ADOLESCENT SUBSTANCE ABUSE & THE FAMILY

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1 ADOLESCENT SUBSTANCE ABUSE & THE FAMILY KARA S. BAGOT, M.D. UNIVERSITY OF CALIFORNIA, SAN DIEGO OVERVIEW HBO ADDICTION -VIDEO EPIDEMIOLOGY OF ADOLESCENT SUBSTANCE USE ADOLESCENT NEURODEVELOPMENT COMORBID PSYCHIATRIC ILLNESS ADVERSE CHILDHOOD EXPERIENCES CONSEQUENCES TREATMENT RECOVERY 1

2 THE ADOLESCENT ADDICT HBO THIS IS ME IN THE 6 TH GRADE 2

3 I JUST EXPERIMENTED WITH ALL OF THEM 100% 90% 80% 70% 60% 8th grade 12th grade College Students 50% 40% 30% 20% 10% 0% Monitoring the Future, 2015 PREVALENCE OF DISORDERS (U.S.) 100% 75% 50% % 0% Alcohol Drugs NATIONAL HOUSEHOLD DRUG USE & HEALTH,

AGE OF FIRST DRINK % Meeting Alcohol Use Disorder Criteria by Adulthood 100 75 50 25 0 17 14 or Younger 10 4 15-17 18-20 21 or Older Age at First Drink 3 National Household Drug Use & Health, 2010

4 AGE OF FIRST DRINK % Meeting Alcohol Use Disorder Criteria by Adulthood or Younger or Older Age at First Drink 3 National Household Drug Use & Health, 2010 TOBACCO USE 24.6% OF HIGH SCHOOL STUDENTS REPORT CURRENT USE OF A TOBACCO PRODUCT 12.7% REPORT CURRENT USE OF 2+ TOBACCO PRODUCTS E-CIGARETTES (13.4%), HOOKAHS (9.4%), CIGARETTES (9.2%), CIGARS (8.2%), SMOKELESS TOBACCO (5.5%), SNUS (1.9%), PIPES (1.5%), BIDIS (0.9%), AND DISSOLVABLES (0.6%) 1 IN 4 HIGH SCHOOL STUDENTS AND 1 IN 13 MIDDLE SCHOOL STUDENTS USE 1+ TOBACCO PRODUCTS IN PAST 30 DAYS INCREASE IN NON-CIGARETTE PRODUCT USE INCLUDING E-CIG AND HOOKAH WITH CONCOMITANT DECREASE IN CIGARETTES AND CIGARS NO CHANGE IN OVERALL USE CDC, MMWR Morb Mortal Wkly Rep

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6 CANNABIS USE 4.2 MILLION 12 YEARS WITH CANNABIS USE DISORDER PREVALENCE IN HIGH SCHOOL SENIORS = 35.1% MOST COMMON ILLICIT SUBSTANCE AMONG NEW USERS, ~2% DEVELOP CUD DURING THE FIRST 1 2 YEARS AFTER ONSET OF USE DEVELOPMENT OF CUD ~ FREQUENCY & AGE Gray, 2013, Lambert et al., 2005, MTF 2014, Wu et al., 2014 THE ADOLESCENT BRAIN IS DIFFERENT FROM THAT OF AN ADULT Prefrontal Cortex Gogtay, Giedd et al.; PNAS

7 Arain et al; Neuropsychiatr Dis Treat 2013 NEUROBIOLOGY OF ADOLESCENT SUBSTANCE USE Crews & Boettiger; Pharmacol Biochem Behav

KIDS COMING INTO TREATMENT ARE CHARACTERIZED BY MANY THINGS ADHD ANXIETY DISORDERS PANIC SOCIAL PHOBIA OBSESSIVE-COMPULSIVE SX MOOD DISORDERS DEPRESSION BIPOLAR DISORDER PERSONALITY DISORDERS

8 KIDS COMING INTO TREATMENT ARE CHARACTERIZED BY MANY THINGS ADHD ANXIETY DISORDERS PANIC SOCIAL PHOBIA OBSESSIVE-COMPULSIVE SX MOOD DISORDERS DEPRESSION BIPOLAR DISORDER PERSONALITY DISORDERS SCHIZOTYPAL BORDERLINE CONDUCT DISORDER/DELINQUENT BEHAVIORS Bagot & Krishnan-Sarin, review in preparation PSYCHOSIS PSYCHOSIS 16 YRS ASSOCIATED WITH PSYCHOSIS YRS ASSOCIATED WITH SEVERE PSYCHOTIC SX DOSE-RESPONSE EFFECT LONGER DURATION OF PSYCHOSIS PRIOR TO SEEKING TREATMENT WORSE FUNCTIONING AT TREATMENT ONSET SX SEVERITY Bagot et al., Subst Abuse

9 PSYCHOSIS & TREATMENT ACHIEVE ABSTINENCE: MEAN AGE OF CU ONSET = 17.4 ± 4.2 YRS PERSISTENT CU: MEAN AGE OF CU ONSET = 14.5 ± 1.9 YRS ILLNESS SEVERITY DURATION OF HOSPITALIZATION FREQUENCY OF HOSPITALIZATION TREATMENT ENGAGEMENT ILLNESS SEVERITY POORER FUNCTIONING AT DISCHARGE POSITIVE SX Bagot et al., Subst Abuse 2015 WHEN HIS BIRTH FATHER LEFT HIM drugabuse.gov 9

