Substance Abuse in Children and Adolescents

1. Substance Abuse in Children and Adolescents Jessica Stewart CEP 504 – Fall 2011

2. street names • Whippersnappers • Hoodlums • Rugrats • Ankle Biters • Punks • Tweens • Just Kidding…

3. The vast majority of people who suffer from addiction encountered the beginnings of their illness when they were teenagers. Ninety-five percent of people who are dependent on alcohol or other drugs started before they were 20 years old. - Dr. Mark Willenbring, Director of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism

4. It is also important to keep in mind that substance abuse in adolescence does not always lead to substance addiction later in life. (Heyman, 2009)

5. trends in drug use • Slow but steady increase in overall illicit drug use over the past several years

6. trends in alcohol use • Consistent decrease in Alcohol use

7. trends in marijuana use • Daily marijuana use increased among 8th, 10th, and 12th graders from 2009 to 2010. Among 12th graders, use was at its highest point since the early 1980s, at 6.1 percent • THC levels in marijuana are at their highest ever – 9.6 percent in 2007

9. a few more trends • Teen smoking rates are at their lowest point in the history of the survey. • After several years of decline, current and past-year use of ecstasy(MDMA) has risen among 8th and 10th graders. • Amphetamine use peaked in 1996 at 15.5 percent and decreased to 8.9 percent in 2010. • Methamphetamine use declined from 6.5 percent in 1999 to 2.2 percent in 2010.

10. are children and adolescents more vulnerable to substance abuse? • Immature brain of adolescents associated with poor judgment, impulsivity, inability to contemplate consequences • Greater feelings of social disinhibition with alcohol (less shyness in social settings reinforces use) • Lower sensitivity to intoxicating effects of alcohol resulting in use of larger amounts • Combination of these effects may contribute to initial decision to use and make experience rewarding enough to repeat • May lead to substance use disorders-abuse and dependency

11. adolescent brain development • During childhood and adolescent, the brain is still plastic • Parietal lobe (spatial reasoning), frontal lobe (planning and impulse control) and temporal lobe (language and non-verbal communication) are all still developing • So how does drug and alcohol use during this stage of development affect the brain?

12. adolescent brain development • Alcohol produces greater cognitive dysfunctions in adolescents (Spear, 2002). • more disruption in memory • impairment of neurotransmission in hippocampus and cortex • Adolescents with a history of alcohol use disorder have a smaller hippocampus (Tapert& Schweinsburg, 2005) • the hippocampus encodes new information to the memory

13. adolescent brain development • Heavy drug use during times of critical brain development may cause permanent changes in the way the brain works and responds to rewards and consequences:

14. adolescent brain development • Methamphetamines and cocaine are known to cause a flood of dopamine into the brain – which is one reason they are so addictive: their use is associated with a tremendous sense of reward. It has been found, though, that cocaine addicts have a decreased sense of perception for certain types of reward, and it is thought that cocaine, and meth, over time override the brain’s ability to sense rewards accurately. The effects of these drugs can be devastating to the ability of the user to feel satisfaction from life.

15. adolescent brain development • Adolescent perceptive abilities are not fully developed. Adults use their frontal lobes to determine facial expressions, while teens use their amygdala – the more primitive brain structure that is associated with emotions such as worry or fear. Adult perception is more accurate. Marijuana, like all drugs, changes perception. And like most drugs, it provokes perception that is fearful, emotional, defensive, and often inaccurate. If marijuana use is chronic or constant enough to hinder perceptual maturation, an adolescent user may misinterpret failures in school, work, and relationships, which in turn re-enforce the desire to retreat to drugs.

16. adolescent brain development • the human brain is sculpted by experience. Pruning of unused neural connections and strengthening of regularly used neural connections occurs throughout childhood and adolescence • If the brain is not developing a pattern of logical thought (pre-frontal cortex)during this plastic stage, the neurons that are used for logical thinking will be pruned.

17. risk factors - individual • Begins use at an early age (10-12 years old) • Attention Deficit Hyperactivity Disorder • History of abuse (physical, emotional or sexual) • Learning disabilities • Excessive aggression, impulsivity or risk-taking • Mental health disorders such as depression, anxiety and conduct disorders • Rebelliousness • Unable to control impulses • Low self-esteem • Poor social skills

18. risk factors - family • Family history of substance abuse (even smoking) • Poor child-parent relationships • Lack of supervision • Enabling • Family conflict • Inconsistent or severe discipline • Conditional love • Unrealistically high expectations from parents • Depression, anxiety or trauma within the parents • Access to alcohol or drugs in the home

19. risk factors - community • Availability of alcohol/other drugs • Transitions and mobility (moving a lot) • Low neighborhood attachment & community disorganization • Poverty

20. protective factors - individual • High self esteem • Treatment of depression, anxiety or other mental health issues • Tutoring, counseling, medication, resolutions of behavioral problems, and better supervision in attending school • Religious or spiritual involvement

21. protective factors - family • Family connectedness • Positive parenting style • Living in a two parent family • Higher parent education • High parental expectations about school • Parental abstinence of drugs and alcohol • Religious or spiritual involvement • Parental supervision

