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SUBSTANCE ABUSE:

Recognition & Treatment in


Adolescents

Georgina M. Gozo-Oliver, MD, FCAPPI


Child & Adolescent Psychiatrist
Substance Use in Adolescents
 Normal Trajectory

 Adolescents experiment with the use of cigarettes, alcohol, &


other drugs.

 Adolescents who use alcohol & other drugs experiment with a


wide variety of substances for a while, & then abandon their
use.

 Few youth advance to more serious levels of substance use.

 Relatively low percentages of young people develop a


substance use disorder during adolescence.
Substance Use:
Why do Adolescents use Substances?

 Reasons for Substance Use

 Recreational benefits (To have fun)


 Social conformity *
 Mood enhancement *
 Coping with stress

 * Youth with a substance use dependence disorder


assign more importance to these factors than less
experienced adolescents
Substance Use: Stages
 Stages of Substance Use (Kandel, et al, 1975)

 No use of any drug

 Use of beer or wine

 Use of cigarettes or hard liquor

 Use of illicit substances starting with marijuana


Substance Abuse: Stages

 Stages of Substance Use

 Useof other illicit substances like


methamphetamine & inhalants

 “Carry-over effects”

 Multiple drug use


Substance Abuse: Recognition
 Who are at risk?

 Family factors

 Peer factors

 Community factors

 Individual factors
Substance Abuse: Recognition
 Who are at risk?
Family factors

 Substance abusing members

 Excessive family conflict

 Low parent-child attachment

 Poor parenting skills

 Low parental supervision

 Child abuse or neglect


Substance Abuse: Recognition
 Who are at risk?

 Peer Factors

 In mid-adolescence, peer influence


peaks

 Drug taking friends exert the


strongest influence
Substance Abuse: Recognition
 Who are at risk?

 Community Factors

 Poverty

 Overpopulation

 High crime rate


Substance Abuse: Recognition
 Who are at risk?

 Individual factors

 Children of substance abusers

 Victims of child abuse

 Youth with mental health problems

 Physically disabled

 Children with poor academic achievement


Substance Abuse: Recognition

 Early Detection

 Mostcommonly missed pediatric


diagnosis

 Medical
findings depend on the type of
substance used
Substance Abuse: Recognition
 Early Detection

 COMMON PHYSICAL SIGNS

 Weight Loss
 Chronic Fatigue

 Chronic cough

 Red eyes

 Poor personal hygiene

 General apathy

 Malaise
Substance Abuse: Recognition
 Early Detection

 MENTAL STATE

 Impaired memory
 Impaired attention/concentration

 Disorientation

 Illusions

 Disordered thought

 Low self esteem

 Guilt

 Suicidal Thoughts
Substance Abuse: Recognition
 Early Detection

 BEHAVIORAL CHANGES

 Irritability
 Aggression

 Sleep pattern changes

 Mood swings

 Change in social relationships

 Failure in school

 Social withdrawal

 Substance-related legal difficulties


Substance Abuse: Recognition
 Early Detection
 CRAFFT: Questions to Identify Adolescents with Substance
Abuse
 (American Academy of Pediatrics, 2006)

C Have you ever ridden in a CAR driven by someone (including yourself)


who was “high” or had been using alcohol or drugs?

R Do you ever use alcohol or drugs to RELAX, feel better about


yourself, or fit in?

A Do you ever use alcohol or drugs while you are by yourself or ALONE?
Substance Abuse: Recognition
 Early Detection

 CRAFFT: Questions to Identify Adolescents with Substance


Abuse

F Do you ever FORGET things you did while using alcohol or drugs?

F Do your family or FRIENDS ever tell you that you should cut down
on your drinking or drug use?

T Have you ever gotten into TROUBLE while you were using alcohol or
drugs?
Referral for Treatment
 Toxicology
 Psychiatry
Substance Abuse:
Treatment
 Goals of Treatment

 Abstinence or reduction in the use & effects of


substances

 Reduction in the frequency & severity of relapse

 Improvement in psychological & adaptive functioning.


Substance Abuse:
Treatment
 Principles of Effective Treatment

 No single treatment is appropriate for all individuals.

 Effective treatment attends to the multiple needs of the


individual, not just his or her drug use.

 The individual treatment plan must be assessed


continually & modified as necessary to ensure that the
plan meets the person’s changing needs.
Substance Abuse: Treatment
 Principles of Effective Treatment

 Remaining in treatment for an adequate period of time


is critical for treatment effectiveness.