VIOLENCE/CRIME PARENTAL SUBSTANCE USE CULTURE McCrory &

10 FAMILY & ENVIRONMENT ADVERSE CHILDHOOD EXPERIENCES ABUSE/NEGLECT FAMILIAL DYSFUNCTION EXPOSURE TO VIOLENCE/CRIME PARENTAL SUBSTANCE USE CULTURE McCrory & Mayes; Curr Addict Rep 2015 De Bellis; Psychoneuroendocrinology

11 FAMILY & ENVIRONMENT ADVERSE CHILDHOOD EXPERIENCES PARENTAL SUBSTANCE USE & PSYCHOPATHOLOGY ABUSE/NEGLECT PARENT-CHILD CONFLICT EXPOSURE TO VIOLENCE/CRIME RESOURCE DIVERSION RESIDENTIAL INSTABILITY CULTURE Hines et al.;

12 FAMILY & ENVIRONMENT ADVERSE CHILDHOOD EXPERIENCES PARENTAL SUBSTANCE USE & PSYCHOPATHOLOGY CULTURE AMERICAN INDIAN & ALASKA NATIVE: RISK: POVERTY, POOR SOCIAL CONDITIONS, ADULT MODELS, COMMUNITY TRANSMISSION, COHESION/SOLIDARITY, FORCED ACCULTURATION, GENERATIONAL TRAUMA, ETHNIC DISLOCATION, UNSTRUCTURED TIME ON RESERVATIONS, DISCRIMINATION, LOSS OF TRADITIONAL LAND, CULTURE & RIGHTS AFRICAN AMERICAN PROTECTIVE: STRONG RACIAL IDENTITY, RACIAL SOCIALIZATION HISPANIC RISK: FAMILY VALUES DETERIORATE, ATTITUDES, FAMILISTIC BEHAVIORS, DIFFERENTIAL ACCULTURATION, ACCULTURATION STRESS PROTECTIVE: ACCULTURATION/BORN IN U.S./LIVED IN U.S. FOR YEARS Hawkins et al.; Psychol Bull 2004; Szapocznik et al.; Annu Rev Clin Psychol 2007 HIS MOM CALLED THE SHERIFF AND IT WAS VERY HARD TO TURN IN YOUR OWN SON DRIVING MVA ARRESTS RIDING WITH INTOXICATED DRIVERS OTHER RISKY BEHAVIORS RISKY SEXUAL BEHAVIORS OTHER SUBSTANCE USE HEALTH COGNITION PSYCHIATRIC SYMPTOMS LIVER DYSFUNCTION TRAUMA LEGAL 12

13 I AM THE RESPONSIBLE ADULT FOR THIS CHILD, THIS KID, AND THERE IS NOTHING I CAN DO HEALTH ANGER FEAR EMBARRASSMENT FUNCTIONING TRUST CONCEPT OF NORMATIVE BEHAVIORS NEGATIVISM INCONSISTENCY ATTACHMENTS RESENTMENT SAMSHA, LESS THAN 1 IN 10 CHILDREN/ADOLESCENTS WHO MEET CRITERIA FOR ABUSE/DEPENDENCE ARE SHOWING UP FOR TREATMENT CM Therapy MST CBT MDFT MET Behavioral Family FFT ACRA BFST FBT 13

14 PARENTS REALLY ANGRY HARD TIME WITH TRUST OR POSITIVELY REINFORCING BEHAVIORS PARENTING SKILLS PARENTAL MONITORING LIMIT SETTING EMOTIONAL ATTACHMENT COMMUNICATION SKILLS FAMILY CONFLICT KIDS DON T COME TO TREATMENT AND SAY I WANT TO STOP USING DRUGS, WHY WOULD THEY, IT S THE BEST THING THAT EVER HAPPENED TO THEM THEY RE ONE COPING SKILL 14

15 FLUNKED OUT OF AN OUTPATIENT PROCESS THEMES OF RELAPSE % OF GROUP EMOTIONAL 90% LIFE STRESSORS 85% COGNITIVE FACTORS 75% SOCIALIZATION PROCESSES 65% ENVIRONMENTAL ISSUES 55% Gonzales et al., 2012 IT S NOT JUST WHAT CAN YOU DO FOR YOUR SON/DAUGHTER TODAY, BUT THIS IS AFFECTING THE NEXT YEARS OF THEIR LIFE CONSEQUENCES OF SU WHO IS AFFECTED HOW ARE THEY AFFECTED KEY INDIVIDUALS AGENTS OF CHANGE SOLUTIONS & ALTERNATIVES ANTICIPATED BARRIERS EXISTING, CURRENT, PAST PROGRAMS WHO ARE/DID THEY SERVE? EFFECTIVE? WHY DID THEY END? Work Group on Health Promotion and Community Development at the University of Kansas 15

16 Work Group on Health Promotion and Community Development at the University of Kansas Work Group on Health Promotion and Community Development at the University of Kansas 16

17 Work Group on Health Promotion and Community Development at the University of Kansas Work Group on Health Promotion and Community Development at the University of Kansas 17

18 THIS IS A TREATABLE ILLNESS 18

19 THANK YOU ADOLESCENT SUBSTANCE ABUSE & THE FAMILY KARA S. BAGOT, M.D. UNIVERSITY OF CALIFORNIA, SAN DIEGO 19

Rates of Co-Occurring Disorders Among Youth. Working with Adolescents with Substance Use Disorders

Rates of Co-Occurring Disorders Among Youth. Working with Adolescents with Substance Use Disorders 1 Working with Adolescents with Substance Use Disorders Michael S. Levy, Ph.D. CAB Health & Recovery Services, Inc. Health and Education Services 8% of 12-17 year old youth have substance abuse or dependence