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Indiana Prevention Resource Center Indiana University

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					The Dilemma of Underage
   Drinking in Indiana

  Barbara Seitz de Martinez, PhD, MLS, CPP
               Deputy Director,
     Indiana Prevention Resource Center




Safe & Drug Free Schools Workshop
                                  Spring 2008

     The Indiana Prevention Resource Center is funded, in part, by a contract with the Indiana Family
     and Social Services Administration, Division of Mental Health and Addiction, financially
     supported through HHS/Substance Abuse Mental Health Services Administration, Center for
     Substance Abuse Prevention, Substance Abuse Prevention and Treatment Block Grant. The
     IPRC is operated by the Indiana University Department of Applied Health Science and School of
     Health, Physical Education and Recreation. It is affiliated with the Department's Institute of Drug
     Abuse Prevention.
            Gateway Drugs
Research has shown that the majority of
 individuals' illicit drug use occurs only after
 they use cigarettes, alcohol, or marijuana.
 These three are known as the "gateway
 drugs." (Bailey, 1992; Donovan & Jessor,
 1983; Fleming, Leventhal, Glynn, &
 Ershler, 1989; Golub & Johnson, 2001;
 Kandel & Yamaguchi, 1993).
                       Alcohol and Rx Drugs
Males and females with alcohol dependence are 18x more likely to
abuse prescription drugs than are those who abstain from alcohol
use. Youth under age 25 are especially vulnerable to abusing both
alcohol and prescription drugs.

Source: Elizabeth Ashton, “Alcohol Abuse Makes Prescription Drug
Abuse More Likely,” NIDA Notes 21/5 (March 2008):8-9.



Note: Preventing or delaying use of alcohol will reduce the likelihood of drug use and of other
associated problem behaviors.




 IPRC: Call 800 – 346-3077
 www.drugs.indiana.edu
  We need to remember that alcohol is a gateway drug.
  When new drug trends emerge we must remember that alcohol, along with tobacco,
  is a primary drug of abuse and must be addressed aggressively .

ATOD Survey, p. 112
ATOD Survey, p. 112
ATOD Survey, p. 112
ATOD Survey, p. 112
•   ATOD Survey, p. 122
ATOD Survey, p. 112
                Indiana Students’ Use




3-10+ times in last 2 wks. 1.3%   2.3%   4.2%   5.5%   7.7%   8.3%   10.8%




  IPRC, ATOD Survey Monograph, 2007
      Drugs and Driving by American
      High School Seniors, 2001-2006
  • In 2006, 30% of HS seniors reported
    exposure to a drugged or drinking driver in
    the past 2 weeks
  • This was down from 35% in 2001
  • Exposure was widespread
  • Individual lifestyle factors were associated
    with outcome behaviors
Source: Patrick M. O’Malley, “Drugs and Driving by Am HS Sr, 2001-2006,” Jrnl
of Studies on Alcohol and Drugs 68/6 (November 2007):834-842.
         Individual Lifestyle Factors
      Associated with Drugs and Driving
  •   Religiosity
  •   Grade point average
  •   Truancy
  •   Frequency of evenings out for fun
  •   Hours of work
Source: Patrick M. O’Malley, “Drugs and Driving by Am HS Sr, 2001-2006,” Jrnl
of Studies on Alcohol and Drugs 68/6 (November 2007):834-842.


 IPRC: Call 800 – 346-3077
 www.drugs.indiana.edu
                            Age of 1st Use
. . . the younger a person is when she or he begins using alcohol, the more
likely the person is to experience alcohol dependence and abuse
(Grant, Stinson, & Harford, 2001; Warner & White, 2003).

A recent study found that compared to persons who began drinking at age 21 or
older, those who began drinking before age 14 were more likely to experience
alcohol dependence later in life (R. W. Hingson, Heeren, & Winter, 2006).

