Transcript Youth Suicide and Co-Occurring Disorders

Suicide and
Co-Occurring
Disorders
Jean McCracken, CAC-AD
Safe & Drug Free Schools Project
[email protected]
Medical Definition of Addiction
DSM-IV – Answer yes to 3 or more questions
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Tolerance. Has your use of drugs or alcohol increased over time?
Withdrawal. When you stop using, have you ever experienced physical or
emotional withdrawal? Have you had any of the following symptoms: irritability,
anxiety, shakes, sweats, nausea, or vomiting?
Difficulty controlling your use. Do you sometimes use more or for a longer time
than you would like? Do you drink to get drunk? Do you stop after a few drinks or
does one drink lead to another?
Negative consequences. Have you continued to use even though there have been
negative consequences to your mood, self-esteem, health, job, or family?
Putting off or neglecting activities. Have you ever put off or reduced social,
recreational, work, or household activities because of your use?
Spending significant time or emotional energy. Have you spent a significant
amount of time obtaining, using, concealing, planning, or recovering from your
use? Have you spend a lot of time thinking about using? Have you ever concealed
or minimized your use? Have you ever thought of schemes to avoid getting
caught?
Desire to cut down. Have you sometimes thought about cutting down or
controlling your use? Have you ever made unsuccessful attempts to cut down or
control your use?
Definition of Addiction
Continued use despite
negative consequences
Addiction is a “bio-psycho-social-spiritual” disorder
Addiction is a brain disorder
Drug of Choice for Past Year Use of Illicit Drugs
Aged 12 or Older: 2008
Alcohol Dependence or Abuse in the Past Year among Adults Aged 21 or
Older, by Age at First Use of Alcohol: 2008
FACT: Addiction starts in adolescence.
Anne Arundel County
Percent of Students By Grade Who Reported “Ever Used” these Substances
Substance
Cigarettes
Any form of alcohol
5 or more servings of
alcohol at one time
Marijuana
Cocaine
Hallucinogens
(shrooms/not LSD)
Designer Drugs
Heroin
Narcotics (Percocet,
OxyContin, Vicodin)
6th Grade
8th Grade
10th Grade
12th Grade
4.4
9.9
*3.4
8.8
13.3
32.6
*10.6
25.7
24.0
55.1
*20.1
48.7
35.9
75.8
*30.8
66.6
3.1
1.3
0.5
2.0
1.3
0.4
14.7
9.2
1.8
9.0
8.0
1.1
36.1
27.3
4.5
27.4
24.0
3.4
58.6
45.9
7.8
46.9
38.7
5.5
0.0
0.2
0.2
0.2
0.4
0.6
1.4
1.6
1.1
1.3
1.3
1.0
5.7
5.3
2.3
4.3
3.4
1.4
12.0
9.6
2.4
7.4
6.0
1.8
0.0
0.3
2.0
1.2
6.6
4.4
12.7
8.2
0.2
0.9
3.2
2.4
4.9
4.6
9.3
6.3
0.0
0.2
0.2
0.7
6.6
2.2
12.7
5.0
7.5
3.4
17.2
15.0
31.6
28.8
49.8
35.8
Amphetamines (Ritalin,
Dexadrine, Caffeine)
Barbiturates (Valium,
Xanax)
Any drug other than
alcohol or tobacco
*Maryland State Results
2007 Maryland Adolescent Survey (www.marylandpublicschools.org)
What does this mean for educators?
712 8th graders are smoking cigarettes (which puts them at
great risk for smoking marijuana)
1,617 10th graders have smoked marijuana (wonder how
many were 9th grade repeaters???)
2,880 12th graders are binge drinking (how many will make it
through their freshmen year of college?)
520 6th graders are beginning to drink alcohol (which
ones will become the 1 in 10 Americans who become addicted adults?)
920 8th graders (going into high school) and 2,447 12th
graders (going into adult society) have or are using illicit
drugs!!!
Why Do Kids Use Alcohol and Other Drugs?
