Chemical and the Neonate

1
Chemical and the Neonate

• Chapter 20

2
Fetal Alcohol Exposure and the Brain

• describes a pattern of birth defects found in
  children of mothers who consumed alcohol during
  pregnancy
• Today, FAS remains the leading known preventable
  cause of mental retardation
• Behavioral and neurological problems associated
  with prenatal alcohol exposure may lead to poor
  academic performance as well as legal and
  employment difficulties in adolescence and
  adulthood
• Despite attempts to increase public awareness of
  the risks involved, increasing numbers of women
  are drinking during pregnancy (NIAAA National
  Institute on Alcohol Abuse and Alcoholism)

3
Scope of the Problem

• A period of special vulnerability
• 60 of the blood that the fetus receives from the
  umbilical cord is processed by the liver before
  it proceeds to the rest of body
• In the US
• 19 of women will use alcohol
• 20 smoke cigarettes
• 5.5 use illicit drugs
• At some point during pregnancy

4
Definitions and Incidence

• FAS is defined by four criteria maternal
  drinking during pregnancy a characteristic
  pattern of facial abnormalities growth
  retardation and brain damage, which often is
  manifested by intellectual difficulties or
  behavioral problems (3). When signs of brain
  damage appear following fetal alcohol exposure in
  the absence of other indications of FAS, the
  condition is termed "alcohol-related
  neurodevelopmental disorder" (ARND) (3). NIAAA

5
Specific Cognitive and Behavioral Impairments

• Attention.
• Visual-Spatial Learning spatial relationships
  among objects
• Verbal Learning language and memory
• Reaction Time how quickly the brain processes
  information
• Executive Functions (i.e., activities that
  require abstract thinking, such as planning and
  organizing).

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Other effects

• Page 262

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fetal alcohol spectrum disorders (FASDs)

• has emerged to address the need to describe the
  spectrum of disorders related to fetal alcohol
  exposure. It is an umbrella term describing the
  range of effects that can occur in an individual
  whose mother drank alcohol during pregnancy.
  These effects can include physical, mental,
  behavioral, learning disabilities, or a
  combination of these, with possible lifelong
  implications.

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FAS

• FAS is a permanent condition. It affects every
  aspect of an individuals life and the lives of
  his or her family. However, FAS is 100
  preventableif a woman does not drink alcohol
  while she is pregnant.

9
Is there any safe amount of alcohol to drink
during pregnancy?

• There is no known safe amount of alcohol that a
  woman can drink during pregnancy. There is also
  no safe time during pregnancy to drink alcohol.
  Alcohol can have negative effects on a fetus in
  every trimester of pregnancy. Therefore, women
  should not drink if they are pregnant, planning
  to become pregnant, or could become pregnant
  (that is, sexually active and not using an
  effective form of birth control).

10
Refer to breakout sessions for other drugs

• Cocaine
• Amphetamine
• Opiate
• Marijuana
• Cigarettes

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Special Populations

• CHAPTER 21

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Hidden Faces

• Women
• Elderly
• Homosexuals
• Disabled
• Ethnic Minority

13
Buzz Session

• Count your points only if your group answers the
  following
• 1. scope of the problem
• 2. Impact of the use of chemicals
• 3. Treatment considerations
• 4. What are the barriers you think that an
  individual in your identified group faces in
  treatment

14
Chapter 23

• CHEMICAL USE BY CHILDREN AND ADOLESCENTS

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CONSEQUENCES

• WHAT ARE SOME OF THE LIFE LONG CONSEQUENCES OF
  CHILDHOOD OR ADOLECENT DRUG/ALCOHOL USE?

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Problem

• 80 of 18 yr. olds have used alcohol at least
  once
• 4 use regular
• 66 of 18 yr. olds have tried cigarettes
• 13 smoke at least ½ pack per day

17
Special vulnerability

• Those that use in adolescence are at greater risk
  to become addicted
• 16 of children who experiment with marijuana
  before that age of 12 will go on to use heroin,
  compared to only 8 of those whose first
  marijuana exposure is after the age of 12
• Attachment bonds help protect them from addictions

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Controversy

• Some believe any use is a serious problem
• Others believe that experimental use is a part
  of adolescence
• What do you think?
• Page 305

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Scope of the problem

• Estimate nationally that 800,000 adolescents
  between 12 and 17 are thought to be addicted to
  an illicit drug
• Alcohol is popular-parental denial
• 45 of older than 12 admit to using alcohol at
  least once in the past 30 days

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Why worry?

• Brain still developing
• Gateway drug theory

21
Tobacco Use

• Avg. age a smoker begins is age 12
• Which are regular smokers at age 14
• In US avg. of 6,000 adolescents start smoking
  every day, ½ become daily users
• 1997 major lawsuit
• Parental influence
• Victimization theory
• Rebellion

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Tweed (1998) symptoms of adolescent SA problem

• Weight loss
• Nasal irritation
• Frequent colds or allergies
• Hoarseness
• Chronic cough
• Unexplained injuries
• Needle tracks
• Social withdrawal
• Promiscuity
• Fights
• Hiding bottles.drug paraphernalia
• Selling possessions
• Legal problems
• Drastic change in sleep patterns

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Problems with diagnosis

• Standards for diagnosis and treatment are
  primitive and there is little research done
• Referrals for evaluation often come from juvenile
  court system, schools
• Many of the evaluations are done by the treatment
  center and not an independent evaluator
• Adolescents tend to have immature view of life,
  fatalistic-misinterpreted by treatment staff as
  denial

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Diagnosis

• Stages page 314
• Criteria page 317