Dare to Discuss Drugs Forum Pomperaug High School June 8, 2010
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Transcript of Dare to Discuss Drugs Forum Pomperaug High School June 8, 2010
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Dare to Discuss Drugs ForumDare to Discuss Drugs ForumPomperaug High School Pomperaug High School
June 8, 2010June 8, 2010
John Hamilton, LMFT,LADCJohn Hamilton, LMFT,LADC(203) 858-8028(203) 858-8028
[email protected]@rnpinc.org
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New Trends
Binge drinking Over the counterPrescription Drugs Girls competing with boysIncreased purity (heroin and marijuana)
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11.7 years old11.7 years old20% greater20% greater1 out of 5 kids1 out of 5 kids38%/19%38%/19%40% chance40% chance70,000 per year70,000 per yearParticipation in HS sportsParticipation in HS sports
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National Epidemiologic Survey on Alcohol and Related Conditions, 2003
Age
Age at tobacco, at alcohol and at cannabis dependence, as per DSM IV
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
5 10 15 20 25 30 35 40 45 50 55 60 65
% in
eac
h ag
e gr
oup
to d
evel
op
first
-tim
e de
pend
ence
THCALCOHOL
TOBACCO
Addiction Is a Developmental Disease starts in childhood and adolescence
70 75
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Grade Alcohol % Marijuana % Any Illicit %
8 20 8 10
10 35 18 21
12 49 22 25
Substance Use by Youth - Prior Month 2002
(Monitoring the Futures, 2003)
Substance Abuse/Dependence rates vary:
3-15%
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Can Addiction be Prevented by Can Addiction be Prevented by Delaying Alcohol Onset?Delaying Alcohol Onset?
• Every year use of alcohol is Every year use of alcohol is delayed, the risk of delayed, the risk of developing an alcohol developing an alcohol disorder is reduced. disorder is reduced.
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Percentages of Past Year Alcohol Dependence or Abuse Percentages of Past Year Alcohol Dependence or Abuse Among Adults Aged 21 or Older, by Age of First Use Among Adults Aged 21 or Older, by Age of First Use
(SAMHSA)(SAMHSA)
16 15
9
4.22.6
0
5
10
15
20
<12 yrs 12-14 yrs 15-17 yrs 18-20 yrs 21+ yrs
Age Started Drinking
Perc
ent
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Adolescence is a period of profound brain maturation. It was believed
that brain development was complete during childhood
The maturation process is not complete until about age 24!!!
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• Back of brain matures before to the front of the brain…• sensory and physical activities
favored over complex, cognitive-demanding activities
• propensity toward risky, impulsive behaviors • group setting may promote risk
taking• poor planning and judgment
Arrested Development
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motivation
emotion
judgment
cerebellum
amygdala
nucleus accumbens
Pruning occurs in stages, from back of the brain to the front
prefrontal cortex
physical coordination; sensory processing;
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motivation
emotionjudgment
Age 24
physical coordination; sensory processing;
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Are adolescents more susceptible Are adolescents more susceptible to alcohol than adults?to alcohol than adults?
• Adult studies suggest that the areas of the Adult studies suggest that the areas of the adolescent brain that are remodeled are adolescent brain that are remodeled are sensitive to the effects of alcoholsensitive to the effects of alcohol
• Four Four pieces of evidencepieces of evidence
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Are adolescents more susceptible to Are adolescents more susceptible to alcohol than adults?alcohol than adults?
1.1. Reduced sensitivity to Reduced sensitivity to intoxicationintoxication
2.2. Increased sensitivity to social Increased sensitivity to social disinhibitionsdisinhibitions
4.4. Medicates “hyper excitability”Medicates “hyper excitability”
Increases reinforcing properties
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Are adolescents more susceptible to Are adolescents more susceptible to alcohol than adults?alcohol than adults?
Greater deficits
3 Greater adverse effects to Greater adverse effects to cognitive functioningcognitive functioning
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How do your kids view your How do your kids view your relationship?relationship?
0102030405060708090
100
7thGrade
8thGrade
9thGrade
10thGrade
GreatCould Be BetterBad
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There is a perception among many There is a perception among many students that parents contribute to students that parents contribute to the pressures. Many seemed to be the pressures. Many seemed to be seeking acceptance for who they seeking acceptance for who they were rather than for who their were rather than for who their parents wanted them to be.parents wanted them to be.
