Innovation Strategies & Solutions in Youth Recovery

Ken Winters, Ph.D.Department of PsychiatryUniversity of Minnesotawinte001@umn.edu

ARS 2013 ConferenceJuly 12, 2013Del Mar, CA

www.psychiatry.umn.edu/research/casar/home.html

1. Brain development

2. Innovation-1:Counseling that is

teen-brainfriendly

4. Summary

3. Innovation-2:Counseling that

supportsrecovery

1. Brain development

Emerging Science:Brain Imaging

New insights because:

• 1990’s information explosion due to the development of brain imaging techniques (e.g., CT, PET and MRI).

When I get too technical, the audience starts to look like this….

Adolescence is a period of profound brain maturation.

We thought brain development was complete by adolescence

We now know… maturation is not complete until

about age 25!!!

Important ages of majority and privileges

16 - emancipation

- driving

18 - gambling (usually age 21 when alcohol served)

- smoking (some at age 19

- military

21 -drinking

Allstate ad, NY Times, May, 2007

An Immature Brain = Less Brakes on the “Go” System

Maturation Occurs from Back to Front of the BrainImages of Brain Development in Healthy Youth

(Ages 5 – 20)

Source: PHAS USA 2004 May 25; 101(21): 8174-8179. Epub 2004 May 17.

Blue represents maturing of brain areas

Earlier: Motor Coordination Emotion Motivation

Later: Judgment

Limbic or Go System

Tests measuring different forms of executive function skills indicate that they begin to develop shortly after birth, with ages 3 to 5 a window of opportunity for dramatic growth in these skills. Development continues throughout adolescence and early adulthood.

• Preference for ….1. physical activity2. high excitement and rewarding activities3. activities with peers that trigger high

intensity/arousal4. novelty

• Less than optimal..5. control of emotional arousal6. consideration of negative conseq.

• Greater tendency to…7. be attentive to social information8. take risks and show impulsiveness

Implications of Brain Development for Adolescent Behavior

Youth vulnerability and drug use

•Greater risk for drug abuse?

Prevalence of Past-Year DSM-IV Alcohol Dependence: United States, 2001-2002(Grant, B.F., et al., Drug and Alcohol Dependence, 74, 223-234, 2004)

12.211

5.8

4.1 3.9 3.8 3.7

1.9

0.3 0.20

2

4

6

8

10

12

14

15-20 21-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+

%

The Water Maze Test

Hidden

Slide courtesySion Kim Harris, Ph.D.

• Saline vs alcohol • Measures

-Swimming speed-Time to find platform

Wanna lookfor some cheese

with me?Sure!

Youth vulnerability and drug use

•Greater risk for mental disorders?

Psychosis: Prevalence of Past Year Serious Mental Illness Among Lifetime Marijuana Users Aged 18+

(SAMHSA, 2005; data collected 2002-2003)

21

17.4

12.210.5

0

5

10

15

20

25

< age 12 age 12-14 age 15-17 > age 17

per

cen

tag

es

age of marijuana onset

Psychosis: Drug Use and Age at Onset of Psychosis Based on a Meta-Analysis

(Large et al., 2011)

0.28

2.7

1.7

0

1

2

3

4

5

Alcohol Cannabis Any Drug

years earlierpsychosis onset

mean years earlier of age at onset of psychosis compared to non-drug using controls

* = nonsig. with controls

*

1. Brain development

2. Innovation-1:Counseling

that is teen-brainfriendly

Brain Development: Opportunities for Prevention and Treatment

• Discuss with teenagers the science of the neurobiology of addiction

Brain Development: Opportunities for Prevention and Treatment

• Discuss the implications of using substances when the brain is still developing.

