Transcript Working with Substance-Abusing Adolescents

Rick Cresta LICSW, MSW/MPH
Schedule of the Day
9:00-10:30 Introduction
Substance Abuse 101
Drug Classifications
10:30-10:45 Break
10:45-12:00 Trends
Chronic Marijuana Use
12:00-1:15
Lunch
1:15-2:30
Chronic Marijuana
Treatment Strategies
2:30-2:45
Break
2:45-4:00
Confidentiality
Decision Making
Video
Evaluations
Introduction
 25 Years Working with Adolescents
 Residential, Schools, Home-based, DCF/DYS
 Adjunct Professor BUSSW
 Trainer and Consultant
 Private Practice with Court-Involved Youth
 Behavioral v. Legal and Neuroscientific Focus
 Census of Participants
Substance Abuse 101
 Psychoactive Substances*1a
 “Normal” Use
 Abuse and Addiction*1b
 Physical and Psychological Dependence
 Denial and Lying
 The “Loss”
 Rock Bottom and Mandated Treatment*1c
*1a
Energy Drinks
1b
3 Life Spheres
Relationships
Health
Vocation
1c
101 (cont.)
 Benefits and Consequences
 Risk and Protective Factors
 Dual Diagnosis
 Disease or Choice
 Supply v. Demand
 Drug Categories*
Drug Classifications
 Depressants
 Stimulants
 Narcotics
 Hallucinogens
DEPRESSANTS
 ALCOHOL: Wine, Beer, Distilled Spirits
 BENZODIAZEPINE: Valium, Xanax, Klonopin,
Ativan,
 BARBITUATES: Seconal, Phenobarital, Nebutal,
Quaalude
 INHALANTS: Solvents, Cleaning Agents, Aerosols
 GAMMA HYDROXYBUTYRATE: GHB, Liquid X
(Depressants affect the central nervous system causing
impaired judgment, deterioration of motor skills and
cognition, and loss of inhibition)
STIMULANTS
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COCAINE: Coke, Crack, Rock
METHAMPHETAMINE: Ice, Crystal, Crank
METHYLENEDIOXYMETHAMPHETAMINE: XTC
METHYLPHENIATE: Ritalin, Adderall
METHYLENDIOX…: “BATH SALTS”
(Stimulants, on a short-term basis, disrupt the brain’s
dopamine neurotransmitter system which causes mood
elevation and increased motor activity. There is an
increase in heart rate, decrease in appetite, and a marked
change in mood)
NARCOTICS
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CODEINE: Tylenol with Codeine, Fiorinal
HYDROCODONE: Vicodin
OXYCODONE: Oxycontin, Percocet
MORPHINE: MS Contin
HEROIN
MEPERIDINE: Demerol
METHADONE
FENTANYL: Duragesic Patch
SUBOXONE: Buprenorphine and Naloxone
(Narcotics are best known for their analgesic properties, the ability
to provide pain relief. Narcotics include opium drugs made from
the poppy plant and synthetically manufactured opiods)
HALLUCINOGENS
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LYSERGIC ACID DIETHYLAMIDE: LSD, Blotter Acid
PHENCYCLIDINE: PCP, Angel Dust
KETAMINE: Special K, Cat Valium
MARIJUANA: Cannabis
MUSHROOMS
SALVIA
Spice/K2
(Hallucinogens are substances that distort the perception
of objective reality. They induce a state of excitation of the
central nervous system, characterized by alterations of
mood, usually euphoric, but sometimes severely
depressive)
Trends in Adolescent Substance
Use
 Complete MTF survey results are available at:
www.monitoringthefuture.org
 For more information on the survey and its findings,
also visit:
www.drugabuse.gov/related-topics/trendsstatistics/monitoring-future.
Chronic Marijuana Use: “What’s
the Big Deal?”
 Terms (weed, ganja, trees, bud, bliz, l’s refer, pot,
herb, chronic…)
 Dippies, Dusting, Clam Bake,
 What Is The Impact On Them: Cognitive, Behavior,
Emotional?
 Countertransference
 What we bring to the table (personal experience)
 What is different now (frequency, potency)
 What may be different between you and them (trauma
hx, developmental stage)
What Distinguishes it From Other
Drugs
 Causes “less harm” =/= harmless
 “No One Ever Died From It”*2a
 Active Campaign to promote
 Law changes
 Social Consequences
 Portrayal in Media*2b
2a
2b
What is Different (cont.)
 Very Little Defensiveness about “use”
 Consequences Lag Behind Use*3a
 Consequences are More Subtle (storm)
 Significant For What You Don’t Do
 Considered “Natural”
3a
What is different (cont.)
 Cultural Significance (Rasta, Rap)
 Treatment is Geared Towards Harder
drugs
 Same for Self-Help Groups
 Belief that its Non-Addictive
 Medical Applications*
Cart Before the Horse?
 Schedule 1
 Studies
 Dose
 Side Effects
 Compare to Others
 Advil Warnings*3b
 Flu and Meth
 Ptsd and MDMA
3b
Advil Warning
Physician Perspectives on
Marijuana's Medical Use
 "The evidence is overwhelming that marijuana can relieve certain types of pain, nausea,
vomiting and other symptoms caused by such illnesses as multiple sclerosis, cancer and
AIDS -- or by the harsh drugs sometimes used to treat them. And it can do so with
remarkable safety. Indeed, marijuana is less toxic than many of the drugs that physicians
prescribe every day.“
- Joycelyn Elders, MD
Former US Surgeon General
Editorial, Providence Journal
Mar. 26, 2004
 "Although I understand many believe marijuana is the most effective drug in combating
their medical ailments, I would caution against this assumption due to the lack of
consistent, repeatable scientific data available to prove marijuana's medical benefits.