To satisfy curiosity
To feel good and relax
To escape problems
To fit in and belong
To take risks and rebel
To feel “grown up”
To not be “bored”
Why Do Kids Resist Drugs?
 Feeling connected to
family.
 Being committed to school
or a vocational goal
 Strong Faith
Adolescent Stages of Use
1. Experimentation
Rarely use – behavior does not change
Curious
Friends use
Relax
Rebel
Escape problems
Problem: If you like the way it makes you
feel, will you continue to use!?
2. Use/Abuse
Use on a regular basis with a change in attitude
May buy it – drugs are now something you value
Begin to lie to parents about what you are doing
Care less about school work
Break more rules like curfew, doing chores, etc.
May lose friends who don’t use
Begin to have negative consequences
Problem: Using drugs takes time away
from healthy activities. The brain begins
to change and develop a tolerance .
3. Addiction/Chemical Dependency
A brain disease which takes away self-control
and craves the use of drugs.
Use to feel normal
Drugs are the focal point in life
Unable to make good decisions
Affects the way you act, think and feel
Problem: Your brain has chemically and
physically changed and you need to use to
function.
Over the Counter (OTC)
Most popular are DXM and Caffeine (energy pills, diet pills)
DXM: Dextromethorphan is a cough-suppressing ingredient found in a
variety of OTC cold medications. Robotussin/cough syrups, Coricidin Cough
and Cold (red pills – not blue with antihistamine)
Street names: Triple Cs, Skittles, Robo, Robotrippin, Tussin
What are short term effects of DXM and caffeine?
DXM users describe “plateaus” depending upon tolerance and amount
taken which range from hallucinations to “out of body” dissociative
sensations. Physical effects of both can include dizziness, confusion, slurred
speech, impaired coordination, abdominal pain, nausea /vomiting, rapid
heart beat and drowsiness.
What are long term effects?
DXM can damage liver and pancreas (used with alcohol, can be deadly).
Prescription Drug Abuse
3 out of 4 drugs used illegally are prescription medications
Narcotic/Opioid Painkillers – Percocet, Vicodin, OxyContin, Morphine, Codeine
Sedatives /Tranquilizers,- Xanax, Valium, Ativan
Stimulants – Ritalin, Adderall (ADHD medications)
Short Term Effects:
Narcotics: Constipation, Depression , Low blood pressure , Decreased respiration rate ,
Confusion
Sedatives: Drowsiness , Confusion , Unsteady gait , Impaired judgment , Involuntary and rapid
movement of the eyeball
Stimulants: Weight loss, Agitation , Irritability , Insomnia , High blood pressure , Irregular
heartbeat
OxyContin and prescription pain relievers cause euphoria or feelings of well being by affecting the
brain regions that mediate pleasure. They are often crushed to diminish the time release
factor.
Xanax slows down the central nervous system, triggering an alcohol-like high, creating a state of
euphoria, lowering inhibitions and increasing sociability.
Withdrawal Symptoms
Emotional Withdrawal Symptoms
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Anxiety
Restlessness
Irritability
Insomnia
Headaches
Poor concentration
Depression
Social isolation
Physical Withdrawal Symptoms
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Sweating
Racing heart
Palpitations
Muscle tension
Tightness in the chest
Difficulty breathing
Tremor
Nausea, vomiting, or diarrhea
When is Detox Needed?
When can you die from withdrawal?
When withdrawing from depressants:
 alcohol
 tranquilizers (Valium)
 benzodiazepines (Xanax)
A medically supervised detox can minimize your withdrawal symptoms and life
threatening complications such as:
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Grand mal seizures
Heart attacks
Strokes
Hallucinations
Delirium tremens (DTs)
Withdrawal from opiates like heroin and OxyContin is extremely uncomfortable, but
not usually dangerous. Heroin withdrawal is like having a severe case of the flu but
does not produce seizures, heart attacks, strokes, or delirium tremens.
