basic stuff parents need to know -...

DRUGSBasic Stuff Parents Need to

Know

Dr Stephen StathisConsultant C&A Psychiatrist

Agenda

• Basic summary about different types of drugs• More in-depth look at specific drugs common in

adolescent population in Brisbane– Marijuana (Cannabis)

– Amphetamine & Ice

– MDMA (Ecstasy)

– VSA / Inhalants

• Discussion of drug use in Brisbane Youth Detention Centre (BYDC)

• Minimal discussion on Assessment & Treatment

Types of Drugs –1. Stimulants

“Speed the body up”

Stimulate the CNS (central nervous system)

Effects: • increased energy• confidence• talkativeness• sleeplessness• irritability and aggression

AmphetaminesEcstasy ** (both stimulant and hallucingenic)

CocaineNicotineCaffeine

Types of Drugs –2. Hallucinogens

Hallucination : “a perceptual disturbance that occurs as an internal thought in the absence of an external sensory stimulation.”– Theoretically = any of the senses

Effects : heightened perception, bizarre behaviour, anxiety, paranoia, hallucinations

Ecstasy ** (both hallucinogenic and stimulant)

Cannabis ** (both hallucinogenic and depressant)

Magic mushroomsLSD

Types of Drugs –3. Depressants

“Slow you down”They do not necessarily make you

depressed

Effects : Relaxation, sense of pleasure and well-being, impaired decision making slow reflexes, fewer inhibitions, ↓ Pulse rate & breathing rate

AlcoholCannabis ** (both depressant and hallucinogen)

Benzodiazepines/minor tranquilisersHeroinInhalants

Harmful Use

• “A pattern of psychoactive substance use that causes damage to health”. (a psychoactive substance is a drug that affects the brain)

– Physical• Eg hepatitis from the self-administration of

injected psychoactive substances– Mental

• Eg depression secondary to heavy consumption of alcohol

Dependence

• “A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use “

• Features are:– Strong desire to take the drug– Difficulties in controlling its use – Persisting use despite harmful consequences – A higher priority given to drug use than to other

activities and obligations– Increased tolerance (physical & psychological)– Physical withdrawal state.

Withdrawal

• Effects of ceasing to use a drug after a person has built up a dependence on that drug

• More than a ‘hangover’• Psychological and physical aspects

Withdrawal Symptoms

Psychological disturbances• Intense craving for the drug• Anxiety• Depression• Sleeping problems & other neurological symptoms• Irritability/aggression

There may also be other mental health reasons that mimic (psychological) withdrawal eg. They may have had a pre-existing anxiety or depresssionproblem

Withdrawal Symptoms

Physiological symptoms• hunger or loss of appetite• fatigue• nausea• vomiting• sweating• in serious form - convulsions,

hallucinations

Psychiatric problems reported in association substance misuse

The following may sometimes lead to substance abuse as well as being caused by the substance

• Depression & suicide• Anxiety • Panic & social phobia• ADHD• Post-traumatic Stress Disorder• Eating disorders• Paranoia & psychosis• Cognitive (thinking and reasoning) problems• Depersonalisation/ derealisation• Sleep disorders

Cannabis

Historical Perspective

• Evidence that cannabis was cultivated in China 6000 yrs ago

• Used throughout India 1000 yrs ago• Multipurpose and hardy crop-uses include

– Cooking oil– Edible seeds– Animal fodder– Hemp fibres– Potent drug

CourtwrightCourtwright, Forces of Habit,, Forces of Habit, 20012001

Cannabis & Cannabinoids• Cannabis is found in the common forms of Cannabis

sativa and Cannabis indica• The term ‘cannabinoid’ (cannabis-like) include ~60

chemicals found primarily in leaves and flowering tops of female cannabis plant.

• Two specific cannabinoid receptors in the body– CB1located in brain and peripheral tissues– CB2 located in the immune system

• Depressant and hallucinogenic effects results primarily from stimulation of mesolimbicdopaminergic neurons via CB1 receptors (the mesolimbicarea is located deep in the brain)

Commonly used terms

• Marijuana : grass, hash, pot, weed, dope etc• Methods of smoking

– Joint: cigarette of marijuana

– Cone: a cone of cannabis, smoked via a water pipe (bong); Stronger than a joint

• Types of marijuana, in increasing strength– Leaf (least strong)

– Head– Oil/resin (most strong)

Cannabis

In 2004• 5.2% 12-15 yrs used cannabis• 18.0% 16-17 yrs• 26.5% 18-19 yrs• ~ stable since 2001

2004 National Drug Strategy Household Survey

What do people like about cannabis?

