Denise Crosson, RN, PhD, LADC Mel Pohl, MD, FASAM

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Denise Crosson, RN, PhD, LADCMel Pohl, MD, FASAM

• Drug Abuse in Adolescents
• The Good News and the Bad News

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Objectives

• Review trends in drug abuse in adolescents
• Identify prescription drug abuse problems
• Review interventions prevention
• Discuss school testing pros and cons

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Estimated Number (in millions) of Persons Aged 12
and Older w/ Past Year Illicit Drug Dependence or
Abuse, by Drug 2002
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Success So Far Teen Drug Use Down 24
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Pharm Party Anyone?
In with the new
Out with the old
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Generation Rx

• From Keg parties to PHARM PARTIES
• First drugs used are Nicotine and Alcohol
• Virtually all smokers drink

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Prescription Drugs

• OPIOIDS - PAIN KILLERS - NARCOTICS - (Lortabs,
  Oxycontin, Methadone, Percocet and others)
• CNS DEPRESSANTS - Anxiolytics,
  Sedative- Hypnotics - (Xanax, Valium, Ambien,
  Lunesta, and others)
• CNS STIMULANTS - ADHD meds, diet pills
  (Adderall, Ritalin, Concerta, and others)

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The Problem

• More young people ages 12-17 abuse prescription
  (Rx) drugs than any illicit drug except marijuana
  ? more than cocaine, heroin and methamphetamine
  combined. (SAMHSA, 2006 National Survey on Drug
  Use and Health, 2007)
• Every day, 2,500 children abuse an Rx painkiller
  for the very first time. (SAMHSA, 2007)

• In 2006, about 3.1 million people ages
  12-25 had used an over-the-counter (OTC) cough
  and cold medication to get high. (SAMHSA, 2008)

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Reversal in Gender Vulnerability

• 12-17 year olds - girls gt boys - dependence and
  abuse (1.8 vs. 1.1)
• Females abuse to increase confidence, reduce
  tension, cope with problems, lose inhibitions or
  lose weight
• Easier access and less social stigma

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The Danger

• There has been a dramatic increase in the number
  of poisonings, hospital visits, and even deaths
  associated with the abuse of Rx drugs. (CDC,
  2007)
• Treatment admissions for addiction to Rx
  painkillers has increased by more than 300 in
  the last 10 years. (TEDS, 2007)

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Conclusions from National Household Survey on
Drug Use and Health 2002-2004Non-Medical Use of
Rx Pain Relievers

• Non-medical use of any prescription
  psychotherapeutic drug was second only to
  past-year use of marijuana (11.3 million vs.
  25.5 million).
• Ages 18-25 had highest rates for all pain
  relievers, followed by 12- to 17-year olds.
• Males had higher rates except for youths 12-17,
  where females had higher rates.
• Most non-medical users of psychotherapeutic drugs
  also used other illicit drugs (82). 98 of
  methamphetamine users were lifetime users of
  nonprescription illicit drugs.

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The Concern

• Many parents are not aware of the dangers of
  teen Rx drug abuse. (Partnership for a Drug-Free
  America, 2007)
• Parents are not having frequent and detailed
  discussions with their kids about the risks of
  Rx or OTC drug abuse. (PDFA, 2007)
• Youth whose parents express strong disapproval
  of drug use are far less likely to engage in
  substance use. (SAMHSA, 2007)

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When teens want to get high
YOUR PRESCRIPTION IS AVAILABLE FOR PICK UP.
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The Concern
70 of Rx abusers get their drugs from family and
relatives often for free and sometimes without
asking
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Reason for Using Prescription Pain Relievers PATS
Attitude Tracking Study 2005

• Easy to get from parents medicine cabinets 62
• Available everywhere 52
• They are not illegal drugs 51
• Easy to get through other peoples prescriptions
  50
• Teens can claim to have a prescription if caught
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• They are cheap 43
• Safer to use than illegal drugs 35

NIDAs Monitoring the Future (MTF)
Partnership Attitude Tracking Survey (PATS)
Teens in Grades 7-12, 2005
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As we grow older, we lose dopamine transporters
in our brain methamphetamine accelerates this
loss.
28 years
Will affect motor reflexes
44 years
Methamphetamine 28 years
Will affect memory
84 years
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Young brains are especially susceptible to
alcohol and other psychoactive addictive drugs.
Norm Volkow Ph.D., Director of Natl. Inst. Drug
Abuse
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Recent brain imaging research shows that brain
development is ongoing during adolescence and
continues into the early twenties, contrary to
what was previously thought.
Spear, Alc Res Health, 26287, 2002
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Young brains are especially susceptible to
alcohol and other psychoactive addictive drugs
Frontal Cortex

