Downloaded 103 times
Uploaded byGreenville Health System
Adolescents and substance abuse ucaya
This document discusses adolescent substance abuse, including: - Common drugs of abuse such as alcohol, marijuana, and tobacco and emerging trends like bath salts and e-cigarettes. - How the adolescent brain is still developing which can increase risk-taking behaviors and substance abuse. - The co-morbidity of substance abuse with mental health conditions like depression and anxiety. - Prevention strategies are needed to address the myths surrounding substance use and the health risks to adolescents.
More Related Content
Similar to Adolescents and substance abuse ucaya
Adolescents and substance abuse ucaya
- 1. Adolescent Substance Abuse MikeGuyton, MD Assistant Clinical Professor/Academic Faculty in General Pediatrics
- 2. Overview • Myths, Misconceptions,and the Adolescent Brain • Common Drugs of Abuse – Alcohol – Marijuana – Tobacco • Emerging Trends in Substance Abuse • Co-morbid conditions with Substance Abuse – Depression and Anxiety – Bullying – High Risk Sexual Behavior • Prevention Strategies/Resources
- 3. Drug Myths andMisconceptions • Drug addiction is a choice • Substance use is just a phase during adolescence • Marijuana is safer than traditional tobacco products • Teenagers are drinking alcohol and doing drugs now more than ever
- 4. Drug Facts • Illicitdrug use among teenagers remains high, largely due to increasing popularity of marijuana. – Rising marijuana use reflects changing perceptions and attitudes. • Nonmedical use of prescription and over-the-counter medicines remains a significant part of the teen drug problem. – Purple Drank/Sizzurp/Lean • Alcohol use among teens remains at historically low levels. • Fewer teens smoke cigarettes than smoke marijuana. • Other forms of smoked tobacco are becoming popular, however. – Hookah Water Pipes, Small Cigars
- 5. The Biology ofAdolescence • In general, adolescence includes ages 10-25 • Lack of frontal lobe lack of judgment • Behavior controlled by response to impulses – Amygdala/Limbic System
- 7. Alcohol • The mostwidely used/abused drug among US adolescents – In US, children and adolescents account for 11% of total alcohol consumed – Almost 40% of HS students report current use; ¼ binge drink • Multitude of negative health effects associated with abuse – Acute Effects • Nervous System Depression, Hypoglycemia, Dehydration, GI – Chronic Effects • Chronic Liver disease, Nutritional deficiencies, Impairment in Cognition • Many negative societal outcomes as well – Fatal MVA’s, aggression, suicidal behavior, unplanned pregnancies, sexual assault
- 8. How much istoo much? • Legal limit in SC is 0.08 • Reaching limit depends on many factors – Age and Gender – Weight – Rate of consumption – Metabolism – Hydration
- 9.
- 10. Binge Drinking Facts •In general, risk of experiencing problems is greater for binge drinkers – School, social, legal, etc. • Youth who start drinking <15yo are 5X more like to develop alcohol dependence or abuse – Vs those after 21yo • Data from 2011 Youth Risk Behavior Survey – 16% of youth 12-20 report binge drinking – In high school students, 22% reported binge drinking in the last 30 days Standard Drink Measurements (0.6-oz of pure alcohol): • 12-oz of beer (5% a.c) • 8-oz of malt liquor • 5-oz of wine (12% a.c.) • 1.5-oz of 80 proof liquor Binge Drinking = 4+(women) or 5+(men) drinks on one occasion
- 11. Binge Drinking • Neknominate –Most popular in the UK/Ireland, trend spreading over 2014 – Believed to be directly responsible for 5 deaths in the UK – Each nomination more intense, daring, or humiliating than the last
- 12. Tobacco • Leading preventablecause of disease, disability, and death in US – Causing/related to 1 in 5 deaths in the US – 41,000 non-smokers die annually due to passive smoke exposure • Active ingredient is Nicotine – The most addictive substance in existence; withdrawal – Toxic/Fatal in certain quantities – Stimulates adrenal glands/nervous system • blood pressure, heart rate, respiration • Cigarette smoking alone accounts for 1/3 of all cancers, in addition to those caused by smokeless tobacco • Passive smoke exposure also linked with health compromise – Heart disease risk (25-30%) and Lung cancer risk (20-30%)
- 13.
