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Substance Abuse in Adolescence Dr Amit Sen Senior Consultant Child/Adolescent Psychiatrist Child & Adolescent Mental Health Program Sitaram Bhartia Institute.

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Presentation on theme: "Substance Abuse in Adolescence Dr Amit Sen Senior Consultant Child/Adolescent Psychiatrist Child & Adolescent Mental Health Program Sitaram Bhartia Institute."— Presentation transcript:

1 Substance Abuse in Adolescence Dr Amit Sen Senior Consultant Child/Adolescent Psychiatrist Child & Adolescent Mental Health Program Sitaram Bhartia Institute of Science & Research

2 Substance Abuse Epidemic proportions in schools Smoking, alcohol, cannabis & solvents are common Behavioural, emotional, relationship and academic problems Associated mental health problems Poor awareness

3 Why use them? Rebellion Curiosity/Adventure Availability- Marketed/Advertised Easy pleasure Being “cool” Peer pressure/Desire to belong Chilled out/Relaxed Relief from pain & chaos Self medication Ape adults/seniors Style, glamour

4 Wide range of warning signs Unexplained weight loss Red eyes, nasal irritation Chronic cough, wheezing Blank, staring into space Needle tracks, scratch marks Poor short term memory Truancy, falling grades Conflict with parents, teachers, suspension Acute psychosis/ paranoia

5 Wide range of warning signs Risk taking behaviours Mood swings, depression, panic reaction Lying, stealing, promiscuity Altered sleep & appetite Poor hygiene Withdrawn, lack of interests Preferences for dress, music, movies identifying with drug culture

6 Co-morbidity ADHD (attention deficit hyperactivity disorder) Conduct Disorders Depression Anxiety PTSD Self harming behaviours psychosis

7 Attention Deficit Hyperactivity Disorder (ADHD) ADHD occurs in 3-5% of school age children. ADHD must begin before the age of seven and it can continue into adulthood. ADHD runs in families with about 25% of biological parents also having this medical condition Male : Female = 4:1 Impairment in three areas: –Attention –Impulsivity –Hyperactivity

8 Attention Deficit Hyperactivity Disorder (ADHD) Easily distracted Makes careless mistakes Forgetful Looses things, disorganised Unfinished work Trouble in listening Underachievers Disruptive, “naughty boys” Rash, impulsive “On the go”, fidgety Noisy/ interrupts

9 ADHD ……contd Persistent and Pervasive Develops from toddler hood Differential Diagnosis –Attachment Problems –Anxiety –Conduct Disorder –SLD Detailed Family and Development Hx

10 Conduct Disorders Persistent patterns of behaviours Aggressive –Fighting or bullying –Cruelty to animals/people –Severe tempers Dissocial –Lying and/or stealing –Fire setting –Destructiveness to property Defiant –Persistence severe disobedience –Truancy/running away from home –Provocative

11 Conduct disorders-contd. Associated Disorders ADHD Depression/Affective Disorder Specific Learning Disability Substance misuse Attachment problems

12 The Depressed Adolescent Behavioural problems –Lying, stealing –Violent outbursts –Truanting –Indiscriminate sexual behaviour Drugs & alcohol Fluctuating moods Increased irritability, anger, or hostility Risk taking behaviours Interpersonal conflicts Extreme sensitivity to rejection or failure Variety of physical complaints Poor performance in school Poor concentration

13 The Depressed Adolescent Frequent sadness, tearfulness, crying Feeling of emptiness Decreased interest in activities Low energy Socially isolated Low self esteem and guilt Change in eating and/or sleeping patterns Talk of or efforts to run away from home Thoughts or expressions of suicide Psychotic Features

14 The Anxious Adolescent Refusing to go to school Irritability and anger outbursts Fear of making mistakes/ “perfectionist” Seeking reassurance from peers Frequent stomach-aches, other physical complaints Overly clingy, panic Trouble sleeping or nightmares Phobias, Social anxiety Sense of doom Constant worries Low self esteem

15 Three main symptoms of PTSD 1.Intrusions- flashbacks & nightmares 2.Avoidance- attempt to reduce exposure to situations that bring back memories 3.Hyper-arousal- tension, hyper-vigilance and increased startle response

16 Effects of Trauma – Developmental Picture Pre-adolescence and Adolescence Nightmares and flashbacks Difficulty sleeping Anxiety & Depression Feeling detached or estranged Impulsive and aggressive behaviours Preoccupation with other concerns unrelated to the trauma Rebelliousness Risk-taking behaviours (drugs, alcohol, sex) Confusion with identity, roles and responsibilities

17 Suicide - High Risk Factors Acute embarrassment/loss Strong desire to die with lethal method in mind Older youth Prior attempts Male Major psychopathology Substance abuse High stressors Poor communication with adults/peers Poor family support

18 Warning Signs Hopelessness, helplessness Definite mood change Withdrawn Couldn’t care less attitude No planning for future High risk taking behaviours Severing of ties Completing certain tasks Cutting/scratching/drug abuse Writing notes

19 MANAGEMENT PREVENTION INTERVENTION

20 Protective Factors Nurturing environment Good communication Adult supervision Positive self-esteem Assertiveness Social competence Good education Good general health High intelligence Adult role models Religious/sense of morality

21 Four Rs of Working with Adolescents Responsible Respect Root Values Relationship

22 Keys to Successful Relationship Contact Congruence Positive Regard/Respect Empathy Perception

23 What is Normal? Rebellion Defiance Rudeness/talking back Mood swings Risk taking/experimenting Lying Crossing limits/breaking rules

24 What is Acceptable? Rebellion Defiance Rudeness/talking back Mood swings Risk taking/experimenting Lying Crossing limits/breaking rules

25 Boundaries Non-Negotiable Negotiable

26 Teenage Skills for Carers Genuineness Level of confidence Follow her lead Be comfortable with lingo Allow time for trust Highlight their interests and strengths Acknowledge vulnerability Stay connected to feelings Self disclosure Taboo subjects

27 Teenage Skills for Carers First Things First! Respect his/her uniqueness Build a supportive, caring and mutually respectful relationship Believe in their competencies

28 Loosen up but don’t let go Rigid /permissive Love & Limits go together Limits for protection & guidance not punishment /power Give reasons Firmness & flexibility Negotiate and resolve conflicts Renegotiate responsibilities and privileges Learn alternative strategies don’t be frustrated with failure Be consistent and firm


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