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Issues With Adolescent Methamphetamine Abuse

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Issues With Adolescent Methamphetamine Abuse By Paulette Mader MSN Major Points to Remember One time use of methamphetamine can result in addiction. – PowerPoint PPT presentation

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Title: Issues With Adolescent Methamphetamine Abuse


1
Issues With Adolescent Methamphetamine Abuse
  • By Paulette Mader MSN

2
Major Points to Remember
  • One time use of methamphetamine can result in
    addiction.
  • There is very little casual use of
    methamphetamine. Addiction progresses rapidly
    with significant adverse results.
  • Methamphetamine use over time causes permanent
    brain changes.
  • Effects of long-term methamphetamine use can
    still be evident up to two years after
    discontinuing the drug.
  • Most methamphetamine users are poly drug abusers.

3
Where is Meth Coming From?
  • Major suppliers in the West and Southwest are
    Mexican criminal gangs cooking in superlabs and
    bringing the product over the border for
    distribution.
  • Local gangs and some private cookers are main
    suppliers in our community.
  • Methamphetamine is a money maker for our local
    gangs and is often used in recruitment of
    members.

4
Signs of Possible Meth Use
  • Poor hygiene
  • Chemical smell
  • Tremor
  • Bruxism (teeth grinding)

5
Signs of Possible Meth Use
  • Acne
  • Scabs or scratches, especially on face and arms
  • Sleeping in class or complaints of being tired
  • Burnt fingertips

6
Signs of Possible Meth Use
  • Lowered grades
  • Attendance issues such as cutting class and
    truancy. (Our policy is 5-6 days undocumented
    absences or 3 tardies truancy.)
  • Verbal expressions of inability to be with other
    students in class often with a push to move to
    home school or another alternative setting.

7
Symptoms of Possible Meth Use
  • Drug language and paraphernalia such as pipes,
    burnt foil, small baggies
  • Symptoms of depression
  • Symptoms of anxiety
  • Flushed look when high and poor color generally

8
Signs of Possible Meth Use
  • Wearing sunglasses indoors
  • Dilated pupils
  • Darting eyes
  • Weight loss

9
Problems Getting Students Into Treatment
  • Students under the influence of methamphetamine
    are not thinking clearly and are not motivated
    for treatment.
  • Parents who use Whats the problem?
  • Parents in denial Whats the problem?

10
Problems Getting Students Into Treatment
  • Students who have been neglected or abused
    have trust issues. Students are used to running
    their own lives with no consistent reasonable
    limits set by adults. These kids have trouble
    giving up control. They often fight moving to a
    shelter or foster home because of rules and fear
    of abandonment. Treatment is scary and perceived
    as loss of control.

11
Problems Getting Students Into Treatment
  • Only outpatient treatment is available for
    adolescents who are substance abusers in our
    county. County Mental Health and New Morning
    have a 30-day wait for outpatient services.
  • Placement in group homes outside our county often
    means no reciprocity for the other county for
    mental health, medical, or recovery services.

12
Problems Getting Students Into Treatment
  • Teenage methamphetamine abusers typically
    enter treatment through the juvenile justice
    system. They are prosecuted for crimes related
    to their substance abuse such as possession of
    drugs and paraphernalia, sales, burglary, and
    assault. Treatment is mandated as part of their
    probation. While incarceration in Juvenile Hall
    is not ideal, it is one way to insure a
    methamphetamine abusing child refrains from using
    meth.

13
Other Treatment Issues
  • Adolescence is a time of crisis with wide ranges
    of physical and emotional maturity levels.
  • Major mental illnesses such as schizophrenia and
    bipolar disorder often are first seen during
    adolescence. Meth use symptoms often mimic these
    disorders.
  • Shortage of health care providers and facilities
    designed to treat dual diagnoses in teens,
    especially in rural areas where meth use is most
    common.

14
Other Treatment Issues
  • Methamphetamine addiction requires intervention
    from a variety of health care providers such as
    medical, dental, psychiatric, and recovery
    providers.
  • Addicts often have legal issues, housing issues,
    and employment issues and require extensive
    social services assistance.