Note: Preventing or delaying use of alcohol will reduce the likelihood of other drug use and of
other associated problem behaviors.
      Age of 1st Use – Alcohol (IN)




IPRC, ATOD Survey Monograph, 2007
                   Age of 1st Use




IPRC, ATOD Monograph, p. 14
          Perceived Risk of Harm
          and Annual Prevalence




IPRC, ATOD Monograph, p. 15
         Perceived Risk of Harm
         and Monthly Prevalence




IPRC, ATOD Monograph, p. 16
         Perceived Peer Approval
          and Annual Prevalence




IPRC, ATOD Monograph, p. 17
         Perceived Peer Approval
         and Monthly Prevalence




IPRC, ATOD Monograph, p. 18
     Perceived Parental Approval
       and Annual Prevalence




IPRC, ATOD Monograph, p. 18.
     Perceived Parental Approval
       and Monthly Prevalence




IPRC, ATOD Monograph, p. 18
  The Importance of Norms
Promoting and maintaining a culture or
environment where the perception of risk
of harm from alcohol use and the
perception of parental and peer
disapproval of alcohol use is greater will
reduce the likelihood of drug use and
associated problems.
           After-School Activities
          and Annual Prevalence




IPRC, ATOD Monograph, p. 18
          After-School Activities
         and Monthly Prevalence




IPRC, ATOD Monograph, p. 18
            Indiana Students’ Use




IPRC, ATOD Survey Monograph, 2007
   Importance of Monitoring
Parental monitoring of their child’s
activities and involvement in those
activities are powerful tools in reducing the
likelihood of drug use. The hours from 3-
6 p.m. are particularly important because
this is a time when many parents are
working and the child may be presented
with temptations to initiate drug use.
   Survey of Alcohol Compliance

  •April 16, 2008
  •new program initiated by State Excise
  Police
  •evaluates the sale of alcohol to persons
  under 21
  •attempts to mirror success of TRIP
Source: Aaron Jones,
http://www.drugs.indiana.edu/news-featured_detail.aspx?seq=12
                  SAC Inspections
        State Excise Police SAC Inspections
        •collaboration -- State Excise Officers and
        18-20 year-olds
        •primary goal -- to reduce access and
        availability
        •one of many strategies

        IPRC Role
        •recruiting and hiring youth
        •other administrative duties
Source: Aaron Jones,
http://www.drugs.indiana.edu/news-featured_detail.aspx?seq=12
             New Knowledge:
       Alcohol and the Alcoholic Lung
  Alcohol abuse increases the risk of acute
    lung injury, e.g., following:
  • major trauma, such as a serious motor
    vehicle accident, gunshot,
  • other event requiring hospitalization,
  • the spread of bacteria attributed to
    infection.
  • …can occur even in young and otherwise
    healthy individuals
Source: Corey D. Kershaw and David Guidot, “Alcoholic Lung
Disease,” Alcohol Research & Health 31/1 (2008):66-75.
              IPRC Activities
•Survey of Alcohol Compliance
•Drug Information Portal
•ATOD Survey of ATOD Use by IN Children and Adolescents
•PREV-STAT GIS Data and Mapping Resources
•After School Prevention Programs – R.O.C.K.
•Grant-Writing and Evaluation Support
•Strategic Prevention Framework approach and SIG support
•School Prevention Curricula
•Library – Literature, Reference Services, AV loans
•Problem Gambling Prevention
                    IPRC Activities
Preventing or delaying use of alcohol will reduce the likelihood of
drug use and of other associated problem behaviors.
The greater the perception of risk of harm from alcohol use and the
greater the perception of parental and peer disapproval of alcohol
use the less likely it is that youth will use alcohol and other drugs or
experience associated problems. Promote or maintain such a culture
in your family and environment.
Parental monitoring of their child’s activities and involvement in those
activities are powerful tools in reducing the likelihood of drug use.
The hours from 3-6 p.m. are particularly important because this is a
time when many parents are working and the child may be presented
with temptations to initiate drug use.
We need to remember that alcohol is a gateway drug.
When new drug trends emerge we must remember that
alcohol, along with tobacco, is a primary drug of abuse
and must be addressed aggressively.
       Tobacco Use
By School Students in Indiana

   Barbara Seitz de Martinez, PhD, MLS, CPP
                Deputy Director,
      Indiana Prevention Resource Center