• Less planned thinking
• More impulsive
• Less self-control
• Higher risk-takers

Limbic System
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Frontal cortex
Brain Maturation
Subcortical areas
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Teens who begin drinking before age 15 years are
4X more likely to develop alcoholism.
Pediatric Adolescent Medicine 152952,1998
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Young adults may be 85 less likely to develop
serious alcohol and other drug problems if the
age of first use is delayed beyond age 22.
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Brain Research Conclusions

• Young brains are more susceptible to drug use
  than adults
• Drug use may impact normal brain development and
  maturation
• Learning ability emotional development
• Implications of these studies are enormous for
  parents

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Underage Drinkers are at Greater Risk for

• Learning problems
• Trouble at school and home
  
• Becoming sexually active
• Using other drugs

J. Am. Acad. Child Adolescent Psychiatry.
37252,1998
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Drug Abuse in Students

• Sudden drop in grades
• Loss of interest in activities or school
• Change of friends
• Lying
• Stealing
• Mood swings
• Financial problems

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Tips for Parents

• Give clear no-use messages about alcohol and
  other drugs
• Start early, be ongoing

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Past Month Use vs. Parents Feelings About
Substance Abuse
SAMHSA 2002 data
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The Response A National Campaign to Prevent
Prescription and Over-the-Counter Drug Abuse by
Teens

• Unprecedented, national public education
  initiative targeting parents
• We are leveraging 14 million to get almost 30
  million in national television, print,
  point-of-purchase, and online advertising that
  will reach over 90 percent of our target
  audience
• Enlisted support of community anti-drug
  coalitions and other partners to reach parents
  and other influential adults
• New online and print resources for parents
• New tools to help local community groups address
  the problem in their community
• Extensive research and testing behind all aspects
  of the Campaign

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Due Diligence

• Extensive research with community groups and
  field experts
• White Paper Report on prescription and
  over-the-counter drug abuse among teens
• Literature Review
• Testing among target audiences
• Parent focus groups
• Quantitative and Qualitative testing with diverse
  segment of parents
• Media Content Analysis
• Analysis of media coverage of teen prescription
  drug abuse

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Parent Reactions to the Ads

• I will be more careful about what I put in the
  medicine cabinet.
• I will safeguard my medicine cabinet and talk
  to my child.
• I will talk to my own mom and dad about their
  house and where they keep the pills.
• I will call my daughters friends parents and
  talk to them about this problem.
• I will talk to my children and then I'm also
  going to lock up all prescription drugs up and
  away from any child that's in my home or come to
  visit my home from now on.
• It is important to talk to your teen and let
  them know your expectations about prescription
  drug abuse.
• Teens who abuse prescription drugs often get
  them from the homes of family and friends.

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Open Letters for Health and School Professionals
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Point-of-Purchase Ads
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New Online Resourceswww.TheAntiDrug.com

• Virtual house tour to learn sources of Rx
• Types of Rx drugs
• Rx tips for parents
• Where do teens get Rx drugs?
• Videos of real teens
• Proper drug disposal
• Early intervention resources
• Bi-weekly parenting tips e-newsletter

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Rx Strategizer a Tool Kit for Communities

• In partnership with the Community Anti-Drug
  Coalitions of America (CADCA)
• To be distributed to community stakeholders,
  including CADCAs member groups, and available
  on www.TheAntiDrug.com
• Includes
• Facts about Prescription Drug Abuse
• Strategies for Effective Prevention Programs
• Promising Approaches for Coalitions
• Resources for Community Groups

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New Rx Brochure for Parents

• Recent research on teens abuse of Rx and OTC
  drugs
• Signs and symptoms
• Sources of Rx drugs
• What to do if you suspect your teen is abusing
  drugs
• Tips for safeguarding medicine
• Action items for preventing Rx abuse

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New, Revamped Center for Campaign Materials at
www.TheAntiDrug.com/Resources

• Resources for Community Groups
• Free, Bulk Distribution, Downloadable
• Tool Kits, Booklets, Handbooks, Posters,
  Postcards, CD-ROM
• For Parents, Teens, Community Leaders
• Multicultural and In-language Available

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• Adolescent Addiction Prevention Treatment

Primary, Secondary, and Tertiary Prevention
Strategies
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Past Approaches

• Just Say No
• DARE
• School-based prevention programs Usually not
  comprehensive and of variable quality, often
  drug specific. They may target binge drinking in
  one school and illegal drug use in another.

