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Identifying SUD in Adolescents. Rebecca S Emmenecker, MA, LLPC, LBSW, CAADC Donald McLaughlin , MA, MS, CADCM , DP-S. Hi, it’s great to meet you!. Why worry about adolescent drug use?. 90% of Americans who are currently addicted started smoking, drinking or using drugs before age 18

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Identifying sud in adolescents

Identifying SUD in Adolescents

Rebecca S Emmenecker, MA, LLPC, LBSW, CAADC

Donald McLaughlin, MA, MS, CADCM , DP-S

Why worry about adolescent drug use
Why worry about adolescent drug use?

  • 90% of Americans who are currently addicted started smoking, drinking or using drugs before age 18

  • A quarter of those who begin using addictive substances at these early ages become addicted as adults, while only one in 25 who start using these substances after age 21 does

  • Science tells us that the earlier we start to use, the greater the risk of becoming addicted. Adolescence is the critical period for starting to use drugs and acquiring addictions, [because] the part of the brain that is responsible for judgment, decision-making and impulse control isn’t completely developed

Adolescent substance use abuse possible signs of use
Adolescent Substance use/abuse: possible signs of use

  • missing school, cutting classes, ditching school, or declining grades

  • Increased secrecy about possessions or activities

  • Use of incense, room deodorant, hairspray or perfume to hide smoke or chemical odors

  • using "coded" language, or the child leaves the room when he/she receives phone calls

Adolescent substance use abuse possible signs of use1
Adolescent Substance use/abuse: possible signs of use

  • Missing prescription drugs

  • Bottles of eye drops

  • New use of mouth wash or breath mints

  • New attitude towards parents/authority

  • Increase in borrowing money, stealing, or possessions coming up missing

  • Drug paraphernalia

Adolescents and marijuana
Adolescents and marijuana

  • Illicit drug use among teenagers has continued at high rates, largely due to the popularity of marijuana

  • In 2012, 6.5 percent of 8th graders, 17.0 percent of 10th graders, and 22.9 percent of 12th graders used marijuana in the past month—an increase among 10th and 12th graders from 14.2 percent, and 18.8 percent in 2007

  • Daily use has also increased; 6.5 percent of 12th graders now use marijuana every day, compared to 5.1 percent in the 2007.

Marijuana use behavioral changes
Marijuana Use & Behavioral Changes

  • distorted perceptions

  • impaired coordination

  • difficulty in thinking and problem solving

  • ongoing problems with learning and memory

Signs of marijuana use
Signs of Marijuana Use

  • red, blurry, bloodshot eyes

  • constant, mucus-filled cough

  • rapid heartbeat

  • hunger, referred to as “munchies”

  • dry mouth

  • anxiety, paranoia, or fear

  • poor memory

  • poor coordination

  • slow reaction time

  • loss of control

Is marijuana addictive
Is Marijuana Addictive?

  • Long-term marijuana abuse can lead to addiction:

    • irritability

    • sleeplessness

    • decreased appetite, which can trigger disordered eating

    • anxiety

    • drug craving

How is marijuana used
How is marijuana used?

  • Marijuana is usually smoked as a cigarette, referred to as a joint, or in a pipe

  • “pipes” can be made of old pop/beer cans, toilet paper rolls with aluminum foil, Pez dispensers, just about anything! (demonstration)

  • It is also smoked in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana

  • Demonstration………………….

How does marijuana work
How does marijuana work?

  • The main active chemical in marijuana is delta-9-tetrahydrocannabinol (THC)

  • When someone smokes marijuana, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to the brain

  • THC acts on specific places in the brain, called cannabinoid receptors, producing a series of cellular reactions that ultimately lead to the high that users seek

  • The highest density of cannabinoid receptors are found in parts of the brain that influence pleasure, memory, thoughts, concentration, sensory and time perception, and coordinated movement

Is marijuana safe to use
Is Marijuana Safe to Use?

