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Substance Abuse in Adolescence

Substance Abuse in Adolescence. Dr Amit Sen Senior Consultant Child/Adolescent Psychiatrist Child & Adolescent Mental Health Program Sitaram Bhartia Institute of Science & Research. Substance Abuse. Epidemic proportions in schools Smoking, alcohol, cannabis & solvents are common

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Substance Abuse in Adolescence

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  1. Substance Abuse in Adolescence Dr Amit Sen Senior Consultant Child/Adolescent Psychiatrist Child & Adolescent Mental Health Program Sitaram Bhartia Institute of Science & Research

  2. Substance Abuse • Epidemic proportions in schools • Smoking, alcohol, cannabis & solvents are common • Behavioural, emotional, relationship and academic problems • Associated mental health problems • Poor awareness

  3. Why use them? • Rebellion • Curiosity/Adventure • Availability- Marketed/Advertised • Easy pleasure • Being “cool” • Peer pressure/Desire to belong • Chilled out/Relaxed • Relief from pain & chaos • Self medication • Ape adults/seniors • Style, glamour

  4. Wide range of warning signs • Unexplained weight loss • Red eyes, nasal irritation • Chronic cough, wheezing • Blank, staring into space • Needle tracks, scratch marks • Poor short term memory • Truancy, falling grades • Conflict with parents, teachers, suspension • Acute psychosis/ paranoia

  5. Wide range of warning signs • Risk taking behaviours • Mood swings, depression, panic reaction • Lying, stealing, promiscuity • Altered sleep & appetite • Poor hygiene • Withdrawn, lack of interests • Preferences for dress, music, movies identifying with drug culture

  6. Co-morbidity • ADHD(attention deficit hyperactivity disorder) • Conduct Disorders • Depression • Anxiety • PTSD • Self harming behaviours • psychosis

  7. Attention Deficit Hyperactivity Disorder (ADHD) ADHD occurs in 3-5% of school age children. ADHD must begin before the age of seven and it can continue into adulthood. ADHD runs in families with about 25% of biological parents also having this medical condition Male : Female = 4:1 Impairment in three areas: • Attention • Impulsivity • Hyperactivity

  8. Attention Deficit Hyperactivity Disorder (ADHD) • Easily distracted • Makes careless mistakes • Forgetful • Looses things, disorganised • Unfinished work • Trouble in listening • Underachievers • Disruptive, “naughty boys” • Rash, impulsive • “On the go”, fidgety • Noisy/ interrupts

  9. ADHD ……contd • Persistent and Pervasive • Develops from toddler hood • Differential Diagnosis • Attachment Problems • Anxiety • Conduct Disorder • SLD • Detailed Family and Development Hx

  10. Conduct Disorders Persistent patterns of behaviours • Aggressive • Fighting or bullying • Cruelty to animals/people • Severe tempers • Dissocial • Lying and/or stealing • Fire setting • Destructiveness to property • Defiant • Persistence severe disobedience • Truancy/running away from home • Provocative

  11. Conduct disorders-contd. Associated Disorders • ADHD • Depression/Affective Disorder • Specific Learning Disability • Substance misuse • Attachment problems

  12. The Depressed Adolescent • Behavioural problems • Lying, stealing • Violent outbursts • Truanting • Indiscriminate sexual behaviour • Drugs & alcohol • Fluctuating moods • Increased irritability, anger, or hostility • Risk taking behaviours • Interpersonal conflicts • Extreme sensitivity to rejection or failure • Variety of physical complaints • Poor performance in school • Poor concentration

  13. The Depressed Adolescent • Frequent sadness, tearfulness, crying • Feeling of emptiness • Decreased interest in activities • Low energy • Socially isolated • Low self esteem and guilt • Change in eating and/or sleeping patterns • Talk of or efforts to run away from home • Thoughts or expressions of suicide • Psychotic Features

  14. The Anxious Adolescent • Refusing to go to school • Irritability and anger outbursts • Fear of making mistakes/ “perfectionist” • Seeking reassurance from peers • Frequent stomach-aches, other physical complaints • Overly clingy, panic • Trouble sleeping or nightmares • Phobias, Social anxiety • Sense of doom • Constant worries • Low self esteem

  15. Three main symptoms of PTSD • Intrusions- flashbacks & nightmares • Avoidance- attempt to reduce exposure to situations that bring back memories • Hyper-arousal- tension, hyper-vigilance and increased startle response

  16. Effects of Trauma – Developmental Picture Pre-adolescence and Adolescence • Nightmares and flashbacks • Difficulty sleeping • Anxiety & Depression • Feeling detached or estranged • Impulsive and aggressive behaviours • Preoccupation with other concerns unrelated to the trauma • Rebelliousness • Risk-taking behaviours (drugs, alcohol, sex) • Confusion with identity, roles and responsibilities

  17. Suicide - High Risk Factors • Acute embarrassment/loss • Strong desire to die with lethal method in mind • Older youth • Prior attempts • Male • Major psychopathology • Substance abuse • High stressors • Poor communication with adults/peers • Poor family support

  18. Warning Signs • Hopelessness, helplessness • Definite mood change • Withdrawn • Couldn’t care less attitude • No planning for future • High risk taking behaviours • Severing of ties • Completing certain tasks • Cutting/scratching/drug abuse • Writing notes

  19. MANAGEMENT • PREVENTION • INTERVENTION

  20. Protective Factors • Nurturing environment • Good communication • Adult supervision • Positive self-esteem • Assertiveness • Social competence • Good education • Good general health • High intelligence • Adult role models • Religious/sense of morality

  21. Four Rs of Working with Adolescents

  22. Keys to Successful Relationship • Contact • Congruence • Positive Regard/Respect • Empathy • Perception

  23. What is Normal? • Rebellion • Defiance • Rudeness/talking back • Mood swings • Risk taking/experimenting • Lying • Crossing limits/breaking rules

  24. What is Acceptable? • Rebellion • Defiance • Rudeness/talking back • Mood swings • Risk taking/experimenting • Lying • Crossing limits/breaking rules

  25. Boundaries Non-Negotiable Negotiable

  26. Teenage Skills for Carers • Genuineness • Level of confidence • Follow her lead • Be comfortable with lingo • Allow time for trust • Highlight their interests and strengths • Acknowledge vulnerability • Stay connected to feelings • Self disclosure • Taboo subjects

  27. Teenage Skills for Carers First Things First! • Respect his/her uniqueness • Build a supportive, caring and mutually respectful relationship • Believe in their competencies

  28. Rigid /permissive Love & Limits go together Limits for protection & guidance not punishment /power Give reasons Firmness & flexibility Negotiate and resolve conflicts Renegotiate responsibilities and privileges Learn alternative strategies don’t be frustrated with failure Be consistent and firm Loosen up but don’t let go

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