanding of how to negotiate how to have a healthy relationship had to have a conversation what do they do if they're thinking that they might want to have sex what do they

Do in that situation we then find that we're having teens who then don't know how to protect themselves and either have sex that was unwanted or sex that was unprotected and teens want to understand they want the truth they want the knowledge I I went to a school and asked whether if I came and talked about cannabis would they come and they said absolutely I want to understand it and there's this great quote that I recently Learned um that said if you know if you don't basically the concept is if you don't teach teens they're

going to seek out information so the quote is having teens learn about sex from porn is like having them learn physics from a Transformer from the Transformers or having them learn how to drive from Fast and Furious We need to give teens the information because they're going to find it that's right they're being exposed to other information Elsewhere um anyway so that so what you're talking about here is um coming up with counterbalances counterbalances real science-based information that's not overblowing the risks that's not scaring them and then that helps them understand it's best to say

no but if you do Fentanyl let's make sure you're not using a loan I mean obviously I don't want somebody using a drug that hasn't been tested and they got off the the internet period because I know kids Who have died it's so scary you know we have close friends that um gosh I I would have never guessed that their kids were using drugs and M maybe they were using drugs at the frequency that was always typical of of Youth I don't know I don't know the situations well enough but you know I would say

about once every four sadly once every um 4 to 8 months I hear about someone's kid or close relative that died of a fentanyl overdose yeah it does Seem to be kids um maybe 30 and younger yeah it was more in the the 20s and 30s it's now really getting into the teens and young adults you're absolutely right and some of the teens I know of who and and young adults who have died were not your drug users you know we talked about not stigmatizing and and that's the other thing if we don't talk then

we're stigmatizing we need to have those conversations but a lot of those teens were not using they They needed a pill cuz they were in pain or they needed something and they were not told and this is again that harm reduction and that conversation they were not told don't buy something off the internet if you do test it and and and test it with a fentanyl strip for example and make sure that you're not using a loan because if you're using a loan we can't then give you an our can we can't do something I

care AR cam with me all the time do you really I do I Have it in my backpack all the time for anyone that you might see that having an overdose or anyone who might see yeah thankfully it hasn't happened but if if if it does I would and and you can't hurt somebody from using it if that's something's happening so should everyone carry a naram I think everybody should have Naran I I do I think I think every school should have Naran I think every Library should have Naran I think every bar should have

Aron um I I absolutely Believe it now test strips is an interesting debate that I've had so I totally believe in this concept of comprehensive if you don't want to say harod action comprehensive drug education comprehensive sex education and what I mean by that is both the spectrum of of use or behavior as well as all kinds of drug sex rock and roll that we talk about the whole thing but FAL test strips has been an interesting dilemma Within Myself and I'll explain Why I've been working with some groups to try to test whether we

could study whether if we put both Naran and Fentanyl test trips in schools would teens you get them so you're my fantasy bowl of condoms bowl of Naran bow of fenal test stps and you have it out for for teens wow that's that's a bold statement it is a very bold statement what about the argument that I imagine some people uh counter with um I'm not Necessarily saying this this is my argument but just um imagining that some people will hear that and say um having those things uh visible freely available will in will create

more of an incentive for risk-taking so I've grappled with that and with condoms we know that that's not the case T it's not going to create teens starting to have sex just going back to what we saying a few minutes ago you're not going to incentivize or create people engaging in Any risk behavior by having the conversation but my Gra with the Naran and with the fentanyl test trips has been there oh well you tell me it's a bad idea to use a drug but I'll just test it make sure it's okay well I have

a couple of problems with that um even though I still believe in it I still believe in having those there because right now we have an overdose epidemic with fentanyl and Other Drugs so I'll be honest with you I Grapple if if if I were in a school and I saw a teenager taking a fentanyl test strip which probably means that they're use it for themselves is the first thing I want to do shake the kid and say are you crazy don't that means that you're thinking about using drugs of course that's my inclination as

a parent as a scientist as a developmental psychologist as a human being you want to say what are you doing so yes I would grapple but at the same time if I know That there's a chance that a teen's going to go to a party or pick up a drug and not know do I would I rather that they're safe yes the problem with fental test stps though is that they're not perfect if you are testing the right side of the pill but it's the left side that has fentanyl you still could die and so

