Adolescent Addiction Service Provides Support and Treatment in Relation to Alcohol and Drug Use For Young People

and Families from Ballyfermot, Clondalkin, Palmerstown, Lucan and Inchicore.

“Challenge & Change”

Presentation to

National Drugs Conference of Ireland

November 2011

© Denis Murray 2011

Introduction

Overview of Adolescent Addiction Service

Referrals

Drug use trends

Participation in education

Approaches to intervention

Case examples

Reflection

3

Adolescent Addiction Service Provides Support and Treatment in Relation to Alcohol and Drug Use For Young

People and Families from Ballyfermot, Clondalkin, Palmerstown, Lucan and Inchicore.

Advice

Support

Assessment

Family Therapy/Counselling

Professional Consultation

Medication (if required)

Contact: Bridge House

Cherry Orchard Hospital

Dublin 10

Phone 01-6206400/6206493

Referrals accepted from :

Family members ,Professionals and Young People

Adolescent Addiction Service

Established 1997 as a structured 12 week outpatient

detoxification programme (involving methadone

prescription) for under 18yr olds who were experiencing

problems in relation to heroin use.

Operated out of Fortune House Clinic, Cherry Orchard

Hospital.

Why an Adolescent Addiction Service?

HRB report showing 33% increase in drug users

presenting to services 1990-1996. For opiate users 65%

between 15-19yrs

Increase in prevalence of Hepatitis C antibodies among

those under age 18yrs

Adolescents are different and have specific developmental

needs

Family involvement in treatment essential © Denis Murray 2011

Challenges Presented

• Programme too rigid based on adult model with expectation of rapid detoxification

• No established social/aftercare supports

• Service not giving sufficient consideration to issue of adolescent development

• Staff team drawn from adult service and did not have experience of working with young people

• Societal attitude to Adolescent Drug Use and Methadone

• Engaging with families (100% parent/guardian contact)

• Participant profile; developmental stage, level of substance use, drug dealing, criminal activity, educational achievement, relationship with other group members and substance use within families

© Denis Murray 2011

© D enis Murray 2011

Rapid Assessment

Family

Therapist

Waiting

List

In Patient

Detox

Young

PersonOP

Detox

Adult

OPDetox

Young

PeopleAnd

Families

Clinical Meeting

FamilyTherapist

Child

AdolescentPsychiatrist

Nurses

Other

SignificantPeople

GP

Individual

CarePlan

Family

Community

GP Nurses

Structured Twelve Week

Out-Patient Detox

Adult

DrugUsers

Referral

CurrentStructures

1997/99

2004

Separation

Therapy/Medical

Inclus ion

Alcohol

2003

PROGRAMME STRUCTURE

© Denis Murray 2011

The primary presentations of 6,950 cases were recorded by gender and age. For the purpose of the audit only one disorder/problem was entered for each case

© Denis Murray 2011

Drug Use Comparison

Primary Drug Use

1998

Parents = 4

IVDU = 6

Average Age

1998 = 16.5yrs

2010 = 15.5yrs

Percentage Female

1998 = 36.5%

2010 = 27%

© Denis Murray 2 011

0

20

40

60

80

100

120

1998 2000 2002 2004 2006 2008 2010

Medical Non-Medical

Drug Free

Medical Non - Medical

Intervention

Active

Drug Use

1998

• Four parents in group under age 17yrs

• Six young people Injecting heroin

• Four young people homeless

• 21 had family members engaged in heroin Use

E

X

P

E

C

T

A

T

I

O

N

A

L

A

P

P

R

O

A

C

H

0

5

10

15

20

25

Completed

Junior Cert

4th yr 5th yr Out of Ed Alt Ed

1998 2010

NACD Report 2010; Highlights that early school leavers and young

people who opt out of mainstream education show higher levels

of substance use. It is proposed that positive relationships with

teachers and involvement of parents is a major protective factor

in school retention and reduced drug use.

Participation in Education

© Den is Murray 2011

Research (Duncan and Miller, 2000 ) suggests that therapeutic approach accounts for less than 15% of success and that most of the variance for therapy outcome is covered by the

common ground between all therapies: client resourcefulness and chance events that

produce change (40%); client-therapist relationship and experience of therapy as empathic, collaborative and affirmative (30%); client expectation & hope for change (15%).

