SUBSTANCE ABUSE

1. SUBSTANCE ABUSE RISK FACTOR FOR HIV/AIDS ACQUISITION IN JAMAICAN ADOLESCENTS W. De La Haye, MD, MPH, DM Department of Community Health and Psychiatry The University of the West Indies Mona Campus

2. Introduction • Substance abuse reduces inhibitions and encourages engagement in high risk sexual behaviours • ¹Substance abusers are disproportionately affected by the AIDS epidemic • ²Young users - much greater network and behavior risk for sexually transmitted diseases and have more sex partners ¹Sorensen et al., July 2002. Science and Practice Perspectives, NIDA 1(1): 4-11 ²Blum, R.W., Center for Adolescent Health, University of Minnesota

3. Introduction • ¹Prevalence of HIV among US drug users entering treatment ranges from 0 – 35% • Intravenous drug use (IDU) is a factor in 1/3 of all AIDS cases in the US • More than 1/2 of new HIV infections 1. Murrill et al., 2001. Journal of Urban Health 78(1):152-161

4. HIV in Jamaica • Concentrated epidemics • HIV prevalence rates in Jamaica are high among those with high risk behaviors: Homo/bisexual males 25% Commercial sex workers 10 – 20% Prisoners 12% STI clinics 6% Ministry of Health, Jamaica, 2001. HIV Surveillance Data

5. Reported risk behavior % N = 4706 National HIV/STD prevention and control program. Jamaica HIV/AIDS epidemic update 2004

6. Reported risk behavior 9% (2002) (2003) % Deported offenders ----------- N = 4706 National HIV/STD prevention and control program. Jamaica HIV/AIDS epidemic update 2004

7. 11.8 % (15 / 127) 5 % 3.9 % (45 / 903) (30 / 776) OR F:M 3.3 HIV seroprevalence (%) by gender % * De La Haye W. World Psychiatric Association “Advances in Psychiatry”, Abstract Issue, March 2005: 190

8. HIV risk factors associated with substance abuse • Risky sexual behavior - selecting sexual partners from similar networks - sex for drugs - unprotected sex - bisexuality, homosexuality - early intercourse (<13 y.o.) • Crack cocaine use • Unemployment • Marijuana smoking before sex

9. Adolescence • Transitions from one developmental stage to another are vulnerable periods • High risk for substance abuse - cognitive, attitudinal, personality, behavioral, social, environmental, genetic • Experimentation and recreational use of alcohol, cigarettes, cannabis

10. Comorbid illnesses • Depression • Conduct disorder • ADHD • ODD

11. Risk factors for S A • Greater potential for drug use - Ineffective parenting - Unstable home environment - Poor nurturing in childhood - Poor social coping skills - Affiliation with deviant groups - Drug trafficking - Availability

12. Protective factors against S A • Reduced potential for drug use - Strong family bond - Schools prevention programs - Religious organizations - Parental monitoring of children - Knowledge of conventional norms about drug use - Awareness of personal and community hazards of drug use

13. Impact of risk and protective factors • Function of stage of psychological and social development of an individual • Exposure, experimentation, recreational use, regular use and subsequently dependence • *Early initiation of alcohol, tobacco and illicit drug use among adolescents is a strong predictor of subsequent drug dependence *Wagner, F. A., Anthony J. C. 2001: American Journal of Epidemiology; 155(10):918-925.

14. Age profile of population (%)

15. % N = 8000, 63 schools, grades 9 - 13 National Schools’ Drug Survey, 1987, 1997. NCDA National Schools’ Drug Survey, 1987, 1997

16. % N = 8000, 63 schools, grades 9 - 13 National Schools’ Drug Survey, 1987, 1997. NCDA National Schools’ Drug Survey, 1987, 1997

17. % N = 8000, 63 schools, grades 9 - 13 National Schools’ Drug Survey, 1987, 1997. NCDA