15
Other Treatment Issues
  • Practitioners with middle-class values are often
    very uncomfortable hearing about the life styles
    of substance abusing patients.
  • Many antidepressants are not ruled safe for use
    in teens. Use of antidepressants in teens
    associated with some risk for suicide.

16
One Girls Diagnoses Over a Two-Year Period
  • Major Depression
  • Poly Drug Abuse
  • Borderline Personality Disorder
  • Conduct Disorder
  • Reactive Attachment Disorder
  • Anxiety Disorder
  • Post Traumatic Stress Disorder
  • Bipolar Disorder
  • Dysthymic Disorder
  • Antisocial Personality Disorder
  • Psychotic Episode
  • Schizophrenia
  • ADHD
  • Adjustment Disorder

17
Meth Can Cause Extreme Disorganization of Behavior
  • Young women getting into strangers cars for a
    hit of meth.
  • Prostitution for methamphetamine (whether for
    money or the drug).
  • Jumping out of a second story window to avoid
    talking to a family member.
  • Hanging around dangerous adults, some who carry
    weapons or are abusive because these adults will
    supply the drug.
  • Criminal behavior to earn money to purchase
    drugs.

18
Disorganization of Behavior
  • Aggressive behavior. Family members assaulted.
  • Hallucinations and delusions that are very
    frightening. (Strangers perceived as FBI agents
    who are after the meth user. One young man
    peeked out of his blinds 7 hours straight as he
    was worried someone was after him.)
  • Running away from home, sometimes days at a time.

19
Disorganization of Behavior
  • Unplanned pregnancy with lack of prenatal care.
    Continuing meth use during the pregnancy resulted
    in a positve tox baby.
  • There is a high risk of domestic violence and
    child abuse in households where meth is used.
    Parents who use often expose children to
    dangerous drugs, dangerous people, and dangerous
    situations.

20
Safety Issues
  • Tweakers are never seen at school. Kids who are
    binging on meth will do so away from school and
    sleep it off, sometimes for days.
  • Attendance records will show this pattern until
    the student stops coming to school.
  • A person who is tweaking can be very dangerous.
    He/she will often be paranoid and delusional.

21
Safety Issues Continued
  • Set up your office with your safety in mind. Sit
    closest to the door bathrooms that lock should
    have a key to open them from outside. Hard chairs
    are easier to get out of than soft chairs.
  • Be observant to details.
  • Reduce stimuli any way possible dont stand too
    close, keep light low, lower voice, slow speech,
    move slowly, keep hands visible.
  • Keep the person talking. Silence may mean the
    persons delusions have taken over and the
    current environment incorporated in the delusion.
  • Back-up help is always welcome!
  • Do not confront!

22
Adverse Childhood Experiences A Study By Vincent
J. Felitti, MD and Robert Anda, MD
  • 17,421 patients of Kaiser Permanentes Department
    of Preventive Medicine in San Diego.
  • 80 White, 10 Black, 10 Asian, generally in
    their fifties, middle class.
  • Detailed biomedical, psychological, and social
    evaluations done.
  • The study measured effects of adverse childhood
    experiences on adult health status a half century
    after they occurred.
  • ACE scores ran from 0-8.

23
Categories of Adverse Childhood Experiences
  • Recurrent physical abuse
  • Recurrent severe emotional abuse
  • Contact sexual abuse
  • Household member in prison
  • Mother treated violently in household
  • Alcoholic or drug abuser in household
  • Household member chronically depressed, mentally
    ill, or suicidal
  • Biological parent lost during childhood
    regardless of cause

24
Results of ACE Study
  • Adverse childhood experiences are more common
    than previously believed.
  • Adverse childhood experiences have a powerful
    relation to adult health.
  • Health risk behaviors such as smoking,
    overeating, and drug use are actually coping
    mechanisms to deal with ACE.

25
More Results
  • Slightly more than half experienced one or more
    categories of ACE.
  • One in four exposed to two categories of ACE.
  • One in sixteen exposed to four categories of ACE.
  • Exposure to one category increases likelihood of
    exposure to another category by 80.