• Cheap (~$1-3 per cone); $25 & $50 bags• Easy to grow • Non-stigmatised• For “Relaxation”• To enjoy the ‘escape’ of perceptual distortions• Aids sleep difficulties• To relieve positive symptoms of schizophrenia• Relief of suffering (nausea, anorexia and distress)

associated with serious illness (cancer and advanced HIV)

Adverse effects

• Anxiety, dysphoria, panic, paranoia– especially among naive users

• Cognitive (thinking) and psychomotor (moving/activity)

impairment while intoxicated leading to..– Accidental injury– Impaired task performance

• Psychotic symptoms more likely if– high doses of cannabis

– vulnerability (genetic)

Natural history of cannabis use (under prohibition)

• Initiation in mid teens• Most use intermittently

– Surveys indicate a relatively low daily use capture rate

• Usually discontinue in mid to late 20s– ? Due to impact of ‘marriage, mortgages & children’

• Persistent use relatively rare, but more likely if– early initiation

– heavier use

Current monthly use of various drugs by age

0

10

20

30

40

50

60

70

80

90

100

10 12 14 16 18 20 22 24 26 28 30 32 34

age

pro

po

rtio

n

alcohol

cigarettes

cannabis

other illicit

prescribed psychoactives

Chen & Kandel, 1995

But ……

• In those adults that continue to misuse, weekly or more frequent use accounts for 96% of use– Not so with YP (young people); binging more common

• Most YP smoke ‘heads’; fewer use bongs• If initiation of use is earlier, then:

– more regular use by younger users is likely

– more problem users and long term users

• More use among vulnerable groups• persons with schizophrenia

• conduct disordered adolescents

Common misconceptions

• “You can’t get addicted to cannabis”• “It’s a gateway drug (leads to use of ‘harder’

drugs)”

• “Rising potency in recent years, leading to more harm”

• “Causes schizophrenia “• “Harmless, and safer than many licit drugs”

All not entirely true All not entirely true ……!!

Addiction. Is it a Gateway Drug?

• Theory: sequence of drug involvement– alcohol & tobacco precede cannabis, which

precedes amphetamines & other drugs

• However, < 5% of those who’ve tried cannabis go on to use ‘harder’ drugs

• Progression to harder drugs more likely if:– earlier initiation & heavier use– ?genetic vulnerability

Why association with other drugs?

• Selective recruitment to use– At risk youth more likely to use

• YP with conduct disorder have increased risk cannabis use (as well as amphetamines and psychosis)

– “Toxic peer group”- friends that use drugs• regular users affiliate with peers who use • peer culture supportive of drug use & crime

• Drug markets– provide opportunities to use other illicit drugs

• Genetic vulnerability – drug dependence– psychosis?

Potency: THC content of marijuana 1980-98

0

1

2

3

4

5

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98

% T

HC

US US Potency Monitoring Project Potency Monitoring Project

Is High Potency a Problem?

• For naive users– higher risk of dysphoria (bad trip) & psychotic

symptoms • This may mean higher rates of discontinuation?

a “positive?”• But may mean higher rates of accidental injury?

a “negative”?• For regular users

– lower respiratory risks (!)(they smoke less drug to get their fix, so less lung damage)

– But higher risk of dependence? • especially among adolescents

– more cognitive impairment?

Cannabis and psychosis• Cannabis psychosis-two types

– Toxic psychosis i.e. as a direct of the cannabis intoxication– Functional psychosis i.e. persists once cannabis no longer present

• Mild dose-dependent paranoia common

• High prevalence of cannabis use at same period of ↑↑↑↑ risk for psychosis– Males = 18-25– Complicates causal attribution

• Cannabis use is a risk factor for schizophrenia-why?• Possibly precipitates disorder in the vulnerable

– Historically - Swedish conscript study & many others– Numerous studies now support

• Cannabis use exacerbates psychotic disorders– Reasonable prospective evidence

– Adolescent (early) onset increases risk further

GeneticsThere is some now proven genetic factors that make one susceptible to developing psychosis and cannabis may interact with these genetic factors

when present• Catechol-o-methyltransferase (COMT)

– Located on chromosome 22q11, a region implicated in genomic scans of schizophrenia

• Involved in the metabolism of dopamine– disturbances in dopamine function have been implicated in the pathogeneses

of schizophrenia• G to A missense mutation produces a valine to methionine substitution at codon 158