- 14. Marijuana • Most commonillicit drug used in the US – Increasingly popular among teenagers • Use is extremely controversial – Schedule 1 per Federal Government – Approved for medicinal use in 21 states – Approved for recreational use in 2 states • Nervous System effects are the most well known – THC attacks the cannabinoid receptors in the brain affect pleasure, memory, thinking, concentration, and coordination – Overstimulation altered perceptions, “high” – Affects brain development in heavy/chronic users • Loss of, on average, 8 IQ points between age 13-38 when started in teenage years
- 15. Lesser Known Facts RecognizedMedicinal Uses • Chemotherapy related Nausea and vomiting • Appetite Stimulation • Cancer Pain Relief • Anxiety and Sleep Long Term Health Effects • Substance Addiction • Carcinogen Exposure – Benzopyrene – Benzanthracene • Increased respiratory infections • Increase risk of CVD • Mental Illness • Infertility/Pregnancy Related concerns
- 17. Emerging Trends inSubstance Abuse http://www.drugabuse.gov/
- 18. Emerging Trends Days ofYore • Cigarettes • Alcohol • Cocaine • Heroin • Marijuana New Kids on the Block • Bath Salts • Inhalants • K2/Spice • MDMA • Steroids • Krokodil • Natural Substances – Caffeine – Spices
- 19. Bath Salts • Drugscontaining 1+ synthetic cathinones – Amphetamine-like stimulant • Marketed under many names; used in several ways – Ivory Wave, Vanilla Sky, White Lightning – Orally, Inhaled, Injected • Symptoms of “excited delirium” – Elevated HR/BP, Euphoria, Paranoia, hallucinations, panic attacks
- 20. Traditional Caffeine Use •Traditionally, soda and tea have been the main sources of caffeine for kids and adolescents – ~73% consume caffeine on a given day • Mean caffeine intake among adolescents and young adults in the US has remained stable over the years – Actually decreased among young kids over the last 10 years • Proportion of intake from soda has decreased, but intake from coffee and energy drinks has markedly increased – Coffee: 10% 24% (2009-2010); Energy Drinks: 0% 6% (2009-2010) • AAP has a very clear statement – “Stimulant-containing energy drinks have no place in the diets of children and adolescents”
- 21. Caffeine of 2014:Caffeine Powder • Hit the headlines in March 2014 – Fatal overdose by a senior high school student • Caffeine powder is pharmaceutical grade – Basically 100% pure; safe amounts can not be measured with traditional household/kitchen measuring tools • Some potential uses have been discussed – Added stimulatory/concentration effects – Help in losing weight • Side effects are varied – Arrhythmia – Seizures – AMS – GI Symptoms: Nausea, Vomiting, Diarrhea
- 22. How does caffeinepowder measure up? Caffeine Powder • 1/16 tsp = 190mg • 1/8 tsp = 380mg • ¼ tsp = 760mg • 1tsp = ~3,000mg Traditional sources of Caffeine • Coffee = 80-175mg • Tea = 15-60mg • Red Bull = 80mg • Mountain Dew = 55mg • Diet Coke = 45mg • 5-hour energy = ~210mg 1tsp of Caffeine Powder = ~25-30 cups of Coffee
- 23. The E-Cig Craze •First nicotine based E- cigarette was created in 2003 • Cost ranges from $10 to hundreds of dollars • The trend, known as “vaping,” is set to surpass the sales of regular cigarettes in the next 10 years • Doctor Plug • Office Plug
- 24. E-cig? Never heardof them! What's the Difference • Vapor vs Smoke – No burning means no CO • Nicotine Levels – Not as predictable • Lack of Carcinogens • Reusable – Charging stations, cartridges • Cheaper – $600/year vs $1,000/year What's the Problem • Not FDA regulated….yet – Family Smoking Prevention and Tobacco Control Act • Health Risks of Nicotine Alone – Lethal at certain doses – Multiple forms of exposure • Impact on Lungs – Decreased lung function, increased airway resistance, cellular changes • Risks not related to Vaping – Accidental poisoning of children
