adolescent substance abuse
DESCRIPTION
Adolescent Substance Abuse. Rachel Gonzales, Ph.D. What is Prescription and Over the Counter Drug Misuse?. Any Rx and OTC drug can be “ misused ” Misuse = “ Non-medical use ” or any use that is outside of a medically prescribed regimen Examples can include: - PowerPoint PPT PresentationTRANSCRIPT
Adolescent Substance Abuse
Rachel Gonzales, Ph.D.
What is Prescription and Over the Counter Drug Misuse?
Any Rx and OTC drug can be “misused”
Misuse = “Non-medical use” or any use that is outside of a medically prescribed regimen
Examples can include:Taking for psychoactive “high” effectsTaking in extreme dosesMixing pillsUsing with alcohol or other illicit substancesObtaining from non-medical sources
Adolescents & Young Adults
0
10
20
30
'96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06
MTF Study; Past Month Use for 12th Graders
Nationally, there’s Good News…
Illicit Drugs
Cigarettes
Alcohol
-35%
-57%
-47%
Every Generation of Teens Looks for New Ways to Get “High”
Nationally, there’s also Bad News…
Cough medicine
Inhalants
Vicodin
Generation“Pharming Culture”
Epidemiology of Rx and OTC Drug Misuse Among Youth
What do we know about the problem?
NationallyNational Survey on Drug Use and Health (NSDUH)Monitoring the Future Study (MTF)
State/CountyBiannual California Student SurveyPublicly-funded treatment admission data from county data systems
GHBGHB
HeroinHeroin
KetamineKetamine
LSDLSD
MethMeth
EcstasyEcstasy
Cough MedicineCough Medicine
Crack/CocaineCrack/Cocaine
MarijuanaMarijuana 8.6 8.6 millionmillion4.5 million4.5 million
2.4 million2.4 million
2.4 million2.4 million
1.3 million1.3 million1.9 million1.9 million
1.9 million1.9 million
1.1 million1.1 million
1 million1 million
1 million1 million
Prescription MedicinePrescription Medicine
NSDUH, 2006
Landscape of Drug* Abuse among Teens
*Excludes ETOH
“Pharming Culture”
Today's teens are more likely to have abused Rx and OTC drugs than most illicit drugs
Every day 2,500 teens 12-17 try a painkiller for the 1st time
MTF, 2006
Commonly Misused Rx Drugs
Opiates: pain-killersEx) Vicodin, Oxycontin
Sedatives/Tranquilizers (Depressants): treat anxiety and sleep disorders
Ex) Xanax, Valium
Stimulants: treat ADHDEx) Aderall, Ritalin, Concerta
OTC Medicine Misuse•Dextromethorphan DXM (narcotic codeine) the active ingredient in over 100 cold/cough remedies.
•Found in tablets, capsules, gel caps, lozenges & syrups
•Teens discovered using mass quantities of DXM-containing products get them “high”.
