Understanding Adolescent Mental Health & Substance Use Disorders

1. The Young Brain: The Impact of Mental Health & Substance Use Jill S. Perry, MS, NCC, LPC, CAADC, SAP JP Counseling & Associates, LLC February 27, 2019

2. Objectives • Participants will understand the basic development of adolescents • Participants will recognize the signs and symptoms of mental health and substance use disorders in adolescents • Participants will develop skills to work with adolescents with co-occurring issues

7. Stigma JP Counseling & Associates, LLCHealing for Adults, Youth and Families

8. 5 Rules to Eliminate Stigma • 1) Don’t label people who have a mental illness or addiction • 2) Don’t be afraid of people with mental illness or addiction • 3) Don’t use disrespectful terms for people with mental illness or addiction • 4) Don’t be insensitive or blame people with mental illness or addiction • 5) Be a role model JP Counseling & Associates, LLCHealing for Adults, Youth and Families

9. Evolving Field of Co-occurring Disorders • Early association between depression and substance abuse • Growing evidence of impact on course of both illnesses • Treatment modifications can enhance effectiveness • Identification of mental health & substance use issues in adolescents

10. Evolving Field of Co-occurring Disorders • Bi-Directional • Dual Diagnosis • Co-occurring • ASAM • New Models and Strategies

11. Overview

12. Adolescents with SUD • Are largely undiagnosed • Are distributed across diverse health & social service systems • Have been adjudicated delinquent • Have histories of child abuse, neglect and sexual abuse • Have high co-morbidity with psychiatric conditions

13. Adolescents with SUD • 2.9 million adolescents currently use alcohol • Approximately 2.2 million adolescents (aged 12- 17) are current illicit drug users • Approximately 1.3 million adolescents have an Substance Use Disorder (SUD)

14. Young Adults (ages 21-25) w/ SUD • 68% of young adults are currently using alcohol **90% have used during lifetime • 19% of young adults are currently using illicit drugs **61% lifetime

15. Mental Health Statistics • More than 1 in 5 children/adolescents have a diagnosable mental health disorder • Approximately 2.6 million (10%) of adolescents have experienced a Major Depressive Episode in the past year • About 21% of children 9-17yo have mental health or substance use disorder with at least minimal impairment

16. Co-occurring Disorder Statistics • 1.4% of all adolescents have both SUD and a Major Depressive Episode • Adolescents with SED (serious emotional disturbance) are five times more likely to have an alcohol dependence problem than those without SED • 43% of youth receiving mental health (MH) treatment services have a COD • 90% with COD had one mental disorder prior to the onset of an SUD

17. Co-occurring Disorder Statistics • Rates of COD are approximately 50% for adolescents diagnosed with either a mental health disorder or SUD • Among young adults ages 18-25 with a serious mental illness, 48% report past-year illicit substance use, and 36% meet criteria for a SUD • 36% of all adults with COD are ages 18-25 years

18. COD and Juvenile Justice • Nearly 2/3 of incarcerated youth with substance use disorders have at least one other mental health disorder. • As many as 50% of substance abusing juvenile offenders have ADHD.

19. COD and Juvenile Justice • Among incarcerated youth with substance use disorders, nearly 1/3 have a mood or anxiety disorder. • Those exposed to high levels of traumatic violence might experience symptoms of posttraumatic stress which correlates with increased rates of substance abuse.

20. Traumatic Victimization Adolescents in SUD Treatment: • 40-90% have been victimized • 20-25% report in past 90 days • concerns about reoccurrence Associated with higher rates of - Risky behaviors - Substance use - Co-occurring disorders

21. Implications for Practice • Systematically screen • Train staff how to respond • Incorporate information into placement decisions • Address staff concerns

22. Implications for Practice • Addressing trauma is complex • Person may be victim and abuser • Track trauma in diagnosis and for program planning

23. Sources of Adolescent Referrals Source: Dennis, Dawud-Nourski, Muck & McDermeit, 2002 and 1995 Treatment Episode Data Set (TEDS)

24. Level of Care at Admission Source: Dennis, Dawud-Nourski, Muck & McDermeit, 2002 and 1995 Treatment Episode Data Set (TEDS)

25. Multiple Co-occurring Problems Are the Norm and Increase with Level of Care

26. Best Practice Model to Provide Treatment for Co-occurring Disorders

27. Traditional Approaches • Sequential - One disorder then the other • Parallel - Treated simultaneously by different professionals

28. Six Guiding Principles (SAMHSA, TIP 42) • Employ a recovery perspective 2. Adopt a multi-problem viewpoint 3. Develop a phased approach to treatment