- 25. How does thisaffect our Adolescents • Between 2010-2012, ever use of e-cigarettes among U.S. youth doubled 3.3% 6.8%; current use doubled 1.1% 2.1% • Well known that adolescents are impressionable, stubborn and for the most part invincible – Majority of adolescents (64%) see the harmfulness of cigarettes as dose-dependent and on a continuity • Curiosity is a hallmark of this period of development – Estimated 30% of youth are curious about cigarette smoking • Brain is still making pathways that can be interrupted – In animal studies, deficits in serial pattern learning, attention and impulsivity, and memory were seen after exposure to nicotine – Also, increased anxiety and depression
- 27. Combining Curiosity andExposure • Youth exposure to TV E-cig ads increased 256% from 2011 2013 – Reaches 24 million youth • Cable television accounts for the largest source of exposure • Depicts e-cigs with vapor that looks similar to smoke – Visual Cue urge to smoke • Ads harp on smoking being an adult behavior • All this combined can alter and create new social norms about tobacco, thus influencing smoking behaviors
- 28. Current Burden ofMental Illness Among Youth • Depression – Point prevalence in those 4-17yo estimated to be 3-3.5% – Lifetime prevalence as high as 7-8% • Relapse as high as 40% in 2 years – F:M 2:1; increased risk to those born in latter half of 20th century • Anxiety – Usually co-morbid with depression • Estimated to be current in ~3% of those 3-17yo • Suicide – 3rd leading cause of death among all children and adolescents in the US – In 2010, rates estimated to be 4.5/100,000 youth 10-19yo – Overall, rates of pediatric suicide are increasing
- 29. Depression, Anxiety, andSubstance Abuse • Association is multifaceted – Anxiety/Depression may increase substance use; substance use may affect course and severity of anxiety/depression • Stress highly linked with relapse – HPA axis shows responses that can promote relapse • Many neurochemical components shared between depression/anxiety and substance use disorders – Dopamine – Catecholamines – GABA receptors
- 30. What Makes IdentificationTough • Kids/Adolescents have many reasons to hide their feelings of depression/anxiety – Fear of Stigma – Belief that depression is not treatable by primary care docs – Depression is not a “real” illness, but instead a personal flaw – Concerns about confidentiality – Do not want medication or involvement of a psychiatrist
- 31. Teen suicide triesincreased after FDA toughened antidepressant warning
- 32. The Study • HarvardMedical School followed 2.5 million teens/young adults between 2000-2010 – Published in The BMJ June 18, 2014 • Use of SSRI’s fell by 25%-30% – Young adults and teens respectively • Suicide attempts rose 22% in teens and 34% in young adults • At the heart, its all about communication – Treating depression in teens with SSRI’s has been proven safe and effective time and time again – Appropriate follow-up must be an integral part of the management plan – View SSRI treatment as a temporary measure, and communicate that to the patient – Don’t neglect to role of psychotherapy as well
- 33. Bullying • “Repeated inflictionof harm on younger, smaller, or less powerful peers” • 10% of students grade 6-12 have reported bullying in varying environments – School, on the way to school, online, extracurricular activities/sports • Both the bully and victim are affected – Victim: Physical injury/symptoms, lapse in concentration, anxiety depression, poor self esteem, high school absence – Bullies (long term): incarceration, social/financial/personal strife • Bullying Vulnerability Impulsivity substance abuse
- 34. Anabolic Steroids • Officialname is Anabolic-Androgenic Steroids (AAS) – Synthetic variants of testosterone • Prevalence trend has been overall stable from 2010-2013 – Ranging 1.1%-2.1% for 8th-12th grade adolescents; as high as 5.4% – Sexual Minority Boys have a prevalence of 21% • Abusers usually “cycle” use but use higher dosages than those medically prescribed • Many long term side effects – Stunted growth – Gynecomastia – Testicular atrophy – Androgenic effects – Infertility – Increased risk of prostate cancer