Early Stages of Recovery
Once an adolescent is not using alcohol or other drugs, it is often the expectation that
their behavior and attitude will improve and they will be able to academically get back
on track. However, the reality is that between two months to two years the following
may be experienced:
Mood Swings
Anxiety
Irritability
Tiredness
Variable energy
Low enthusiasm
Variable concentration
Disturbed sleep
Did you know. . .
 Suicide is the 8th ranked cause of death in the United States.
 Suicide is the 3rd leading cause of death for those ages 10-24 .
 Suicide is the 2nd leading cause for ages 25-34.
 For every completed suicide, there are 25 suicide attempts.
 30% of those with bipolar disorder will attempt suicide at least once in their lives.
 30% of those with clinical depression will attempt suicide, and 15% will succeed.
 50 % of all suicide attempts involve alcohol and illegal drugs.
 25 % of completed suicides occur among substance abusers.
 Young adults who drink heavily have an increased rate of suicide in middle age.
 More than 70 % of teens who commit suicide have a history of alcohol and drug use.
 Nearly every troubled teenager has suicidal thoughts at some point.
Many teens who are considering suicide suffer from depression.
Signs of Teen Substance Use
Decline in school or work performance, attendance, grades and behavior
Loss of interest in extracurricular activities that used to be important
Changes in attitude, mood, or temper
Less responsible and lack of motivation
Extreme mood swings
Isolating self from family or withdrawing from family activities
Change or deterioration of physical appearance and grooming
Unusual borrowing of money from friends and family
Signs of Teen Suicidal Behavior
Expresses thoughts of death and a desire to leave this life /gives possessions away
Loss of interest in schoolwork (may have declining or failing grades)
Loss of interest in extracurricular activities that were once important
Isolating self from family (and possibly friends)
Substance use or abuse
Extreme mood swings (may become very happy after feeling very depressed)
Changes in normal habits, such as eating and sleeping
Dramatic weight fluctuations, in any direction
Change or deterioration of physical appearance and grooming
Brain Chemistry and Addiction
Dopamine is the chemical in our brain that makes us
“feel good”. Neurotransmitters release these
chemicals which make us feel good when something
positive happens. Any unused dopamine goes back
into the neurotransmitter to be stored for the next
time it is to be released. This is a chemical balance.
Healthy Brain
Drug Abuser (less
dopamine and brain activity)
The brain chemistry relating to neurotransmitters becomes unbalanced. What pushes these
chemicals off course? One possibility is the stress. Triggers may include a traumatic event;
losing a loved one or a job; certain medications; substance abuse; hormonal changes ; or even
the weather.
Illustrated here are neurons (nerve cells) in the brain communicating via neurotransmitters
The most effective way to prevent
suicide is through the early
identification and treatment of those
at risk.
Yet, surveys report that an average of only 36% of
youths at risk for suicide receive mental health
treatment during this same time period.
Percentages of Youths Aged 12 to 17 at Risk for Suicide During the Past Year Reporting that
They Received Mental Health Services During this Same Time Period (2000)
Past Year Mental Health Service Use among Youths Aged 12 to 17, by
Gender: 2008
Past Year Mental Health Care and Treatment for Substance Use Problems among
Adults Aged 18 or Older with Both Serious Mental Illness and a Substance Use
Disorder: 2008
Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration http://www.oas.samhsa.gov.
Hard copies may be obtained from http://www.oas.samhsa.gov/copies.cfm
Substance Use among Youths Aged 12 to 17, by
Major Depressive Episode in the Past Year: 2008
Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration http://www.oas.samhsa.gov.
Hard copies may be obtained from http://www.oas.samhsa.gov/copies.cfm
Substance Dependence or Abuse among Adults Aged 18 or Older,
by Major Depressive Episode in the Past Year: 2008
Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration http://www.oas.samhsa.gov.
Hard copies may be obtained from http://www.oas.samhsa.gov/copies.cfm
Teen Suicide Prevention
One of the most important aspects of teen suicide prevention is support .
Teens need to know that you are willing to help him or her find hope in life
again.
