Drugs 101:Understanding the connection between adolescent substance use and abuse

1. Drugs 101:Understanding the connection between adolescent substance use and abuse Justin Wolfe LCPC, CADC, CRC Clinical Therapist at Linden Oaks Hospital Justin.Wolfe@EEHealth.org

2. Where does this all begin? • Parents basements • Young Persons disease • The reasons people continue to use are different than the reasons that they began to use

3. Progression of use • Starts in 1of 3 places • Marijuana • Alcohol • Prescription Medications • Cross Addiction • Self injury • Eating disordered behaviors

4. Risk Factors for Substance Use • Being Male • Family History of addiction • Parents modeling behaviors • Impulsivity • Problems in school • Family Conflict • Divorce • Any kind of Abuse • Trauma • Lack of Positive Connections

5. What is contributing to this boom? • Messages from media and Music/Musicians • Idea that Marijuana went from the great evil to a cure all • Lil Xan, Lil Purp, Lil Pump, Lil Peep • Music that glorifies drug using culture (Molly, Percocet) • Take a look at who they are following….. • Increase in Access • Declining Perceived Risk • Social Media • Snapchat is the drug dealers mass marketing tool • Who are they following???

6. Chasing Happiness • Opening up the front door (Happiness) • At the same time it opens the back (Depression/Anxiety) • Develops in to using to “Feel normal”

7. Behaviors that indicate something is off…. • Lying-“Game of smoke and mirrors” • Stealing-Money appears in their wallet or disappears from yours • Selling- Gifts/Shoes/Belts/Scales appear or little baggies • Social Media/Finsta- How are they putting themselves out there? • Car/clothes smell of marijuana • Eyes are blood shot or pupils are dilated • Speech is slowed/rapid/slurred • Come home and go straight into their room • Random times of massive food intake (munchies) • Turning off their tracking on cell phone • Hanging out with new friends that you have not met • Change in clothing style- What are they saying?

8. Common Hiding Places • Dresser Drawers, beneath, or between clothes • Small Boxes- Jewelry, pencil etc • Backpacks, duffle bags • Under the bed • In a plant, buried in the dirt • In books with pages cut out • In fake soda bottles with false bottoms • Inside over the counter medicine containers • In the ceiling/floor boards

9. Talking about Substance Use • PARENT TALK KIT-ONLINE RESOURCE • Be proactive, ask about what they are hearing/seeing in school. • Talk to them about it • Kids want to be able to share with out fear of being blamed for thoughts • Increasing communication will build trust/support relationship • Better before than after the fact • It is okay that your child is sharing that they want to use • People in recovery talk • If your involved with your kid you know when things are off. • Trust your intuition • Refrain from judgements- You want them to feel safe coming to you • Choose a neutral ground • Communicate clearly that you do not approve of use • FYI Marijuana today is much different than your days in high school • Allow them to share without interrupting, show that you are listening

10. The importance of the Family Relationship • More time together the better • Engaging in activities that bring the family together • Making sure that parents know what is going on in their children's life • “I never knew they were doing that” • Making time each day to sit with one another • The family relationship can be the strongest buffer to using

11. What are we seeing treatment • Benzos (Anti Anxiety Medications)- Xanax, Klonopin, Ativan • Marijuana – Dabs, Shatter, Wax, Edibles • Opioids- Fake Xanax (Fentanyl pressed into Xanax bars) • Hallucinogens- LSD, 25i • Alcohol • ADHD Medications

12. Vaping-The New Gateway • Electronic devices that heat liquid into vapor that is then inhaled • Can range from flavored water type, to nicotine to THC • Cigarette use is down and Vaping is increasing rapidly • No long term research on negative effects of vaping • Perceived as completely harmless • “it wont give you as much cancer” • Inhaling massive amounts of nicotine at one time • Gives a head rush/”buzz” • 1 pod=1 pack of cigarettes

