Mary Wheeler

1
Can We Prevent Future Harm? Identifying new
approaches to prevention and education with drug
involved youth.

• Mary Wheeler
• Street Outreach Coordinator
• Amy Delaney-Monks
• Outreach Educator
• CAB Health and Recovery Services
• 280 Union Street
• Lynn, MA
• 01901

2
Presentation Overview

• Overview of Harm Reduction
• Whats happening in Massachusetts?
• Barriers to successful substance use/abuse
  prevention
• Options and New Ideas
• Comments/Questions/Wrap-up

3
Harm Reduction

• Practical Strategies
• Attempts to reduce negative consequences of
  harmful behavior.
• Accepts for BETTER or WORSE but does not condemn
• Substance use and other risk-taking behaviors are
  multi-faceted and encompasses a continuum of
  behaviors.
• Severe abuse to total abstinence
• Establishes quality of individual and community
  life and well-being, not necessarily cessation of
  all substance use.
• Any positive change.
• Non-judgemental, non-coercive provision of
  services and resources to people who use
  substances, and the communities in which they
  live.

4
Principles of Harm Reduction

• Ensures that substance users and those with a
  history of substance use routinely have a real
  voice in the creation of programs and policies
  designed to serve them.
• Affirms substance users themselves as the primary
  agents of reducing the harms of their drug use.
• Seeks to empower users to share information and
  support each other in strategies which meet their
  actual conditions of use.
• Recognizes that the realities of poverty, class,
  racism, social isolation, past trauma, sex-based
  discrimination, and social inequalities effect
  both peoples vulnerability to, and capacity for
  effectively dealing with substance-related harm.
• Does not attempt to minimize or ignore the real
  and tragic harm and danger associated with licit
  and illicit substance use.

5
Harms associated with not practicing Harm
Reduction

• Alienate the client/youth/program participant
• Perpetuate stigma about those who get involved
  with drugs
• Fail to meet basic prevention needs
• Fail to engage client/youth/program participant
  in much-needed services
• Disregard the client/youth/program participants
  ability and willingness to make behavior changes

6
What are we up against?

• Drug/Pharmaceutical Companies (Vicodin most
  prescribed and most diverted drug in the US)
• Internet Availability
• National and International Drug Trade
• The brain function of the adolescent
• No work ethic
• No hobbies
• Rehabilitation with no frame of reference
• Stress, School, PRESSURE
• Peer Influence/Media Influence
• Family History of Use or Mental Illness
• More?

7
The Brain and Adolescence

• Pre-frontal cortex
• Impulse control
• Planning
• Decision Making
• Damage to dopamine neurons causes future problems
• Brain development thought to continue into the
  twenties
• Egocentric
• Peer Influence
• Media
• Emotions/Hormones
• Everything is VERY serious

8
Heroin Use in Massachusetts

• Heroin is the primary threat to New England -
  the only region in the country where this drug is
  the leading problem.
• The heroin problem in NE is driven in part by
  pharmaceutical abuse pharmaceutical abusers
  often switch to heroin because of the drugs
  lower cost and higher purity.
• (National Drug Threat
  Assessment, 2007)

9
HCV and young people, MA

• From 2002 to 2006, rates of newly diagnosed
  reported HCV infection in 15 to 25 year-olds in
  Massachusetts rose from 16 to 44 per 100,000
  population.
• 1,054 (14) of cases in 2006 were 15 to 25 years
  of age.
• From 2002 2007 case rate in this age group
  increased from 73 to 127 (per 100,000
  population).
• Massachusetts Hepatitis Surveillance Program
• Onofrey SL, Church DR, Heisey-Grove DM, Briggs P,
  Bertrand TE, DeMaria A Jr.
• Massachusetts Department of Public Health
  Bureau of Infectious Disease Prevention, Response
  and Services

10
National and Regional Drug Threat
United States
New England
38.8
37.6
36.5
33.2
15.5
11
8.5
9.3
3.9
1.9
Cocaine Heroin Methamphetamine Marijuana
Pharmaceuticals
Cocaine Heroin Methamphetamine Marijuana
Pharmaceuticals
(National Drug Threat Assessment, 2007) slide
courtesy Chuck Klevegaard, MDPH
11
Drug Threat by Region
Please note that Pharmaceuticals in NE has
risen by more than 5. NE is higher for Heroin
and Pharmaceuticals than any other region in the
US. National Drug Intelligence Center
National Drug Threat Assessment 2009 
12
Figure 3. Alcohol Use in the Past Month among
Full-Time College Students Aged 18 to 22, by Past
Year Nonmedical Use of Adderall 2006 and 2007
13
Cambridge Cares Needle Exchange YIDU Study
14
Who was interviewed?

