What makes a teenager turn to alcohol — and how can we help them find their way back? In this episode, Dr. Denise Millstine talks with bestselling author Kathleen Glasgow and Mayo Clinic psychiatrist Dr. Eric Noble to explore THE GLASS GIRL, a gripping young adult novel about 15-year-old Bella’s struggle with alcohol addiction. We unpack the emotional roots of addiction, the realities of rehab and recovery, and the importance of empathy, boundaries and open communication.
What makes a teenager turn to alcohol — and how can we help them find their way back? In this episode, Dr. Denise Millstine talks with bestselling author Kathleen Glasgow and Mayo Clinic psychiatrist Dr. Eric Noble to explore THE GLASS GIRL, a gripping young adult novel about 15-year-old Bella’s struggle with alcohol addiction. We unpack the emotional roots of addiction, the realities of rehab and recovery, and the importance of empathy, boundaries and open communication.
This episode was made possible with the generous support of Ken Stevens.
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Welcome to the “Read. Talk. Grow.” podcast, where we explore women’s health topics through books. Our topic today is teen alcohol addiction and use. Our book is “The Glass Girl” by Kathleen Glasgow. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine and integrative medicine, and I'm so excited about my guests.
Kathleen Glasgow is “The New York Times” and internationally bestselling author of “Girl in Pieces,” “The Glass Girl,” “You'd Be Home Now,” and “How to Make Friends with the Dark.” Her latest novel, “The Glass Girl,” is a “New York Times” bestseller and was named Target's “Young Adult Book of the Year.”
Kathleen, it's such an honor to have you on the show. “Girl in Pieces” was an inspiration for “Read. Talk. Grow.” I truly didn't understand self-harm and cutting until I read your book, so I'm so thrilled that you're here with us.
Thank you so much for having me. It's my honor and a pleasure to get to talk to you.
Thank you. And Dr. Eric Noble is our expert guest whose return to “Read. Talk. Grow.” He's a board-certified psychiatrist who trained at UCLA and board-certified in addiction medicine. He's now a staff psychiatrist at the Mayo Clinic in Arizona, and long-term listeners might recognize him for being on Episode 35, where we talked about psychedelics with the book, “Trippy.” Eric, welcome back to the show.
Thanks so much for having me again. Always so much fun to do this.
“The Glass Girl” is a young adult novel about 15-year-old Bella whose world has turned upside down. Her parents have divorced after years of fighting. Her younger sister depends on her. Her grandmother has passed away. She's gone through a breakup with a boy who told her she's just too much, and she's navigating tumultuous friendships. All while she's fallen into a pattern of drinking alcohol to soften the edges and that eventually leads to some disastrous decisions.
Okay, you both know how “Read. Talk. Grow.” works; we discuss books that portray health topics in an effort to better understand health experiences through story. Let's talk about alcohol addiction and “The Glass Girl.” Kathleen, anyone who reads Bella's story is going to walk away heartbroken. You comment in your author's note that Bella's voice came to you very quietly, and that you knew she was a girl who needed to be treated with care. Will you tell our listeners about that?
So Bella is she was a very special character for me to write because I feel like she was the most probably besides Charlie in “Girl in Pieces,” she was the most interior character. She's not a talker at all. She's a person who absorbs things and keeps things inside. I like to describe this book as Bella, a 15-year-old girl who has been self-medicating with alcohol to manage her anxiety and her problems with her family, and she ends up in rehab.
And when I started this book, I started it thinking about how does addiction begin in some people? All of my books, they start with a kernel of something that happened to me or adjacent to me. They're not about my experiences. I had my first drink at 11, like Bella does. Even at that age, I felt like, oh, I'm home. This is where I was meant to be. Like, it immediately soothed everything that was tie me up into knots. That led me down like a very long road in my personal life. And I'm happy to say that I'm almost 19 years sober now and in recovery, so that's really great.
So how does it begin? And maybe Eric can talk about this? I wanted to write about that in a fictional world about a girl that experiences that and what that journey is like for her. And because this is a book of contemporary realistic fiction when I was writing it, I have to pay attention to like, sequences of events or what might happen in the type of rehab that she goes to and what will happen when she gets out of rehab. But I really wanted to follow. When I started writing it like, besides genetics, how does addiction just attach itself to a person?
