August 14, 2014 Jeff R. Temple, PhD Current Trends in Drug Use Among

 Discuss common drugs/substances abused by adolescents  Describe the impact of drug use on adolescent development  Identify the importance of screening for adolescent drug use OVERVIEW

 Since 1975, the MTF (Monitoring the Future) survey has measured drug, alcohol, and cigarette use and related attitudes among 12th graders, nationwide.  41,675 students from 389 public and private schools in the 8th, 10th, and 12th grades participated in the 2013 survey.  The survey is funded by NIDA (National Institute on Drug Abuse; under NIH) and conducted by the University of Michigan. Results from the survey are released each December. Monitoring the Future Study: National Survey on Drug Use Among Youth

 Illicit Drug Use A. Marijuana ● Illicit drug use remains high due to the popularity of marijuana use ● In 2013, 7.0 percent of 8th graders, 18.0 percent of 10th graders, and 22.7 percent of 12th graders used marijuana in the past month, up from 5.8 percent, 13.8 percent, and 19.4 percent in B. Synthetic Marijuana (also known as K2 or Spice) ● Its use is not increasing. In 2011, 11.4 % of high school seniors reported using it; in 2013, it dropped to 7.9 %. C. Non-medical Use ● Using over-the-counter drugs and prescription drugs without medical reasons is a significant concern for youth drug use D. Cocaine ● Positive trends in the past several years include reduced use of inhalants and less use of cocaine (see next slide) Results of the MTF: Current Trends in Drug Use Among Youth Monitoring the Future Study 2014 National Institute on Drug Abuse_NIH

 Alcohol Consumption has significantly decreased. In 2013:  8 th graders: 3.5%  10 th graders: 12.8%  12 th graders: 26% reported getting drunk in the past month  Tobacco Fewer teens smoke cigarettes than smoke marijuana. In 2013:  marijuana smokers: 22.7%  cigarette smokers: 16.3% Results of the MTF: Current Trends in Drug Use Among Youth Monitoring the Future Study 2014 National Institute on Drug Abuse_NIH

Current Trends in Drug Use → Indicating reduced use of inhalants and less use of cocaine, especially crack cocaine Monitoring the Future Study 2014 National Institute on Drug Abuse_NIH

Current Trends in Drug Use → Recently, more teens use marijuana than cigarettes Monitoring the Future Study 2014 National Institute on Drug Abuse_NIH

Dating it Safe (Temple et al., 2013)

 A total of 1,042 high school students (n=1042, 583 female, 459 male) between the ages of 13 and 18 years old (mean age=15.09) are the analytic sample for year 1 (2010)  Ethnicity included: 31.4% Hispanic, 29.4% White, non-Hispanic 27.9% Black or African American 3.6% Asian and Pacific Islander 7.7% other ethnic groups Demographics: Dating It Safe Study

Longitudinal Result: Dating It Safe Study

 Adolescents are more likely to use drugs if: 1.There is a history of substance abuse in their family 2.They are depressed or impulsive 3.Have experienced a trauma 4.Have low self-efficacy 5.Do poorly in school 6.Associate with alcohol/drug using peers/partners Identification of Risk Factors for Drug Abuse

 Negative effects on adolescents’ brain development → Alcohol, consumed early adolescence, can disrupt endocrine development → Marijuana is known to adversely affect learning and memory performance of adolescents measured by standardized testing  Adolescents engage in sexual activities more frequently → Adolescents engage in sexual activities after using substances or alcohol, and less likely to use contraception → Teens who smoke marijuana are four times more likely to have been pregnant or to have gotten pregnant Effects of Substance Abuse on Adolescent Development

 Accident Risk Increase → Substance abuse can be added to driving inexperience, leading auto accident to increase among youth  Risk of Addiction → One out of four people starting drugs or alcohol as a teenager becomes addicted  Arrested Development → When teens start using drugs or drinking alcohol during the developmental years, their social and emotional development stops Effects of Substance Abuse on Adolescent Development

Prolonged drug use, especially marijuana, changes the brain in fundamental and long-lasting ways:  Long-term effects of marijuana use among youth 1.Ability to do complex tasks could be compromised (e.g., poor coordination, lowered concentration) 2.People who use marijuana over the long term report less life satisfaction, poorer education & job achievement, and more interpersonal problems 3.Approximately, 9 percent of people who use marijuana become dependent on it, and the number increases to about one in six among those who start using it at a young age, and to 25 to 50 percent among daily users Long-term Effects of Marijuana Use on Development Of Youth

