Living In The Cloud: Adolescent Nicotine Use

Transcription

1 Living In The Cloud: Adolescent Nicotine Use Presented by Beth Donnellan, M.Ed, ABD, CCTP, CATP January 23, 2019

2 Samson Teklemariam, MA, LPC Director of Training and Professional Development NAADAC, the Association for Addiction Professionals

3 Produced By NAADAC, the Association for Addiction Professionals

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6 Cost to Watch: Free CE Hours Available: 1.5 CEs CE Certificate for NAADAC Members: Free CE Certificate for Non-members: $20 CE Certificate To obtain a CE Certificate for the time you spent watching this webinar: 1. Watch and listen to this entire webinar. 2. Pass the online CE quiz, which is posted at 3. If applicable, submit payment for CE certificate or join NAADAC. 4. A CE certificate will be ed to you within 21 days of submitting the quiz.

7 Using GoToWebinar (Live Participants Only) Control Panel Asking Questions Audio (phone preferred) Polling Questions

8 Webinar Presenter Beth Donnellan, M.Ed, ABD, CCTP, CATP Addictions Studies School of Social and Behavioral Sciences (813) Your

9 Webinar Learning Objectives LO #1 Participants will be able to describe the basic psychopharmacological process of nicotine addiction. LO #2 Participants will be able to list at least three prevention and three treatment strategies of nicotine use (adolescent focus). LO #3 Participants will be able to explain the initiation process into nicotine use including vaping.

10 Terms Addiction: occurs when the body adapts to an outside chemical (some substance that we ingest or absorb). The body begins to expect the presence of the substance and to accommodate it, stops making certain neurotransmitters or hormones. Neurotransmitters: chemicals used in the brain to transmit messages from one area to another in order to coordinate movement/thought/processing of sensory information or memory. They are small molecules (e.g. acetylcholine) and large molecules (e.g. proteins like substance P). Hormones: chemicals used by the body to communicate action through the circulatory system (e.g. small-cortisol and large-growth hormones).

11 Learning Objectives 1. Participants will be able to describe the basic psychopharmacological process of nicotine addiction. 2. Participants will be able to explain the initiation process into nicotine use (vaping). 3. Participants will be able to list at least three prevention and three treatment strategies of nicotine use (adolescent focus). *the presentation is divided into three parts using these objectives

12 Properties of Adolescent Development

13 Polling Question #1: When is the best time to teach nicotine prevention lessons to children/adolescents? A. Pre teen B. Adolescence C. Pre-school through elementary

14 To Start My Life Erikson (1968) psychosocial development: identity vs role confusion - ego crisis of defining self *compares idea of self to perceived peer perception (and to family self ) *develops a hidden life- hides new thoughts, opinions, friends, and ambitions (healthy and unhealthy development) *adolescent ego-centrism develops as periods of intense self-focus *might try on new identities by spending time in new peer groups

15 Personal Fable What if you were the only person on earth What if you were actually surrounded by millions, but thought that you were the only person on earth who has ever felt this way before? Personal Fable: adolescent cognition malfunctions during this neural pruning period (neurons rewire to help them with social cognition) so that occasionally, they feel INTENSELY that no one can possibly understand their experiences, thoughts, and emotions.

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17 Imaginary Audience EVERYONE is laughing at me because of what happened in chem. today! Close your eyes and imagine a teenager who feels as if everyone can hear and see what he/she does in life. Everyone s entire focus is on ability to succeed. Everyone waits to poke fun when the teen fails. (you just met with your teenage self!) Imaginary Audience (Elkind, 1967): Temporary state of distorted belief that others are focused on them, heightened self-consciousness, tendency towards conformity (and fads), and mistaken interpretations of others actions/thoughts.

18 Incomplete Myelination Myelination: growth of white matter across the brain structures (called grey matter) used to send/receive neurotransmitter communications. This process continues through life with most areas being fully connected by age 25. This results in +risk taking with cognitive moderation!

19 High Risk/Low Control Age 14 years: the ventral striatum is fully connected to other parts of the brain. This means that risk messages are strong. Little moderation by pre-frontal cortex (pfc), so little prediction, weighing of consequences, problem-solving, and impulse control.

