If you drive either direction on the I-15 in Utah, you'll see the billboard faces. The two usually contrast each other either in age, style, race or gender. And the message is clear: opioids are an epidemic that can affect anyone.
One of the people those faces symbolize is Cassidy Cochran. It was a Friday morning in November when Charla Bocchicchio, Cassidy's mom, woke up to do yoga. That morning, Bocchicchio's life changed forever. She knew it as soon as she saw multiple missed calls from her ex-husband in the middle of the night. Cassidy died from overdosing on fentanyl. She was 22-years-old.
Bocchicchio was first aware of Cassidy's experimentation with drugs - cocaine and heroin - when Cassidy was 15. She found out later Cassidy started experimenting with alcohol and possibly pot around 13.
Bocchicchio was open about Cassidy's cause of death from the beginning. Cassidy's obituary read, "She died of a heroin overdose in the early morning hours of November 11, 2016. We write this not to dishonor her memory but to shine some light on an illness that is taking the lives of far too many."
Opioid addiction is now considered a public health emergency. In 2016, more Americans died of drug overdose than died in the Vietnam War. Two-thirds of those overdose deaths were from opioids.
It's a heavy, tragic topic. So, how do you talk to your children about something so hard?
Bocchicchio, who now blogs about her experience to spread awareness writes, "If we allow shame, guilt or embarrassment to cause this illness to become a dark family secret, hiding in the shadows, everyone loses."
"This has become my battle cry - to remove the stigma from mental health; From addiction," Bocchicchio told Famifi.
Change the verbiage
Bocchicchio says she believes even the words we use when talking to our children about drugs creates a stigma. Sarah Wakeman, medical director of the Substance Use Disorders initiative and the Addiction Consult team at Massachusetts General Hospital, agrees.
"It's so hard for people to give up the 'abuse' word," she told The Harvard Gazette.
Using phrases like this to describe drugs and those who use drugs creates a culture of shame. Instead of talking about someone as an addict, the proper phrase is "someone who suffers from substance use disorder."
Bocchicchio also recommends replacing the phrase "she's clean right now" with "she's not using right now." Using the word "clean" tells someone when they are using drugs, they are dirty - they aren't a good person.
Tekulve Jackson, the clinical director for Alpine Recovery Lodge, agrees that the way parents talk about drugs is critical.
"When they [children] feel guilt or shame they are less likely to be open with their parents," Jackson said.
He recommends using a phrase like, "In our family we have this value system, and we don't allow for substance use, but also in our family system we allow for mistakes, so if this is happening or happens, let's talk about it."
Pay attention to the non-verbal cues
When first asked about when Cassidy's substance use began, Bocchicchio said it was a complicated answer.
As a young child, Cassidy had a lot of anxiety, which developed into depression as she grew. At age 12, Cassidy started cutting herself. They took her to therapists. She also spent a few nights at a youth psychiatric ward.
It was that inner-turmoil Bocchicchio believes was the real reason Cassidy turned to drugs.
"I don't believe that drugs are the problem in and of themselves," Bocchicchio said. "I think young people who have things like anxiety and depression try to find something outside of themselves that will help them feel better, and when they find something that will help them feel better, I mean, why wouldn't they want to do that thing?"
Bocchicchio thinks a critical point is recognizing those symptoms and helping out as much as possible before they try to self-medicate. Noticing those non-verbal cues are as critical as the conversations you have with your children as well.
"If we can get to them before they self-medicate themselves, it could make all the difference. Because once they use a substance to feel better... I think for my daughter it was too late."
Two months before Charla and Cassidy's tragedy, another mom experienced the close-up effects of opioids in a different setting.
Emily Sutherland is the principal at Treasure Mountain Junior High in Park City, Utah. Park City is a small, mountain town known for hosting the 2002 Winter Olympics and the Sundance Film Festival. In this small town, Sutherland says many parents use marijuana although it is illegal in Utah. Sutherland saw this slipping into her schools as well, so in April of 2016 she had a parent-drug evening. The evening went well, but the takeaway was different than Sutherland expected.
"What we discovered there was that parents and students really wanted to know about the harder drugs," Sutherland said. "What occured to me that night was we apparently had a bigger problem in this community."
There were rumors that one or two students had some kind of white powder, but no one really knew what it was for sure. Sutherland said one mom thought it was a crushed up sleep aid.
The faculty decided they would tackle this issue hard the coming school year during red ribbon week in October.
But in September, only three weeks after the school year started, two students at Treasure Mountain Junior High died of overdose within 48 hours of each other. The drug was called "U-4" or "pink." It was a type of opioid.
It's been nearly a year and a half since the boys in her school died, and Sutherland continues to openly talk to her students about drugs.
