adolescent substance abuse and suicide geoff wilson, lcsw, cadc the ridge behavioral health system

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Adolescent Substance Adolescent Substance Abuse and Suicide Abuse and Suicide Geoff Wilson, LCSW, CADC Geoff Wilson, LCSW, CADC The Ridge Behavioral Health The Ridge Behavioral Health System System

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Adolescent Substance Adolescent Substance Abuse and SuicideAbuse and Suicide

Geoff Wilson, LCSW, CADCGeoff Wilson, LCSW, CADC

The Ridge Behavioral Health The Ridge Behavioral Health SystemSystem

AgendaAgenda

What’s New With Youth What’s New With Youth Drug/Alcohol Use.Drug/Alcohol Use.Co-occurring Disorders are more Co-occurring Disorders are more the norm!!the norm!!Suicide and Substance Abuse.Suicide and Substance Abuse.Questions/Answers.Questions/Answers.

AlcoholAlcohol Alcohol Alcohol remains the substance most remains the substance most

widely used by today’s teenagers. widely used by today’s teenagers. Despite recent declining rates, seven Despite recent declining rates, seven

out of every ten students (69%) have out of every ten students (69%) have consumed alcohol (more than just a few consumed alcohol (more than just a few sips) by the end of high school, and sips) by the end of high school, and three out of ten (30%) have done so by three out of ten (30%) have done so by 8th grade. 8th grade.

In fact, over half (54%) of 12th graders In fact, over half (54%) of 12th graders and more than one seventh (13%) of and more than one seventh (13%) of 8th graders in 2012 report having been 8th graders in 2012 report having been drunk at least once in their life.drunk at least once in their life.

MarijuanaMarijuana

Marijuana use among teens rose in 2012 Marijuana use among teens rose in 2012 for the fifth straight year. Daily for the fifth straight year. Daily marijuana use among high school marijuana use among high school seniors is now at a 30 year peak among seniors is now at a 30 year peak among high school seniors.high school seniors.

"Put another way, one in every fifteen "Put another way, one in every fifteen high school seniors today is smoking pot high school seniors today is smoking pot on a daily or near daily basis," said on a daily or near daily basis," said Lloyd Johnston, the principal Lloyd Johnston, the principal investigator of the study, "And that's the investigator of the study, "And that's the highest rate that we have seen over the highest rate that we have seen over the past thirty years—since 1981."past thirty years—since 1981."

MARIJUANA USE CONTINUES TO RISE MARIJUANA USE CONTINUES TO RISE AMONG U.S. TEENSAMONG U.S. TEENS

Source: Monitoring Source: Monitoring the Futurethe Future

MarijuanaMarijuana

Much more availableMuch more available Much more potentMuch more potent Much greater negative effect on short-Much greater negative effect on short-

term memory, mood, leading to term memory, mood, leading to anhedonia and amotivational anhedonia and amotivational syndromesyndrome

Correlation to school functioning, Correlation to school functioning, truancy, etc.truancy, etc.

What do we think???What do we think???

Synthetic Synthetic MarijuanaMarijuana

Spice is NOT Marijuana, it is a Spice is NOT Marijuana, it is a dangerous Hallucinogenic Drug!!dangerous Hallucinogenic Drug!!

Intentionally mislabeled as “herbal Intentionally mislabeled as “herbal incense” or “potpourri”.incense” or “potpourri”.

Marked “Not for human Marked “Not for human consumption”.consumption”.

Dangers of SpiceDangers of Spice

Unregulated and Untested on HumansUnregulated and Untested on Humans No long term studies , true effects are No long term studies , true effects are

not known.not known. It is physically addictive!!It is physically addictive!! Very Dangerous…..One time use has Very Dangerous…..One time use has

resulted in death!!resulted in death!! Flavors are added to it to make it Flavors are added to it to make it

more appealing to kids (Bubble Gum, more appealing to kids (Bubble Gum, Grape, etc.)Grape, etc.)

Synthetic Synthetic CannabinoidsCannabinoids

•SpiceSpice•K2K2•Herbal IncenseHerbal Incense

Cannabinoid CompoundsCannabinoid Compounds

From 1984 to 2011, John Huffman and his From 1984 to 2011, John Huffman and his team from Clemson created 460 synthetic team from Clemson created 460 synthetic cannabinoid compounds for test on lab cannabinoid compounds for test on lab animalsanimals

Shown promise in treatment of nausea, Shown promise in treatment of nausea, pain, inflammation, and some skin pain, inflammation, and some skin cancers.cancers.

