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Working with Youth with Co-Occurring Disorders

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Title: Working with Youth with Co-Occurring Disorders


1
Working with Youth with Co-Occurring Disorders
  • Sharon Hunt, TA Partnership Interim Substance
    Abuse Resource Specialist
  • Rachel Freed, Research Associate for the TA
    Partnership
  • Rebecca Spotts, Research Assistant for the TA
    Partnership
  • Cathy Ciano, Executive Director, Parent Support
    Network of Rhode Island
  • Nick Vaske, youth presenter from Families First
    Foremost

2
Overview
  • Sharon R. Hunt
  • 202-403-6914
  • shunt_at_air.org

3
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4
Prevalence Chronicity
  • Co-occurring mental disorders are common and
    serious (prevalence rates 20 - 80, depending on
    sample pool).
  • Research indicates the onset of the mental
    disorder often precedes the addictive disorder.
    (Temporal order)
  • The likelihood of adolescent substance use and
    dependence is strongly associated with younger
    age of onset, severity of emotional and
    behavioral problems, true across age and gender.
  • Initially use is voluntary, thus the earlier the
    intervention the greater the impact on offsetting
    what later becomes a chronic, relapsing disease
    in which brain chemistry is altered.

5
(No Transcript)
6
Most Common Presenting Problems
  • Verbal/physical Aggressiveness
  • Academic Difficulties
  • Impulsivity
  • Hyperactivity
  • Depressed Mood
  • Poor Social Skills

7
Substance Use History at Intake by Age Category
Have you ever used
Substances
11 to 14 Years Old Number of children varied
from 2,440 to 2,452. 15 to 18 Years Old Number
of children varied from 1,571 to 1,575.
Substance use information was based on self
reports from youth 11 years or older.
8
Multiple Co-occurring Problems Are the Norm and
Increase with Level of Care
Source CSATs Cannabis Youth Treatment (CYT),
Adolescent Treatment Model (ATM), and Persistent
Effects of Treatment Study of Adolescents
(PETS-A) studies
9
Multiple Co-occurring Problems By Lifetime
Dependence Diagnosis
Source CSATs Cannabis Youth Treatment (CYT),
Adolescent Treatment Model (ATM), and Persistent
Effects of Treatment Study of Adolescents
(PETS-A) studies
10
Adolescents in TreatmentSubstance Use Disorders
  • 40 90 Report Victimization
  • 20 25 Report Victimization in last 90 days, or
    current concern regarding reoccurrence
  • Source Dennis, Stevens Chaffin, in press

11
Clinical Diagnosis on any Axis at Intake by
Comorbidity Status
Clinical Diagnoses
No Comorbidity n 4,855. Comorbidity w/o
Substance Use n 4,633. Comorbidity w/
Substance Use n 697.
Percent
Because children may have more than one
diagnosis, the diagnosis variable may add to more
than 100. V Code refers to Relational
Problems, Problems Related to Abuse or Neglect,
and additional conditions that may be a focus of
clinical attention.
12
Treatment Prognosis
  • Prognosis is worse for youth with co-occurring
    disorders for many reasons motivation academic,
    family, and behavior problems and limited coping
    and social skills.
  • May lag in important adolescent development tasks
    individuation, moral development and
    conceptualization of future family, vocational
    and educational goals.

13
Cumulative Recovery Pattern at 30 months(The
majority vacillate in and out of recovery)
5 Sustained
Recovery
37 Sustained
19 Intermittent,
Problems
currently in
recovery
39 Intermittent,
currently not in
recovery
Source Dennis et al, in press forthcoming,
CYT, PETSA
14
Adapting Treatment for Adolescents
  • Examples need to be altered to relevant
    substances, situations, and triggers
  • Consequences have to be altered to things of
    concern to adolescents
  • Most adolescents do not recognize their substance
    use as a problem and are being mandated to
    treatment
  • All materials need to be converted from abstract
    to concrete concepts
  • Comorbid problems (mental, trauma, legal) are the
    norm and often predate substance use
  • Treatment has to take into account the multiple
    systems (family, school, welfare, criminal
    justice)
  • Less control of life and recovery environment
  • Less aftercare and social support
  • Complicated staffing needs

