Teen Mental Health and Substance Abuse Cheryl Houtekamer AHS - AADAC Youth Services Calgary
Agenda Me? Talk about mental health?? Adolescent development Brain development Adolescent drug use Mental health Substance abuse and mental health Protective factors
Adolescent development Time of significant life changes and stress Experimenting, learning, developing Exploring identities and roles Laying down groundwork for future establishing life-long health behaviors, beliefs and attitudes Seeking independence, rebellion Social interaction, belonging, acceptance from peers
Development continued Puberty/physical maturation Some emotional states are triggered more quickly and experienced more intensely than before or after (Storm and Stress) Tendency to seek experiences that create high intensity feelings (risk-taking) A liking of arousal, excitement and high intensity (sensation seeking)
Adolescent brain development Teen brains still under construction Adolescence is a period of profound brain maturation We thought brain development was complete by adolescence We now know maturation is not complete until about age 24
Construction ahead Wave of over production during late childhood - neurons increase their number of connections in preparation for adulthood Connections start to be pruned off around the age of 11 for girls and 12 ½ for boys When the pruning is complete the brain is faster and more efficient BUT during the pruning process, the brain is not functioning at full capacity
Pruning starts at the back of the brain and moves to the front Judgment Amygdala Emotion Prefrontal Cortex Motivation Notice that judgment is the last to develop Nucleus Accumbens Cerebellum Physical coordination
Age 24. Judgment Emotion Motivation Physical coordination, sensory processing Ahh Balance, Finally!
What this process means for adolescent behavior. Physical activities benefit from earlier back of brain development Complex, judgment-demanding thinking is compromised by later front of brain development Preference for physical activity Poor planning and judgment More risky, impulsive behaviour Minimal consideration of negative consequences
Adolescents are at peak risk for Accidents Suicides Homicides Depression and anxiety Alcohol and other drug abuse Violence Reckless behaviour (ex. Drunk driving) Risky sexual behaviour
Adolescent drug use Experimentation starts early (Gr. 6 & 7) Many youth experiment, but most will not develop a problem Number of youth using substances increases with age/grade level Some youth are more at risk of developing a long term problem with substances. The earlier the behaviour starts, and the more often it is repeated, the greater the likelihood of long term difficulties.
Age and drug use 90 80 70 60 50 40 30 20 10 0 Age 12 Age 14 Age 16 Age 18 Tobacco Marijuana Alcohol
What does a drug problem look like? Drugs as means to change moods, escape feelings and problems, deal with stress Frequent or ongoing use. Using alone, at inappropriate times and places Avoid activities that don t allow for use Feeling of need must have it, cravings and withdrawal Experience consequences in major life areas (ex. Family, school, work, health, relationships, leisure) Friends are also drug involved
Drug use during brain development? When brain is most vulnerable is also when youth most likely to use alcohol and other drugs Drug use may have impact on pruning process Alcohol use during adolescence can impact learning, memory and cause other problems later in life A brain under development is more vulnerable to drug dependence
What is mental health? The World Health Organization defines mental health as: a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.
What is mental illness? Mental illnesses are characterized by alterations in thinking, mood or behaviour (or some combination thereof) associated with significant distress and impaired functioning over an extended period of time. Mental illnesses can occur together (ex. Depression and anxiety) Many people have co-occurring or concurrent disorders (mental health, addiction, physical health)
Youth and mental health The onset of most mental illnesses occurs during adolescence and young adulthood. 1 in 7 children in Canada will experience mental health problems serious enough to impair their development and functioning. Problems deserve attention when they are severe, persistent, and impact on daily activities
Youth and mental health Ontario Student Drug Use Survey (OSDUS) 2001: About one in four students report elevated psychological distress. About one in three females report elevated psychological distress. About one in four students report being bullied at school. About one in three students report bullying someone at school. About one in five males report fighting at school.
