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
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