The most effective, research based teen suicide prevention programs
consist of identifying and treating the following problems:
•Mental and learning disorders
•Substance abuse problems
•Problems dealing with stress
•Behavior problems(such as controlling aggressive and impulsive
behavior)
All of the above issues can be difficult for a teenager to cope with, leading
to helplessness and discouragement, which in turn can turn to selfdestructive thoughts in order to make an escape from the seemingly
insurmountable pressures of life.
Getting help for underlying problems, which almost always include teen
depression can lead to more effective teen suicide prevention. Your
support as a teenager you know enters therapy can help him or her more
effectively recover and know that there are people who want to help him
or her deal with the issues of life.
Risk Factors for Suicide Attempts
The strongest risk factors for attempted suicide in adults:
• depression
• alcohol abuse
• cocaine use
• separation or divorce
• loss of job
The strongest risk factors for attempted suicide in youth:
• depression
• alcohol or other drug use (including binge drinking )
• aggressive or disruptive behaviors
Suicide attempts among substance abusers are 5 times greater than among people who do
not abuse alcohol or other drugs:
• Major depression occurs among 50 % of alcoholics vs. non-alcoholics.
•Self medication leads to greater anxiety, depression, and thoughts of suicide.
• Many people recovering from heroin addiction make suicide attempts.
• Drug abusers often have feel unwell or unhappy. These feelings may not last long
enough to qualify as major depression, but they increase the risk of attempting
suicide.
•There is a direct relationship between injecting drugs and suicide attempts.
Evaluating Teens for Attempting Suicide
Any combination of these risk factors can be key in recognizing potential teen suicide:
Family history - This can include a family history of suicide, mental
disorders, and/or substance abuse.
Substance Abuse - The use of alcohol and other drugs, including
prescription and over the counter drugs can create feelings of dependency,
illness and depression. When this leads to feelings of being out of control
and powerless, there is a major risk of a suicidal attempt.
Abuse and Violence - Mental, emotional, physical or sexual abuse can increase the
likelihood of attempted suicide.
Mental, emotional or physical disorders. There are some disorders that
teenagers find difficult to deal with. In these cases, it is important to realize that the stress
caused by these disorders can actually trigger suicidal thoughts.
Emotional and Behavioral Changes Associated With Suicide
Teens and/or Adults
Emotionally, the suicidal person may be feeling:
overwhelming pain
hopelessness
powerlessness
worthlessness, shame, guilt or self-hatred
fear of losing control and harming themselves or others
Behaviorally, the person may:
appear sad, withdrawn, tired, apathetic, anxious, irritable, or angry
not be performing well in school, work, or other activities
become socially isolated or fall in with the wrong crowd
have declining interest in sex, friends, or activities previously enjoyed
neglect personal welfare or let their appearance go
experience a change in eating or sleeping habits
Depression + Substance Use + Major
Interpersonal Event = Potential Suicide
Teen Risk Factors:
Stressful situations such as breakup with boy/girlfriend /friend drama /bullying
School failure or stress to perform and achieve
Exposure to violence (mental, physical, sexual or emotional)
Loss of a loved one
Divorce of parents
Change in economic or social situation
Changing schools
Moving to another town
Adult Risk Factors:
Unemployment or loss of job
 Separation/divorce or living alone
 Lack of the support of family and friends at the time of this severe upset
 Serious medical problems or diagnosis
Sex, Drug Use Increase Teen Suicide Risk
Abstainers Have Lowest Levels of Depression
From Health Behavior News Service, Updated September 12, 2004
Denise D. Hallfors, Ph.D., a Senior Research Scientist at the Pacific Institute for Research
and Evaluation in Chapel Hill, NC, and colleagues analyzed various sex and drug behavior
patterns via data from a survey of nearly 19,000 teens in grades 7 through 12 from 132
U.S. schools as part of the National Longitudinal Study of Adolescent Health. The results
appear in the American Journal of Preventive Medicine. Funding for the study was from
the National Institute of Drug Abuse.
