Domonique Greene was a young man with a bright future, and he was a model son to parents Kayla and David. He was very close with both his mother and father, and never disrespected them growing up. But, unknown to his parents, Dominique began experimenting with opioid pills while still in high school, and by his early twenties had developed a heroin addiction. He asked his parents for help, but, like many, he struggled to overcome his addiction. He suffered five overdoses before taking a combination of heroin and the synthetic opioid fentanyl. Domonique Greene died in October 2015 at age 23.
Kayla and David Greene founded the Domonique Greene Foundation in their son’s honor to provide resources to both parents and children to help prevent substance use before it starts. They are among the guests in KET’s latest Health Three60, which examines a public health issue from three perspectives. In this episode, host Renee Shaw speaks with national leaders in drug prevention at the Rx & Heroin Abuse Summit in Atlanta and also talks with three sets of guests at KET’s studio.
The program focuses on three main areas: the family as the first line of defense in prevention; how local communities are forming innovative policies in drug prevention; and the evolution of drug prevention practices from a “Just Say No” approach to a more holistic framework that encompasses a child’s cognitive and emotional development.
“If kids don’t get into trouble with drug abuse by the time they’re 19, it’s pretty unlikely they’re going to – but if they’re in trouble at the age of 13, the chance they’re going to end up lifelong is extremely high,” says Francis Collins, MD, PhD, and director of the National Institutes of Health, in an interview clip from the Rx & Heroin Summit. “So, that’s a very vulnerable spot there that we need to pay attention to, and every bit of effort is worthwhile in that place.”
According to Robert DuPont, MD, founding president for the Institute for Behavior and Health, Inc., and a leading authority on drug abuse for over 40 years, the adolescent brain develops its reward center in the early teen years, well before areas in the frontal lobes develop that form thoughts of judgment, restraint, and long-term reasoning. This makes adolescents more susceptible to the attraction of experimenting with drugs.
“The goal for prevention is really, really simple,” he says in an interview clip from the Atlanta drug summit. “It’s really, really clear: … any use of alcohol, any use of nicotine, any use of marijuana, any use of other drugs, by somebody under 21, is unhealthy. It is also illegal. And my mission is to get adults and kids to be able to articulate that health goal.”
Education and Support for Parents, the First Line of Defense
Kayla and David Greene have also made it their mission to educate parents on ways to help steer their children away from the temptations of substance use, and to help them find resources to treat their child if he or she has already started using. They are studio guests for the program’s first segment, along with Jean Schumm, founder and president of Operation: PARENT, a nonprofit that provides ongoing education and support to those raising teens and pre-teens.
Schumm says that parents are facing a cultural environment that is very aggressive, even toxic, and that organizations such as Operation: PARENT can help them navigate all of the pitfalls — that they may not be aware of — in a modern, media-driven culture. And she stresses that the earlier parents engage with their kids about drug prevention, the better.
“It knocked my feet off the floor when I read that the American Academy of Pediatrics recommends that we start these conversations at age 9 – that’s when a child is in fourth grade,” she says. “Now we have taken it down to the elementary level and are trying to get in front of parents as early as possible. Part of that is that these kids have cell phones, cell phones [smart phones] have opened up their worlds. They’ve given kids access to the internet, they can Google anything – suddenly they’re exposed to things that they otherwise never would have been.”
Domonique Greene first experimented with opioid pills at a high school football party held at a booster mom’s house, an environment where the supervising adult was far too lenient. David Greene says that he was not an overtly strict parent but did keep a close watch on his three children, and had a hard time believing at first that his son had developed an opioid addiction.
David Greene says that he now tells parents that “As much as your children love you, when they’re on this drug, they will lie to you. Not because they want to be disobedient, but because, out of Domonique’s words, the drug controls them.”
He advises parents that their children may behave in ways that the parents’ never would have expected from them, and that parents therefore must be persistent with their support. Kayla Greene also says that for opioid addiction, the treatment required to successfully overcome the disease is much more extensive and will require more time. She says that their foundation strongly advocates for increasing the numbers of beds in drug treatment facilities in Kentucky.
Despite the challenges, Schumm and the Greenes believe that parents are the most effective counselors and mentors for children who are growing up in a culture of risk-taking and temptation, and this belief drives their advocacy work.
Research supports this conclusion, as well, says Sara Howe, MS, CHES, the CEO of the Illinois Association of Behavioral Health in an interview clip from the Atlanta summit. “When you actually look at the data, children listen to their parents – they may not tell them they are listening, but they do,” she says. “And a lot of our youth, most of our youth, do not want to disappoint their parents.”
Schumm recommends that parents draw up a written contract between themselves and each child, with the child’s input. “You’re talking to your child and you’re agreeing on these things together, as opposed to an authoritarian approach, you know, ‘these are the rules.’ And the kid has some ownership and some response to it.”
This give-and-take approach, but with the parent having the final say, can enable adolescent or pre-teen children to be actively involved in crafting their own prevention standards as well as strengthen the familial bond. “Another old saying: rules without relationships equals rebellion,” Schumm says.
How Communities are Innovating to Prevent Drug Use
According to Sue Thau, a public policy consultant for Community Anti-Drug Coalitions of America interviewed in Atlanta, “There is no silver bullet in prevention – there’s no one program, no one strategy, no one activity that’s going to inoculate kids against using drugs. It takes an entire community working together, looking at what their problems, their issues, and also their resources and their assets are, and then getting everyone who has anything to do with youth around the same table to figure out not only what’s going on in their community, but also what’s causing the problem. And once you understand that, you have a problem and what’s causing it, then you can develop these really comprehensive community-wide responses where everybody understands their part in solving the problem.”