26
More Results
  • Physical diseases such as chronic obstructive
    pulmonary disease, hepatitis, sexually
    transmitted disease, tobacco use, and IV drug
    abuse all showed progressive dose response with
    every increase in ACE score.
  • Other diseases with a graded response to ACE
    score were heart disease, fractures, diabetes,
    obesity, unintended pregnancy, and alcoholism.
  • Depression and suicide attempts had a similar
    strong relationship to ACE score. A patient with
    an ACE score of 4 or more was 460 more likely to
    be depressed and 1,220 more likely to attempt
    suicide. Between 66 and 80 of all suicide
    attempts could be attributed to ACE.

27
Still More Results
  • 22 of Kaiser patients were sexually abused (28
    women and 16 men).
  • A male child with an ACE score of 6 has a 4,600
    increase in likelihood to be an IV drug user
    compared to a male child with an ACE score of 0.
  • ACE scores above 4 had a 3000-5,100 increase in
    attempted suicide over the group with an ACE core
    of 0.

28
Clinical Implications
  • It is important to ask questions routinely in
    intakes to elicit information about possible
    adverse childhood experiences.
  • Dr. Felitti recommends asking after an ACE is
    confirmed, How do you think this experience
    affects your adult health?
  • Dr. Felitti reported a 35 reduction in office
    visits after a biopsychosocial approach adopted
    at the clinic.

29
Prevention of Prime Importance
  • Prevention of ACE is of great importance for
    optimum adult health.
  • 5 million children a year are exposed to
    traumatic events.

30
Neuroarcheology
  • Dr. Bruce Perry, M.D., Ph. D, a Fellow of the
    Child Trauma Academy uses the term
    neuroarcheology to describe how our experiences
    change our brains.
  • His research on trauma and neglect in children
    demonstrates that the traumas we experience in
    childhood can permanently limit our ability to
    react appropriately to our environment.

31
Introduction
  • Dr. Perry states
  • Childhood maltreatment has profound effect on
    the emotional, behavioral, cognitive, social, and
    physical functioning of children. Developmental
    experiences determine the organizational and
    functional status of the mature brain and,
    therefore, adverse events can have a tremendous
    negative impact on the development of the brain.
    In turn, these neurodevelopmental effects may
    result in significant cost to the individual,
    their family, community, and ultimately, society.
    In essence, childhood maltreatment alters the
    potential of a child and, thereby, robs us all.

32
Main Principles of Brain Development
  • We each have a set of genes that makes us unique
    the full expression of our gene potential is
    through interaction with the environment.
  • A brain develops in sequence and hierarchically
    from least to most complex (brainstem to limbic
    to cortex). Rapidly organizing brain systems are
    more sensitive to insults than slower organizing
    brain systems.

33
Main Principles of Brain Development
  • The brain organizes in a use-dependent way
    undeveloped neural systems are dependent upon
    environmental and micro-environmental cues to
    organize.
  • There are windows of opportunity and
    vulnerability in brain development. There are
    times when a developing neural system is more
    sensitive to environment than others. The unique
    demands of the environment create from a broad
    genetic potential those characteristics that best
    fit the environment.

34
Main Principles of Brain Development
  • Hot zones are sensitive periods when an area
    of the brain is rapidly organizing. The
    brainstem which controls basic body functions
    like breathing, must be developed by birth. The
    hot zone for the brainstem is the prenatal
    period. The neocortex which controls reasoning,
    problem-solving, abstraction, and sensory
    organization develops over a long period of time,
    from childhood to adulthood.

35
Neglect Affects Childrens Brain
  • There is a shifting of the vulnerability of the
    brain to experience. An infant or child whose
    brain is more malleable to experience than an
    adult, is also more vulnerable.
  • It is easier to influence the function of a
    developing brain system than to alter the
    functioning of a developed system. A babys
    development and ultimate ability to function is
    much more affected by lack of stimulation than an
    adults ability.
  • Permanent changes in the brain, i.e. lack of
    neural connections and pathways may permanently
    limit the childs ability to develop normally.

36
Trauma Affects Childrens Brains
  • Just as lack of sensory stimuli can permanently
    limit a brains development, so can traumatic
    stress such as the adverse childhood experiences
    in Felittis study.
  • External threat is met by significant and
    persistent neurophysiologic systems designed to
    respond to the threat.
  • The longer the activation of a threat response,
    the more likely a use-dependent change in neural
    systems will occur.

