Transcript Issues With Adolescent Methamphetamine Abuse

Issues With Adolescent
Methamphetamine Abuse
By Paulette Mader MSN
Major Points to Remember
• One time use of methamphetamine can result in
addiction.
• There is very little “casual use” of methamphetamine.
Addiction progresses rapidly with significant adverse
results.
• Methamphetamine use over time causes permanent
brain changes.
• Effects of long-term methamphetamine use can still be
evident up to two years after discontinuing the drug.
• Most methamphetamine users are poly drug abusers.
Where is Meth Coming From?
• Major suppliers in the West and Southwest are Mexican
criminal gangs cooking in superlabs and bringing the
product over the border for distribution.
• Local gangs and some private cookers are main
suppliers in our community.
• Methamphetamine is a money maker for our local gangs
and is often used in recruitment of members.
Signs of Possible Meth Use
• Poor hygiene
• Chemical smell
• Tremor
• Bruxism (teeth grinding)
Signs of Possible Meth Use
• Acne
• Scabs or scratches, especially on face and arms
• Sleeping in class or complaints of being tired
• Burnt fingertips
Signs of Possible Meth Use
• Lowered grades
• Attendance issues such as cutting class and
truancy. (Our policy is 5-6 days undocumented
absences or 3 tardies= truancy.)
• Verbal expressions of inability to be with other
students in class often with a push to move to
home school or another alternative setting.
Symptoms of Possible Meth Use
• Drug language and paraphernalia such as pipes,
burnt foil, small baggies
• Symptoms of depression
• Symptoms of anxiety
• Flushed look when high and poor color generally
Signs of Possible Meth Use
• Wearing sunglasses indoors
• Dilated pupils
• Darting eyes
• Weight loss
Problems Getting Students Into
Treatment
• Students under the influence of
methamphetamine are not thinking clearly
and are not motivated for treatment.
• Parents who use: “What’s the problem?”
• Parents in denial: “What’s the problem?”
Problems Getting Students Into
Treatment
Students who have been neglected or
abused have trust issues. Students are
used to running their own lives with no
consistent reasonable limits set by adults.
These kids have trouble giving up control.
They often fight moving to a shelter or
foster home because of rules and fear of
abandonment. Treatment is scary and
perceived as loss of control.
Problems Getting Students Into
Treatment
• Only outpatient treatment is available for
adolescents who are substance abusers in our
county. County Mental Health and New Morning
have a 30-day wait for outpatient services.
• Placement in group homes outside our county
often means no reciprocity for the other county
for mental health, medical, or recovery services.
Problems Getting Students Into
Treatment
Teenage methamphetamine abusers typically
enter treatment through the juvenile justice
system. They are prosecuted for crimes related
to their substance abuse such as possession of
drugs and paraphernalia, sales, burglary, and
assault. Treatment is mandated as part of their
probation. While incarceration in Juvenile Hall is
not ideal, it is one way to insure a
methamphetamine abusing child refrains from
using meth.
Other Treatment Issues
• Adolescence is a time of crisis with wide ranges
of physical and emotional maturity levels.
• Major mental illnesses such as schizophrenia
and bipolar disorder often are first seen during
adolescence. Meth use symptoms often mimic
these disorders.
• Shortage of health care providers and facilities
designed to treat dual diagnoses in teens,
especially in rural areas where meth use is most
common.
Other Treatment Issues
• Methamphetamine addiction requires
intervention from a variety of health care
providers such as medical, dental,
psychiatric, and recovery providers.
• Addicts often have legal issues, housing
issues, and employment issues and
require extensive social services
assistance.
Other Treatment Issues
• Practitioners with middle-class values are
often very uncomfortable hearing about
the life styles of substance abusing
patients.
• Many antidepressants are not ruled safe
for use in teens. Use of antidepressants in
teens associated with some risk for
suicide.
One Girl’s Diagnoses Over a TwoYear Period
• Major Depression
• Poly Drug Abuse
• Borderline Personality
Disorder
• Conduct Disorder
• Reactive Attachment
Disorder
• Anxiety Disorder
• Post Traumatic Stress
Disorder
• Bipolar Disorder
• Dysthymic Disorder
• Antisocial Personality
Disorder
• Psychotic Episode
• Schizophrenia
• ADHD
• Adjustment Disorder
Meth Can Cause Extreme
Disorganization of Behavior
• Young women getting into stranger’s cars for a hit of meth.
• Prostitution for methamphetamine (whether for money or the drug).
• Jumping out of a second story window to avoid talking to a family
member.
• Hanging around dangerous adults, some who carry weapons or are
abusive because these adults will supply the drug.
• Criminal behavior to earn money to purchase drugs.
Disorganization of Behavior
• Aggressive behavior. Family members
assaulted.
• Hallucinations and delusions that are very
frightening. (Strangers perceived as FBI agents
who are after the meth user. One young man
peeked out of his blinds 7 hours straight as he
was worried someone was after him.)
• Running away from home, sometimes days at a
time.