Eric, do you want to respond and tell us your reaction to the book?
Yeah, absolutely. First off, I want to just say congrats on 19 years of sobriety, Kathleen, that's truly wonderful. And also congrats on writing this beautiful book. The thing that really struck me about it was just its honesty. It was a very honest voice and characterization. It wasn't sensationalizing things. It wasn't having a fairy tale ending. I thought it was just a really accurate portrayal of a teenager struggling through this journey. So kudos to you for capturing that so honestly.
I was drawn to work in this field because it's at the cross-section of so many fascinating areas. And so I think I talked about this on the last podcast, but it's so important worth repeating again. Medicine. We really take this bio-psycho-spiritual-social view of medical illnesses. And the thing about addiction is that it's at the true crossroads of all of those things. And I think Bella's story exemplifies that. We can talk a little bit breaking it down from each of those angles. But as you mentioned, it's not just genetic. It's a combination of things and that was really reflected.
Yeah, I think at some point for some people, based on the current makeup of your mental health and your emotional issues at that time. Sometimes you try something and it just hits you like it caught you at that perfect bellwether moment to sort of latch onto you. And then, of course, it can spiral out of control like it does for Bella in the novel.
And I'm glad that you said like there were no happy endings in the book, because it is a piece of realistic fiction, and I can't, especially when writing for younger people, I do have to keep some things in mind. I don't ever want to lie in my books because I do write about such difficult topics. I don't want to say just because you go to rehab and find new friends, that everything's going to be great when you get out, and you're never going to think about taking a drink again or doing a drug, because that's not the way it is.
And especially with addiction, I think in recovery it's not linear and people do relapse. And that did have to be a factor in the book. But every day and every hour you have to manage it. You have to learn how to manage it. And that can be especially difficult for someone who is 15 years old, who doesn't have the toolkit that we might have as adults to learn how to manage something like that.
I think that the tone toward the end was optimistic, but a cautious optimism. Yeah, and I think as you're saying, recovery is an ongoing, lifelong non-linear process. And most people have relapses and that's part of it. What you said initially is that sense of maybe someone after their first drink, feeling like what was missing is now kind of, everything seems to feel better or makes sense, or they feel home after that first drink.
And that reminds me, I've participated. I've had family members struggle with substance use, so I participated in Al-Anon for many years, which is a 12-step program for friends and family who have a loved one struggling with addiction. And part of that. I listen to speaker tapes from AA and Al-Anon, and one of my favorite people who I listen to is a gentleman, Sandy Beach. I don't know if you've ever heard of him, Kathleen by funny, ridiculous name, but so eloquent and a wonderful speaker. He's passed away now, but he had one share at a meeting that really resonated with me. He just said that alcohol is almost a perfect solution for what's missing.
And Carl Jung said that alcoholism is, at its core, kind of this thirst for God, this thirst for wholeness and alcohol almost provides that perfectly but in the end, those things that alcohol fixes short term, they're still there. And you alluded to that throughout your book. You still have to face yourself. I think that was in Fran’s poem. Fran was one of the staff members at Bella’s rehab, and that poem was just so, so beautiful and resonated. But I think that was the core of it at the end, once the effects of alcohol wear off, you have to face yourself.
It's true. I think that's probably the most difficult thing about recovery, is that you can go through all these steps and you can be in rehab, and you can create a cohort of people who support you, hopefully. But you have to face everything that you were trying to squash with alcohol or any drug in the first place. It's still there, it is still there, and it's still inside you. It's very difficult, and I think it's even more difficult for younger people because they're not fully formed yet.
I read something and I don't know, Eric, if like you have studied this, but I read something somewhere a long time ago that emotionally and intellectually, people who've suffered a trauma or an addiction at a young age, they kind of stopped developing emotionally at that moment that it takes hold of them. You could be like a 36-year-old person on the outside, but really your response to things is very much like 14 or 15 years old.
What you're bringing up for me, it makes me think of in medicine, we talk a lot about ACEs, and particularly in psychiatry, ACEs is this concept called Adverse Childhood Events.
