Barbara Seitz de Martinez, PhD, MLS, CPP Deputy Director, Indiana Prevention Resource Center

1
Barbara Seitz de Martinez, PhD, MLS, CPPDeputy
Director,Indiana Prevention Resource Center
The Dilemma of Underage Drinking in Indiana

• Safe Drug Free Schools Workshop
• Spring 2008

The Indiana Prevention Resource Center is funded,
in part, by a contract with the Indiana Family
and Social Services Administration, Division of
Mental Health and Addiction, financially
supported through HHS/Substance Abuse Mental
Health Services Administration, Center for
Substance Abuse Prevention, Substance Abuse
Prevention and Treatment Block Grant. The IPRC is
operated by the Indiana University Department of
Applied Health Science and School of Health,
Physical Education and Recreation. It is
affiliated with the Department's Institute of
Drug Abuse Prevention.
2
Gateway Drugs

• Research has shown that the majority of
  individuals' illicit drug use occurs only after
  they use cigarettes, alcohol, or marijuana. These
  three are known as the "gateway drugs." (Bailey,
  1992 Donovan Jessor, 1983 Fleming, Leventhal,
  Glynn, Ershler, 1989 Golub Johnson, 2001
  Kandel Yamaguchi, 1993).

3
Alcohol and Rx Drugs
Males and females with alcohol dependence are 18x
more likely to abuse prescription drugs than are
those who abstain from alcohol use. Youth under
age 25 are especially vulnerable to abusing both
alcohol and prescription drugs. Source
Elizabeth Ashton, Alcohol Abuse Makes
Prescription Drug Abuse More Likely, NIDA Notes
21/5 (March 2008)8-9.
Note Preventing or delaying use of alcohol will
reduce the likelihood of drug use and of other
associated problem behaviors.
IPRC Call 800 346-3077 www.drugs.indiana.edu
4

• We need to remember that alcohol is a gateway
  drug.
• When new drug trends emerge we must remember that
  alcohol, along with tobacco,
• is a primary drug of abuse and must be addressed
  aggressively .

ATOD Survey, p. 112
5
ATOD Survey, p. 112
6
ATOD Survey, p. 112
7
ATOD Survey, p. 112
8

• ATOD Survey, p. 122

9
ATOD Survey, p. 112
10
Indiana Students Use
3-10 times in last 2 wks. 1.3 2.3 4.2
5.5 7.7 8.3 10.8
IPRC, ATOD Survey Monograph, 2007
11
Drugs and Driving by American High School
Seniors, 2001-2006

• In 2006, 30 of HS seniors reported exposure to a
  drugged or drinking driver in the past 2 weeks
• This was down from 35 in 2001
• Exposure was widespread
• Individual lifestyle factors were associated with
  outcome behaviors

Source Patrick M. OMalley, Drugs and Driving
by Am HS Sr, 2001-2006, Jrnl of Studies on
Alcohol and Drugs 68/6 (November 2007)834-842.
12
Individual Lifestyle Factors Associated with
Drugs and Driving

• Religiosity
• Grade point average
• Truancy
• Frequency of evenings out for fun
• Hours of work