  • The highest density of cannabinoid receptors are found in parts of the brain that influence pleasure, memory, thoughts, concentration, sensory and time perception, and coordinated movement…impairs

  • Cancer of the lungs is also linked to marijuana use because unfiltered marijuana smoke has more carcinogens than cigarettes

  • More teens are in treatment with a primary diagnosis of marijuana dependence than for all other illegal drugs combined

  • Gateway drug…Mouse Party

Synthetic marijuana spice potpourri
Synthetic Marijuana (Spice/Potpourri)

  • Herbal mixtures laced with synthetic cannabinoids, chemicals that act in the brain similarly to THC

  • These mixtures could be obtained legally until recently and are still wrongly perceived as a safe alternative to marijuana

  • 11.4 percent of 12th graders—one in nine—reported using it in 2011

  • In 2012, 4.4 percent of 8th graders, 8.8 percent of 10th graders, and 11.3 percent of 12th graders reported past-year use

Spice potpourri

  • “Spice” is a mix of herbs that produce experiences similar to marijuana

  • They contain dried, shredded plant material along with manmade chemicals that cause mind-altering effects

  • The Drug Enforcement Administration (DEA) has made it against the law to sell, buy, or possess them

  • Individuals make this at home and sell it, can purchase ingredients on the internet

Psychological effects of synthetic marijuana use
Psychological effects of synthetic marijuana use

  • Paranoia

  • Panic attacks

  • Giddiness

  • Psychotic episodes

  • Hallucinations

  • Elevated mood

  • Relaxation

  • Altered perception


  • Salvia (Salvia divinorum) is an herb found in southern Mexico and Central and South America

  • People who abuse Salvia generally experience hallucinations or a loss of contact with reality. The effects are intense but do not last long, appearing in less than 1 minute and lasting less than 30 minutes. They include changes in visual perception, mood and body sensations, emotional swings, and feelings of detachment. People also report a very different perception of reality and of oneself and have trouble interacting with their surroundings


  • Traditionally, people chew fresh salvia divinorum leaves or drink their extracted juices. The dried leaves of salvia divinorum can also be smoked as a joint, inhaled through water pipes, or vaporized and inhaled

  • People also report a very different perception of reality and of oneself and have trouble interacting with their surroundings. This last effect has raised worry about the dangers of driving under the influence of Salvia. The long-term effects of Salvia abuse have not been fully studied. Recent experiments in rodents show that salvinorin A harms learning and memory

Bath salts
Bath Salts

  • “Bath salts” are a new family of drugs containing one or more manmade chemicals related to cathinone, an amphetamine-like stimulant found naturally in the khatplant

  • There have been reports of severe intoxication and dangerous health effects from using bath salts

  • The synthetic cathinones in bath salts can produce feelings of joy and increased sociability and sex drive. Some people who abuse bath salts experience paranoia, agitation, and hallucinations; some lose contact with reality and act violently. Deaths have been reported in several cases

Bath salts1
Bath Salts

  • Bath salts are typically swallowed, inhaled, or injected, Chemically, they are similar to amphetamines (such as methamphetamine) and to MDMA (Ecstasy)

  • Bath salts have been marketed as cheap (and until recently, legal) substitutes for stimulants like amphetamines and cocaine as they have similar effects

  • A recent study found that MDPV—the most common manmade cathinone found in the blood and urine of patients admitted to emergency departments after taking bath salts—raises brain dopamine in the same way as cocaine but is at least 10 times stronger

Mdma molly ecstasy

  • “Ecstasy” and "Molly" are slang terms for MDMA, short for 3,4-methylenedioxymethamphetamine, a name that’s nearly as long as the all-night parties where MDMA is often used…that’s why it’s called a “club drug”

  • It has effects similar to those of other stimulants, and it often makes the person feel like everyone is his or her friend, even when that’s not the case

  • There are a lot of slang words for MDMA. “Ecstasy” and "Molly" are two of the most common

  • Most people who abuse MDMA take a pill, tablet, or capsule. These pills can be different colors, and sometimes have cartoon-like images on them. Some people take more than one pill at a time, called "bumping."

Mdma molly ecstasy1
MDMA/Molly Ecstasy

  • For most people, a “hit” of MDMA lasts for 3 to 6 hours. Once the pill is swallowed, it takes only about 15 minutes for MDMA to enter the bloodstream and reach the brain. About 45 minutes later, the person experiences MDMA's “high.”

  • People who use MDMA might feel very alert, or “hyper,” at first

  • Some lose a sense of time and experience other changes in perception, such as an enhanced sense of touch.