15
MENTAL HEALTH INTERVENTIONS FOR CO-OCCURING
DISORDERS
  • EVIDENCE-BASED INTERVENTIONS
  • COGNITIVE BEHAVIOR-THERAPY(CBT)
  • INTEGRATED COGNITIVE-BEHAVIOR THERAPY FOR
    TRAUMATIC STRESS SYMPTOMS AND SUBSTANCE ABUSE
  • MULTI-SYSTEMIC THERAPY
  • MOTIVATIONAL ENHANCEMENT THERAPY WITH CBT
  • EFFECTIVE INTERVENTIONS
  • SUPPORTIVE THERAPY
  • SYSTEMIC FAMILY THERAPY
  • INTENSIVE CASE MANAGEMENT
  • COMMUNITY REINFORCEMENT
  • NETWORK THERAPY
  • METHADONE
  • NALTREXONE

16
Racial/Ethnic Disparities in Drug Prevalence
among Youth
  • Rebecca Spotts
  • rspotts_at_air.org
  • 202-403-5847

17
Racial/Ethnic Disparities in Drug Prevalence
among Youth
  • Prevalence
  • The role of culture
  • Equal access to treatment

18
Prevalence by Race/Ethnicity
  • Evidence shows a significantly greater prevalence
    of substance abuse among Hispanics and Caucasian
    youth than African American youth at every grade
    level (National Institutes for Health)
  • American Indian/Alaska Native youth had the
    highest rate of illicit drug use among youth age
    12-17 at 19.6, compared to 10.9 for Caucasian
    youth and 10.7 for African American youth(1999
    National Household Survey on Drug Abuse)

19
Estimated Lifetime Prevalence of Selected Drugs
by Race/Ethnicity for Students in Grade 12 ()
2000.Source U.S. Department of Health and
Human Services National Institutes of Health
report Drug Use Among Racial/Ethnic Minorities
20
  • Dr. Gayle Porter, TA Partnership

21
  • Dr. Gayle Porter, TA Partnership

22
What puts youth at risk for drug abuse? The role
of culture
  • The cultures from which people hail affect all
    aspects of mental health and illness, including
    the types of stresses that they confront, whether
    they seek help, what type of help they seekand
    what types of coping styles and social supports
    they possess.
  • (U.S. Department of Health and Human
    Services, 2001)

23
Sources of Risk for Substance Abuse(www.safeyouth
.org)
  • Three sources
  • Individual child factors - biology, behavior and
    personality
  • Youth with emotional and psychological problems
    are at greater risk for substance use and abuse
    (www.safeyouth.org)
  • Family factors
  • Do not perceive a strong parental disapproval for
    drug use
  • Environmental factors
  • Youth do not perceive appropriate risk involved
    with substance abuse

24
Increased Risk Environmental Factors(www.safeyou
th.org)
  • Community disorganization
  • Lack of community bonding
  • Community attitudes toward favorable drug use
  • Inadequate services and opportunities for youth
  • Pro-drug messages in the media

25
Disparities for Children of Diverse Racial and
Ethnic Groups
  • African American and Hispanic/Latino youth
    identified/referred at same rates as general
    population, but less likely to receive mental
    health or meds (Kelleher, 2000)
  • Minority children tend to receive mental health
    services through juvenile justice and child
    welfare systems more often that through schools
    or mental health settings (Allegria, 2000)
  • African American and Hispanic/Latino children
    have the highest rates of unmet need (Strum,
    2000)

26
How do youth get access to substance abuse
treatment?
  • Primary referral source by Racial and Ethnic
    Group in 1998-99 Funded SOC communities
    (Guilford, 2004 ORC Macro)

