Prevention Profiles: Take Five - Sarah Mariani (President of the National Prevention Network)

Rich Lucey: Hi, this Rich Lucey with the Drug Enforcement Administration's Community Outreach and Prevention Support Section and welcome to this episode of our podcast series Prevention Profiles: Take Five.
 
I do want to say from the onset that this is the first episode that we have recorded during the COVID-19 pandemic.
 
So many of us in DEA like all of you out there are working remotely.
 
A lot of us are working from home, and so we're going to cross our fingers and hope that the podcast technology gods are with us and that this will go off without any kind of a hitch.
 
And with that I'm going to introduce today's guest, Sarah Mariani.
 
And let me tell you a little bit about Sarah before we get into our questions.
 
So Sarah Mariani currently is the Section Manager overseeing Substance Misuse Prevention and Mental Health Promotion Services for the Washington State Division of Behavioral Health and Recovery.
 
Sarah has a strong commitment to serving youth and families in high need communities in all of the Section's programs and initiatives.
 
Currently she focuses on policy development and strategic planning to ensure effective service delivery and outcomes.
 
Sarah is the Co-chair for the State Prevention Enhancement Policy Consortium that oversees the state's five-year strategic plan for substance use disorder prevention and mental health promotion.
 
Sarah is Washington State's representative to the National Prevention Network.
 
She is currently the President of the National Prevention Network and she also is the Vice-President for Prevention on the Board of Directors for the National Association of State Alcohol and Drug Abuse Directors.
 
With that, Sarah, welcome to the podcast.

Sarah Mariani: Thank you, Rich.
 
I appreciate the invite to join today.

Lucey: Absolutely.
 
And we've got the whole east coast, west coast thing going on here today, from Washington D.C. and out in Washington state.
 
So I hope you are doing well and I'm really pleased that you've been able to join us today and offer your perspective on some of the things that we're going to talk about.
 
So I'm going to jump right into our first question.
 
And talking about Washington state, perhaps it's not a surprise I want to talk a little bit about marijuana use.
 
In November 2012 voters in Washington state approved an initiative that legalizes marijuana use for adults 21 and older which went into effect, I believe it was in July of 2014.
 
So Sarah, from your perspective what has been the biggest impact of legalizing retail cannabis use on Washington state's colleges and universities?
 
 
Sarah: When we started this work here, and you are correct, July 2014, one of the things that I think came up is that we knew as the law passed that lots of normalization had already happened around marijuana.
 
But passing the law continued to promote the norm that it's acceptable to use marijuana, and in some respects also by the advertising that the marijuana industry has done that it is a harmless substance to use.
 
And so one of the major impact is this ongoing gaining acceptance of marijuana as a substance that's harmless, which we know isn't true.
 
We know from research that it's one of the most used drugs by young adults, particularly those under 21.
 
We know that when we look at our state data coming out of our young adult health survey and the most recent results that were published in 2019 from the 2018 data that almost half of the young adults, just under 50%, reported that they had used marijuana in the past year, which is an increase, a statistically significant increase, not huge, but from 2014 when the first doors started to open where we were at about 44%.
 
We also know that when we look at the young adults, more than half of them also have simultaneous use with alcohol and marijuana, which can be a very dangerous combination.
 
I think one of the other things that kind of worries us about this then is when you think about the consequences.
 
So you have a young brain that isn't fully developed, particularly when we're talking about those under the age of 25 and what the different impacts of that can be.
 
And in particular when we look at the mental health impacts, the impairment to memory, attention, the negative impacts it can have around academic success, that becomes very concerning.
 
Particularly some of the research that has been done has shown that consistently students who use marijuana even occasionally in college are more likely to skip classes, drop out of school, study less, have lower grades.
 
And unfortunately this can also lead to failing and having trouble keeping employment while they're in university.
 
And all of that we know from; all of our prevention work has down line impacts as that person ages and struggles in employment and education and the impacts of that.
 
Those are some of the things that I think really worry us about this age group in particular.
 
But the other part that we've seen in terms of the actual impact from legalization is product proliferation.
 
So whereas in, you know, we used to kind of just talk about marijuana as a flower product, now the dare I say creativity of the industry has brought about all kinds of products and really brought them to the forefront, which has increased the number of people that may choose to use because they don't necessarily have to smoke it.
 
So you have edibles.
 
And because it's soluble, you can put it in pretty much anything.
 
And that was true before legalization, but it definitely is something that is promoted more widely now.
 
And then the vapor products with the flavors.
 
And so we really are seeing when we look at young adults, and for us in our survey and our data, that's 18 to 25 to be specific.
 
The daily use we're looking at has increased from 6% in 2014 up to 8% in 2018.
 
