Presentation is loading. Please wait.

Presentation is loading. Please wait.

Addressing Teen Substance Use: A Clinical Perspective on Adolescent Brain Development Ken Winters, Ph.D. Department of Psychiatry University of Minnesota.

Similar presentations


Presentation on theme: "Addressing Teen Substance Use: A Clinical Perspective on Adolescent Brain Development Ken Winters, Ph.D. Department of Psychiatry University of Minnesota."— Presentation transcript:

1 Addressing Teen Substance Use: A Clinical Perspective on Adolescent Brain Development Ken Winters, Ph.D. Department of Psychiatry University of Minnesota Drug Free Communities – Waukesha County Waukesha, WI September 26, 2013

2 Resources Brief Interventions and Brief Therapies for Substance Abuse TIPS #34, SAMHSA-CSAT Enhancing Motivation for Change in Substance Abuse Treatment TIPS #35, SAMHSA-CSAT MotivationalIinterviewing, Third Edition: Preparing People for Change The Guilford Press (2013) $

3 Resources Adolescents, Alcohol, and Substance Abuse: Reaching Teens through Brief Interventions The Guilford Press (2001) Motivational Interviewing with Adolescents and Young Adults The Guilford Press (2011) TeenIntervene Hazelden Press (2012, 2 nd edition) $ $ $

4 Outline of Talk Brief Interventions (BI) Screening Motivational Interviewing (MI) Teen Intervene Update Case Example

5 Outline of Talk Brief Interventions (BI) Screening Motivational Interviewing (MI) Teen Intervene Update Case Example

6 Why BIs Are Teen-Friendly

7

8 Preference for …. 1.physical activity 2.high excitement and low effort activities 3.activities with peers that trigger high intensity/arousal 4.novelty Less than optimal.. 5.balance of emotion and logic when making decisions 6.consideration of negative conseq. Greater tendency to… 7.take risks and show impulsiveness Seven Implications of Arrested Development for Adolescent Behavior

9 Response Options Adapted from Broadening the Base of Alcohol Treatment (IOM) Primary Prevention (Intensive for High Risk) Abstinence Infrequent use Dependence Intensive Treatment Assess & Referral Challenges Drug Involvement MI has several applications within intensive tx Brief Intervention Abuse Misuse

10 Cost Containment Abstinence Infrequent use Early abuse Abuse Dependence Tx Gap Intensive Treatment Drug Involvement Adapted from Broadening the Base of Alcohol Treatment (IOM) Bull Market: 1980’s - mid 1990’s Prevention

11 Cost Containment Abstinence Infrequent use Dependence Intensive Treatment Drug Involvement Adapted from Broadening the Base of Alcohol Treatment (IOM) Bear Market: since mid 1990’s higher or more stringent admission threshold Tx Gap Brief Intervention- MI Prevention Misuse Abuse

12 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 % = % light drinkers 65.7% non users

13 How Brief is a Brief Intervention?

14 Source: Linda Sobell

15 How Brief is a Brief Intervention? Some have been a few minutes or a single session (usually during an opportunistic situation). Typical: 2-4 sessions.

16 Assumptions of Brief Intervention “Thinking Outside the Box” Public health, not disease Harmful consequences on a continuum Recognize abstinence as ideal but open to alternatives Does not have to enable addiction Therapy as usual

17 Why Brief Interventions Makes Sense for Youth Person-centered approach is appealing to young people. Commitment to lengthy and intensive interventions can be difficult at this age. Multiple applications

18 Possible Applications Primary Prevention Abstinence Infrequent use Dependence Intensive Treatment Drug Involvement Adapted from Broadening the Base of Alcohol Treatment (IOM) Brief Intervention Schools, courts, pediatric clinics, emergency rooms, mental health clinics Misuse Abuse

19 May not be appropriate for severe end cases (e.g., dependence) Supplemental treatment is warranted to address co-existing conditions Non-abstinence goals common to brief interventions (e.g., harm reduction, risk reduction) may not be suitable for some settings and for some counselors’ clinical orientation Abstinence via shaping (“reduction to abstinence”) Cautions

20 Outline of Talk Brief Interventions (BI) Screening Motivational Interviewing (MI) Teen Intervene Update Case Example

21 Screening Issues Primary Prevention (Intensive for High Risk) Abstinence Infrequent use Dependence Intensive Treatment Screening & Referral Challenges Drug Involvement Brief Intervention Abuse Misuse

22 Screening Issues Primary Prevention (Intensive for High Risk) Abstinence Infrequent use Dependence Intensive Treatment Screening & Referral Challenges Drug Involvement Brief Intervention Abuse Misuse 1 standardized screening tool & brief clinical interview

23 Screening vs. Assessment Prob Identif.Referral Tx Plan Screening Probable?Assess? NA Assessment Definitive?Treatment? Goals/Strategy?

