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Substance Use

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									Substance Use
    Why do adolescents use
         substances?
Curiosity

Boredom

Fit in with peers/peer pressure

Normal adolescent exploration
2004 National Survey on Drug Use and
          Health (SAMHSA, 2005)
 Alcohol – Prevalence increases with age
 – 2% of 12 year olds use alcohol
 – 36% of 17 year olds
 – Peaks at 71% at age 21
 Tobacco
 – 15.2% of adolescents between ages 12 & 17
   report using tobacco
 – Males are more likely to use tobacco than
   females, but females are more likely to smoke
   than males
2004 National Survey on Drug Use and
          Health (SAMHSA, 2005)
 Illegal Drugs – 11.6% of adolescents between
 12 & 17 (4.2% between ages 12 & 13) use illegal
 drugs (other than alcohol and tobacco)
 – Use is high among boys than girls
 – Boys are more likely to use marijuana than girls
 – Girls are more likely to use prescription drugs
 Inhalants – the only drug whose use decreases
 during adolescence
 – 4.1% at age 13
 – 2.2% at age 15
 – 1.5% at age 17
    Annual Numbers of New Users of
        Marijuana: 1965–2002




Source: SAMHSA
     Annual Numbers of New Nonmedical
     Users of Pain Relievers: 1965–2002




Source: SAMHSA
     Annual Numbers of New Users of
    Ecstasy, LSD, and PCP: 1965–2002




Source: SAMHSA
      Associated Concerns
Physical problems
– Heart problems

– Liver functioning/Hepatitis C

– Neuronal/brain damage

– Overdose/death
      Associated Concerns
Social/Behavioral
– Impact on education
    Increased likelihood of being diagnosed with a learning
    disability
    Impaired concentration
    Behavioral disruptions
    Truancy
    School Drop out
– Correlated with
    Increased Aggressiveness
    Limited frustration tolerance
    Delinquency
Past Month Illicit Drug Use among Youths Aged
    12 to 17, by Participation in Delinquent
                 Behaviors
     Associated Concerns
Most common co-morbid disorders
– Conduct disorder

– ADHD

– Depression/Bi-polar Disorder

– Learning Disorders
Substance Abuse History - DSM
 DSM-III (1980)
 – Prior to DSM-III diagnosis consisted of “addiction”
 – “Abuse” and “Dependence” replaced “addiction” in
   DSM-III
 DSM-III-R (1987)
 – Dependence criteria reorganized to fit Edwards &
   Gross “Alcohol Dependence Syndrome”, from their
   observations of patients
 – Abuse was a residual category for people who had a
   problem but did not meet the criteria for dependence
Substance Abuse History - DSM
 DSM-IV (1994)

 – Criteria were again reorganized

 – Abuse designed to serve as its own
   independent diagnosis

 – Physiological vs. psychological dependence
                       DSM-IV Criteria for Substance Abuse

A. A maladaptive pattern of substance use leading to clinically significant impairment
   or distress, as manifested by one (or more) of the following, occurring within a 12-
   month period:

(1)      recurrent substance use in situations in which it is physically hazardous
         (e.g., driving an automobile or operating a machine when impaired by
         substance use)
(2)      continued substance use despite having persistent or recurrent social or
         interpersonal problems caused or exacerbated by the effects of the
         substance (e.g., arguments with spouse about consequences of intoxication,
         physical fights)
(3)      recurrent substance-related legal problems (e.g., arrests for substance-
         related disorderly conduct)
(4)      recurrent substance use resulting in a failure to fulfill major role obligations
         at work, school, or home (e.g., repeated absences or poor work
         performance related to substance use; substance-related absences,
         suspensions, or expulsions from school; neglect of children or household)
B.       The individual has never met criteria for Substance Dependence for the
         same class of substance.
                     DSM-IV Criteria for Substance Dependence