 Counseling (individual or group) & other behavioral


therapies are critical components of effective treatment
for the addiction.

 Medications are an important element of treatment for


many patients. 50-90% of substance abusers have dual
diagnosis.
Substance Abuse:
Treatment
 Principles of Effective Treatment

 Medicaldetoxification is only the first stage of


addiction treatment & by itself does little to
change long-term drug use.

 Possible
drug use during treatment must be
monitored continuously.
Substance Abuse:
Treatment
 Stages

 Detoxification

 Rehabilitation

 Relapse Prevention
Substance Abuse:
Treatment
 DETOXIFICATION

 Provides a setting in which a patient may enter


recovery from addiction.

 Serves to eliminate only the physical


dependence on the drug.

 Does nothing to eliminate the disease


(Addiction).
Substance Abuse: Treatment
 DETOXIFICATION: Objectives

 Enhances the removal of the substance(s) from the body


to minimize its damaging effects

 Treat or minimize the physical or psychiatric symptoms


associated with withdrawal

 Identify & manage associated medical illnesses which


may or may not be related to the substance use.

 Provide an initial setting for patient’s recovery


Substance Abuse: Treatment
 DETOXIFICATION: Techniques

 Urine Acidification

 Forced Diuresis

 Multiple Dose Activated Charcoal


Substance Abuse: Treatment
 REHABILITATION

 Therapeutic Community

 Structured Outpatient Group Therapy

 Family Therapy

 Individual Therapies

 Network Therapy
Substance Abuse: Treatment
 REHABILITATION: The Therapeutic Community

 Founded on a Social Learning model that fosters


behavioral & attitudinal change as a result of membership
in a community

 Through intensive peer-based approach, the patient learns


& addresses:

 Pro-social values

 Self-Destructive & Anti-social behavioral patterns


Substance Abuse: Treatment
 REHABILITATION: The Therapeutic Community

 A concept designed to provide tools for growth on an


emotional, spiritual, & intellectual plane

 Offers individual & group counseling, family services, medical


& mental health services, vocational & educational services

 As patients progress in treatment, they earn more challenging


& responsible assignments & a higher status level.
Substance Abuse: Treatment
 REHABILITATION: The Therapeutic Community

 ACTIVITIES

 Morning meetings Static Groups

 Encounter groups Request Groups

 Seminars Skills Development


Substance Abuse: Treatment
 REHABILITATION: The Therapeutic Community

 SPECIAL POPULATIONS

 Mothers in Recovery

 Dual Diagnosis Clients

 Adolescent Services
Substance Abuse: Treatment
 REHABILITATION: Structured Outpatient Group
Therapy
 Not a stand-alone modality
 Part of a structured, comprehensive treatment
program that provides

 Individual Counseling
 Supervised Urine Testing

 Family Counseling

 Educational Sessions

 Encouragement to participate in self-help recovery

meetings
Substance Abuse: Treatment
 REHABILITATION: Family Therapy
 Stages
 Defining the problem & negotiating a contract

 Establishing the context of a chemical-free life

 Ceasing substance abuse

 Managing the crisis & stablizing the family

 Family reorganization & recovery

 Termination
Substance Abuse: Treatment
 REHABILITATION: Individual Therapies

 Traditionalweekly, insight-oriented
psychotherapy sessions are not appropriate
treatment for substance abusers who are actively
using or recently detoxified from a substance

 Clinicians
can modify psychotherapeutic
approaches or combine with other treatment
elements
Substance Abuse: Treatment
 REHABILITATION: Network Therapy

 Specificfamily members & friends are enlisted to


provide ongoing support & to promote attitude
change

 Network members are part of the therapist’s


“working team”

 Goal: the prompt achievement of abstinence with


relapse prevention & the development of a drug-
free adaptation
Substance Abuse: Treatment

 RELAPSE PREVENTION

 Case Management

 Educationalprograms that
painstakingly help patients find new
ways to work, associate, & recreate
Substance Abuse: Treatment
 RELAPSE PREVENTION: Goals

 Empower patients

 Gently
appraise them of their
psychopathology

 Encouragethem to examine how drugs &


psychopathology have affected their lives
Substance Abuse: Treatment
 RELAPSE PREVENTION: Goals

 Discusstreatment issues like rule-


breaking, lack of sharing, etc.

 Promote awareness of self-medicating


behavior

 Repetitionof concrete rules of behavior


for severely disturbed
 THANKYOU
FOR
LISTENING!