Of the many cannabinoid compounds that Of the many cannabinoid compounds that are now illegal, three bear his initials: are now illegal, three bear his initials: JWH-018, JWH-073, JWH-200JWH-018, JWH-073, JWH-200

But What’s Miley Cyrus But What’s Miley Cyrus Have to Say About This….Have to Say About This…. Miley Cyrus has standards when it Miley Cyrus has standards when it

comes to drugs.comes to drugs. Weed, for instance, "is the best drug Weed, for instance, "is the best drug

on earth," she told on earth," she told Rolling Stone.Rolling Stone.   "And Molly, too. Those are happy "And Molly, too. Those are happy

drugs — social drugs. They make you drugs — social drugs. They make you want to be with friends. You're out in want to be with friends. You're out in the open. You're not in a bathroom.“the open. You're not in a bathroom.“

How many Twitter followers did she How many Twitter followers did she have__? have__?

HeroinHeroin

HeroinHeroin

““Slamming” Slamming” HeroinHeroin

Basically placing Heroin on your finger Basically placing Heroin on your finger and rubbing it into your gums.and rubbing it into your gums.

Get the effect fairly quickly through Get the effect fairly quickly through membrane, like smokeless tobacco.membrane, like smokeless tobacco.

No smoke, no IV, no Runny Nose!!No smoke, no IV, no Runny Nose!! Popular with youth and can do it in Popular with youth and can do it in

School!!School!! ““Buttons”-Heroin placed in pill Buttons”-Heroin placed in pill

capsules sold for around $10.00capsules sold for around $10.00

Percodan, Percocet, Percodan, Percocet, OxycontinOxycontin

Opiates Opiates

Lortab, Lorcet, VicodinLortab, Lorcet, Vicodin

Drugs of AbuseDrugs of Abuse

““Powerful new painkiller Powerful new painkiller Zohydro stirs fears of Zohydro stirs fears of overdose, addiction!”overdose, addiction!”

Zohydro will be the first pure Zohydro will be the first pure hydrocodone medication available in hydrocodone medication available in the United States.the United States.

Because of its purity, Zohydro is Because of its purity, Zohydro is potentially 10 times stronger when potentially 10 times stronger when abused than any other version of abused than any other version of hydrocodone (Vicodin) currently hydrocodone (Vicodin) currently available.available.

SuboxoneSuboxone

SuboxoneSuboxone

A long-acting partial agonist that acts on A long-acting partial agonist that acts on the same receptors as heroin and the same receptors as heroin and morphine, relieving drug cravings morphine, relieving drug cravings without producing the same intense high without producing the same intense high or dangerous side effects.or dangerous side effects.

Approved in 2002 for dispensing in Approved in 2002 for dispensing in physician offices and pharmacies, the physician offices and pharmacies, the first time opioid replacement therapy first time opioid replacement therapy could be given in privacy outside of a could be given in privacy outside of a drug clinic.drug clinic.

Prescription DrugsPrescription Drugs

BenzodiazepinesBenzodiazepines

ADHD PrescriptionsADHD Prescriptions

AmphetamineAmphetamine

So If There’s a Problem, So If There’s a Problem, What’s the Problem???What’s the Problem???

““You have a Problem!” You have a Problem!” “I don’t have a problem”“I don’t have a problem” ““You had Weed on youYou had Weed on you “I was just holding it for him”“I was just holding it for him” ““You tested positive “They were smoking in the carYou tested positive “They were smoking in the car ““You tested positiveYou tested positive “My mom gave me a poppy “My mom gave me a poppy seed bagel”seed bagel” ““You blew a 1.8!”You blew a 1.8!” “Has that been calibrated?”“Has that been calibrated?” ““Your failing school!”Your failing school!” “Everyone fails Mr Hs class”“Everyone fails Mr Hs class” ““Your parents are upset”Your parents are upset” “You’d smoke weed too if the“You’d smoke weed too if the

were your were your parents!” parents!”

““You got arrested”You got arrested” “They’re always trying to“They’re always trying to

get ME!!”get ME!!”

Houston….We Have a Houston….We Have a Brain Problem!!!Brain Problem!!!

Adolescent Brain DevelopmentAdolescent Brain Development1) Mid-Brain or “Old Brain”:1) Mid-Brain or “Old Brain”:The way-station for incoming sensory The way-station for incoming sensory

information on the way to the cortex.information on the way to the cortex.Mid-Brain is the SURVIVAL BrainMid-Brain is the SURVIVAL BrainWhat handles the next thirty seconds.What handles the next thirty seconds.Plays major role in how brain reacts to Plays major role in how brain reacts to

STRESS!!!STRESS!!!Drugs and Alcohol can become SURVIVAL.Drugs and Alcohol can become SURVIVAL.

Adolescent Brain Adolescent Brain DevelopmentDevelopment

2) 2) Pre-Frontal Cortex:Pre-Frontal Cortex: It confers semantic content onto objects in the It confers semantic content onto objects in the

world.world.Seat of the self and personalitySeat of the self and personalityCenter for love, morality, decency, Center for love, morality, decency,

responsibility, spiritualityresponsibility, spiritualityConsciousConsciousIf it is immature, it’s the neurobiological If it is immature, it’s the neurobiological

explanation for why teenagers show poor explanation for why teenagers show poor judgment and act before thinking.judgment and act before thinking.