Source Patrick M. OMalley, Drugs and Driving
by Am HS Sr, 2001-2006, Jrnl of Studies on
Alcohol and Drugs 68/6 (November 2007)834-842.
IPRC Call 800 346-3077 www.drugs.indiana.edu
13
Age of 1st Use
. . . the younger a person is when she or he
begins using alcohol, the more likely the person
is to experience alcohol dependence and
abuse (Grant, Stinson, Harford, 2001 Warner
White, 2003). A recent study found that
compared to persons who began drinking at age 21
or older, those who began drinking before age 14
were more likely to experience alcohol dependence
later in life (R. W. Hingson, Heeren, Winter,
2006).
Note Preventing or delaying use of alcohol will
reduce the likelihood of other drug use and of
other associated problem behaviors.
14
Age of 1st Use Alcohol (IN)
IPRC, ATOD Survey Monograph, 2007
15
Age of 1st Use
IPRC, ATOD Monograph, p. 14
16
Perceived Risk of Harmand Annual Prevalence
IPRC, ATOD Monograph, p. 15
17
Perceived Risk of Harmand Monthly Prevalence
IPRC, ATOD Monograph, p. 16
18
Perceived Peer Approvaland Annual Prevalence
IPRC, ATOD Monograph, p. 17
19
Perceived Peer Approvaland Monthly Prevalence
IPRC, ATOD Monograph, p. 18
20
Perceived Parental Approvaland Annual Prevalence
IPRC, ATOD Monograph, p. 18.
21
Perceived Parental Approvaland Monthly Prevalence
IPRC, ATOD Monograph, p. 18
22
The Importance of Norms

• Promoting and maintaining a culture or
  environment where the perception of risk of harm
  from alcohol use and the perception of parental
  and peer disapproval of alcohol use is greater
  will reduce the likelihood of drug use and
  associated problems.

23
After-School Activitiesand Annual Prevalence
IPRC, ATOD Monograph, p. 18
24
After-School Activitiesand Monthly Prevalence
IPRC, ATOD Monograph, p. 18
25
Indiana Students Use
IPRC, ATOD Survey Monograph, 2007
26
Importance of Monitoring

• Parental monitoring of their childs activities
  and involvement in those activities are powerful
  tools in reducing the likelihood of drug use.
  The hours from 3-6 p.m. are particularly
  important because this is a time when many
  parents are working and the child may be
  presented with temptations to initiate drug use.

27
Survey of Alcohol Compliance

• April 16, 2008
• new program initiated by State Excise Police
• evaluates the sale of alcohol to persons under 21
  
• attempts to mirror success of TRIP

Source Aaron Jones, http//www.drugs.indiana.edu
/news-featured_detail.aspx?seq12
28
SAC Inspections

• State Excise Police SAC Inspections
• collaboration -- State Excise Officers and 18-20
  year-olds
• primary goal -- to reduce access and availability
  
• one of many strategies
• IPRC Role
• recruiting and hiring youth
• other administrative duties

Source Aaron Jones, http//www.drugs.indiana.edu
/news-featured_detail.aspx?seq12
29
New KnowledgeAlcohol and the Alcoholic Lung

• Alcohol abuse increases the risk of acute lung
  injury, e.g., following
• major trauma, such as a serious motor vehicle
  accident, gunshot,
• other event requiring hospitalization,
• the spread of bacteria attributed to infection.
• can occur even in young and otherwise healthy
  individuals

Source Corey D. Kershaw and David Guidot,
Alcoholic Lung Disease, Alcohol Research
Health 31/1 (2008)66-75.
30
IPRC Activities

• Survey of Alcohol Compliance
• Drug Information Portal
• ATOD Survey of ATOD Use by IN Children and
  Adolescents
• PREV-STAT GIS Data and Mapping Resources
• After School Prevention Programs R.O.C.K.
• Grant-Writing and Evaluation Support
• Strategic Prevention Framework approach and SIG
  support
• School Prevention Curricula
• Library Literature, Reference Services, AV
  loans
• Problem Gambling Prevention

31
IPRC Activities
Preventing or delaying use of alcohol will reduce
the likelihood of drug use and of other
associated problem behaviors.
The greater the perception of risk of harm from
alcohol use and the greater the perception of
parental and peer disapproval of alcohol use the
less likely it is that youth will use alcohol and
other drugs or experience associated problems.
Promote or maintain such a culture in your family
and environment.
Parental monitoring of their childs activities
and involvement in those activities are powerful
tools in reducing the likelihood of drug use.
The hours from 3-6 p.m. are particularly
important because this is a time when many
parents are working and the child may be
presented with temptations to initiate drug use.
We need to remember that alcohol is a gateway
drug. When new drug trends emerge we must
remember that alcohol, along with tobacco, is a
primary drug of abuse and must be addressed
aggressively.
32
Barbara Seitz de Martinez, PhD, MLS, CPPDeputy
Director,Indiana Prevention Resource Center
Tobacco Use By School Students in Indiana

