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Teen restart
 

Teen restart

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    Teen restart Teen restart Presentation Transcript

    •  Giving teens the opportunity to regain their future!
    •  As of 2009: o 32.0 percent of all substance related reports in emergency department visits made by patients ages 12 to 17. • were alcohol related and 18.7 percent were marijuana related. o 21.6 percent of sexually-active high school students report having used alcohol or other drugs before their last sexual experience o 1 out of 5 teens and young adults report having unprotected sex after drinking or using other drugs. As of 2011: o 46.1% of high school students admitted to currently using alcohol or another drug. o 11.9% have a diagnosable clinical substance use disorder. (CASA, 2011)
    •  Violent Crimes - Due to possible: o Increased paranoia o Acceptance in subcultures Vehicle Accidents & Injuries o 23% of high school car accidents were driving under the influence. Academics o High school academic performance dramatically reduces o Poor high-school performance decreases the chances of higher education. Cost of Association – Teens (even those who are not using) report that someone else’s substance use has been associated with: o someone personally who has gotten into trouble with parents, their school or the authorities (41.0 percent) o who has gotten into an accident (26.8 percent) o whose ability to perform school or work activities has been disturbed (24.5 percent) o who has been injured or harassed (19.4 percent each) o who has had an unintended pregnancy (13.8 percent) o who has experienced physical abuse (11.1 percent) o who has been sexually assaulted or raped (7.0 percent) (Sempe, 2007; King, Meehan, Trim, & Chassin, 2006; CASA. 2011)
    •  Adult Substance Use o 9 out of 10 adults with substance abuse disorders started using before 18. o 1 out of 4 who started before 18 are likely to be addicted vs. 1 out of 25 who did not. Critical Developmental Periods – Many areas of critical development are delayed or stunted from substance use o Brain • Still considerable maturing process until 20s • prefrontal cortex, limbic system and white matter still developing • important for decision making • Substances reduce white matter • Cause changes in volume (pre-frontal cortex and hippocampus o Cognitive • Verbal and language abilities • Decision making • Planning • Attention • Abstract reasoning • Problem solving • Memory (short and long term) o Forebrain and reward pathways still developing. Impacted by highly addictive substances which increase the sensitivity to these effects. (Bava, & Tapert, 2010; Kirby, 2010; CASA, 2011)
    •  $467.7 billion per year--almost $1,500 for every person in America--driven primarily by those who began their use as teens. $68.0 billion associated with underage drinking alone $14.4 billion associated with substance-related juvenile justice programs annually. Multiple sources cause fiscal impact including: o health care o criminal justice o family court o education services o social service systems o Accidents o Diseases o Crimes o child neglect and abuse o unplanned pregnancies o Homelessness o unemployment (CASA, 2011)
    •  Any kind of Victimization o Sexual Assault o Physical Assault (including bullying) o Witnessed Violence Family History of Alcohol or Drug Abuse A genetic predisposition Neglect Co-occurring mental health problems Other un-healthy behaviors Violence or Aggressive behavior Exposure by media Need for social acceptance – Peer Pressure Low socioeconomic status Adolescent LGBT is at even greater risk (190% more likely) (Kilpatrick et al., 2000; CASA, 2011; Sempe, 2007; Lopez, Katsulis, and Robillard, 2009; Marshal et al., 2008)
    •  AA/NA o Developed for adults o 7 year longitudinal trajectory showed that only 14% of teens stayed in AA/AA. High rates of comorbidity o Depression o Anxiety o BiPolar o ADHD o Conduct Disorder (Chi, Campbell, Sterling, & Weisner, 2012; Deas & Thomas, 2002; Goldstein, 2008)