I have taken that test and that just makes me sad. Like every time when I look like every couple of years, I'll go back and like do that survey. And I'm like, this is really awful.
What resonates for you most about that test and that concept?
You know, it's just shocking when you're like looking at something and you're like, well, that explains a lot. And I feel like everyone should at some point take that because I see it again, like something I read where people on the outside great. They're like a picture of health. A 45-year-old woman, she jogs, has a great job, great marriage, everything, picture of health and like, drops dead of a heart attack. And if they had taken that survey, you would have seen that even on the outside they looked great, but on the inside they were not, because the stress of like growing up that way, with whatever their answers were on that survey, wore them down physically on the inside.
Yeah, for the listeners. So it was actually a concept developed in the 1990s by these researchers and doctors at Kaiser. They had a large cohort of patients, and they looked into a list of about, I think, ten adverse childhood experiences, anything that ranged from abuse, emotional, sexual, physical or neglect, or even things like a parent's substance use or a parent's divorce separation. And what they found was that the more ACEs someone had, the higher the risk of an array of medical issues. So not just psychiatric, such as addiction or depression, but also heart disease and certain types of cancer even. It was actually a real landmark thing. Research that that has changed the way that we think about medical illnesses.
I think it's a super interesting study.
I agree this was really surprising. I think we had often understood the impact on mental health, and we're surprised to see the impact on future cancers, metabolic health, chronic conditions. But let's go back to Bella. We've talked about a lot of the concepts here, and I want to take our listeners through some of the moments in the book where we see these come to light.
So, Kathleen, it starts at the very beginning. We meet Bella when she's driving around with her friends. They're trying to figure out how to buy alcohol, and they nudge Bella to be the person who approaches a stranger to buy for them. And the way she thinks about it is, she says, If I'm being honest, I don't really mind doing this because I know where I'll end up feeling better and you just relay how that moment is pretty important to what Bella's navigating at the beginning of the novel.
Bella is tasked by you, her friends, and her family is like to do things for them. Like always. Like her parents use her as a go between for their relationship. Just take care of her little sister. She had to take care of her grandmother. And her friends always know that Bella will be the one to get alcohol for them if they want it, and Bella is willing to do things like that because she knows at the end of it she will be able to get drunk and that's really what matters. But it also shows, I think, to a perceptive reader, that she's willing to do some somewhat dangerous things in order to get drunk, to get that high, to get that feeling. And a reader should be aware, like at that moment, that Bella is kind of in pretty deep if she's willing to put herself in what could be like a very dangerous spot, like approaching strangers for alcohol.
The way I saw this, Eric, was that from the outside, you might look at this as a typical or very common teen experience. But then there are elements of Bella's alcohol use that you can see are starting to come out of her control, even though she's insistent that she has it under control. We see her start to drink at school and at work, or to feel better because she feels so bad after having been drinking the night before. Can you highlight some of those early signs? Early, I mean, in the novel where the realization that Bella's relationship with alcohol was more than social drinking.
Yeah, for sure. I think you're highlighting on some really important points. To me the trajectory of the novel is really step one for Bella. And in 12 step, step one is we admitted to ourselves that we were powerless over alcohol, that our lives had become unmanageable. And Bella goes from pre contemplative, not really recognizing it's an issue to finally at page 401 or whatever it is, she says, I'm an alcoholic and that's the trajectory. And I think it's a journey for each person. And usually it's not a lightning bolt moment, but an accumulation of experiences and conversations for someone to finally connect the dots and have that full admission.
Some of the things I've pointed out of what Bella said before, kind of even before she goes to rehab and then in rehab, she says, I still don't think I'm an addict, but yeah, there might be a problem. And then she said in one of the sessions, I'm Bella and I drink a lot. And then she says, I'm not normal. I can't do this like other people, to finally saying I'm an alcoholic and there's a lot of resistance. But I think that step one is the key to recovery, because there has to be a realization.
And I love that word admission because it has a double meaning. I think in that you're admitting, you're recognizing that there's a problem and that you need help, but it's also your admission ticket to recovery, to a better way of life. And I think this story captures that process for Bella.