• Safe Drug Free Schools Workshop
• Spring 2008

The Indiana Prevention Resource Center is funded,
in part, by a contract with the Indiana Family
and Social Services Administration, Division of
Mental Health and Addiction, financially
supported through HHS/Substance Abuse Mental
Health Services Administration, Center for
Substance Abuse Prevention, Substance Abuse
Prevention and Treatment Block Grant. The IPRC is
operated by the Indiana University Department of
Applied Health Science and School of Health,
Physical Education and Recreation. It is
affiliated with the Department's Institute of
Drug Abuse Prevention.
33
IPRC, ATOD Survey Monograph, 2007
34
IPRC, ATOD Survey Monograph, 2007
35
Indiana Students Use
IPRC, ATOD Survey Monograph, 2007
36
Indiana Students Use
IPRC, ATOD Survey Monograph, 2007
37
IPRC, ATOD Survey Monograph, 2007
38
IPRC, ATOD Survey Monograph, 2007
39
Age of 1st Use Cigarettes (IN)
IPRC, ATOD Survey Monograph, 2007
40
Barbara Seitz de Martinez, PhD, MLS, CPPDeputy
Director,Indiana Prevention Resource Center
Marijuana Use among School Studentsin Indiana

• Safe Drug Free Schools Workshop
• Spring 2008

The Indiana Prevention Resource Center is funded,
in part, by a contract with the Indiana Family
and Social Services Administration, Division of
Mental Health and Addiction, financially
supported through HHS/Substance Abuse Mental
Health Services Administration, Center for
Substance Abuse Prevention, Substance Abuse
Prevention and Treatment Block Grant. The IPRC is
operated by the Indiana University Department of
Applied Health Science and School of Health,
Physical Education and Recreation. It is
affiliated with the Department's Institute of
Drug Abuse Prevention.
41
Marijuana

• Most widely used illicit drug (US/EU) 4 million
  in US
• Most widely used secondary drug for stimulant or
  opiate dependence (p.9)
• Marijuana dependence exists
• Very similar to other substances
• Adults seeking treatment (10 yrs/6 serious quit
  attempts)
• Withdrawal creates real symptoms
• Dependence 2x as prevalent as any other illicit
  drug
• About 50 of heavy marijuana users also smoke
  tobacco

Source Budney, Alan J., et al., Marijuana
Dependence and Its Treatment, Addiction Science
Clinical Practice (December 2007)4-16.
42
IPRC, ATOD Survey Monograph, 2007
43
IPRC, ATOD Survey Monograph, 2007
44
Indiana Students Use
IPRC, ATOD Survey Monograph, 2007
45
IPRC, ATOD Survey Monograph, 2007
46
Indiana Students Use
IPRC, ATOD Survey Monograph, 2007
47
IPRC, ATOD Survey Monograph, 2007
48
Marijuana Impaired Driving

• 5 of persons 12 (NSDUH)
• 15-18 of 18-21 yr. olds (illicit -- NSDUH)
• 20 of HS drivers in Canada

49
High School Seniors DUI
18.2
Source Patrick M. OMalley, Drugs and Driving
by Am HS Sr, 2001-2006, Jrnl of Studies on
Alcohol and Drugs 68/6 (November 2007)834-842.
50
High School Seniors Riding with an Impaired
Driver
24.4
Source Patrick M. OMalley, Drugs and Driving
by Am HS Sr, 2001-2006, Jrnl of Studies on
Alcohol and Drugs 68/6 (November 2007)834-842.
51
High School Seniors DUI or Riding with an
Impaired Driver
29.6
Source Patrick M. OMalley, Drugs and Driving
by Am HS Sr, 2001-2006, Jrnl of Studies on
Alcohol and Drugs 68/6 (November 2007)834-842.
52
Withdrawal Symptoms

