Transcript Substance-Abuse-Policy-Employment-and-Change-p

Substance Abuse, Policy
Employment and Change
2009 Region II Peer to Peer YouthBuild
Learning Exchange
Harrisburg, PA
Travis Fretwell, MAC, NCACII, CCS
TCJA Resolutions
770-823-1631
[email protected]
Lilburn, Georgia
1
Social Use is:
 Using
to the point of increased
interaction.
 Easy to limit use
 Not about drinking to get drunk
2
Drug Abuse is:
 Physical,
psychological,
economic, legal, or social harm to
the individual user or to others
affected by the drug users
behavior.
 Drinking to the point of physical
impairment
3
Addiction is:
A
chronic brain disease
 Expressed as compulsive behavior
 Expressed within a social context
 Prone to relapse
 Treatable
4
What the Research Tells Us Epidemiological Knowledge







Consequences go up as severity increases from use to
multiple substance use, abuse, and dependence.
Substance use disorders typically on-set during adolescence
and last for decades.
The earlier the age of onset, the longer the course of
substance use
The earlier treatment is received, the shorter the course of
substance use
Marijuana has become the leading substance problem
Less than 1 in 10 adolescents with substance abuse or
dependence problems receive treatment
Over 88% are treated in the public system
Source: Michael Dennis, Ph.D., Chestnut Health Systems, November 2005
5
Age of First Use Predicts Dependence
an Average of 22 years Later
100
Under Age 15
% with 1+ Past Year Symptoms
90
Aged 15-17
80
Aged 18 or older
71
70
63
62
60
51
50
40
45
39 37
30
30
48
41
34
23
20
10
0
Tobacco:
Alcohol:
Pop.=151,442,082
Tobacco,
OR=1.3*, Pop.=176,188,916
Alcohol, OR=1.9*,
Pop.=151,442,082
Pop.=176,188,916
OR=1.49*
OR=2.74*
Source:
Marijuana:
Other Drugs:
Pop.=71,704,012
Marijuana, OR=1.5*, Pop.=38,997,916
Other, OR=1.5*,
Pop.=71,704,012 OR=2.65*
Pop.=38,997,916
OR=2.45*
* p<.05
Dennis, Babor, Roebuck & Donaldson (2002) and 1998 NHSDA
6
Severity of Past Year Substance
Use/Disorders (2002 U.S. Household
Population age 12+= 235,143,246)
Dependence 5%
Abuse 4%
Regular AOD
Use 8%
Any Infrequent
Drug Use 4%
Light Alcohol
Use Only 47%
No Alcohol or
Drug Use
32%
Source: 2002 NSDUH &
Dennis 2005
7
Common Drugs of Abuse/Choice
Marijuana
 Alcohol
 Cocaine
 Methamphetamine
 Opioids
 Prescription Meds
 Inhalants

8
Weed


Marijuana - often called pot, grass, reefer, weed,
herb, mary jane, or mj - is a greenish-gray
mixture of the dried, shredded leaves, stems,
seeds, and flowers of Cannabis sativa, the hemp
plant. Most users smoke marijuana in hand-rolled
cigarettes called joints, among other names;
some use pipes or water pipes called bongs.
Marijuana cigars called blunts have also become
popular. To make blunts, users slice open cigars
and replace the tobacco with marijuana, often
combined with another drug, such as crack
cocaine. Marijuana also is used to brew tea and is
sometimes mixed into foods.
9
The Growing Incidence of Adolescent
Marijuana Use: 1965-2002
Source: OAS (2004). Results from the 2003 National Survey on Drug Use and Health: National Findings. Rockville, MD: SAMHSA.
http://oas.samhsa.gov/nhsda/2k3nsduh/2k3ResultsW.pdf
10
Marijuana
Brain Regions where Cannabinoids
Receptors are Abundant
 Cerebellum – Body Movement Coordination
 Hippocampus – Learning & Memory
 Cerebral cortex, especially cingulate, frontal,
and parietal regions – Higher Cognitive
Function
 Nucleus accumbens - Rewards
 Basal ganglia Substantia nigra pars reticulata
Entopeduncular nucleus Globus pallidus
Putamen – Movement Control
NIDA 2008
11
12
13
Source: National Institute on Drug Abuse Teaching Packet
Marijuana & Alcohol

Combined marijuana and alcohol users are 4 to
47 times more likely than non-users to have a
wide range of dependence, behavioral, school,
health and legal problems.