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HONESTYHONESTY
56% of students 56% of students surveyed said they surveyed said they are NOT honest with are NOT honest with their fathers their fathers
Why?Why?““No way! If my dad knew No way! If my dad knew
what I was doing he what I was doing he would flip!” 10would flip!” 10thth, m, , m, privateprivate
““I am honest… just not I am honest… just not when it comes to when it comes to drinking” 8drinking” 8thth, f, private, f, private
““I don’t tell him things if I I don’t tell him things if I know he will get mad know he will get mad about it” 9about it” 9thth, f, public, f, public
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HONESTYHONESTY
Only 35% of students Only 35% of students surveyed believes surveyed believes their father is honest their father is honest with them.with them.
This is what they are saying…This is what they are saying…
““My dad lies to me all the My dad lies to me all the time” 9time” 9thth, f, public, f, public
““My dad hides everything My dad hides everything from me” 8from me” 8thth, f, private, f, private
““Yeah, I think my dad is Yeah, I think my dad is honest with me most of honest with me most of the time” 7the time” 7thth, f, public, f, public
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If you could, what would you change If you could, what would you change about your relationship with your dad?about your relationship with your dad?
The top 5 answers:The top 5 answers:
5. Trust me more5. Trust me more4. Be home more4. Be home more3. Be more 3. Be more
understandingunderstanding2. Spend more time 2. Spend more time
togethertogether1. Communicate more.1. Communicate more.
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DA
D2
Rec
epto
r A
vaila
bilit
y
Cocaine
Alcohol
DA
DA
DA
DA DA DA
DA
Reward Circuits
DA DA DA DA
DA
Reward Circuits
DA
DA
DA
DA DA
DA
Drug Abuser
Non-Drug Abuser
Heroin
Meth
Dopamine D2 Receptors are Lower in Addiction
control addicted
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Becomes SubordinateStress remains
IndividuallyHoused
GroupHoused
Morgan, D. et al. Nature Neuroscience, 5: 169-174, 2002.
**
S.003 .01 .03 .1
0
10
20
30
40
50
Rei
nfor
cers
(per
sess
ion)
Cocaine (mg/kg/injection)
Dominant
Subordinate
Becomes DominantNo longer stressed
Isolation Can Change Neurobiology
Effects of a Social Stressor on Brain DA D2 Receptors and Propensity to Administer Drugs
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NIAAA GuidelinesNIAAA GuidelinesMen-less than 4 drinks Men-less than 4 drinks daily/14 per week totaldaily/14 per week totalWomen-less than 3 Women-less than 3 drinks daily/ 7 per weekdrinks daily/ 7 per week
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DRINKING PATTERNSDRINKING PATTERNS
Never exceed the daily or Never exceed the daily or weekly limits-1 in 100weekly limits-1 in 100Exceed only the daily Exceed only the daily limit-1 in 5limit-1 in 5Exceed both daily and Exceed both daily and weekly limits -1 in 2weekly limits -1 in 2
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Dimensional Diagnosis of Dimensional Diagnosis of AUD: One ApproachAUD: One Approach
Never exceedsdaily limits
• Exceedsdaily limits
• No current sequelae
• Exceedsdaily limits
• Current sequelae
• Daily or neardaily heavydrinking
• Current sequelae
• Withdrawal
• Daily or neardaily heavydrinking
• Current sequelae
• Withdrawal• Chronic orrelapsing
None Mild(“At-risk”)
Moderate(Harmful use)
Severe(Dependence)
Chronicdependence
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Rehabilitation
Public health perspective of Public health perspective of alcohol use and disordersalcohol use and disorders
Use &Problems
Modality
None
1º Prevention2º Prevention
ModerateSevere
Chronic
Disease Management
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Rehabilitation
Continuum of Care for Continuum of Care for AddictionsAddictions
Use &Problems
Modality
None
1º Prevention2º Prevention
ModerateSevere
Chronic
Disease Management
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Facilitatedself change
Heavy drinking only
Chronic
Disease Management
Briefmotivationalcounseling
Medicalmanagement +pharmacotx or CBI
Specializedremission-orientedtreatment
Increased quantity, frequency & consequences of alcohol use