• Cravings
• Anxiety
• Depression -- feelings of misery
• Difficulty sleeping
• Chills and muscle pain
• Irritability
• Predictable (timeframe)
• Mild compared to heroin or severe alcohol

Budney et al, 2004 Budney and Hughes, 2006.
Cited in Research Review Marijuana Dependence
and Its Treatment, Addiction Science Clinical
Practice 4/1 (December 2007)10.
53
Percent of SA Treatment Admissions due to
Marijuana
Marijuana admissions nearly doubled 1993-2005
Cocaine
Marijuana
Source SAMHSA, 2006. Cited by Budney, Alan J.,
et al., Marijuana Dependence and Its Treatment,
Addiction Science Clinical Practice (December
2007)4-16.
54
Adolescent Drug Treatment
Marijuana the most adolescent admissions
Source SAMHSA, 2006. Cited by Budney, Alan J.,
et al., Marijuana Dependence and Its Treatment,
Addiction Science Clinical Practice (December
2007)4-16.
55
Why the Rise in Youth Use?

• Higher potency marijuana
• Initiation of use at younger age
• Rise in use among young adult African-American
  and Hispanic men and African-American women

Source Compton, 2004 JAMA 291/17. Cited by
Budney, Alan J., et al., Marijuana Dependence
and Its Treatment, Addiction Science Clinical
Practice (December 2007)4-16.
56
Why the Rise among Minorities?

• Effects of acculturation on Hispanic youth
• More minority youth attending college
• Environmental and economic factors
• Higher prices and stricter government policies
  for other drugs

Source Budney, Alan J., et al., Marijuana
Dependence and Its Treatment, Addiction Science
Clinical Practice (December 2007)4-16.
57
Adolescent Risks

• Adverse health and psychosocial consequences
• Sexually transmitted diseases and pregnancy
• Early school dropout
• Delinquency
• Legal problems
• Lowered educational and occupational aspirations
• Typically forced into treatment (Diamond et al,
  06)

Source Budney, Alan J., et al., Marijuana
Dependence and Its Treatment, Addiction Science
Clinical Practice (December 2007)4-16.
58
Barbara Seitz de Martinez, PhD, MLS, CPPDeputy
Director,Indiana Prevention Resource Center
The Dilemma of Rx and OTC Drug Abuse in Indiana

• Safe Drug Free Schools Workshop
• Spring 2008

The Indiana Prevention Resource Center is funded,
in part, by a contract with the Indiana Family
and Social Services Administration, Division of
Mental Health and Addiction, financially
supported through HHS/Substance Abuse Mental
Health Services Administration, Center for
Substance Abuse Prevention, Substance Abuse
Prevention and Treatment Block Grant. The IPRC is
operated by the Indiana University Department of
Applied Health Science and School of Health,
Physical Education and Recreation. It is
affiliated with the Department's Institute of
Drug Abuse Prevention.
59
Recommended web site

• www.theantidrug.com

60
The Family Medicine Cabinet

• Pain Killers (e.g., post-surgical Rx)
• Depressants (e.g., sleeping, anti-anxiety)
• Stimulants (e.g., for ADHD)
• OTC (e.g., cough and cold remedies)

www.theantidrug.com
61
Danger

• Pain Meds and Depressants breathing failure
• Stimulants heart system failure, seizures
• OTC blurred vision, nausea, vomiting, coma,
  death
• Combining the above risks respiratory failure and
  death.

www.theantidrug.com
62
Upsetting Trend Pain Meds

• Every day
• 2500 teens ages 12-17
• abuse a pain medication
• for the 1st time.
• Many dont realize the danger.

www.theantidrug.com
63
Upsetting Trend Pain Meds

• Nearly 1 in 5 teens (18 or 4.3 million) report
  abusing Vicodin
• 1 in 10 teens (10 or 2.3 million) report abusing
  OxyContin

Partnership for a Drug-Free America,
www.drugfree.org
64
Upsetting Trend Stimulants

• 1 in 10 teens (10 or 2.3 million) report trying
  Ritalin and/or Adderall without a doctors
  order.
• 1 in 11 teens (9 or 2.2 million) has abused OTC
  cough meds to get high (contains
  dextromethorphan).

