innovation strategies & solutions in youth recovery ken winters, ph.d. department of psychiatry...
TRANSCRIPT
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Innovation Strategies & Solutions in Youth Recovery
Ken Winters, Ph.D.Department of PsychiatryUniversity of [email protected]
ARS 2013 ConferenceJuly 12, 2013Del Mar, CA
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www.psychiatry.umn.edu/research/casar/home.html
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1. Brain development
2. Innovation-1:Counseling that is
teen-brainfriendly
4. Summary
3. Innovation-2:Counseling that
supportsrecovery
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1. Brain development
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Emerging Science:Brain Imaging
New insights because:
• 1990’s information explosion due to the development of brain imaging techniques (e.g., CT, PET and MRI).
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When I get too technical, the audience starts to look like this….
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Adolescence is a period of profound brain maturation.
We thought brain development was complete by adolescence
We now know… maturation is not complete until
about age 25!!!
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Important ages of majority and privileges
16 - emancipation
- driving
18 - gambling (usually age 21 when alcohol served)
- smoking (some at age 19
- military
21 -drinking
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Allstate ad, NY Times, May, 2007
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An Immature Brain = Less Brakes on the “Go” System
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Maturation Occurs from Back to Front of the BrainImages of Brain Development in Healthy Youth
(Ages 5 – 20)
Source: PHAS USA 2004 May 25; 101(21): 8174-8179. Epub 2004 May 17.
Blue represents maturing of brain areas
Earlier: Motor Coordination Emotion Motivation
Later: Judgment
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Limbic or Go System
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Tests measuring different forms of executive function skills indicate that they begin to develop shortly after birth, with ages 3 to 5 a window of opportunity for dramatic growth in these skills. Development continues throughout adolescence and early adulthood.
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• Preference for ….1. physical activity2. high excitement and rewarding activities3. activities with peers that trigger high
intensity/arousal4. novelty
• Less than optimal..5. control of emotional arousal6. consideration of negative conseq.
• Greater tendency to…7. be attentive to social information8. take risks and show impulsiveness
Implications of Brain Development for Adolescent Behavior
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Youth vulnerability and drug use
•Greater risk for drug abuse?
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Prevalence of Past-Year DSM-IV Alcohol Dependence: United States, 2001-2002(Grant, B.F., et al., Drug and Alcohol Dependence, 74, 223-234, 2004)
12.211
5.8
4.1 3.9 3.8 3.7
1.9
0.3 0.20
2
4
6
8
10
12
14
15-20 21-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+
%
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The Water Maze Test
Hidden
Slide courtesySion Kim Harris, Ph.D.
• Saline vs alcohol • Measures
-Swimming speed-Time to find platform
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Wanna lookfor some cheese
with me?Sure!
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Youth vulnerability and drug use
•Greater risk for mental disorders?
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Psychosis: Prevalence of Past Year Serious Mental Illness Among Lifetime Marijuana Users Aged 18+
(SAMHSA, 2005; data collected 2002-2003)
21
17.4
12.210.5
0
5
10
15
20
25
< age 12 age 12-14 age 15-17 > age 17
per
cen
tag
es
age of marijuana onset
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Psychosis: Drug Use and Age at Onset of Psychosis Based on a Meta-Analysis
(Large et al., 2011)
0.28
2.7
1.7
0
1
2
3
4
5
Alcohol Cannabis Any Drug
years earlierpsychosis onset
mean years earlier of age at onset of psychosis compared to non-drug using controls
* = nonsig. with controls
*
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1. Brain development
2. Innovation-1:Counseling
that is teen-brainfriendly
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Brain Development: Opportunities for Prevention and Treatment
• Discuss with teenagers the science of the neurobiology of addiction
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Brain Development: Opportunities for Prevention and Treatment
• Discuss the implications of using substances when the brain is still developing.