Average age of maturity?______Average age of maturity?______

Adolescent Brain Adolescent Brain DevelopmentDevelopment

3) 3) Nucleus AccumbensNucleus Accumbens::

It directs motor behavior.It directs motor behavior.

Is responsible for how much effort we Is responsible for how much effort we will expand in order to seek rewards, will expand in order to seek rewards, “Pay Offs”.“Pay Offs”.

If it is immature, adolescents will lean If it is immature, adolescents will lean toward activities that require little toward activities that require little effort, yet produce high “Pay Off”, like effort, yet produce high “Pay Off”, like video games, drugs, etc.video games, drugs, etc.

Adolescent Brain Adolescent Brain DevelopmentDevelopment

4) 4) AmygdalaAmygdala: It integrates our emotional : It integrates our emotional reactions to pleasurable and aversive reactions to pleasurable and aversive experiences.experiences.

Lights up for FOOD, SEX, SURVIVAL.Lights up for FOOD, SEX, SURVIVAL.Lights up for cues to using and for using drugs.Lights up for cues to using and for using drugs.As it develops, two distinct behavioral effects tend As it develops, two distinct behavioral effects tend

to occur: to occur: Teenagers react explosively to situations Teenagers react explosively to situations

rather than calm.rather than calm. Teenagers have a propensity to misread Teenagers have a propensity to misread

neutral facial expressions as being neutral facial expressions as being angry/disappointed.angry/disappointed.

Adolescent DevelopmentAdolescent Development

Adolescence is a 10-20 year period of Adolescence is a 10-20 year period of transition from dependence to independence.transition from dependence to independence.

Normal Adolescence is characterized by……Normal Adolescence is characterized by…… Increase in conflicts with family membersIncrease in conflicts with family members Desire to be with one’s friendsDesire to be with one’s friends Resistance to messages from authorityResistance to messages from authority IrritabilityIrritability Risk takingRisk taking Proclamations of sheer boredomProclamations of sheer boredom (Ken Winters, Ph.D., 2007).(Ken Winters, Ph.D., 2007).

Adolescent Co-Occurring Adolescent Co-Occurring DisordersDisorders

Reported rates of co-occurring PTSD and Reported rates of co-occurring PTSD and substance use in youths range from 25 percent substance use in youths range from 25 percent for males to 75 percent for females (Kaminer, for males to 75 percent for females (Kaminer, 2004).2004).

Associations with sub-clinical trauma also have Associations with sub-clinical trauma also have been noted in research studies as risk factor, been noted in research studies as risk factor, frequently associated with youth engaged in frequently associated with youth engaged in substance abuse treatment (Dennis, 2004.)substance abuse treatment (Dennis, 2004.)

If you understand trauma, you understand If you understand trauma, you understand substance abuse issues!substance abuse issues!

Depression, Anxiety, Bipolar, ADHD, etc.Depression, Anxiety, Bipolar, ADHD, etc.

(De Bellis et al., 1999)

Suicidal ThoughtsSuicidal Thoughts

Suicidal thoughts are often a Suicidal thoughts are often a symptom of depression.symptom of depression.

The presence of suicidal thoughts The presence of suicidal thoughts may tell us that the depression is may tell us that the depression is increased in severity or intensity.increased in severity or intensity.

Children and adolescents don’t Children and adolescents don’t always volunteer that they are always volunteer that they are having suicidal thoughts so asking having suicidal thoughts so asking them these questions is appropriate.them these questions is appropriate.

SuicideSuicide

32,000 deaths per year by suicide32,000 deaths per year by suicide -This is the equivalent of 89 suicides per day-This is the equivalent of 89 suicides per day -One every 16 minutes-One every 16 minutes -More than 395,000 people with self-inflicted -More than 395,000 people with self-inflicted injuries are treated in emergency rooms each injuries are treated in emergency rooms each year.year. Every day there are approximately 12 youth Every day there are approximately 12 youth

suicides.suicides. Every 2 hours and 11 minutes, a person under the Every 2 hours and 11 minutes, a person under the

age of 25 completes suicide.age of 25 completes suicide. Rates much higher in patients with mood disorders.Rates much higher in patients with mood disorders. More than 90% with co-morbid psychiatric disorder.More than 90% with co-morbid psychiatric disorder.

What do the Statistics tell What do the Statistics tell us!!us!!

