1. PCCYFS 2012 Annual Spring Conference Moving Toward Early Intervention in Adolescent Substance Abuse Presented by: Rachel Baker, MA, CAADC Molly Stanton, MS

2. PCCYFS 2012 Annual Spring Conference 2 Learning Objectives Understand scope of adolescent substance abuse today Identify risk factors for substance use Identify early warning signs of substance abuse in clinical and community settings Increase clinician’s understanding of important role of family in interventions for adolescent problem behaviors Acquire new skills to engage families of adolescents with substance abuse issues

3. PCCYFS 2012 Annual Spring Conference 3 What is addiction? Addiction is a primary, chronic brain disease of reward, motivation, and memory that can be fatal.

4. PCCYFS 2012 Annual Spring Conference 4 Tolerance: Use of substances increases in frequency and amount over time Difficulty controlling use: Using more or longer than intended Negative consequences: Continued use despite adverse consequences Neglecting other activities: Use often results in elimination of previously valued activities combined with increasing time and focus spent on obtaining or fantasizing about use Desire to reduce use: Generally coupled with an inability to consistently do so Withdrawal: When use ceases, symptoms of physical and psychological withdrawal can occur Characteristics of Addiction

5. PCCYFS 2012 Annual Spring Conference 5 Substance Abuse or Dependence?

6. PCCYFS 2012 Annual Spring Conference 6 Past month substance use

7. PCCYFS 2012 Annual Spring Conference 7 Past month substance use

8. PCCYFS 2012 Annual Spring Conference 8 Long-term Consequences For People Who Begin Using In Youth Biological- Probability of damage to multiple body systems Increased risk of serious addiction as an adult Increased risk of teen pregnancy or STDs Likely consequences for adult brain functioning related to memory, impulse control, anger Psychological- Increased probability of other mental health problems Increased risk of suicide Increased risk of trauma

9. PCCYFS 2012 Annual Spring Conference 9 Psychological Increased probability of other mental health problems Increased risk of suicide Increased risk of trauma Social Less likely to complete education Legal problems Difficulty in social functioning-acquiring or maintaining relationships Long-term Consequences For People Who Begin Using In Youth

10. PCCYFS 2012 Annual Spring Conference 10 How do teens view their use?

11. PCCYFS 2012 Annual Spring Conference 11 Perception of use continued

12. PCCYFS 2012 Annual Spring Conference 12 Why Do We Minimize Substance Use? Pregnancy Disease Legal consequences TBI or other injury Increased risk or assault or rape Death Just one instance of binge use can result in:

13. PCCYFS 2012 Annual Spring Conference 13 Risk Factors Which May Be Present Prior To Substance Use Biological –Early maturation in girls Psychological -Temperament/personality traits –Mental health issues –i.e., ADHD, Autism spectrum disorders, affective disorders –Impact of trauma

14. PCCYFS 2012 Annual Spring Conference 14 Risk Factors continued Social / Family –Poor parental supervision –Exposure to drug use in home or peer group –Engaging in peer system which condones use and associated consequences –Legal involvement –Poor interactions with teachers or peers in school or community settings

15. PCCYFS 2012 Annual Spring Conference 15 Early Signs Of Substance Use Family setting Withdrawal from family members or family activities Poor ADLs Weight loss/health problems Change in peer group Changes in hobbies or clubs/sports Sudden gains or losses of money for youth or household Systems or Clinical setting Legal involvement Changes in academic performance Frequent cancelling of appointments Lack of progression in mental health treatment or school/ systems assistance

16. PCCYFS 2012 Annual Spring Conference 16 Why Family Interventions For Adolescent Substance Use? Improved outcomes for clients whose families take part in therapy Improved engagement in services when parents or caregivers are involved in treatment Siblings may get secondary benefit from improved family relationships and parenting skills Peer group treatment alone tends to increase negative behaviors due to reinforcement of antisocial behaviors

17. PCCYFS 2012 Annual Spring Conference 17 Troubleshooting: Why Would Families Not Want To Be Involved? Cultural issues Systems engagement has been negative in the past Other family members’ mental health or substance use problems Lack of understanding of treatment goals Minimization of substance use or related consequences Work schedules-child’s or parents Childcare for younger siblings Transportation problems Other physical health, mental health or legal appointments

18. PCCYFS 2012 Annual Spring Conference 18 Breaking Down Barriers Understand the client’s practical barriers Know referral sources in your service area Facilitate ICM services when needed Be flexible with time or place of appointments when possible

19. PCCYFS 2012 Annual Spring Conference 19 Tips For Engaging The Family Seek goals that are relevant to the family’s needs Address cultural or systems issues directly and openly if necessary Provide addiction or mental health education Engage extended or non traditional family members with respect Aid families in viewing treatment as a means to increase positive behaviors, rather than punishment for negative behaviors

20. PCCYFS 2012 Annual Spring Conference 20 Build A Therapeutic Alliance Establish a positive rapport with parents and youth Encourage honest discussion Use a sense of humor Show empathy

21. PCCYFS 2012 Annual Spring Conference 21 Recovery Above all: Believe that change is possible and share that with clients.