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Prevalence of Past-Year DSM-IV Alcohol Dependence: United States, 2001-2002(Grant, B.F., et al., Drug and Alcohol Dependence, 74, 223-234, 2004)
12.211
5.8
4.1 3.9 3.8 3.7
1.9
0.3 0.20
2
4
6
8
10
12
14
15-20 21-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+
%
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Memory Effects
8687
9796
70
75
80
85
90
95
100
Alc Dep
Non-AlcDep
Verbalinformation
Nonverbalinformation
Rete
nti
on
Rate
%
Source: Brown et al., 2000
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• Resource from BSCS Drug Abuse, Addiction
and the Adolescent Brain
(www.BSCS.org)
• Hazelden has published an 8-lesson multi-media resource: Drugs and the Developing Brain (www.hazelden.org)
Classroom Resources
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• Apply two major treatment approaches seem accommodating to the teen brain:
• Cognitive – behavioral therapy (CBT)
• Motivational interviewing
Brain Development: Opportunities for Treatment
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Characteristics of CBT
•Focus on immediate, relevant and specific problems
•Solutions are realistic, concrete, specific
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Value of CBT• Teach important skills not optimal for the teen brain
• impulse control
• “second” thought processes
• social decision making
• dealing with risk situations
• taking healthy risks
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Characteristics of Motivational Interviewing
• De-emphasize labels• Emphasis on personal choice
and responsibility• Therapist focuses on eliciting
the client's own concerns• Resistance is met with
reflection and non-argumentation
• Treatment goals are negotiated; client’s involvement is seen as vital
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• Teen-brain friendly features of the 12-Step Model
• abstinence• novelty – new approach to
life• structure• spiritual component• fellowship
Brain Development: Opportunities for Treatment
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• But…..elements of the 12-Step Model that are challenging to the teenager
• life-long disease• committing to life long
changes• self-help groups may not be teen friendly
Brain Development: Opportunities for Treatment
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Recovery Options that are Socially Suitable for Youth
• AA/NA support groups that are relevant, meaningful, engaging and fun for youth
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John Kelly’s Research Program
• Modest beneficial effects of 12-Step attendance was found.
• Several factors noted as favorable features of 12-Step meetings.
• Listened to others’ struggles and successes• Provided support to another addict/alcoholic• Met new people
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Recovery Options that are Socially Suitable for Youth
Rockers In Recovery Music and Art Festival
November 2, 2013- 1PM-11PM Fort Lauderdale Venue: CB Smith Park
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1. Brain development
2. Innovation-1:Counseling tools
that are teen-brainfriendly
3. Innovation-2:Counseling that
supports recovery
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3-1. Expand use ofSBIRT to addressearly stage drugInvolvement.
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SBIRT
Abstinence Infrequent use Early abuse Abuse Dependence
Intensive Treatment
Drug Involvement
Adapted from Broadening the Base of Alcohol Treatment (IOM)
Tx GapBrief
Intervention-MIPrevention
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Estimates of Mutually Exclusive “Mild-to-Moderate” Drug Abusing Groups of Youth (12-18-years-old) (based on data from SAMHSA, 2005)
5.8 6.3
1.3
11.3
5.2
0
5
10
15
20
Abuse only Binge alc. Heavy alc. Illicit drug Dependnece
%
Binge and heavy alcohol: past 30 daysAbuse only, Illicit drug, and dependence: past year
Total % = 24.7
4.4% light drinkers
65.7% non users
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Common Elements of Brief Interventions Evidence-based approaches in NREPPBrief Therapies or Interventions (www.nrepp.samhsa.gov
•1 – 4 sessions
•Motivational interviewing and CBT
•Negotiated goals
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3-2. Expand recoveryhigh schools andcolleges.
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Collegiate Recovery Programs and Efforts
Source: Stacie Mathewson Foundation
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1. Brain development
2. Innovation-1:Counseling tools
that are teen-brainfriendly
4. Summary
3. Innovation-2:Counseling toolsthat are recovery
friendly
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Youth Today
• Approx. 20-35 have already experienced a substance use disorder
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Treatment Works !
(but we can do better)
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New 12-Step Programfor Adolescents ?
12-Steps of Self-Regulation1. impulse control
2. “second thought” processes
3. social decision making
4. dealing with risk situations
5. taking healthy risks
6. attention regulation
7. anger control
8. modulating reward incentives
9. choosing options
10. considering consequences
11. minimizing arousal
12. dealing with peer influences
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Thank You !
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Comments and Questions