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Adolescent Addiction Service Provides Support and Treatment in Relation to Alcohol and Drug Use For Young People
and Families from Ballyfermot, Clondalkin, Palmerstown, Lucan and Inchicore.
“Challenge & Change”
Presentation to
National Drugs Conference of Ireland
November 2011
© Denis Murray 2011
Introduction
Overview of Adolescent Addiction Service
Referrals
Drug use trends
Participation in education
Approaches to intervention
Case examples
Reflection
3
Adolescent Addiction Service Provides Support and Treatment in Relation to Alcohol and Drug Use For Young
People and Families from Ballyfermot, Clondalkin, Palmerstown, Lucan and Inchicore.
Advice
Support
Assessment
Family Therapy/Counselling
Professional Consultation
Medication (if required)
Contact: Bridge House
Cherry Orchard Hospital
Dublin 10
Phone 01-6206400/6206493
Referrals accepted from :
Family members ,Professionals and Young People
Adolescent Addiction Service
Established 1997 as a structured 12 week outpatient
detoxification programme (involving methadone
prescription) for under 18yr olds who were experiencing
problems in relation to heroin use.
Operated out of Fortune House Clinic, Cherry Orchard
Hospital.
Why an Adolescent Addiction Service?
HRB report showing 33% increase in drug users
presenting to services 1990-1996. For opiate users 65%
between 15-19yrs
Increase in prevalence of Hepatitis C antibodies among
those under age 18yrs
Adolescents are different and have specific developmental
needs
Family involvement in treatment essential © Denis Murray 2011
Challenges Presented
• Programme too rigid based on adult model with expectation of rapid detoxification
• No established social/aftercare supports
• Service not giving sufficient consideration to issue of adolescent development
• Staff team drawn from adult service and did not have experience of working with young people
• Societal attitude to Adolescent Drug Use and Methadone
• Engaging with families (100% parent/guardian contact)
• Participant profile; developmental stage, level of substance use, drug dealing, criminal activity, educational achievement, relationship with other group members and substance use within families
© Denis Murray 2011
© D enis Murray 2011
Rapid Assessment
Family
Therapist
Waiting
List
In Patient
Detox
Young
PersonOP
Detox
Adult
OPDetox
Young
PeopleAnd
Families
Clinical Meeting
FamilyTherapist
Child
AdolescentPsychiatrist
Nurses
Other
SignificantPeople
GP
Individual
CarePlan
Family
Community
GP Nurses
Structured Twelve Week
Out-Patient Detox
Adult
DrugUsers
Referral
CurrentStructures
1997/99
2004
Separation
Therapy/Medical
Inclus ion
Alcohol
2003
PROGRAMME STRUCTURE
© Denis Murray 2011
The primary presentations of 6,950 cases were recorded by gender and age. For the purpose of the audit only one disorder/problem was entered for each case
© Denis Murray 2011
Drug Use Comparison
Primary Drug Use
1998
Parents = 4
IVDU = 6
Average Age
1998 = 16.5yrs
2010 = 15.5yrs
Percentage Female
1998 = 36.5%
2010 = 27%
© Denis Murray 2 011
0
20
40
60
80
100
120
1998 2000 2002 2004 2006 2008 2010
Medical Non-Medical
Drug Free
Medical Non - Medical
Intervention
Active
Drug Use
1998
• Four parents in group under age 17yrs
• Six young people Injecting heroin
• Four young people homeless
• 21 had family members engaged in heroin Use
E
X
P
E
C
T
A
T
I
O
N
A
L
A
P
P
R
O
A
C
H
0
5
10
15
20
25
Completed
Junior Cert
4th yr 5th yr Out of Ed Alt Ed
1998 2010
NACD Report 2010; Highlights that early school leavers and young
people who opt out of mainstream education show higher levels
of substance use. It is proposed that positive relationships with
teachers and involvement of parents is a major protective factor
in school retention and reduced drug use.
Participation in Education
© Den is Murray 2011
Research (Duncan and Miller, 2000 ) suggests that therapeutic approach accounts for less than 15% of success and that most of the variance for therapy outcome is covered by the
common ground between all therapies: client resourcefulness and chance events that
produce change (40%); client-therapist relationship and experience of therapy as empathic, collaborative and affirmative (30%); client expectation & hope for change (15%).