Partnership for a Drug-Free America,
www.drugfree.org
65
Upsetting Trend Rx Drugs

• Of illicit drugs, only marijuana has more teen
  abusers
• More than 2.1 million teens reported abusing Rx
  drugs
• The Drug of Choice for 12-13 year olds

www.theantidrug.com
66
Multiple Drug Use

• Individuals who report using Oxycontin
  typically have a history of multiple drug use
  including non-medical use of other prescription
  medications such as tranquilizers, sedatives and
  stimulants. (Sees et al, 2005)

IPRC, ATOD monograph, 2007.
67
Indiana Stats Rx Drugs

• ATOD Survey of 6th-12th graders asks about
• Amphetamines
• Methamphetamines
• Ritalin or Adderall
• Tranquilizers
• Rohypnol
• Over the Counter Drugs

68
Indiana Stats Rx Drugs
Drug 6th 6th 8th 8th 10th 10th 12th 12th
IN US IN US IN US IN US
Amphetamines 0.3 2.3 4.7 5.7 7.9 5.4 8.1
Methamphetamine 0.2 1.2 1.8 1.9 1.8 1.9 2.5
Tranquilizers 2.8 6.7 2.6 9.5 5.2 8.3 6.6
Ritalin or Adderall 0.7 3.3 2.6 7.4 3.6 7.0 4.4
Rohypnol 0.1 0.8 0.5 1.1 0.5 1.0 1.1
OTC 3.8 8.0 10.3 8.5
69
What to do if you suspect

• Get educated
• Have the talk Let them know you know
• Be specific about your concerns
• Dont make excuses
• Try to remain calm and connect with him/her
• Be prepared practice what youll say
• Act now monitor your child, get involved
• Be available to listen
• Set and enforce rules

www.theantidrug.com
70
Prevention What You Can Do

• Keep all drugs at home. Monitor and control
  meds.
• Set clear rules about all drugs
• Teach child to follow doctors advise and dosage
• Teach child to not share medications
• Be a good role model
• Properly conceal and dispose of unused meds
• Ask friends and family to control their Rx and
  OTC
• Talk to your teen

www.theantidrug.com
71
Barbara Seitz de Martinez, PhD, MLS, CPPDeputy
Director,Indiana Prevention Resource Center
Methamphetamine Impact on Indiana School Children

• Safe Drug Free Schools Workshop
• Spring 2008

The Indiana Prevention Resource Center is funded,
in part, by a contract with the Indiana Family
and Social Services Administration, Division of
Mental Health and Addiction, financially
supported through HHS/Substance Abuse Mental
Health Services Administration, Center for
Substance Abuse Prevention, Substance Abuse
Prevention and Treatment Block Grant. The IPRC is
operated by the Indiana University Department of
Applied Health Science and School of Health,
Physical Education and Recreation. It is
affiliated with the Department's Institute of
Drug Abuse Prevention.
72
Vigo County Profile, 6.5
Methamphetamine Laboratory Seizures, 1998-2005 (ISP, 2006) Methamphetamine Laboratory Seizures, 1998-2005 (ISP, 2006) Methamphetamine Laboratory Seizures, 1998-2005 (ISP, 2006)
Vigo Indiana
1998 (Any Agency) 1 43
1999 (Any Agency) 18 129
2000 (Any Agency) 52 314
2001 (Any Agency) 66 542
2002 (Any Agency) 105 988
2003 (Any Agency) 108 1,278
2004 (Any Agency) 166 1,549
2005 (IPS) 19 989
2005 (Any Agency) 83 1,303
Table 6.5 Clandestine Methamphetamine Lab Seizures, (ISP, 2007)(ATC, Indiana State Excise Police, 2006)
73
Map Meth Lab Busts (prism)
Source IN State Police, 2007
Total lab busts in 2006, 993
Indiana Prevention Resource Center
74
Meth Impact on Parenting