20 Distorted Social Interpretations Adolescent development includes a rewiring of the brain so that they develop social understanding of social cues, facial expressions, social rules (differ according to settings), and impulse control in social settings. During these changes, adolescents are unable to properly encode facial expressions of adults (BioMed, 2009). Adolescent interpretation of adult facial expressions (no emotion, fear, anger, sadness, etc.) is angry. This distorted interpretation adds even more stress to the parent-child relationship (Somerville, 2013).

21 Adolescence in Summary Adolescent cognitive and behavioral risks can be environmental, but are also innately, developmental. 1. development of self-identity vs role confusion (can lead to isolation) 2. development of secret life from parents + authorities (can lead to isolation) 3. cognitive changes that distort understanding of self and others (increased emotionality, confusion, desire to be different from parents) 4. increased impulsivity while the brain continues myelinating meaning there is a lack of steady communication between pfc and limbic system (high risk taking and low control = impulsivity) 5. cognitive interpretation of social cues and rules is immature (increased frustration/anger) Teen years are too late to begin prevention, but not to late to continue it!

22 Culture of Nicotine Use

23 Rates of Use: Cigarettes + ST Johnston, L.D., O Malley, P.M., Miech, R.A., Bachman, J.G., & Schulenberg, J.E. (2016).Monitoring the Future national survey results on drug use, : Overview, key findings on adolescent drug use. Ann Arbor, MI: Institute for Social Research, The University of Michigan. Retrieved June 3, 2016, from - PDF

24 Marketing is Targeting Key marketing strategies of nicotine companies are designed to entice teens to find ways to use (though illegal). Target: early adolescents through use of colorful/youthful advertising. Creating incentives (Camel cash, Juul flavored liquid for vaping). Selling on internet to increase accessibility. Sponsor events and competitions: cloud chasing events at stores + exhibitions. Use social media to post cool images and messages. Lobby state legislators to slow tobacco use policies/laws.

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26 Vaping: Flavors and Clouds Vape liquids: include toxins used in cigarettes including formaldehyde, diacetyl (butane-2,3-dione) flavoring, and many other carcinogens. Diacetyl is a butter-like flavoring that when smoked, creates a condition called popcorn lung. Small blisters develop in the lungs which in rare cases can lead to the development of asthma in users. Teens learn how to vape by watching friends and YouTube videos. Males in particular like watching cloud chasing competitions on YouTube, at friends, or at local stores. Laws are still murky- state laws differ from each other. Most prohibit the sale of vaporizers and e-cigarettes to underage teens. Many have no laws that prohibit the use of them though. *JUUL just lost a lawsuit that requires them to stop making fruit flavors and withdraw their social media campaigns*

27 (CDC, 2015)

28 Rituals of use: Teens enjoy choosing liquid cartridges and continue to use the internet and friends as resources to find ways to increase enjoyment. Dripping: increased nicotine effect by dripping the liquid directly on the hot coils of the device. Normally the liquid is distributed by a wick to an atomizer which slowly dispatches the liquid. Dripping increases the cloud, flavor, and nicotine. It also creates stronger carcinogens. (CDC, 2015)

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30 Current Use Cigarettes From 2011 to 2017, current cigarette smoking declined among middle and high school students. About 2 of every 100 middle school students (2.1%) reported in 2017 that they smoked cigarettes in the past 30 days a decrease from 4.3% in Nearly 8 of every 100 high school students (7.6%) reported in 2017 that they smoked cigarettes in the past 30 days a decrease from 15.8% in Electronic Cigarettes Current use of electronic cigarettes increased among middle and high school students from 2011 to About 3 of every 100 middle school students (3.3%) reported in 2017 that they used electronic cigarettes in the past 30 days an increase from 0.6% in Nearly 12 of every 100 high school students (11.7%) reported in 2017 that they used electronic cigarettes in the past 30 days an increase from 1.5% in Smokeless Tobacco In 2017: Nearly 2 of every 100 middle school students (1.9%) reported current use of smokeless tobacco. Nearly 6 of every 100 high school students (5.5%) reported current use of smokeless tobacco.