A maladaptive pattern of substance use, leading to clinically significant impairment or
   distress, as manifested by 3 (or more) of the following, occurring during a 12-month
   period:
1. Tolerance, as defined by either of the following:
   a.    a need for markedly increased amounts of the substance to achieve intoxication
   b.    markedly diminished effect with continued use of the same amount of the
         substance
2. Withdrawal, as manifested by either of the following:
   a.    the characteristic withdrawal syndrome for the substance
   b.    the same (or related) substance is taken to relieve or avoid withdrawal
         symptoms
3. The substance is often taken in larger Amounts or over a longer period than was
         intended
4. There is a persistent desire or unsuccessful efforts to cut down or Control substance
         use
5. A great deal of Time is spent in activities necessary to obtain the substance (e.g.,
         visiting multiple doctors or driving long distances), use the substance (e.g.,
         chain-smoking), or recover from its effects
6. Important social, occupational, or recreational activities are given up or reduced
         because of substance use
7. The substance use is continued despite Knowledge of having a persistent or recurrent
         physical or psychological problem that is likely to have been caused or
         exacerbated by the substance (e.g., cocaine-induced depression, or ulcer from
         drinking)
    DSM-IV Drug Categories
Alcohol            Nicotine
Amphetamine &      Opioid
Amphetamine-like   Phencyclidine &
Caffeine           phencyclidine-like
Cannabis           Sedative, hypnotic,
Cocaine            anxiolytic
Hallucinogen       Polysubstance
Inhalant           Other
Problems with the DSM-IV Substance Use
  Criteria when used with Children and
              Adolescents
Abuse criteria are composed of how an individual
interacts with his or her environment.

Requiring three or more dependence criteria for the
dependence diagnosis
– about 1/3 of adolescent “regular” alcohol users “fall through the
  cracks” because they meet only one or two criteria (called
  diagnostic orphans)
– about 1/5 of adult regular drinkers are diagnostic orphans.

Should substance use during adolescence even be
categorized as a disorder because of how common it is
for adolescents to use alcohol and other substances
     Should substance use during
adolescence even be categorized as a
disorder because of how common it is
  for adolescents to use alcohol and
          other substances?
Regardless of how common substance use
 is, adolescents who meet the criteria of
 abuse: continued use in spite of the
 problems that use causes, are still using in
 a pathological manner.
  Assessing Substance Use
Clinical interviews (child/parent/others)
Self-Report Inventories
– Substance Abuse Subtle Screening Inventory
  (SASSI)
– MMPI-A McCarthy Scale
Drug Tests
– Urine
– Blood/Cerebrospinal fluid
– Hair
    Treatment of Adolescent
    Substance Use Disorders
Medications
– Alcohol
    Librium
    Antabuse
    Naltrexone
– Heroine/opioids
    Methadone
    Buprenorphine
– Cocaine
    Ibogaine
    Treatment of Adolescent
    Substance Use Disorders
Medications
– Anti-depressants

– Mood stabilizers

– Anti-anxiety medications

– Anti-psychotics
    Treatment of Adolescent
    Substance Use Disorders
Behavioral and Cognitive-Behavioral
Treatments
– Behavioral Therapy
    Create new associations
    Change behaviors
    Antabuse
– Rational Emotive Therapy
    Develop an internal locus of control
    Dispute irrational beliefs
    Treatment of Adolescent
    Substance Use Disorders
Group Therapy
– The most effective form of therapy for
  adolescent substance abuse
– May be mixed gender or single gender
– Groups are for both support and for treatment
– Should focus on social skills training, coping
  skills, refusal skills, and self-awareness as
  well as addiction treatment and education
    Treatment of Adolescent
    Substance Use Disorders
Support groups
– Alcoholics Anonymous (AA) and Narcotics
  Anonymous (NA)
    No facilitator
    Adolescents should attend adolescent groups, not
    adult groups!
– SMART Recovery (Self-Management and
  Recovery Training)
    Uses an adult facilitator
    Treatment of Adolescent
    Substance Use Disorders
Residential Treatment
– Generally 30 to 90 days for adolescents
– Usually rely on AA/NA as well as traditional
  group therapies
– Therapeutic Community
       Levels of Treatment
 Outpatient Treatment
1. Traditional Outpatient
   – Individual therapy
   – Group Therapy
   – Family Therapy
2. Intensive Outpatient Programs
   – Individual and group therapy
   – Family and family groups
3. Partial Hospitalization
      Levels of Treatment
Medically Monitored
4. Detoxification
  – Staffed by counselors, sometimes nurses
  – Not really “treatment”, but “drying out”
  – Not meant to be the last stop of treatment
5. Rehabilitation
  – Staffed by counselors, therapists, nurse
  – Doctor is “on-call” and consults with staff
      Levels of Treatment
Medically Managed
6. Detoxification
  – Usually a hospital setting
  – Staffed by nurses and doctors
7. Rehabilitation
  – Usually in hospital setting
  – Staffed by nurses and doctors
  – Usually shorter-term than medically monitored
    rehab, but can also be long-term
Prevention rather than Treatment
Treatment has limited success; prevention
is cheaper and more effective
D.A.R.E.
– Not found to be effective
– Actually found to positively correlate with
  substance use
Life Skills Training
– Evidence-based prevention program
– School-based/community-based groups
– Cognitive-behavioral based treatment

								
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