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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