SAVING OUR YOUTH FROM SUBSTANCE USE:

EVIDENCED BASED KNOWLEDGE AND INTERVENTIONS

Manny Alvano, MHA, MSN, PMHRN-BCResnick Neuropsychiatric Hospital at UCLA

MANNY ALVANO

Has No Relevant Financial Relationships or Commercial Interests

LEARNING OUTCOMES

1. Participants will identify at least 4 drugs of abuse by youth

2. Participants will identify a screening tool for substance use

3. Participants will identify 2 motivational interviewing techniques

STORY TELLING VERSUS SCIENTIFIC EVIDENCE

COMMUNICATING MEDICINEThe Importance of Narrative in Communicating Evidence-Based ScienceBy Jason Karlawish | Monday, November 28th, 2011Psychologists have found that pure evidence is often less persuasive than narrative in the court of public opinion. In the Journal of the American Medical Association, Zachary F. Meisel and Jason Karlawish, MD make the case that, although the practice of science must inherently be based on evidence rather than anecdote, scientists should not eschew narrative completely in the communication of evidence-based findings.

DICKY SANDERS DRUGS INC. SEASON 2, EPISODE 7

DICKY SANDERS FIRST DUI AGE 16

DICKY SANDERS

DICKY SANDERS

Cause of Death: Self-inflicted gunshot wound to the head secondary to Substance Induced Psychosis

(Synthetic cathinones)

DSM-5: SUBSTANCE USE DISORDERS(DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS)

A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1. The substance is often taken in larger amounts or over a longer period than was intended.

2. There is a persistent desire or unsuccessful efforts to cut down or control use.

3. A great deal of time is spent in activities necessary to obtain the substance, use, or recover from its effects.

4. Craving, or a strong desire or urge to use.

DSM-5: S.U.D. CONTINUED

5. Recurrent use resulting in a failure to fulfill major role obligations at work, school, or home.

6. Continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.

7. Important social, occupational, or recreational activities are given up or reduced because of use.

8. Recurrent use in situations in which it is physically hazardous.

DSM-5: S.U.D. CONTINUED

9. Use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by use.

10. Tolerance, as defined by either of the following:• A need for markedly increased amounts of the substance to

achieve intoxication or desired effect.• A markedly diminished effect with continued use of the same

amount.11. Withdrawal symptoms as manifested by the specific drug

involved.

DSM-5: S.U.D. SEVERITY

•Mild: Presence of 2–3 symptoms.•Moderate: Presence of 4–5 symptoms.•Severe: Presence of 6 or more symptoms.

DSM-5Substance Induced Mood DisorderSubstance Induced Psychotic DisorderSubstance Induced Neurocognitive Disorder

• The disorder developed during or within 1 month of a substance intoxication or withdrawal or taking a medication; and

• The involved substance/medication is capable of producing the mental disorder.

• Potentially severe, usually temporary, but sometimes persisting central nervous system (CNS) syndromes

RISK AND PROTECTIVE FACTORS

RISK FACTORS PROTECTIVE FACTORSEarly aggressive behavior Self-control; mood regulation skillsLack of parental supervision Parental monitoringDrug availability Anti-drug use exposure through

school/community programsParental use/genetics Parental role modelingDifficulty transitioning (7th, 9th, 1st yr. College) Healthy adjustmentAcademic failure Academic successDrug using peers Peers involved in school activities; non-usersUndiagnosed psychiatric disorders Early treatment and interventionChildhood emotional, physical, sexual trauma No history of abuse or trauma

WHY DO TEENS USE DRUGS AND ALCOHOL

SPECT SCANS (SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY)

•

•12 years of marijuana use 10 years of heroin use 20 years of daily

(daily) alcohol use

SPECT SCAN: 1 YEAR RECOVERY

DRUG/ALCOHOL USE 1 YEAR RECOVERY

ANNUAL PREVALENCE OF USE: GRADES 8TH, 10TH, 12TH

SUBSTANCE 8th 10th 12th

Any Illicit Drug 12.9 27.8 39.9Alcohol 18.2 37.7 55.7Marijuana 10.1 25.5 37.1Amphetamines 3.5 5.6 5.9Hallucinogens 1.1 2.8 4.4Benzodiazepines 2.0 4.4 4.7Marijuana (synthetic) 2.0 2.7 3.7OxyContin 0.8 2.2 2.7MDMA (Ecstasy) 0.8 2.2 2.7Cocaine 0.8 1.4 2.7Bath Salts 0.5 0.4 0.8Inhalants 4.7 2.3 1.5

Of the 2-3 Million youth with Substance Use Disorders in the U.S.

only 6% receive specialized treatment.

