adolescent substance abuse john sargent, m.d.. learning objectives: 1)learn features associated with...
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Adolescent Substance Abuse
John Sargent, M.D.
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• Learning Objectives:• 1)Learn features associated with
substance abuse in adolescents.• 2) Learn a clinical approach to
treating substance abusing adolescents and their families
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Current Massachusetts Data (within last month)
• Alcohol use 40%• Binge drinking 40%• Marijuana use 16%• Cigarette use 35%, regular use 20%
(from Kids Count, Casey Foln)
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• Adolescents because of immaturity of impulse control and judgment are especially prone to experimentation with drug & alcohol use
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• Novelty seeking, poor parental supervision and peer involvement further reinforce use
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• Adolescent autonomy and freedom offer opportunities for use
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• Teens with ADHD, Conduct Disorder, Trauma history and school failure are especially at risk
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• Situations with limited opportunity, easy access to drugs, routine family and community use amplify use
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Specific risks of drug use:
• Binge Drinking• Inexperience coupled with
impulsivity• Secondary problem – unwanted
sexual behavior, rape• Disinhibition• Driving while intoxicated
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• Addiction with associated withdrawal is rare in adolescence, however other consequences are common – poor school performance, family conflict and legal difficulties
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• Drug use is indicative of a health-compromising lifestyle
• Drug use is a choice, something that one willfully does for definable reasons
• Parents are important throughout adolescence
• When teens are using drugs a great deal, there are consequences that are upsetting to them
• Some drug use is normal
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Assessment
• Substance Use History• Drugs used• Frequency of use• Places used
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• Type of use: impulsive, planned, measured
• Goals of use of each drug• Progression of use
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Consequences of Use
• Costs• Drug influenced behaviors• Arrests
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• School failure• Peer relations• Pregnancy
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• Erratic and unreliable behavior• Lying• Irritability, argumentativeness,
relationship problems
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Mental Health Co morbidities
• Depression• Anxiety• Post trauma difficulties• Sequellae of childhood
maltreatment
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• ADHD• Bipolar Disorder• Adolescent schizophrenia• Eating disorders, especially bulimia
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Family Situation and Relationships
• Socioeconomic concerns• Parental mental health concerns,
especially mood disorders• Parental substance use• Parenting style especially
supervision and monitoring
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• Parental response to drug use• Marital or post divorce conflict• Parental preoccupation
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• Be sure to assess strengths, capacities, interests and possibilities
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Approach to Treatment
• Motivation is malleable• Relationships critical• Treatment individualized• Planning and flexibility operate
together
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Domains of adolescent function
• Identify development/support autonomy linked with responsibility
• Peers• Bonding to prosocial institutions
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• Racial/cultural issues• Health/sexuality• Drug use
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• Look for impairments in 2 or more domains
• Look for development detouring effects
• Multiple approaches • Multiple targets• Multiple interventions
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Treatment involves…
• Development • Preventing problem behavior• Therapy
– Individual – Family
• Treatment parameters time, space, frequency, etc
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• Motivational interviewing can be very useful in helping youth appreciate consequences of drug use and deciding if drug use furthers their personal goals
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Attend to Risk:
• Economic Deprivation• Parental Difficulty• Family Conflict
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• Poor parental management• Poor conflict resolution• Frustration – relief through
disconnect with child
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• Family primary location for child treatment
• Buffers negative peer environment• Goal interdependence
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• Engagement of parents– hopeful, enthusiastic and realistic– question denial
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• Offer respectful interest in teen– especially attentive to strengths and
interests– quiet concern about problems that
have been drug related– offer opportunity to join treatment
team
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• Develop drug free expectation– rules– monitoring– consequences– reparations– parental collaboration
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• Decide how to deal with crises– suicide– intoxication– arrest– school responses– peer difficulties
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• Promoting positive family interaction
– conflict resolution– supportive engagement– hope for sober outcomes
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– addressing family conflicts openly– constructive not punitive– reinforcing drug free activities– enhancing communication
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• Encouraging adolescent voice and goals – individual sessions
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• Dealing with relapses– harm reduction
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• Encouraging engagement with mutual support organizations and drug treatment programs
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• Engage family in treatment of – co morbid problems in child– Co morbid problems in parent
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Prevention efforts:
• Enhancement of academic opportunities
• Provide treatment for co morbid problems
• Engage families in shared activities• Provide after school opportunities –
activities, sports, jobs
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• Target especially at risk teens• Build drug-free recreation
experiences
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Resources
• Schools• Jobs• Prosocial Support• Activities• Medical• Other
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Goals
• Build a therapeutic alliance with the adolescent
• Create a collaborative agenda• Establish a developmental –
ecological framework of treatment
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• Improve functioning in several developmental domains
• Transform a drug – using lifestyle into a developmentally normal lifestyle
• Facilitate developmentally adaptive competence in multiple settings
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• Build a therapeutic alliance with a parent
• Create a collaborative agenda• Establish a developmental –
ecological framework• Facilitate parental commitment
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• Prevent parental abdication • Facilitate an improved relationship or
improved communication between the parent and adolescent
• Increase knowledge about and effectiveness of parenting practices (e.g. limit setting, monitoring, appropriate autonomy granting)