It's interesting that you mentioned, like, the moment in the book where she tells her counselor, I'm an alcoholic because some earlier drafts of the book, my editor, those scenes weren't in there. And my editor said, Does Bella think she's an alcoholic? And I said, no, she's 15. She doesn't think she's that person. That person to her is somebody outside on a street corner or somebody's grandpa who's falling all over the place. It's not a 15-year-old girl that's not her. She doesn't perceive herself to be that way. It is a novel for young adults. My editor, who's really great, said, well, I need her to say it. I need her to say it and put it on the page. And I said, okay. And I went back and did it. And then I, you know, for good measure, I was like, you know what? People relapse and rehab all the time. I'm going to have her relapse as well. And that's going to be her moment.
Like the toughest part about this book was, is remembering that she's 15 and how she's going to respond to things. And like to her saying that she's an alcoholic means that she's something she's not prepared to accept. And it means that at 15, she has to look at her life in a certain way. Like, am I never going to be able to go to parties or have friends or do anything that other people will get to do in their life that involve alcohol? Because alcohol is everywhere.
And some people have told me like, well, you know, most teens don't drink. This book is not really realistic. They're not drinking. Then I would say that they are drinking because it is around. It's the most around thing that you can find. It's in your house because your parents might drink. You can get a friend's older sibling to get it for you. You can go shoulder tap outside a bar. You can find fake IDs very easily.
I know a woman who bought a fake ID for her child who is going to college because she wanted to take her to a bar to drink so that she would know what it was like to drink before she went to college, so that she wouldn't have a bad experience at parties and get drunk for the first time around strangers.
People's attitudes around alcohol and addiction are really interesting to me. And I also wanted to reflect that in Bella's home life that when she goes home, she can't go back to her dad's house if he's going to have alcohol in the house, because sometimes family members are very firmly of the opinion that your addiction is your problem, not mine.
And even recognizing that it's a problem, Bella ends up in rehab, which we've mentioned, but after a traumatic and disastrous evening, and there's debates in the hospital from her father predominantly, that this is not necessarily a problem, even though I just said in the hospital.
He thinks she's just pushing boundaries because that's what kids do. Like everyone's going to try and drink and whatever, but she's been drinking secretly for a long time.
And would you say that there are adults in her life who intentionally didn't see that? Or do you think -- I'm thinking of the father's girlfriend -- that she truly was just that clueless? That she had all these other reasons for Bella being sullen or having headaches or those kinds of things.
So I think that her father is really resistant to it, and he doesn't want to see it because he doesn't want to see it, because then he has to look at himself and say, is any of this like my doing? And parents, I am a parent. Parents never want to believe that they're the reason that their kids might be having problems, right? Because then you have to face something within yourself. And I think that Vanessa, the father's girlfriend, I would say that the reason Vanessa doesn't actively do anything is because she thinks it's not her place. She's not their mom. She can't. You know, there's a very, like, tenuous relationship there between like, you know, the mother is very upset that there is this girlfriend that she was never told about that is like staying over that her youngest daughter adores. Like, that's a very real emotion in terms of, like, what those relationships are like, you know, because you don't want to think like your child is going to like this other woman more than they like you. Even though we all know, logically speaking, that's not true.
So there's all this tension around Bella. And I think that for Vanessa, she's just going to choose not to do anything because it's not her place and she doesn't want to step on anyone's toes.
And then there's Bella's mother who sees the problem. And maybe Eric, you can comment on this and her response is to say, don't go to parties. If I just make this boundary, the drinking will stop. Then not recognizing that there are lots of other opportunities for Bella to find it to use alcohol.
The character of her mother, I mean, her mother grew up with no boundaries, and I've described that with like the grandmother Laurel and being like on the sort of artistic commune when she was growing up and her grandmother not really being there. I think that her mother's response then is to have like a very boundary life as much as possible.
And sometimes you do that because you don't understand what else you should do. And also, her mother might be a little hesitant to do anything because, I mean, if you look at the character of Bella's grandmother, Laurel, she's an alcoholic and she's been an alcoholic for a long time, and her mother grew up with that. And so her mother's response to seeing that in her own daughter is probably one of like, abject fear and shame that she couldn't recognize that right away and help her more. And that, like I said before, like maybe some of her actions contributed to Bella's anxiety and stress.