 Based on current evidence, I believe that marijuana is a dangerous drug and that there
are less dangerous medicines offering the same relief from pain and other medical
symptoms.“
-- Bill Frist, MD
Former US Senator (R-TN)
Correspondence to ProCon.org
Oct. 20, 2003
Medical Marijuana Debate and Its
Effect on Youth Drug Use
 "While it is not possible with existing data to determine conclusively that state medical
marijuana laws caused the documented declines in adolescent marijuana use, the
overwhelming downward trend strongly suggests that the effect of state medical
marijuana laws on teen marijuana use has been either neutral or positive, discouraging
youthful experimentation with the drug.“
 -- Mitch Earleywine, PhD
Associate Professor of Psychology, State University of New York at Albany
Sep. 2005
 "By characterizing the use of illegal drugs as quasi-legal, state-sanctioned, Saturday
afternoon fun, legalizers destabilize the societal norm that drug use is dangerous. They
undercut the goals of stopping the initiation of drug use to prevent addiction....
Children entering drug abuse treatment routinely report that they heard that 'pot is
medicine' and, therefore, believed it to be good for them.“
 -- Andrea Barthwell, MD
Former Deputy Director, White House Office of National Drug Control Policy (ONDCP)
Chicago Tribune editorial
Feb. 17, 2004
Reasons For Use/Discerning Its
Role
 Do not bombard with Negatives
 Start with Why They Like it
 Do not overstate the facts
 Do not get “sucked into” a debate
 “No one ever died”
 “Cigarettes are worse”
 Recognize Autonomy
 Engagement v. Increasing Defensiveness
 Common Reasons Given:
In Their Words
 “It relaxes me” “Helps me chill”
 “Its fun”
 “Helps when I’m angry”
 “I do better in school” “Helps me focus”
 “Makes me more creative”
 “Stops me from being bored”
 Others…
The Truth
 It DOES do these things, at least in the short term
 Diminishing effects, dissipates over time (like smoke)
 There are better ways to achieve each
 Dose response
 What they don’t as a result…
Questions to Increase Motivation
 Have you noticed ANY negative consequences? (“My




uncle…)
Observed in others? (Joey’s cousin)
Do you plan on always using at your current level?
…like you do now?
If not, why?
What have you been told about its consequences?
Public Health Campaign
 3 Things We Have All Been Told…
 1. Gate Way Drug
 2. Kills Brain Cells
 3. Lowers Sperm Count
 There is Truth in Each But Delivery Missed
the Mark
 More Recent Effort to Address Impact on
Motivation
The Impact
 Research limitations, Schedule 1
 Empirical Data as it relates to Them
 Emphasis on Chronic Use
 Physical Effects
 Cognitive Effects
 Behavioral Effects
 Psychological/Emotional Effects
Physiological/Physical Effects
 Testicular Cancer (2x’s the risk if weekly user or
since teen)
 Increased Cancer Risk due to Smoke (too far off)
 Low Birth Weight Babies
 “Man Boobs”
 Hang Over “Baby Neck”
Cognitive Impact
 Slow But Real For Chronic Users
 College Student Experiment
 Conner’s Dad
 “Helps me in school”
 Vacuum Cleaner analogy
 State Dependent memory
 Alternatives
Behavioral Impact
 Amotivational Syndrome
 “I still do stuff” What stuff?
 Sand Bag Effect, Getting Over the Fence
 Goals remain But Attainment Falls-Off
 Impact of Self Esteem
 “If you are just making it…”
 “Might want to wait until…”
 “it’s a great thing to d if you Don’t want things to
change”
Behavioral Impact (cont.)
 Significant for What You Don’t Do
 Connection to Boredom
 Role of Boredom in Development
 Stoop Analogy
 “Painting the room”
 Changing the way something appears v. reality
 Can become primary activity, Who you are, not just
what you do.
 Narrows Experience
Psychological & Emotional Impact
 Link to Schizophrenia
 “Tipping the scales”
 Can Increase Apathy (IDC line)
 Considered a Depressant (conflicting studies)*4a
 Developmental Tasks, Coping Skills
Psychological & Emotional Impact (cont.)
 Takes Edge Off Difficult Emotions
 “Blunts” Emotions v. Explore & Express
 “helps me not cry”
 Cognitive & Emotional Separation v. Integration
 Impact on Intimate Connections
 Authentic Self (Chris)
4a
Treatment Planning
 Explore Role in Your Life
 Increase Internal Desire & External Influence
 “Get both sides so you can make best decision for you”
 Trial Stoppage, Info. Gathering v. Challenge
 Harm Reduction
 Replacement Activities
 Finding Allies
 Prepare for Withdrawal & Relapse
 “Nothing to lose, much to gain”
Treatment Modalities
 Group Treatment
 Inpatient
 Family
 Self Help AA, NA, Alanon, Alateen
 Recovery High Schools
 Faith-Based programs
 Alternative, Complimentary Tx
Challenges With Confidentiality
 Justin Vignette
 Sean Vignette
 Meghan Vignette
 John Vignette
Other Issues
 Message Delivery & Relationship
 Psychopharmacology
 Self-Disclosure
 Drug Testing
 Decision Making Exercises
 Connection to Other (-) Behaviors
Resources:
 Join Together - The Partnership at Drugfree.org
 www.drugfree.org/join-together
 The Substance Abuse and Mental Health Services
Administration ...
 www.samhsa.gov
 National Institute on Drug Abuse
 www.drugabuse.gov/