I don't want to give the impression that that there's one stop is going to fix anything right now it is not and that that is the the issue with The comprehensive drug education or harm reduction uh conversations I'm not saying that it's perfect I'm not saying saying that it's going to stop young people from engaging or young people from from getting hurt or or you know unfortunately dying but if you have a group of Youth who are going to use I would still rather arm them with that information so they don't find themselves in trouble

um that is the biggest part that scares me is fentel Making its way into all Pharmaceuticals like benzo um MDMA I'm thinking about some of the things are taken recreationally um benzo MDMA um is it in cannabis so most of what I've seen is either by itself fentanyl um using or that it's mixed into pain pain um pills a lot um why would kids want to take pain pills I mean they're in pain they're stressed they're or so they're doing they're doing it sort of Self-directed clinical correct or Prozac they're anxious I see so it's

not like they're doing it for recreational drug use at parties some are some aren't I mean there there's been so many different circumstances um cannabis and vaping have been interesting debates and we actually had this just the other day uh some of the studies suggest and the that and and suggest that biologically we can't necessarily combine cannabis or Nicotine and Fentanyl and have the same reaction on the body and some suggesting that the studies haven't been there but and it's still so new but I will tell you that they're that talking to teens and some

some studies suggesting that yes teens are combining or at least getting and a lot of times it's not knowingly it's cut the fentanyl is cutting or the the uh drug manufacturers and sellers are cutting a drug with fentanyl and so they're not even teens Are knowing it but that some um I was talking to a a person the other day who said that he has definitely heard of and seen some teens with fentanyl overdoses from Cannabis or from vaping so there's so much studies that are still needed right now and to understand the biological mechanism

um as well as the the access to these drugs that we don't know but I I'm nervous so we teach about drug testing we teach about not getting something off it used to be a uh Skittle Drug uh parties you'd go and people would take drugs and all different things and put them in the in the middle of a bowl in the middle of the room and just you take whatever who oh yeah when was that this is not long ago maybe 5 10 years ago I was hearing about these I never went to a

party like that I didn't either but I didn't go to many parties I was I was Square kid but yeah it's interesting may maybe it was just where it was I mean there were certainly drugs Around but um I feel like now recreational pharmacology it sounds like it's everywhere so so different yeah and self-medication is is everywhere that wasn't that wasn't common that wasn't as common but we or if it was people weren't talking about it I think it was I I remember as a middle school student walking into the bathroom and somebody had taken

I think what's called a lwd then and and had passed out um it it was certainly around uh different drugs uh But not the not the same that we're seeing now and we definitely saw cocaine overdoses when I was younger yeah I I feel like there was a lot of weed cannabis that is um alcohol um Sil cyb and then as a recreational drug now obviously it's being explored as a clinical tool as his cannabis for that matter um but hard drugs like cocaine amphetamine were PCP were discussed in the media a lot but and

it certainly existed in some High schools and colleges and things like that but sounds like it's seeping out of everywhere um it and it's in these commercial products I mean I think the picture that um has been created here is kind of an ominous one so how optimistic are you I I will tell you I'm optimist istic in seeing a a change in the landscape of Education now some people say education doesn't work that we need policies we need both I mean we we have Federal policies and regulations That are slipping through the cracks uh

FDA with regulation of ecigarettes with cannabis uh legalization but not being enforced we have uh age restrictions not being enforced so we certainly need education and I'm seeing more and more people for example the concept of of harm reduction or comprehensive education comprehensive sex said not everybody's of course up for it but or open to it but I'm seeing more of a shift towards understanding the need I'm Definitely seeing more teens as we were talking about earlier more teens being willing to say no that's not something I'm going to do more teens joining youth groups

more teens speaking out about concerns and and trying to be healthier and make healthier decisions for themselves so I'm optimistic in the the human capital and the social capital I'm not optimistic when it comes to the the pharmacology or or the drug Capital so to speak um more and more drugs Infiltrating infiltrating our youth I mean you could Vape dot dot dot anything nowadays and that makes me very nervous I do think vaping um and I am using vaping instead of eat cigarettes there to be more lay conversations there or or what the the the

culture is saying vaping is just more normalized than it than we've ever ever had it just like smoking was normalized vaping and now vaping anything is very scary to me and very Much normalized so that worries me again the fentanyl the hallucinate gens um making its way more and more so that the drugs themselves and the new devices scares me the social and the human capital gives me optimism very grateful to hear that you have optimism sounds to me and correct me where I'm wrong please um and add anything that for parents for siblings for

teachers for educators or for any concerned citizen it seems like having Conversations about these things the fact that they're happening so not turning a blind eye the fact that um you know kids are aware of it they're you know that we're fooling ourselves if we think that they aren't aware of these risk-taking behaviors they're sort of they're all around them uh anyway so we shouldn't shy away from those conversations and that at least having a conversation about the difference between avoiding behaviors and harm Reduction is something that one ought to consider I mean obviously this

is a household by household Choice absolutely um in some cases school by school or classroom by classroom choice but certainly household maybe even parent by parent choice but that um because of social media and just because of the nature of Youth that young people are having these conversations anyway that that's what I'm hearing coming through and that and that it you said don't Formalize the conversation so much that you know Saturday at 3:00 we're going to have a discussion about drugs but make it part of the landscape to create some ease um solely make it