18. SITE:Adolescent Drug Free Outpatient Clinic at the Assessment, Detoxification and Early Rehabilitation Unit (DETOX) • SAMPLE:Adolescent substance abusers presenting for treatment • PERIOD:January 2004 – January 2005 • METHOD: Retrospective chart extractions

19. (n = 96) % (n = 7) N = 103, p = 0.000 Gender distribution

20. Age distribution % Years N = 103, Mean age 15.4 + 1.74 years, range 10 – 18 years, p = 0.000

21. Parish of residence % N = 103, P = 0.000

22. % N = 103, P = 0.000 Living arrangement

23. % Stressor

24. % Stressor

25. N = 103, P = 0.000 Mode of referral %

26. % N = 103 Substances abused

27. % N = 103 Substances abused

28. % N = 103 Substances abused

29. % N = 103 Substances abused

30. % N = 103, P = 0.000 Pattern of substance abuse

31. % N = 103 Drug of onset

32. % N = 103 Drug of onset

33. % N = 103 Drug of onset

34. % N = 103 Drug of onset

35. % N = 103, P = 0.000 Introduction to first use

36. Age of onset % Years Mean age of onset 13 ± 1.8 years, range 7 – 16 years, p = 0.000

37. Dependentsubstances AdultsCohort 2 Abused substancesAdolescentsCohort 1 % % N = 103 Range 10 – 18 yrs. N = 150 Range 21 – 55 yrs.

38. Discussion • There is early age of onset in this cohort of adolescent substance abusers • Peers play a significant role in the introduction of adolescents to their first use of a drug • Schools and mothers play a significant role in referring these clients for treatment

39. Implications of early onset • The age of initiation of alcohol, tobacco and illicit drug use among adolescents is a strong predictor of later drug problems, especially when use begins before age 15 years • Research shows that for females tobacco use and for males alcohol is a strong predictor of other drug use

40. Cannabis use in Jamaican adolescents • Potentially catastrophic implications • With regards to cocaine exposure opportunities and sexual practices • Parental supervision can help in disrupting drug exposure opportunities • Address self-awareness leading to healthy lifestyle choices

41. Cannabis use in Jamaica • Educate children about the potential consequences of cannabis abuse • Ganjacanmake you mad! • Why take achance? • Smoking anything is hazardous to your health!

42. Aim of education • Provide students, teachers and families with accurate information about drug abuse, addiction and association with high risk sexual behaviour • Reduce exposure opportunities • Break the chain of experimentation, regular use, abuse and dependence

43. Outcome • Stops drug use before it starts • Reduces violence associated with drug use / distribution • Reduces load on treatment system • Reduces load on criminal justice system • Reduces lost productivity • Reduces acquisition and transmission of STIs (HIV/AIDS)

44. Role of exposure • Parents, paediatricians and GPs must ask kids about chances to try illegal drugs • Kids more likely to talk about their chances to try than their use • Once there is a chance, it should raise a RED FLAG!

45. Role of prevention • Drug abuse is a preventable behaviour • Drug addiction is a preventable disease • Substance abusers are more likely to engage in high-risk sexual activities • Substance abuse prevention in adolescents is HIV prevention

46. Role of prevention • The presence of risk factors and absence of protective factors in adolescents lead to increased “Exposure Opportunity” to substances of abuse • Prevention programs must focus on reducing “Exposure Opportunities” to substances of abuse in Jamaican adolescents • Implement prevention programs as early as kindergarten!!!

47. Conclusion • Role of drug treatment programs in preventing acquisition and transmission of HIV / AIDS • The results endorse the need to screen for HIV in all substance abuse treatment facilities in Jamaica • Conduct research to improve understanding of the interrelationship between non-IV substance use and high risk sexual behaviour

48. Summary • Substance abuse prevention is HIV prevention • Reducing the gap between substance abusers needing treatment and prevention and those getting help • Reduce the risk of risky sexual behaviour associated with substance abuse

49. Caution • Use of any mood altering substance (including legal ones) can result in risky sexual behaviour • One does not need to be chemically dependent to have risk associated with their drug use!

50. Our fight against drug use is a fight for our children’s future!!!