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Given the Facts

• Escalating and changing drug use in
  adolescent and young adults
• Consistent implementation of these programs and
  approaches to prevent drug use
• Research literature and a common sense look
  around agree and would suggest that past
  approaches did not produce the desired results

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Scope of the Problem vs. Scope of the Intervention

• Drug abuse and addiction are pervasive problems
  in this culture
• Children get many messages from a variety of
  sources that glorify drug use and even condone
  or glorify impairment
• Spending limited amounts of time in one setting
  to combat that information is unlikely to have
  a meaningful impact

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In order to Prevent you have to Understand

• Why do people use drugs in the face of the known
  risks?
• To feel good (risk group sensation seeking
  people who want euphoria or energy)
• To feel better (risk group people in emotional
  or physical pain)
• To do better (risk group people with excessive
  need to succeed in athletic or scholastic
  ambitions)
• Curiosity and because other people are doing it
  (risk groups adolescents and young adults)

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Prevention

• Primary activities are aimed at avoiding the
  development of a disease.
• Secondary activities are aimed at early disease
  detection, thereby increasing opportunities for
  interventions to prevent progression of the
  disease and emergence of symptoms.
• Tertiary reduces the negative impact of an
  already established disease by restoring function
  and reducing disease-related complications.

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Prevention Strategies

• Must address the four reasons people use drugs in
  the first place
• To feel good (Good prevention strategies must
  offer ways to feel good without drugs)
• To feel better (Good prevention strategies must
  offer ways to decrease distress without drugs)
• To do better (Good prevention strategies must
  offer realistic ways to do better and achieve
  balance without drugs)

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Prevention Strategies Continued

• Curiosity and because other people are doing it
  (Good prevention strategies must offer ways to
  satisfy adolescent need for thrills and daring
  behavior in healthy ways AND offer refusal skills
  that do not result in exclusion of the adolescent
  from the social group.)

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Primary Prevention Strategies

• Know your population of interest
• Education re scope of the problem, availability
  of solutions and to decrease stigma. Scare
  tactics do not work on parents or adolescents
• General interventions to increase resilience and
  decrease risk for whole population
• Reduce availability
• Strengthen anti-drug-use attitudes and norms
• Strengthen social bonding

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Secondary Prevention Strategies

• 1) Focus special attention on persons within the
  population who are high risk and low
  protection/resilience
• 2) Screening including random drug testing.
• 3) Intervene early
• 4) Decrease stigma for help seeking
• 5) Ease of access to treatment
• Random student drug testing is a powerful public
  health tool that discourages students from using
  dangerous, addictive drugs, and confidentially
  identifies those who may need help or drug
  treatment. Random testing also promotes a safer,
  healthier school learning environment. ONDCP

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Tertiary Prevention Strategies

• Ensure that interventions are appropriate for
  the populations being addressed
• Intervene early
• Reinforce interventions over time
• Intervene in appropriate settings and domains
• Monitor and evaluate programs and refine based
  on data collected.

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Ecological Approach

• Considers risk and resilience factors that are
  both internal (within the child) and external
  (others and the environment)
• Uses multiple approaches by multiple players to
  encourage non-use
• Includes child, peers, teachers, parents, other
  adults, the school, other social groups,
  religious and spiritual groups, and whole
  community interventions

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Ecological Prevention

• Child Build resilience, mitigate risk
• Peers Interventions and activities that are
  inclusive and support all children. Teach
  help-seeking skills and help-offering skills.
• Teachers, Parents Other adults Teach how to
  talk to kids about drugs. NOT educating about
  drugs or scare tactics but positive supportive
  reasons to refuse and tactics for refusal.
• School community Non-punitive approaches to help
  seeking or help offering of all students
• General Community Decrease availability of all
  drugs and sex appeal of drug use

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Questions??? Thank You! Denise Crosson, RN, PhD,
LADC Mel Pohl, MD, FASAM 702-515-1373