Young women are more likely to experience internalizing problems (depression, psychological distress and suicide ideation) Male students are more likely to engage in risk behaviors (or externalizing behaviors) such as delinquent acts and pathological gambling Gay, lesbian, bisexual or transgendered youth are at high risk for mood-related disorders, self-mutilation and suicide. At least one in five young people entering the youth justice system experience a serious mental or emotional disorder
What causes mental health problems? Genetics/heredity Individual factors/personality Environment Family factors Social experience Economic Culture All these factors interact and influence each other. These are the same factors that impact substance use.
Substance abuse and mental health Often occur together the relationship Relationship between the two is difficult to determine Both typically begin in adolescence Alcohol/drugs/mental disorder together produce a wider range of symptoms and functioning difficulties, require more resources to treat, and are more difficult to treat than either one alone.
Why is there a connection? Different schools of thought: Use of substances triggers or encourages development of mental illness Adolescent are attracted to substances because they somehow medicate emerging symptoms of mental health concerns There is something about the person (genetic, social, environmental, family) that makes them more likely to experience both substance abuse and mental health problems
Relationship between mental health and substance use Create - Substance use creates psychiatric symptoms. Trigger - Substance use can trigger the emergence of some mental health disorders if a youth is predisposed. Exacerbate - Symptoms of mental illness may get worse when a youth uses alcohol and drugs.
Relationship between mental health and substance use Mimic - Substance use can look like symptoms of a psychiatric disorder. Mask - Symptoms of mental illness may be hidden by drug and alcohol use. Independence - A mental health disorder and substance abuse disorder may not be related to each other, but a common factor may underlie them both.
Prevalence of concurrent disorders in substance users Depression - 2002 study major depressive episode had been experienced by: 15% of persons who were alcohol dependent 26% of person who were drug dependent Within the general population, 5% had experienced a major depressive episode
Mood and anxiety disorders, psychotic disorders, personality disorders and eating disorders prevalence of substance abuse is 40% - 65% or higher. In one US study, 54% of those with a lifetime history of at least one mental illness also had at least one other mental illness or addiction to substances.
Implications All people with mental health problems should be screened for alcohol/drug use. All people seeking help for substance use should be screened for mental health issues. Prevention initiatives with children and youth can help protect against both substance abuse and mental health concerns.
AADAC Youth Services Many youth who access services struggle with mental health concerns: ADD/ADHD Bipolar Disorder Conduct Disorders Depression Eating Disorders Schizophrenia Social Anxiety Developmental Disabilities
ADHD Frequently goes undiagnosed, sometimes resulting in self -medication through the use of stimulants or depressants. Frequently misdiagnosed as other disorders or behaviors that mimic the symptoms of ADHD or that coexist with ADHD. Substances such as cannabis are used by youth with ADHD to reduce impulsivity, although cannabis can also increase inattentiveness. Ritalin, the stimulant commonly prescribed to youth with ADHD, is the most effective treatment for ADHD symptoms, even in youth with substance use problems (Ballon, in press).
Bipolar disorder Among youth with bipolar disorder, substance use may begin at an early age. Substance use can cause bipolar symptoms to appear mixed or it can create a rapid-cycling effect. Substance use is found more often among people in manic episodes than in any other psychiatric disorder. Bipolar disorder can be difficult to diagnose when there is abuse of cocaine or other major stimulants. Usually, a period of abstinence is needed for a correct diagnosis.
Conduct disorders Conduct disorders are highly linked with problem substance use and usually precede it. They are also commonly associated with ADHD. Youth with conduct disorders are typically risk-takers and heavy users of multiple substances because of the excitement and rush they get from drugs (CAMH, 2002a).
Depression Depression often precedes problem substance use. Common practice for youth to use substances to alleviate negative feelings associated with depression. Stimulants can be used to increase energy in people with depression, but they can also increase anxiety. Many of the drugs that depressed youth use (e.g., alcohol, marijuana) can cause greater depression with chronic use (CAMH, 2002a). It should be noted that withdrawal from certain substances could induce depression.