Marijuana and alcohol are the leading substances
mentioned in arrests, emergency room
admissions, autopsies, and treatment admissions.
14
Health Risk











Acute (present during intoxication)
Impairs short-term memory
Impairs attention, judgment, and other cognitive
functions
Impairs coordination and balance
Increases heart rate
Persistent (lasting longer than intoxication, but may
not be permanent)
Impairs memory and learning skills
Long-term (cumulative, potentially permanent
effects of chronic abuse)
Can lead to addiction
Increases risk of chronic cough, bronchitis, and
emphysema
Increases risk of cancer of the head, neck, and lungs
NIDA 2008
15
Drug Intoxication is:
A
consequence of excessive
consumption of a drug
 Usually disruptive changes in
physical and psychological
functioning, mood and cognitive
functioning.
16
Alcohol Stages of Intoxication

1. Euphoria (BAC = .10)
The person becomes more confident and daring.
They have trouble paying attention.
They have more color in their face.
They lack good judgment, acting on impulse.
They find tasks requiring fine motor control difficult.

2. Excitement (BAC .20)
The person may become sleepy.
Their short term memory is impaired.
Their reaction time is greatly reduced.
Their gross motor skills are uncoordinated.
They have trouble maintaining their balance.
Vision becomes blurry.
Their senses become dull (hearing, tasting, touch,
etc.)
17
Alcohol Intoxication Con’t

3. Confusion (BAC .30)
The person might not know where they are or
what they are doing.
Walking may be difficult.
Emotions run high - aggressive, withdrawn,
overly affectionate.
Vision is very blurry.
They are very sleepy.
The sensation of pain is dulled.
18

4. Stupor (BAC .40)
The person can barely move.
They do not respond to external stimuli.
Walking or standing is impossible.
They may vomit repeatedly.
They may become unconscious.

5. Coma (BAC .50)
The person is unconscious.
Pupils are unresponsive to light.
Body temperature is lower than normal.
Breathing is shallow.
Pulse rate is slow.
Death may occur.
Source: howthingswork.com
19
Alcohol
 Poison
 Liver
Laps
 Acetic Acid
20
Healthy Liver
21
Cirrhosis of the Liver
22
Source: Dr. Susan Tapert; University of California- San Diego
23
Cocaine



Cocaine is a powerfully addictive stimulant that
directly affects the brain.
There are basically two chemical forms of cocaine:
the hydrochloride salt and the “freebase.” The
hydrochloride salt, or powdered form of cocaine,
dissolves in water and, when abused, can be taken
intravenously (by vein) or intranasally (in the nose).
Freebase refers to a compound that has not been
neutralized by an acid to make the hydrochloride
salt. The freebase form of cocaine is smokable
Crack is the street name given to a freebase form of
cocaine that has been processed from the powdered
cocaine hydrochloride form to a smokable substance.
The term “crack” refers to the crackling sound heard
when the mixture is smoked.
24
Methamphetamine



An addictive stimulant that is closely related to
amphetamine, but has longer lasting and more
toxic effects on the central nervous system. It has
a high potential for abuse and addiction.
Increases wakefulness and physical activity and
decreases appetite. Chronic, long-term use can
lead to psychotic behavior, hallucinations, and
stroke.
In 2006, 1.9 million Americans age 12 and older
had abused methamphetamine at least once in the
year prior to being surveyed. Source: National
Survey on Drug Use and Health
25
Partial Recovery of Brain Dopamine Transporters
in Methamphetamine (METH)
User After Protracted Abstinence
3
0
ml/gm
Normal Control
METH User
(1 month detox)
METH User
(14 months detox)
Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.
26
Heroin

Heroin is a synthetic opiate drug that is highly
addictive. It is made from morphine, a naturally
occurring substance extracted from the seed pod of
the Asian opium poppy plant. Heroin usually appears
as a white or brown powder or as a black sticky
substance, known as “black tar heroin.”

Heroin can be injected, snorted/sniffed, or smoked—
routes of administration that rapidly deliver the drug
to the brain.

