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Adolescent Substance Abuse

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John Sargent, M.D. Learning Objectives: 1)Learn features associated with substance abuse in adolescents. 2) Learn a clinical approach to treating substance abusing ... – PowerPoint PPT presentation

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Title: Adolescent Substance Abuse


1
Adolescent Substance Abuse
  • John Sargent, M.D.

2
  • Learning Objectives
  • 1)Learn features associated with substance abuse
    in adolescents.
  • 2) Learn a clinical approach to treating
    substance abusing adolescents and their families

3
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)

4
  • Adolescents because of immaturity of impulse
    control and judgment are especially prone to
    experimentation with drug alcohol use

5
  • Novelty seeking, poor parental supervision and
    peer involvement further reinforce use

6
  • Adolescent autonomy and freedom offer
    opportunities for use

7
  • Teens with ADHD, Conduct Disorder, Trauma history
    and school failure are especially at risk

8
  • Situations with limited opportunity, easy access
    to drugs, routine family and community use
    amplify use

9
Specific risks of drug use
  • Binge Drinking
  • Inexperience coupled with impulsivity
  • Secondary problem unwanted sexual behavior,
    rape
  • Disinhibition
  • Driving while intoxicated

10
  • Addiction with associated withdrawal is rare in
    adolescence, however other consequences are
    common poor school performance, family conflict
    and legal difficulties

11
  • 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

12
Assessment
  • Substance Use History
  • Drugs used
  • Frequency of use
  • Places used

13
  • Type of use impulsive, planned, measured
  • Goals of use of each drug
  • Progression of use

14
Consequences of Use
  • Costs
  • Drug influenced behaviors
  • Arrests

15
  • School failure
  • Peer relations
  • Pregnancy

16
  • Erratic and unreliable behavior
  • Lying
  • Irritability, argumentativeness, relationship
    problems

17
Mental Health Co morbidities
  • Depression
  • Anxiety
  • Post trauma difficulties
  • Sequellae of childhood maltreatment

18
  • ADHD
  • Bipolar Disorder
  • Adolescent schizophrenia
  • Eating disorders, especially bulimia

19
Family Situation and Relationships
  • Socioeconomic concerns
  • Parental mental health concerns, especially mood
    disorders
  • Parental substance use
  • Parenting style especially supervision and
    monitoring

20
  • Parental response to drug use
  • Marital or post divorce conflict
  • Parental preoccupation

21
  • Be sure to assess strengths, capacities,
    interests and possibilities

22
Approach to Treatment
  • Motivation is malleable
  • Relationships critical
  • Treatment individualized
  • Planning and flexibility operate together

23
Domains of adolescent function
  • Identify development/support autonomy linked with
    responsibility
  • Peers
  • Bonding to prosocial institutions

24
  • Racial/cultural issues
  • Health/sexuality
  • Drug use

25
  • Look for impairments in 2 or more domains
  • Look for development detouring effects
  • Multiple approaches
  • Multiple targets
  • Multiple interventions

26
Treatment involves
  • Development
  • Preventing problem behavior
  • Therapy
  • Individual
  • Family
  • Treatment parameters time, space, frequency, etc

27
  • Motivational interviewing can be very useful in
    helping youth appreciate consequences of drug use
    and deciding if drug use furthers their personal
    goals

28
Attend to Risk
  • Economic Deprivation
  • Parental Difficulty
  • Family Conflict

29
  • Poor parental management
  • Poor conflict resolution
  • Frustration relief through disconnect with child

30
  • Family primary location for child treatment
  • Buffers negative peer environment
  • Goal interdependence

31
  • Engagement of parents
  • hopeful, enthusiastic and realistic
  • question denial

32
  • 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

33
  • Develop drug free expectation
  • rules
  • monitoring
  • consequences
  • reparations
  • parental collaboration

34
  • Decide how to deal with crises
  • suicide
  • intoxication
  • arrest
  • school responses
  • peer difficulties

35
  • Promoting positive family interaction
  • conflict resolution
  • supportive engagement
  • hope for sober outcomes

36
  • addressing family conflicts openly
  • constructive not punitive
  • reinforcing drug free activities
  • enhancing communication

37
  • Encouraging adolescent voice and goals
    individual sessions

38
  • Dealing with relapses
  • harm reduction

39
  • Encouraging engagement with mutual support
    organizations and drug treatment programs

40
  • Engage family in treatment of
  • co morbid problems in child
  • Co morbid problems in parent

41
Prevention efforts
  • Enhancement of academic opportunities
  • Provide treatment for co morbid problems
  • Engage families in shared activities
  • Provide after school opportunities activities,
    sports, jobs

42
  • Target especially at risk teens
  • Build drug-free recreation experiences

43
Resources
  • Schools
  • Jobs
  • Prosocial Support
  • Activities
  • Medical
  • Other

44
Goals
  • Build a therapeutic alliance with the adolescent
  • Create a collaborative agenda
  • Establish a developmental ecological framework
    of treatment

45
  • Improve functioning in several developmental
    domains
  • Transform a drug using lifestyle into a
    developmentally normal lifestyle
  • Facilitate developmentally adaptive competence in
    multiple settings

46
  • Build a therapeutic alliance with a parent
  • Create a collaborative agenda
  • Establish a developmental ecological framework
  • Facilitate parental commitment

47
  • 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)
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