13. Vaping in the Schools • Big money is being made by upper classman targeting freshman and selling them at huge markups • Juuling in the bathrooms and classes in school • Can swallow the vapor, blow it in their sweatshirts or just hold it in to let it disappear

14. Vape Nation Debunked • FDA has reported the presence of harmful chemicals such as nitrosamines (carcinogens) and diethylene glycol in the e­liquids • diethylene glycol been involved in a number of prominent mass poisonings spanning back to 1937!!!! • Regulation is fragmented, online retailers sell higher concentrations/quantity • Inconsistent packaging • Laboratory testing has found nicotine content to be several times stronger than advertised!!!

15. Benzodiazepines • This is the next big outbreak • Not intended for long term use • Tolerance and dependence can develop quickly • Fatal overdoses quadrupled between 1996 and 2013 • Combiningbenzo’s with opioids is also contributing to the increasing numbers of drug deaths. • Highly impulsive/reckless behaviors • Sexually acting out, falling asleep while driving

16. How it is now being abused • Gummy Xanax (combined with gummy candy) • Dissolving in drinks • Chewing • Snorting • Smoking Xanax • Combined with other substances (laced marijuana)

17. Why adolescents use this • To get high • To “get rid of anxiety” • Risk: Act on total/complete impulse • “To not think” • To avoid memories

19. Alcohol • The most commonly used drug by adolescents. • 9 out of 10 teenage automobile accidents involved the use of alcohol. • Alcohol is a DOWNER!!! • People who struggle with depression are more likely to attempt suicide when under the influence. • More likely to use other substances when under the influence

20. Alcohol: Why its not seen as a problem • Most do not use every night • About 90% of the alcohol consumed by high school students is through binging • Nearly 1 out 5 high school students (16%) have experienced a “black out” • Large numbers of High School and College students drink with one goal, intoxication. • Very easily accessible • Viewed as an acceptable social activity • Even in “safe” places , horrific things do happen

21. Amphetamines • Medications prescribed for ADHD • Easily obtained due to large # of prescriptions • Ritalin, Vyvance, Adderall, Concerta • Belief that they help improve academic performance • Research does not support enhanced learning or thinking ability in those without ADHD • Putting self at risk for perceived benefit

22. Amphetamines affect on the brain • Disrupts normal communication between brain cells • Leads to possible euphoria increasing risk of addiction • Increase in risk taking behaviors • Increase feelings of hostility and paranoia • Withdrawal • Fatigue, depression, and disrupted sleep cycles

23. Marijuana AKA…. • Hash, Dabs, Chronic, Dro, Ganja, Mary Jane (not really used anymore), devils lettuce, Broccoli, Loud, Kush, Reefer, Bud

24. Why does it seem like everyone is doing this ?

26. Yes, Marijuana is addictive • “Psychological” Addiction • Obsessions • Euphoric Recall • Change behaviors/schedule to accommodate smoking • Gravitate towards people who smoke • Smoking to “feel normal” • Physiological Addiction • When stopped, loss of appetite, difficulty concentrating, disruption of sleep cycle • Increase in marijuana induced psychosis due to potency

27. Not marketing to adolescents?

28. Drugged Driving • Statistics from 2015 show individuals killed in crashes more likely to be on drugs than drinking • 43% on drugs • More than 33% Marijuana • 9% Amphetamines • 37% drinking • Marijuana related traffic deaths increased by 48% in Colorado post legalization • Users do not view marijuana impairing driving

30. The Marijuana Lifestyle/Culture • Encompasses all that one does • Day is based around using • Meet up at specific spots w/ specific people • Embrace the attitude and beliefs • Clothing • Attitude

31. Depression: Marijuana a drug of isolation • Isolation from family, peers and self • Addiction is characterized by losses • Pull away from previously enjoyed activities • Values change with continued use • Amotivational syndrome • Lack of pleasure experienced without substance • Lack of motivation to engage in goal oriented activities • “smoking to feel normal” • 7x greater risk for suicide attempt(study out of New Zealand)