Harmful drinking Dependence
Extended ContinuumExtended Continuum
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INCREASED INCREASED EXPOSURE TO EXPOSURE TO BOTH STRESS AND BOTH STRESS AND SUBSTANCES SUBSTANCES INCREASES RISKINCREASES RISK
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GeneticsGenetics
EnvironmentEnvironment
Gene/Gene/EnvironmentEnvironmentInteractionInteraction
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DRUGSDRUGS
BRAIN BRAIN MECHANISMSMECHANISMS
BEHAVIORBEHAVIOR
ENVIRONMENTENVIRONMENT
HISTORICALHISTORICAL
ENVIRONMENTALENVIRONMENTAL
- previous history- previous history- expectation- expectation- learning- learning
- social interactions- social interactions- stress- stress- conditioned stimuli- conditioned stimuli
- genetics- genetics- circadian rhythms- circadian rhythms- disease states- disease states- gender- gender
PHYSIOLOGICALPHYSIOLOGICAL
Drug Addiction:Drug Addiction:A Complex Behavioral and Neurobiological DisorderA Complex Behavioral and Neurobiological Disorder
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RESILIENCYRESILIENCY
SOCIAL COMPETENCESOCIAL COMPETENCEPROBLEM SOLVING SKILLSPROBLEM SOLVING SKILLSAUTONOMYAUTONOMYSENSE OF PURPOSESENSE OF PURPOSE
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RISK AND PROTECTIVE RISK AND PROTECTIVE FACTORSFACTORS
Risk FactorsRisk Factors DomainDomain Protective Protective FactorsFactors
Sensation-seekerSensation-seeker IndividualIndividual Successful studentSuccessful student
Child of drug userChild of drug user Bonds with familyBonds with family
No supervisionNo supervision FamilyFamily Consistent disciplineConsistent discipline
Parent/sibling drug useParent/sibling drug use Anti-drug family rulesAnti-drug family rules
Pro-drug use normPro-drug use norm SchoolSchool Anti-drug use normAnti-drug use norm
Availability of drugsAvailability of drugs High academicsHigh academics
Crime/povertyCrime/poverty CommunityCommunity Consistent anti-drug Consistent anti-drug messagemessage
No afterschool programsNo afterschool programs Strong law enforcementStrong law enforcement
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CRAFFTCRAFFT
CarCarRelaxRelaxAloneAloneFamily or FriendsFamily or FriendsForgotForgotTroubleTrouble
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Demographics of prescription drug misusers
In 2006, a study sponsored by a Partnership for a Drug-Free America (PDFA) that 1 in 5 teens misuse prescription drugs. This finding is significant as youth believe that painkillers are a “safer” way to get high as opposed to illicit drugs.
The Partnership Attitude Tracking Study found that 62% of youth reported access to “powerful painkillers” at home while 52% reported that prescription drugs were “available everywhere”.
(Join Together, 2006)
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Prescription Drug AbuseIn 2002, an estimated 6.2 million people –
2.6% of the population aged 2 and older were currently (in last month) using prescription drugs non-medically (up from 4 million in 1999)
Pain relievers – 2.6 million usersSedatives/tranquilizers – 1.3 million usersStimulants – 4 million users
NIDA Research Report Series – Prescription Drugs: Abuse and Addiction Trends in prescription drug abuse
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Reported Non-Medical Prescription Drug s of Abuse (2005)
S edatives
S timulants
TranquilizersPainkillers
4,700,0001,800,000
1,100,000272,000
(Substance Abuse and Mental Health Services Administration [SAMHSA], 2005)
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Demographics of prescription drug misusers
Among adolescents and young adults, prescription drug abuse is highest nationally among young adults aged 18-25 years old.The National Institute on Drug Abuse’s Monitoring the Future survey in 2005 found that 12 graders reported using OxyContin and Vicodin without a prescription.This is a concern since youth who use other drugs are likely to abuse prescription medications.
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Prescription drug use in AmericaThe National Surveys on Drug Use and Health (NSDUH) asked non-medical users of prescription-type psychotherapeutic drugs regarding how they obtained the drugs they recently used non-medically.