Kathleen, just since we're on the topic of the grandma, one thing I was really curious about throughout the book, Bella always refers to her as Laurel. And then at the end, page 439 she says, Grandma, I so curious about what went into that and what was the meaning of that?
I think she refers to her as Laurel in the beginning because, like her grandmother was a semi-famous person and also was a little bit even though she was very close to Bella. I mean, Bella is in awe of her, so she calls her Laurel like, she's kind of like a spectral important being. And then at the end, she realizes she was just a person too, with a lot of her own problems and she's just grandma.
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An important feature too we talked about, so The adults have all different roles in Bella's drinking. But Laurel and then even this adult coworker are providing Bella with alcohol and thinking that it’s like a treat or you know that they're treating her more adult than she is. Eric, can you talk about how toxic that is?
Right? Yeah, I think ignoring the problem is the path of least resistance, and I think that's why it's often done. There's so many more reasons, “benefits to ignore.” The downsides are obvious. You're going to impact your relationship. You're going to cause trauma and drama and turmoil. And there's not a lot of benefits for intervening or speaking up.
And it is so interesting that sort of alcohol is like taken on sort of this connotation of a treat, sort of a parent to kind of seem cool or like on the side of their kid, kind of finds occasions to kind of let them do that, which adds kind of a certain cachet to drinking. And I think it's innocent, but it has a consequence, and it's important.
I think, as we were talking about, you know, addiction is a bio-psycho-social-spiritual disease. And the social aspect is that it's everywhere and it's so prominent and it's legal. Not only are adults using it, but teenagers. I mean, in Bella's life, all of her friends at all the parties she went to, it was something that was being used. So it's really hard to avoid. And all of the ads that are on TV.
And because we have treated it as such, going back to what we talked about earlier, it's just seen as like an adolescent rite of passage. You see it in movies and everyone has like their red solo cups and people are supposed to get wasted, or you have it at like, grandfather gives you like wine at a wedding or something.
And it's just seen as like, that's the way it is. And we really push home. I think the idea that getting a little tipsy is your nice, sweet treat after a long day, you know, wine o'clock with like, moms and like, toddler happy hour. And you get together with your friends and have wine and your kids are playing. But for some people, that can really turn into a dependance. You know, I think that we just have to be careful about the message. And I think that's up to everybody's different family structure.
I know that, like for me as a parent, I can't protect my kids from what is going to happen to them when they step outside the house. The world is going to offer them choices that they have to make. And I'm not against any of those choices because you have to learn what works for you and what doesn't. I just have to remember to, like, be here for them when they come back, if they need help, and to not treat their choices with like, judgment or shame, because then they'll stop talking to me. And when a teenager stops talking to you, they're in trouble. That's when like, the trouble is happening.
But a big difference between having an open line of communication and thinking to yourself, well, they're drinking anyways, they might as well also drink with me. That's a big, that's a huge difference, right, than just saying whatever choices you made, like when you come back into our space, I'm open to talking about them and hearing about them and understanding them.
Yeah, I have a 17-year-old, we'll hang out at your mom's house and watch movies and swim in the pool, and I'm always happy to do that. But I have a thing, which is I don't want any alcohol or drugs here, and you guys can do what you want and play music and swim and have fun and have a party. But I can't have those things in my house because this is my safe place.
Whatever you do at someone else's house, if someone needs me to come pick them up later and you need to come sleep it off at my house, please call me because I will drive you. I don't want anyone getting in a car. Or if you feel like something is happening, you can call me and I'll come get you. No shame, no yelling. I will just come pick you up. But like for me, I've made that clear to my kids. And they're really very respectful. I can't have that in my house because this is like my safe place.
Yeah. And we're talking about how other parents deal with this. And I think maybe a little understanding of the teenage brain and the neuroscience can really actually empower and be helpful for parents. My son is only ten months old, so I'm speaking about something that I don't have any practical wisdom about it.
But, you know, teenagers get a really bad rap. They're angsty, hormonal, overly emotional, impulsive, obsessed with friends, cliquey but there's a lot of new research going on kind of shedding light about: Teenagers are actually an evolutionary wonder that their brain is beautifully wired to me.
