Youth and Addiction:  A Guide to Help Attorneys Make the Best Choices for Addicted Youth in Trouble With the Law  Michael Crosby LCSW Ph.D.

Causes of Adolescent Substance Abuse  External Factors  Insufficient parental supervision and monitoring  Lack of communication and interaction between parent and teen  Poorly defined rules and expectations against substance use  Inconsistent and excessively severe discipline  Family conflict  Favorable parental attitudes toward adolescent substance use  Parental alcoholism, drug use, or abuse  Addiction during pregnancy  Peer pressure  Media Outlets  Misinformation

Causes of Adolescent Substance Abuse  Internal Factors  high sensation seeking  impulsiveness  psychological distress  difficulty maintaining emotional stability  perceptions of extensive use by peers  perceived low harmfulness to use  Self-medication  Low self-confidence  Boredom  Rebellion  Attention Seeking  Instant Gratification

Treatment Options  Medications  withdrawal and treatment  Behavioral Treatments  Outpatient: Cognitive-Behavioral Therapy, Multidimensional Family Therapy, Motivational Interviewing, Group Counseling  Inpatient: Residential Facilities  Aftercare: Continued support after leaving

Treatment Options  Treatment Programs  Individual and group counseling  Substance abuse education  Family education  Recreation therapy  Mindfulness groups  Relapse Prevention  Dual-Diagnosis/Co-Occurring Treatment

Treatment  Education must be a component for treatment to be successful  Education must be a part of treatment for the whole system (parents as well as the identified client)  Education must include developing skills for parents to learn to set limits and enforce consequences for inappropriate behavior

Statistics of Teen Use  More teens die from prescription drugs than heroin/cocaine combined  More than 60% of teens said that drugs were sold, used, or kept at their school  1 in 9 high school seniors has synthetic marijuana  1.3% of seniors have used bath salts  Young people who drink alcohol are 50 times more likely to use cocaine than teens who never drink  About 64% of teens who have abused pain relievers say they got them from friends or relatives

Statistics of Teen Use  Adderall use (mostly prescribed to treat ADHD) has increased among high school seniors from 5% in 2009 to 8%  Only 35% of 12th graders believe that using Adderall occasionally is risky  By 8th grade, 30% percent of adolescents have consumed alcohol, 16% percent have smoked cigarettes, and 15% have used marijuana  Teens whose parents talk to them regularly about the dangers of drugs are 42% less likely to use drugs than those whose parents don't. However, only a quarter of teens report having these conversations.  7% of high school seniors smoke daily, up from 5% five years ago

Statistics of Teen Use  Marijuana- 17% of 10 th graders and 23% of 12 th graders have used in the past month  Synthetic Marijuana- 9% of 10 th graders and 11% of 12 th graders have used in the past year  Prescription Drugs- 15% of 12 th graders have used non-medically in the past year, yet only 35% feel they are taking a risk  Alcohol- 15% of 10 th graders and 28% of 12 th graders have gotten drunk in the past month  Cigarettes- 17% of 12 th graders have used in the past month

Consequences Leading to Treatment  Neglecting Responsibilities  School, work, or home  Legal Ramifications  Arrests, tickets, jail time  Problems in Relationships  Family, friends, significant other, job  Engaging in high-risk behaviors  Health problems

Adult and Adolescent Assessment  Assessments for drug or alcohol addiction evaluate the condition of each patient in order to determine whether or not a diagnosis of chemical dependency or chemical abuse exists  Adolescents do not show the same psychological, behavioral, and physiological characteristics central to adult assessment

Adult and Adolescent Assessment  Adolescents and adults differ in the pattern of alcohol and drug use as well as the development of substance abuse  Teens are less likely to abuse just alcohol, but are more likely to abuse marijuana and other drugs with alcohol  Adults in treatment are most likely there for just alcohol dependence  Teens meet diagnostic criteria for substance abuse faster than adults

Internal vs. External Motivation  Internal Motivation  Motivation driven by an interest in the task itself; exists within the individual  External Motivation  The performance of an activity to attain an outcome; comes from outside of the individual

Family Involvement  Practical Definition  The active engagement and participation of family members in the practice, program, and policy areas of teen substance abuse treatment, recovery services, and support  Importance  Families learn about current services, policies and procedures, emerging trends/challenges and research on the system from professionals  Professionals learn about unique experiences, perspectives, strengths and weaknesses from families

Family Involvement  Three key areas of focus: Practice, program, and policy  Practice  Adolescent substance abuse treatment service providers welcome, engage, support, and respect families where they are  Family members gain awareness and understanding of addiction as a brain disease, develop realistic treatment and recovery expectations, and identify available family support services

Family Involvement  Program  Families empowered to provide valuable input for agency/program on quality improvement planning  Provide input into developing valuable community based family support services  Policy  Policy-makers listen to family member experiences, welcoming and respecting family expertise and seeking family input as part of the policy making process  Family members experience opportunities to influence policy and develop relationships with policy-makers and other family advocates

Difficulties With Family Involvement  Problem is too severe  Family is the root of the problem  Family lacks resources  Failure of the foster care system  Failure of the Department of Juvenile Justice

Co-occurring Illnesses  As many as 6 in 10 people with a substance use disorder also suffer from a mental health condition  Fewer than 10% of adults with co-occurring disorders receive treatment for both conditions; more than half of them receive no treatment at all

Reevaluating Progress  Have the interventions worked?  How would the teen be without them?  Possible improvements to treatment  Potential for relapse  Re-administering tests  ?????????

Dealing With Relapse  Between 66 and 80% of adolescents and adults begin using again within the first six months after a treatment episode  Triggers: peer influence, life changes, socially isolated situations, stress, over-confidence, complacency, mental or physical pain, remembering the positives of past using, boredom, self-pity  Support Team Relapse Prevention- keep drugs and alcohol out of the house, praise and encourage, talk openly about feelings of relapse and threats to sobriety, relieve stress, encourage self-care practices  What to do after ??????????????

Drug Testing Strategies  Type (hair vs. urine)  Frequency  What you test for  What is positive  Confirmation (GCMS)  Consequences

Aftercare Services in the Community  Requires creation of a set of systems across formal and informal social control networks as well as the use of community services to prevent relapse  Includes peer support group programs, individual and family therapy sessions, and relapse prevention strategies utilizing friends, family, and leisure activities