Heroin enters the brain, where it is converted to
morphine and binds to receptors known as opioid
receptors. These receptors are located in many areas
of the brain (and in the body), especially those
involved in the perception of pain and in reward.
27
Oxycodone

Oxycodone, best known by the trade name
OxyContin®, is a controlled release form of
opioid analgesic prescribed to treat moderate to
severe pain of constant and prolonged duration.

Persons abusing this medication risk addiction
and death, particularly if oxycodone is used in
association with other drugs. Abusers may
progress to usage by intravenous injection and to
usage of other opiates or drugs of abuse.
28
Prescription Medication
Prescription drugs that are abused or used
for nonmedical reasons can alter brain
activity and lead to dependence.
 Commonly abused classes of prescription
drugs include opioids (often prescribed to
treat pain), central nervous system
depressants (often prescribed to treat
anxiety and sleep disorders), and
stimulants (prescribed to treat narcolepsy,
ADHD, and obesity).

29
Prescription Medication



Commonly used opioids include oxycodone
(OxyContin), propoxyphene (Darvon),
hydrocodone (Vicodin), hydromorphone
(Dilaudid), meperidine (Demerol), and
diphenoxylate (Lomotil).
Common central nervous system depressants
include barbiturates such as pentobarbital sodium
(Nembutal), and benzodiazepines such as
diazepam (Valium) and alprazolam (Xanax).
Stimulants include dextroamphetamine
(Dexedrine) and methylphenidate (Ritalin).
30
Prescription Medications
31
Inhalants
Breathable chemical vapors that users
intentionally inhale because of the
chemicals' mind-altering effects. The
substances inhaled are often common
household products that contain volatile
solvents or aerosols.
 Most inhalants produce a rapid high that
resembles alcohol intoxication. If
sufficient amounts are inhaled, nearly all
solvents and gases produce a loss of
sensation, and even unconsciousness.

32
Inhalants
The NIDA-funded 2007 Monitoring the
Future Study showed that 8.3% of 8th
graders, 6.6% of 10th graders, and 3.7% of
12th graders had abused inhalants at least
once in the year prior to being surveyed.
 Street names include: Whippets, poppers,
snappers

33
Consequences of Drug Use
100
77
80
69
67
57
60
51
47
44
40
47
29
13
20
0
11
0 1
25
15
33
28
17
23
17
11
6
1
0
% 1+
% 1+
% Clinical
Symptom of Symptom of Behavior
Alcohol
Cannabis
Problems
Disorder
Disorder
% Physical
Fight
% Out of
School
% with 1+
ER in the
past year
% Any
Illegal
Activity
% 1+
Arrests
No Past Year Alcohol or Marijuana Use
Weekly Alcohol Use
Weekly Marijuana Use (with Alcohol Use)
Source: Dennis, Godley and Titus (1999) and 1997 NHSDA
34
Why Youth use











Family history
Environmental factors
Depression
Reduce Anxiety
Reduce Stress
Socialization- Acceptance by peer group
Trauma
Don’t recognize the use as a problem
Provide Identity
Boredom
Instant Change
35
Working With Young People
Requires
Commitment
 Patience
 Empathy
 Staying inform
 Creativity
 A sense of humor
 Ability to motivate while, instilling a since
of respect and accomplishment

36
The Stages of Change
Model
Permanent Exit?
Relapse?
Pre-contemplation
Maintenance
Action
Contemplation
Determination
37
Prochaska and DiClemente
Stages of Change
Stage 1
 Pre-Contemplation
Youth:
 Not yet considering possibility of change
 Surprised , not defensive
Tasks:
 Raise doubt; provide information
38
Stages of Change
Stage 2
Contemplation
Youth:
 Ambivalent
 “Yes, but…” considers & rejects change
Tasks:
 Tip the balance in favor of change
 Build motivation: elicit self-motivational
statements

39
Stages of Change
Stage 3
Determination
Youth:
 “I’ve got to do something about this?”
 “What can I do?”
Tasks:
 Take advantage of the window of opportunity
 Strengthen commitment to change
 Match to change strategies that is acceptable,
accessible, appropriate, effective