American Indian/Alaska Native Caregiver/Self (44.7)
African American Juvenile Justice (24.9)
White Non-Hispanic Education (20.1)
Hispanic/Latino Juvenile Justice (28.4)
Asian Juvenile Justice (28.2)
Native Hawaiian Child Welfare (22.2)
Multi-Race Mental Health (32.5)
Other Mental Health (22.4)
27
Access to Services and Treatment
  • SOC communities must develop a culturally
    competent strategy to reach out to at-risk youth
    in their area to combat substance abuse before it
    begins.
  • www.preventioncurriculum.com/handbook/Chapter5Full
    Text.pdf

28
Nick VaskeFamilies First Foremost
  • 402-441-3803 (Number for Families First
    Foremost)
  • nvaske_at_neb.rr.com

29
Ecstasy and Club Drugs
  • Rachel Freed
  • 202-403-5389
  • rfreed_at_air.org

30
  • I remember the feeling I had the first time I
    did Ecstasy complete and utter bliss. I could
    feel the pulse of the universe I let every
    breath, touch and molecule move my soul. It was
    as if I had unlocked some sort of secret world
    it was as if I'd found heaven. And I have to
    admit, I wondered how anything that made you feel
    so good could possibly be bad.
  • Lynn Smith

31
What Are Club Drugs?
The most widely used club drugs are GHB,
Rohypnol, Ketamine, and MDMA
Drug Street Name
GHB G, liquid ecstasy, Grievous Bodily Harm, gib, soap, scoop, nitro
Rohypnol Mexican valium, circles, roofies, la rocha, roche, rophies, R2, rope, forget-me pill
Ketamine K, special K, super K, vitamin K, kit-kat, keets, super acid, jet, cat valiums
MDMA Ecstasy, X, M, E, XTC, rolls, beans, Clarity, Adam, lover's speed, hug drug
32
What Are Club Drugs?
  • GBH
  • GHB is usually abused either for its
    intoxicating/sedating/euphoria-inducing
    properties, or for its growth hormone-releasing
    effects
  • Overdose may result in seizures, coma, and death
  • May also produce withdrawal effects, including
    insomnia, anxiety, tremors, and sweating
  • Ketamine
  • Large doses cause reactions similar to those
    associated with use of PCP, such as dream-like
    states and altered perceptions or
    hallucinations. 
  • At higher doses, can cause delirium, amnesia,
    impaired motor function, high blood pressure,
    depression, and potentially fatal respiratory
    problems
  • Rohypnol
  • Produces sensations of floating outside the body,
    visual hallucinations, and a dream-like state
  • When mixed with alcohol, it can incapacitate
    victims and prevent them from resisting sexual
    assault
  • Often produces anterograde amnesia
  • May be lethal when mixed with alcohol and/or
    other depressants.

33
What is Ecstasy?The Facts
  • An illegal psychoactive drug
  • Produces effects similar to hallucinogens and
    stimulants
  • energizing effect
  • distortions in time and sensory perceptions
  • feelings of peace and happiness and empathy for
    others
  • suppresses the desire to eat, drink, or sleep
  • Popular at raves and other all-night party scenes

34
Myths and inaccurate information about the
effects and long-term consequences of Ecstasy are
widespread among its users . . .
35
Physical Effects
  • In low doses . . .
  • faintness
  • dehydration
  • muscle tension
  • involuntary teeth clenching
  • nausea
  • blurred vision
  • chills or sweating
  • hypertension
  • increases in heart rate, blood pressure, and
    temperature
  • In high doses . . .
  • liver, kidney, and heart failure
  • strokes
  • seizures

36
Psychological Effects
  • depression
  • delusions
  • mood swings
  • lapses in memory
  • anxiety
  • panic attacks
  • confusion
  • disorientation

Research on animals suggests that Ecstasy use
can cause long-term damage to the parts of the
brain that use serotonin (NIDA, 2005).
37
Other Risks
  • There is no control over the pill ingredients
  • The ingredients are difficult to obtain, so
    manufacturers often substitute ingredients
  • ephedrine
  • dextromethorphan
  • caffeine
  • Other, more dangerous drugs are sometimes sold as
    ecstasy.
  • ketamine
  • cocaine
  • methamphetamine