It's open, they're open, their brains are open to like, everything.
Exactly. And so what's happening, neuro-scientifically, is that the prefrontal cortex is still getting myelinated and laid down and wired. So the limbic system is still having more of a strong voice. And this section of the brain called the striatum, that's important in terms of learning and rewards is really active in teenagers.
So what does that mean for teenagers is that they're really optimized for learning and for exploring their environment, which evolutionarily is actually a really important thing, in order to establish independence from a caregiver, to explore your environment for new food resources if we were still animals.
I think appreciating that is the baseline. So adolescents need risks. And as a parent, the goal isn't to remove risk taking but to create a healthy opportunity. So maybe helping someone try out for a play that they're terrified, or asking someone out on a date. Risk is actually really wired into teens and needed, but in a healthy manner. And that wiring, those changes are actually happening through age 25. So adolescence doesn't stop at 18, actually goes all the way until 25.
And is this part of the reason that we see Bella have some of these explosive emotions, particularly when she's been drinking. There's an episode at a party where she really loses her composure. She has some episodes of saying and texting some things to friends that are over emotive and actually difficult for the friend who receives them. Is that why, because of the teenage brain, or is that true for all people when alcohol is added?
That's a tough question. I think teenagers are kind of because of that prevalence of the limbic system are more prone to have stronger emotions. But all of this is on a spectrum. And certainly drinking lowers inhibitions and makes people somewhat more impulsive. But, you know, if I were working with Bella, this seems to be a bit outside the normal spectrum of teenage behavior.
And so I would be interested in whether she meets criteria for something like Borderline Personality Disorder, which has a terrible name and reputation. It's unfortunate that there's such a stigma around it, because to me, BPD is just like any other medical or mental health condition. It's a combination of genetics and environment, and at its core, BPD is difficulty regulating emotions, and a lot of it is due to trauma.
And because someone has difficulty regulating emotions, they develop all these compensatory behaviors, including cutting perhaps, or risky substance use behavior or risky sexual behavior. And that in the beginning is sort of useful to help regulate the emotions, but in the end causes more harm than good. The bad news about BPD is that it causes distress. The good news is that there's actually really good treatment, which is called DBT, Dialectic Behavioral Therapy. And after a year of solid treatment, most people outgrow the diagnosis of BPD and no longer meet criteria. So obviously, Bella, I've never met with Bella clinically in person. It's a fictional character, but that would be something that on my radar if I were to be working with her.
I'm going to write that down.
And we need her to be away from the alcohol in order to fully assess that, because it can be really hard to parse out to what degree is this your dependance, your addiction, your withdrawal symptoms versus actually an underlying condition? Am I saying that accurately, Eric, or would you disagree?
Yeah, there's so much difficulty and controversy. I mean, substance use is it's dual diagnosis, which means that there's often, more often than not, you know, an underlying psychiatric issue such as depression, anxiety, bipolar, borderline co-occurring with this substance use. And so there's controversy. Well, do we need to focus on substance use first or the underlying psychiatric issue? In my experience, you need to address both at the same time because they're so interwoven and intimately linked. So variety is super important. And kind of overtime, as someone gains more sobriety, we can reconsider whether they meet criteria for an underlying psychiatric disorder. But I think addressing both at the same time is important.
We were just having a conversation about social anxiety disorder for another episode, and that is exactly what the psychologist said was that nobody comes in and says, oh, hi, I have social anxiety disorder. They come to be known by us because they've been self-medicating with substances or have found themselves in a difficult situation.
Can we shift Kathleen and talk about the detox program? I particularly loved the character of Fran. Fran says at one point, “Addiction of any kind sits in your brain like a cat with yarn batting around your synapses and impulses and logic for sports. And then it says to your body, hey, you want to play?” I thought Fran was fabulous. Will you talk about Bella's rehab experience and the characters she meets to some degree?
I have been in like a psychiatric hospital, like in my early 20s, like three times, but I have never been in a rehab for addiction. So I had to create Bella's specific rehab from the ground up. Like one, I knew that I wanted it to be run by people in recovery. There would be a different type of rehab, a little bit more holistic, working with animals, taking care of themselves, learning the three things that they learned there how to feed yourself, care for yourself and keep yourself warm. I did some research on what kind of program that would look like online. Like I looked up different centers for teens with behavioral addiction issues, and then I just went with what I wanted to do within like that framework of what might be required of them in a program.