29. Six Guiding Principles (SAMHSA, TIP 42) 4. Address specific real-life problems early in treatment 5. Plan for cognitive and functional impairments • Use support systems to maintain and extend treatment effectiveness

30. Delivery of Services • Provide access • Complete a full assessment • Provide appropriate level of care • Achieve integrated treatment - Treatment Planning and Review - Psychopharmacology

31. Delivery of Services Provide comprehensive services - Supportive and Ancillary Wrap Services • Ensure continuity of care - Extended Care, Halfway Homes and other housing alternatives

32. Vision of Fully Integrated Treatment • One program that provides treatment for both disorders. • Mental and substance use disorders are treated by the same clinicians. • The clinicians are trained in psychopathology, assessment, and treatment strategies for both disorders.

33. Vision of Fully Integrated Treatment • The focus is on preventing anxiety rather than breaking through denial. • Emphasis is placed on trust, understanding, and learning. • Treatment is characterized by a slow pace and a long-term perspective. • Providers offer stagewise and motivational counseling.

34. Vision of Fully Integrated Treatment • Supportive clinicians are readily available. • 12-Step groups are available to those who choose to participate and can benefit from participation. • Pharmacotherapies are indicated according to clients’ psychiatric and other medical needs.

35. ADOLESCENT DEVELOPMENT

36. GET OUT OF MY LIFE!!!... But first could you... You call this NORMAL!

37. Summary of Adolescent Development • Adolescence is a profound period of developmental transformation • Adolescence is defined by fundamental biopsychosocial state changes

38. Summary of Adolescent Development • Successful navigation toward young adulthood requires sufficient accomplishment of a number of specific developmental tasks associated with the fundamental changes • Each adolescent represents a unique combination of biopsychosocial competencies, resiliencies, vulnerabilities and challenges

39. Summary of Adolescent Development • The potential to meet, negotiate, work through, adapt and emerge successfully is greatly influenced by presence or absence of: - Strong family ties/support - Education - Formal and Informal - Clear and consistent values - Moral development - extending the capacity for ethically directed choices and behavior - Spiritual centeredness as it is individually conceptualized and understood

40. Adolescence: A “Normal” Developmental Perspective • Puberty and Physiological Change (Tanner) • Separation / Individuation (Mahler, Blos) • Identity Formation and Autonomy (Erickson) • Cognitive Development - “Formal Operational Thinking” (Piaget)

41. Adolescence: A “Normal” Developmental Perspective • Shift from Parental / Family authority to Peer Group authority • Moral Development (Kohlberg, Kagan, Bandura, Gilligan) • Transition and Transformation - The road to Adulthood

42. Physical Adolescent Developmental Changes (Early, Middle & Late) • Hormonal & Growth Changes • Acne • Menstruation • Breast development • Shape Changes • Spontaneous Erection • Nocturnal Emissions

43. Physical Adolescent Developmental Changes (Early, Middle & Late) • Voice Changes (cracking) • Body Odor • Rapid growth • Disproportionate Growth • Emergence of sexual feelings and drives • Brain maturation

44. Cognitive (Thinking) Changes • Shift from “Concrete to Formal Operational” thinking capacity with the emergence of abstract and conceptual processes • Omnipotence & Omniscience (Terminal Uniqueness) • Meta-Cognition (the ability to think about ones thinking) • Egocentricity (Early-Middles)

45. Social Changes • Family authority versus Peer Authority • Onset of parent / child conflict (Ex. Backtalk) • Challenges to parental knowledge and rules • Comparisons to “Everyone else’s Parents” • Increased Demands for the “right” fashion trend(s) • Apparent disregard for once held family values/priorities in favor of peer values and priorities

46. Teen Brain: Under Construction (video)

47. Characteristic Behaviors and Attitudes • Role Experimentation • Practicing • Questioning & Challenging • Peer bonding • Here & Now focus • Sense of Invulnerability

49. Challenges to “Normal” Adolescent Development • Genetic Vulnerabilities / Predispositions / Risk Factors • Family History of: • Substance Use Disorders • Psychiatric / Psychological Disorders • Learning Disorders • Other Cognitive/Developmental Disorders

50. Challenges to “Normal” Adolescent Development • Environmental Vulnerabilities / Risk Factors • Parent / Family / Caretaker Dysfunction • Inconsistency / Instability • Lack of Clear Values, Expectations and Boundaries • Absence / Uninvolved • Over Involvement / Over Indulgent • Frequent Relocation