When we include family members and significant others in process we get a multiplier
effect.
CRAFT
Solution Focused
MDFT FFT
Family
Systems Theory
Motivational
Interviewing
BriefTherapy
CBT
Relationship
Re
lati
n
sh
ip
CASE EXAMPLE
37 35
15.5
4
12
St James
Hospital
X 1
36
Tallaght
Hospital
X 3
Adolescent
Addiction
Service
Out Of
Hours
Service
Warrenstown
Time Line 3.5yrs
Social
Work
Completed LCA
Drug Use
Heroin
Benzo
Cocaine
Alcohol
Ant abuse
Referral
AMH CAMS
Youth
Project
© Denis Murray
Youthreach SCHOOL CAMS YSTU AAS CUMAS Aislinn Centre
16 11 19 13 4
CASE EXAMPLE
In treatment on methadone
Social Work
CASP
Violent Relationship
CDTF (funding)
Drug Use Heroin Benzo Cocaine Alcohol
© Denis Murray
RIP
*
***
*
© Denis Murray 2011
Suicide
Suicide
Suicide
16
Family
Community
OutpouringOf Grief
CAMS
Threats/AssaultInternet Abuse
Anxiety/Distress/GuiltSleep Disturbance GP
AASCommunityWorker
Console
Short termBenzo Prescription
14 17 20 19 22 11 16 18
21 24
Individual
Sessions
With FT
IP Detox
Coolmine
Therapeutic
Community
IP Detox
REHAB
Keltoi
Community
Project
College
IP Detox
Soilse
1 2
3
OP
Stabilisation
Youth reach
Work
OP DEOX
Remained
Education
NO
DRUG USE
Time Line = Two and a half years
Alcohol Abuse after years of sobriety Sober attending AA
Professional Employed
Heroin
Use
&
BENZO
Heroin
Use
Heroin
Use
Heroin
Use
ACRG
Talk to
YPP
Group
Rowlagh
Parish AAS CASP CDVEC
LISA Group
9 11 20 23
Case Example
EMPLOYER
© Denis Murray
Challenges in a Changing Environment
Br ie f Intervention
R e duce Risk by Increasing
Pro tective & Preventative
In terventions
Identify young people who are most at risk of developing drug use problems
or associated activity
Introduce protective/preventative interventions to support young people and families within local community (build capacity & resilience)
Show less tolerance for alcohol & cannabis use (stated by YPP Youthreach)
Prioritise inter agency working ( respecting boundaries & maintaining confidentiality)
Be aware of the malign consequences of Government policies in order to avoid separating peoples problems from their social and economic context
© D enis Murray 2011
Thank you for your attention. Questions? © Denis Murray 2011
CASE EXAMPLE
15.7
Primary
School
CAMH
(1) Age 9
CAMH
(2) Age 10
Secondary
School Age 11/12
CAMH
(3) Age14
Counselling
Service Age 12/13
Hospital
Adolescent
Addiction
Service
JLO Age 14/15
Out
Of
Hours
Court
Social
Work
Residential
Placement
Education
Project Age 14/15
M
o
v
e
H
o
u
s
e
M
o
v
e
H
o
u
s
e
Substance Use
Alcohol age 11
Cannabis age 12
Benzo age 13
Cocaine age 14
Ketamine age 15
Ecstasy age 15
Zimmovane age 14/15
(Prescribed)
EWO
Sleeping Rough
Substance Use
Time Line = 2.7yrs
Community of Origin
Temporary
Accommodation
Independent
Living Further
Education Drug
Free
Indebted
Family
Home
Attacked © Denis Murray
© Denis Murray 2011
Adolescent Addiction Service
Established 1997 as a structured 12 week outpatient
detoxification programme (involving methadone prescription)
for under 18yr olds who were experiencing problems in
relation to heroin use.
Operated out of Fortune House Clinic, Cherry Orchard
Hospital.
Why an Adolescent Addiction Service?
HRB report showing 33% increase in drug users presenting
to services 1990-1996. For opiate users 65% between 15-
19yrs
Increase in prevalence of Hepatitis C antibodies among those
under age 18yrs
Adolescents are different and have specific developmental
needs
Family involvement in treatment essential
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