  • Others experience negative effects right away. They may become anxious and agitated. Sweating or chills may occur, and people may feel faint or dizzy

Mdma molly ecstasy2

  • MDMA can also cause muscle tension, nausea, blurred vision, and increased heart rate and blood pressure. Forceful clenching of the teeth can occur, and individuals at clubs have been known to chew on pacifiers to relieve some of the tension

  • High levels of the drug in the blood stream can increase the risk of seizures and affect the heart's ability to maintain its normal rhythms

Prescription drugs
Prescription Drugs

  • Opioids (such as the pain relievers OxyContin and Vicodin), central nervous system depressants (e.g., Xanax, Valium), and stimulants (e.g., Concerta, Adderall) are the most commonly abused prescription drugs among Americans.

  • Prescription drugs may have side effects. For example, OxyContin stops pain, but it also causes constipation and drowsiness. Stimulants such as Adderall increase attention but also raise blood pressure and heart rate. These side effects can be worse when prescription drugs are not taken as prescribed or are abused in combination with other substances—including alcohol, other prescription drugs, and even over-the-counter drugs, such as cold medicines. For instance, some people mix alcohol and benzodiazepines (e.g., Valium), both of which can slow breathing. This combination could stop breathing altogether.

Prescription drugs1
Prescription Drugs

  • According to the 2012 Monitoring the Future survey, prescription and over-the-counter drugs are among the most commonly abused drugs by 12th graders, after alcohol, marijuana, synthetic marijuana (e.g., "Spice"), and tobacco. Youth who abuse prescription medications are also more likely to report use of other drugs.

  • The majority of both teens and young adults obtain prescription drugs they abuse from friends and relatives, sometimes without their knowledge. And according to the 2012 Monitoring the Future survey, about 50 percent of high school seniors said that opioid drugs other than heroin (e.g., Vicodin) would be fairly or very easy to get.

Adhd medications stimulants
ADHD Medications/Stimulants

  • Stimulant medications including amphetamines (e.g., Adderall) and methylphenidate (e.g., Ritalin and Concerta) are often prescribed to treat children, adolescents, or adults diagnosed with attention-deficit hyperactivity disorder (ADHD).

Adhd medications stimulants1
ADHD Medications/Stimulants

  • Stimulant abuse can cause paranoia, dangerously high body temperatures, and an irregular heartbeat, especially if stimulants are taken in large doses or in ways other than swallowing a pill

  • As their name suggests, prescription stimulants increase—or "stimulate"—activities and processes in the body. This increased activity can boost alertness, attention, and energy. It also can raise a person's blood pressure and heart rate

Adhd medications stimulants2
ADHD Medications/Stimulants

  • Stimulants suppress appetite, increase wakefulness, and increase focus and attention, they are frequently abused for purposes of weight loss or performance enhancement

  • Because they may produce euphoria, these drugs are also frequently abused for recreational purposes

  • Euphoria from stimulants is generally produced when pills are crushed and then snorted or mixed with water and injected

  • stimulants work by increasing dopamine levels in the brain

Adhd medications stimulants3
ADHD Medications/Stimulants

  • When taken in doses and via routes other than those prescribed, prescription stimulants can increase brain dopamine in a rapid and highly amplified manner (similar to other drugs of abuse such as methamphetamine), thereby disrupting normal communication between brain cells and producing euphoria and, as a result, increasing the risk of addiction

  • Stimulants can lead to malnutrition and its consequences. Repeated abuse of stimulants can lead to feelings of hostility and paranoia. At high doses, they can lead to serious cardiovascular complications, including stroke

Prescription opiates
Prescription Opiates

  • While alcohol use among teens has started to drop slightly between 2009 and 2010, misuse of prescription drugs such as Oxycontin and medications for attention deficit disorder continues to climb

  • Abuse of opioids can cause drowsiness, nausea, constipation, and, depending on the amount taken, slowed breathing or stopped breathing.

What are opiates
What are opiates?

  • Opiates are commonly referred to as painkillers

  • They are derived from opium or synthetic versions of it (opioids) and used in pain relief

  • Common opiates/opioids include Vicodin, Percocet, OxyContin, oxycodone, Fentanyl, and codeine

Opiate withdrawal symptoms
Opiate Withdrawal Symptoms:

  • Cravings to use the drugs

  • Nausea

  • Cramping in the stomach

  • Sweating

  • Chills or goose bumps

  • Vomiting

  • Diarrhea

  • Irritation or agitation

  • Anxiety

  • Muscle aches

  • Shakes or trembling

  • Insomnia

  • Dilated pupils

  • Bone pain

Opiate tolerance
Opiate Tolerance:

  • Tolerance is the term used to define the phenomenon in which an organism is less susceptible to the effect of a drug as a consequence of its prior administration or repeated use.