And weekly use has increased from 17% to 19%.
 
And medical use has increased from 24% to 28%.
 
So what does this tell us?
 
This tells us that young adults are using and using more frequently.
 
And that is concerning.


Lucey: So all this, all of this data and the concern that you have and the others obviously around this issue is so appropriately placed, and it leads me actually to the next question where I want to talk a little bit about, so we know about the use and the data and the rates are going up.
 
The normalization is there and certainly focusing on consequences.
 
But I want to talk just a little bit about evidence-based strategies.
 
So I know from my interaction with you, I've known you for several years now in my work, both previously at CSAP and now here at DEA.
 
Several years ago your agency developed a list of evidence-based programs that are effective in preventing and reducing marijuana use in youth and young adults.
 
How did you and the team there develop that list and do you update the list on a fairly regular basis?
 
 
Sarah: We do update the list fairly regularly.
 
We were updating it about every year as this first started and we wanted to make sure that we got information out and available for our communities to use right away, but knowing that we had more work to do, we do update it regularly.
 
Now that things have stabilized a little bit, we update it about every two years.
 
So in the development of it, we first consulted with the University of Washington who is a longtime partner with us in this work.
 
And the social development research group out of the University of Washington in nationally and internationally known for the work that they've done around evidence-based practices in prevention.
 
And so we worked with them as well as at the time the Substance Abuse for Mental Health Services Administration's Center for the Application of Prevention Technology.
 
And we looked really specifically at, when we look at lists that already exist for evidence-based programs, which of those programs had specific outcomes around reducing marijuana use or delaying the onset of marijuana use?
 
That developed our original list, and from that then we grew the list looking at, we did a risk factor path analysis where we said, which of those risk factors in general the impact substance use disorder prevention, which of those risk factors are most salient in having an impact on marijuana use?
 
 And so we identified the risk factors that were most salient, mostly focusing around family and community.
 
The individual and peer domain really impacts directly marijuana use whereas the family and the community have that indirect impact marijuana.
 
And so from there we went and again looked at all the evidence-based practices that were focused in those areas and added those to our list.
 
The last part that we did, and that was done in concert with both University of Washington and Washington State University's impact lab which we're fortunate also to have a longstanding relationship with that well known, nationally known prevention group of researchers.
 
The last piece that we did then is we had a quick consult with PIRE to look and see.
 
PIRE has done a lot of work around, excuse me, alcohol policy and the impacts of environmental strategies for alcohol.
 
And so we asked the question.
 
Now mind you, we were asking this question back in 2013-2014 so it continues to evolve for sure.
 
But we asked the question which was, which environmental strategies that we know have an impact on alcohol, if you made the assumption that because in our state marijuana was legalized in a way that much mirrors alcohol, we could have a strong hypothesis that using those strategies could also impact marijuana.
 
Of course they couldn't be tested right then in that moment, but we wanted to make sure that we were promoting the best cases scenario of having an impact.
 
And so with that we developed a very short list of environmental strategies to start to tackle.
 
The last piece.
 
Sorry.


Lucey: I was going to mention I think that you bring up; sorry to interrupt.
 
And that point right there I think is really important because it says to me there are lessons learned from our work in preventing alcohol misuse, alcohol use among youths and certainly among college students.
 
And so you've been able to translate that and those lessons learned to your work in preventing marijuana use.


Sarah: Absolutely, absolutely.
 
And looking at the lessons learned around tobacco prevention was also a really important piece, and we did that as well.
 
 
Lucey: Where, if any of our listeners were interested in seeing that list, I do think if I remember correctly it is publicly available, right?
 
Is there a website they can go to to see the list as it currently exists?
 
 
Sarah: Yes, we have it posted on our website that we have for our providers which is called theathenaforum.org and within that website there's a list called The Excellence in Prevention List.
 
And so go ahead and go to that website, theathenaforum.org and look for the Excellence in Prevention List.
 
 
Lucey: And we'll be sure to highlight that, and people who will see the transcript of our interview, they'll certainly see that link embedded in the interview.
 
So that's great that there is someplace that they can access that.
 
Sarah, I want to move on to the third question and it's the commonality that you and I have.
 
It's how I cut my teeth in this career, and that was working in a state agency.
 
I started my career overseeing the higher education initiatives for the New York State Office of Alcoholism and Substance Abuse Services.
 
And throughout my career at both the state and the federal levels, I was very, very fortunate.
 
We had a really robust portfolio of initiatives, resources around preventing alcohol and drug use among college students at that time.
 
And I've heard from campus-based prevention professionals.
 
They have difficulty engaging their state agency that deals with drug misuse preventions.
 
So as someone who is the director of prevention for a state and you've come up through the ranks in a state agency, what advice do you have for our listeners who struggle with this and are trying to engage their state agency in their prevention efforts?
 
