Substance Abuse in Adolescence

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

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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

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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

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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• Withdrawn, lack of interests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

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Co-morbidity

• ADHD(attention deficit hyperactivity disorder)
• Conduct Disorders
• Depression
• Anxiety
• PTSD
• Self harming behaviours
• psychosis

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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 41
• Impairment in three areas
• Attention
• Impulsivity
• Hyperactivity

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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

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ADHD contd

• Persistent and Pervasive
• Develops from toddler hood
• Differential Diagnosis
• Attachment Problems
• Anxiety
• Conduct Disorder
• SLD
• Detailed Family and Development Hx

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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

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Conduct disorders-contd.

• Associated Disorders
• ADHD
• Depression/Affective Disorder
• Specific Learning Disability
• Substance misuse
• Attachment problems

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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

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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

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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

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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

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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

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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

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Warning Signs

• Hopelessness, helplessness
• Definite mood change
• Withdrawn
• Couldnt care less attitude
• No planning for future
• High risk taking behaviours
• Severing of ties
• Completing certain tasks
• Cutting/scratching/drug abuse
• Writing notes

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MANAGEMENT

• PREVENTION
• INTERVENTION

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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

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Four Rs of Working with Adolescents
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Keys to Successful Relationship

• Contact
• Congruence
• Positive Regard/Respect
• Empathy
• Perception

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What is Normal?

• Rebellion
• Defiance
• Rudeness/talking back
• Mood swings
• Risk taking/experimenting
• Lying
• Crossing limits/breaking rules

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What is Acceptable?

• Rebellion
• Defiance
• Rudeness/talking back
• Mood swings
• Risk taking/experimenting
• Lying
• Crossing limits/breaking rules

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Boundaries
Non-Negotiable
Negotiable
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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

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Teenage Skills for Carers

• First Things First!
• Respect his/her uniqueness
• Build a supportive, caring and mutually
  respectful relationship
• Believe in their competencies

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Loosen up but dont 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 dont be frustrated
  with failure
• Be consistent and firm