24 My Favorite Screens Brief screening CRAFFT Screening ADI DAST-Adolescent PESQ SASSI-adolescent GAIN-Short Screen

25

26 Interview - General Issues Who should be in the room for first session? maximizing adolescent engagement consider dividing the session: both first, then youth alone, OR youth first, then parent

27 Brief Interview - HEADS H = Home E = Education/Eating A = Activities D = Drugs S = Sex/Suicidality/Safety

28 Outline of Talk Brief Interventions (BI) Screening Motivational Interviewing (MI) Teen Intervene Update Case Example

29 MI = The Counseling Style Used in BI’s

30 Interviewing Techniques Confrontational vs. Motivational

31

32

33 Contrasts Between Confrontational and Motivational Approaches Miller & Rollnick, 1991 Confrontational Motivational Heavy emphasis on self as having a De-emphasis on labels problem and acceptance of diagnosis Emphasis on personality pathology,Emphasis on personal choice which reduces personal choice and controland responsibility Therapist presents evidence of problemsTherapist focuses on eliciting the client’s own concerns

34 Contrasts Between Confrontational and Motivational Approaches Miller & Rollnick, 1991 Confrontational Motivational Resistance is seen as “denial” which is Resistance is met with reflection confronted.nonargumentation. Goals of treatment and strategies,Treatment goals and strategies prescribed, client assumed to be are negotiated; clients involvement incapable of sound decisions seen as vital

35 When is a confrontational style (in light form) indicated? ________________________________________

36 Motivational Interviewing Change Talk Behavior Change The Goal of MI

37 Identifying Change Talk Desire to change Ability to change Reasons for change Need for change COMMITMENT to making a change

38 Four Principles of Motivational Interviewing R E D S

39 R: Roll with Resistance Reluctance and ambivalence are to be acknowledged (and even respected) and not confronted directly Questions and problems may be turned back to the client for solution Explicit permission is given to disregard what the interviewer is saying Resistance supplies energy which can be used therapeutically

40 E: Express Empathy Therapist empathy repeatedly shown to be predictor of client success in changing addictive behavior The operational definition of empathy is reflective listening Empathy indicates that the speaker has been understood

41 D: Develop Discrepancy The discrepancy between client values and current behavior is the location of fruitful therapeutic work Weighing pros and cons in nonjudgmental fashion will facilitate this discrepancy The client, not the therapist, must verbalize arguments for change

42 S: Support Self-efficacy Efficacy is the belief that a person can make a specific change Robust predictor of outcomes with a variety of clinical problems Interviewers may search for optimism in client’s previous successes

43 Decisional Balance What are the pros of the adolescent’s drug use? ____________________________________________________________________ What are the cons (negatives) of the adolescent’s drug use? ____________________________________________________________________ What is accomplished with this procedure? ____________________________________________________________________ How does it enhance self-motivation? ____________________________________________________________________ How does it help with establishing goals? ____________________________________________________________________

44 Outline of Talk Brief Interventions (BI) Screening Motivational Interviewing (MI) Teen Intervene Update Case Example

45 teen-intervene

46 Teen Intervene Update Latest research data Implementation Use in groups Learning TI Collecting follow-up data New parent project (Home Base)

47 Teen Intervene Update Latest research data New summary in NREPP (www.nrepp.samhsa.gov) Ratings were in the 3-4 range

48 Teen Intervene Update Latest research data New summary in NREPP (www.nrepp.samhsa.gov) Ratings were in the 3-4 range Recent publications in scientific literature SUD sample - 6 and 12 month outcome JSAT and PAB Truant sample – 18 month outcome JCASA

49 Teen Intervene Update SUD sample - 6 and 12-month outcome Full 3-session version is better than the 2- session (youth only) although at 12-months, minimal difference 2-session better than assessment only

50 Research Abstinence rates at 6-months post-intervention for each of the 3 groups VariableBI-YBI-YPControl Alcohol abstinence, prior 90 days at 6 month follow-up 50%59%29% Marijuana abstinence, prior 90 days at 6 month follow-up 59%68%22% Source: Winters (CPDD, 2008). Notes. Groups: BI-Y = BI-Youth only; BI-YP = BI-Youth and Parent; CON = Control, assessment only.

51 Teen Intervene Update SUD sample – 6 and 12-month outcome Full 3-session version is better than the 2-session (youth only) But 2-session still better than assessment only Mechanisms of change: > utilization of additional services > problem solving > motivation to change

52 Teen Intervene Update Latest research data Implementation 2 nd edition published in 2012 No substantive changes Alterations: formatting and wording changes with some worksheets and suggested script

53 Teen Intervene Update Latest research data Implementation 2 nd edition published in 2012 No substantive changes Alterations: formatting and wording changes with some worksheets and suggested script Implemented with more than 75,000 youth in more than 1,500 sites (all 50 States and numerous countries) Statewide in 3 states; others in consideration Part of many youth SBIRT programs

54 Teen Intervene Update Latest research data Implementation Use in groups

55 Teen Intervene Update Latest research data Implementation Use in groups Learning TI I am available for long-distance consultation and mini-supervision (either ad hoc or on-going) Listening to taped sessions Self-fidelity checks Booster training is available

56 Teen Intervene Update Latest research data Implementation Use in groups Learning TI Collecting follow-up data Low key model baseline and post-intervention (e.g., 6-months) of drug use frequency and motivation to change (use Part 1 and 2 of Client Questionnaire) Cadillac model full battery available from our research group

57 Teen Intervene Update Latest research data Implementation Use in groups Learning TI Collecting follow-up data New parent project (Home Base)

58 Home Base

59 Outline of Talk Brief Interventions (BI) Screening Motivational Interviewing (MI) Teen Intervene Update Case Example

60 Case Example - Lynette

61 THANK YOU!


Download ppt "Addressing Teen Substance Use: A Clinical Perspective on Adolescent Brain Development Ken Winters, Ph.D. Department of Psychiatry University of Minnesota."

Similar presentations


Ads by Google