When we include family members and significant others in process we get a multiplier

effect.

CRAFT

Solution Focused

MDFT FFT

Family

Systems Theory

Motivational

Interviewing

BriefTherapy

CBT

Relationship

Re

lati

n

sh

ip

CASE EXAMPLE

37 35

15.5

4

12

St James

Hospital

X 1

36

Tallaght

Hospital

X 3

Adolescent

Addiction

Service

Out Of

Hours

Service

Warrenstown

Time Line 3.5yrs

Social

Work

Completed LCA

Drug Use

Heroin

Benzo

Cocaine

Alcohol

Ant abuse

Referral

AMH CAMS

Youth

Project

© Denis Murray

Youthreach SCHOOL CAMS YSTU AAS CUMAS Aislinn Centre

16 11 19 13 4

CASE EXAMPLE

In treatment on methadone

Social Work

CASP

Violent Relationship

CDTF (funding)

Drug Use Heroin Benzo Cocaine Alcohol

© Denis Murray

RIP

*

***

*

© Denis Murray 2011

Suicide

Suicide

Suicide

16

Family

Community

OutpouringOf Grief

CAMS

Threats/AssaultInternet Abuse

Anxiety/Distress/GuiltSleep Disturbance GP

AASCommunityWorker

Console

Short termBenzo Prescription

14 17 20 19 22 11 16 18

21 24

Individual

Sessions

With FT

IP Detox

Coolmine

Therapeutic

Community

IP Detox

REHAB

Keltoi

Community

Project

College

IP Detox

Soilse

1 2

3

OP

Stabilisation

Youth reach

Work

OP DEOX

Remained

Education

NO

DRUG USE

Time Line = Two and a half years

Alcohol Abuse after years of sobriety Sober attending AA

Professional Employed

Heroin

Use

&

BENZO

Heroin

Use

Heroin

Use

Heroin

Use

ACRG

Talk to

YPP

Group

Rowlagh

Parish AAS CASP CDVEC

LISA Group

9 11 20 23

Case Example

EMPLOYER

© Denis Murray

Challenges in a Changing Environment

Br ie f Intervention

R e duce Risk by Increasing

Pro tective & Preventative

In terventions

Identify young people who are most at risk of developing drug use problems

or associated activity

Introduce protective/preventative interventions to support young people and families within local community (build capacity & resilience)

Show less tolerance for alcohol & cannabis use (stated by YPP Youthreach)

Prioritise inter agency working ( respecting boundaries & maintaining confidentiality)

Be aware of the malign consequences of Government policies in order to avoid separating peoples problems from their social and economic context

© D enis Murray 2011

Thank you for your attention. Questions? © Denis Murray 2011

CASE EXAMPLE

15.7

Primary

School

CAMH

(1) Age 9

CAMH

(2) Age 10

Secondary

School Age 11/12

CAMH

(3) Age14

Counselling

Service Age 12/13

Hospital

Adolescent

Addiction

Service

JLO Age 14/15

Out

Of

Hours

Court

Social

Work

Residential

Placement

Education

Project Age 14/15

M

o

v

e

H

o

u

s

e

M

o

v

e

H

o

u

s

e

Substance Use

Alcohol age 11

Cannabis age 12

Benzo age 13

Cocaine age 14

Ketamine age 15

Ecstasy age 15

Zimmovane age 14/15

(Prescribed)

EWO

Sleeping Rough

Substance Use

Time Line = 2.7yrs

Community of Origin

Temporary

Accommodation

Independent

Living Further

Education Drug

Free

Indebted

Family

Home

Attacked © Denis Murray

© Denis Murray 2011

Adolescent Addiction Service

Established 1997 as a structured 12 week outpatient

detoxification programme (involving methadone prescription)

for under 18yr olds who were experiencing problems in

relation to heroin use.

Operated out of Fortune House Clinic, Cherry Orchard

Hospital.

Why an Adolescent Addiction Service?

HRB report showing 33% increase in drug users presenting

to services 1990-1996. For opiate users 65% between 15-

19yrs

Increase in prevalence of Hepatitis C antibodies among those

under age 18yrs

Adolescents are different and have specific developmental

needs

Family involvement in treatment essential