Intervention with Young Adults and Adolescents

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Intervention with Young Adultsand Adolescents

• Heather R. Hayes, M.Ed., LPC
• Atlanta, Georgia

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Can you intervene too early?

• Diabetes vs. Juvenile Diabetes

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Importance of EarlyIntervention

• Teens starting alcohol by 14 are
• 4 times more likely to develop alcohol dependence
  than those starting at 20
• Reduce odds of dependence for each year delayed
• OBrien, et al, 2005
  

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Adolescent males

• If at ages 12-14
• Neurobehavioral disinhibition AND
• Parental Substance Use Disorder AND
• Psychosocial Problems
• Then by Age 22
• 92 probability of Sub Abuse Disorder
• Kiriski, Vanyukov, Tarter, 2005

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Adolescent males

• If at Ages 12-14
• Neurobehavioral disinhibition AND
• Parental Substance Use Disorder WITHOUT
• Psychosocial Problems
• Then by Age 22
• 39 probability of Sub Abuse Disorder
• 
  Kiriski, Vanyukov, Tarter, 2005

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Brain Chemistry

• The adolescent brain is not developed
• Chemicals poured on an immature brain and
  nervous system (not to mention hormones)
• Developmental Arrest
• Telescope

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Why Use??

• Experimentation
• Acceptance from peers
• Alleviate depression
• Modify unpleasant feelings
• Readily available
• To be cool

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• Adolescents who use one drug are likely to use
  another

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• Most adolescents do not experience the more
  dramatic withdrawal symptoms or long-term
  consequences (loss or job, marriage, home) like
  adults

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Adolescent vs. Adult Substance Abuse

• Less physical dependence
• Fewer physical problems
• Consume less over all, but more at one time
• More negative consequences
• Move faster from abuse to dependence
• OBrien, et al, 2005

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Larger set of enablers

• Parents
• Grandparents
• Teachers
• Friends Parents
• Extended family
• Coaches

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Risk Factors
Individual
Peer Related
Parent/family
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Peer Related Factors

• Peer substance use
• Peer attitudes on substance use
• Greater orientation to peers
• Perception of peer use attitudes
• Buckstien, O.G. Adolescent substance abuse
• Assessment, prevention, treatment. Wiley 1995

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Parent/Family Risk Factors

• Parental attitudes substance abuse
• Parental tolerance or deviant behavior
• Lack of involvement with children
• Lack of supervision/discipline
• Non intact/single parent families
• Physical/sexual abuse
• Buckstien, O.G. Adolescent substance abuse
• Assessment, prevention, treatment. Wiley 1995

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Individual Risk factors

• Early conduct problems/ aggression
• Poor academic performance
• Acceptance of drug/deviant lifestyles
• Expectancies
• Risk-taking behaviors
• Genetic Vulnerability
• Buckstien, O.G. Adolescent substance abuse
• Assessment, prevention, treatment. Wiley 1995

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Assessment

• Where pt. stands on the following dimensions
• Alcohol/drug use
• Negative consequences
• Dependence
• Family history
• Neuropsychological functioning
• Physical sequelae
• Psychological functioning
• Educational functioning
• Sexuality and sexual issues

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Substance Abuse Can

• Mimic psychiatric disorders
• Worsen pre-existing psychiatric illness
• Preclude treatment of psychiatric illness
• Escalate to more serious problems

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Common Presentations

• Anxiety
• Sleep disturbance
• Depression
• Interpersonal conflict
• Behavior characteristic of borderline personality
  disorder or oppositional defiant disorder

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Components of history

• Quantity frequency
• Tolerance/withdrawal
• Medical
• Vocational/academic
• Interpersonal
• Social
• Legal
• Negative behaviors
• Personality changes
• Emotional
• Peers

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Assessing Consequences of Use

• Physical health
• Emotional health
• Self-esteem
• Sexuality and sexual behavior
• Achievement of personal goals
• Relationships with significant others
• Academic functioning
• Job functioning
• Legal status
• Finances

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Stages of Addiction

• Early

• Middle

• Late

• Too Late

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Continuum of Substance Use

• Use
• Non-problematic, non-compulsive
• Abuse
• Problematic, patterned, progressive,
  non-compulsive
• Dependence
• Severely problematic, patterned, progressive,
  compulsive

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Early Stage

• Experimentation
• Usually between 11 and 12
• Peer pressure
• Use with parents or with parental supervision
  (attitude that use is OK)
• Use becomes more regular
• Increased mental and physical energy put into
  getting high

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Middle Stage

• Negative consequences begin
• Shift in priorities
• Change in attitude
• Problems at school, work and home
• Legal Problems
• Change in friends
• Physical problems (trips to ER, car wrecks, etc.)
• Seeking the high
• Blackouts