fasile to talk about these things concerns um and probably listen to them too they're right there in the midst of it um so they have a data set internally about what what's actually happening totally agree totally agree and and I often say to to parents or Educators if you're they're listening to this podcast or any it it's actually say hey I I learned something can we have a conversation about what I learned and not confront again that it's a conversation not a confrontation it's let's normalize drug discussions let's normalize uh Behavior discussions not normalize the

use or the behavior itself so talk to your teens you're absolutely right talk to your teens this is what I just learned what Do you know can we find out some information together go on our reach websites go on other web websites go learn information out there learn together and not lecture but have a conversation you may not know right away a team may not tell you right away yes I'm using or yes I'm having sex or yes I'm drinking alcohol or yes I'm doing something that is just a risky Behavior but that's not necessarily

our goal is as adults to find out today Whether or not somebody is doing something it's okay okay to let it be a little bit more organic it's a it's okay to start that conversation and see that's your building trust it is parent to parent but I would say I'm not going to bust you I certainly I'm not going to be happy but let's have a conversation so that way we can build the trust and I could help you either not use get help stop using or be safer in using or help you prevent from

using it all so having That conversation that organic and and talking to where they're at as a developmentalist that's what we do meet people where they're at meet youth where they're at whether that's using already not using don't come at them with your preconceived notions as an adult because it will not work it will backfire we need to use the strengths young people are strong young people are smart we need to use their strengths take their lead and then use our adult wisdom and Experiences to then turn that into the proper conversation I love it

well on the topic of conversation and communication one of the um kind of unique features of this podcast is that we have a uh a large social media um footprint um and inside of that footprint we not only broadcast information but we get information back so in anticipation of uh this conversation today I reached out to uh followers of huberman lab social media On X formerly known as Twitter and Instagram and they had a lot of questions for you we don't have time to go into the many thousands of questions but I'm going to just

ask you um if I may in kind of a um short Q&A format a few of them and if you don't have answers you can just say pass we'll get back to that maybe we'll do another episode another time uh please don't feel um obligated to give thorough answers this is uh we just wouldn't have Time yeah so one of the top questions is would love to learn more about how to get teens to see the longer term implications of the choices they make and the habits they form now is there any way to get

them to understand how now leads to later we've done studies where we've asked teens about their goals and I want to be a dancer we had one teen tell us or I want to be a doctor or I want to be whatever it is asking teens about their Goals about their aspirations and then connecting their current behavior and their current risks and and keeping themselves healthy and how that plays into their goals that tends to work a lot and we've seen that in our studies teens set boundaries I don't want to get pregnant because I

want to be a dancer things like that so really linking what they're doing now to their ultimate goals is one way to really help them think that through I like that how a Different maybe even larger goal um if you could supersede these like short-term behaviors and they could see how those things link up absolutely that's great um there's another question came in requesting some positive news about teenagers to be shared quote every discussion is around risk or emotional distress or social anxiety or phone addiction as if they're all dysfunctional U because of their brains

We never dismiss toddlers learning to talk and walk because their brains are offline so I think the point is that um you know can we highlight some of the ways in which the Adolescent teen brain is um is exceptional at something that perhaps the rest of uh the brains out there are not so I mentioned some of them around our youth group and about the youth movement now against drugs and and other things I think and it comes the optimism I I I I'm the biggest teen Advocate out there it's why I study adolescence and

I do the prevention and advocacy work that I do teenagers are fundamentally fantastic uh they're creative they're passionate teens care about the environment kids really teens really care about social justice teens do care about our future and our planet that is wonderful well more than do adults right now so I think we should be capitalizing on that teens are incredibly creative we need to be Working with teens and young adults in everything that we do because they are a future and I don't mean that as a cliche I really mean that so having the conversation

let them be be part part of that conversation help them find out what they think we should do to solve some of the problems they're the ones to talk to so I very optimistic about teenagers we have 40 teenagers who and young adults who work with us all the time on our work because we trust them So I think some people are afraid of teens I embrace them I think they're fantastic love it do we know how vaping shapes the teen brain in other words are there any known biological changes in the developing brain as

a consequence of of vaping and here I'm going to assume it's vaping nicotine but you know we talked about um cannabis as it relates to uh psychosis earlier so let's just keep it restricted to um nicotine sure well we know that during the adolescence That nicotine changes the brain wiring and what do I mean by that we're actually born with the nicotinic receptors we're born with the ability to become addicted to nicotine same thing with the um cannabis you were talking about before so if we don't during the Adolescent time when we're pruning away and

getting rid of the the connections the neurons that we don't need what happens is uh dur during that process anything that we don't use that we don't Reinforce goes away well if we introduce nicotine in into our brain it solidifies it keeps that that receptor there and also makes it to where our receptor is really kind of I think of it as like um keys and locks in a key and suddenly you've got that receptor and it says ooh you're putting nicotine in there keep that in there or cups it's developing those cups I often

