Transcript Newport Academy Integrated Marketing Strategy

Prescription Opioid Addiction in
Adolescence: Exploring New Concepts in
Treatment
David E. Smith, MD, FASAM, FAACT
Chair, Adolescent Addiction Treatment, Newport Academy
Medical Director, Center Point
Adjunct Professor, University of California, San Francisco
Diplomate, American Board of Addiction Medicine
Past President, American Society of Addiction Medicine
Founder, Haight Ashbury Free Medical Clinic
Adolescent Drug Epidemic
In 2008, there were a quarter of a million drug-related
emergency hospital visits by adolescents.
ASAM News. Volume 25(5)
In 2008, approximately 2,500 adolescents
abused pain relievers for the first time.
Admissions related to opiate addiction increased
from 16% in 1998 to 20% in 2008.
ASAM News. Volume 25(5)
Average day in 2008
• More than 76,000 adolescents received
outpatient treatment
• More than 9,000 received non-hospital
residential treatment
• More than 700 received hospital inpatient
treatment
ASAM News. Volume 25(5)
Prescription Drug Misuse
The number of U.S. emergency department
visits involving nonmedical use of narcotic pain
relievers more then doubled from 2004 to 2008.
The two most reported narcotic pain relievers:
• Oxycodone (152% increase)
• Hydrocodone (123% increase)
Cesar Fax. Volume 19(27)
Buprenorphine is being used for opiate detox
and maintenance in clinical studies but no
controlled studies of Buprenorphine in
adolescence.
Many dual diagnosis patients with major
psychiatric disorders, such as manic-depressive
disorders, self medicate with opiates.
Opiate addiction can be treated with
Buprenorphine while the patient is on
Psychotropic medication.
Brain & Personality
• Still developing during adolescence
• Young brains more vulnerable to addiction
• Psychosocial development delayed and
distorted by substance abuse
• Adolescent addiction occurs in an immature
brain, disrupts process of brain maturation
Adolescent Epidemiology, cont.
• Up to 80% exhibit co-occurring psychiatric
disorders (ADHD, depression, oppositiondefiant disorder, PTSD, learning disabilities,
etc.)
• 10% receive SA treatment; only 25% of those
receive enough to achieve results
• Inadequate treatment availability outside
juvenile justice system
• Up to 85% of CYA wards have SA problems
Addiction as a Brain Disease
top down surface view
top down surface view
during substance abuse
after a year drug and alcohol free
underside surface view
SPECT Images courtesy of D.G. Amen, MD
underside surface view
Adolescent Brain Development and Addiction
The brain’s “front part,” or prefrontal cortex, the
thinking part of the brain, is responsible for
slowing us down or stopping our impulsive
behaviors. This region considers the risks and
benefits of our actions, and it helps us “hit the
brakes” when we consider doing things that are
too risky.
NIDA – Adolescent and Substance Use Problems; Section 5 – A Growing Problem
Continued…
This part of the brain is still developing connections
to the rest of the brain until adulthood, so
adolescents’ brains lack some of the “wiring” that
carries “brake” or “stop” messages to the rest of the
brain.
Lacking some of the wiring for the “stop” message,
adolescents’ brains may not be capable of fully
weighing the risks of drug use.
Section 5 – A Growing Problem
Heavy drug use during times of critical brain
development may cause permanent changes in the
way the brain works and responds to rewards and
consequences. Therefore, it is important to begin
to address a developing substance use problem as
early as possible.
Section 5 – A Growing Problem
Drug Reward Pathways
Drug abuse actually changes the reward pathways
in the brain. Every time a drug is used, it releases
“pleasure chemicals” that make the user feel that
“high” they get from using. After a period of
consistent use, the brain adapts to having the
pleasure chemicals present, and will function
normally in this way.
Koob, George & Kreek, Mary Jean (2007). Stress, dysregulation of drug reward pathways, and
the transition to drug dependence. The American Journal of Psychiatry, 164 (8)
Drug Reward Pathways Continued…
When the user attempts to stop using the drug,
stress chemicals are released, and this causes panic
in the user, which makes them want to use again in
order to feel “calm.” This process also causes
withdrawal, as once the brain has adapted to
functioning on the drug, removing it causes the
brain to lose its ability to function normally.