Disorganization of Behavior
• Unplanned pregnancy with lack of prenatal
care. Continuing meth use during the
pregnancy resulted in a positve tox baby.
• There is a high risk of domestic violence
and child abuse in households where meth
is used. Parents who use often expose
children to dangerous drugs, dangerous
people, and dangerous situations.
Safety Issues
• Tweakers are never seen at school. Kids
who are binging on meth will do so away
from school and sleep it off, sometimes for
days.
• Attendance records will show this pattern
until the student stops coming to school.
• A person who is tweaking can be very
dangerous. He/she will often be paranoid
and delusional.
Safety Issues Continued
• Set up your office with your safety in mind. Sit closest to
the door; bathrooms that lock should have a key to open
them from outside. Hard chairs are easier to get out of
than soft chairs.
• Be observant to details.
• Reduce stimuli any way possible: don’t stand too close,
keep light low, lower voice, slow speech, move slowly,
keep hands visible.
• Keep the person talking. Silence may mean the
person’s delusions have taken over and the current
environment incorporated in the delusion.
• Back-up help is always welcome!
• Do not confront!
Adverse Childhood Experiences
A Study By Vincent J. Felitti, MD and Robert
Anda, MD
• 17,421 patients of Kaiser Permanente’s Department of Preventive
Medicine in San Diego.
• 80% White, 10% Black, 10% Asian, generally in their fifties, middle
class.
• Detailed biomedical, psychological, and social evaluations done.
• The study measured effects of adverse childhood experiences on
adult health status a half century after they occurred.
• ACE scores ran from 0-8.
Categories of Adverse Childhood
Experiences
•
•
•
•
•
•
•
Recurrent physical abuse
Recurrent severe emotional abuse
Contact sexual abuse
Household member in prison
Mother treated violently in household
Alcoholic or drug abuser in household
Household member chronically depressed,
mentally ill, or suicidal
• Biological parent lost during childhood
regardless of cause
Results of ACE Study
• Adverse childhood experiences are more
common than previously believed.
• Adverse childhood experiences have a
powerful relation to adult health.
• Health risk behaviors such as smoking,
overeating, and drug use are actually
coping mechanisms to deal with ACE.
More Results
• Slightly more than half experienced one or
more categories of ACE.
• One in four exposed to two categories of
ACE.
• One in sixteen exposed to four categories
of ACE.
• Exposure to one category increases
likelihood of exposure to another category
by 80%.
More Results
• Physical diseases such as chronic obstructive pulmonary
disease, hepatitis, sexually transmitted disease, tobacco
use, and IV drug abuse all showed progressive dose
response with every increase in ACE score.
• Other diseases with a graded response to ACE score
were heart disease, fractures, diabetes, obesity,
unintended pregnancy, and alcoholism.
• Depression and suicide attempts had a similar strong
relationship to ACE score. A patient with an ACE score of
4 or more was 460% more likely to be depressed and
1,220% more likely to attempt suicide. Between 66% and
80% of all suicide attempts could be attributed to ACE.
Still More Results
• 22% of Kaiser patients were sexually
abused (28% women and 16% men).
• A male child with an ACE score of 6 has a
4,600% increase in likelihood to be an IV
drug user compared to a male child with
an ACE score of 0.
• ACE scores above 4 had a 3000%5,100% increase in attempted suicide over
the group with an ACE core of 0.
Clinical Implications
• It is important to ask questions routinely in
intakes to elicit information about possible
adverse childhood experiences.
• Dr. Felitti recommends asking after an
ACE is confirmed, “How do you think this
experience affects your adult health?”
• Dr. Felitti reported a 35% reduction in
office visits after a biopsychosocial
approach adopted at the clinic.
Prevention of Prime Importance
• Prevention of ACE is of
great importance for
optimum adult health.
• 5 million children a year are
exposed to traumatic
events.
Neuroarcheology
• Dr. Bruce Perry, M.D., Ph. D, a Fellow of
the Child Trauma Academy uses the term
“neuroarcheology” to describe how our
experiences change our brains.
• His research on trauma and neglect in
children demonstrates that the traumas we
experience in childhood can permanently
limit our ability to react appropriately to our
environment.
Introduction
Dr. Perry states:
“Childhood maltreatment has profound effect on the
emotional, behavioral, cognitive, social, and physical
functioning of children. Developmental experiences
determine the organizational and functional status of the
mature brain and, therefore, adverse events can have a
tremendous negative impact on the development of the
brain. In turn, these neurodevelopmental effects may
result in significant cost to the individual, their family,
community, and ultimately, society. In essence,
childhood maltreatment alters the potential of a child
and, thereby, robs us all.”
Main Principles of Brain
Development
• We each have a set of genes that makes us
unique; the full expression of our gene potential
is through interaction with the environment.
• A brain develops in sequence and hierarchically
from least to most complex (brainstem to limbic
to cortex). Rapidly organizing brain systems are
more sensitive to insults than slower organizing
brain systems.
Main Principles of Brain
Development
• The brain organizes in a use-dependent way;
undeveloped neural systems are dependent
upon environmental and micro-environmental
cues to organize.