For every completed suicide by youth , it is For every completed suicide by youth , it is estimated that 100 to 200 attempts are madeestimated that 100 to 200 attempts are made

Based on the 2012 Youth Risk Behavior Based on the 2012 Youth Risk Behavior Surveillance Survey:Surveillance Survey:

14.5% of students had seriously considered 14.5% of students had seriously considered attempting suicide in the past 12 months.attempting suicide in the past 12 months.

11.3% of students had made a plan for how 11.3% of students had made a plan for how they would attempt suicide.they would attempt suicide.

6.9% of students had attempted at least one 6.9% of students had attempted at least one time during the 12 months prior to the survey.time during the 12 months prior to the survey.

Warning Signs of SuicideWarning Signs of Suicide

A previous suicide attempt.A previous suicide attempt. Current talk of suicide, or making a Current talk of suicide, or making a

plan.plan. Strong wish to die or Strong wish to die or

preoccupation with death.preoccupation with death. Increase alcohol and/or drug use.Increase alcohol and/or drug use. Recent suicide attempt by a Recent suicide attempt by a

friend/family member.friend/family member.

Alcohol/Substance Abuse in Alcohol/Substance Abuse in Youth and SuicidalityYouth and Suicidality

Adolescents with alcohol abuse/dependence Adolescents with alcohol abuse/dependence nearly 7 times more likely to attempt nearly 7 times more likely to attempt suicide than others.suicide than others.

Alcohol abuse predicts eventual suicide in 5 Alcohol abuse predicts eventual suicide in 5 year follow-up of hospitalized attempters.year follow-up of hospitalized attempters.

Recent alcohol ingestion common in suicideRecent alcohol ingestion common in suicide

(28%, Hoberman & Garfinkel, 1988; 51% (28%, Hoberman & Garfinkel, 1988; 51% Marttunen et al., 1991).Marttunen et al., 1991).

Risk Factors for SuicideRisk Factors for Suicide

Negative Personal HistoryNegative Personal History Psychopathology and Negative Psychopathology and Negative

Personality AttributesPersonality Attributes Social and Interpersonal Isolation Social and Interpersonal Isolation

&Alienation&Alienation Parent PsychopathologyParent Psychopathology Family DysfunctionFamily Dysfunction Availability and AccessibilityAvailability and Accessibility

Family and Interpersonal Family and Interpersonal StressStress

Interpersonal conflict/loss is most Interpersonal conflict/loss is most common precipitant of completed common precipitant of completed suicide suicide (Martunnen et al., 1993).(Martunnen et al., 1993).

Interpersonal conflict/loss and Interpersonal conflict/loss and legal/disciplinary problems relate legal/disciplinary problems relate to suicide attempts.to suicide attempts.

Family loss/instability is Family loss/instability is nonspecific predictor of suicidalitynonspecific predictor of suicidality

Protective FactorsProtective Factors

Contact with a caring adult!!!Contact with a caring adult!!! Sense of connection and participation, Sense of connection and participation,

especially with sober, supportive especially with sober, supportive youth/adults.youth/adults.

Positive self-esteem and coping skills.Positive self-esteem and coping skills. Again, access to care for depression, Again, access to care for depression,

trauma, anxiety, substance abuse, trauma, anxiety, substance abuse, etc.etc.

Myths About SuicideMyths About Suicide

Asking about Suicide may cause Asking about Suicide may cause Suicidal Behavior.Suicidal Behavior.

Most attempts are impulsive acts Most attempts are impulsive acts without forethought.without forethought.

Those who attempt Suicide get medical Those who attempt Suicide get medical treatment.treatment.

Suicide attempters leave suicide notesSuicide attempters leave suicide notes Parents know if their child is suicidalParents know if their child is suicidal (Reynolds, 1988).(Reynolds, 1988).

EngagementEngagement

The quality of the relationship more potent The quality of the relationship more potent predictor of outcome than theoretical orientation, predictor of outcome than theoretical orientation, experience level, or professional discipline (S. experience level, or professional discipline (S. Miller).Miller).

Client perception of the relationship a better Client perception of the relationship a better predictor of outcomes than therapist’s perception.predictor of outcomes than therapist’s perception.

Assist adolescent with focusing on ONE thing that Assist adolescent with focusing on ONE thing that will be beneficial for them by coming to see YOU!will be beneficial for them by coming to see YOU!

Try to target something positive as a “pay-off” Try to target something positive as a “pay-off” that is as emotionally meaningful as their drug that is as emotionally meaningful as their drug and alcohol use.and alcohol use.

Questions, Comments, Questions, Comments, Concerns??!!Concerns??!!

Thank You!!Thank You!! Geoff Wilson, LCSW, CADCGeoff Wilson, LCSW, CADC The Ridge Behavioral Health The Ridge Behavioral Health

SystemSystem 3050 Rio Dosa Drive3050 Rio Dosa Drive Lexington, KY 40509Lexington, KY 40509 [email protected]@uhsinc.com