Youth and Elderly Addiction Issues

April 10-12, 2012 Walt Disney World Swan Resort

Learning Objectives: 1. Describe the successful icanhelpsm program’s three-pronged approach for early engagement of adolescents most at-risk of addiction. 2. Explain the importance of educating the caregivers and others of the elderly (over 50) population on the potential for prescription drug misuse, abuse, addiction and becoming victims of pill-seekers. 3. Describe the essential services needed to provide both the youth and the elderly an opportunity to live productive, healthy lives, and identify common barriers to accessing treatment.

Disclosure Statement

•  All presenters for this session, Deborah Beck and Michelle Muffett-Lipiniski, have disclosed no relevant, real or apparent personal or professional financial relationships.

icanhelpSM a program for early engagement by

establishing “safe” places for adolescents to develop a trusting rapport with adults

in the community http://

icanhelp.me

Michelle  Muffe*-­‐Lipinski,  M  Ed  icanhelp  Director  Phone:  603-­‐842-­‐0029  Email:  LipinskiM@icanhelp.me  

Barbara  Bruhns  Frey,  PhD  Phone:  801-­‐512-­‐3239  Email:  FreyBB@icanhelp.me  

© 2012 Potential Connections LLC This presentation and training is the property of Potential Connections LLC. Do not duplicated, reproduce or distribute without permission (email: icanhelp@potentialconnections.com).

Alyssa….

http://www.youtube.com/watch?v=q6JqSOcfmn0&feature=share

Drug Use Across the Ages

•  Nonmedical use of Rx pain relievers – Starts young & w/ age – Although drug use generally by middle

age, the baby-boom generation* has higher rates than previous generations •  Aging of baby boomers will lead to in illicit

drug use & nonmedical Rx drug use among persons aged ≥50

–  Possibly doubling by 2020

SAMHSA. (2011). Results from the 2010 National Survey on Drug Use and Health: Detailed Tables. Office of Applied Studies, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD.

SAMHSA. (2011).The NSDUH Report: Illicit Drug Use among Older Adults. Rockville, MD. Duncan DF, et al. J Aging Soc Policy. 2010;22:237-48. Kalapatapu RK, et al. Am J Addict. 2010;19:515-22.

*Born 1946-1964

Nonmedical Use •  National studies

– National Survey on Drug Use & Health (NSDUH)

– Monitoring the Future (MTF) – National Survey of American Attitudes on

Substance Abuse XVI – Partnership Attitude Tracking Survey (PATS) – Treatment Episode Data Set (TEDS)

Each define “nonmedical” use differently

Past-Yr Initiates of Specific Drugs Among Persons Age ≥12-Yr

SAMHSA. (2011). Results from the 2010 National Survey on Drug Use and Health: Detailed Tables.

Office of Applied Studies, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD.

The total initiates of nonmedical Rx drug use (red bars) taken together greatly exceeds

initiates of marijuana in 2010

Monitoring the Future (MTF) 2011 Survey

•  46,700 grade 8, 10, & 12 students in 400 secondary schools nationwide – Misuse of Rx drugs (amphetamines,

sedatives, tranquilizers, & opioids other than heroin) •  Respondents instructed to include only use

“. . . on your own—that is, without a doctor telling you to take them”

Johnston LD, et al. (2012). Monitoring the Future–National Results on Adolescent Drug Use: Overview of Key Findings, 2011. Ann Arbor: Institute for Social Research, University of Michigan.

MTF: Rx Drug Abuse in Grade 12

Johnston LD, et al. (2012). Monitoring the Future–National Results on Adolescent Drug Use: Overview

of Key Findings, 2011. Ann Arbor: Institute for Social Research, University of Michigan.

Percentage of grade 12 students reporting nonmedical Rx drug use: rates for opioids highest

Source of Most Recent Rx Opioids: Among 12-17-Yr-Olds

SAMHSA. (2011). Results from the 2010 National Survey on Drug Use and Health: Detailed Tables. Office of Applied Studies, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD.

Source where friend/relative obtained:

58.8% from 1 MD

10.5% took: friend/relative

9.6% free: friend/relative

6.1% bought: friend/relative

5.8% from >1 MD

3.5% bought: drug dealer

Effect of Rx Opioids Kept in Home

The National Center on Addiction & Substance Abuse at Columbia University. National Survey of

American Attitudes on Substance Abuse XVI: Teens & Parents. Aug 2011.