 Safe & Drug Free Schools Workshop
                                   Spring 2008

      The Indiana Prevention Resource Center is funded, in part, by a contract with the Indiana Family
      and Social Services Administration, Division of Mental Health and Addiction, financially
      supported through HHS/Substance Abuse Mental Health Services Administration, Center for
      Substance Abuse Prevention, Substance Abuse Prevention and Treatment Block Grant. The
      IPRC is operated by the Indiana University Department of Applied Health Science and School of
      Health, Physical Education and Recreation. It is affiliated with the Department's Institute of Drug
      Abuse Prevention.
IPRC, ATOD Survey Monograph, 2007
IPRC, ATOD Survey Monograph, 2007
            Indiana Students’ Use




IPRC, ATOD Survey Monograph, 2007
            Indiana Students’ Use




IPRC, ATOD Survey Monograph, 2007
IPRC, ATOD Survey Monograph, 2007
IPRC, ATOD Survey Monograph, 2007
   Age of 1st Use – Cigarettes (IN)




IPRC, ATOD Survey Monograph, 2007
     Marijuana Use
  among School Students
       in Indiana
  Barbara Seitz de Martinez, PhD, MLS, CPP
               Deputy Director,
     Indiana Prevention Resource Center




Safe & Drug Free Schools Workshop
                                  Spring 2008

     The Indiana Prevention Resource Center is funded, in part, by a contract with the Indiana Family
     and Social Services Administration, Division of Mental Health and Addiction, financially
     supported through HHS/Substance Abuse Mental Health Services Administration, Center for
     Substance Abuse Prevention, Substance Abuse Prevention and Treatment Block Grant. The
     IPRC is operated by the Indiana University Department of Applied Health Science and School of
     Health, Physical Education and Recreation. It is affiliated with the Department's Institute of Drug
     Abuse Prevention.
                         Marijuana
• Most widely used illicit drug (US/EU) – 4 million in US
• Most widely used secondary drug for stimulant or opiate
  dependence (p.9)
• Marijuana dependence exists
• Very similar to other substances
• Adults seeking treatment (10 yrs/6 serious quit attempts)
• Withdrawal creates real symptoms
• Dependence 2x as prevalent as any other illicit drug
• About 50% of heavy marijuana users also smoke
  tobacco

 Source: Budney, Alan J., et al., “Marijuana
 Dependence and Its Treatment, Addiction Science &
 Clinical Practice (December 2007):4-16.
IPRC, ATOD Survey Monograph, 2007
IPRC, ATOD Survey Monograph, 2007
            Indiana Students’ Use




IPRC, ATOD Survey Monograph, 2007
IPRC, ATOD Survey Monograph, 2007
            Indiana Students’ Use




IPRC, ATOD Survey Monograph, 2007
IPRC, ATOD Survey Monograph, 2007
   Marijuana Impaired Driving
• 5% of persons 12+ (NSDUH)
• 15-18% of 18-21 yr. olds (illicit -- NSDUH)
• 20% of HS drivers in Canada
     High School Seniors DUI
25
                                      18.2%
20
                                         Marijuana
15                                       Illicit Not Marij
                                         Alcohol
10
                                         Heavy Drinking
                                         Any of Above
5

0
     2001   2005       2006
               Source: Patrick M. O’Malley, “Drugs
               and Driving by Am HS Sr, 2001-2006,”
               Jrnl of Studies on Alcohol and Drugs
               68/6 (November 2007):834-842.
          High School Seniors
     Riding with an Impaired Driver
30
                                      24.4%
25

20                                         Marijuana
                                           Illicit not Marij
15
                                           Alcohol
10                                         Heavy Drinking
                                           Any of Above
5

