1. Adolescent Substance Abuse and Addictions Youth Transition Program Statewide Conference Marcus Poppen, B.A., QMHA University of Oregon February 23 rd, 2012

2. Substance Use and Addictions

3. What is a substance? Something we use to change how we feel, or act, which affects both our minds and bodies.

4. Drug Classifications and What are they? Narcotics Narcotics Stimulants (Uppers) Stimulants (Uppers) Depressants (Downers) Depressants (Downers) Hallucinogens Hallucinogens Nicotine Nicotine -- Reduce pain while providing an intense sense of pleasure -- Reduce pain while providing an intense sense of pleasure -- Speed up or excite our brains -- Speed up or excite our brains -- Slow down our brains -- Alter our perceptions of reality -- Combine properties of stimulants and depressants Milkman, H., & Wanberg, K. (2005). Pathways to Self-Discovery and Change.

5. Drug Classifications and Examples Narcotics Narcotics Stimulants (Uppers) Stimulants (Uppers) Depressants (Downers) Depressants (Downers) Hallucinogens Hallucinogens Nicotine Nicotine -- Heroin, Codeine, Morphine -- Methamphetamines, Cocaine, Caffeine -- Alcohol, Barbiturates, Xanax, Valium -- MDMA, Marijuana, LSD -- Cigarettes, Chewing Tobacco Milkman, H., & Wanberg, K. (2005). Pathways to Self-Discovery and Change.

6. Effects of Substances Substances affect us both directly and indirectly. Substances affect us both directly and indirectly. Milkman, H., & Wanberg, K. (2005). Pathways to Self-Discovery and Change. Direct effects Direct effects This is what is happening to us when we are using a substance. This is what is happening to us when we are using a substance. Indirect effects Indirect effects This is what is happens to us after we are using a substance. This is what is happens to us after we are using a substance.

7. Effects of Substances Milkman, H., & Wanberg, K. (2005). Pathways to Self-Discovery and Change. Substances affect us physiologically. Substances affect us physiologically. Liver Liver Increases build up of fatty tissues, getting in the way of healthy cells and blood supply, leading to dead cells. Your body replaces the dead cells with scar tissue (cirrhosis), preventing your liver from working right. Increases build up of fatty tissues, getting in the way of healthy cells and blood supply, leading to dead cells. Your body replaces the dead cells with scar tissue (cirrhosis), preventing your liver from working right. Stomach and Gut Alcohol can burn holes in the lining of your stomach and gut (also known as creating stomach ulcers). Alcohol can burn holes in the lining of your stomach and gut (also known as creating stomach ulcers). Heart and Blood Heavy drinking can increase your blood pressure and can cause heart problems. Heavy drinking can increase your blood pressure and can cause heart problems. Brain and Nerves Alcohol can damage and kill brain cells. Alcohol can damage and kill brain cells. Lets take alcohol for example: Lets take alcohol for example:

8. Effects of Substances Tolerance Milkman, H., & Wanberg, K. (2005). Pathways to Self-Discovery and Change. Over time our bodies require an increase in the amount of the substance we put into our bodies because our bodies will give us less of the feelings we want. Over time our bodies require an increase in the amount of the substance we put into our bodies because our bodies will give us less of the feelings we want.

9. Effects of Substances Withdrawal Milkman, H., & Wanberg, K. (2005). Pathways to Self-Discovery and Change. Substances are poison to our bodies. When a substance leaves our body, our body has to try and return to normal. Sometimes this rebalancing can cause shock to our body and is also known as withdrawal. Most often this effect is psychological, however, this effect and also be physiological. Substances are poison to our bodies. When a substance leaves our body, our body has to try and return to normal. Sometimes this rebalancing can cause shock to our body and is also known as withdrawal. Most often this effect is psychological, however, this effect and also be physiological.

10. Milkman, H., & Wanberg, K. (2005). Pathways to Self-Discovery and Change. Class Physical Withdrawal Psychological Withdrawal Narcotics Nausea, tremors, chills, sweating, cramps Irritability, panic, anxiety Stimulants (Uppers) Cravings, tiredness, headaches Depressions, paranoia, aggression, anxiety Depressants (Downers) Loss off appetite, insomnia, tremors Delirium, anxiety, psychosis Hallucinogens Hyperactivity, loss of appetite Paranoia, anxiety, irritability, depression Nicotine Cravings, headaches, fatigue, insomnia Irritability, depression, restlessness, feelings of frustration and anger

11. Adolescents and Substances and Addictions Substance use vs. Substance abuse Substance use vs. Substance abuse McWhirter, J., et al. (2007). At-Risk Youth, Chapter 8. Substance use often linked to social influence Substance use often linked to social influence Substance abuse often linked to internal processes Substance abuse often linked to internal processes For adolescents, most of the correlates of substance use are identical to substance abuse. For adolescents, most of the correlates of substance use are identical to substance abuse.