38
Mental Health and Ecstasy
  • Strong correlation between Ecstasy use and
    depression
  • 2 possible reasons
  • Some users may be more vulnerable to the adverse
    effects of Ecstasy
  • Users may have pre-existing mental health
    problems for which they self-medicate by using
    ecstasy
  • Some ex-users experience a mental health
    impairment that persists for years after they
    stop using this drug. Verheyden SL, Maidment R,
    Curran HV (2003) Quitting ecstasy an
    investigation of why people stop taking the drug
    and their subsequent mental health. J
    Psychopharmacol., 17(4), 371-378.

39
Mental Health and Ecstasy (cont.)
A study by Lieb and colleagues (2002) followed
the same 2,500 14-24 year olds for four years,
tracking changes in drug use and mental health
  • Lieb R, Schuetz CG, Pfister H, von Sydow K,
    Wittchen H "Mental disorders in ecstasy users a
    prospective-longitudinal investigation." Drug
    Alcohol Depend 2002 68 195-207

40
Mental Health and Ecstasy (cont.)
  • The same study found that although most Ecstasy
    users had some form of mental illness during the
    study, in the vast majority of cases, the problem
    emerged before they began using Ecstasy.

Lieb R, Schuetz CG, Pfister H, von Sydow K,
Wittchen H "Mental disorders in ecstasy users a
prospective-longitudinal investigation." Drug
Alcohol Depend 2002 68 195-207
41
Why is it Important to Get the Facts Out?
  • Almost half of all parents in America (48) do
    not know the effects of Ecstasy
  • 79 of parents do not know what is in Ecstasy
  • Ecstasy is the least likely drug to be discussed
    when parents discuss specific drugs with their
    child.

Partnership for a Drug Free America (2003). 2003
Partnership Attitude Tracking Study. Retrieved
July 2005 from http//demo.pdfav3.somethingdigital
.com/Files/Full_Report_PATS_2003
42
Why is it Important to Get the Facts Out?
3 of parents of teens think their teen has tried Ecstasy 11 of teens report trying Ecstasy
13 of parents of teens believe that Ecstasy would be very easy for their teen to get. 22 of teens say Ecstasy is very easy for them to get.
5 of parents of teens believe their teen has friends who have tried Ecstasy. 34 say they have close friends who use Ecstasy.
Partnership for a Drug Free America (2003). 2003
Partnership Attitude Tracking Study. Retrieved
July 2005 from http//demo.pdfav3.somethingdigital
.com/Files/Full_Report_PATS_2003
43
Treatment Options
  • There are currently no evidence-based treatments
    designed specifically for Ecstasy abuse.
  • The most effective treatments for drug abuse and
    addiction in general are cognitive behavioral
    interventions.
  • Substance abuse recovery support groups can also
    be effective in combination with behavioral
    interventions to support long-term, drug-free
    recovery.
  • In addition, antidepressant medications might be
    helpful in treating the symptoms of depression
    and anxiety seen in Ecstasy users.

44
  • I hear people say Ecstasy is a harmless, happy
    drug. There's nothing happy about the way that
    "harmless" drug chipped away at my life. Ecstasy
    took my strength, my motivation, my dreams, my
    friends, my apartment, my money and most of all,
    my sanity. I worry about my future and my health
    every day.
  • Lynn Smith

45
Internet Resources
  • http//www.clubdrugs.org/
  • http//www.drugabuse.com/
  • http//www.drugabuse.gov/drugpages/clubdrugs.html
  • http//www.drugdigest.org/
  • http//www.drugid.org/
  • http//www.erowid.org/
  • http//www.streetdrugs.org/

46
Cathy CianoExecutive DirectorParent Support
Network of Rhode Island
  • 401-467-6855
  • CathyCiano_at_aol.com
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