• There are windows of opportunity and
vulnerability in brain development. There are
times when a developing neural system is more
sensitive to environment than others. The unique
demands of the environment create from a
broad genetic potential those characteristics that
best fit the environment.
Main Principles of Brain
Development
“Hot zones” are sensitive periods when an
area of the brain is rapidly organizing. The
brainstem which controls basic body
functions like breathing, must be
developed by birth. The hot zone for the
brainstem is the prenatal period. The
neocortex which controls reasoning,
problem-solving, abstraction, and sensory
organization develops over a long period
of time, from childhood to adulthood.
Neglect Affects Children’s Brain
• There is a shifting of the vulnerability of the brain to
experience. An infant or child whose brain is more
malleable to experience than an adult, is also more
vulnerable.
• It is easier to influence the function of a developing brain
system than to alter the functioning of a developed
system. A baby’s development and ultimate ability to
function is much more affected by lack of stimulation
than an adult’s ability.
• Permanent changes in the brain, i.e. lack of neural
connections and pathways may permanently limit the
child’s ability to develop normally.
Trauma Affects Children’s Brains
• Just as lack of sensory stimuli can permanently
limit a brain’s development, so can traumatic
stress such as the adverse childhood
experiences in Felitti’s study.
• External threat is met by significant and
persistent neurophysiologic systems designed to
respond to the threat.
• The longer the activation of a threat response,
the more likely a use-dependent change in
neural systems will occur.
Trauma Affects Children’s Brain
Development
• It is adaptive for a child growing up in a
chronically stressed environment to be
hypersensitive to stimuli and hyper vigilant in an
environment.
• Neural systems will adapt to this kind of state
and literally organize around it.
• While adults with PTSD have cue-specific stimuli
relating to a specific traumatic event that set off
stress responses, children develop a
generalized hypersensitivity to all cues that
activate the stress-response.
Affects of Trauma on Children’s
Behavior
As Dr. Perry states about children exposed to
chronic trauma: “These children are hyper
vigilant; they do not have a core abnormality of
their capacity to attend to a given task. These
children have behavioral impulsivity, and
cognitive distortions all of which result from a
use-dependent organization of the brain. During
development, these children spent so much time
in a low-level state of fear, that they consistently
were focusing on non-verbal but not verbal
cues.”
Recommendations
• Often these kids are not able to operate on a cognitive
level. The hyper arousal of the brainstem and limbic
system must be addressed.
• The child’s ability to participate in treatment must be
assessed. A developmental assessment is most useful.
• Modalities such as dance therapy and a supportive
positive environment are most effective initially.
The Big Problem
As mentioned before, there is little casual use with
methamphetamine. There comes a time with escalating
use when behavior becomes more disorganized and the
teenager is at high risk for terrible consequences yet
does not qualify for commitment.
How do we keep these kids safe?
Where do we put them?
Who treats them?
Works Cited
California Healthy Kids Survey Most Recent Performance Indicators, El Dorado high School, 2004-2005.
CAPRI* Concerned Advocates for Perinatal Related Issues. Handout from Presentation for the Perinatal Council of El
Dorado, EMS Conference Room, Placerville, California. February 17, 2004.
Dansie, Roberto. “Anger, Pain, and Healing in the Native American Indian Community.” February 24, 2006
<http://www.robertodansie.com/articles/anger.htm>.
Dube, Shanta R. MPH; Felitti, Vincent J. MD; Dong, Maxia, MD, PhD; Chapman, Daniel P., PhD; Giles, Wayne H., MD;
Anda, Robert F. , MD. “Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use:
The Adverse Childhood Experiences Study.” Pediatrics. March 2003. February 2, 2006
<http://pediatrics.aappublication.org/cgi/content/full/111/3/564>.
El Dorado County Meth Awareness and Prevention Project (MAPP). Handout.
Felitti, Vincent J. MD. Presentation Given to Healthy Start and After School Program Coordinators. Hilton Hotel. Napa,
California. January 26,2006.
Felitti, VJ. English Translation of “Belastungen in der Kindheitund Gesundheit im Erwachsenenalter: die Verwandlung
von Gold in Blei.” Z Psychom Med Psychother. 2002; 48(4): 359-369.
Perry, Bruce MD, PhD. “The Neuroarcheology of Childhood Mistreatment The Neurodevelopmental Costs of Adverse
Childhood Events.” July 27, 2000. February 2, 2006 <http://www.ChildTrauma.org/>.
Perry, Bruce MD, PhD. Presentation “The Power of Community: How Healthy Communities Create Healthy Children.”
Sponsored by Placer County Health and Human Services, California State Department of Health Services, and
First Five Commission of Placer County. Sierra Bible Church. Sonora, California. March 31, 2005.
Perry, Bruce MD, PhD. Presentation “Working with Children Exposed to Trauma and Violence.” Sponsored by The
Perinatal Multidisciplinary Team of Tuolumne County, The Tuolumne County YES Partnership, with support from
the California Attorney General’s Office-Safe from the Start Initiative. Sierra Bible Church. Sonora, California.
September 1, 2004.