1. Virginia Summer Institute for Addiction Studies July 11, 2016 Malcolm V. King MS CSAC Child and Family Program Specialists Virginia Department of Behavioral Health and Developmental Services

2. Session Objectives Participants will become familiar with the current state and national trends related to adolescent use of illegal drugs Participants will become familiar with adolescent brain development and drug use Participants will review strategies on how to overcome challenges in developing an appropriate substance use treatment plan for adolescents Participants will receive information on developing and implementing effective strategies in engaging and providing treatment services for adolescents affected by substance use disorders.

3. Adolescent Substance Use National Trends 44,892 students participated in MF 2015 survey 68.1% of high school seniors do not view regular THC use as harmful 71% disapprove of regular THC use Daily marijuana use exceeded daily tobacco cigarette use among 12th graders Past year use of heroin, is at an all-time low at 0.3 percent for eighth graders, and 0.5 for 10th and 12th graders Monitoring The Future Survey – 2015 Survey Results

4. Adolescent Substance Use National Trends - Continued Use of ("synthetic marijuana") declined 6.2% since 2011 Heroin use is at an all time low among 8-12 th graders Prescription opioids continues a downward trend Most teens reported getting opioids from friends or family members. One-third report getting them from their own prescriptions Monitoring The Future Survey – 2015 Survey Results

5. Adolescent Substance Use State Trends 7,809 received services through the CSB 53.4% presented with a co-occurring mental health diagnosis 2,191 treated for opiate use as primary diagnosis 28% overall treated with opiate use

6. Factors Leading to Substance Use Disorders Environment Heredity Drug UseDevelopmental Immaturity Mental Health Issues Drug Influenced Lifestyle Family Attitude

8. Adolescent Substance Use Treatment Critical Treatment Challenges 1. Brain not fully developed 2. Adolescent brains are biologically wired to take risks 3. Inherited genetic vulnerability 4. Thoughts of “drug use is cool and harmless” 5. The culture of substance use in the family

9. Vocational Services Mental Health Screening Medical Services Testing Ongoing Educational Services Family & Natural Support Involvement Legal Services Primary Treatment Screening Assessment Direct Treatment Substance Use Monitoring Support Services & Continuing Care Life Skills Services

10. Overcoming Treatment Challenges Overarching Principles of Care 1. Developmentally Appropriate Care 2. Cultural and Gender Competence 3. Trauma-informed Care Approach 4. Family Centered and Youth Guided Care 5. Utilization of Best Practice Models

11. Treatment Considerations Treatment Process is developmentally relevant 1. Age Consideration 2. Maturation 3. Cognitive Processing 4. Special Needs Develop systems collaboration among local youth-serving agencies Consider a Recovery-Oriented Systems of Care Approach Screen for substance use and co-occurring mental health disorders

12. Essential Service Elements 1. Screening, Assessment, and Treatment Planning 2. Medication-Assisted Withdrawal 3. Direct Treatment Services 4. Recovery Support Services

13. Screening, Assessment, and Planning Screening – The first step toward making recommendations for an assessment and/or interventions. Assessment – Used to identify the level of severity of use and the appropriate level of care needed Treatment and Recovery Planning – Serves as roadmaps for treatment and recovery support service delivery.

14. Sometimes referred to as detoxification Usually provided in an inpatient setting but ambulatory detoxification may be considered Only trained professionals should administer and monitor withdrawal through medication. Medicated Assisted Withdrawal

15. Direct Treatment Services Considerations Levels of Care are determined by the assessment Treatment is gender specific, being sensitive to: Unique developmental needs of males and females Unique needs of LGBTQ community Family members or natural support partners involved in all aspects of treatment All services are to be grounded in Best Practice Models

16. Recovery Support Services Adolescent Recovery Support includes: 1. Continuing Care and Support 2. Continuing Education Services 3. Prosocial Activity Involvement 4. Vocational Services 5. Housing Assistance 6. Parenting Assistance 7. Peer Mentoring/Recovery Coaching

17. References SAMSA’s National Registry of Evidence-based Programs and Practices - http://nrepp.samhsa.gov/01_landing.aspxhttp://nrepp.samhsa.gov/01_landing.aspx Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide - National Institute of Drug Abuse Publication Number 14-7953 January 2014 NASADAD - State Adolescent Substance Use Disorder Treatment and Recovery Practice Guide – September 2014 Monitoring The Future Survey – 2015 Survey Results

18. Malcolm King, MS CSAC Department of Behavioral Health and Developmental Services Phone (804) 371-4604 malcolm.king@dbhds.Virginia.gov

19. Thank You !!! Any Questions