0
      2001   2005        2006

               Source: Patrick M. O’Malley, “Drugs
               and Driving by Am HS Sr, 2001-2006,”
               Jrnl of Studies on Alcohol and Drugs
               68/6 (November 2007):834-842.
      High School Seniors DUI or
     Riding with an Impaired Driver
35
                                      29.6%
30
25
                                           Marijuana
20                                         Illicit not Marij
15                                         Alcohol
                                           Heavy Drinking
10
                                           Any of Above
5
0
      2001   2005        2006
               Source: Patrick M. O’Malley, “Drugs
               and Driving by Am HS Sr, 2001-2006,”
               Jrnl of Studies on Alcohol and Drugs
               68/6 (November 2007):834-842.
           Withdrawal Symptoms
  •   Cravings
  •   Anxiety
  •   Depression -- feelings of misery
  •   Difficulty sleeping
  •   Chills and muscle pain
  •   Irritability
  •   Predictable (timeframe)
  •   Mild compared to heroin or severe alcohol
Budney et al, 2004; Budney and Hughes, 2006. Cited
in “Research Review – Marijuana Dependence and Its
Treatment, Addiction Science & Clinical Practice 4/1
(December 2007):10.
          Percent of SA Treatment
         Admissions due to Marijuana
              60

              50

              40

              30                                           1993
                                                           2005
              20
                                                          Marijuana
              10                                          admissions
                                                          nearly doubled
               0                                          1993-2005
                   Alcohol Cocaine Heroin Marijuana
Source: SAMHSA, 2006. Cited by Budney, Alan J., et al.,
“Marijuana Dependence and Its Treatment, Addiction
Science & Clinical Practice (December 2007):4-16.
        Adolescent Drug Treatment
               70
               60
               50
                                                          Marijuana
               40
                                                          Cocaine
               30                                         Heroin
Marijuana –
the most       20                                         Alcohol
adolescent
               10
admissions
                0
                    '12-17   18-20   21-34   35-55

Source: SAMHSA, 2006. Cited by Budney, Alan J., et al.,
“Marijuana Dependence and Its Treatment, Addiction
Science & Clinical Practice (December 2007):4-16.
      Why the Rise in Youth Use?
 • Higher potency marijuana
 • Initiation of use at younger age
 • Rise in use among young adult African-
   American and Hispanic men and African-
   American women
Source: Compton, 2004 JAMA 291/17. Cited by Budney,
Alan J., et al., “Marijuana Dependence and Its Treatment,
Addiction Science & Clinical Practice (December 2007):4-
16.
    Why the Rise among Minorities?

•   Effects of acculturation on Hispanic youth
•   More minority youth attending college
•   Environmental and economic factors
•   Higher prices and stricter government policies
    for other drugs

Source: Budney, Alan J., et al., “Marijuana
Dependence and Its Treatment, Addiction Science &
Clinical Practice (December 2007):4-16.
                  Adolescent Risks
•   Adverse health and psychosocial consequences
•   Sexually transmitted diseases and pregnancy
•   Early school dropout
•   Delinquency
•   Legal problems
•   Lowered educational and occupational aspirations
•   Typically “forced” into treatment (Diamond et al, ’06)


Source: Budney, Alan J., et al., “Marijuana Dependence
and Its Treatment, Addiction Science & Clinical Practice
(December 2007):4-16.
The Dilemma of Rx and OTC
   Drug Abuse in Indiana

  Barbara Seitz de Martinez, PhD, MLS, CPP
               Deputy Director,
     Indiana Prevention Resource Center




Safe & Drug Free Schools Workshop
                                  Spring 2008

     The Indiana Prevention Resource Center is funded, in part, by a contract with the Indiana Family
     and Social Services Administration, Division of Mental Health and Addiction, financially
     supported through HHS/Substance Abuse Mental Health Services Administration, Center for
     Substance Abuse Prevention, Substance Abuse Prevention and Treatment Block Grant. The
     IPRC is operated by the Indiana University Department of Applied Health Science and School of
     Health, Physical Education and Recreation. It is affiliated with the Department's Institute of Drug
     Abuse Prevention.
Recommended web site:

   www.theantidrug.com
     The Family Medicine Cabinet
 •   Pain Killers (e.g., post-surgical Rx)
 •   Depressants (e.g., sleeping, anti-anxiety)
 •   Stimulants (e.g., for ADHD)
 •   OTC (e.g., cough and cold remedies)




www.theantidrug.com
                      Danger:
 • Pain Meds and Depressants: breathing
   failure
 • Stimulants: heart system failure, seizures
 • OTC: blurred vision, nausea, vomiting,
   coma, death
 • Combining the above risks respiratory
   failure and death.

www.theantidrug.com
      Upsetting Trend: Pain Meds
 Every day
     2500 teens ages 12-17
           abuse a pain medication
                    for the 1st time.