think about and filling those cups with nicotine and those cups are your receptors that were Already there you then take away that nicotine and your cups say I need more so you're rewiring your brain you're wiring your brain to be more likely to become addicted and now you're addicted and you need to keep feeding those cups with nicotine or you're going to go through a withdrawal and so that is what H is happening during an adolescent and young adult that we don't see in adults that's why we really want to keep young people away from

nicotine as long as Possible a lot of questions about um are there negative effects of of pornography on the developing brain I imagine there's a lot of literature on that yeah I I don't know as much actually in the developing brain um I'm sure there is I I don't know it there is but there's clear evidence about viewing pornography around just not having goodal healthy sexual relationships because porn is not normal it is it is not a normal relationship between two people what you Are doing is really making it so that way you um you're

you're not necessarily developing a healthy relationship with your partner because you're assuming some gold standard out there that may or may not be able to be achieved so um and it also is also a problem with body shaming and the body types that most people don't have and can't achieve and that's that that's another problem out there with with uh with with pornography a lot of questions about how social Media impacts brain development that's probably an entire episode unto itself it is it is that that we could do another time and we should and um

if you'd be so gracious to come back and do that we we will um I think as a just a final question you know is there any um information about potential causality between the Mental Health crisis that we observe in Youth and um let's just say substance use um of the sorts that we talked about today obviously the Directionality is tricky there you can imagine that a lot of HGC cannabis use is leading to more psychosis but seems more likely that um kids are self-medicating correct in the face of like immense challenge you know not

just the lockdowns and the culture around isolating kids from other kids and um the stress that was on everybody um stress generally the sociopolitical landscape social media I mean it's hard to not feel like it's at least a Cloudier maybe a darker time than it used to be but I don't know I mean we humans have evolved through a lot um and it I don't know that it's also fair to say that everyone's you know bummed out about what they see presumably there's still some optimists out there so absolutely uh there there plenty of studies

that show the bidirectional relationship between anxiety depression Mental Health and substance use you're right a lot of teens are self-medicating By using various substances to reduce their anxiety reduce their stress and also just social lubrication right of going into a party and and pregaming or going into a party and using drugs to make themselves uh less stiff less less stressed during that situation but more what we're talking about is that they're self-medicating because they're feeling sad or uncomfortable and this is they think helping them again it's not helping it's making them feel less bad Had

by continuing to use but we also do know that drugs also lead to suicidal ideations suicide attempts psychosis and other mental health issues we also know that drugs lead to reduce academic achievement um even though there's some potential uh cognitive in reinforcement that's going on there's also some issues with lack of concentration the other piece by the way that we didn't really talk about a lot but is the co-use that we're seeing a Lot of te not just using multiple products but using them together so a lot of teens who are chasing cannabis and tobacco

because it enhances the high or they're using cannabis with alcohol and other mixing of drugs which is uh enhancing the high but not in a good way and very scary uh for for young people and and a lot of times young people don't even realize like with blunts which is truly as I was saying before using nicotine and cannabis together That you're actually becoming addicted to both products really simultaneously and that we're seeing young people who are having mental health issues and depression more likely to use both products uh so definitely linkage is there amongst

mental health issues and multiple products as well so poly pharmacology yeah well I don't want to end on a down note but I don't think it's a down note I think uh what you've Done today and sharing with us the the realistic landscape of What's Happen happening out there and the realistic landscape of what you're trying to do to amarate these issues is uh nothing short of spectacular meaning uh as cloudy as it may seem in uh in our youth uh there's also great hope in everything that you're conveying which is um to put it

simply uh why would you be trying so hard to fix these problems if you didn't believe that they could be fixed so so I I find great optimism in the message I also I like data and you've shared with us a tremendous amount of data about what's happening what likely needs to change and the optimal change an optimal route to change as well as some you know realistic perhaps less than optimal but realistic approaches like sometimes it's just a matter of harm reduction there's we're not going to eliminate these potentially dangerous behaviors or dangerous behaviors

so for all of that I Want to say thank you it's a tremendous gift to us all and I know that we have a lot of parents and kids and nonparents and um every age um and background that listen to this podcast and uh what's clear to me is that it's going to be a community effort to try and face all this and I keep hearing in the back of my mind this thing that you've said several times now that kids know what's happening we have to have these conversations they're hard conversations To have um

for any of us they're uncomfortable for adults to have but that until we normalize at least the conversation it's unlikely that we're going to solve these problems so thank you for your incredible efforts in the research domain and also for helping to normalize and bring about these conversations they're oh so important thank you so much thank you very much thank you for joining me for today's discussion with Dr Bonnie Halper felsher Please be sure to check out the links in our show note captions to Dr Halper felcher's Laboratory an opportunity to contribute to the research

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