22. protective factors - community • Positive connection to other adults • Safe, supportive, connected neighborhood • Strong community infrastructure (services for those in need) • Local, state policies and practices that support healthy norms and child-youth programs • Range of opportunities in the community for meaningful youth engagement

23. physical signs of substance abuse • Changes in sleep patterns • Speech is slurred, or talking excessively and rapidly. • Red, watery or glassy eyes • Staggering or walking very slowly.  • Poor motor coordination. • Change in eating habits • Shaking hands; excessively sweaty hands; very cold hands.  • Unusual skin abrasions or bruises; needle marks; rashes around nose and mouth.  • Neglecting appearance, not bathing.  • Nose bleeds; runny nose; sniffing excessively; hacking cough; smoker's cough.  • Nausea, throwing up, excessive sweating, dizziness, frequently feeling faint.  • Excessive nervousness, irritability, anxiety, restlessness.  • Irregular heartbeat • Paranoid, irrational, or bizarre thoughts. 

24. behavioral signs of substance abuse • Sudden personality changes that include abrupt changes in work or school attendance, quality of work, work output, grades, discipline • Unusual outbreaks of temper • Withdrawal from responsibility • General changes in overall attitude • Loss of interest in hobbies • Changes in friends • Unusual borrowing of money • Stealing items from employer, home or school

25. what’s a parent to do? • Educate themselves about drugs, alcohol and their child’s world • http://www.theantidrug.com • Talk about the use with your teen • be honest and specific about your concerns • Don’t make excuses for your teen • Be prepared (with info and what you are going to say) • Take care of yourself • Act now • setting and enforcing new rules • getting outside help if necessary

26. teenagers in denial

27. getting a teen into treatment • Laws vary by state as to whether or not a parent can force a child into rehab. • Court mandated treatment is common • In WNY, there are only a few inpatient treatment facilities specifically for adolescents

28. treatment Addiction treatment has three stages • Detoxification/Stabilization • not treatment - only preparation for treatment. Detoxification must be followed by continued rehabilitative treatment for lasting improvement.

29. treatment Addiction treatment has three stages • Rehabilitation • Rehabilitation care typically offers an array of treatment components to help to address the many health and social problems associated with substance use

30. treatment Addiction treatment has three stages • Continuing Care • The first 3-6 months following addiction treatment is the period of greatest vulnerability to relapse. Continuing care services are designed to monitor the emotional health of recovering people, remind them of their commitment to lifestyle change and support their needs as they attempt the difficult job of living their former lives with a new perspective and resolve.

31. treatment • Treatment for teens can not just be scaled down adult treatment plans. Adolescents have different concerns and needs • have more family difficulties • more likely to have psychological problems • more likely to have attempted suicide • Their alcohol and drug-use patterns are also different. • Teens tend to abuse multiple substances, while adults are more singular in their focus.

32. treatment • Once in treatment, adolescents seek out different treatment than adults: • favoring group therapy over individual • need to have their family included in treatment • must have a school-based component if in inpatient or residential treatment • most adult treatment programs are not set up to deal with the oppositional or acting-out behaviors characteristic of adolescent substance abusers

33. treatment • Adolescent treatment centers must not only address substance use but help an adolescent navigate the normal developmental tasks of identity formation that are often neglected while using chemicals. • problem solving and social skills need to be learned in order to build self-esteem • Basic trust must be built or rebuilt • Basic feelings must be identified and a language of emotional communications must be established • Coexisting mental health issues such as depression, anxiety and post-traumatic stress disorder (PTSD) must be evaluated

34. neurofeedback • Neurofeedback, also called EEG biofeedback, is a computer-based technology that teaches the brain to function more efficiently by arousing or calming the nervous system. Using a computer and sensors that detect brain waves, patients learn how to control the brain’s electrical patterns by responding to images on a screen or sounds that reflect the electrical activity in their brain • As patients focus their attention on the screen and work to control their emotions, they receive feedback indicating when their brain waves are in the desired zone. After repeating the process a number of times, the brain waves become conditioned to stay within a certain range, eliminating the need for ongoing neurofeedback sessions.

35. neurofeedback • After just a few sessions, patients often report:• Improved ability to focus and pay attention• Decreased impulsivity• Better ability to cope • Less anxiety• Improved ability to maintain sobriety • It is non-invasive and has no negative side effects (no chemical or electrical impulses enter the body at any time). • Based on learning - more practice results in more lasting changes • Patient-guided - the patient decides which training they’d like repeated • It creates lasting change - studies show few patients return for the same problem

36. neurofeedback • meets the American Academy of Child and Adolescent Psychiatry criteria for clinical guidelines established for the treatment of addiction, ADHD, seizure disorders, anxiety, depression and learning disabilities • Patients receiving neurofeedback: • Spend more time in treatment • Are less dependent on medication • Are better able to manage emotional symptoms, such as anxiety, depression and impulsivity • Are more likely to have maintained abstinence one year after completion of treatment • According to a 2005 study published in the American Journal of Drug and Alcohol Abuse, patients recovering from drug and alcohol addictions have an 80 percent abstinence rate after completing neurofeedback training.