• Inconsistent and inappropriate emotional
  responsiveness to children
• Unpredictable and impulsive
• Paranoid and delusional
• Disorganized lifestyle
• Experience interpersonal violence

Source Brown, Julie A. and Melinda Hohman, The
Impact of Methamphetmine Use on Parenting, in
The Impact of Substance Abuse on Children and
Families Research and Practice Implications,
Shulamith Lala Ashenberg Straussner and
ChristineHuff Fewell, eds. New York Haworth
Press, 2006, pp. 63-88.
75
Themes Impact on Parenting

• Polar Parenting
• Drug Management
• The Separate Life
• Domestic Violence
• Effects on Children
• Retrospective Ambivalence

Source Brown, Julie A. and Melinda Hohman, The
Impact of Methamphetmine Use on Parenting, in
The Impact of Substance Abuse on Children and
Families Research and Practice Implications,
Shulamith Lala Ashenberg Straussner and
ChristineHuff Fewell, eds. New York Haworth
Press, 2006, pp. 63-88.
76
Themes RE Impacts on Parenting Themes RE Impacts on Parenting
Polar Parenting Extreme feelings of anger or apathy, not balanced by positive expressions
Drug Management The logistics of using meth as a parent of young children
The Separate Life Parents removing themselves, and their drug use from their children
Domestic Violence Violence between marital and live-in partners violent crimes against family members in the home a side effect of use
Effects on Children Physical, environmental, emotional, and psychological impacts.
Retrospective Ambivalence Differing opinions and beliefs about whether or not they were able to handle their parental role while using meth
Source Julie A Brown and Melinda Hohman, Impact
of SA on Children and Families Research and
Practice Implications. Haworth Press, 200670
77
Child Experience in Meth Home

• Neglect (due to use and binge/crash cycle)
• Often exposed to home manufacturing
• Exposure to toxic chemicals and fumes
• Exposed to violent, aggressive behavior
• Parents multiple sex partners
• Withdrawal intense depression/irritability
• Very similar to other substances

Source Brown, Julie A. and Melinda Hohman, The
Impact of Methamphetmine Use on Parenting, in
The Impact of Substance Abuse on Children and
Families Research and Practice Implications,
Shulamith Lala Ashenberg Straussner and
ChristineHuff Fewell, eds. New York Haworth
Press, 2006, pp. 63-88.
78
IPRC Activities
Preventing or delaying use of gateway drugs will
reduce the likelihood of drug use and of other
associated problem behaviors.
The greater the perception of risk of harm from
drug use and the greater the perception of
parental and peer disapproval of alcohol use the
less likely it is that youth will use alcohol or
other drugs or experience associated problems.
Promote or maintain such a culture in your family
and environment.
Parental monitoring of their childs activities
and involvement in those activities are powerful
tools in reducing the likelihood of drug use.
The hours from 3-6 p.m. are particularly
important because this is a time when many
parents are working and the child may be
presented with temptations to initiate drug use.
Remember the gateway drugs. When new drug trends
emerge we must remember that alcohol and/or
tobacco are usually the 1st drugs used. Dont
forget the importance of addressing these
aggressively, as well as enhancing protective
factors.
79
Protective Factors
IPRC, ATOD Survey Monograph, 2007
80
Protective Factors
IPRC, ATOD Survey Monograph, 2007
81
Promote a healthy lifestyle, strong values,
bonding w/ family, school, community.
IPRC, ATOD Survey Monograph, 2007
82
Thank you!

• Call 327 / 855-0851
• E-mail seitzb_at_indiana.edu
• www.drugs.indiana.edu