  • Opiate/Opioid tolerance may be acquired rather quickly, and may also change/decrease when one stops using the drug for a period of time

  • Discontinuing the opiate/opioid for a period of time and then beginning use again at the same dose is often when the individual overdoses. This is unfortunately often a fatal event


Prescription opiates1
Prescription Opiates:

  • IN 2000, The CDC reported that nearly three out of four prescription drug overdoses were caused by opiates

  • Prescription painkiller overdoses killed nearly 15,000 people in the US in 2008. This is more than 3 times the 4,000 people killed by these drugs in 1999.

  • In 2010, about 12 million Americans (age 12 or older) reported nonmedical use of prescription painkillers in the past year

  • According to a CDC study, over 100 people die from drug overdoses every day in the U.S., and most of those deaths are caused by prescription painkillers

  • Americans, constituting only 4.6% of the world’s population, have been consuming 80% of the global oxycodone supply, and 99% of the global hydrocodone supply

Over the counter medications
Over The Counter Medications

  • Abusing over-the-counter drugs that contain dextromethorphan (DXM) —which usually involves taking doses much bigger than recommended for treating coughs and colds—can impair motor function (such as walking or sitting up); produce numbness, nausea, and increase heart rate and blood pressure.

  • At high doses, DXM causes effects similar to those of the drugs ketamine (general anesthesia) or PCP (Phencyclidine) by affecting similar sites in the brain. Ketamine and PCP are considered "dissociative" drugs, which make people feel disconnected from their normal selves.

Over the counter medications1
Over the Counter Medications

  • Cold medicines such as Robitussin, Nyquil, Vicks Formula 44, and Coricidin HBP Cough and Cold tablets contain a chemical called Dextromethorphan (DXM), which is found in more than 120 non-prescription cough and cold medications

  • Teenagers have various nicknames for DXM including: Robo, Skittles, Triple C’s, Dex, Vitamin D, and Tussin. Coricidin HBP Cough and Cold tablets contain much more potent doses of DXM than cough syrups, so the kids don’t need to drink a whole bottle of nasty tasting cough syrup. They can easily and conveniently take a few pills containing DXM to get high.

Over the counter medications2
Over the Counter Medications

  • The Drug Enforcement Administration classifies DXM as a “drug of concern” because if misused it can be very dangerous. However, there are no legal restrictions on purchasing the drug

  • Motion sickness pills such as Dramamine are being used by teens; taken in large doses (one entire package or more), Dramamine can cause hallucinations. Sleep aids such as Tylenol PM, Excedrin PM, and Sominex can cause extreme drowsiness when abused

  • Over the counter drugs can be extremely dangerous resulting in overdose, and even death

  • Website: calculate how much you need to trip

Alcohol use among teens has dropped to historically low levels
Alcohol use among teens has dropped to historically low levels

  • In 2012, 3.6 percent of 8th graders, 14.5 percent of 10th graders, and 28.1 percent of 12th graders reported getting drunk in the past month

  • Significant declines include 5-year drops in daily alcohol use by 8th, 10th and 12th graders (0.3 percent, 1.0 percent and 2.5 percent, respectively, in 2012).

  • In 2012, 23.7 percent of high-school seniors reported binge drinking (defined as 5 or more drinks in a row in the past 2 weeks)—a drop of one-quarter since the late 1990s

Family factors that may place teens at risk of developing drug problems
Family Factors that may place teens at risk of developing drug problems:

  • Insufficient parental supervising and monitoring

  • Lack of communication and interaction between parent and teen

  • Poorly defined rules and expectations regarding drug use

  • Inconsistent or excessively severe discipline

  • Family conflict

  • Favorable parental attitudes toward adolescent drug and alcohol use, or parental drug use or alcohol use

Other risk factors
Other risk factors drug problems:

  • High sensation seeking behavior

  • Impulsiveness

  • Psychological distress

  • Difficulty maintaining emotional stability

  • Perceptions of extensive use by peers

  • Perceived low harmfulness of use

What are the signs of use
What are the signs of use? drug problems:

