Substance Use

Melissa Corcoran, BSc
Megan Lowe, MA
Youth Outreach Service
Centre for Addiction and Mental Health
May 2, 2013
The materials set out are general principles and
approaches to assessment and treatment pertaining
to mental health and concurrent disorders, but do
not constitute clinical advice and do not replace the
need for individualized clinical assessment and
treatment plans by health care professionals.
© Melissa Corcoran & Megan Lowe, May 2, 2013
No unauthorized copying, distribution or amendment
without the written permission of Melissa Corcoran
& Megan Lowe
Defining Mental Health
Youth and Substance Use
Concurrent Disorders
Parenting Strategies and Tips
Resources and Supports
Question and Answer Period
A state marked by the absence of mental illness (DSM-IV-TR)
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 (World Health Organization)
Mental health means striking a balance in all aspects of one’s life:
social, physical, spiritual, economic and mental. At times, the
balance may be tipped too much in one direction and one’s footing
has to be found again. Everyone’s personal balance is unique and
the challenge is to stay mentally healthy by keeping the right
balance (Canadian Mental Health Association)
Generalized Anxiety Disorder
Major Depressive Disorder
Eating Disorders (Anorexia)
Disordered eating
Emotion regulation
Substance Use
Physical Changes
Hormonal changes
Changes in brain
Increase in appetite
Changes in sleep (fall
asleep later, wake
Cognitive Changes
Greater ability for
abstract thinking
Can take perspectives
of others
Capable of generating
hypotheses and
formulating opinions
independence from
Develop meaningful
relationships outside
Improved ability to
regulate emotions
Begin plans for selfsufficiency
Adolescence is also often a time of experimentation, exploration and risk-taking
Risk Factors
• Maternal Pre-natal SU
• Parenting styles
• Exposure to violence at
• Parental SU/MH Problems
• Physical, psychological or
sexual abuse
• Poor academic achievement
• Poverty
• Neighbourhood /
Community Problems
• Peers
Protective Factors
• High-quality infantcaregiver relationship
• Appropriate discipline and
limit setting
• Strong affiliations with prosocial institutions
• Strong bond with
parent/significant adult
• Success in school
• Public policies that ensure
adequate income
• Involvement in appropriate
recreational/leisure activities
Substance Use
Your Estimate %:
CAMH 2011 OSDUHS Survey % :
• Alcohol
_______ %
• Alcohol
_______ %
• Tobacco
• Tobacco
• Opioid Pain
Relievers ________%
• Opioid Pain
Relievers ________%
• Cannabis ________%
• Cannabis ________%
• Cocaine
• Cocaine
Your Estimate %:
CAMH 2011 OSDUHS Survey % :
• Alcohol
_______ %
• Alcohol
54.9 %
• Tobacco
• Tobacco
8.7 %
• Opioid Pain
Relievers ________%
• Opioid Pain
• Cannabis ________%
• Cannabis
• Cocaine
• Cocaine
2.1 %
There is no definitive cause of substance use
problems among youth
Many risk and protective factors play a role in
determining which youth will go beyond
experimentation to developing substance abuse or
dependence problems
Involves complex relationships among
biological, psychological, and social factors in
the adolescent, their family, and the broader
environment (e.g. school, peers, community)
Non Use
Substance Abuse
Continuing substance use that results in
serious problems such as:
• Inability to function adequately at
work, school or home.
• Risk to self or others (e.g. drunk
• Repeated legal problems.
• Frequent interpersonal or family
Substance Dependence
Continuing substance use that results in major
physical, psychological, and behavioural
problems such as:
• Tolerance to the substance.
• Withdrawal from the substance.
• Use that is greater or longer than
• Desire to quit or unsuccessful efforts
to do so.
• Much time spent obtaining, using or
recovering from the substance.
• Giving up or reduced involvement in
usual activities.
• Continued use despite physical or
psychological problems resulting
from the substance.
What are Concurrent Disorders?
Young people who develop substance use problems are
often dealing with many other issues, including mental
health problems
The combination of a substance use disorder and a mental
health disorder is referred to as “concurrent disorders”
Mental health problems may precede substance use and an
individual may be using substances to cope or “selfmedicate” mental health problems
Mental health symptoms may develop as a result of
substance use (e.g. alcohol and depression)
Trigger: Substance use triggers mental health disorder in
youth with predisposition to that disorder
Create: Substance use produces psychological
Exacerbate: Psychological symptoms get worse when
substances are used
Mimic: Substance use effects look like mental health
Mask: Psychological symptoms hidden by substance use
Independence: Substance use and mental health
disorder are not related to each other, but both may be
related to a common underlying factor
Co-occurrence is high, unrecognized and always higher
than you think
Addressing single “problems” in isolation is not effective
Early intervention can decrease severity, duration and
onset of additional problems
Youth with CD are at higher risk for:
 Homelessness
 Suicide
 Victimization
 Poor health outcomes
 Incarceration/legal problems
 Re-hospitalization
Personal Narrative
Parenting Strategies and Tips
Change in sleep patterns
 Change in eating habits
 Change in mood
 Change in grades
 Change in finances
(asking for money, theft,
pawning possessions)
 Secrecy
Loss of interest in
previous commitments
(hobbies, sports teams,
school clubs)
Significant avoidance
of family
Loss of friends
Surrounds self with
other drug users
Education vs. Scare Tactics
Frightening or ‘worst case scenarios’ are often
 Discussing issues together (e.g. researching online)
I statements
 Identifying appropriate times to address issues
 Open-ended questions, paraphrase, reflect,
Be with them in the moment as they express themselves
 Remember what it was like to be an adolescent
Parenting style and boundary setting
 Authoritarian
vs. Authoritative vs. Permissive
Self-care and managing emotions
Accessing support for yourself and child
We are all broken and wounded in this world.
Some choose to grow strong at the broken places.
(Harold J. Duarte-Bernhardt)
Centre for Addiction and Mental Health (CAMH)
oYouth Outreach Service
Ext 4548
oYouth Addiction & Concurrent Disorders Service (YACDS)
Ext 1730
oSubstance Abuse Program for Afro-Canadian & Caribbean Youth (SAPACCY)
Ext 6767
oOther Child, Youth, & Family Program Services
Ext 4366
Ontario Health Services Information
oDrug and Alcohol Helpline
oMental Health Helpline
oOntario Problem Gambling Helpline
Canadian Mental Health Association
Kids Help Phone
Family Services Toronto
Gerstein Crisis Centre
211 Toronto
416-929-5200 crisis line
dial 211
Centre for Addiction and Mental Health Resources:
The mental health and addiction 101 series (online tutorials)
Straight Talk and Do you know drug series…
Mental health information guides (depression, anxiety, schizophrenia, etc.)
Teens and Tweens Podcast Series
for talking to your kids about substance use
Paglia-Boak, A., Mann, R.E., Adlaf, E.M., & Rehm, J. (2009). Drug use among Ontario
students, 1977-2009: Detailed OSDUHS findings. (CAMH Research Document Series No.
27). Toronto, ON: Centre for Addiction and Mental Health.
Barankin, T. & Khanlou, N. (2007). Growing up resilient: Ways to build resilience in children
and youth.
Wolfe, D. A, et al. (Spring 2011, CAMH). What parents need to know about teens: Strategies
for reducing the risks of alcohol, tobacco, other drugs and gambling.
Wolfe, D. A. (Ed.) (2007, CAMH). Acting out: Understanding and reducing aggressive
behaviour in children and youth.
Question & Answer Period
Melissa Corcoran
Ext 39127
Megan Lowe
Ext 36770