continuing medical education committee members and those involved in the planning of this cme event...
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Continuing Medical Education committee members and those involved in the planning of this CME Event have no financial relationships to disclose.
Marya T. Schulte:
I have no financial relationships to disclose
- and
I will not discuss off label use and/or investigational use in my presentation
Marya T. Schulte, Ph.D.University of California, Los Angeles - Integrated Substance Abuse Programs
Semel Institute for Neuroscience and Human Behavior
(1) Define Alcohol Use Disorder (AUD) and describe prevalence rates for alcohol use and AUD among teens and young adults.
(2) Understand the risk factors and consequences associated with drinking.
(3) Describe gender and racial/ethnic differences in drinking patterns and risk for development of AUD.
(4) Learn about prevention and intervention strategies for reducing dangerous drinking in youth.
A problem pattern of alcohol use leading to clinically significant impairment or distress, manifested by 2 or more of the following in a 12-month period:
◦ Alcohol drunk in larger amounts or for a longer time◦ Persistent desire or unsuccessful efforts to cut down◦ Inordinate amount of time obtaining alcohol◦ Craving (strong desire to use alcohol)◦ Failure to fulfill work, school, or home obligations◦ Continued use despite social or interpersonal problems◦ Societal, occupational, or recreational activities reduced◦ Recurrent use when physically hazardous◦ Continued use despite physiological or psychological problems◦ Tolerance◦ Withdrawal
13.9% 12- month & 29.1% lifetime
◦Men 17.6% 12-month & 36% lifetime
◦White 14.0% 12-month & 32.6% lifetime◦Native American 19.2% 12-month & 43.4% lifetime
◦Younger 26.7% 12-month & 37% lifetime Heaviest drinking in early adulthood (18-29 year olds)
◦Treatment/help seeking among AUD adults 7.7% 12-month & 19.8% lifetime
Grant, Goldstein, Saha et al., 2015
“Alcoholic drink”◦ Shot of liquor, glass of wine, can of beer
Binge drinking◦ 4 or more for women◦ 5 or more for men
Chronic drinking◦Daily or almost daily consumption of alcohol
Drinking has become a daily habit
By the time of high school graduation…
66.0% have tried alcohol
60.2% have had an alcoholic drink in the past year
41.4% have been drunk in the past year
19.4% report 1+ binge drinking episodes in past 2 wks
1.9% report daily drinking for at least 1month at some point in their lives
Monitoring the Future, 2014
Current, Binge, and Heavy Alcohol Use among Persons Aged 12 to 20, by Gender: 2013
SAMHSA, 2014
Past month alcohol use◦ 15.2% Asian◦ 17.8% African American◦ 17.8% Native American or Alaskan Native ◦ 20.6% Hispanic ◦ 25.8% White/Caucasian
Binge drinking◦ 7.6% Asian◦ 8.4% African American◦ 13.9% Native American or Alaskan Native◦ 13.5% Hispanic◦ 16.8% White/Caucasian
◦ SAMHSA, 2014
Brain maturation◦Reward sensitivity
Increased risk-taking & sensation-seeking
Development of self-regulation skills
Endocrine changes/puberty◦ Impact of alcohol on BAC
Brown & Tapert, 2004;Schulte, Ramo & Brown, 2009
Environmental changes◦Driving◦ Entering high school/moving away for college
Increased autonomy from parents/family◦ Personal decision-making◦Greater peer influence
Social role changes◦Development of romantic/sexual relationships◦Gender expectations
Parental monitoring Perceptions of peer use
Brown & Tapert, 2004;Schulte, Ramo & Brown, 2009
◦Irritability/restlessness◦Confusion/memory problems◦Poor motor coordination/slurred speech◦Lowered inhibition◦Relationship problems◦School performance
◦Accidents and injuries Car accidents, falling, drowning
◦Illegal behavior Driving drunk Physical/sexual assault
◦Risky sexual behavior Unwanted, unintended, and/or unprotected sexual activity Multiple partners
◦Death Car accidents, accidental overdose, homicide and suicide
National Survey on Drug Use and Health, 2014
Adolescent brains are undergoing significant change
Neuronal pruning◦ Loss of neurons for increased efficiency ◦Up to 50% of neuronal connections are lost in some regions◦ Some new connections are formed
Prefrontal cortex is not fully pruned/developed until mid-20s
Amygdala shows less pruning◦ This impacts decision-making and impacts adolescent
behavior!
Alcohol CAUSES structural and functional brain changes
Brain changes CAUSE increased drinking
Behavior becomes compulsive and persists despite serious consequences
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Common comorbidities◦Depression, anxiety, ADHD, ODD, CD, eating disorders
Often predate onset of AUD
Increases risk for relapse
May require medication to treat
Less likely to suffer from the complications of protracted use◦Medical problems, social/occupational disruption
Use is more episodic and less likely to be chronic
More likely to use other drugs in addition to alcohol
Difficult to parse apart consequences of drinking from effects of developmental changes/problems◦Can mimic or exacerbate effects of alcohol
Substance use history◦ Licit and illicit drugs
Biological Physical health, pubertal stage
Psychological/neuropsychological Psychiatric comorbidity, cognitive functioning, emotional well-
being Social
Social skills, family functioning, peer affiliations, legal status, school adjustment, recreational activities
Do not use judgmental or argumentative language
Be aware of your tone◦Fear is a bad motivator
Describe each result and its meaning
Work as a team◦Solicit feedback from parents and teen◦Remain open to their feedback and needs
Be prepared for strong emotional reactions
Miller & Rollnick, 1991
Assess motivation and meet them where they are at
Involve family members
Provide structure and accountability
Assess and treat comorbid psychiatric disorder(s)
Environment supportive of recovery
Individual therapy◦Cognitive Behavioral Therapy
Relapse Prevention
◦Motivational Enhancement Therapy Motivational Interviewing
◦Contingency Management
Family approaches◦Adolescent Community Reinforcement Approach◦Multidimensional Family Therapy◦Brief Strategic Family Therapy◦ Family Behavior Therapy◦ Functional Family Therapy
NIDA, 2014
Few in need of treatment actually receive services!
Motivation◦ Treatment not self-initiated
Parental buy-in
Logistical◦ Transportation, geography
Normalization of drinking◦Association with positive events
African American and Hispanic youth are less likely than white teens to receive and complete treatment
Minority youth are less likely to:◦ have health insurance ◦ be identified and referred to treatment◦ have treatment facilities nearby
Minority youth may be:◦more mistrustful of providers◦ experiencing more life stressors of greater severity
Saloner et al., 2014; Cummings et al., 2014
Enforcement of minimum legal drinking age laws
National media campaigns targeting youth and adults
Reducing youth exposure to alcohol advertising
Increasing alcohol taxes
Regulation of alcohol outlet density
Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Uses universal screening (S) with validated brief self-report questionnaires to identify those at-risk for substance use problems
Teens with positive screens are given a brief intervention (BI) and/or a referral to treatment (RT)◦ Intervention delivers personalized feedback about the risks and
consequences of excessive drinking◦Referral dependent upon severity of problem use
School-based prevention
◦Developmentally appropriate and accurate information
◦Structured skills training◦Family and community involvement◦Multiple sessions over multiple years◦Cultural sensitivity
Dangerous drinking continues to be a problem among American youth
Alcohol use differs by gender and race/ethnicity
Assessment and treatment should use a developmental approach and account for individual needs
Prevention, or at least early intervention, is the best medicine!
THANK YOU!
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