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Late Stage

• Hiding, lying, conning
• Low self-esteem
• Use to feel normal
• Loneliness
• Expelled or dropped out of school
• Run away
• Pregnancy
• Legal problems

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Drugs Used

• Cigarettes
• Alcohol
• Marijuana

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Marijuana

• 50 to 80 more potent than in the 1970s
• We know much more about marijuana and the damage
  it can cause
• Often laced with something else
• (Salvia)

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Drugs Used

• Methamphetamine
• And
• Cocaine
• Route of administration must be considered

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Drugs Used

• Pills
• Opiates
• Benzodiazepines
• Adderal

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• Heroin
• Route of administration must be considered

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Old Hallucinogens

• Entactogens drugs that generate tactile
  hallucinations (MDA, MDMA)
• Entheogens drugs that generate religious
  experiences (LSD, Mescaline, Psilocybin)
• Dissociants Cataleptic anesthetics (PCP,
  Ketamine)
• Cannabinoids drugs that have activity at CN
  receptors (THC, Marinol, Ondansetron)

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Entactogens

• XTC

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Entheogens

• LSD
• Mushrooms
• Salvia
• Mescaline

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Dissociants

• Ketamine
• Dextromethorphan
• PCP
• Over-the-counter cough medications
• Robitussin (Robotripping)
• Coricidin (Skittles
• GHB

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Inhalants
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Withdrawal

• Opiate
• Cocaine/Meth
• Alcohol
• Benzodiazepines
• Post - Acute Withdrawal Syndrome

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Family Systems

• Families are systems and have a homeostasis
• The family members are impacted by the disease of
  addiction
• Often the family members are sicker than the
  addicts
• Held together by rules and roles

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Dysfunctional Family

• Addiction to chemicals or process addiction
• Emotionally or psychologically disturbed family
• Physical, sexual, and/or emotional abuse or
  neglect
• Fundamentalistic or rigidly dogmatic families

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Roles

• The Addict/alcoholic
• Co-dependent
• Hero
• Scapegoat
• Mascot
• Lost child

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Hero

• The good kid
• Self-esteem from outside the family
• Holds the familys self esteem
• Never good enough
• Parentified at a young age

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Scapegoat

• The bad kid
• Angry
• Acting out
• Defiant
• Using chemicals
• Sexually acting out
• Shifts focus off of the adult addict
• Self-harm
• Most honest person in the family

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Mascot

• The funny one
• Distracter
• Family entertainer
• Class clown
• Full of anxiety
• Cant be serious when needs to be
• Prone to eating disorders

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Lost Child

• Quiet
• Well behaved
• Does not expect much from the family
• Isolated
• Lives in fantasy
• Depression
• Most disturbed in family
• Serious suicide attempts

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Rules

• Its not OK to talk about problems
• Its not OK to talk about or express our feelings
  openly
• Dont address issues or relationships
  directly-triangulate
• Always be strong, good and perfect

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Rules

• Do as I say. not as I do
• Its not OK to play
• Dont rock the boat
• We all have the same thoughts and opinions
• Dont be selfish

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Importance of Family Involvement

• Family education about the Disease (we wouldnt
  send a diabetic child home with educating the
  family about diabetes)
• Family treatment
• Family therapy
• Alanon/Naranon/Families Anonymous
• Multi-family group- helps reduce shame and
  isolation and introduces families to step work

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• Treatment NEED NOT be voluntary
• To be effective!!

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Treatment What Works

• Intervention that tackles different domains of
  functioning Educational, Family, Behavioral
• Completion of treatment
• Treatment includes family members
• Group therapy
• Abstinence based program

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Treatment

• What makes a good program
• Based in Disease Model
• Twelve Step
• Coping skills
• Appropriate Medications/Addictionologist
• Sleep Hygiene
• Workbooks
• Daily meetings
• 12 step work

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Treatment

• Drug testing
• Daily groups
• Morning meditation and goals
• Evening wrap up
• DBT
• Motivational Counseling/Interviewing
• Stages of Change
• Trauma work
• Dual-diagnosis

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Treatment Issues

• Address physical, psychosocial, educational,
  spiritual/existential aspects of the client

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Length of treatment

• NIDA
• For residential or outpatient treatment,
  participation for less than 90 days is of limited
  or no effectiveness

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Habilitation vs. Re-habilitation

• Failure to address developmental delays can set
  up for relapse
• Educational delays
• Social skills delays (socializing with out
  chemicals is difficult)
• Immaturity
• Self-confidence, promiscuity, inability to deal
  with feelings
• Very few tools in their toolbox

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Complicating Factors

• Use of multiple substances
• Family members are also abusing
• Poor parenting practices
• Adolescents rarely seek treatment voluntarily
• Involvement in multiple systems legal, school,
  medical
• High attrition rates