So I knew that when Bella went there, that she would just really be going there to get away from her parents, one, because she's not at this stage, like Eric said, where she's ready to get her admission ticket to recovery. She's not ready to say anything like that. I knew that because this is a novel for young adults. One thing that younger readers really like is when you put a bunch of kids with problems together and see what happens, and so it's true. They want because what they're really wanting when they read things like that, or watch movies like that, like “Girl Interrupted.” or I think it's like “Short Term 12.” or something. What they're really looking for is the sense that if I need to go to one of these places one day, what's it going to be like? Will it be okay for me? And what that really means is maybe what I'm reading right now and seeing how these kids interact with each other, and it's making me feel better about myself and less alone. I'm going to go ask someone for help now, and I'm going to say, I need to go to a program like this, right?
That's like sometimes you're your hope outside of just writing a good story as a writer. But I wanted her to go into this place and be confronted with kids who had similar traumas to her and similar issues, so that she could see that she was not alone and also get support in that way away from her family, who were really causing a lot of her issues. And also to address her anxiety, some of which stemmed from not being in control of her life and the way that she was being brought up by her parents and their divorce, and learning how to control her anxiety holistically through the chanting and the mantra that she learns. And I just really wanted her to let loose with these other kids and learn their backstories too, and learn that a lot of people have problems in the world, and a lot of people have tried to soothe that with self-medication and addiction, and that it with the proper support, you can overcome that.
And I wanted to have a lot of fun just fictionally devising, Sonora and Sunrise, and what might happen there, while remembering that the counselors are not perfect people either. They make mistakes, they're good-hearted. They are not doctors by any means.
Eric, when Bella gets there, right on her first night, she has a true severe panic attack. I wonder if you'll tell listeners what that can look like, and if you can offer any strategies for what people can do if they find themselves having a panic attack.
Yeah, panic attack. It's an intense, sharp spike in anxiety that usually lasts around 20 to 30 minutes. And it's so intense that you'll have catastrophic thoughts of what's going to happen right then and there, that maybe you're going to stop breathing, or that you're going to have a heart attack, or that you're going to spontaneously combust. Something catastrophic is going to happen in that moment, and it can just be really terrifying. And it's hard for someone who's never had that to really comprehend what it's like.
So from a treatment standpoint, you know, there's both non-medication and medication interventions. And non-medication that are really important are grounding techniques. So focusing on your five senses, what you see, hear, smell, and having someone in a soothing voice just guiding you along with that, some box breathing techniques, progressive muscle relaxation.
For someone who doesn't have substance use disorder, there can be kind of some rescue medications, but those are biochemically pretty much identical to alcohol. So, you know, we would want to be really cautious. Something like Xanax, Ativan, Valium, so cautious in someone who has a history of substance use disorder.
But I think really the most important, if someone has had an experience of panic attack, is practicing these non-medication techniques when they're just in their normal day to day life, so that they're building their muscle and honing these techniques so that when game time arrives, when they are having a sharp spike in anxiety, they have the practice and experience of how to navigate a panic attack.
I love that you said that. I say this to my patients all the time to do breathing exercises on a regular cadence, just like you're going to be stronger if you go to the gym regularly, you're going to build up that strength. Same thing with techniques like a breathing exercise. If you're doing them regularly, you're going to be stronger at it when you pull it out in a time of need.
Kathleen, there's another I want to say character, but person who's at the rehab, who actually takes them on runs first thing in the morning.
Chuck.
Chuck. Thank you. Yeah. Would you comment on just that physical aspect and how movement can be a powerful component in rehab, detox?
Oh well, that's a positive endorphin rush. And that can get your I think, your synapses firing in a positive way. It's exercise. It makes you feel better. It can also, if you're having intrusive thoughts or you're not feeling great, if you can get up and move around, go for a walk, get your body moving and your blood flowing and lower your blood pressure. It will pass like the moment will pass. And you know that was something I had to learn. Like with like my own history of self-harm, was you have to learn different techniques to make that moment pass, rather than looking for the rush of doing what you were about to do. So, and I think that exercise is a positive, healthy way that you can do that.