Percentage of teens reporting: Time to get Rx drugs: Other substance use:

Drug Overdose Death Rates •  Drugs are 2nd leading cause of injury

death – 36.4K vs 39.9K for MVA in 2008

•  Overdose rate in 2008 nearly 4x 1999 rate

Paulozzi LJ, et al. MMWR. 2011;60:1-6. CDC. Vital Signs. Prescription painkiller overdoses in

the US. 2011. www.cdc.gov/VitalSigns/PainkillerOverdoses/index.html

The problem

They  don’t  realized  that  we  can  help  them  

We are not reaching our youth who need help The youth do not know they have a problem

How is This Program Different Than Other Early Identification Programs?

•  No wrong door approach •  Identify “safe” & trained people who can engage with

youth •  Help youth initiate the conversation

•  The icanhelp program is designed to improve outcomes related to: –  Accessibility of resources and services –  Academic performance –  Mental and physical health –  Quality of life –  Gaps in service –  New links for individuals and the community

icanhelp Program Overview The program • has community oversight and planning through an icanhelp team/advisory board • builds a network of trained individuals who are trained and designated icanhelp Representatives • increases early identification and engagement of young people who need a “safe, educated person” to help them access the appropriate service essential to their well-being • provides online access to listings of community resources and services

icanhelp Representative

Follow-­‐up

Who and Where Do Young People Go for Help?

Trainees

•  Identify trainees to become icanhelp Representatives

•  Community members who work directly with youth: •  School personnel •  Health personnel •  Law enforcement (SRO) •  Prevention specialist (Drug Free

Communities) •  Coaches and other youth mentors •  After school/Out of school activity

coordinators/workers •  Parents, families and young adults •  Clergy and other nonprofit

employees •  Government personnel •  Others

Increasing Our Presence

Engagement

Develop strategies and plans for building student and family awareness and engagement • Communicate icanhelp core concepts with young people & others in the community • Make presentations

•  Possible locations: youth groups/centers, school announcements, newspapers & websites, parent groups, substance abuse coalitions, etc.

Increasing Your Presence Youth awareness and facilitating a

conversation

If you’re thinking these thoughts...you may need help.Look for the I CAN HELP stickerto find a safe person to talk to.www.icanhelp.me

If you’re thinking these thoughts...you may need help.Look for the I CAN HELP stickerto find a safe person to talk to.www.icanhelp.me

Display icanhelp posters Examples of posters related to addictive behavior and issues

Increasing Your Presence

Engagement

Identify icanhelp Representatives using icanhelp Logos

The presence of the icanhelp logo signals this is a safe person to speak with

Logos are reserved for people who have been trained and are members of the icanhelp team

Who Do Young People Go To For Help?

Communication style •  Building an alliance with youth so they feel

safe and welcome •  Strength-based vs. punitive, be supportive

and non-punitive •  Frame questions in a non-judgemental way •  Start where the student is at •  Youth need encouragement, validation and

support for expressing their opinions •  Including the student in decisions, encourage

open and honest bidirectional discussions •  Empower the student to take responsibility for

seeking solutions, and build incrementally on small successes

Where Do Youth Go for Help?

Creating a safe space •  School & Institutional Policies •  Cultural competency, biases •  Working within the parameters

of our licensure & the law; mandated reporting

•  Stigma and label free •  Risk/Protective factors

Why Target Adolescents? •  About one in every five youth meets the

criteria for a mental health disorder in the US. •  The prevalence is even higher that other

major health conditions including asthma and diabetes (Merikangas et al., 2010)

•  Only a third of youth in need of treatment for mental health disorders receives treatment and frequently the treatment is incomplete or inadequate for their level of need (Merikangas et al., 2011)

•  Dennis et al. (2005) found that the sooner an individual receives treatment the shorter the lifetime struggle related to managing their disease

Prevalence of Mental Health Disorders  

Common  reasons  for  receiving  mental  health  treatment  among  adolescents  (age  12-­‐17)  who  received  treatment  (NSDUH,  2008)  

48.6 28.9

25.7 20.4 19.6 18.9

16.3 14

0 10 20 30 40 50 60

Felt Depressed Problems at home/family Breaking rules/acting out Felt very afraid or tense

Contemplates/attempted suicide

Problems at school Trouble controlling anger

Problems with friends

Percent of children receiving treatment

Does  not  include  treatment  for  problems  caused  by  drug  or  alcohol  use.    Respondents  could  list  more  than  one  reason  for  treatment.  