Eating disorders The likelihood of developing a concurrent substance use problem increases by 12 to 18 per cent among people with anorexia and by 30 to 70 per cent among people with bulimia. The onset of eating disorders usually occurs during adolescence. Young people with eating disorders tend to use substances such as nicotine, alcohol or stimulants (e.g., diet pills, caffeine pills, speed, cocaine) to suppress their appetites (CAMH, 2002a).
Schizophrenia People with schizophrenia use alcohol primarily for its euphoric and relaxing effects. Some research has shown that people with schizophrenia who use cannabis heavily have earlier onset of illness by five to 10 years compared to others who have not used cannabis. The rate of tobacco use in this population is much higher than in the general public, partially because nicotine blunts the side effects of antipsychotic medications. Cocaine can reduce negative symptoms and relieve feelings of depression
Social anxiety disorders Initially, avoidance behavior can protect a young person from using a substance. Once person tries alcohol or other drugs, the anxietyreducing effect of the substance can promote ongoing use (CAMH, 2002a). Use of substances can alleviate the symptoms of social anxiety, and youth who self-medicate in this way appear to be functioning reasonably well. However, as tolerance develops, the effects of the drugs diminish and symptoms of the anxiety can be exacerbated.
Developmental Disabilities People with developmental disabilities who are using alcohol/illicit drugs are more difficult to identify. The inherent limitations that people with developmental disabilities face in their lives and the resulting anxiety and depressive disorders tend to render these individuals more vulnerable to substance use for self-medication or stress relief
Challenges in youth concurrent disorders More challenging to treat concurrent disorder than either condition alone Variety of biological, psychological and social components Adolescents with concurrent disorder begin using substances at an earlier age, present with more severe substance abuse problems, and present with greater treatment needs in a greater variety of life areas.
Treatment outcome Researcher have concluded that youth with concurrent disorders have a higher rate of post-treatment substance use relapse than those without mental health problems. Youth with concurrent disorders are more likely to move in and out of treatment over a period of months or years.
Assessment Is the starting point for identifying client needs, developing treatment and support plan Comprehensive assessment by addictions counsellor includes: personal history, behavioural component, psychosocial functioning, evaluation of supports/motivation for change. Psychiatric diagnosis requires assessment by physician or mental health professional
Assessment Chronology of symptoms onset: Were the mental health issues present prior to the use of substances? Relationship between symptoms: Do the mental health symptoms worsen or improve with substance use? Do the symptoms dissipate with abstinence?
Issues in treatment Longer time needed for engagement/development of trust Pace of treatment is slower, over a longer period of time, with frequent setbacks Must address stigma of/preconceptions about mental health Self medication seen as solution Cognitive ability, attention span, thought processes (ex. Hard to work in groups re: focus, attention seeking and relationship issues)
Treatment approaches Both substance abuse and concurrent disorders share common approaches in treatment Range of interventions Stages of Change Model/Motivational Interviewing/Solution Focused Cognitive Behavioural Therapy Strength based, client/family centred Individual, family and group therapy Family involvement increases effectiveness.
Risk and Protective Factors All adolescents experience risk and protective factors in their lives Risk Factors make it more likely individuals will experience poor overall adjustment or negative outcomes, such as mental health or substance use problems Protective factors reduce the potentially negative effects of risk factors
Adolescent Protective Factors Individual Self esteem Self reliance Social skills Can experience range of emotions. School Connection Good performance Community Participation in and availability of prosocial activities Norms of non-use Family Close relationships Support/monitoring High expectations Participate in decisions Cope with hard times
Preventing concurrent disorders Social determinants of health Secure attachment and good parenting Social support and friendship Meaningful role for individual Preventing early trauma Teaching psycho social strategies for dealing with stress and anxiety Ensure community is educated and aware of signs and symptoms this supports early detection/intervention. Stigma of mental health/addictions is addressed
Centre for Addiction and Mental Health (CAMH) www.camh.net Resources for Professionals Youth & Drugs and Mental Health
Cheryl Houtekamer AADAC Youth Services Calgary, AB cheryl.houtekamer@aadac.gov.ab.ca 403 297 4664