31 Tobacco Use* Among High School Students in Tobacco Product Overall Females Males Any tobacco product 19.6% 17.5% 21.5% Electronic cigarettes 11.7% 9.9% 13.3% Cigarettes 7.6% 7.5% 7.6% Cigars 7.7% 6.3% 9.0% Smokeless tobacco 5.5% 3.0% 7.7% Hookahs 3.3% 3.2% 3.3% Pipe tobacco 0.8% 0.5% 1.0% Summary All Tobacco Product Use In 2017, nearly 6 of every 100 middle school students (5.6%) and nearly 20 of every 100 high school students (19.6%) reported current use of some type of tobacco product. In 2013, nearly 18 of every 100 middle school students (17.7%) and nearly half (46.0%) of high school students said they had ever tried a tobacco product. *Teens who use e-cigarettes/vape pens are at much greater risk for use of cigarettes or smokeless tobacco products later in life (CDC, 2015). Bidis 0.7% 0.6% 0.7%

32 Polling Question #2: How are most teens initiated into nicotine use? A. Celebrities B. Friends, YouTube, vape contests C. Parents cigarettes, e-cigarettes

33 Prevention and Treatment

34 Addiction Develops: Nicotine Nicotine: liquid alkaloid that is colorless and highly volatile (means it can change chemical make up easily like when burned) When smoked, it becomes oxidized (brown and smells) and can be highly addictive. Tolerance builds quickly making it one of the easiest substances for addiction.

35 Nicotine in the Body Inhalation: this is the strongest way to get nicotine into the bloodstream. Almost 90% of the nicotine that enters the body is immediately absorbed. It is highly toxic. A lethal dose of 60mg can kill someone in only a few minutes. Cigars contains enough nicotine for two lethal doses. Chewing: smokeless tobacco (ST) is better absorbed in high ph environments. Tobacco companies have increased the absorption rate of nicotine by raising ph levels in flavoring. Unflavored tobacco is average (7.7 ph) while flavored can be boosted to (8.3 ph) by adding sodium carbonate. The liver metabolizes nicotine with 80-90% of the nicotine changed before leaving the liver to the kidneys. The tar in nicotine increases liver activity for deactivation (of nicotine).

36 Nicotine in the Brain Addictive properties: The brain has nicotinic acetylcholine receptors which are used for acetylcholine messaging (neurotransmitter). Nicotine also uses those receptor sites, if we ingest nicotine. Since the receptor site cannot have two neurotransmitters occupying it, nicotine displaces acetylcholine. +nicotine means acetylcholine for the brain to use = addiction Acetylcholine: is a widely used neurotransmitter to help guide attention, get muscles ready to move, and for learning. Epinephrine: is a hormone that is activated once the acetylcholine is displaced increasing heartrate, respiratory process, and metabolism. Homeostasis: process by which the brain regulates neurotransmissions to create a state of equilibrium.

37 Treatment for Adolescents nicotine patches, spray, and gum are primary tx options for teens (less cognitive interference) develop behavioral options for what to do when stressed, anxious, depressed, hungry support group if possible (talk through issues with peers) watch for signs of increased mental health distress drug education to encourage abstinence from all other psychoactive drugs relapse prevention social support and relapse prevention education, relapse rates are higher. It takes the body + brain almost 6 weeks to regain homeostasis. (Klesges, Johnson, & Somes, 2003) Nicotine Cessation Flu-like symptoms, foggy cognition, cravings, irritability, and headaches are common symptoms.

38 Polling Question #3: Why is nicotine so addictive? A. Easy for teens to obtain B. Peer influence at an early age C. Nicotine replaces acetylcholine

39 Risk & Protective Factors Social + Physical environments susceptibility to mass media and social media campaigns belief that nicotine that is normal/abnormal judge by rate of peer use having friends who use nicotine H.S. male athletes more apt to use ST than non-athletes parents who smoke, use ST, or vape Biological factors some studies suggest that teen brains are more susceptible to nicotine addiction than adults potential genetic factors might interfere with nicotine cessation attempts mother who smoked during pregnancy ( Perception/expectation of use expectation for positive outcome from use being rewarded for use (lose weight, gain friends) Mental health link between nicotine use and mental health disorders related to depression, anxiety, stress, and behavioral disorders (e.g. ADHD).