In 2005, the most prevalent source from which recently used drugs were obtained among non-medical users of prescription-type drugs was "from a friend or relative for free.
Among persons aged 12 or older who used pain relievers non-medically in the past 12 months, 59.8% reported that the source of the drug the most recent time they used was from a friend or relative for free.
(Substance Abuse and Mental Health Services Administration [SAMHSA], 2005)
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Demographics of prescription drug misusers
Men and women have similar rates of non-medical use of prescription drugs. Gender differences in prescription drug abuse can be observed among girls aged 12-17 years old.
Women are at increased risk of abusing benzodiazepines.
(National Institute on Drug Abuse [NIDA], 2005)
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TRI scienceaddiction
Rx Opiate UserRx Opiate User White
Rural, suburban
Higher SES
Heroin UserHeroin User Minority
Urban
Lower SES
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Commonly used prescription drugs
The most commonly abused prescription drugs can be classified in three classes:– Opioids– Central Nervous System (CNS) depressants– Stimulants
(National Institute on Drug Abuse [NIDA], 2005)
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Commonly used prescription drugs
– Opioids are mostly used to treat pain.Some examples of opioids are codeine, morphine, and opium.
– Central nervous system (CNS) depressants are used to treat anxiety and sleep disorders.
Some examples of CNS depressants are flunitrazepam, barbiturates, and benzodiazepines.
– Stimulants are prescribed to treat the sleep disorder narcolepsy and attention-deficit hyperactivity disorder (ADHD).
Some examples of stimulants are cocaine, methamphetamine, and amphetamines.
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(National Institute on Drug Abuse [NIDA], 2005)
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Preventing prescription drug abuse/misuse
Increasing the role of the physicianPrescription drug abuse prevention is a is an important part of patient care.
Nearly 70 percent of Americans (191 million people) - visit a health care provider, such as a primary care physician, at least once every 2 years.
Accurate screening and increases in medication should be careful monitored by physicians as well as the patient receiving the medication.
(National Institute on Drug Abuse [NIDA], 2001)
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Warning signs of potential prescription drug abuse
You take more pain medication than your doctor has prescribed.
You request prescriptions from multiple doctors.
You use alcohol or other medications to increase the effects of the pain medication.
You take pain medication to deal with other problems, such as anxiety or stress.
Your doctor, friends or loved ones express concern about your use of pain medication.
(The Mayo Clinic, 2006)
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School-based preventionAmong school-age children and adolescents who may be at risk of non-medical use of pharmaceuticals, McCabe, Teter, & Boyd (2004) suggest that physicians, parents, pharmacists, school nurses, social workers, counselors, and principals be educated about the prescription drug misuse.Other school administrators such as school nurses, social workers, etc. can help monitor which students are prescribed medications and may be at risk for prescription drug diversion.
McCabe, S.E., Teter, C.J., & Boyd, C.J. (2004). The use, misuse, and diversion of prescription stimulants among middle and high school students. Substance Abuse & Misuse, 93, 7, 1095-1116.
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Why is heroin use growing?– Lower price– Longer “high”– Increasing purity
Nasal inhalation– Increased availability– Reduced social stigma around use– Opiate prescriptions leading to heroin use
Oxycodone, hydrocodone, & codeine
The Heroin Epidemic
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Major reduction in Alcohol and Cocaine admissions from 1996 to 2002
Heroin increases significantly over the same period
68
50
37
56
41
48
303540455055606570
1996 2002
AlcoholCocaineHeroin
The Heroin Epidemic
DMHAS – Connecticut & UConn
Getting Better: A Study of Addiction Services in Connecticut
Admission Statistics – Self-Identified problem substance at admission to treatment
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Opioid Withdrawal SeverityS
e ve r
ity o
f Wit h
d raw
a l
Days Since Last Opiate Dose
0
5 10 15
Heroin
Buprenorphine
Methadone
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Contingency management reduces drug useOpioids
(Bickel et al., 1997; Preston et al., 1998)
Cocaine(Higgins et al., 1991, 1993, 1994; Silverman et al.,
1996)
Benzodiazepines(Stitzer et al., 1992)
Marijuana (Budney et al., 1991, Budney et al., 2000)
Nicotine (Stitzer & Bigelow, 1984; Roll et al., 1996)
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Dysfunctional Family
There is no such thing as a dysfunctional family. All behavior is adaptive and has a function.
