Youth and Elderly Addiction Issues National Rx Drug Abuse Summit 4-11-12

1. Youth and Elderly
Addiction Issues
April 10-12, 2012
Walt Disney World Swan Resort

2. Learning Objectives:
1. Describe the successful icanhelpsm program’s three-
pronged approach for early engagement of
adolescents most at-risk of addiction.
2. Explain the importance of educating the caregivers
and others of the elderly (over 50) population on the
potential for prescription drug misuse, abuse, addiction
and becoming victims of pill-seekers.
3. Describe the essential services needed to provide
both the youth and the elderly an opportunity to live
productive, healthy lives, and identify common barriers
to accessing treatment.

3. Disclosure Statement
• All presenters for this session, Deborah
Beck and Michelle Muffett-Lipiniski,
have disclosed no relevant, real or
apparent personal or professional
financial relationships.

4. icanhelpSM
a program for early engagement by
establishing “safe” places for adolescents
to develop a trusting rapport with adults
in the community
http://
icanhelp.me
Michelle
Muffe*-­‐Lipinski,
M
Ed
Barbara
Bruhns
Frey,
PhD
icanhelp
Director
Phone:
801-­‐512-­‐3239
Phone:
603-­‐842-­‐0029
Email:
FreyBB@icanhelp.me
Email:
LipinskiM@icanhelp.me
© 2012 Potential Connections LLC
This presentation and training is the property of Potential Connections LLC. Do not duplicated,
reproduce or distribute without permission (email: icanhelp@potentialconnections.com).

5. Alyssa….
http://www.youtube.com/watch?
v=q6JqSOcfmn0&feature=share

6. Drug Use Across the Ages
• Nonmedical use of Rx pain relievers
– Starts young &  w/ age
– Although drug use generally  by middle
age, the baby-boom generation* has
higher rates than previous generations
• Aging of baby boomers will lead to  in illicit
drug use & nonmedical Rx drug use among
persons aged ≥50
– Possibly doubling by 2020 *Born 1946-1964
SAMHSA. (2011). Results from the 2010 National Survey on Drug Use and Health: Detailed Tables.
Office of Applied Studies, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD.
SAMHSA. (2011).The NSDUH Report: Illicit Drug Use among Older Adults. Rockville, MD. Duncan DF,
et al. J Aging Soc Policy. 2010;22:237-48. Kalapatapu RK, et al. Am J Addict. 2010;19:515-22.

7. Nonmedical Use
• National studies
– National Survey on Drug Use & Health
(NSDUH)
– Monitoring the Future (MTF)
– National Survey of American Attitudes on
Substance Abuse XVI
– Partnership Attitude Tracking Survey (PATS)
– Treatment Episode Data Set (TEDS)
Each define “nonmedical” use differently

8. Past-Yr Initiates of Specific Drugs
Among Persons Age ≥12-Yr
The total initiates of nonmedical Rx drug use
(red bars) taken together greatly exceeds
initiates of marijuana in 2010
SAMHSA. (2011). Results from the 2010 National Survey on Drug Use and Health: Detailed
Tables.
Office of Applied Studies, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658.
Rockville, MD.

9. Monitoring the Future (MTF)
2011 Survey
• 46,700 grade 8, 10, & 12 students in
400 secondary schools nationwide
– Misuse of Rx drugs (amphetamines,
sedatives, tranquilizers, & opioids other than
heroin)
• Respondents instructed to include only use
“. . . on your own—that is, without a doctor
telling you to take them”
Johnston LD, et al. (2012). Monitoring the Future–National Results on Adolescent Drug Use: Overview
of Key Findings, 2011. Ann Arbor: Institute for Social Research, University of Michigan.

10. MTF:
Rx Drug Abuse in Grade 12
Percentage of grade 12 students reporting
nonmedical Rx drug use: rates for opioids highest
Johnston LD, et al. (2012). Monitoring the Future–National Results on Adolescent Drug
Use: Overview
of Key Findings, 2011. Ann Arbor: Institute for Social Research, University of Michigan.

11. Source of Most Recent Rx Opioids:
Among 12-17-Yr-Olds
Source where friend/
relative obtained:
58.8% from 1 MD
10.5% took: friend/relative
9.6% free: friend/relative
6.1% bought: friend/relative
5.8% from >1 MD
3.5% bought: drug dealer
SAMHSA. (2011). Results from the 2010 National Survey on Drug Use and Health: Detailed Tables.
Office of Applied Studies, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD.