 Alcohol impacts adolescents differently than it does adults → Recent brain research with MRI(Magnetic Resonance Image) suggests that young people are more vulnerable to the negative effects of alcohol on the hippocampus, the part of the brain that regulates working memory and learning. 1.Heavy use of alcohol and other drugs during the teen years can result in lower scores on tests of memory and attention in one’s early to mid-20s. 2.People who begin drinking before age 15 are four times more likely to become alcohol-dependent than those who wait until they’re Teens also tend to be less sensitive to Alcohol’s sedative qualities. Teens are able to stay awake longer than adults, which enables them to drink more and be more vulnerable to cognitive impairment and perhaps brain damage from alcohol poisoning than adults. Specific Effects of Alcohol Abuse on Development Of Youth

Do Adolescents Really React Differently Than Adults To Substances Use? → rats exposed to nicotine in adolescence self-administer more nicotine than rats first exposed as adults Collins et al, Neuropharmacology, 2004, Levin et al, Psychopharmacology, 2003

Addiction is a Developmental Disease: It Starts Early

 Alcohol and substance use are associated with three major causes of youth mortality: accidents (primarily motor vehicle accidents), homicide, and suicide. Among youth, more than 30 percent of all deaths from injuries can be directly linked to alcohol.  In addition, cocaine use can produce acute cardiovascular and other complications (e.g., arrhythmias, myocardial infarction, seizures), and chronic use of marijuana has been associated with respiratory inflammation and increased risk of airway cancer.  Indirect legal, social, and economic consequences of drug use need to be noted. (e.g., cost of crime and incarceration, reduced productivity, etc.) Why Is It Important To Screen For Adolescent Alcohol And Substance Abuse?

 Health service providers, juvenile justice workers, educators, and other professionals who work with adolescents at risk should be able to screen and refer to further assessment  The CRAFFT is a behavioral health screening tool for use with children under the age of 21 and is recommended by the American Academy Of Pediatrics’ Committee on Substance Abuse for use with adolescents  It consists of a series of 6 questions developed to screen adolescents for high risk alcohol and other drug use disorders simultaneously. It is a short, effective screening tool meant to assess whether a longer conversation about the context of use, frequency, and other risks and consequences of alcohol and other drug use is warranted. Screening for Adolescents Drug Use: Introducing CRAFFT

CRAFFT: Example of Screening Questions → Screening using the CRAFFT begins by asking the adolescent to answer these next questions honestly; reminding him or her confidentiality; and then ask three opening questions

 Adolescents who screen as high risk(e.g., CRAFFT score of 2 or more) should have further assessment to determine whether they have developed dependence (addiction) to alcohol or another drug  Adolescents who are high-risk users but have not developed an addiction may benefit from a brief intervention – 1 or 2 brief intervention sessions either conducted by a primary care provider or allied mental health professional to discuss the impact of drugs or alcohol on their lives or their futures Timely Management: Referral or Intervention

 motivational interviewing (or change talk) skill is valuable for healthcare providers → change talk is meant to be self-motivating dialogue → change is facilitated by communicating in a way that elicits the person’s own reasons for and advantages of change → can be helpful in assisting patient to resolve his/her ambivalence towards the impact of using alcohol and other drugs Prevention of Alcohol/Substance Abuse

 For families: 1.Evidence-based family skills training programs (e.g., Strategic Prevention Framework offered by the Substance Abuse and Mental Health Service Administration) have been found to be the most effective way to prevent substance use among children and adolescents 2.Programs target the whole family and offer skills-building for parents on monitoring and supervision of children's activities, communication and setting age appropriate limits. Preventing Drug Use Among Youth

 For Schools/Communities: Organize a Kick Off Event To garner community-wide attention, organize a walk or run culminating in a rally featuring presentations from community leaders on the importance of preventing drug use before it begins Utilize Social Media Post information about substance abuse and initiate discussions, media feeds, and open forums about prevention on your coalition’s Facebook page and Twitter feed Promote Alternative Activities Sports, art, and other healthy and fun activities such as a substance-free tailgate before a school football game or a safe homecoming after-party in a community center or gymnasium are great ways to deter youth from substance use and other risky behaviors Preventing Drug Use Among Youth

Any Questions?

Jeff R. Temple, PhD Associate Professor and Psychologist Director, Behavioral Health and Research Department of Ob/Gyn UTMB Health THANK