Medicine Cabinet to Heroin Addiction: a brief and deadly journey

The Problem

• 1 in 5 teens has abused Rx drugs.• 1 in 3 teens reports there is “nothing wrong”

when using Rx drugs “every once and a while.”

• 1 in 3 teens report knowing someone who abuses Rx drugs.

• Every day, almost 2,500 teens abuse a prescription drug for the first time.

• Prescription drugs are abused more than cocaine, heroin, ecstasy and methamphetamine combined.

What is Rx drug abuse?• The misuse of Rx drugs is a growing, under-recognized problem that puts

young lives at risk.

• Misuse includes:

• Rx drugs serve an important purpose when used under a doctor’s care.

• Misuse can lead to overdose, addiction and even death.

Why Are Teens Abusing Rx Drugs?

• They’re easy to get• Thrill seeking • Friends are doing it• Escape problems or self-medicate • Lack of self-esteem• Seen as safer alternative with fewer side

effects• Less stigma associated with Rx drugs• Parents less likely to disapprove

Other Factors Driving Trend: Accessibility

• Rx medicines can be found in homes of family or friends.

• Many parents aren’t aware of the dangers.

• Many parents do not know how to effectively talk with their children about Rx drug abuse.

Other Factors Driving Trend: Invincibility

• Teens mistakenly believe:• It’s safer to abuse Rx drugs than illicit drugs,

even if they’re not prescribed by a doctor.• Rx drugs have fewer side effects and are not as

addictive.• It’s okay to share these drugs.

Other Factors Driving Trend: Pill-Taking Society

• Rx medications are all around us…and teens notice.

• Patients leave the doctor’s office with a prescription in hand in 7 out of 10 visits.

• Direct-to-consumer advertising on TV and in magazines.

• Many people don’t know how to safely use these medications or ignore their doctor’s instructions.

Where Do Teens Get These Drugs?

Source: SAMHSA, 2008 National Survey on Drug Use and Health

All People who use substances are at risk for two types of problems

Impairment Problems

Addiction Problems

Addiction Problems

Social Factors Psychological Factors

Biology

+Quantity & Frequency Choices

=Addiction

No Addiction

Unhealthy Risks...Vs.

....Healthy Risks

Multiple Contexts/Domains

IndividualFamilyCommunity(School/Work)Society(Community)

Substance Abuse and Mental Health Services Administration’s Center for the Application of Prevention Technologies contract. Reference #277-08-0218.

This is Your Brain on Adolescence

Resource for presentations to parents

Tammy Rhein LMSW, CASAC, CPPDirector of Mental Health and Chemical

DependencyOrange County Department of Mental Health

Source:Ken Winters, Ph.D.

winte001@umn.eduDepartment of Psychiatry

University of Minnesota2011

New insights about:

• Risk taking by teenagers

• How teenagers may be highly vulnerable to drug abuse

Emerging Science:Teen Brains Are Still “Under Construction”

Emerging Science:Brain Imaging

New insights because:

• 1990’s information explosion due to the development of brain imaging techniques (e.g., CT, PET and MRI).

• Adolescence is a period of profound brain maturation.

• We thought brain development was complete by adolescence

• We now know… maturation is not complete until about age 25!

What Have We Learned?

Source: Giedd, 2004.

Brain Development

When the pruning is complete, the brain is faster and more efficient.

But… during the pruning process, the brain is not functioning optimally.

Source: Giedd, 2004.

Brain Development

Maturation Occurs from Back to Front of the Brain

Images of Brain Development in Healthy Youth (Ages 5 – 20)

Blue represents maturing of brain areas

Source: Gogtay, Giedd, et al., 2004.

Alcohol, tobacco and other drug use starts early and

peaks in the teen years

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Infant Teen Adult Older AdultChild

Evidence from surveys

• There is also the need to educate parents – both because they better explain adolescent behavior and because they present cautionary signs that parents may want to heed.

• If the seemingly irresponsible behaviors of teens are not truly willful acts but are the result of the brain still “under construction,” parents will want to be more tolerant of such annoying behaviors common during adolescence.

Opportunities for Parents

• Rather than the message: • “I need to know where you are and

who you are with.”

• Use this more scientifically justified message is: • “Let’s discuss how you are going to

handle a risky situation.”

Opportunities for Parents

Take Home for ParentsPromote activities that capitalize on the strengths of the developing

brain

Assist your child with challenges that require planning

Reinforce their seeking advice from you and other adults

Encourage lifestyle that promotes healthy brain development

Never underestimate drug effects on developing brain

Tolerate “oops” behaviors common during the teens

1. Many opportunities for conventional involvement, positive family involvement

2. Good impulse control3. Follows rules and avoids delinquent peers4. Negative attitudes toward drugs5. Low availability of drugs6. High commitment to school7. High perceived risk of drug use8. Rewarded for involvement in conventional activities9. Family attitudes do not favor drug use10.Family is close

Key Protective Factors that Improve the Likelihood of a Drug-Free Child

Take Home for Parents

Adolescent signs of Substance Use:

Change s in appetite or sleep patterns

Deterioration of physical appearance .

Withdrawal from social or important activities

Unexplained need for money or secretive about spending habits.

Sudden change in friends or locations.

Take Home for Parents

Adolescent signs of Substance Use:

Increased interpersonal or legal problems.

Change in personality or attitude

Neglecting responsibilities.

Using despite knowing it is dangerous.

Description of Opioid Intoxication:

Opioids can stop a person’s breathing and, in rare cases, lead to heart rhythm abnormalities (QT prolongation and torsades de pointes).The duration of action of opioids varies. Close monitoring is required when a person overdoses on long-acting opioids, especially methadone.Early warning signs:

1. drowsiness with “nodding off” or falling asleep when left alone for a few minutes

2. conjunctival injection

3. euphoria.

Description of Opioid Intoxication cont.:

Diagnosis: Opioid intoxication should be suspected in patients presenting with the following clinical triad:1. depressed level of consciousness,2. respiratory depression, and3. pupillary miosis (“pin-point pupils”). However, pupillary miosis not always present.Even if patients appear alert for brief moments, they must be monitored by a health professional as the progressive nature of overdose may lead to death, especially when patients fall asleep. Opioids prolong GI transit times, causing delayed and prolonged absorption of ingested opioids.Note that if the person uses opioids orally or by snorting there will be no needle marks.

Take Home for Parents

Signs of opiate withdrawal:

Early symptoms of withdrawal include:

Agitation Anxiety Muscle aches Increased tearing Insomnia Runny nose Sweating Yawning

Late symptoms of withdrawal include:

Abdominal cramping

Diarrhea

Dilated pupils

Goose bumps

Nausea

Vomiting

Paraphernalia

Proper Disposal

• New York State Police – Anytime

• Orange County Sheriffs Dept. – Business Hours

• Semi Annual DEA drop-off events – Check with local Law Enforcement or Substance Abuse Coalition

• Hospitals - Check with your local Hospital

Treatment Modalities

Detoxification: Monitored Withdrawal• Medically Managed (Hospital)• Medically Monitored (Crisis Center)

Inpatient Rehabilitation: Short term intensive inpatient experience / Long Term treatment

Day Treatment (Day Rehab): Day-long treatment, activities, multiple days, outpatient

Intensive Outpatient: Multiple sessions per week, individual & group therapy

Treatment Modalities (cont.)Outpatient Clinic: Occasional treatment sessions,

one- three times per week

Residential: • Half-way house• Supportive living

Self-help, support groups, twelve-step

www.adacinfo.com

Recovery Coaching: