4Trends:Past month MJ amongst teens is up 42% (up from 19% in 2008 to 27% in 2011), which is equivalent to about 4 million teens.Past year MJ amongst teens is up 26% (up from 31% in 2008 to 39% in 2011), which is equivalent to about 6 million teens.Lifetime MJ amongst teens is up 21% (up from 39% in 2008 to 47% in 2011), which is equivalent to about 8 million teens.
5Background:Over the last several decades, while MJ use has continued to increase, albeit slightly, the age of onset of first use has declined.While previous investigations have reported alterations in both brain structure and function which are associated with onset of marijuana use, few have made direct comparisons between early and later onset MJ smokers.
6Cognitive tasks and MJ use Summary:Cognitive tasks and MJ useMarijuana use among year olds rose to 7.3% in 2009, a significant increase from Moreover, age of onset of use continues to drop, with a significant decrease from from 17.8 to 17.0 years.Early onset smokers used MJ 1.5 times as frequently per week and smoked more than 2.5 times as much MJ as later onset MJ smokers.Early onset MJ smokers demonstrate significantly worse performance on cognitive tasks, specifically, those requiring executive function, relative to later onset MJ smokers and controls.Significant associations were detected between performance on neurocognitve tasks and MJ use patterns (age of onset, number of smokes per week, and grams used per week)
7Summary: Neuroimaging Results As hypothesized, early onset MJ smokers demonstrated poorer performance and altered patterns of activation during frontal/inhibitory tasks relative to late onset smokers and control subjects.Early age of onset of MJ use is associated with lower white matter microstructural integrity, suggesting structural brain changes secondary to early exposure to MJ. In this group, lower white matter integrity was associated with higher levels of impulsivity.
8ImplicationsEarly exposure to MJ during a critical period of development results in more significant alterations in neurocognitive performance, white matter microstructure, and brain activation patterns relative to later onset MJ use.Brain regions associated with judgment, decision making and impulsivity are the last to develop, yet are critical for the ability to reason and inhibit inappropriate behaviors, making adolescent or young adults less likely to make the right choices in stressful situations without drugs ‘on board’.These findings underscore the importance of early identification and treatment of early, regular MJ smokers, as exposure during a period of developmental vulnerability may result in neurophysiologic changes, which have long term implications.
13Developmental Mismatch Most adolescent treatment is based on an adult modelOperates on a passive vs assertive approachAssumption: Build it and they will come….Reality: NO THEY WON’TThis may happen physically but not with overt motivation
14What do we do in Treatment? Motivational Interviewing and CBT
15Why use MI The perception of harm is low and getting lower One of the hardest addictions to treat because of thisMI is nonjudgmental so you can avoid the political/its natural discussionFew adolescents volunteer for treatment they are usually bumped into treatment
16Spirit of Motivational Interviewing with Adolescents
17THE SPIRIT OF MOTIVATIONAL INTERVIEWING COLLABORATION—Counseling involves a partnership that honors the client’s expertise and perspectives. The counselor provides an atmosphere that is conducive rather than coercive to changeEVOCATION—The resources and motivation for change are presumed to reside within the client. Intrinsic motivation for change is enhanced by drawing on the client’s own perceptions, goals, and valuesAUTONOMY—The counselor affirms the client’s right and capacity for self-direction and facilitates informed choicePatience, Patience, Patience
18Fundamental Processes in MI EngagingFocusingEvokingPlanning
19Motivational Interviewing with a Twist Should use the same principles of empathy, discrepancy, evocation, and self-efficacyConfrontation with a motivational style, creative empathic reflectionBe sure to keep your integrity with the factsUse personal feedback to enhance motivation (DSM IV Criteria)
20Cognitive Behavioral Therapy Tremendous amount of evidence showing positive results for adultsDearth of efficacy trials for adolescents, however gaining clinical supportCannabis Youth Treatment Study: Showed significant increase in days of abstinence (combination of MI+CBT)Strategies include; self monitoring, altering reinforcement contingencies, skills training
21Family TherapyMany different types of family based treatments with great successCommunity Reinforcement and Family Training (CRAFT) (Waldron et al, 2007)Contingency Management ApproachesOutcome depends on the treatment setting, number of sessions, and populationAs with MI, it improves the potency of all interventions with adolescent substance abusers
22Self-Help Groups Difficult for adolescents to get to Not enough groups for young peopleProfessional involvement has shown to enhance outcomeWhen it works, it works wellExtends benefits of treatment (Kelly et al, 2010)Adolescents should be exposed to the principles of self-help groups
23STEP ONE HISTORY (Combination of MI +CBT+TSF) ObsessionProgressionLossesRelapseFamily InteractionInsanityBehaviorsWritten history of substance useIncreases change talkMoves patients from one stage of change to another
24Cue ExposureRationale: Told to avoid cues/triggers, is it possible for adolescents? Urges decrease while in residential treatment giving a false sense of confidenceExposure Planning: Patients develop a list of triggers and create a trigger hierarchy range from high to lowSkills Training: The first two exposures pts are encouraged to use skills coaching after that they will start this process on their own