Adolescent Substance Abuse

1. Adolescent Substance Abuse What We Know … and How to Prevent It! Michael T. Flaherty, Ph.D. Executive Director/Clinical Psychologist Institute for Research, Education and Training in Addictions (IRETA), Regional Enterprise Tower, 425 Sixth Avenue, Suite 1710Pittsburgh, PA 15219, (412) 391-4449 www.ireta.orgm, flahertym@ireta.org

2. Some Background and Quick Premises • Addiction to illegal drugs is America’s No. 1, preventable, health problem. • Addiction to any drug (alcohol, tobacco, illicit drug) is a chronic illness requiring a continuum of care. • The abuse of alcohol and tobacco is a critically important, greatly under-funded, National problem. 50-75% of adolescents in psychiatric care use substance abuse.

3. Some Background and Quick Premises(Continued) • Drug use is drug abuse and, however it begins, leads to dependence (psychological) and potentially addiction. • The solution of this problem in our society requires a greater partnership of the community with our schools, providers, policy makers, funders, scientists and media.

4. Adolescent Substance Abuse • Despite reports of leveling off (see PPG 1/5/03), substance abuse by adolescents remains high. • More than 90% of adults with current substance abuse problems began use before the age of 18 …one-half before the age of 15! • In a 2001 national survey, 23% of 8th graders reported being drunk at least once .. with 21.5% reporting current alcohol use.

5. Adolescent Substance Abuse(Continued) • 54% of all high school graduates in the U.S. have used illicit drugs by the time they graduate. • Among 8th graders, illicit drug use is higher in Anglo-Americans than in African-Americans … in fact, suburban America is both at greater risk and a higher target for drugs.

6. The Treatment Continuum for Adolescents Outreach - School/Community/CJ Assessment - Public/Private/CJ Treatment - Public/Private/CJ

7. The Treatment Continuum for Adolescents(Continued) • Outpatient - Standard (1 x wk) - Intensive OP (3 x wk) - Partial Hosp. (3+ x wk) • Residential - Detox (1-2 days) - Rehab (1-4 wks) - Stepdown/Halfway (2-6 mos)

8. The Treatment Continuum for Adolescents(Continued) • Inpatient - Detox (2-3 Days)(Hospital) - Rehab (12-21 Days) • Aftercare - Up to 12 months in Continuumat progressively less restrictive care. Self-Help - AA, NA, Al-Anon, Al-Ateen (Not Treatment)

9. Scientific studies have now documented that adolescents are at-risk for illicit alcohol/ tobacco/drug use as a result of a unique trajectory of: • Biology • Environment • Development

10. The above factors combine during the critical adolescent years to create a “heightened risk” period – often made obvious by increased externalized behavior and manifest opposition, secrecy and/or aggression. Ref: Maziade, M., “Should Adverse Temperament Matter to the Clinician?” in Temperament in Childhood, 1989, New York: Wiley

11. Who is Most At Risk Among Adolescents? • Low Self Esteem • Poor Coping Skills • Low Behavioral Self Regulation • Social Skills Deficits Ongoing interaction with the environment interacting with individual bio-behavioral aspects. Ref.: Tarter, et.al., Psychology of Addictive Behaviors, December, 2002

12. Who is Most at Risk Among Adolescents?(Continued) If any use* occurs as a result of a composite, unique interaction between environment, development and biology, and we know who is at most risk, can we prevent it? *Defined as Tobacco, Alcohol or Illicit Drug.

13. Yes! A review of the current literature indicates that we can best “intervene” or disrupt the drug use trajectory by:

14. 1. Building Social Competence • Building self-understanding. • Owning one’s perspective. • Building social problem-solving skills. • Having quality child-environment interactions. • Teaching addiction/drug impact.

15. 2. Developing School Bonding* and Achievement • Building a commitment to school/self. • Build methods that increase bond to school and the opportunity for academic success. • Build aspiration for success. • Motivate, motivate … motivate. • Be long-term. *Maladjustment in elementary school is a high predictor/risk factor for Substance Abuse. Low school engagement correlates to low self-esteem, low self-expectation and high association to deviant peers … all of which greatly increases likelihood of drub abuse.

16. 3. Teaching Self-Regulation • Teach methods and reasoning for emotional regulation, anger management and impulse control. • Teach normative role modeling and problem solving skills. • Improve self-control/executive regulation. • Be age specific and culturally sensitive. • Be interactive. • Teach skills.

17. 4. Support and Build Parental/ Adult Involvement • Nothing builds child and adolescent resiliency better than qualitative parental/child or adult/child relationship! • The absence of parental involvement highly predicts Substance Abuse use/psychological dysregulation. Parental/child conflict with low involvement highly predicts delinquency and illicit drug use.

18. Overall, addressing the above four interventions in a sustained manner proportionally reduces, in a significant manner, the likelihood of adolescent substance abuse, aggression and social deviancy. Ref: Tarter, R., “Predictor Variables by Developmental Stages: A Center for Sustained Abuse Prevention Multi-State Study” in Psychology of Addictive Behaviors, Vol. 16, No. 45, 2002.

19. Four Prevention Techniques with Adolescents • Building Social Competence • Developing School Bonding and Achievement • Teaching Self-Regulation • Supporting and Building Parental/Adult-Child Involvement

20. Other Sources of Help/Information • Allegheny County Treatment System Handout • Institute for Research, Education and Training in Addictions (IRETA); 412-391-4449; www.ireta.org • National Institute on Alcoholism; www.niaaa.nih.gov • Making the Grade, www.drugstrategies.org • Join Together; www.jointogether.org • Center for Substance Abuse Prevention; www.samhsa.gov/centers/csap • Community Anti-Drug Coalitions of America; www.cadea.org