40
Stages of Change
Stage 4
Action
Youth:
 Engages in particular actions intended to
bring about a change
Task:
 Help client take steps toward change

41
Stages of Change
Stage 5
Maintenance
Youth:
 Makes broader changes in life to sustain
desired changes
Tasks:
 Identify and develop strategies and skills
needed to maintain change

42
Stages of Change
Stage 6
Relapse
Youth:
 Return to unwanted behaviors
Tasks:
 Help avoid discouragement
 Initiate renewal of processes of
contemplation, determination and action,
without becoming stuck

43
Culture of Addiction


Social group where heavy use of drugs is
the norm, fun often centers around drug
use
Dress is:
Overly focused on grooming, appearance
or not focused on it at all
Language is:
Grandiose, Drug, Hustling and Cop
Related
44
Culture of Addiction
Values:
 Excitement through risk
 Avoid responsibility
 Drug first
 Don’t trust
 Don’t feel
45
Substance Abuse, Retention
and Work










Process Improvement Policy/Non-Policy
Integrate SA and work
Start efforts before the work begins
Screen for SA/MH issues and refer to treatment
It is about the relationship
Use rewards/incentives
Sanctions- treatment is not a sanction
Be creative
Identify what matters
Engage community- i.e. churches, Schools,
leaders
46
Engaging Youth
 It’s
all about the relationship
 Maximize existing supports
 Work and play
 Enthusiasm
 Challenge
 Choice
 Purpose and relevance
47
Role Play
48
Policy
Substance use current policy
 What you would change
 Barriers
 Consequences
 Stages of Change

49
Exercise
50
Policy










Readiness for change
Change agents
Feedback
Steps to implementation
Cool for kids
Enthusiastically
Flexibility with boundaries
“Emergent change”
Permission to act
Involve youth
51
Drug Screens
To screen or not to screen that is the
question.
 Pros
 Cons
 Barriers
 Consequences

52
Approximate Detection Time of
Some Common Drugs in Urine
Alcohol
up to 1 day
Amphetamines (including MDMA,
1-3 days
MDA)
Barbiturates
1-3 days
Benzodiazepines
1-3 days
up to 14 Cannabis
30 days
Cocaine
1-3 days
Codeine
Heroin (morphine)
1-2 days
Up to 1 day
53
Culture of Abstinence
Values based consequences
 Place responsibility back on youth
 Teach values
 Should be action oriented
 Atonement base
 Extend over time
 Empathy and concern
 Attachment vs. isolation
Janice Gabe, values based consequences
54
Employed vs. Unemployed Youth

An estimated 33.7 percent of youths aged 15 to 17 were
employed either part or full time during the past week

Employed youths were more likely than youths who were
not employed to have used alcohol (35.9 vs. 24.4
percent), to have engaged in binge alcohol use (24.6 vs.
15.2 percent), and to have used an illicit drug (19.4 vs.
15.6 percent) during the past month

Youths working 20 or more hours per week were more
likely than those working 19 or fewer hours per week to
have drunk alcohol (41.1 vs. 33.8 percent), to have
binged on alcohol (29.0 vs. 23.1 percent), and to have
used any illicit drug (22.3 vs. 18.5 percent) during the
past month
Source: NSDUH Report SA Use & Employment Youth 15-17, 2006
55
Hours of Youth Employment
Source: NSDUH Report SA Use & Employment Youth 15-17, 2006
56
The Big Picture
57
It takes a Village
Involve the community
 Work collaboratively with other agencies
 Find out what has worked in the past
 Share information with other locations
 Be creative when working with youth and
their families
 Families are the greatest natural support

58
59
Treatment Works
Alcohol and other drug abuse is
preventable
 Addiction is a disease
 Recovery from addiction is real and
happens all the time
 Despite many differences, virtually all
substances with the potential for addiction
affect dopamine levels in the
pleasure/reward pathway of the brain.

60
Effectiveness of Treatment
40-60%
40-60%
Drug Use
Crime
Source: National Institute on Drug Abuse July 2006
40%
Employment
61
Ask Participants About Problems
With:
Relationships
 School
 Work
 Accidents
 Health
 Family
Then tie in Substances

62
SA, Policy, Employment
and Change
Q&A
63