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WHAT WORKSMotivational Enhancement Therapy (MET)Motivational Incentives (Contingency Management)Matrix Model (Stimulants)Seeking Safety Model (Women and Trauma)Relapse Prevention (Marlatt)Cognitive Behavioral Therapy
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Evidence Based Adolescent Treatment
BSFT-Brief Strategic Family Therapy (Szapocznick)MST-Multisystemic Therapy (Henggeler)MDFT-Multidimensional Family Therapy (Little)
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What Does Not WorkConfrontation -confrontation is only effective if it is perceived as concern . It assumes a therapeutic relationship.
(The goal of the first session is to have a second session)Substance abuse education aloneGroup therapy and residential treatment with some adolescent populations
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Stages Of Change Pre-Contemplation (Denial)
(“I’m Only Here Because …”) Contemplation (Ambivalence)
(“I’m Not Sure What To Do”) Preparation (Early Recovery)
(“I’ve Cut Back A Little Already”) Action (Treatment Ready)
(“I’ll Do What It Takes”) Maintenance (Relapse Prevention)
(“This Isn’t As Easy As I Thought”)
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Match Tx To “Stages Of Change”
Where is your child at?Where are you at?Where is the rest of the family at?Where is the community at?
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H=WH=W - - - - - -- - - - - -
S DS D
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ENJOY YOR ENJOY YOR MATE MORE MATE MORE THAN YOUR THAN YOUR CHILDRENCHILDREN
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The greatest gift a father can give to The greatest gift a father can give to his children is to love their mother and his children is to love their mother and the greatest gift a mother can give to the greatest gift a mother can give to her children is to love their father.her children is to love their father.
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This is where kids learn intimacy This is where kids learn intimacy and dignity and respectand dignity and respect
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All your statements with your All your statements with your teens should start with “I know teens should start with “I know I can’t stop you from……at this I can’t stop you from……at this party – however, if you do this, party – however, if you do this, this will happen”this will happen”Consequences must be Consequences must be reasonable and enforceablereasonable and enforceable
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Meet your kids Meet your kids where they are atwhere they are at
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IF YOU MEET YOUR KIDS IF YOU MEET YOUR KIDS WHERE THEY ARE YOU WHERE THEY ARE YOU
WILL ALWAYS WALK WILL ALWAYS WALK AWAY WITH AWAY WITH
COMPASSION AND NEW COMPASSION AND NEW UNDERSTANDINGUNDERSTANDING
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ALWAYS ASSESSALWAYS ASSESS
ABILITYABILITYWILLINGNESSWILLINGNESS
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THE TWO JOBS OF THE TWO JOBS OF CHILDRENCHILDREN
RECEIVE LOVERECEIVE LOVELEARNLEARN
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INDIVIDUATIONINDIVIDUATIONSEPARATIONSEPARATIONAUTONOMYAUTONOMYCOOPERATIONCOOPERATION
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TRUSTTRUST VS VS FAITHFAITH
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EVERYONE MAKES THE BEST EVERYONE MAKES THE BEST DECISIONS AVAILABLE TO THEM AT DECISIONS AVAILABLE TO THEM AT THE TIME WITH THE CHOICES THE TIME WITH THE CHOICES AVAILABLE TO THEM.AVAILABLE TO THEM.
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CONTROLCONTROL
vs.vs.
INFLUENCE INFLUENCE
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EVERY TIME YOU EVERY TIME YOU ENGAGE IN A CONFLICT ENGAGE IN A CONFLICT WITH YOUR CHILD WITH YOUR CHILD
YOUR CHILD MISSES AN YOUR CHILD MISSES AN OPPORTUNITY OPPORTUNITY
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Higher levels of family conflict were Higher levels of family conflict were associated associated
with high levels of peer with high levels of peer antisocial activity.antisocial activity.
________NIDA NIDA
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Anxiety of parents will influence Anxiety of parents will influence the anxietythe anxietyof your teens.of your teens.