- 35. High Risk SexualBehavior • Link between substance use and high risk sexual behavior – Decreased inhibitions poor decision making • Compounded by natural curiosity about sex and biological impulsivity – Lack of prefrontal cortex control • Interventions should be multifaceted – Education on safe/responsible sexual practices – Assessment of degree of substance use – Screening for episodes of domestic violence • Sexual minorities particularly at risk
- 36. Prevention Strategies • Routinemedical care • Don’t be afraid to ask questions • Educate yourself on the common signs of substance abuse • Focus on reduction of risk factors – Teaching life skills at school – Education/discussion on co-morbid conditions
- 37. Common Signs ofSubstance Abuse • Physical Signs – Bloodshot eyes – Weight loss – Deterioration in personal hygiene – Tremors, slurred speech • Behavioral Signs – Increased withdrawal from others – Loss of enjoyment in activities previously liked – Sudden changes in friends – Change in school/work performance – Unexplained need for money • Psychological Signs – Anxiety/Fear/Paranoia for no reason – Sudden mood swings – Lack of motivation
- 38. Resources • Greenville FamilyPartnership • Local Law Enforcement: Greenville County Police Department/Greenville City Police Department • CDC: www.cdc.gov • National Institute on Drug Abuse: www.nida.nih.gov ; www.nida.nih.gov/students.html • Partnership for a Drug Free America: www.drugfree.org
Editor's Notes
- #5 Positive trends in the past several years include reduced use of inhalants and less use of cocaine, especially crack cocaine. -Hookah has many of the same health risks as cigarette smoking; use is increasing among youth and college students; among high school students, 1:5 boys and 1:6 girls have used in the last year -Charcoal used to heat can release metals and CO, associated with lung, bladder, and oral cancers; passing of infections due to communal use -Shisha (non-tobacco products) also associated with exposure to CO and toxins)
- #7 -Use it or lose it pruning system
- #11 -Binge drinking as high as 27% in European youth
- #12 -Deaths were of men all under the age of 30. Youngest was 19 yo, where the victim jumped into a river while in the middle of his neknomination Some examples: one death occurred after drinking 2 pints of straight gin, drinking liquor from a toilet, mixing a dead mouse with liquor as a cocktail, non alcoholic nominations like stripping in the middle of a supermarket
- #13 -On average, adults who smoke die 10yrs earlier than those who don’t
- #15 -Schedule 1: No currently accepted medical uses and high risk of abuse; most dangerous class of drugs per government -Use been increasing among teens since 2007. -Large long-term study in New Zealand -Recreational Use: Colorado and Washington state -SC is not a legal medical marijuana state
- #16 -Cannabidiol: active cannabinoid which is believed to relieve pain and lower inflammation -Addiction: ~9% of users become addicted and report withdrawal symptoms when trying to quit CVD: 4.8 fold increase in risk of hear attack in the first hour after smoking the drug (greater in older/comorbid individuals) -Mental Illness: several studies linking use with development of psychosis -
- #19 -Krokodil: synthetic form of heroin (desomorphine) made by combining codeine tablets with toxic substances such as lighter fluid and industrial cleaners. Scaly, gray-green dead skin forms at the site of injection and can spread further causing skin and tissue destruction -Purple Drank, Sizzurp, Lean: Rx strength cough syrup with promethazine and soda -Molly: slang for molecular, pure crystalline version of MDMA purchased as capsules (ecstasy is pills). Like Ecstasy, can dangerously affect body temp, cause hallucinations/psychosis, and structural brain changes over time. Many feel that by doing Molly rather than ecstasy, they are avoiding the drug being mixed with other contaminants, but some molly has been found to be mixed with items such as bath salts, equally as dangerous.
