BRATTLEBORO — In his duties as director of ambulatory services at the Brattleboro Retreat, Kurt White works with clients in recovery.
While a variety of factors influence a person's risk of developing an addiction, one factor reduces it.
That measure: delaying the use of substances - tobacco, alcohol, opiates, cocaine - until adulthood.
Substances affect the developing brain of a young person differently from that of an adult, he said.
Cindy Hayford, coordinator of Deerfield Valley Community Partnership, agrees.
DVCP is one of four prevention coalitions in Windham County delivering primary prevention services to students, most of whom are in middle or high school, although the coalitions also work with students as young as fifth graders.
“Our mantra is delay, delay, delay,” said Hayford, who works with students in Halifax, Readsboro, Stanford, Whitingham, and Wilmington.
Quoting statistics from the National Institute on Drug Abuse, she said that 40 percent of people with alcohol-use disorder started drinking before they turned 15 years old. In comparison, only 7 percent of people who waited until age 21 to start drinking alcohol develop a misuse disorder.
DVCP and other prevention coalitions use data from the National Youth Risk Behavior Survey to track trends around the health and well-being of young people.
The survey, completed every two years for middle- and high-school students, looks at a variety of behaviors and health influences ranging from bicycle helmet use to bullying to nutrition to substance use to young people's perceptions of how they are valued by their community.
For Windham County high school students as a whole, their substance use rates were similar to those of students across Vermont.
But the survey reports that Windham County students who smoke cigarettes before the age of 13, use e-cigarettes in general, and use marijuana before the age of 13 do so at higher rates than students in Vermont as a whole.
Hayford noted that data from the 2009 National Youth Risk Behavior Survey also shows an association between substance use and lower grades.
While the survey report's writers caution that other factors might contribute to lower academic achievement than substance misuse alone, Hayford said the data still points to the importance of delaying kids' use of substances.
Substances create 'pathways to addiction'
According to Hayford and the other prevention coalition leaders in Windham County, primary prevention is not just about targeting one specific substance such as alcohol or opiates.
Tobacco, cocaine, or opiates - they're all the same to the young brain, she said.
“These substances are creating pathways in their brains towards addiction,” she said.
Hayford says prevention programs are about giving youth the tools to navigate their everyday lives and challenges so that they don't turn to substances in the first place. The prevention experts referred to these tools - which help kids deal with everything from peer pressure to family stress - as young people's “internal protective factors.”
Hayford explained that primary prevention also focuses on the community as a whole.
For kids to thrive, they also need a community that supports them, one where they feel valued and one that provides clear messages about substance use.
For example, Hayford has worked with municipal staff around zoning for a marijuana dispensary, because how a community treats substances also delivers messages of what “normal” substance use looks like, she said.
For example, opening a marijuana dispensary on Main Street sends the message that the drug is harmless.
In general, substance use among students in the Deerfield Valley has shown a downward trend over the past 20 years, according to Hayford. She attributes this downward trend in part to sustained funding.
The Deerfield Valley Community Partnership's budget averages $100,000 a year, said Hayford. The organization receives funding from the Vermont Department of Health and Vermont Agency of Education.
Not all prevention coalitions have benefited from consistent funding, which affects their ability to deliver services, she said.
Creating prevention strategies is not a one-size-fits-all situation, Hayford said. Each community has its own risk factors and root causes of the risks, so therefore requires customized solutions. For example, she said, the Deerfield Valley is influenced by its resort and seasonal economy, which draws people to the region specifically to relax and party.
Hayford hears from parents that it's possible “to teach kids to drink responsibly” at home, she said.
She disagrees.
Delaying substance use until after a brain stops developing in a person's mid-20s is a better way to ensure a person has the ability to drink responsibly, Hayford said.
She also hears a number of parents say that once kids turn 18 - the age at which they are eligible to serve in the military - they should be able to drink. Hayford counters that just because the law says a person is an adult doesn't mean that person's brain has reached maturity, leaving one at heightened risk for dependency issues.
Hayford has witnessed some recent trends in the Deerfield Valley that she describes as exciting and worrying.
On the positive side, she's finding that more community members have released some of the stigma they once felt around substance misuse and have become willing to talk about the issue.
On the challenging side, the school system is seeing more “transitional families,” or families that move into the community, take on seasonal work, and then leave.
For kids whose families are also struggling, it's hard to provide consistent services, she said.
“How do you support kids with families with substance misuse disorder who are coming and going?” Hayford said.
A community sends a message
Cassandra Holloway, director of the Brattleboro Area Prevention Coalition, stressed that how a community treats substances such as alcohol creates an environment for young people.
For example, serving alcohol to adults at an event geared to kids sends the message that alcohol consumption is normal, she said.
