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 Behavioural, emotional, relationship and academic problems Associated mental health problems Poor awareness Why use them? • Rebellion • Curiosity/Adventure • AvailabilityMarketed/Advertised • Easy pleasure • Being “cool” • Peer pressure/Desire to belong • Chilled out/Relaxed • Relief from pain & chaos • Self medication • Ape adults/seniors • Style, glamour 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 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behaviours Mood swings, depression, panic reaction Lying, stealing, promiscuity Altered sleep & appetite Poor hygiene Withdrawn, lack of interests Preferences for dress, music, movies identifying with drug culture Co-morbidity • • • • • • • ADHD(attention deficit hyperactivity disorder) Conduct Disorders Depression Anxiety PTSD Self harming behaviours psychosis 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 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 ADHD ……contd • • • Persistent and Pervasive Develops from toddler hood Differential Diagnosis – – – – • Attachment Problems Anxiety Conduct Disorder SLD Detailed Family and Development Hx Conduct Disorders Persistent patterns of behaviours • Aggressive – – – • Dissocial – – – • Fighting or bullying Cruelty to animals/people Severe tempers Lying and/or stealing Fire setting Destructiveness to property Defiant – – – Persistence severe disobedience Truancy/running away from home Provocative Conduct disorders-contd. Associated Disorders • ADHD • Depression/Affective Disorder • Specific Learning Disability • Substance misuse • Attachment problems 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 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 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 Three main symptoms of PTSD 1. Intrusions- flashbacks & nightmares 2. Avoidance- attempt to reduce exposure to situations that bring back memories 3. Hyper-arousal- tension, hyper-vigilance and increased startle response 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 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 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 MANAGEMENT • PREVENTION • INTERVENTION 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 Four Rs of Working with Adolescents Responsible Respect Root Values Relationship Keys to Successful Relationship • • • • • Contact Congruence Positive Regard/Respect Empathy Perception What is Normal? • • • • • • • Rebellion Defiance Rudeness/talking back Mood swings Risk taking/experimenting Lying Crossing limits/breaking rules What is Acceptable? • • • • • • • Rebellion Defiance Rudeness/talking back Mood swings Risk taking/experimenting Lying Crossing limits/breaking rules Boundaries Negotiable Non-Negotiable 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 Teenage Skills for Carers First Things First! • Respect his/her uniqueness • Build a supportive, caring and mutually respectful relationship • Believe in their competencies Loosen up but don’t let go • 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