Examples of Popular OTC Products
Coricidin HBP Cough & Cold Robitussin Cough products Sudafed Cough medicines Dimetapp DM Tylenol Cold products Vicks NyQuil and Dayquil Alka-Seltzer Plus Cold &
Cough Triaminic Cough syrups
Top 5 Drugs Used by 12th Graders
31.5%
9.7%4.3% 7.5% 6.9% 6.6%
0%
10%
20%
30%
40%M
ariju
ana
Vic
odin
Oxy
cont
in
Am
phet
amin
es
OT
C C
ough
/Col
dM
eds
Seda
tives
/Tra
nqsPe
rcen
t of R
espo
nden
ts
Past Year
SOURCE: MTF, 2006
3.8%
Rita
lin
OTC Medications Misused by Teens
38.6%
17.8%18.1%
30.5%
0%
10%
20%
30%
40%N
yQui
lPr
oduc
ts
Cor
icid
inPr
oduc
ts
Rob
otus
sin
Prod
ucts
Oth
er O
TC
Med
icat
ions
Perc
ent o
f Res
pond
ents
Past Year
SOURCE: MTF, 2006
Concerning Trends
Adolescents 12-13
Teen Females
Young Adults 18-24
Extent of Rx & OTC Drug Misuse among Youth in California
12th Biennial California Student Survey: Drug, Alcohol & Tobacco Use
Secondary students (7th, 9th, 11th graders)
Representative State sample: random schools & classrooms
13,930 students
48 middle and 68 high schools (including 10 continuation)
Misuse of opiate painkillers (no prescription) to get high 2006: 15% of 11th graders 9% of 9th graders 4% of 7th graders
California Student Survey 2006
Changes to Survey
2007: Expanded substances and made separate question on recreational use of pharmaceuticals (high school only)
Added cold/cough medicines, diet pills, and Ritalin/Adderal
Lifetime PrevalenceGrade 9 Grade 11
(%) (%)
Street Drugs Marijuana 25 42 Methamphetamines 5 7 Ecstasy 6 10Prescription/Medicinal Drugs* Painkillers 12 18 Barbiturates 2 3 Sedatives/tranquilizers 4 6 Diet pills 9 8 Ritalin/Adderal 4 6OTC Cold/Cough Medicines 26 25
*to get high – not for medicinal reasons
The Pharming Subculture: Generation Rx
Youth & Young Adult Risk Factors
Top Reasons for Rx & OTC Drug Misuse
Social with friends
Legal - Widely Available
Easily Accessible
Affordable: Low Cost/Free
Safe - Prescribed
Non-addictive: Medicine
Partnership Attitude Tracking Survey (PAT): Released in April 2006 by The Partnership for a Drug-Free America
Recent Research: Why Teens Use?
Teens admit to misusing Rx drugs for reasons other than getting high, including to relieve pain or anxiety, to sleep better, just to experiment, to help with concentration or to increase alertness. (Boyd, McCabe, Cranford & young, 2006).
More than 1/3 of teens say they feel pressure to abuse Rx drugs and say using these drugs is an important part of fitting in with their friends. (Seventeen, 2006).
When teens abuse Rx drugs, they often characterize their use as “responsible” or “controlled” (Friedman, 2006).
Access & Availability
Family & Friends Homes
Retail Pharmacies
Increasing trend to use Psychiatric Drugs to Treat Youth Behavioral Problems…
Problem: Massive Media Marketing from Pharma
Modern Culture
Direct-to-Consumer Advertising of Rx Drugs
“Amazon.com pushing ADHD drugs with front-page, celebrity-endorsed”Free Trials
The RealityBig PharmaEx) Several reports suggest that Purdue Pharma, the maker of OxyContin, helped fuel widespread abuse of the drug by aggressively promoting it to general practitioners not skilled in pain treatment or in recognizing drug abuse…Sales grew from $48 million in 1996 to $1.1 billion in 2000Became leading drug of abuse in 2004…
Oxycontin alone had 21 million prescriptions written for them in 2007 to 3.7 million patients (many of which were minors and young adults)
Van Zee, 2009
# of new non-medical users
Pharm Sales Grew
Oxycontin alone had 21 million prescriptions written for them in 2007 to 3.7 million patients (many of which were minors and young adults)
Development of Medicine Subculture
Endorsements from MDs
The Internet & Technology
Social Networking Web Sites
Venues for penetrating the Medicine Abuse Subculture
YouTubeMySpace
LiveJournal Facebook
Footage of teens “high”User Guides: Rx & OTC abuse instructions (recipes)Blogs & videos of experiences
Social Rx & OTC Slang
Xbrs or xanabars: anti-anxiety Xanax
Vic: Vicodin Skittles, Dex, Robo, Tussin, (any
OTC cold pill containing DXM) Triple Cs or CCC: Coricidin Cough
& Cold med SIZ’zurp: cough syrup & ETOH Trail Mix: Pharm Party
Keeping Parents Clueless
Treatment for Rx Drug Misuse
Abusing Rx drugs before the age of 16 leads to a greater risk of dependence later in life.
The # of teens going into treatment for Rx drug abuse has increased by more than 300% during the last 10 years.
Between 2004-05, the proportion of youth seeking treatment for Rx drugs increased by 9%.