When asked for her advice to parents about talking to children about opiods, Sutherland clarifies that she is no expert in the topic. But based on her personal experiences dealing with students and drugs, and as a parent to two herself, she thinks parents make a mistake if they skirt around it.
Teach that secrets aren't helping anyone
Soon after the tragedy at Sutherland's school occured, she found out some students and parents knew the use was going on and didn't report it.
"I'm not blaming them, because I hadn't established a lot of trust. It had only been three weeks since school started, but what I thought was important moving forward was, 'there are no more secrets about this,'" she said.
She's made the emphasis on no secrets a part of the conversation with students. With the two deaths in the school, students now know what the consequences of not "snitching" could be.
"If there are students on the dark web ordering stuff from China, you have to report. There is a responsibility. Your secret isn't precious enough — it doesn't outweigh someone's life," she tells students.
Approach it like you would another disease
Reliance on drugs is a disease, and Bocchicchio said she wishes she'd approached it more that way in the beginning.
"As soon as we found out, I wish we would have approached it as a parent finding out their child has diabetes. Surround and support. We tried this, but we failed a little bit," she said.
Learn to talk about mental health as you would any other disease, and this can help your child feel more comfortable talking about it in the future.
Whatever you do, just talk
Jackson said these conversations are best around the dinner table where people feel comfortable. It tends to make the conversation less awkward. And Sutherland agrees with this.
"Just talk about it. Talk about it at the dinner table," Sutherland told Famifi. "I think the biggest mistake is to not talk to them about it."
Her own two children are still years away from being teens, but Sutherland thinks how she talks to them about drugs changed because of her experiences.
She bases their conversations on age-appropriate content, but already at age 7, those conversations have started.
"We talk about about how some people drink alcohol but they drink too much or some people take medicine, but they don't take it when they are really sick. And they'll ask about it sometimes," Sutherland explains. "I haven't talked to my kids specifically about marijuana and opioids. We gauge our conversations based on their questions. It's mainly covered alcohol and drugs in a broad conversation, and we talk about addiction."
Jackson and Bocchicchio both agree with this. Jackson said when it comes to talking about opioids "being vague is not effective."
Bocchicchio said shying away from it only adds to the stigma. While she tried to do this with Cassidy, looking back she said there are some ways she could have had this conversation better. Overall, she says the most critical part is to keep communication channels open.
"Tell them, 'Yes, you might want to try to drugs someday. I'm not going to shame you. I'm not going to make you feel bad, because probably there is some underlying issue here. Let's talk about it and figure it out together,'" Bocchicchio said.
Don't be overly careful about privacy
Sutherland also said she thinks parents are sometimes too worried about invading a teens privacy.
"I think a lot of times kids are getting involved in these risky behaviors for a number of reasons. One is lack of supervision. I think it's important to be around. Usually around age 14-15 parents pull back a little and give them space. I think that's the exact age they need us around more."
From being a mom herself and observing her many students, Sutherland recommends setting an upfront expectation that you will be searching their private information: rooms, phones, etc.
"It's your job to keep them safe. Parents are sometimes too worried about invading a teen's privacy, but I think we need to be in our kids' business," she said.
Let your kids be imperfect
Both Bocchicchio and Sutherland emphasized the importance of children feeling like there's room to make mistakes and to be average.
Sutherland's community is full of over-achievers. It's those who are average she worries the most about. These students, she said, start to feel disconnected.
"If they aren't the top or the best they don't know if there's a place for them," She said. "A lot of us have high expectations for our kids. I think as parents we need to quickly adjust and realize our kids need to be who they are and they don't have to be amazing at something to be involved in it."
Bocchicchio thinks this pressure to appear perfect is what prevents people from getting the help they need, or having the conversations that could make a difference.
"There's this idea that you have to have this perfect life," Bocchicchio said. "I think that makes it worse too... There's nothing in the community that allows for that conversation. It would be better if we could allow people to say, 'Hey I'm really struggling here.' and to not make them feel badly."
Do your kids know they can be who they want to be - not who you expect them to be? That is a critical part in addressing drugs.
Since those fateful days a year and a half ago, Sutherland and Bocchicchio created ways to help fight against the opioid epidemic. Bocchicchio openly talks about her experiences and blogs in order to help fight the stigma. Sutherland started after-school programs where the students chose the group topics. They have a remote control club and a club similar to the #MeToo movement. They are student picked and student led. They also have an anonymous tip line students use weekly to report incidents anywhere from someone being bullied to someone bringing drugs to school.
Although both Sutherland and Bocchicchio said they made some mistakes along the way, both acknowledged they did the best with the information they had at the time, and for most parents, that's all we can ask for. Having these conversations with your children about opioids and other drugs will likely not go perfectly, but it's better than skirting around the topic.