________John GottmanJohn Gottman
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Greatest problem is that Greatest problem is that parents were afraid ofparents were afraid of stating their beliefs andstating their beliefs and
feelings.feelings.
NIH/Risky Adolescent Behavior StudyNIH/Risky Adolescent Behavior Study
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Cut the roof off in yourCut the roof off in your home and look at what home and look at what is going on.is going on.
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Reasonable parenting – Reasonable parenting – –based on who your child is not based on who your child is not
who you think they should bewho you think they should be–show them how much you care show them how much you care
before you show them how before you show them how much you knowmuch you know
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ListenListenUnderstand Understand Take serious Take serious AffirmAffirm
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Do what the Do what the relationship allows relationship allows
for the momentfor the moment
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THE MORE YOU SHOW YOUR THE MORE YOU SHOW YOUR HUMANESS, THE MORE YOU HUMANESS, THE MORE YOU ARE LOVABLEARE LOVABLE
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ReframeReframe(changing your lens)(changing your lens)
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Reframe in Reframe in positive terms positive terms
what your child is what your child is really telling you.really telling you.
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See your child’sSee your child’s behavior as information, behavior as information, he or she is giving youhe or she is giving you an opportunity to learn.an opportunity to learn.
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What was the lastWhat was the last good conversation yougood conversation you had with your child?had with your child?
What were you doing?What were you doing?
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DEPERSONALIZEDEPERSONALIZEBE NICE AND BE NICE AND FORGIVEFORGIVE
(STAY THE ADULT)(STAY THE ADULT)
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Externalize Externalize and and
Depersonalize Depersonalize the problemthe problem
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Your child is Your child is not the problemnot the problem
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The problem The problem is the problemis the problem
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Mental HealthMental Health
–LovableLovable–CapableCapable–ConnectedConnected
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Most kids respond to Most kids respond to incentives – Win/Win – earned incentives – Win/Win – earned rewardsrewards
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Some kids respond to negative Some kids respond to negative consequenceconsequence
(if they perceive the (if they perceive the consequences as fair)consequences as fair)
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Have your kids participate in their Have your kids participate in their respective consequencesrespective consequences
-Empowers your kids-Empowers your kids-Reduces possible power struggle-Reduces possible power struggle-Increases ownership in the -Increases ownership in the
outcomeoutcome
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Tailor intervention based on Tailor intervention based on your relationship with your your relationship with your child and your child’s child and your child’s relationship with alcohol and relationship with alcohol and drugsdrugs
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STRIKE WHILE THE STRIKE WHILE THE IRON IS COLD!IRON IS COLD!
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WHO BELIEVED IN WHO BELIEVED IN YOU?YOU?
( HOW DID YOU KNOW?)( HOW DID YOU KNOW?)
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What messages do you give What messages do you give your kids that you believe in your kids that you believe in them, have faith in them?them, have faith in them?
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ASK YOUR KIDSASK YOUR KIDSHow am I doing as your parent?How am I doing as your parent?What am I doing well?What am I doing well?What could I do better?What could I do better?What are the messages I give What are the messages I give you that tell you I believe in you?you that tell you I believe in you?
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More QuestionsMore QuestionsDo you feel you can tell me Do you feel you can tell me anything?anything?(and if not what am I doing that is (and if not what am I doing that is getting in the way)getting in the way)Do you feel I am honest with you?Do you feel I am honest with you?Do you feel you know me?Do you feel you know me?
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More QuestionsMore Questions
Is there anything you want to Is there anything you want to know about me (such as what know about me (such as what I was like in high school?)I was like in high school?)Does what I do now (or what I Does what I do now (or what I did in high school) influence did in high school) influence your decisions today?your decisions today?
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Always offer hope and faith Always offer hope and faith and be willing to do whatever it and be willing to do whatever it takes to improve your takes to improve your relationship with your childrelationship with your child
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WEBSITESwww.drugabuse.gov (NIDA) www.samhsa.gov (Substance Abuse and Mental Health Administration)www.salis.org (Substance Abuse Librarians and Information Specialists)www.promisingpractices.net (Promising Practices Network on Children, Families and Communities)www.JoinTogether.org (Join Together)