32. Anxiety and Marijuana: An uncomfortable relationship • 7x greater likelihood to develop dependence compared to general population (Buckner, J. &Schmidt, N., 2009) • Effect expectancies • Slow down racing thoughts, fuel avoidant behaviors etc. • Can trigger: anxiety/paranoia/delusional thinking • When no longer under the influence, symptoms return more intense

33. Hallucinogens • Increase in LSD use among adolescents seen in outpatient treatment. • Declining perceived risk • “open your mind” • Perceived as “pure” • Belief is : “You have to be in the right frame of mind” • Effects are unpredictable leading to impulsive behaviors • Risk of :Drug Induced Psychosis following use • 25I aka NBOMB • Is being sold as LSD on blotter paper

34. Opioids • Heroin • Lean • Oxycodone • Vicodin • Codeine • Fentanyl

35. DuPage County 2015    36 = Heroin alone       7 = Heroin/Fentanyl mixture  8 = Fentanyl alone Total deaths = 51                                  2016    36 = Heroin alone       (no change) 26 = Heroin/Fentanyl mixture (increase 370%)   16 = Fentanyl alone  (increase 100%) Total deaths = 78 (increase 53%)

36. Heroin • 50% of heroin users start out using prescription pain medications • Switch due to price and availability • What has led to increase in overdoses is changes in supply • Do not know what it is being cut with • Fentanyl laced heroin • Sought for pain killing effects • Emotional pain • Depression is risk factor

37. Fentanyl • Similar to morphine but is 50-100x more potent • High potency increases risk of overdose/death • USER IS UNAWARE IT IS MIXED IN!!!!! • Heroin cut with fentanyl • Fake Xanax and marijuana being laced • How does the addicted mind work when it hears of overdose deaths?

38. Carfentanil • Animal opioid sedative • Elephant anesthesia • Powder mixed in with heroin • Pressed into pills looking like prescription drugs • 10,000x stronger than morphine • Longer to breakdown in body leading to longer high • Makes it more difficult to revive them

39. Chasing the Dragon • Always chasing the high from the 1st time! • The high=the nod • The fine line between life/death • Vivid memory, feeling attached • Dangerous/impulsive choice to “catch” the dragon

40. Good Samaritan Law • Accidental overdose deaths are now the leading cause of accidental death in the United States • Many of these deaths are preventable if emergency medical assistance is summoned • Protects the individual who has overdosed and the caller from legal prosecution

41. When is Treatment Needed • We ALL play a role in promoting a sober lifestyle • When use is negatively affecting areas of life • School • Relationships • Mood/ Personality Changes • Family conflict • Worsening mental health symptoms • Clearly Established Pattern of use • Inability/unwillingness to attain sobriety • Finding Substances/Drug Paraphernalia around the home

42. Promoting Positive Decision Making • High Levels of parental involvement • Setting Clear Expectations/Boundaries • Communicating clearly that substance use is not approved • Being a parent and not a friend • Parents modeling healthy behavior choices • Having Balance in their lives • Helping them see there is something outside of the box

43. Get kids involved in groups/activities! • Structure kids time for success • It is okay to say no! • Helps hold patient accountable and build trust • Identifies activities that can be engaged in that do not involve substance use • Helps develop supports for physical, emotional and social supports

45. Suggested Reading • I’ll Quit Tomorrow -Vernon Johnson • Beautiful Boy - David Scheff • Paths to Recovery (Al-Anon literature) • For Parents and Teenagers (Previously Unhappy Teenagers) - William Glasser • Clean – David Scheff • Treating the Unmanageable Adolescent: A Guide to Oppositional Defiant and Conduct Disorders- Neil Bernstein • Parenting a Child who has Intense Emotions- Pat Harvey & Jeanie Penzo