Identifying Youth in Need of support Services

Connection to their world •  There are many routes to identification

of a youth in need of support services. •  Who are the members of your

community who work closely with youth?

•  Schools •  Families •  Friends •  Online & technology communities •  Volunteer activities •  Faith-base, religious activities •  Employment •  Extracurricular activities

•  Sports •  After school out

of school time (ASOST)

Identifying Youth Issues Specific to Your Community

Life events •  Separation or loss of family/friends/

home •  Trauma & victimization, Bullying/

cyber bullying •  Child abuse

•  Depression •  Suicide •  Anxiety disorders •  ADHD •  Eating disorders •  Prescription drug abuse

•  Tobacco •  Performance enhancing

drugs •  Marijuana •  Alcohol •  Gambling addiction

Mental health, addictive and co-occurring disorders

Life challenges •  Disabilities, developmental

disorders •  Physical health – injuries, illness

Link to Community Resources & Services

icanhelp Resource Guide

Link to Community Resources

•  Importance of establishing personal relationships with people listed on your resource guide

•  In a crisis or urgent situation, this relationship will be important

•  Make the guide as comprehensive as possible – divide and conquer – complete it as a team

•  The contact information on the resource guides can be loaded into the online icanhelp resource database

Developing an icanhelp Resource Guide for Your Community

Link to Community Resources & Services icanhelp Program: Building Linkages to

Community Resources

Link to Community Resources

Online Services •  Resource database

•  http://icanhelp.me

•  Community •  http://icanhelp.me/community/ •  Wiki •  Blog •  and more

•  Facebook •  http://www.facebook.com/icanhelp.me

•  Future services •  icanhelp newsletter & mailing list •  Training Portal: Re-launch soon •  Expanded search options for

resource database

icanhelp Website: http://icanhelp.me

icanhelp Follow-up Preventing youth from “falling

through the cracks” Why linking with services doesn’t always work • Youth or family not always ready to receive services, personal factors related to mental and cognitive functioning of individual or family • No service available within a reasonable distance, dropped services • Practical factors such as insurance, cost, transport, child care, eligibility rules or program scheduling • Cultural factors such as language, citizenship and status • Negative experience/bad rapport with provider • Stigma and labeling • Lack of cultural competency

Follow-­‐up

icanhelp Follow-up Preventing youth from “falling

through the cracks”

Some solutions • Use MI and other approaches to build readiness • Increased training in community • Assist adolescents and their caregivers to develop alternative plans • Expand community resources and services

Follow-­‐up

Continua of School Services

AODA Tx and Continuing Care

Brief Intervention

Primary Prevention

Dependence/ Abuse (10%)

AODA Model—Winters, Caldwell Education Model—OSEP-PBIS

SOURCE: Finch, 2010; Moberg, 2010

icanhelp Outcomes •  6-week implementation and evaluation of the icanhelpSM program in

seven northeastern Massachusetts schools •  Twenty high school personnel participated •  Personnel roles were grouped into three categories: Administrators

(n=3), Teachers (n=9) and Health Professions (n=8)

Most youth directed their questions about the program to teachers

Youth tended to discuss their specific questions regarding the posters with health professionals

icanhelp Outcomes Teachers indicated the largest increase in linkages due to icanhelp

Next steps icanhelp team/advisory board • Develop and communicate community crisis plan • Develop icanhelp deployment/implementation plan

–  What are the targets/goals for the first year • Assist icanhelp Representatives in compiling a community resource database • Develop a sustainability plan

icanhelp Representatives • Join icanhelp community • Work with team to compiling a community resource database • Display icanhelp posters and logos • Give brief presentations about the program to youth and other community members

icanhelp Resource Database • Make connections to key community

linkages/resources/services • Submit or upload resources from your community

(can send file to Barbara)

Thank You!

In today’s society with undeniable amounts of access to technology, our young people need a village of supports to help them navigate safely into adulthood. Help us expand this village.

Icanhelp.me

Michelle