37
Trauma Affects Childrens Brain Development
  • It is adaptive for a child growing up in a
    chronically stressed environment to be
    hypersensitive to stimuli and hyper vigilant in
    an environment.
  • Neural systems will adapt to this kind of state
    and literally organize around it.
  • While adults with PTSD have cue-specific stimuli
    relating to a specific traumatic event that set
    off stress responses, children develop a
    generalized hypersensitivity to all cues that
    activate the stress-response.

38
Affects of Trauma on Childrens Behavior
  • As Dr. Perry states about children exposed to
    chronic trauma These children are hyper
    vigilant they do not have a core abnormality of
    their capacity to attend to a given task. These
    children have behavioral impulsivity, and
    cognitive distortions all of which result from a
    use-dependent organization of the brain. During
    development, these children spent so much time in
    a low-level state of fear, that they consistently
    were focusing on non-verbal but not verbal cues.

39
Recommendations
  • Often these kids are not able to operate on a
    cognitive level. The hyper arousal of the
    brainstem and limbic system must be addressed.
  • The childs ability to participate in treatment
    must be assessed. A developmental assessment is
    most useful.
  • Modalities such as dance therapy and a supportive
    positive environment are most effective
    initially.

40
The Big Problem
  • As mentioned before, there is little casual use
    with methamphetamine. There comes a time with
    escalating use when behavior becomes more
    disorganized and the teenager is at high risk for
    terrible consequences yet does not qualify for
    commitment.
  • How do we keep these kids safe?
  • Where do we put them?
  • Who treats them?

41
Works Cited
  • California Healthy Kids Survey Most Recent
    Performance Indicators, El Dorado high School,
    2004-2005.
  • CAPRI Concerned Advocates for Perinatal Related
    Issues. Handout from Presentation for the
    Perinatal Council of El Dorado, EMS Conference
    Room, Placerville, California. February 17, 2004.
  • Dansie, Roberto. Anger, Pain, and Healing in
    the Native American Indian Community. February
    24, 2006 lthttp//www.robertodansie.com/articles/an
    ger.htmgt.
  • Dube, Shanta R. MPH Felitti, Vincent J. MD
    Dong, Maxia, MD, PhD Chapman, Daniel P., PhD
    Giles, Wayne H., MD Anda, Robert F. , MD.
    Childhood Abuse, Neglect, and Household
    Dysfunction and the Risk of Illicit Drug Use
    The Adverse Childhood Experiences Study.
    Pediatrics. March 2003. February 2, 2006
    lthttp//pediatrics.aappublication.org/cgi/content/
    full/111/3/564gt.
  • El Dorado County Meth Awareness and Prevention
    Project (MAPP). Handout.
  • Felitti, Vincent J. MD. Presentation Given to
    Healthy Start and After School Program
    Coordinators. Hilton Hotel. Napa, California.
    January 26,2006.
  • Felitti, VJ. English Translation of Belastungen
    in der Kindheitund Gesundheit im
    Erwachsenenalter die Verwandlung von Gold in
    Blei. Z Psychom Med Psychother. 2002 48(4)
    359-369.
  • Perry, Bruce MD, PhD. The Neuroarcheology of
    Childhood Mistreatment The Neurodevelopmental
    Costs of Adverse Childhood Events. July 27,
    2000. February 2, 2006 lthttp//www.ChildTrauma.or
    g/gt.
  • Perry, Bruce MD, PhD. Presentation The Power of
    Community How Healthy Communities Create
    Healthy Children. Sponsored by Placer County
    Health and Human Services, California State
    Department of Health Services, and First Five
    Commission of Placer County. Sierra Bible
    Church. Sonora, California. March 31, 2005.
  • Perry, Bruce MD, PhD. Presentation Working with
    Children Exposed to Trauma and Violence.
    Sponsored by The Perinatal Multidisciplinary Team
    of Tuolumne County, The Tuolumne County YES
    Partnership, with support from the California
    Attorney Generals Office-Safe from the Start
    Initiative. Sierra Bible Church. Sonora,
    California. September 1, 2004.
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