  • Physical evidence of drugs or drug paraphernalia

  • Behavior problems/poor grades in school

  • Emotional distancing, isolation, depression, fatigue

  • Changes in friendships

  • Extreme influence by peers

  • Hostility, irritability

  • Changes in level of cooperation

  • Lying, Increased evasiveness about whereabouts

  • Decreased interest in personal appearance

What are the signs of use1
What are the signs of use? drug problems:

  • Physical signs may include:

    • Bloodshot eyes

    • Runny nose

    • Frequent sore throats

    • Weight loss/gain

    • Dry mouth

    • Pupil dilation

What are the signs of use2
What are the signs of use? drug problems:

  • Changes in mood

  • Changes in appetite

  • Changes in sleeping patterns

  • Strange or unusual behavior

  • Dizziness

  • Memory problems

  • Increased anger outbursts

  • Avoiding contact with authority/parental figures

  • Stealing (extreme stealing; car hopping)

  • Selling personal items

What role does trauma play
What role does Trauma play? drug problems:

  • Data from the National Survey of Adolescents (PDF) and other studies indicate that one in four children and adolescents in the United States experience at least one potentially traumatic event before the age of 16, and more than 13% of 17-year-olds—one in eight—have experienced posttraumatic stress disorder (PTSD) at some point in their lives.

What role does trauma play1
What role does Trauma play? drug problems:

  • Research demonstrates a strong link between

    exposure to traumatic events and substance

    use problems

What role does trauma play2
What role does Trauma play? drug problems:

  • Adolescents who have experienced trauma may

    turn to alcohol or drugs to help them deal with

    emotional pain, bad memories, poor sleep,

    guilt, shame, anxiety, or terror

What role does trauma play3
What role does Trauma play? drug problems:

  • Adolescents may find themselves in a vicious cycle in

    which exposure to traumatic events produces increased

    alcohol and drug use, which produces new traumatic

    event experiences, which leads to even worse

    substance use, and so forth

Sexual assault
Sexual assault drug problems:

  • Compared to adolescents who have not

    been sexually assaulted, adolescent sexual

    assault victims are 4.5 times more likely

    to experience alcohol abuse or dependence,

    4 times more likely to experience marijuana

    abuse or dependence, and 9 times more

    likely to experience hard drug abuse or


Co occurring disorders
Co-Occurring Disorders drug problems:

  • 8.9 million adults have co-occurring disorders; that is they have both a mental and substance use disorder

  • The combination of mental illness and substance abuse is so common that many clinicians now expect to find it. Studies show that more than half of young persons with a substance abuse diagnosis also have a diagnosable mental illness

  • Adolescents are often referred to treatment for substance abuse, but are not referred to a qualified mental health professional for appropriate diagnosis and treatment of any underlying cause for their drug and alcohol abuse

Screening tools mast dast
Screening Tools – MAST/DAST drug problems:

  • The Michigan Alcohol Screening Test (MAST) is nationally recognized by alcoholism and drug dependence professionals. It is a 22 item tool that is easy to use

  • The Drug Abuse Screening Test (DAST) parallels the MAST. It is a 28-item tool, also easy to use


Screening tools cage crafft
Screening Tools – CAGE/CRAFFT drug problems:

  • Consisting of just four questions, the CAGE questionnaire ranks among the simplest, most efficient diagnostic tools available

  • The CRAFFT The six-question CRAFFT Quiz evaluates people under 21 for alcohol and other drug abuse risks simultaneously

  • CRAFFT is a mnemonic acronym that stands for a key word in each question: CAR, RELAX, ALONE, FORGET, FAMILY/FRIENDS, TROUBLE


Screening tools midas
Screening Tools - MIDAS drug problems:


  • Created by Kenneth Minkoff, MD

  • 17 question screening tool

  • Simple to use, free to use

SUMMARY drug problems:

  • Drug abuse is a disease and should be treated like one. As with any terminal illness this should be caught early to avoid it getting much worse over time

  • Some teens might be using to fit in, some teens might have an underlying mental illness such as depression or anxiety or some might just be using because they fell in love instantly with the feeling of being high

  • Whatever reason they have, it is best to get them help as soon as possible for the best results

Questions comments
Questions? Comments? drug problems:

Holy Cross

Youth and Family Services