She noted that the use of substances by Brattleboro students tends to mirror the use rates of all Vermont students in the Youth Risk Behavioral Study.
Prevention is the job of the whole community, she said. “One group can only do so much,” she said.
Holloway said with the normalization of marijuana use happening statewide, it's important for communities to think about the message they're sending to their youth.
She points to using terms such as “medical” or “recreational” marijuana as two examples of how the community could be inadvertently sending a message to kids that marijuana is good for them.
She believes the state could do a better job countering some of the messages not only around marijuana but also the growing industries for beer.
Manufacturers of electronic cigarettes market nicotine cartridges in flavors that kids tend to prefer, a marketing tactic that also concerns Holloway.
“We have to understand the power of that,” she said.
When working with young people, Holloway said, it's important to help them develop life skills around cultivating healthy relationships, experiencing a range of emotions, doing meaningful activities, and dealing with conflict.
“Basically, experiencing life in a whole way and not just the happy feelings,” she said.
For rural communities, a programming puzzle
West River Valley Thrives, the youngest of the county's prevention coalitions, serves seven towns - Brookline, Jamaica, Marlboro, Newfane, Townshend, Wardsboro, and Windham from space at Leland & Gray Union High School.
Executive Director Steve Tavella said WRVT has made excellent connections with students and teachers, including delivering teacher trainings and developing curriculum.
The substance use among students that concerns him the most right now includes use of electronic cigarettes (vaping) and of marijuana.
The potency of marijuana is measured in terms of the amount of tetrahydrocannabinol, or THC, the main psychoactive compound in the cannabis plant.
Marijuana potency is much higher today than it was 30 years ago, said Tavella, who noted that the substance, which used to contain a THC potency of 5 percent, now measures around 30 percent. Some electronic-cigarette cartridges can contain as much as 95 percent THC potency.
According to Tavella, WRVT also serves some of the county's more rural towns, none of which have a commercial downtown or active community center. This means the schools serve as their communities' respective central meeting spaces.
This aspect of Vermont life can prove a challenge for engaging adults in the WRVT's programing, Tavella said, and noted that it is one part of the programing puzzle on which he is working this year.
Tavella said that when assessing how well a community supports youth, some protective factors can also be risk factors.
For example, the rural towns that WRVT serves are a protective factor for many young people because small towns - and their small schools - tend to have strong support networks.
Small towns, however, can also foster isolation, which is a risk factor, he added.
“I am struggling to get two local legislative representatives from the seven towns to come to breakfast,” Tavella said.
He is also talking to municipalities about zoning and how the towns might want to prepare for the eventual arrival of commercial marijuana retail spaces or similar businesses.
Accentuating the positive
Laura Schairbaum, executive director of Greater Falls Connections in Bellows Falls, noted that social and peer connections are critical for young people. Greater Falls operates an after-school program that also focuses on youth leadership.
It's one thing for a community to tell young people not to use substances, she said. But to be effective, she said, the community must also ask, “What can we do to encourage them to do what's positive?”
Schairbaum said that several of the students enrolled in activities with Greater Falls Connections have come from families that have dealt with or are currently experiencing substance-use disorder.
“So for them, prevention looks different,” she said.
As a result, these students have created a space where they can share their experiences and support one another.
Schairbaum agreed with Holloway's concern about messaging around marijuana use. When the perceived risk of a substance goes down, use tends to go up, she said.
“The state needs to get its message consistent for kids around marijuana use, despite what people feel about adult use,” she said.
Schairbaum is excited by her agency's collaboration with the town of Rockingham on its Town Plan, which the town revises regularly and uses as a blueprint for public policy. She said the people working on the document have been willing to take a deep dive into creating a vision for the town - a vision centered on providing a healthy community for all residents.
Schairbaum said that she focused on one data point in the Youth Risk Survey: whether young people feel valued by their community. In general, Vermont scores well in this category, she said, but communities can do even more to ensure they are listening to their young people.
In that vein, Greater Falls Connections will join Turning Point Recovery Center of Springfield, WOOL-fm, and Greater Falls Community Justice Center to host a community forum - “Stories of Hope: See the Change, Be the Change” - on Wednesday, June 5 at 6:30 p.m. at the Rockingham Free Public Library, 65 Westminster St., Bellows Falls.
This follow-up to “The Importance of Hope,” a forum in 2018, will highlight stories and progress on the community's efforts to respond to the opioid epidemic.
The event's panel will include members of community recovery groups and families of those experiencing addiction.
Panelists will also share their personal experiences with opioids and how recovery has positively impacted their lives.
Recovery Coaching, a peer-based and peer-led program, will provide insight into the many pathways to recovery. Training on how to administer Narcan, the opioid overdose reversal drug, will also be available.
For more information, visit greaterfallsconnections.org.