Research found 28 % of U.S. high school students experienced severe depression.
Suicide death rates among 15- to 19-year-olds doubled between 1960 and 2001.
Teens who engage in high-risk behaviors involving sex and drugs have significantly
higher odds of depression, suicidal thoughts and suicide attempts.
"These results suggest that healthcare professionals who identify adolescent patients
reporting sexual intercourse or drug use should screening for depression and risk of
suicide." says Hallfors. "It is particularly important not to miss opportunities to
diagnose depression because effective treatments are available, or to overlook suicide
risk because suicide can be prevented.”
The researchers clustered the teens in 16 groups according to their behaviors.
Groups included:
•abstainers of sex and drugs
•sex dabblers
•alcohol and sex dabblers
•teens with multiple sexual partners
•illegal drug users
Findings:
Abstainers had the lowest levels of depression, suicidal thoughts and suicide attempts
Heavy use of illegal drugs (including “just” marijuana) and sex had the highest levels
In between were the dabblers in sex, drugs, alcohol and tobacco
Girls were less likely than boys to pursue high-risk behaviors, but girls who did were
more vulnerable than boys to depression, suicidal thoughts and suicide attempts.
Surprising Socioeconomic Findings:
Higher socioeconomic status reduced the likelihood of depression by about half;
however, it increased the risk of suicidal thoughts.
Hallfors believes more research is needed to understand which comes first: sex and
drugs or poor mental health
All teens should be screened for sexual behaviors and drug use
Teens who do more than dabble, should be screened for depression and suicide risk
What Can Educators Do?
Implement and participate in Student Assistance
Programs for substance use and depression.
Don’t assume that only “difficult” teens are at-risk
for substance abuse or suicide.
Rule out the possibility of substance use FIRST with
an adolescent who is not successful.
Be educated in the latest trends of substance use.
Don’t be afraid to question or show your concern
about depression, substance use or suicidal
thoughts and behavior.
What Recovering Students Want You to Know!
If “someone” hadn’t intervened or told my parents, I would still be using
today.
Recovery is a process, not an event. One referral might not be enough.
Teachers and administrators can be manipulated and charmed.
Teachers often don’t know what is going on with drugs – right under their
noses – all the time.
Lecturing students about drugs doesn’t work. Talk to them like you know
what is happening and you are concerned.
Kids will be angry when you confront them about drug use or an
intervention is done.
Students in recovery may look healthy (and happier) but
the trip back is hard.
Want to help? Be truthful, set limits, be a good listener
and don’t let me get away with anything.
The Real Deal
We read in the papers, we hear on the air,
Of stealing and killing, and crime everywhere.
We sigh and we say as we notice the trend,
“This young generation, where will it end?”
But can we be sure it is their fault alone?
Maybe most of it is really our own.
Too much money to spend, too much idle time,
Too many movies of passion and crime.
Too many children encouraged to roam
By too many parents who won’t stay at home.
Kids don’t make the liquor, they don’t run the bars,
They don’t make the laws, nor make high speed cars.
They don’t make the drugs that rattle the brain,
It’s all done by older folks just greedy for gain!
ONLINE RESOURCES
These web sites provide substance abuse information for parents, teens, and professionals.
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www.cesar.umd.edu
www.clubdrugs.org
www.drugfree.org
www.freevibe.com
www.health.org
1-800-729-6686
www.nodrugs.com
www.monitoringthefuture.org
www.nida.nih.gov
1-888-NIH-NIDA
www.samhsa.gov
www.streetdrugs.org
www.teencentral.net
www.thecoolspot.org
www.theantidrug.com
1-800-788-2800
www.whitehousedrugpolicy.gov 1-800-666-3332
Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration
http://www.oas.samhsa.gov.
www.aacap.org/cs/root/facts_for_families/teen_suicide
www.teensuicide.us/articles7.html
www.alcoholism.about.com/od/teens/a/blbhns040911.htm
www.keepkidshealthy.com/welcome/conditions/youth_suicide.html