40 Prevention Strategies Pre-school-elementary: help them develop goal-setting, problem-solving, and social skills to increase their confidence in navigating their life choices. Develop education programs to teach how nicotine harms the body (age appropriate). Middle School: demonstrate the effects of smoking as it pertains to their social life (cost, smell, and hassle of hiding it). Education about physical harm done to the brain and body. Help them to develop specific short-long term goals for their future. Encourage thought on how smoking can interfere with those goals. High School: teach the psychopharmacology of nicotine, teach about marketing techniques, encourage continued development of interests/talents and skills. Communities: raise tobacco purchase/use age to 21 years, provide counter-advertising, and offer nicotine education programs (schools, community fairs, after school programs, workplaces), offer smoking cessation programs.

41 Polling Question #4: Which of the following strategies for children is effective for preventing nicotine use? A. Say: never use drugs B. Teach long and short-term goals C. Have them smoke a cigarette (to show impact)

42 References BioMed Central. (2009, September 18). Face Off: Misunderstood Expressions Facilitate Adolescent Aggression. ScienceDaily. Retrieved November 20, 2018 from Centers for Disease Control and Prevention. Tobacco Product Use Among Middle and High School Students United States, 2011 and Morbidity and Mortality Weekly Report, 2013;62(45):893 7 [accessed 2018 Oct 15]. Elkind, D., (1967) Imaginary audience behavior in children and adolescents. Developmental Psychology, 15(1), Erikson, E. H. (1968). Identity: Youth and crisis. New York: Norton. Johnston, L.D., O Malley, P.M., Miech, R.A., Bachman, J.G., & Schulenberg, J.E. (2016).Monitoring the Future national survey results on drug use, : Overview, key findings on adolescent drug use. Ann Arbor, MI: Institute for Social Research, The University of Michigan. Retrieved June 3, 2016, from - PDF Klesges LM, Johnson KC, Somes G, et al. Use of nicotine replacement therapy in adolescent smokers and nonsmokers. Arch Pediatr Adolesc Med. 2003;157:

43 References Somerville, L.H., (2013). Special issue on the teenage brain: Sensitivity to social evaluation, Current Directions of Psychological Science, 22(2),

44 Thank You! Beth Donnellan, M.Ed, ABD, CCTP, CATP Addictions Studies School of Social and Behavioral Sciences (813) Your

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46 Cost to Watch: Free CE Hours Available: 1.5 CEs CE Certificate for NAADAC Members: Free CE Certificate for Non-members: $20 CE Certificate To obtain a CE Certificate for the time you spent watching this webinar: 1. Watch and listen to this entire webinar. 2. Pass the online CE quiz, which is posted at 3. If applicable, submit payment for CE certificate or join NAADAC. 4. A CE certificate will be ed to you within 21 days of submitting the quiz.

47 Upcoming Webinars February 13, 2019 Finding Ambivalence and 10 other Things about Motivational Interviewing by Richard Choate, LADC, CADC II March 13, 2019 Hunger for Healing: Evidence-Based Practice for Binge Eating Disorder by Michael Bricker, MS, CADC-II, NCAC-2, LPC February 27, 2019 March 27, 2019 Addressing the Opioid Crisis via Community- Based Technical Assistance by Holly Hagle, PhD Guidelines to Developing Competence with Mindfulness-Based Interventions by John Paulson, ACSW, LCSW, MAC, LCAC, CCS, HS-BCP

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49 WEBINAR SERIES Over 145 CEs of free educational webinars are available. Education credits are FREE for NAADAC members. MAGAZINE ARTICLES In each issue of Advances in Addiction & Recovery, NAADAC's magazine, one article is eligible for CEs. FACE-TO-FACE SEMINARS NAADAC offers face-to-face seminars of varying lengths in the U.S. and abroad. INDEPENDENT STUDY COURSES Earn CEs at home and at your own pace (includes study guide and online examination). CONFERENCES NAADAC Annual Conference, September 28 October 2, 2019 Orlando, Florida CERTIFICATE PROGRAMS Demonstrate advanced education in diverse topics with the NAADAC Certificate Programs: Recovery to Practice Conflict Resolution in Recovery National Certificate in Tobacco Treatment Practice

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