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• Co-occurring
• Disorders

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Co-occurring Disorders

• A D use can mask and mimic psychiatric
  disorders
• Anxiety
• Depression
• Lability
• Appetite/sleep problems
• Low frustration tolerance
• Poor impulse control

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Co-occurring Disorders

• Chronic use and early age use can cause severe
  disruption in psychosocial functioning
• How to differentiate
• History when did problems start
• Observe as sobriety is achieved (4-6 weeks)

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Co-occurring Disorders

• Integrated treatment is better than sequential
  treatment
• Poorer outcomes with co-morbid disorders
• Pharmacology alone will not help substance abuse
• Substance abuse tx alone will not help co-morbid
  disorder

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Co-occurring Disorders

• Bi-polar
• Oppositional Defiant Disorder
• Conduct Disorder
• ADD/ADHD
• Depression
• Eating Disorders
• Psychosis

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Adolescent Girls

• As young womens bodies begin to experience the
  hormonal changes brought on by puberty and
  natural growth, their risk of substance use is
  heightened.

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• Young woman who mature faster than their peers
  are at an increased risk for negative outcomes
  including substance use and abuse
• Girls that attain sexual maturity earlier have
  an increased possibility of engaging in substance
  abuse earlier and in greater quantities then
  their peers who reach sexual maturity later
• The link between increased testosterone levels
  and substance use may also explain the tendency
  for early maturing girls to spend more time with
  older, more risk taking peers

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• Teenage girls who report low self-esteem are
  much more likely to report substance use or
  abuse.
• Body image plays a significant role in the
  development of self-esteem of younger girls.
• Younger girls tend to associate weight loss with
  being prettier and popular whereas older girls
  specifically associate it with being more
  attractive.

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Treatment of Adolescent Girls

• Habilitation vs. Rehabilitation
• Eating Disorder/Body Image
• Self-esteem Nurturing
• Sexuality/Relationship Issues
• Self-mutilation
• Abusive Relationships
• Educational/vocational issues

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Treatment of Adolescent Girls

• Habilitation vs. Rehabilitation
• Eating Disorder/Body Image
• Self-esteem Nurturing
• Sexuality/Relationship Issues
• Self-mutilation
• Abusive Relationships
• Educational/vocational issues

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Adolescent/Young Adult Intervention
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Under 18 (or legal adult age)

• Parents may check their child into treatment
  against their will.
• Does help disrupt destructive behaviors

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Best Way to get the Adolescent into Treatment

• Taken in the middle of the night
• Vs.
• Formal Intervention with no choice in treatment

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Intervention in Action

• Intervention is a very structured meeting
• No judgment
• No anger
• Designed to be different than every other kind of
  meeting

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Role of the Professional

• Help with communication
• Monitor feelings
• Structure the intervention
• Stop the power struggles
• Keep the direction positive and loving

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Role of the Professional (cont)

• Be firm when needed
• Assist in treatment options
• Take into consideration co-occurring psychiatric
  disorders
• Assess for safety issues
• Support the family if the addict does not go to
  treatment

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Who Attends?

• Anyone with a QUALITY relationship with the
  addicted person

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Message to the Teen/Young Adult

• You are valuable
• You have many good qualities
• Because we love you, we are together talking to
  about your problem, despite the fact that we were
  afraid you would be angry
• You are worth our taking the time out of our
  lives to do an intervention

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Message to the Addict(Cont)

• You have a disease - and just as if you had
  cancer or diabetes and did not want to get help,
  we would be here saying the same thing

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Message to the Addict(cont)

• And we are here offering/insisting that you get
  help

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First Letter

• Written in three parts
• All the participant loves about the IP
  (Identified Patient) what makes them special and
  valuable
• Describe the impact the IPs disease of chemical
  dependency has on each participant (focus on
  disease, not on IP)
• Request the IP get help

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First Letter

• Reduces Shame
• Protects Addicts fragile self-esteem
• Places the burden of blame on the disease
• Asks for accountability and responsibility

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Second Letter If IP refuses to accept the help
offered

• Usually starts out If I am reading you this
  letter, I am extremely disappointed and scared.
• Here are my boundaries given you are going to
  continue using
• Must be each individuals bottom line, not the
  leaders

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Using Intervention Before ChildLeaves with
Transport

• Sends the child off in a loving way
• Fully explains to child where s/he is going and
  why
• Introduces the transport personelle
• Gives the rehab facility or wilderness a better
  client to start with
• Can help decrease anger (or at least not add to
  it)

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Using Intervention Before ChildLeaves with
Transport

• It is no more or less difficult doing the
  intervention at 3am or at normal wake up time
• Holds parents accountable for their decision

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• Thank you for your attention.
• Any Questions?
• Heather R Hayes, M.Ed., LPC
• Atlanta, Georgia
• Hrhheatherhayes_at_aol.com
• 770.335.5004