Substance Abuse

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Substance Abuse
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Youth Risk Behavior Survey1999
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Remember. . .

• These statistics understate the problem.
• The data comes from teens who are still in school.

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Care is determined by the stage of use.
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Stage 1

• EXPERIMENTAL
• use of drugs is in a social setting
• use is in response to peer pressure
• learns the euphoric high
• obtains drugs from friends
• often inept

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Stage 2

• ACTIVE SEEKING
• maintains own supply
• seeks euphoria
• modulates dose for desired effect
• gets high with each use
• use may be affecting daily life

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Stage 3

• PREOCCUPATION
• loss of control- compulsive use
• cant cope without drugs
• future orientation is to next high
• in trouble with the law, school, and family
• often use multiple substances

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Stage 4(rarely seen in teens)

• BURNOUT
• uses drugs to prevent negative effects of
  withdrawal
• needs to use to feel normal
• flattened affect and thought processing
  difficulties
• often no home or work life left

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Factors

• Genetics
• Personality
• Family environment
• Educational progress
• Community background

ABUSE
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syncope
DEPRESSION
caught in the act/ drunkeness
antisocial behavior
"monotype illness"
seizures
toxidromal symptoms
pSyChOsIs
school failure
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Clues or tips that the teen may be using
substances.
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Smoking shows that peer pressure overcame the
patients protective knowledge.
Primitive peer pressure
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Haircuts, tattoos, jewelry, and clothing may
indicate the patient identifies with the drug
culture.
Punk Flamingos
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High Times is a monthly magazine which encourages
the recreational use of marijuana
Literature demonstrates interest in the drug
culture.
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Decreasing academic performance may indicate a
change in priorities.
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Peer group is important.If peers are users, it
is likely the patient uses as well.
Butterflies from the wrong side of the meadow
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Interviewing

• Confidentiality should be granted for stage 1
  use.
• Consider involving the parents if the teen is
  stage 2 and not compliant with treatment or
  abstinence.

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• Begin with general lifestyle questions
• Home/family relations
• Education/employment
• Activities-clubs, peer relationships
• Dietary/ drugs
• prescriptions/ OTCs
• tobacco
• alcohol
• marijuana
• other illicit drugs
• Sexuality/ suicidal ideation/depression

• allows development of physician/patient
  relationship
• provides basis for risk assessment
• start with least threatening
• moving to increasingly more threatening
• moving from socially acceptable
• to socially tolerated
• to socially disapproved
• to overtly illegal
• completes risk assessment

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Questions...

• Do you go to parties? What happens at these
  parties? Do you drink? Get drunk? Get high?
• Do you drive after using? Have you ridden with a
  driver who was drunk or stoned? Could you call
  home for a ride? What would your parents say?
• Do you go to concerts? Do you drink or get high?
  Who drives after the concert?
• Have you recently dropped some of your old
  friends and started going with a new group? Why?

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• After using, have you ever forgotten where you
  have been or what you have done?
• Do you feel that lately you are moody, bitchy,
  or irritable? Do you find yourself getting into
  more arguments with friends and family? Do you
  find yourself being physically abusive to others?
• Do you have a boyfriend/girlfriend? How is it
  going? More arguments? Have you recently broken
  up?
• Do you think your drinking or drug use is a
  problem? Why?

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Confusing the issues

• You really dont think Id use the stuff, do you?
• I am just keeping it for a friend.
• All of the kids do it!
• You (adults) take a drink or a smoke and as a
  kid, I should be allowed a little fun now and
  then!

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Parent interview...

• Does your teen spend many hours alone in his
  bedroom apparently doing nothing?
• Does your child resist talking to you or isolate
  himself from the family?
• Has your daughters taste in music undergone a
  dramatic change?
• Has there been a definite change in your sons
  attitude toward school?

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• Does your daughter always seem unhappy and unable
  to cope with frustration?
• Has your son shown recent pronounced mood swings
  with increased irritability and anger?
• Has your childs personality changed from being
  considerate and caring to being selfish,
  unfriendly, and unsympathetic?
• Does your teen seem confused/ spacey?
• Have money or valuable items disappeared from
  your home?

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• Does your son neglect homework or chores?
• Have your daughters friends changed?
• Has there been a change in your teens appearance
  (I.e., sloppy, poor grooming or hygiene)?
• Have there been excuses and alibis made? Has
  there been lying in order to prevent
  confrontation or getting caught?
• Do you feel like you have lost control of your
  child?
• Has your son begun lying to cover up the source
  of possessions and money?
• Have you noticed the use of mouth washes, eye
  drops, incense, or other curious items?

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Drug testing

• is not a substitute for a good history and
  physical.
• should not be done secretly.
• misses many commonly abused substances.
• misses almost all substances if used ? 4 days
  prior.
• can be defeated.

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• no consent is required for emergent life
  threatening illness or altered mental status.
• the teen should grant verbal consent.
• parental consent is not required.
• Testing, in of itself, fails to address the
  issues.

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Treatment

• Anticipatory guidance should be done with all
  patients throughout adolescence.

Where all the young farm animals go to smoke
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Care should be determined by the stage of use.

• Stage 1 should be dealt with by the primary
  caretaker.
• It is important to educate the teen on the
  dangers of the substance, the role of peer
  pressure, and other related at risk behaviors.

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• Stages 3 4 should be referred to an
  individual or program experienced in substance
  abuse.

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• Stage 2 can be dealt with by most primary
  caretakers. Often this requires involvement of
  the family.

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• Drug use is the first problem to be dealt with!

Criminy! Kevins oozing his way up onto the
tableSome slugs have a few drinks and just go
nuts!
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Expect Parental reactions of terror, outrage,
bewilderment, sadness, and denial.

• Do
• give parents time to think
• not give them more than they can handle
• educate them about drugs/ paraphernalia
• have them list problems secondary to drug use

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• Do not confront the teen when he is high!

Dammit! I resent being treated as if I were
sober!
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• Take charge of the users life. Specific rules
  should be set and specific consequences for
  violations should be discussed.
• As the teen earns the familys trust, the rules
  are gradually softened.

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• Immediate cessation of use.
• Termination of contact with using friends.
• Parties/ concerts only with supervision.
• Appropriate curfew.
• No use of the car.
• Limited spending money.
• Restitution for stolen items.
• No verbal or physical abuse.
• Drug testing weekly.

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• Treatment does not always lead to a cure.
  Often the patient will have repeated
  exacerbations followed by remissions. This does
  not constitute a failure in treatment!