    •  During this time, adolescents are going through a phase of separation and initiation. Separating from parents and family to discover their own identity. Evolutionary need to test their limits and seek out risky behaviors. This inhibits support from authorities and increases susceptibility with problem behavior peer groups. Efficacy of family systems oriented therapy shows relational confusion, loss and needs of teens through this transitional time. Incarcerated teenage girls who used drugs together with their parents are seeking relational bonding that is otherwise not achieved. (Kirby, 2010b; Baldwin, Christian & Shadish, Psychosocial need for risk behaviors andK. A., Bell, belonging2009; 2012; Lopez, Katsulis, & Robillard, Kerksiek, group N. J., & Harris, K. S. 2008)
    •  To provide successful care and support for the treatment of adolescent substance use disorders through the integration of evidence based treatments. To assist families in creating better dynamics as well and support. To reduce adult recidivism and psychiatric comorbidity To optimize their integration into society, academic performance and social aptitude. To contribute to the greater community through quality research
    •  Comprehensive Assessments –vital in guiding treatment o Cognitive – Cognitive abilities show us the strengths and weakness of an individual and may guide treatment and academic needs that precipitate use. o Psychiatric – Comorbid assessment not only provides diagnostic guidance, but information regarding coping strategies and possible uses for substances. o Physiological • Neuroelectrical imbalances as well as autonomic dysregulation have been shown to be associated with impulsivity, lack of inhibition and poor decision making; • Blood levels of substances o Functional Analysis of antecedents and consequences to target circumstances that maintain the behaviorsKofoed, 1991; (McCrady, Smith, 1986; Peniston, & Kulkosky, 1989; Mathias, & Stanford, 2003; Tuten, Jones, Schaeffer, & Stitzer, 2012)
    •  Family Therapy - shown to be effective in Tx of adolescence with substance abuse o Foster healthy family dynamics to ensure greatest familial support and reduce home stressors for teen o Family sessions without the teen to provide support and realistic expectations to aid in the overall treatment process o Direct liaison service with social workers to aid in additional resources Self – Acceptance and Commitment Therapy (ACT) o Acceptance based skills to counter Experiential Avoidance • Effective in anxiety and depressive symptoms • Cannot change the past or anyone else • Self o Value based Actions to counter the need for only good feelings • Building a sense of identity • Who they are • Who they want to be • Values that relate to identity o Mindfulness coping strategies to counter Fusion • Working through Negative Automatic Thoughts through diffusion • Urge Surfing • Cognitive Distortions (Baldwin et al., 2012; Petersen, & Zettle, 2009)
    •  Biofeedback o Heart Rate Variability (HRV) Biofeedback has been shown to balance the autonomic nervous system which decreases sensitivity to stressors as well as sympathetically mediated impulsivity. o Neurofeedback (optional) has been shown to decrease impulsivity, increase attention and inhibition with frontal control. Community o Social network that is solely made up of teens and a staff monitor. o Creates accountability o Opportunity for social and relational skill building Tutoring and Academic Support o Enable teens to stay caught up through school o Work through any learning challenges that deterred them from school to begin with Teen Activity Center o Video game consoles, music and entertainment centers, pool tables, billiards o Events to celebrate successful milestones for families and teens o Teens need a safe place to mingle and “chill” o Removes the need to find something to do o Positive reinforcement is effective in maintaining target behaviors. (Peniston, & Kulkosky, 1989; Knox et al., 2011; Wills, Vaughan, 1989; Bryant, Schulenberg, OMalley, Bachman, & Johnston, 2003;
    •  Promises to be at the forefront of adolescent structured research to give back the field o Randomized Controlled Trials with particular treatment modalities o Correlational studies for matching, personality and temperament o Longitudinal data on all clients willing to participate Will help further guide funding and treatment procedures
    •  Reduce rates of recidivism Reduce future incarcerations Reduce future health care cost in substance abuse Reduce conduct disorders
    • ???
