Melissa Corcoran, BScMegan Lowe, MA

Youth Outreach ServiceCentre for Addiction and Mental Health

May 2, 2013

The materials set out are general principles and approaches to assessment and treatment pertaining to mental health and concurrent disorders, but do not constitute clinical advice and do not replace the need for individualized clinical assessment and treatment plans by health care professionals.

© Melissa Corcoran & Megan Lowe, May 2, 2013

No unauthorized copying, distribution or amendment without the written permission of Melissa Corcoran & Megan Lowe

Defining Mental Health Youth and Substance Use Concurrent Disorders Parenting Strategies and Tips Resources and Supports Question and Answer Period

A state marked by the absence of mental illness (DSM-IV-TR)

A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community (World Health Organization)

Mental health means striking a balance in all aspects of one’s life: social, physical, spiritual, economic and mental. At times, the balance may be tipped too much in one direction and one’s footing has to be found again. Everyone’s personal balance is unique and the challenge is to stay mentally healthy by keeping the right balance (Canadian Mental Health Association)

Disorders

Generalized Anxiety Disorder

Major Depressive Disorder

Eating Disorders (Anorexia)

Schizophrenia

Issues

Anxiety

Depression

Disordered eating

Emotion regulation

CopingTalking

MedicationsCounselling

Breathing/Meditation

Substance Use

Alcohol

Marijuana

Opioids

Cocaine

Physical Changes

Cognitive Changes

Psychological Changes

• Hormonal changes• Changes in brain

structure• Increase in appetite• Changes in sleep (fall

asleep later, wake later)

• Greater ability for abstract thinking

• Can take perspectives of others

• Capable of generating hypotheses and formulating opinions

• Increased independence from parents

• Develop meaningful relationships outside family

• Improved ability to regulate emotions

• Begin plans for self-sufficiency

Adolescence is also often a time of experimentation, exploration and risk-taking

Risk Factors Protective Factors• Maternal Pre-natal SU• Parenting styles• Exposure to violence at

home• Parental SU/MH Problems• Physical, psychological or

sexual abuse• Poor academic

achievement• Poverty• Neighbourhood /

Community Problems• Peers

• High-quality infant-caregiver relationship

• Appropriate discipline and limit setting

• Strong affiliations with pro-social institutions

• Strong bond with parent/significant adult

• Success in school• Public policies that

ensure adequate income• Involvement in

appropriate recreational/leisure activities

Substance Use

Your Estimate %: CAMH 2011 OSDUHS Survey % :

• Alcohol _______ %

• Tobacco ________%

• Opioid Pain Relievers ________%

• Cannabis ________%

• Cocaine ________%

• Alcohol _______ %

• Tobacco ________%

• Opioid Pain Relievers ________%

• Cannabis ________%

• Cocaine ________%

Your Estimate %: CAMH 2011 OSDUHS Survey % :

• Alcohol _______ %

• Tobacco ________%

• Opioid Pain Relievers ________%

• Cannabis ________%

• Cocaine ________%

• Alcohol 54.9 %

• Tobacco 8.7 %

• Opioid Pain Relievers 14%

• Cannabis 22%

• Cocaine 2.1 %

There is no definitive cause of substance use problems among youth

Many risk and protective factors play a role in determining which youth will go beyond experimentation to developing substance abuse or dependence problems

Involves complex relationships among biological, psychological, and social factors in the adolescent, their family, and the broader environment (e.g. school, peers, community)

Non Use /Experimentation

Use

Misuse

Abuse

DependencyAddiction

Substance Abuse Substance DependenceContinuing substance use that results in serious problems such as:

•Inability to function adequately at work, school or home.

•Risk to self or others (e.g. drunk driving).

•Repeated legal problems.

•Frequent interpersonal or family conflicts.

Continuing substance use that results in major physical, psychological, and behavioural problems such as:

•Tolerance to the substance.•Withdrawal from the substance.•Use that is greater or longer than intended.•Desire to quit or unsuccessful efforts to do so.•Much time spent obtaining, using or recovering from the substance.•Giving up or reduced involvement in usual activities.•Continued use despite physical or psychological problems resulting from the substance.

