1 / 102

Asking about Substance Use in the Biopsychosocial Interview

Asking about Substance Use in the Biopsychosocial Interview. Charles E. Irwin, Jr., M.D. Division of Adolescent/Young Adult Medicine Department of Pediatrics UCSF Benioff Children ’ s Hospital University of California, San Francisco January 2014. Disclosure.

kimn
Download Presentation

Asking about Substance Use in the Biopsychosocial Interview

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Asking about Substance Use in the Biopsychosocial Interview Charles E. Irwin, Jr., M.D. Division of Adolescent/Young Adult Medicine Department of Pediatrics UCSF Benioff Children’s Hospital University of California, San Francisco January 2014

  2. Disclosure • Neither I nor any member of my immediate family has a financial relationship or interest with any proprietary entity producing health care good or services related to the content of this CME activity • My content will not include discussion/reference to any commercial products or services • I do not intend to discuss an unapproved/investigative use of commercial products/devices

  3. Overview of Presentation • Adolescent Health • Risk taking • Review of substance use by age and trends • Adolescent Development & how it fits with substance use • Clinical practice

  4. Adolescent Health Substance use Accidents & injury Mental health & well being Sexual health Chronic illness Obesity & eating disorders Prevention - early intervention - clinical care

  5. Risk Taking – Background • Majority of morbidity/mortality during adolescence is preventable • Behaviors/Disorders responsible for leading causes of morbidity/mortality during adolescence & adulthood - initiated or onset during second decade of life • Co-occurrence of risk behaviors is common

  6. Leading Causes of Death in U.S.: Ages 10-19 & Ages 25-44, 2010 Source: National Center for Injury Prevention & Control, WISQARS database, 2012

  7. Risky Behaviors During Adolescence

  8. Specific Behaviors & Outcomes • Substance Use: Habituation & Trauma • Sexual Activity: STI’s & Pregnancy • Injury Related Behavior: Trauma & Disability • Eating Behaviors: Eating Disorders, Obesity & Chronic Physical & Mental Health Disorders • Mental Health Disorders: Disability

  9. Health Risk Behaviors - Trends Arrows denote trends in prevalence over past decade

  10. Covariation of Behaviors • Injury-related Behavior & Substance Use • Violent behaviors & Substance Use • Substance Use/Substance Use - Sequence & Developmental Trajectory by Gender • Sexual Behavior & Substance Use • Eating Behaviors & Other Risk Behaviors (including Substance Use) • Certain Behaviors as Markers (e.g., Sexual Activity, Substance Use, etc.)

  11. Single & Multiple Risk-Taking Among 7th-12th Graders, by Behavior 5% 7% 11% 11% 14% Source: Urban Institute, 2000, analysis of 1995 Add Health data

  12. Covariation of Risk Behaviors Among Adolescents (% of Sx, N=1241) * Dangerous vehicle users include subjects who reported driving or riding in vehicles when the driver is under the influence of alcohol or other substances. Source: Irwin et. al. 1998

  13. Covariation of Behaviors Summary of Covariation of Behaviors • High Prevalence Rate • Early Age of Onset • Gender Specificity • Peers/Family • Behaviors/Not Isolated

  14. Overview of Substance Use • Substance Used • Marijuana • Tobacco • Alcohol • Smokeless Tobacco • Nonmedical Use of Prescription Drugs • By Age Group (MTF data) • 8th, 10th & 12th graders

  15. Sources of Substance Use Data

  16. Source: Monitoring the Future, 2012; NSDUH,2011

  17. Source: Monitoring the Future, 2012; NSDUH,2011

  18. Source: Monitoring the Future, 2012; NSDUH,2011

  19. Source: Monitoring the Future, 2012

  20. Source: National Survey on Drug Use and Health, 2011

  21. By 8th grade • Cigarettes: 16% • Alcohol: 30% • Been Drunk: 13% • Marijuana: 15% • Smokeless Tobacco: 8% • Prescription Drugs: 4.% Source: Monitoring the Future, 2012; NSDUH, 2011

