1. Innovation Strategies & Solutions in Youth Recovery Ken Winters, Ph.D. Department of Psychiatry University of Minnesota winte001@umn.edu ARS 2013 Conference July 12, 2013 Del Mar, CA

3. www.psychiatry.umn.edu/research/casar/home.html

9. 1.Brain development 2. Innovation-1: Counseling that is teen-brain friendly 4.Summary 3. Innovation-2: Counseling that supports recovery

10. 1.Brain development

11. Emerging Science: Brain Imaging New insights because: 1990’s information explosion due to the development of brain imaging techniques (e.g., CT, PET and MRI).

12. When I get too technical, the audience starts to look like this….

14.  Adolescence is a period of profound brain maturation.  We thought brain development was complete by adolescence  We now know… maturation is not complete until about age 25!!!

15. Important ages of majority and privileges 16- emancipation - driving 18- gambling (usually age 21 when alcohol served) - smoking (some at age 19 - military 21-drinking

16. Allstate ad, NY Times, May, 2007

17. An Immature Brain = Less Brakes on the “Go” System

18. Maturation Occurs from Back to Front of the Brain Images of Brain Development in Healthy Youth (Ages 5 – 20) Source: PHAS USA 2004 May 25; 101(21): 8174-8179. Epub 2004 May 17. Blue represents maturing of brain areas Earlier: Motor Coordination Emotion Motivation Later: Judgment

19. Limbic or Go System

20. Tests measuring different forms of executive function skills indicate that they begin to develop shortly after birth, with ages 3 to 5 a window of opportunity for dramatic growth in these skills. Development continues throughout adolescence and early adulthood.

21. Preference for …. 1.physical activity 2.high excitement and rewarding activities 3.activities with peers that trigger high intensity/arousal 4.novelty Less than optimal.. 5.control of emotional arousal 6.consideration of negative conseq. Greater tendency to… 7.be attentive to social information 8.take risks and show impulsiveness Implications of Brain Development for Adolescent Behavior

22. Youth vulnerability and drug use Greater risk for drug abuse?

23. Prevalence of Past-Year DSM-IV Alcohol Dependence: United States, 2001-2002 (Grant, B.F., et al., Drug and Alcohol Dependence, 74, 223-234, 2004) %

24. The Water Maze Test Hidden Slide courtesy Sion Kim Harris, Ph.D. Saline vs alcohol Measures -Swimming speed -Time to find platform

25. Wanna look for some cheese with me? Sure!

26. Youth vulnerability and drug use Greater risk for mental disorders?

27. Psychosis : Prevalence of Past Year Serious Mental Illness Among Lifetime Marijuana Users Aged 18+ (SAMHSA, 2005; data collected 2002-2003 ) percentages age of marijuana onset

28. Psychosis: Drug Use and Age at Onset of Psychosis Based on a Meta-Analysis (Large et al., 2011) mean years earlier of age at onset of psychosis compared to non-drug using controls * = nonsig. with controls *

29. 1.Brain development 2. Innovation-1: Counseling that is teen-brain friendly

31. Brain Development: Opportunities for Prevention and Treatment Discuss with teenagers the science of the neurobiology of addiction

33. Brain Development: Opportunities for Prevention and Treatment Discuss the implications of using substances when the brain is still developing.

34. Prevalence of Past-Year DSM-IV Alcohol Dependence: United States, 2001-2002 (Grant, B.F., et al., Drug and Alcohol Dependence, 74, 223-234, 2004) %

35. Memory Effects Verbal information Nonverbal information Retention Rate % Source: Brown et al., 2000

36. Resource from BSCS Drug Abuse, Addiction and the Adolescent Brain (www.BSCS.org ) Hazelden has published an 8-lesson multi-media resource: Drugs and the Developing Brain (www.hazelden.org) Classroom Resources

37. Apply two major treatment approaches seem accommodating to the teen brain: Cognitive – behavioral therapy (CBT) Motivational interviewing Brain Development: Opportunities for Treatment

38. Characteristics of CBT Focus on immediate, relevant and specific problems Solutions are realistic, concrete, specific

39. Value of CBT Teach important skills not optimal for the teen brain impulse control “second” thought processes social decision making dealing with risk situations taking healthy risks

40. Characteristics of Motivational Interviewing De-emphasize labels Emphasis on personal choice and responsibility Therapist focuses on eliciting the client's own concerns Resistance is met with reflection and non-argumentation Treatment goals are negotiated; client’s involvement is seen as vital

41. Teen-brain friendly features of the 12-Step Model abstinence novelty – new approach to life structure spiritual component fellowship Brain Development: Opportunities for Treatment

42. But…..elements of the 12- Step Model that are challenging to the teenager life-long disease committing to life long changes self-help groups may not be teen friendly Brain Development: Opportunities for Treatment

43. Recovery Options that are Socially Suitable for Youth AA/NA support groups that are relevant, meaningful, engaging and fun for youth

44. John Kelly’s Research Program Modest beneficial effects of 12-Step attendance was found. Several factors noted as favorable features of 12-Step meetings. Listened to others’ struggles and successes Provided support to another addict/alcoholic Met new people

45. Recovery Options that are Socially Suitable for Youth Rockers In Recovery Music and Art Festival November 2, 2013- 1PM-11PM Fort Lauderdale Venue: CB Smith Park

46. 1.Brain development 2. Innovation-1: Counseling tools that are teen-brain friendly 3. Innovation-2: Counseling that supports recovery

47. 3-1. Expand use of SBIRT to address early stage drug Involvement.

48. SBIRT Abstinence Infrequent use Early abuse Abuse Dependence Intensive Treatment Drug Involvement Adapted from Broadening the Base of Alcohol Treatment (IOM) Tx Gap Brief Intervention-MI Prevention

49. Estimates of Mutually Exclusive “Mild-to-Moderate” Drug Abusing Groups of Youth (12-18-years-old) (based on data from SAMHSA, 2005) % Binge and heavy alcohol: past 30 days Abuse only, Illicit drug, and dependence: past year Total % = 24.7 4.4% light drinkers 65.7% non users

50. Common Elements of Brief Interventions Evidence-based approaches in NREPP Brief Therapies or Interventions (www.nrepp.samhsa.gov 1 – 4 sessions Motivational interviewing and CBT Negotiated goals

51. 3-2. Expand recovery high schools and colleges.

52. Collegiate Recovery Programs and Efforts Source: Stacie Mathewson Foundation

53. 1.Brain development 2. Innovation-1: Counseling tools that are teen-brain friendly 4.Summary 3. Innovation-2: Counseling tools that are recovery friendly

54. Youth Today Approx. 20-35 have already experienced a substance use disorder

55. Treatment Works ! (but we can do better)

57. New 12-Step Program for Adolescents ? 12-Steps of Self-Regulation 1.impulse control 2.“second thought” processes 3.social decision making 4.dealing with risk situations 5.taking healthy risks 6.attention regulation 7.anger control 8.modulating reward incentives 9.choosing options 10.considering consequences 11.minimizing arousal 12.dealing with peer influences

58. Thank You !

59. Comments and Questions