SREENING, BRIEF INTERVENTION, REFERRAL TO TREATMENT(S.B.I.R.T.)

DESCRIPTION QUESTION

C CONCERN by the person that there is a problem

Have you ever felt like you should CUT down on yourdrinking or use?

A APPARENT to others that there is a problem

Have you ever felt ANNOYEDby others who are concerned about your use?

G GRAVE consequences Have you ever felt GUILTYabout your use?

E EVIDENCE of dependence or tolerance

Have you ever had to have an EYE OPENER to function for the rest of the day?

MOTIVATIONAL INTERVIEWING (INTERVENTION)

Definition: A collaborative, person-centered form of guiding to elicit and strengthen motivation for change

NO ARMS, NO LEGS, NO WORRIES

Nick Vujicic

https://www.bing.com/videos/search?q=youtube+no+arms++no+legs+no+wrrries&view=detail&mid=638458388F10D8867F98638458388F10D8867F98&FORM=VIRE

INTERVENTION: MOTIVATIONAL INTERVIEWING

Four Basic Principles:1. Express Empathy with a warm nonjudgmental approach,

active listening, and reflecting back what is said.2. Develop Discrepancy between the patient’s choice to use

and his or her goals, values, or beliefs.3. Roll with Resistance by acknowledging the patient’s

viewpoint, avoiding debate, and affirming autonomy.4. Support Self-efficacy by expressing confidence and

pointing to strengths and past successes.

ENCOURAGING MOTIVATION TO CHANGE

1. Do I listen more than I talk?2. Do I keep myself sensitive and open to this person’s issues,

whatever they might be?3. Do I invite this person to talk about and explore his/her

own ideas for change? 4. Do I encourage this person to talk about his/her reasons

for not changing?5. Do I ask permission to give my feedback?

ENCOURAGING MOTIVATION TO CHANGE

6. Do I reassure this person that ambivalence to change is normal?

7. Do I help this person identify successes and challenges from his/her past and relate them to present change efforts?

8. Do I summarize for this person what I am hearing?9. Do I value this person’s opinion more than my own?10. Do I remind myself that this person is capable of making

his/her own choices?

REFERRAL TO TREATMENT

• Intensive Out Patient Programs (IOP)• Adolescent Partial Hospitalization Programs (PHP)• Child and Adolescent In-Patient Care• Residential Treatment Centers ($6,000 to $60,000 per month)• Sober Living Group Homes• Sober companions• Alateen

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

When a farmer uses fertilizer that does not have any effect, he has to change the fertilizer. The same is true for us. If the practice we are doing has not brought about transformation and healing, we have to reconsider the situation. We must change our approach and learn more in order to find the right practice that can transform the lives of the people we care for and our own. Thich Nhat Hanh

ONE QUICK STORY; Q & A

REFERENCESBrewer, L. B. & Collins, M. (2014). A review of clinical manifestations in adolescent and young adults after use of synthetic cannabinoids. Journal for Specialists in Pediatric Nursing, 19, 119-126.Carroll, K. S., Alston, W., Marsal, E. S., & Harris, A. (2014). Substance abuse treatment: Spice and bath salts addiction – So what’s next. Journal of Human Behavior in the Social Environment, 24, 573-581.Case Western Reserve University. (2011). Evidenced based practice: Motivational interviewing. https://www.centerforebp.case.edu/Chodron, P. (2002). The places that scare you: A guide to fearlessness in difficult times. Boston, MA. Shambala publications.Drugs Inc. (2012). Designer drugs. http://crimedocumentary.com/drugs-inc-complete-season-2-2012/Johnston, L. D. et al (2017). Monitoring the future: National survey results on drug use.Jordan, J. T. & Harrison, B. E. (2013). Bath salts ingestion: Diagnosis and treatment of substance-induced disorders. The Journal of Nurse Practitioners, 9(7), 403-410.National Institute of Health. (2002). CAGE questionnaire. https://pubs.niaaa.nih.gov/publications/inscage.htmSubstance Abuse and Mental Health Services Administration. (2017). Keeping youth drug free. https://store.samhsa.gov/product/Keeping-Youth-Drug-Free/SMA17-3772 Suzuki, J., Poklis, J. L., & Polkis, A. (2014). My friend said it was good LSD: A suicide attempt following analytically confirmed 251-NBOMe ingestion. Journal of Psychoactive Drugs, 46(5), 379-382.