Substance Abuse by gSt0zm

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									Substance Abuse
  Youth Risk Behavior Survey
             1999
                    Alcohol
               th      th      th    th
grade         9      10       11    12

Ever          73%    83%      81%   88%
Last 30
days          41%    50%      51%   61%
 5 drinks
in a row in
the last 30   21%    32%      34%   42%
days
                    Tobacco
               th      th      th    th
grade         9       10      11    12
Tried
smoking       62%    74%      70%   78%
Smoked in
the last 30   28%    35%      36%   43%
days
Chewing
tobacco
last 30       7%      7%      8%    9%
days
                Marijuana
           th       th       th    th
grade     9       10        11    12

Ever      35%     49%       50%   58%
Last 30
days      22%     28%       27%   32%
                  Other drugs
             th        th       th    th
grade       9        10     11       12
Ever
cocaine     6%       10%    10%      14%
Ever
inhalants   17%      16%    13%      11%
Ever PCP,
LSD, etc.   15%      16%    18%      18%
       Remember. . .

  These statistics understate the
              problem.

The data comes from teens who are
           still in school.
Care is determined by the
     “stage of use.”
                Stage 1
            EXPERIMENTAL
• use of drugs is in a social setting
•   use is in response to peer pressure
•   learns the “euphoric high”
•   obtains drugs from friends
•   often inept
                Stage 2
           ACTIVE SEEKING
• maintains own supply
•   seeks euphoria
•   modulates dose for desired effect
•   gets high with each use
•   use may be affecting daily life
              Stage 3
         PREOCCUPATION
• loss of control- compulsive use
• can’t cope without drugs
• future orientation is to “next high”
• in trouble with the law, school, and
  family
• often use multiple substances
               Stage 4
            (rarely seen in teens)

              BURNOUT
• uses drugs to prevent negative
 effects of withdrawal
• needs to use to feel “normal”
• flattened affect and thought
  processing difficulties
• often no home or work life left
                Factors
• Genetics
• Personality
• Family
  environment
• Educational
  progress
• Community
  background
Clues or tips that the teen
may be using substances.
               Primitive peer pressure

     Smoking shows that peer pressure
overcame the patient’s protective knowledge.
    Haircuts, tattoos, jewelry, and clothing
may indicate the patient identifies with the
               drug culture.




                Punk Flamingos
                                High Times is a monthly
                                   magazine which
                                    encourages the
                                  recreational use of
                                      marijuana




Literature demonstrates interest in the drug
                 culture.
Decreasing academic performance may
    indicate a change in priorities.
Peer group is important.

  If peers are users, it is
likely the patient uses as
            well.


                              Butterflies from the wrong side of the
                                             meadow
         Interviewing
   Confidentiality should be granted
for stage 1 use.

   Consider involving the parents if
the teen is stage 2 and not compliant
with treatment or abstinence.
Begin with general lifestyle   allows development of
questions                      physician/patient relationship
 – Home/family relations           provides basis for risk
                                   assessment
 – Education/employment
                                   start with least threatening
– Activities-clubs, peer
                                   moving to increasingly more
  relationships                    threatening
– Dietary/ drugs
    •   prescriptions/ OTCs    moving from socially acceptable
    •   tobacco                to socially tolerated
    •   alcohol                to socially disapproved
    •   marijuana              to overtly illegal
    •   other illicit drugs
– Sexuality/ suicidal          completes risk assessment
  ideation/depression
              Questions...
Do you go to parties? What happens at these
  parties? Do you drink? Get drunk? Get high?

Do you drive after using? Have you ridden with a
  driver who was drunk or stoned? Could you call
  home for a ride? What would your parents say?

Do you go to concerts? Do you drink or get high?
  Who drives after the concert?

Have you recently dropped some of your old friends
  and started going with a new group? Why?
After using, have you ever forgotten where you
  have been or what you have done?

Do you feel that lately you are moody, “bitchy,” or
  irritable? Do you find yourself getting into more
  arguments with friends and family? Do you find
  yourself being physically abusive to others?

Do you have a boyfriend/girlfriend? How is it going?
  More arguments? Have you recently broken up?

Do you think your drinking or drug use is a
  problem? Why?
      Confusing the issues
You really don’t think I’d use the stuff, do you?

        I am just keeping it for a friend.

              All of the kids do it!

You (adults) take a drink or a smoke and as a
 kid, I should be allowed a little fun now and
                      then!
         Parent interview...
Does your teen spend many hours alone in his
  bedroom apparently doing nothing?

Does your child resist talking to you or isolate
  himself from the family?

Has your daughter’s taste in music undergone a
  dramatic change?

Has there been a definite change in your son’s
  attitude toward school?
Does your daughter always seem unhappy and
  unable to cope with frustration?

Has your son shown recent pronounced mood
  swings with increased irritability and anger?

Has your child’s personality changed from being
  considerate and caring to being selfish,
  unfriendly, and unsympathetic?

Does your teen seem confused/ spacey?

Have money or valuable items disappeared from
  your home?
Does your son neglect homework or chores?

Have your daughter’s friends changed?
Has there been a change in your teen’s appearance
  (I.e., sloppy, poor grooming or hygiene)?

Have there been excuses and alibis made? Has
  there been lying in order to prevent confrontation
  or getting caught?

Do you feel like you have lost control of your child?

Has your son begun lying to cover up the source of
  possessions and money?

Have you noticed the use of mouth washes, eye
  drops, incense, or other curious items?
            Drug testing
• is not a substitute for a good history and
  physical.

• should not be done secretly.

• misses many commonly abused
  substances.

• misses almost all substances if used  4
  days prior.

• can be defeated.
• no consent is required for emergent life
  threatening illness or altered mental
  status.

• the teen should grant verbal consent.

• parental consent is not required.


  Testing, in of itself, fails to address the
                     issues.
            Treatment
• Anticipatory guidance should be
  done with all patients throughout
  adolescence.




                Where all the young farm animals go to
                                smoke
Care should be determined
  by the “stage of use.”
   Stage 1 should be dealt with by
the primary caretaker.

   It is important to educate the teen
on the dangers of the substance, the
role of peer pressure, and other
related “at risk” behaviors.
   Stages 3 & 4 should be referred
to an individual or program
experienced in substance abuse.
   Stage 2 can be dealt with by most
primary caretakers. Often this
requires involvement of the family.
   Drug use is
   the first
problem to be
  dealt with!



                  “Criminy! Kevin’s oozing his way up
                 onto the table…Some slugs have a few
                        drinks and just go nuts!”
     Expect Parental reactions of terror,
outrage, bewilderment, sadness, and
denial.
Do
  – give parents time to think
  – not give them more than they can
    handle
  – educate them about drugs/
    paraphernalia
  – have them list problems secondary to
    drug use
Do not confront the teen when he is
                high!




     “Dammit! I resent being treated as if I were sober!”
  Take charge of the user’s life.
Specific rules should be set and
specific consequences for violations
should be discussed.

   As the teen earns the family’s
trust, the rules are gradually
softened.
Immediate cessation of use.
Termination of contact with using friends.
Parties/ concerts only with supervision.
Appropriate curfew.
No use of the car.
Limited spending money.
Restitution for stolen items.
No verbal or physical abuse.
Drug testing weekly.
    Treatment does not always lead to a
“cure.” Often the patient will have
repeated exacerbations followed by
remissions. This does not constitute a
failure in treatment!

								
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