Factors Placing Border Youth at Risk of Substance Abuse and Traumatic Stress DDRAC Border Symposium Austin Texas , Au

1. Factors Placing Border Youth at Risk of Substance Abuse and Traumatic Stress DDRAC Border Symposium Austin Texas, August 4, 2009 Luis E. Flores, M.A., LPC, LCDC, RPT-S Executive Vice President Serving Children and Adolescents in Need Inc.

2. Juan’s Story

3. The Texas-Mexico Border • Distant Neighbors: Understanding La Frontera and Fronterizos • Isolation • Diversity within the border • Interactional dynamism • Duality • Third Culture • Stereotypes and impact on self-concept

4. Adverse Conditions • Poorest Areas in the State and Nation • High Teen Age Pregnancy rates • Low Educational Attainment • Strong Cultural Roots • Unique expressions of poverty • Poor service infrastructure • Medical self-treatment • In Webb County, 70% ever victimized, 20 to 50% victimized past year and over 20% victimized past 90 days • Co-Occurring Disorders

5. Shortage of Professionals (Ratio per 100,000 ) (Source: U.S. HHS, HRSA 2003) Hogg Foundation, 2008) (LCDC, Roster, Retrieved 07-15-09)

6. Substance Use Problems Among Border Students • High availability of cheap drugs, alcohol and prescription drugs • Higher Lifetime and past month use of tobacco, inhalants, cocaine, crack and Rohypnol • Higher current use of alcohol • Higher use of cocaine (and more pronounced in upper grades) • Three times more likely to report Rohypnol use • Source: Liu, L.Y, (2008). Adolescent substance use in Texas. Mental Health and Substance Abuse Services Division, Texas Department of State Health Services • Easier to obtain alcohol at parties (74% vs. 64%) and from a store (23% vs. 18) • Consider tobacco, alcohol, marijuana and steroids very dangerous but are less likely to consider cocaine, crack, inhalants and heroin as dangerous • Less likely to participate in multiple extracurricular activities • Source: Liu, L.Y, (2008). Texas school survey of substance use among students: grades 7-12: 2006. Mental Health and Substance Abuse Program Services, Texas Department of State Health Services

7. Youth in Need of treatment • Youth are at higher risk of victimization and traumatic experiences • Youth in residential care have more traumatic experiences, particularly females • Higher severity but less ability to access any type of service • Challenges in accessing continuing care • Barriers identifying and meeting family’s comprehensive needs • Barriers in providing integrated care for MH and substance abuse

8. Risk Factor: Community Violence • Drug wars not a new phenomenon • Violence affects general population • Border Violence and environmental safety • Border youth perceive less environmental safety in their neighborhood and at school (Liu, 2004) • Border becomes a cue for danger • Media Coverage • Conditions create higher risks for traumatic stress which is also a risk for substance abuse

9. Narco Cultura Santísima Muerte Narco Saint Narco Corridos

10. Child Traumatic Stress • Traumatic events overwhelm a child’s capacity to cope and elicit feelings of terror, powerlessness, and out-of-control physiological arousal. • Child traumatic stress= physical and emotional responsesto exposure to extreme threat, injury or death. • Re-experiencing • Increased Arousal • Avoidance • Mood regulation • Dissociation • Behavioral control

11. Traumatic Stress Types of Trauma Effects of Trauma Attachment Biology Mood regulation Dissociation Behavioral control Cognition Self-concept • Acute trauma • Chronic trauma • Complex trauma

12. Child Abuse and Child Traumatic Stress • When trauma is associated with the failure of those who should be protecting and nurturing the child, it has profound and far-reaching effects on nearly every aspect of the child’s life. • Response may have a profound effect on his/her perception of self, the world, and the future. • Traumatic events may affect children’s: • Ability to trust others • Sense of personal safety • Effectiveness in navigating life changes

13. The Link Between Trauma and Substance Abuse Traumatic stress and substance abuse frequently co-occur among adolescents.1, 2, 3 Trauma exposure can have serious consequences for the normal development of children’s brains, brain chemistry, and nervous system. Substance use in adolescence causes disruption of normal brain development (brain is not fully developed until age 24-25) 1. Kilpatrick et al., 2003; 2. Deykin & Buka, 1997; 3. Funk et al., 2003; 4. Diamond et al., 2006

14. Recommendations • Use available NCTSN products and expertise • It is an issue of resources • Increased understanding of the border • Research on border-specific risk and protective factors and development of culturally informed interventions • Increase understanding of trauma and attachment to foster trauma-informed systems and care • Foster and reward integration of services among systems