Renee’s studio guests each detail how their organization works with communities to create and implement specific prevention programs that target their own youth population. Tom Vicini is the deputy director of Operation UNITE, a well-known nonprofit that serves at-risk youth in Kentucky’s 5th Congressional District. He says that in each county in that district, Operation UNITE has a community coalition that is responsible for developing effective prevention programs. These range from sports camps to fishing excursions, art and drama clubs, and other groups. “It’s amazing how communities are different,” he says. “And when you bring all of those partners together within a community coalition, they really have some great ideas.”
Shelly Steiner, a prevention specialist with Pathways Regional Prevention Center and the director of the Carter County Drug-Free Coalition, talks about several of the coalition’s initiatives. They include a life skills curriculum at Carter Co. schools, a drug “take back” box at the county sheriff’s office, and kids’ food programs for weekends and summer.
“What we’ve also tried to do is incorporate our fathers,” Steiner says. “A lot of times, it seems like – well, our family unit is so different now. And so, we do a fatherhood initiative, and also do a ‘Day Out with Dad,’ which has kids from 3 to 20 come in with their dads, or grandparents, we even had a great-grandfather bring in his great-grandchildren. And they fish, build bird houses, do arts and crafts, you know, just things we can do to build our family unit back together.”
Jim Scott is the resident agent in charge with the Louisville office of the federal Drug Enforcement Administration. The DEA is usually associated with tasks such as pursuing high-level drug traffickers, but Scott says that the agency is now widening their enforcement scope to smaller-dose opioid dealers due to the drugs’ lethality. It is also bolstering prevention efforts, exemplified by the DEA’s 360 program. As part of this program, the DEA is engaging the medical community to reform prescription practices. Community outreach is also emphasized with endeavors such as the relatively new DEA Youth Dance Program, which fills in the after-school hours for at-risk youth in Louisville by giving them an outlet for dancing and creativity.
“We often come in with an enforcement operation, take out the bad guy, and walk away and think we’re done,” Scott says. “But you’re leaving a vacuum there. And we’re really trying to fill that with something positive.”
One of Operation UNITE’s most successful programs is its annual Camp UNITE, held during the summer at the University of the Cumberlands in Williamsburg. The camp, which has 248 middle school-age youth registered this year, matches these at-risk kids with college-age mentors to participate in a wide range of activities.
“Most of these kids who are our mentors came to us as sixth-graders or seventh-graders,” Vicini says. “And now they are our mentors, which means that we’ve kept them, or we’ve helped to keep them off drugs, from seventh grade into college now. So that’s a great testimony to what we’re trying to do.”
A Paradigm Shift in Drug Prevention Policy
Experts interviewed in Atlanta’s Rx & Heroin Abuse Summit, including Sue Thau, Laura Winn with the Project Amp Center for Social Innovation, and Kavitha Kailasam with Rise Above Colorado, agree that the old “Just Say No” model of indoctrinating drug prevention into young people’s behavior is not effective. They, and the rest of the drug prevention community, are moving toward a more holistic model that recognizes the importance of developing strong cognitive and behavioral skills in kids.
“The thing we find to be the most helpful is providing young people with a space to explore, so it’s more of a conversation and less of a checklist of ‘Do this, this, and this,’ and that’s not the right answer,” Kailasam says. “Because young people really are, you know, trying to seek out their own path and what’s right for them, and so I think [we try to create] more of a space for a conversation that we find useful.”
Studio guest Vestena Robbins, PhD, is a policy advisor for the Kentucky Department of Behavioral Health, Developmental and Intellectual Disabilities. She and her colleagues are navigating a sea change in terms of prevention policy emphasis. “We’re evolving our thoughts around how important it is to develop social and emotional competence in children,” she says, “starting at a much earlier age. Having conversations, promoting their resiliency, creating a sense of belonging, with their school and their community, those kinds of things.”
Guest Jennifer Lawrence, MS, works as the director of Cairn Guidance, a group of national consultants who foster healthy learning environments for schools and communities. Cairn has a contract with the Department of Defense to develop a program on a national scale that will serve a role similar to the well-known D.A.R.E. (Drug Abuse Resistance Education) program. Cairn’s initiative merges mental and emotional health development practices with alcohol, tobacco, and drug prevention.
“With some of our students, it’s not just about getting them to say no, but they’re living in homes that are infected. So, how do they get help? How do they ask for support? How do they reach out and find something that’s valid and reliable at school? Also, we teach advocacy: advocating for themselves and others. And decision-making and goal-setting as well.”
Lawrence also talks about a new educational framework that is a partnership between the Centers for Disease Control and Prevention and the Association for Supervision and Curriculum Development (ASCD), which is the largest professional organization for educators in the world. This model, called the Whole School-Whole Community-Whole Child model, has a strong public health component and insists on wide collaboration among all school employees and departments.
“The health teacher should be working with food service, should be working with mental health, should be working with the school nurse and the community partners,” Lawrence says.
Jamie Sparks, director of coordinated school health at the Kentucky Department of Education, says that a new federal education law mandating school districts to move beyond an over-emphasis on test scores will allow Kentucky’s education policy to embrace more of a comprehensive approach to teaching that incorporates health education standards. Sparks is a supporter of the Whole School-Whole Community-Whole Child model, and is currently communicating with school boards across the commonwealth to introduce these practices to their curricula.
“We know that there are skills children are not learning from their family, and they’re not learning in their community, and so those schools have to be that agent of change,” he says.