 Many don’t realize the danger.


www.theantidrug.com
      Upsetting Trend: Pain Meds
 Nearly 1 in 5 teens (18% or 4.3 million) report
  abusing Vicodin®

 1 in 10 teens (10% or 2.3 million) report
   abusing OxyContin®




Partnership for a Drug-Free
America, www.drugfree.org
       Upsetting Trend: Stimulants
 1 in 10 teens (10% or 2.3 million) report trying
   Ritalin® and/or Adderall® without a doctor’s
   order.

 1 in 11 teens (9% or 2.2 million) has abused
   OTC cough meds to get high (contains
   dextromethorphan).


Partnership for a Drug-Free
America, www.drugfree.org
      Upsetting Trend: Rx Drugs
 • Of illicit drugs, only marijuana has more teen
   abusers
 • More than 2.1 million teens reported
   abusing Rx drugs
 • The Drug of Choice for 12-13 year olds




www.theantidrug.com
               Multiple Drug Use
 “Individuals who report using Oxycontin®
   typically have a history of multiple drug use
   including non-medical use of other
   prescription medications such as
   tranquilizers, sedatives and stimulants.”
   (Sees et al, 2005)



IPRC, ATOD monograph, 2007.
     Indiana Stats: Rx Drugs
ATOD Survey of 6th-12th graders asks about:
• Amphetamines
• Methamphetamines
• Ritalin or Adderall
• Tranquilizers
• Rohypnol
• Over the Counter Drugs
         Indiana Stats: Rx Drugs
Drug                        6th     8th     10th    12th
                      IN      US IN US IN US IN US
Amphetamines          0.3         2.3 4.7 5.7 7.9 5.4 8.1
Methamphetamine       0.2         1.2 1.8 1.9 1.8 1.9 2.5
Tranquilizers         2.8         6.7 2.6 9.5 5.2 8.3 6.6
Ritalin or Adderall   0.7         3.3 2.6 7.4 3.6 7.0 4.4
Rohypnol              0.1         0.8 0.5 1.1 0.5 1.0 1.1
OTC                   3.8         8.0     10.3     8.5
        What to do if you suspect:
 •   Get educated
 •   Have the talk – Let them know you know
 •   Be specific about your concerns
 •   Don’t make excuses
 •   Try to remain calm and connect with him/her
 •   Be prepared – practice what you’ll say
 •   Act now – monitor your child, get involved
 •   Be available to listen
 •   Set and enforce rules

www.theantidrug.com
    Prevention: What You Can Do
•   Keep all drugs at home. Monitor and control meds.
•   Set clear rules about all drugs
•   Teach child to follow doctor’s advise and dosage
•   Teach child to not share medications
•   Be a good role model
•   Properly conceal and dispose of unused meds
•   Ask friends and family to control their Rx and OTC
•   Talk to your teen


www.theantidrug.com
Methamphetamine Impact on
  Indiana School Children

  Barbara Seitz de Martinez, PhD, MLS, CPP
               Deputy Director,
     Indiana Prevention Resource Center




Safe & Drug Free Schools Workshop
                                  Spring 2008

     The Indiana Prevention Resource Center is funded, in part, by a contract with the Indiana Family
     and Social Services Administration, Division of Mental Health and Addiction, financially
     supported through HHS/Substance Abuse Mental Health Services Administration, Center for
     Substance Abuse Prevention, Substance Abuse Prevention and Treatment Block Grant. The
     IPRC is operated by the Indiana University Department of Applied Health Science and School of
     Health, Physical Education and Recreation. It is affiliated with the Department's Institute of Drug
     Abuse Prevention.
              Vigo County Profile, 6.5
Methamphetamine Laboratory Seizures, 1998-2005
(ISP, 2006)
                                                  Table 6.5:
                           Vigo         Indiana   Clandestine
                                                  Methampheta
1998 (Any Agency)            1            43      mine Lab
1999 (Any Agency)           18            129     Seizures,
                                                  (ISP,
2000 (Any Agency)           52            314     2007)(ATC,
2001 (Any Agency)           66            542     Indiana State
                                                  Excise
2002 (Any Agency)           105           988     Police, 2006)
2003 (Any Agency)           108          1,278
2004 (Any Agency)           166          1,549
2005 (IPS)                  19            989
2005 (Any Agency)           83           1,303
    Map: Meth Lab Busts (prism)