  22. By 10th grade • Cigarettes: 28% • Alcohol: 54% • Been Drunk: 35% • Marijuana: 34% • Smokeless Tobacco: 15% • Prescription Drugs: 11% Source: Monitoring the Future, 2012; NSDUH,2011

  23. By 12th grade • Cigarettes: 40% • Alcohol: 69% • Been Drunk: 54% • Marijuana: 45% • Smokeless Tobacco: 17% • Prescription Drugs: 21% Source: Monitoring the Future, 2012

  24. Biopsychosocial Development

  25. Biopsychosocial • Asynchrony of physiologic/psychosocial development - early vs. late maturation • Developmental drives during adolescence – stage of adolescence • Ongoing Brain Development • Attitudes/beliefs • Sense of competence/invulnerability • Lack of awareness of consequences • Male gender

  26. Adolescent Brain Development • Brain development now extends into the adolescent years • Most of this development occurs in the frontal lobe • - Executive functions • - Planning • - Reasoning • - Impulse control

  27. Characteristics of Concrete Thinking • Present orientation • Seeing is believing/my (my friend’s) experience is what counts • Ability to project into future limited • Cannot perceive long-range implications of current decisions

  28. Characteristics of Abstract Thinking • Ability to: • Envision alternatives • Evaluate alternatives • Engage in perspective taking • Reason about chance and probability • PRIORITIZE!

  29. Socioenvironmental • Peer group known to be engaging in problem behavior • Role of Parents/Families • Authoritarian/permissive vs. Authoritative • Family history of alcoholism/substance abuse • Parental/family use of substances • Life transitions • School transitions • Ready availability of substances, vehicles

  30. Behavioral • Lack of skills to resist peer pressure • Sensation-seeking drives • Mental health disorders • Anxiety • ADHD • Depression

  31. A Model of Development Mid adolescence 15-19 yrs Late adolescence 20-24 yrs Early adolescence 10-14 yrs Period of heightened vulnerability to risk taking, problems in terms of affect & behaviour Puberty heightens emotional rousability, sensation-seeking, reward orientation Maturation of brain facilitates regulatory competence Steinberg

  32. Early Adolescence

  33. Biopsychosocial Development During Adolescence/ Emerging AdulthoodEarly Adolescence (Age 10 –14 Years)

  34. Biopsychosocial Development During Adolescence/ Emerging AdulthoodEarly Adolescence (Age 10 –14 Years)

  35. Biopsychosocial Development During Adolescence/ Emerging AdulthoodEarly Adolescence (Age 10 –14 Years)

  36. Middle Adolescence

  37. Biopsychosocial Development During Adolescence/ Emerging AdulthoodMiddle Adolescence (Age 14 – 18 years)

  38. Biopsychosocial Development During Adolescence/ Emerging AdulthoodMiddle Adolescence (Age 14 – 18 years)

  39. Biopsychosocial Development During Adolescence/ Emerging AdulthoodMiddle Adolescence (Age 14 – 18 years)

  40. Biopsychosocial Development During Adolescence/ Emerging AdulthoodMiddle Adolescence (Age 14 – 18 years)

  41. Late Adolescence

  42. Biopsychosocial Development During Adolescence/ Emerging AdulthoodLate Adolescence/Emerging Adulthood (Age 18 – 24 Years)

  43. Biopsychosocial Development During Adolescence/ Emerging AdulthoodLate Adolescence/Emerging Adulthood (Age 18 – 24 Years)

  44. Biopsychosocial Development During Adolescence/ Emerging AdulthoodLate Adolescence/Emerging Adulthood (Age 18 – 24 Years)

  45. Biopsychosocial Development During Adolescence/ Emerging AdulthoodLate Adolescence/Emerging Adulthood (Age 18 – 24 Years)

More Related