TEDS, 2006
•Little known about specific treatments for addressing Rx drug abuse among youth.
Rx Drug Misuse: Treatment Settings
Youth coming to treatment for “self-medicating” with Rx drugs to treat underlying psychiatric condition.
Rx drug misuse among youth in treatment for co-occurring disorders is problematic:
“Cheeking” or saving unswallowed Rx meds for obtaining a later “high”…
Consequences/Effects
The “High”Slurred speechFlushed skin, sweatingLoss of appetiteMild distortions of color/soundConfusion, forgetfulnessClumsiness/loss of motor controlMood swings, irritabilityExcessive energy or sleepiness
The “Lows”
Delusions Panic attacks Memory problemsBlurred visionStomach pain, nausea, vomiting High blood pressure & Rapid heart beat
Numbness of fingers/toesDrowsiness & Dizziness Fever & headachesRashes/itchy skin Loss of consciousness
Side Effects can be Lethal if…
Combining Rx & OTC medications.Taking Rx and OTC meds with alcohol.Using Rx and OTC with other illicit drugs. Interactions: Rx & OTC meds with other physical medications (i.e., HIV or Hepatitis)
Poison Control System: Prescription Narcotics LA 2005-2008
0
2
4
6
8
10
12
14
16
2005 2007 2008
Perc
ent
Hydrocodone Oxycodone Other narc
SOURCE: California Poison Control System
Rx & OTC Drug Over DosesLast 2 months: Rapper Pimp C (Chad Butler): cough syrup & Hennessey– “sizerp”This Year: Heath Ledger: lethal cocktail of Rx drugs - pain, sleeping, anti-anxietyLast Year: Anna Nicole Smith & Son (Daniel) both died due to Rx drugs Last 2 Years: Rapper ODB: fatal mixture of Rx drugs & cocaine
Teens Don’t Understand the Risks & Effects of Abusing Rx and OTC Medicines
Over 50% believe that abusing these medicines to get high is NOT risky…
Join Together, 2006
Unrecognized
Under-screened
Under-treated
Parents Don’t Recognize Problem
Only 8% of parents are aware of Rx & OTC abuse.
75% don’t talk to their kids about the problem.
Unaware that the drug supply can come from their own home.
Under-Screened57.7% of physicians say they don't discuss Rx abuse with their patients because there is a lack of knowledge on what to screen for and how to treatment it...
35.1% of physicians cite time constraints & lack of reimbursements for screening and treating a Rx-abusing patient.
CASA Released Survey of Primary Care Physicians & Patients, 2000
Other Key Stakeholders
Lack of screening and awareness about Rx and OTC problem among:
Substance abuse treatment practitioners
Social workers, juvenile delinquent counselors, probation officers
School teachers, nurses, & counselors
McCabe, S.E., Teter, C.J., & Boyd, C.J. (2004)
Efforts to Address Rx & OTC Misuse
Youth Prevention ActivitiesONDCP
12 week national public awareness campaign Began with 2 Ads aired during Super Bowl1st paid TV advertising targeting parents in 2 years.
DARENew School Curriculum Addresses Rx and OTC Drug Abuse
Five Moms CampaignStopping Cough Medicine Abuse – keeping parents informed and educated of the issue
New Rx Drug Regulations
Action has taken place throughout U.S. federal and state levels.
Federal: address issues with poor Rx practices among MDs:
F.D.A. will be placing new limits on prescriptions of 24 popular narcotics (like OxyContin) for increasing MD responsibility
State: establishing prescription monitoring programs, continuing medical education and practice guidelines
NY Times, 2009; McLellan, 2009
Efforts in CaliforniaEstablishment of Statewide Rx Drug Task force charged with:
Monitoring trends and strategies statewide.
Developing prevention strategies for teens.
Developing intervention strategies for teens entering treatment settings.
Self-Medicated Culture: Be aware of the potential for misuse and abuse
Evidence-based practice…researched-based interventions…science-based services…science-verified practices…empirically-supported practices…essentially mean the same thing.
Programs or practices that are proven to be successful through empirical research study and result in consistently positive results.