    •  Bava, S., & Tapert, S. (2010). Adolescent brain development and the risk for alcohol and other drug problems. Neuropsychology Review, 20(4), 398-413. Baldwin, S. A., Christian, S., Berkeljon, A., & Shadish, W. R. (2012). The Effects of Family Therapies for Adolescent Delinquency and Substance Abuse: A Meta-analysis. Journal of Marital & Family Therapy, 38(1), 281-304. doi: 10.1111/j.1752-0606.2011.00248.x Bryant, A. L., Schulenberg, J. E., OMalley, P. M., Bachman, J. G., & Johnston, L. D. (2003). How Academic Achievement, Attitudes, and Behaviors Relate to the Course of Substance Use During Adolescence: A 6-Year, Multiwave National Longitudinal Study. Journal Of Research On Adolescence (Blackwell Publishing Limited), 13(3), 361-397. doi:10.1111/1532- 7795.1303005 Chi, F. W., Campbell, C. I., Sterling, S., & Weisner, C. (2012). Twelve-Step attendance trajectories over 7 years among adolescents entering substance use treatment in an integrated health plan. Addiction, 107(5), 933-942. doi:10.1111/j.1360- 0443.2011.03758.x Deas, D., & Thomas, S. (2002). Comorbid Psychiatric Factors Contributing to Adolescent Alcohol and Other Drug Use. Alcohol Research & Health, 26(2), 116-121. Goldstein, B. I. & Levitt, A. J. (2008).The specific burden of comorbid anxiety disorders and of substance use disorders in bipolar I disorder. Bipolar Disorders,10(1), pp. 67-78 Kerksiek, K. A., Bell, N. J., & Harris, K. S. (2008). Exploring Meanings of Adolescent and Young Adult Alcohol/Other Drug Use: Perspectives of Students in Recovery. Alcoholism Treatment Quarterly, 26(3), 295-311. doi:10.1080/07347320802072008 Kilpatrick, D. G., Acierno, R., Saunders, B., Resnick, H. S., Best, C. L., & Schnurr, P. P. (2000). Risk factors for adolescent substance abuse and dependence: Data from a national sample. Journal Of Consulting And Clinical Psychology, 68(1), 19- 30. doi:10.1037/0022-006X.68.1.19 Kirby, A (2010a, August 10). Substance Abuse and the Adolescent Brain, Part III: Brain Parts. Retrieved on April, 21 2012, from http://www.youtube.com/watch?feature=player_embedded&v=_fKFjt0IISo#!. Kirby, A (2010b, September 24). Substance Abuse and the Adolescent Brain, Part V: Adolescent Susceptibility. Retrieved on April, 21 2012, from http://www.youtube.com/watch?feature=player_embedded&v=_fKFjt0IISo#!. Knox, M. M., Lentini, J. J., Cummings, T. S., McGrady, A. A., Whearty, K. K., & Sancrant, L. L. (2011). Game-based biofeedback for paediatric anxiety and depression. Mental Health In Family Medicine, 8(3), 195-203. Kofoed, L. (1991). Assessment of comorbid psychiatric illness and substance disorders. New Directions for Mental Health Services, (50), 43-55. Lopez, V., Katsulis, Y., & Robillard, A. (2009). Drug use with parents as a relational strategy for incarcerated female adolescents. Family Relations, 58(2), pp. 135-147.
    •  Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., . . . Morse, J. Q. (2008). Sexual orientation and adolescent substance use: a meta-analysis and methodological review. Addiction, 103(4), 546-556. doi: 10.1111/j.1360- 0443.2008.02149.x Mathias, C. W., & Stanford, M. S. (2003). Impulsiveness and arousal: Heart rate under conditions of rest and challenge in healthy males. Personality And Individual Differences, 35(2), 355-371. doi:10.1016/S0191-8869(02)00195-2 McCrady, B.S., Smith, D.E., (1986). Implications of Cognitive Impairment for the Treatment of Alcoholism Issue. Alcoholism: Clinical and Experimental Research, 10(2), 145–149. National Center on Addiction and Substance Abuse at Columbia, U [CASA]. (2011). Adolescent Substance Use: Americas #1 Public Health Problem. National Center On Addiction And Substance Abuse At Columbia University. Peniston, E.G., & Kulkosky, P.J. (1989). Alpha-theta brainwave training and beta-endorphin levels in alcoholics. Alcoholism, Clinical and Experimental Research, 13(2), 271-279 Petersen, C. L., & Zettle, R. D. (2009). Treating inpatients with comorbid depression and alcohol use disorders: a comparison of acceptance and commitment therapy versus treatment as usual. Psychological Record, 59(4), 521-536. Sempe, M.D. (2007). Relationship between adolescent substance abuse and violence in Batho policing area (Master’s Thesis). Tshwane University of Technology, Pretoria West, South Africa. Stivers, C. (1994). Drug prevention in Zuni, New Mexico: creation of a teen center as an alternative to alcohol and drug use. Journal Of Community Health, 19(5), 343-359. King, K., Meehan, B., Trim, R., & Chassin, L. (2006). Substance use and academic outcomes: Synthesizing findings and future directions. Addiction (Abingdon, England), 101(12), 1688-1689. Tuten, L., Jones, H. E., Schaeffer, C. M., & Stitzer, M. L. (2012). Conducting a functional assessment of substance use. In , Reinforcement-based treatment for substance use disorders: A comprehensive behavioral approach (pp. 43-56). Washington, DC US: American Psychological Association. doi:10.1037/13088-002 Wills, T., & Vaughan, R. (1989). Social support and substance use in early adolescence. Journal of Behavioral Medicine, 12(4), 321-339.