 
Sarah: So in thinking about this question, I really, I kind of went back to those local roots, Rich.
 
And that is prevention at the core is about how do we create collaborations and partnerships?
 
And every time you answer that question, I think regardless of the environment you really have to figure out, what is the neutral benefit?
 
And I can appreciate the question for sure.
 
I think really looking at here's what we need to accomplish from the perspective of, say, the folks in the university but then really thinking about when you look at the state's goals, what can you bring to the table that helps solve the problem that the state is trying to solve?
 
 And start there in the conversation and then build out to say, and here's our problems on the table as well.
 
How do we all work together for that?
 
 And so I think working from that angle of that mutual beneficial and mutual partnerships.
 
And knowing that I've had many meetings with people where I've just said I have no idea how we need to work together in the future.
 
All I know is I think you do good stuff, and we're trying to do stuff.
 
There's got to be an overlap.
 
Let's just keep talking until we figure it out.
 
And just having those quick touch bases and be willing to have faith in the process that having those partnerships may not have an immediate action but it's important to have them for the future action.
 
And that's hard to do.
 
It's hard to do in the fast-paced work environment that we have of investing in those partnerships when they're not yielding results right away, especially when everybody is asking for [inaudible 16:90].
 
But I do think it's important to having those relationships.
 
The other thing is I would say create work groups, task force.
 
Sit on any work groups or task force you can that the state is hosting, or host a meeting and just point blank invite, which sometimes can be difficult.
 
But those of us that work at the state, we're just like everybody else.
 
We're just people trying to do the good work.
 
And so sometimes an invitation can be all the world.
 
The last piece that I would say is I think it is important to reach out.
 
You mentioned when you were describing my work that I work as one of the National Prevention Network representatives for the state of Washington as well serve as the President currently.
 
And so I really would encourage you to reach out to your state's NPN and see if you can make that connection as a way to get let into some of the state work.


Lucey: I can appreciate the plug for NPN, the National Prevention Network.
 
And in fact for our listeners, if you haven't checked it out on our website, campusdrugprevention.gov, if you go to the resources section and specifically in the state and local part of that section, we have an interactive map.
 
And you can just go to the map and go to your state, and one of the three different contacts we list there for you is your National Prevention Network representative.
 
So we've made it easy for you to figure out who that person is and how to get in touch with them.
 
Sarah, you know when you were talking, I was thinking of a longtime really good colleague who I got to know early in my career from your state of Washington, Western Washington University, Pat Saviano.
 
And I still talk about Pat today.
 
And when we talked about model programs, and I stole her phrase and I use it in my presentations all the time.
 
And when she talked about building collaborations, building coalitions, she talked about having a hundred cups of coffee.
 
And what she meant about that was not personally having a hundred cups of coffee, but it was the idea of, the idea of meeting with people and sitting down with people over a cup of coffee, over a soda, over a pizza, over lunch, over whatever to talk about those mutual goals, the common goals.
 
I can appreciate what you said.
 
I think it's helpful to.
 
You're going to know your state best obviously, your state's culture and stuff.
 
But find out what your state agency is focused on at the moment.
 
Find out what grants they might have.
 
I know that when the Partnerships for Success grants were out that focused on underage drinking, prescription drug misuse, obviously college students squarely fit within that focus area.
 
And I think it was pretty easy.
 
And I was there at CSAP when these grants first came out.
 
That was the advice I kept giving to colleges was to knock on the door of your state agency and say, are you focused on colleges with this grant?
 
 We'd love to be part of it.
 
So I think you're absolutely right.
 
Find out what the state's working on and figure out how and where you might fit in that, in that plan.
 
 
Sarah: Absolutely.
 
If I could add one other piece that sometimes has helped is thinking about participatory research projects.
 
And so universities have that unique ability to help form that research to practice and practice to research component in thinking about the wellness programs in the colleges and universities as being right for helping make that connection with the state, other local, other universities but also their own university and the researchers within the universities.
 
 
Lucey: Absolutely good advice.
 
I appreciate you bringing that up.
 
I'm going to move on to our fourth question.
 
I'm going to just kind of speak generally I guess that this point.
 
So not only as the Director for Prevention for the state of Washington but also as the President of the National Prevention Network, what prevention issues keep you up at night?
 
 
Sarah: So specifically where we started in this interview, the conversation around marijuana and where this is going, I think many of the things that I brought up earlier continue to challenge us in the prevention field and really addressing the issue around marijuana so that we don't end up with many, many more adults and young adults needing treatment because they've developed a substance use disorder with marijuana.
 
And in particular what's worrisome about that is these higher and higher THC concentrates, the products that are having really high THC rates.
 