Source: IN State Police, 2007       Total lab busts in 2006, 993

                      Indiana Prevention Resource Center
      Meth Impact on Parenting
• Inconsistent and inappropriate emotional
  responsiveness to children
• Unpredictable and impulsive
• Paranoid and delusional
• Disorganized lifestyle
• Experience interpersonal violence
Source: Brown, Julie A. and Melinda Hohman, “The
Impact of Methamphetmine Use on Parenting,” in The
Impact of Substance Abuse on Children and Families:
Research and Practice Implications, Shulamith Lala
Ashenberg Straussner and ChristineHuff Fewell, eds.
New York: Haworth Press, 2006, pp. 63-88.
    Themes: Impact on Parenting
•   Polar Parenting
•   Drug Management
•   The Separate Life
•   Domestic Violence
•   Effects on Children
•   Retrospective Ambivalence
Source: Brown, Julie A. and Melinda Hohman, “The
Impact of Methamphetmine Use on Parenting,” in The
Impact of Substance Abuse on Children and Families:
Research and Practice Implications, Shulamith Lala
Ashenberg Straussner and ChristineHuff Fewell, eds.
New York: Haworth Press, 2006, pp. 63-88.
             Themes RE: Impacts on Parenting
Polar Parenting     Extreme feelings of anger or apathy, not balanced
                    by positive expressions
Drug Management The logistics of using meth as a parent of young
                children
The Separate Life   Parents removing themselves, and their drug use
                    from their children
Domestic Violence Violence between marital and live-in partners;
                  violent crimes against family members in the
                  home – a side effect of use
Effects on          Physical, environmental, emotional, and
Children            psychological impacts.
Retrospective       Differing opinions and beliefs about whether or
Ambivalence         not they were able to handle their parental role
                    while using meth

 Source: Julie A Brown and Melinda Hohman, Impact
 of SA on Children and Families: Research and
 Practice Implications. Haworth Press, 2006:70+
       Child Experience in Meth Home
  •   Neglect (due to use and binge/crash cycle)
  •   Often exposed to home manufacturing
  •   Exposure to toxic chemicals and fumes
  •   Exposed to violent, aggressive behavior
  •   Parent’s multiple sex partners
  •   Withdrawal – intense depression/irritability
  •   Very similar to other substances
Source: Brown, Julie A. and Melinda Hohman, “The Impact of
Methamphetmine Use on Parenting,” in The Impact of Substance
Abuse on Children and Families: Research and Practice Implications,
Shulamith Lala Ashenberg Straussner and ChristineHuff Fewell, eds.
New York: Haworth Press, 2006, pp. 63-88.
                    IPRC Activities
Preventing or delaying use of gateway drugs will reduce the
likelihood of drug use and of other associated problem behaviors.
The greater the perception of risk of harm from drug use and the
greater the perception of parental and peer disapproval of alcohol
use the less likely it is that youth will use alcohol or other drugs or
experience associated problems. Promote or maintain such a culture
in your family and environment.
Parental monitoring of their child’s activities and involvement in those
activities are powerful tools in reducing the likelihood of drug use.
The hours from 3-6 p.m. are particularly important because this is a
time when many parents are working and the child may be presented
with temptations to initiate drug use.
Remember the gateway drugs. When new drug trends
emerge we must remember that alcohol and/or tobacco
are usually the 1st drugs used. Don’t forget the
importance of addressing these aggressively, as well as
enhancing protective factors.
                Protective Factors




IPRC, ATOD Survey Monograph, 2007
                Protective Factors




IPRC, ATOD Survey Monograph, 2007
 Promote a healthy lifestyle, strong values, bonding w/ family, school, community.




IPRC, ATOD Survey Monograph, 2007
             Thank you!
• Call: 327 / 855-0851
• E-mail: seitzb@indiana.edu
• www.drugs.indiana.edu

				
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