• 150 Young Injection Drug Users (18-25 years old)
• 75 completed 12th grade or higher
• 38 employed in a part or full-time job
• 38 had no health insurance
• 80 were housed (NOT homeless)
• Residents of 46 different Massachusetts towns
  responded to the survey.

15
Drug Use History

• Drug transition (oxy to heroin)
• Boredom, hopelessness, risk-taking
• If I hadnt found drugs, I would have killed
  myself.
• Peer pressure, family pressure
• Experimentation, pain, both emotional and
  physical
• Family Drug use
• Trauma/abuse, unhappiness
• School

16
Average ages of first use
17
Perception of Risk

• Everyone I know has Hep, I know it will affect
  me later
• Major concerns are police, not enough
  money/drugsnot other risks
• Practicing safe behaviors within unsafe social
  networks
• Worrying about risk after the fact
• Inability to make
• Harder to avoid (heroin) than it is to find it.

18
Support Systems

• Other friends who are using
• Isolation, no support
• Family, friends
• Drugs/drug dealers, other users
• Service providers
• School Based Officers
• Guidance Counselors
• Clergy
• Mentors

19
Barriers to Successful Intervention

• Try, try and try again.

20
What They May Already Know

• Drugs are bad, drug users are bad
• But drugs felt really good when I did them so
  therefore you are a LIAR and are not to be
  trusted
• Make bad choices
• Get into accidents
• Sexual Risks/Rape
• Overdose
• Illegal
• Get in trouble
• Not interested
• Getting high is ok, everybody does it.
• Adults do it, including my parents.

21
Some Suggestions

• Youth-only spaces
• Support groups for youth with substance using
  parents
• Peer programming
• All-inclusive spaces
• Low-threshold, non judgmental spaces
• By youth, for youth

• Honest information
• Natural High Activities
• Ask them what they want
• Never ASSUME
• Take youth seriously
• Positive Reinforcement Turn it around
• Voluntary Participation
• Multiple Activities

22
Some More Suggestions

• Safe Environment
• Personalize activities or events
• Journals
• Peer-led programming
• Low-threshold
• Family Intervention
• Willingness
• Social Networks assess level of risk in the
  network in order to develop risk reduction plan
  for individual
• Process not Outcome

23
Lets Get Started!!!

• Questions

• Possible Solutions

• When should we start?
• What do we talk about?
• Do scare tactics work?
• How graphic should we be?
• Does talking about drug use and sex encourage the
  behavior?

• Pre-school and go from there
• Self-esteem, personal responsibility
• Relationships
• Family
• Move into drugs/risk taking etc.,
• Scare tactics dont work.
• Ask the youth and listen to the youth.
• Sex and drugs happen, now at younger and younger
  ages. Do we intervene or continue to ignore and
  go on as we have been?

24
Designing an Intervention

• Deep Structure factors must support the target
  population
• Social Factors
• Psychological Factors
• Environmental Factors
• Historical Factors
• Youth Involvement
• If not peer-led find someone who can relate to
  the population
• Family Involvement
• Small Groups
• One-on-One (back to being taken seriously)
• Up-to-date information

25
Experiences with Youth Programs

• Lynn English High School, Youth on Fire, CABs
  Adolescent Treatment Program

26
Whats out there

• Different options for different behaviors
• Match options to stage of change
• Sometimes we as providers can merely plant the
  seed.
• Have information ready and accessible for youth
  to take with them.
• Basic Needs
• Wellness Groups
• Arts and Music Programs
• Self-help Groups
• Local Agencies

27
Whats out there continued

• Girls Inc.,
• Learn 2 Cope
• Raw Arts
• Artists for Humanity
• Habitat for Humanity
• Safety First Reality based approach to teens and
  drugs
• Homeboy and Homegirl Industries
• Local Outreach Programs drug users, in recovery,
  gangs, homeless, recovery high schools etc.,
• Network, dont be afraid to ask!

28
Thoughts? New Ideas?Where do we go from here?
29
Contact Information

• CAB Health and Recovery Services Inc.,
• Healthy Streets Outreach Program
• 280 Union Street
• Lynn, MA
• Mary Wheeler
• Street Outreach Coordinator
• Phone [phone]
• Email mwheeler_at_cabhealth.org

30
References

• Data from the YIDU Study, designed and
  implemented by Cambridge Cares About AIDS (CCAA)
  and the Institute for Community Health
• NIDA Brief Strategic Family Therapy for
  Adolescent Drug Abuse
• The National Campaign to End Teen Pregnancy The
  Adolescent Brain A Work In Progress Daniel
  R.Weinberger, M.D.,Brita Elvevåg, Ph.D, Jay N.
  Giedd, M.D. http//www.thenationalcampaign.org/res
  ources/pdf/BRAIN.pdf
• Harm Reduction Coalition Principles of Harm
  Reduction www.harmreduction.org
• Myself.