Prevalence of Past-Year DSM-IV Alcohol Dependence: United States, 2001-2002(Grant, B.F., et al., Drug and Alcohol Dependence, 74, 223-234, 2004)

12.211

5.8

4.1 3.9 3.8 3.7

1.9

0.3 0.20

2

4

6

8

10

12

14

15-20 21-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+

%

Memory Effects

8687

9796

70

75

80

85

90

95

100

Alc Dep

Non-AlcDep

Verbalinformation

Nonverbalinformation

Rete

nti

on

Rate

%

Source: Brown et al., 2000

• Resource from BSCS Drug Abuse, Addiction

and the Adolescent Brain

(www.BSCS.org)

• Hazelden has published an 8-lesson multi-media resource: Drugs and the Developing Brain (www.hazelden.org)

Classroom Resources

• Apply two major treatment approaches seem accommodating to the teen brain:

• Cognitive – behavioral therapy (CBT)

• Motivational interviewing

Brain Development: Opportunities for Treatment

Characteristics of CBT

•Focus on immediate, relevant and specific problems

•Solutions are realistic, concrete, specific

Value of CBT• Teach important skills not optimal for the teen brain

• impulse control

• “second” thought processes

• social decision making

• dealing with risk situations

• taking healthy risks

Characteristics of Motivational Interviewing

• De-emphasize labels• Emphasis on personal choice

and responsibility• Therapist focuses on eliciting

the client's own concerns• Resistance is met with

reflection and non-argumentation

• Treatment goals are negotiated; client’s involvement is seen as vital

• Teen-brain friendly features of the 12-Step Model

• abstinence• novelty – new approach to

life• structure• spiritual component• fellowship

Brain Development: Opportunities for Treatment

• But…..elements of the 12-Step Model that are challenging to the teenager

• life-long disease• committing to life long

changes• self-help groups may not be teen friendly

Brain Development: Opportunities for Treatment

Recovery Options that are Socially Suitable for Youth

• AA/NA support groups that are relevant, meaningful, engaging and fun for youth

John Kelly’s Research Program

• Modest beneficial effects of 12-Step attendance was found.

• Several factors noted as favorable features of 12-Step meetings.

• Listened to others’ struggles and successes• Provided support to another addict/alcoholic• Met new people

Recovery Options that are Socially Suitable for Youth

Rockers In Recovery Music and Art Festival

November 2, 2013- 1PM-11PM  Fort Lauderdale Venue: CB Smith Park

 

1. Brain development

2. Innovation-1:Counseling tools

that are teen-brainfriendly

3. Innovation-2:Counseling that

supports recovery

3-1. Expand use ofSBIRT to addressearly stage drugInvolvement.

SBIRT

Abstinence Infrequent use Early abuse Abuse Dependence

Intensive Treatment

Drug Involvement

Adapted from Broadening the Base of Alcohol Treatment (IOM)

Tx GapBrief

Intervention-MIPrevention

Estimates of Mutually Exclusive “Mild-to-Moderate” Drug Abusing Groups of Youth (12-18-years-old) (based on data from SAMHSA, 2005)

5.8 6.3

1.3

11.3

5.2

0

5

10

15

20

Abuse only Binge alc. Heavy alc. Illicit drug Dependnece

%

Binge and heavy alcohol: past 30 daysAbuse only, Illicit drug, and dependence: past year

Total % = 24.7

4.4% light drinkers

65.7% non users

Common Elements of Brief Interventions Evidence-based approaches in NREPPBrief Therapies or Interventions (www.nrepp.samhsa.gov

•1 – 4 sessions

•Motivational interviewing and CBT

•Negotiated goals

3-2. Expand recoveryhigh schools andcolleges.

Collegiate Recovery Programs and Efforts

Source: Stacie Mathewson Foundation

1. Brain development

2. Innovation-1:Counseling tools

that are teen-brainfriendly

4. Summary

3. Innovation-2:Counseling toolsthat are recovery

friendly

Youth Today

• Approx. 20-35 have already experienced a substance use disorder

Treatment Works !

(but we can do better)

New 12-Step Programfor Adolescents ?

12-Steps of Self-Regulation1. impulse control

2. “second thought” processes

3. social decision making

4. dealing with risk situations

5. taking healthy risks

6. attention regulation

7. anger control

8. modulating reward incentives

9. choosing options

10. considering consequences

11. minimizing arousal

12. dealing with peer influences

Thank You !

Comments and Questions