Need for Evidenced-Based Practices
SOURCE: NIDA; Institute of Medicine.
9 Key Elements: Effective Adolescent Treatment Program
Assessment and treatment matching: comprehensive assessments that cover psychiatric, psychological, and medical problems, learning disabilities, family functioning, and other aspects of the adolescents life.Comprehensive, integrated treatment approach: Adolescent’s problems should be addressed comprehensively rather than concentrating solely on curtailing substance abuse.Family involvement in treatment: Engaging both adolescent and parents and maintaining close links with the adolescent’s family, home, school. Developmentally appropriate program: Important that programs be specifically designed for adolescents rather than merely modified adult programs. Engage and retain teens in treatment: Programs should build a climate of trust between the adolescent and the therapist.
SOURCE: Brannigan et al., 2004.
Qualified staff: Staff should be trained in adolescent development, co-occurring mental disorders, substance abuse, and addiction. Gender and cultural competence: Programs should address the distinct needs of adolescent boys and girls as well as cultural differences among minorities. Continuing care: Programs should include relapse prevention training, aftercare plans, referrals to community resources, and follow-up. Treatment outcomes: Rigorous evaluation is required to measure success, target resources, and improve treatment services.
SOURCE: Brannigan et al., 2004.
9 Key Elements: Effective Adolescent Treatment Program
What has Traditionally Been Done?
Historically, adolescents were integrated into adult programs, which ignore the unique needs of youths
CSAT now advocates the separation of adolescent and adult services into “Adolescent-only” care that implements unique evidence-based treatment.
Evidence-Based Youth Treatments
Family-Based Therapies Multi-systemic therapy (MST Henggeler, et al., 1996)Multi-dimensional Family TherapyFunctional family therapy (FFT Waldron et al., 2001)Community Reinforcement Approach
Motivational Enhancement Therapy (Wagner et al., 1999)
12-step approach/Minnesota Model (Winters et al., 2000)
***Studies could not clearly identify a superior treatment approach, optimal dosage, and length of required involvement that maximized short-and long-term treatment outcomes***
Evidence-Based Youth Treatments
Cognitive-Behavioral Therapy (Kaminer et al., 1998)
Contingency Management/Reinforcement (Corby et al., 2000)
Integrative treatment models employing CBT combined with MI and/or with a family intervention (Dennis et al., 2000)
***Studies could not clearly identify a superior treatment approach, optimal dosage, and length of required involvement that maximized short-and long-term treatment outcomes***
Effective Strategies During Treatment Engagement
MedicationsMotivational InterviewingVoucher-based TechniquesCounseling to Promote Transfer to Long Term CareNIATx Strategies
Effective Strategies in Rehabilitation Phase
Interventions/ServicesClinical Case Management CRAFT12-Step FacilitationVoucher ReinforcementMatrix Model Treatment
MedicationsAlcohol (Naltrexone, Disulfiram, Citalopram) Opiates (Naltrexone, Methadone, Buprenorphine)
Types of Continuing CareSelf/mutual help programsMedicationsTraditional counseling visitsHome visitsRecovery “check-ups”
Specialty care-basedPrimary care-based
Telephone-based protocolsMonitoring Monitoring and counseling
Other stuff
Evidence-Based Practices for Adolescent Treatment
Resources/Tools
Treatment Protocols for Youth
Community Reinforcement Approach
Motivational Enhancement Therapy
Cognitive Behavioral Therapy
Multi-Dimensional Family Therapy
Family Support Network
Manualized treatment protocols for youth show promising results in clinical trials
NIDA and SAMHSA Resources
“NIDA Red Book”
“NIDA Blue Book”
TIP 31: Screening & Assessing Adolescents for Substance Use DisordersTIP 32: Treatment of Adolescents With Substance Use Disorders
California Treatment Resources
The Need to Invest in Adolescent Treatment: Policy Recommendations for Adolescent Treatment in California (2004).
California Department of Alcohol and Drug Programs (ADP) Youth Treatment Guidelines
Contact Information
Rachel: [email protected] (310) 267-5316