And that's what Chuck does, is he pushes them in the novel like go running and see your environment like there's a whole outdoors out there. Because I think oftentimes in some addictions we get stuck inside and we're very isolated.
Another young woman in the novel says later in group that her life had to get really small so that she can avoid her addiction triggers in the outside world. And so she basically just stays in her room all the time. And that's it. And you can't do that. But through the character of Chuck, Bella learn so that she can go outside for runs and it makes her feel good and it's healthy and it's part of her routine and it's managing herself. And she takes up running again later in the novel when she's back at home, every morning and she takes the dog with her.
I love this. This is integrative medicine at its best. Breathing, moving your body.
Yeah, and it's free. Just go outside, take a walk, go for a run, walk around the park. You don't need money or a membership to do either of those things. And if you're not physically strong enough, just start by walking. Listen to a podcast while you're walking, or just look around and like, look at people in the world.
When you're in addiction, you miss a lot of like the sensory experience of being alive. It's good to have that back when you're in recovery.
I love that, so powerful. I wonder if we could wrap up by imparting some advice or wisdom to people who are listening to the show who care about a young person with alcohol addiction.
You know, I think that I would just say what I said earlier, it sort of echoes what Eric was saying, too, is that you have to remember what it was like to be young. Everything is wide open to you. Everything is really, in some ways extremely beautiful and also extremely raw. Everything that happens to you is the very first time that it's happened to you, and it means a lot and it's huge. It's not small. Everything is huge when you're younger, and if you see someone who's young, struggling with addiction, don't dismiss it as you know you'll grow out of it or this is just everyone drinks. Try to help them find the root of what's going on, and don't treat them with judgment or shame. Sit and talk to them like a person because they're people. They're not sheep to be herded into adulthood. They're people. And one of the things I like to say is when you're faced with a younger person who is having a problem, the thing to say isn't, why would you do that? The thing to say is, what happened to you? Something happened to put you into this place where you're now relying on alcohol to self-medicate. What happened to you? Let's talk about it.
With curiosity and support. Beautiful.
Yeah, I think that's beautiful wisdom. And I think that highlights what I would say is I'm a fan of the “and approach.” What that means is being empathic, listening, and at the same time having firm boundaries and holding both of those at the same time. So, as Kathleen was mentioning, when you're in my home, this is not acceptable. And this is a clear, firm boundary and there will be consequences. And when you're in my home, I will listen to you and want to know what's going on with curiosity and respect, and treat you like the growing adult that you are. And so I think that “and approach” is really the key.
I think that adolescence especially is such an interesting time because like we talked about earlier, you want to be independent and you want to explore and there's risk taking involved. Some kids are like so ready like 16 to be out of the house and like be an adult and live a life and you have to respect that. But also in the same breath, those same kids will sit down on the couch next to you and say, can we watch “Finding Nemo” tonight? And they still want that, you have to accept, like those two things make a hole and they're sitting right in front of you. They have all this yearning for freedom and like adult life, some of them are encountering really heavy problems. And, you know, they just want to sit down and watch “Finding Nemo” with you sometime.
I love that.
That's the answer, Dr. Millstine, that's our takeaway message.
You have a ten-month-old, and at some point they're going to be a teenager and you're going to say, what happened? Where are they? They're not out of the living room anymore. They're in their rooms like talking to their friends, doing the stuff. And when they come out and say, can we watch “Finding Nemo?” You say, yes, we can and you throw what you were doing down, and you get right on that couch right away because you don't know when it's going to happen again.
Absolutely, amen.
There’s been a lot of great advice on this episode. I want to thank you both for being here with me to talk about teenage alcohol addiction with the book, “The Glass Girl.” Thank you, Dr. Eric Noble. Thank you, Kathleen Glasgow, I really appreciate you both.
Thank you so much for having me. It was a pleasure talking to you both and it was lovely to meet you, Eric.
Yeah, lovely meeting you as well, Kathleen. Thanks again for writing such a great book.
“Read. Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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