12. Effect of Rx Opioids Kept in Home
Percentage of teens reporting:
Time to get Rx drugs: Other substance use:
The National Center on Addiction & Substance Abuse at Columbia University.
National Survey of
American Attitudes on Substance Abuse XVI: Teens & Parents. Aug 2011.

13. Drug Overdose Death Rates
• Drugs are 2nd leading cause of injury
death
– 36.4K vs 39.9K for MVA in 2008
• Overdose rate in 2008 nearly 4x 1999 rate
Paulozzi LJ, et al. MMWR. 2011;60:1-6. CDC. Vital Signs. Prescription
painkiller overdoses in
the US. 2011. www.cdc.gov/VitalSigns/PainkillerOverdoses/index.html

14. The problem
We are not reaching our youth who need help
The youth do not know they have a problem
They
don’t
realized
that
we
can
help
them

15. How is This Program Different Than Other
Early Identification Programs?
• No wrong door approach
• Identify “safe” & trained people who can engage with
youth
• Help youth initiate the conversation
• The icanhelp program is designed to improve outcomes
related to:
– Accessibility of resources and services
– Academic performance
– Mental and physical health
– Quality of life
– Gaps in service
– New links for individuals and the community

16. icanhelp Program Overview
The program
• has community oversight and planning through an
icanhelp team/advisory board
• builds a network of trained individuals who are
trained and designated icanhelp Representatives
• increases early identification and engagement of
young people who need a “safe, educated
person” to help them access the appropriate
service essential to their well-being
• provides online access to listings of community
resources and services

17. icanhelp Representative
Follow-­‐up

18. Who and Where Do Young People Go
for Help?
• Identify trainees to become
icanhelp Representatives
• Community members who work
directly with youth:
Trainees • School personnel
• Health personnel
• Law enforcement (SRO)
• Prevention specialist (Drug Free
Communities)
• Coaches and other youth mentors
• After school/Out of school activity
coordinators/workers
• Parents, families and young adults
• Clergy and other nonprofit
employees
• Government personnel
• Others

19. Increasing Our Presence
Develop strategies and plans
for building student and family
awareness and engagement
• Communicate icanhelp core
concepts with young people & others
Engagement in the community
• Make presentations
• Possible locations: youth groups/
centers, school announcements,
newspapers & websites, parent
groups, substance abuse coalitions,
etc.

20. Increasing Your Presence
Youth awareness and facilitating a
conversation
Display icanhelp posters
Examples of posters related to addictive behavior and issues
If you’re thinking these thoughts... If you’re thinking these thoughts...
you may need help. you may need help.
Look for the I CAN HELP sticker Look for the I CAN HELP sticker
to find a safe person to talk to. to find a safe person to talk to.
www.icanhelp.me www.icanhelp.me

21. Increasing Your Presence
Identify icanhelp Representatives
using icanhelp Logos
Engagement
The presence of the icanhelp logo signals this is a safe
person to speak with
Logos are reserved for people who have been
trained and are members of the icanhelp team

22. Who Do Young People Go To For
Help?
Communication style
• Building an alliance with youth so they feel
safe and welcome
• Strength-based vs. punitive, be supportive
and non-punitive
• Frame questions in a non-judgemental way
• Start where the student is at
• Youth need encouragement, validation and
support for expressing their opinions
• Including the student in decisions, encourage
open and honest bidirectional discussions
• Empower the student to take responsibility for
seeking solutions, and build incrementally on
small successes

23. Where Do Youth Go for Help?
Creating a safe space
• School & Institutional Policies
• Cultural competency, biases
• Working within the parameters
of our licensure & the law;
mandated reporting
• Stigma and label free
• Risk/Protective factors

24. Why Target Adolescents?
• About one in every five youth meets the
criteria for a mental health disorder in the US.
• The prevalence is even higher that other
major health conditions including asthma
and diabetes (Merikangas et al., 2010)
• Only a third of youth in need of treatment for
mental health disorders receives treatment
and frequently the treatment is incomplete
or inadequate for their level of need
(Merikangas et al., 2011)
• Dennis et al. (2005) found that the sooner an individual
receives treatment the shorter the lifetime struggle
related to managing their disease

25. Prevalence of Mental Health
Disorders
Common
reasons
for
receiving
mental
health
treatment
among
adolescents
(age
12-­‐17)
who
received
treatment
(NSDUH,
2008)
Problems with friends 14
Trouble controlling anger 16.3
Problems at school 18.9
Contemplates/attempted 19.6
suicide
Felt very afraid or tense 20.4
Breaking rules/acting out 25.7
Problems at home/family 28.9
Felt Depressed 48.6
0 10 20 30 40 50 60
Percent of children receiving treatment
Does
not
include
treatment
for
problems
caused
by
drug
or
alcohol
use.
Respondents
could
list
more
than
one
reason
for
treatment.

