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Substance Use

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

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Substance Use

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  1. Substance Use

  2. Why do adolescents use substances? • Curiosity • Boredom • Fit in with peers/peer pressure • Normal adolescent exploration

  3. 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

  4. 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

  5. Annual Numbers of New Users of Marijuana: 1965–2002 Source: SAMHSA

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

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

  8. Associated Concerns • Physical problems • Heart problems • Liver functioning/Hepatitis C • Neuronal/brain damage • Overdose/death

  9. 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

  10. Past Month Illicit Drug Use among Youths Aged 12 to 17, by Participation in Delinquent Behaviors

  11. Associated Concerns • Most common co-morbid disorders • Conduct disorder • ADHD • Depression/Bi-polar Disorder • Learning Disorders

  12. 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

  13. Substance Abuse History - DSM • DSM-IV (1994) • Criteria were again reorganized • Abuse designed to serve as its own independent diagnosis • Physiological vs. psychological dependence

  14. DSM-IV Criteria for Substance Abuse • 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.

  15. 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)

  16. Alcohol Amphetamine & Amphetamine-like Caffeine Cannabis Cocaine Hallucinogen Inhalant Nicotine Opioid Phencyclidine & phencyclidine-like Sedative, hypnotic, anxiolytic Polysubstance Other DSM-IV Drug Categories

  17. 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

  18. 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.

  19. 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

  20. Treatment of Adolescent Substance Use Disorders • Medications • Alcohol • Librium • Antabuse • Naltrexone • Heroine/opioids • Methadone • Buprenorphine • Cocaine • Ibogaine

  21. Treatment of Adolescent Substance Use Disorders • Medications • Anti-depressants • Mood stabilizers • Anti-anxiety medications • Anti-psychotics

  22. 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

  23. 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

  24. 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

  25. 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

  26. Levels of Treatment • Outpatient Treatment • Traditional Outpatient • Individual therapy • Group Therapy • Family Therapy • Intensive Outpatient Programs • Individual and group therapy • Family and family groups • Partial Hospitalization

  27. Levels of Treatment • Medically Monitored • Detoxification • Staffed by counselors, sometimes nurses • Not really “treatment”, but “drying out” • Not meant to be the last stop of treatment • Rehabilitation • Staffed by counselors, therapists, nurse • Doctor is “on-call” and consults with staff

  28. Levels of Treatment • Medically Managed • Detoxification • Usually a hospital setting • Staffed by nurses and doctors • Rehabilitation • Usually in hospital setting • Staffed by nurses and doctors • Usually shorter-term than medically monitored rehab, but can also be long-term

  29. 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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