12. Adolescents and Substances and Addictions Environmental and Social Peer InfluenceFamilyPersonal Adolescent Substance Use

13. DSM-IV Definition DSM-IV does not make separate provisions for children and adolescents when defining substance abuse and dependence. DSM-IV does not make separate provisions for children and adolescents when defining substance abuse and dependence. McWhirter, J., et al. (2007). At-Risk Youth, Chapter 8.

14. DSM-IV Definition Based on behaviors and physiological effects occurring within a specific time frame. Based on behaviors and physiological effects occurring within a specific time frame. Abuse (1 or more in a 12-month period) Abuse (1 or more in a 12-month period) Impaired social, school, or occupational functioning Impaired social, school, or occupational functioning Recurrent use in physically hazardous situations Recurrent use in physically hazardous situations Recurrent substance related legal problems Recurrent substance related legal problems Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by substance Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by substance www.csam-asam.org/pdf/misc/ DSM _criteria_for_diagnosis.doc

15. DSM-IV Definition Based on behaviors and physiological effects occurring within a specific time frame. Based on behaviors and physiological effects occurring within a specific time frame. Dependence (3 or more in a 12-month period) Dependence (3 or more in a 12-month period) Tolerance (increased dosage needed to maintain physiological effects) Tolerance (increased dosage needed to maintain physiological effects) Symptoms of withdrawal Symptoms of withdrawal Substances taken in a larger amount and for longer periods of time than intended Substances taken in a larger amount and for longer periods of time than intended Persistent desire and repeated attempts to quit Persistent desire and repeated attempts to quit Planning around obtaining substances, use and recovery Planning around obtaining substances, use and recovery Use continues despite knowledge of adverse consequences Use continues despite knowledge of adverse consequences www.csam-asam.org/pdf/misc/ DSM _criteria_for_diagnosis.doc

16. Substance Use in Adolescents Important to Understand Patterns of Use: Important to Understand Patterns of Use: Frequency Frequency Quantity Quantity Single-Substance vs. Poly-substance Use Single-Substance vs. Poly-substance Use When, Where and with Whom? When, Where and with Whom? Emotional state of the user Emotional state of the user Consequences Consequences McWhirter, J., et al. (2007). At-Risk Youth, Chapter 8.

17. Case Study

18. Identify Patterns of Use using the Case Study Identify Patterns of Use using the Case Study Frequency Frequency Quantity Quantity Single-Substance vs. Poly-substance Use Single-Substance vs. Poly-substance Use When, Where and with Whom? When, Where and with Whom? Emotional state of the user Emotional state of the user Consequences Consequences

19. Case Study Why might it be challenging for this person to change their behaviors around using alcohol and other drugs? Why might it be challenging for this person to change their behaviors around using alcohol and other drugs? What could you do to support this person in making a positive behavior change? What could you do to support this person in making a positive behavior change?

20. Wrap-Up: Case Study

21. Center for Family Development Day Treatment and Reporting Center

22. ASAM Level III Intensive Outpatient Alcohol and Other Drug Treatment Program (12+ hours of treatment each week) ASAM Level III Intensive Outpatient Alcohol and Other Drug Treatment Program (12+ hours of treatment each week) High Risk Adolescents (ages 15-18) with a history of alcohol or other drug use and involvment in the Juvenile Justice System High Risk Adolescents (ages 15-18) with a history of alcohol or other drug use and involvment in the Juvenile Justice System Can be a transition program from residential back into the community. Can be a transition program from residential back into the community. Gender Specific Services Gender Specific Services Titrated Phase System Titrated Phase System Addresses risk factors and enhances resiliency Addresses risk factors and enhances resiliency Center for Family Development Day Treatment and Reporting Center

23. Gender Specific Skills Group Individual Tutoring Creative and Expressive Arts Component Individual Drug and Alcohol Check In’s Drug and Alcohol CBT Skills Group Family Therapy Individual Therapy YOUTH Department of Youth Services Day Treatment and Reporting Center Master Service Plan Team Meetings Daily Coordinated Planning with Juvenile Counselors