26. Identifying Youth in Need of
support Services
Connection to their world
• There are many routes to identification
of a youth in need of support services.
• Who are the members of your
community who work closely with
youth?
• Schools
• Families
• Friends
• Online & technology communities
• Volunteer activities
• Faith-base, religious activities
• Employment
• Extracurricular activities
• Sports
• After school out
of school time (ASOST)

27. Identifying Youth
Issues Specific to Your Community
Life events
• Separation or loss of family/friends/
home
• Trauma & victimization, Bullying/
cyber bullying
• Child abuse
Life challenges
• Disabilities, developmental
disorders
• Physical health – injuries, illness
Mental health, addictive and co-occurring disorders
• Depression • Tobacco
• Suicide • Performance enhancing
• Anxiety disorders drugs
• ADHD • Marijuana
• Eating disorders • Alcohol
• Prescription drug abuse • Gambling addiction

28. Link to Community Resources &
Services
icanhelp Resource Guide
• Importance of establishing personal
relationships with people listed on your
resource guide
Link to • In a crisis or urgent situation, this
Community relationship will be important
Resources
• Make the guide as comprehensive as
possible – divide and conquer – complete
it as a team
• The contact information on the resource
guides can be loaded into the online
icanhelp resource database

29. Developing an icanhelp Resource
Guide for Your Community

30. Link to Community Resources & Services
icanhelp Program: Building Linkages to
Community Resources
Online Services
• Resource database
• http://icanhelp.me
Link to • Community
Community • http://icanhelp.me/community/
Resources • Wiki
• Blog
• and more
• Facebook
• http://www.facebook.com/icanhelp.me
• Future services
• icanhelp newsletter & mailing list
• Training Portal: Re-launch soon
• Expanded search options for
resource database

31. icanhelp Website: http://
icanhelp.me

32. icanhelp Follow-up
Preventing youth from “falling
through the cracks”
Why linking with services doesn’t always work
• Youth or family not always ready to receive services,
Follow-­‐up
personal factors related to mental and cognitive
functioning of individual or family
• No service available within a reasonable distance,
dropped services
• Practical factors such as insurance, cost, transport,
child care, eligibility rules or program scheduling
• Cultural factors such as language, citizenship and
status
• Negative experience/bad rapport with provider
• Stigma and labeling
• Lack of cultural competency

33. icanhelp Follow-up
Preventing youth from “falling
through the cracks”
Some solutions
Follow-­‐up
• Use MI and other approaches to build
readiness
• Increased training in community
• Assist adolescents and their caregivers to
develop alternative plans
• Expand community resources and
services

34. Continua of School Services
Dependence/
Abuse (10%) AODA Tx and
Continuing
Care
Brief
Intervention
Primary
Prevention
Education Model—OSEP-PBIS AODA Model—Winters, Caldwell
SOURCE: Finch, 2010; Moberg, 2010

35. icanhelp Outcomes
• 6-week implementation and evaluation of the icanhelpSM program in
seven northeastern Massachusetts schools
• Twenty high school personnel participated
• Personnel roles were grouped into three categories: Administrators
(n=3), Teachers (n=9) and Health Professions (n=8)
Most youth directed
their questions about
the program to
teachers
Youth tended to discuss
their specific questions
regarding the posters
with health
professionals

36. icanhelp Outcomes
Teachers indicated the largest
increase in linkages due to
icanhelp

37. Next steps
icanhelp team/advisory board
• Develop and communicate community crisis plan
• Develop icanhelp deployment/implementation plan
– What are the targets/goals for the first year
• Assist icanhelp Representatives in compiling a community resource
database
• Develop a sustainability plan
icanhelp Representatives
• Join icanhelp community
• Work with team to compiling a community resource database
• Display icanhelp posters and logos
• Give brief presentations about the program to youth and other
community members
icanhelp Resource Database
• Make connections to key community
linkages/resources/services
• Submit or upload resources from your community
(can send file to Barbara)

38. Thank You!
In today’s society with undeniable
amounts of access to technology, our
young people need a village of supports
to help them navigate safely into
adulthood. Help us expand this village.
Icanhelp.me
Michelle