37. community resources • Erie County Medical Center462 Grider StreetBuffalo, NY 14215 (716) 898-3415 • Downtown Alcoholism Clinic1280 Main StreetBuffalo, NY 14209(716) 883-4517 • Northern Erie Clinical Services2282 Elmwood AvenueBuffalo, NY 14217(716) 874-5536 • Vocational Rehabilitation and Recovery Center c/o Downtown Alcoholism Clinic 1280 Main Street Buffalo, NY 14209 (716) 881-8357

38. community resources • Alcohol & Drug Dependency Services (ADDS) • Renaissance Campus960 Harlem RoadWest Seneca, NY 14224 • Renaissance House(716) 821-0391 • Promise House(716) 332-3391 • Stepping Stones(716) 821-9220 • Alcohol and Drug Dependency Services Family Addiction107 Delaware Avenue Suite 555 Statler TowersBuffalo NY 14202(716) 855-0163 • Horizon Health Servicesmulitiple locationswww.horizon-health.org

39. community resources • Buffalo General HospitalChemical Dependency Outpatient Clinic80 Goodrich Street Buffalo NY 14203(716) 859-1576 ext. 3729 • Beacon Center Sheridan Drive3140 Sheridan Drive Buffalo NY 14226(716) 831-1937 • Beacon Center Ellicott SquareEllicott Square Building 295 Main Street Suite 112Buffalo NY 14203(716) 853-0243

40. community resources • Elmwood Counseling ClinicCity of Buffalo DSAS656 Elmwood Avenue Suite 201Buffalo NY 14222(716) 886-3982 • Genesee-Moselle Counseling ClinicCity of Buffalo DSAS1532 Genesee Street Buffalo NY 14211(716) 891-8334 • Lifetime Health Chemical DependencyOutpatient Clinic130 Empire Drive Buffalo NY 14224(716) 668-6170 ext. 5030(716) 668-3600

41. community resources • Mid-Erie Counseling and Treatment Services • Suburban Clinic:1526 Walden Avenue, Suite 400Cheektowaga, New York 14225(716) 895-6700 • City Clinic:1131 BroadwayBuffalo, New York 14212(716) 896-7712 • BryLinHospital1263 Delaware AveBuffalo  NY 14209 (716) 886-8200 • BryLin Williamsville Outpatient Addictions Clinic5225 Sheridan DriveGeorgetown SquareWilliamsville  NY 14221 (716) 633-1927

42. online resources • www.samhsa.gov • Substance Abuse and Mental Health Services Administration • www.teens.drugabuse.gov • The National Institute on Drug Abuse • www.inspirationsyouth.com • www.abovetheinfluence.com • http://www.tgcoy.com/addiction

43. online resources • Alcoholics Anonymous • http://www.buffaloaany.org • Narcotics Anonymous • http://www.nawny.org

44. online resources for parents • www.timetoact.drugfree.org • http://www.byparents-forparents.com/

45. bibliography - websites • www.makeachangewny.org • www.samhsa.gov • www.nida.nih.gov • www.monitoringthefuture.org • www.samafoundation.org • www.hbo.com/addiction • www.timetoact.drugfree.org • www.byparents-forparents.com • www.tgcoy.com/addiction • www.hss.state.ak.us • www.adolescent-substance-abuse.com • http://www.drugrehabtreatment.com

46. bibliography - lectures • Thomas, K (July7, 2011). Classroom lecture on puberty and cognitive changes. University at Buffalo, Buffalo, NY. bibliography – books • Doweiko, A. E. (2011). Concepts of chemical dependency. (Eighth ed.). a Crosse, WI: Brooks/Cole Pub Co.

47. bibliography – articles • Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2011). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2010. Ann Arbor: Institute for Social Research, The University of Michigan. • Monitoring the Future (MTF) is a long-term study of American adolescents, college students, and adults through age 50. It has been conducted annually by the University of Michigan’s Institute for Social Research since its inception in 1975 and is supported under a series of investigator-initiated, competing research grants from the National Institute on Drug Abuse.

48. Bibliography - articles • Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011. • This report presents the first information from the 2010 National Survey on Drug Use and Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey is the primary source of information on the use of illicit drugs, alcohol, and tobacco in the civilian, noninstitutionalized population of the United States aged 12 years old or older. The survey interviews approximately 67,500 persons each year. Unless otherwise noted, all comparisons in this report described using terms such as "increased," "decreased," or "more than" are statistically significant at the .05 level.

49. bibliography – articles • Spear, L. P. (2002). Alcohol’s effects on adolescents. Alcohol Health and Research World, 26(4), 287-291 • Tapert, S. & Schweinsburg, A.D. (2005). The human adolescent brain and alcohol use disorders (p 177 -197), Recent developments in alcoholism, Vol XVII. Washington D.C.: American Psychiatric Press • Heyman, G.M. (2009). Addiction: A disorder of choice. Cambridge, MA: Harvard University Press