What are Concurrent Disorders?

Young people who develop substance use problems are often dealing with many other issues, including mental health problems

The combination of a substance use disorder and a mental health disorder is referred to as “concurrent disorders”

Mental health problems may precede substance use and an individual may be using substances to cope or “self-medicate” mental health problems

Mental health symptoms may develop as a result of substance use (e.g. alcohol and depression)

Trigger: Substance use triggers mental health disorder in youth with predisposition to that disorder

Create: Substance use produces psychological symptoms

Exacerbate: Psychological symptoms get worse when substances are used

Mimic: Substance use effects look like mental health disorder

Mask: Psychological symptoms hidden by substance use

Independence: Substance use and mental health disorder are not related to each other, but both may be related to a common underlying factor

Co-occurrence is high, unrecognized and always higher than you think

Addressing single “problems” in isolation is not effective

Early intervention can decrease severity, duration and onset of additional problems

Youth with CD are at higher risk for:HomelessnessSuicideVictimizationPoor health outcomes Incarceration/legal problemsRe-hospitalization

Personal Narrative

Parenting Strategies and Tips

Change in sleep patterns

Change in eating habits Change in mood Change in grades Change in finances

(asking for money, theft, pawning possessions)

Secrecy

Loss of interest in previous commitments (hobbies, sports teams, school clubs)

Significant avoidance of family

Loss of friends Surrounds self with

other drug users

Education vs. Scare Tactics Frightening or ‘worst case scenarios’ are often

ineffective Discussing issues together (e.g. researching online)

Communication I statements Identifying appropriate times to address issues Open-ended questions, paraphrase, reflect,

acknowledge Empathy

Be with them in the moment as they express themselves

Remember what it was like to be an adolescent

Parenting style and boundary settingAuthoritarian vs. Authoritative vs. Permissive

Self-care and managing emotions

Accessing support for yourself and child

We are all broken and wounded in this world. Some choose to grow strong at the broken places. (Harold J. Duarte-Bernhardt)

•Connex Ontario Health Services Information www.connexontario.caoDrug and Alcohol Helpline 1-800-565-8603

www.drugandalcoholhelpline.ca oMental Health Helpline 1-800-531-2600

www.mentalhealthhelpline.ca oOntario Problem Gambling Helpline 1-800-230-3505 www.opgh.on.ca

• Canadian Mental Health Association 1-800-668-6868 www.cmha.ca

• Kids Help Phone 1-800-668-6868 www.kidshelpphone.ca

• Family Services Toronto 416-595-9230

www.familyservicetoronto.org

• Gerstein Crisis Centre 416-929-5200 crisis line www.gersteincentre.org

• 211 Toronto dial 211 www.211toronto.ca

Centre for Addiction and Mental Health Resources: www.camh.ca The mental health and addiction 101 series (online tutorials)Straight Talk and Do you know drug series…Mental health information guides (depression, anxiety, schizophrenia, etc.)Teens and Tweens Podcast Series

o http://knowledgex.camh.net/podcasts/tnt/Pages/default.aspxTips for talking to your kids about substance use

o http://www.camh.ca/en/hospital/health_information/for_parents/Pages/Ten-tips-for-talking-to-your-kids-about-substance-use.aspx

Paglia-Boak, A., Mann, R.E., Adlaf, E.M., & Rehm, J. (2009). Drug use among Ontario students, 1977-2009: Detailed OSDUHS findings. (CAMH Research Document Series No. 27). Toronto, ON: Centre for Addiction and Mental Health.

Barankin, T. & Khanlou, N. (2007). Growing up resilient: Ways to build resilience in children and youth.

Wolfe, D. A, et al. (Spring 2011, CAMH). What parents need to know about teens: Strategies for reducing the risks of alcohol, tobacco, other drugs and gambling.

Wolfe, D. A. (Ed.) (2007, CAMH). Acting out: Understanding and reducing aggressive behaviour in children and youth.

Question & Answer Period

Melissa CorcoranMelissa.corcoran@camh.ca 416-535-8501 Ext 39127

Megan LoweMegan.lowe@camh.ca 416-535-8501

Ext 36770