Koob, George & Kreek, Mary Jean (2007) Stress, dysregulation of drug reward pathways, and the
transition to drug dependence. The American Journal of Psychiarty, 164 (8)
The Addiction Cycle and the Four C’s
1. Craving
2. Compulsion
3. Loss of control
4. Continued use in spite of consequences
Warning Signs for Problem Substance Use
• Changes in school performance (falling grades, skipping
school)
• Changes in peer group (drug using, antisocial, older
friends)
• Breaking rules at home, school in the community
• Mood swings, depression, irritability, anger, negative
attitude
• Sudden increase or decrease in activity level
• Withdrawal from family; keeping secrets
Section 5 – A Growing Problem
Warning Signs for Problem Substance Use
• Change in physical appearance (weight loss, lack of
cleanliness, strange odors)
• Red, watery, glassy eyes or runny nose not due to
allergy or cold
• Changes in eating or sleeping habits
• Lack of motivation or interest in things other teenagers
enjoy (hobbies, sports)
• Lying, stealing hiding things
• Using street or drug language or possession of drug
paraphernalia/items
• Cigarette smoking
Section 5 – A Growing Problem
Risk Factors for Early Onset
of Addiction
• Genetic predisposition to addiction in first order relatives
• Co-occurring disorders preceding the onset of addiction
• Childhood traumas
• Disruptive, addictive child rearing environment
National Institute on Drug Addiction
Risk Factors in the Family
Risk factors in the family that may be critical in the
development of substance use problems include:
• Chaotic home environments, particularly when
parents abuse substances or suffer from mental
illness;
• Ineffective parenting, especially with children
who have difficult temperaments and conduct
disorders; and
• Lack of mutual attachments and nurturing.
Risk Factors Outside the Family
Additional risk factors relate to children interacting
with others outside of the family, some of which are:
• Inappropriate shy and aggressive behavior in the
classroom;
• Failure in school performance;
• Poor social coping skills;
• Affiliations with peers exhibiting deviant behaviors;
and
• Perceptions of approval of drug-using behaviors in
the school, peer, and community environments.
Protective Factors
The National Institute of Drug Abuse reports some of
the most salient protective factors include:
• Strong bond with family;
• Experience of parental monitoring with clear rules of
conduct within the family unit and involvement of
parents in the lives of their children
• Success in school performance
• Strong bond with pro-social institutions such as the
family, school and religious organizations; and
• Adoptions of conventional norms about alcohol and
drug use.
Researchers note “when people feel bonded to
society, or to a social unit like the family or school,
they want to live according to its standards or
norms: (Hawkins et al., 1992). Furthermore, reports show
that “strong norms, beliefs, or behavioral standards
that oppose the use of alcohol or the use of illegal
drugs by adolescents protect against drug use and
abuse.” (Hawkins, 2002).
Section 5 – A
The beginning of recovery is to stop abusing your
brain.
Step 1. We admitted we were powerless over our
addictions – that our lives have become
unmanageable.
Unchain Your Brain
Developing brain healthy approaches in adolescent for
prevention, intervention and treatment of addiction.
H – Don’t get too hungry; good nutrition and edible
recovery.
A – Don’t get too angry; beware of stinking thinking (ants)
L – Don’t get too lonely; beware of isolation and focus on a
healthy group process
T – Don’t get too tired; keep a balance of rest and exercise
Step 12. Having had a spiritual awakening is a
result of these steps. We try to carry this message
to alcoholics and practice these principles in all our
affairs.
Create a Brain Healthy Family
Creating a brain healthy family is critical for
successful recovery, whether it is a parent or child
who is trying to break free from addiction.
Set SMART Goals
Specific
Measurable
Attainable
Realistic
Timely
Improve Clinical Outcomes
Adolescents need a different treatment model for
drug addiction than adults.
Gender specific residential treatment models
offer a safe and nurturing environment for this
population.
Therapeutic Alliance
• Development of a strong therapeutic alliance
between adolescent, physicians, and therapists is key
in the process of empowering teens, restoring
families and insuring lifelong recovery.
• Best outcome occurs when family makes major
commitment to understanding the disease of
addiction and actively participates in recovery
process.
Newport Academy™ Overview
• Comprehensive Assessment, Evaluation, and
Treatment Matching
• Mandatory Family Involvement in Treatment
• Highly qualified staff trained in adolescent
development, co-occurring mental disorders,
substance abuse and addiction
• Engaging and Retaining Teens with Experiential
Therapies
• Gender Specific Residential Treatment
Newport Academy™ Overview, cont.
• Highly Individual Treatment Plan
• Individual and Multi-Family Group Treatment
• Comprehensive and Integrated Treatment
Approach
• On-site Equine Assisted Therapy
• Young Person’s 12-Step Involvement
Contact Information
David E. Smith, MD, FASAM, FAACT
856 Stanyan Street, San Francisco, CA 94117
Phone: 415-933-8759
Fax: 415-933-8674
Email: [email protected]
Website: www.DrDave.org