- #20 -Cathinones are alkaloids that are chemically similar to MDMA and amphetamines -Creates a sharp rise in dopamine in the brain like other addictive substances. However, this effect is about 10 times more potent than cocaine with bath salts
- #21 -Most research into the risks of caffeine are done in the adult populations -Caffeine contents of soda, energy drinks, etc. is not regulated by the FDA as it is listed as a dietary supplement, rather than a drug -Side effects of caffeine are well known: tachycardia, arrhythmia, hypertension, hyperactivity, anxiety -Increased blood sugar concentrations as well due to many of these drinks also containing high sugar content
- #23 Lethal Dose of Caffeine: 150-200mg/kg in humans (so, 70kg adolescent = 10,500-14,000mg = 10.5-14g of caffeine; 30kg kid = 4,500-6,000mg = 4.5-6g)
- #24 -from the campus world press, www.coscampusonline.com -Introduced in the US in 2007
- #25 -E cigs contain a combo of nicotine, flavor, propylene glycol, and other “additives” -Nicotine levels can either be equal to or slightly lower than traditional cigarettes -Smoking related illness responsible for 1 in 5 deaths in the US (CDC.gov); traditional cigs have ~7,000 chemicals with 69 known carcinogens -FSPTCA: must disclose all ingredients, can’t be sold to minors (exact age vary by state), all labels must have health warnings -Nicotine lethal at ~1 tablespoon (or less) for adults and ~1tsp for kids -Some e-cigs may also release small amounts of some metals; FDA found that in 2009, some contained 1% diethylene glycol (antifreeze component) -51% of poison control calls (9/2010-2/2014) involved kids <5yo -
- #26 -Info from the 2012 National Youth Tobacco Survey, middle school and high school students -Youth generally understand that cigarette smoking is harmful to one’s health, but underestimate their own risk -1 in 3 students stated that e-cigarette use is less harmful than traditional cigarette use; only 30% surveyed felt that non-daily smoking was harmful (well known to contribute to CV disease, cancer, and addiction) -Curiosity indicates interest, even if there is no urge to use; adolescents who were curious had about 6x increased chance for experimentation in the next 6 years -14% of high school students smoke cigarettes
- #27 -Assesses the extent to which youth aged 12-17 and young adults 18-24 were exposed to US e-cigarette TV ads
- #28 -Measured in Target rating points (TRP’s) from Nielsen data -Young adult exposure increased 321%; young adulthood sees increasing rates of transition to regular smoking -Adolescents have been found to use both e-cigarettes and traditional cigarettes rather than quitting -No current widespread campaigns exist to educate the public about the safety of e-cigarettes -Most widespread ad depicts a film actor exhaling vapor, informing of all the benefits of “smoking” the product, and saying, in closing “We’re all adults here. It’s time to take back your freedom.” -Many adolescents are particularly motivated to appear mature beyond their years -exposure may also delay smoking cessation
- #30 -Stress: Stress causes the release of CRH from the hypothalamus; this extra release is also seen in heavy drug users and promotes craving behaviors; blocking this release leads to decreased relapse rates in mice
- #33 -The BMJ (formerly The British Medical Journal) -FDA warning came out in 2003 and 2004 -While the warning itself could be responsible for the decreased prescribing of SSRI’s, the media exaggeration of the warnings also played a role -Message was intended to be more “pay attention to thoughts/feelings of suicide after giving medication,” not to stop prescribing all together. -Taking SSRI’s do not cause more suicides
- #35 -Cycling helps to avoid SE -Typically orally ingested, injected, or absorbed -No rapid dopamine surge in the brain = less thrill when taking; however, there is long term effect on opioid, serotonin, and dopamine systems leading to alterations in mood and behavior. -Sexual Minority Boys: Higher rates of depressive symptoms/suicidality, victimization, and substance use