That's some of the stuff that is concerning in there, the cross baiting or the simultaneous use of marijuana with other substances, and then the driving under the influence.
 
Quite honestly marijuana, other drugs, alcohol and really the one that seems to have one of the most significant negative impacts is driving under the influence of both alcohol and marijuana at the same time.
 
So those are some of the things specific to the conversation about marijuana that are always on my mind.
 
I think in a more general sense it continues to be the things that our field has been challenged with for awhile quite honestly.
 
And we've seen some movement sometimes.
 
You mentioned the Partnerships for Success grant, but we also I think continue to need to push for thinking ahead and getting our, I would say kind of this society to recognize the value of prevention in this particular arena.
 
It is well recognized when we talk about primary health and physical health, but it seems like we need to get that message out around how do we do good prevention when we're talking about behavioral health?
 
 And that primary prevention piece, that [inaudible 22:51] piece.
 
And how do we get the right resources and enough resources to really address it so we can start to turn down the faucet on those that are showing up in our system later and needing treatment or additional resources, which quite honestly are generally more expensive resources for our society?
 
 I think the other piece that has ebbed and flowed but is a real issue that I worry about a lot is the workforce.
 
When we've looked at workforce surveys and studies, we have a workforce in prevention in our state system where we have a number of people that are retiring.
 
And so we have a younger workforce happening which is great.
 
That brings a certain level of energy, new excitement, new ideas.
 
And one of the things that we're finding is that some of the world history and even written history of prevention which as you and I have talked about creates that value and that depth in terms of doing good practices, good strategies, making sure that we're really having an impact in the communities with those limited resources.
 
I worry that those are being lost as we transition and lose some of the people and resources that have been available in our system to help support that workforce.
 
And as we continue to have workforce shortage in all of behavioral health prevention, it's definitely one of the areas where we really need to figure out how to bring people in and bring them up to speed quickly and more quickly than we currently are.
Lucey: And those are certainly some very weighty issues.
 
And I think a commonality among all of them is that they are not going to be solved overnight.
 
We've been working on these things for awhile.
 
We will see the change, I believe.
 
We have to have faith in that.
 
But it will take long-term planning and long term.
 
We have to have the patience to see these things happen.
 
And that's the challenge in prevention, but it's also the reward in prevention.
 
So I appreciate you identifying those issues that are top of mind for you.
 
I'm going to move on to our fifth question as we wind up, and we have just about two or three minutes to wrap this up.
 
So our last question is, what would you say to encourage the professionals who are listening to this podcast who are working to prevent drug misuse among college students as well as the students themselves?
 
 What would you say to encourage them?
 
 
Sarah: You know, I would say partnerships are critical.
 
Keep working on your partnerships.
 
I agree with you.
 
We are as a field, our field is an interdisciplinary field so we are well positioned for the future and to help be responsive.
 
And that piece around we can answer some of the big questions that are facing our society because we are the field that has that answer.
 
That is what prevention is about.
 
We can help take care of these deep end problems.
 
And so I would say we are making a difference.
 
We are seeing impacts.
 
When you look at the reductions in alcohol use for instance over the last decade, we continue to have that going down.
 
And that's a really promising sign that our strategies are working.
 
We need to stay the course, and we need to make sure that we recognize those little wins and don't lose hope in knowing that this is, this work will take awhile.
 
And recognize those little wins.
 
Be encouraged by those little wins.
 
And then stay focused on the big picture and the goals and the fact that we are making a difference.
 
We make the difference in the lives of children and families and parents and communities every day.
 
And it's important to stay connected to that in your heart and in your mind so that you can be encouraged to keep doing the work.
 
That's how I see it of course.


Lucey: Well, that is such a great note to go out on with the interview.
 
In fact I'm sure I'll probably steal that in a presentation or two.
 
I like the little sound bite.
 
And I've written for myself at the end which is, be encouraged by the little wins while focusing on the big picture.
 
I think that that's so important and to not lose hope because we are making a difference.
 
So with that, Sarah, I want to thank you again.
 
You've given us some great content here in this interview and some of the things that you've talked about and your perspective as a prevention director for a state but also as the president of a national organization focused on prevention.
 
I really appreciated your time with us.


Sarah: Excellent, thank you so much.
 
It's been great talking with you as always, and I wish you all well.


Lucey: Thank you, Sarah.
 
And for our listeners, as I started off the podcast, this is our first interview that we've done while the entire globe actually but our country is dealing with the COVID-19 pandemic.
 
And so as I end our interview with Sarah today, I hope that you are doing everything necessary to keep yourself, your family and friends and your communities safe and healthy during this time.
 
And with that I will say thanks for listening and have a great day.