( Val158Met)– Co-dominant (Val/Val; Val/Met; Met/Met)– Met/Met have the lowest COMT activity; Val/Val carriers having the highest

activity and heterozygotes having intermediate activity of the gene– Met form of the gene produces less enzymatic COMT activity and subsequent

slower breakdown of dopamine• Met/Met is reported to increase the risk of psychosis in the cannabis-smoking

adolescent by 10 fold

– www.rsc.org/Education/EiC/issues/2005Sept/infochem.asp

2. Stimulants

Methamphetamine

• Synthetic drug; molecularly related to adrenaline

• Mirror image of Dexamphetamine (used to treat ADHD) but dex is NOT addictive

• 3 major types in Australia– Base– Powder– Crystalised / ICE

Amphetamines

• Australia has one of the highest rates of amphetamine use in the world,

• Drug offences relating to amphetamines represented 12% of all offences in 2003/4

• Deaths associated with amphetamines were 8% of all drug related deaths.

Amphetamine Laboratories(www.wdp.nsw.gov.au )

00ACT

12TAS

60NT

209WA

333WA

487SA

6119NSW

18955QLD

20041997

Amphetamines & Ecstasy

• 6.6% of YP aged 14-19 had used amphetamines– 2.9% in 1995– Has fluctuated last 5 yrs.

• Similar proportion used Ecstasy (6.2%)– 0.9% 1995– Steady increase since

2004 National Drug Strategy Household Survey

Base

• Oily & Gluggy; damp powder• Yellow or Brown 2nd to impurities• “Base”, “Snot”, “Wax”, “Point”• Made in Australia!!• Usually swallowed, smoked or snorted

– Mixed with dry substances (vitamins!)– Can be injected

• Sold as “points” = 0.1 gm– Currently about $40-$50 per point

• Easily available

Powder

• Usually white; can be coloured– Used to be impure; has increased in last 5 yrs

• “Speed”, “Goey”, “Whiz”• Made in Australia!!• Usually snorted or injected• Sometimes mixed in drinks

Crystalised“ICE”

• Large white or translucent crystals; sometimes coarse powder

• “Ice”, “Meth”, “Yaba”, “Blu” & others• Highly pure and therefore potent• Imported from Asia – increasingly made in Oz• Usually smoked though can be snorted or

injected• Point (0.1g) ~ $80

• ↑↑ common

Speed - Physiology 101

Increase activity on the central and autonomic nervous system – Increase wakefulness; masks fatigue– Reduce appetite; increases insomnia– Promote heightened sense of well-being and

euphoria (feeling good)– Increase heart rate, blood pressure,

respiratory rate– Constrict vessels and dilate pupils

Neurophysiology 101

• Acute but transient blockade of the dopamine transporter (DAT) system

• Acutely increased dopamine levels in the midbrain (VTA & n. accumbens)

•• ““ PLEASURE BURSTPLEASURE BURST ””– highjacks the reward pathway – Also increased noradrenaline and serotonin

• Increased dopamine ⇒⇒⇒⇒ Psychosis

• BUT subsequent depletion of dopamine, noradrenaline and seratonin

• Sudden changes cause perceptual disturbances, withdrawal states

Dopamine, noradrenaline, serotonin

Dopamine Depression

Comedown

Withdrawal

Schizophrenia

panic/anxiety

paranoia/mania

hallucinations

psychosis

agitation/aggression

ANTIPSYCHOTICS dopamine

Antidepr

Dopamine, noradrenaline, seratonin

Intoxication

Withdrawal

Dependence

• Psychologically and physiologically addictive ++

• Those who inject are at significant risk of developing dependence

• May not be a ‘daily use’ pattern

• Binge pattern common: use 3 - 5 days then ‘crash’

• There is often a concurrent dependence of abuse of other sedative or stimulant drugs, especially alcohol and benzodiazepines (adults)

• High risk factor for developing psychotic episodes

Withdrawal Symptoms

• Extreme fatigue and depressive symptoms• Escalates to a broad range of symptoms

– Change in appetite

– Change in libido

– Change in sleep patterns; early and middle insomnia, increased but restless sleep, nightmares

• Irritability & agitation• Anxiety and panic; mood lability

Withdrawal (cont)

• Clinical signs suggestive of withdrawal present ~2 - 4 days after last use

• Most cases resolve in a few days to 2 wks (~ 15% persist for more than a month)

• Observation/symptomatic relief: sedationwith valium or similar

• Antipsychotics should not routinely be used as first line management for withdrawal

Psychosis (cont)• Related in part to dose and route (younger age, quantity, IV)

• Spectrum from restless & fearful � paranoid & psychotic

• Paranoid thought pattern: aggression & violence prominent

– Often grandiose/ persecutory/ command

– Generally: preservation of orientation

– Generally: absence of thought disorder

• Hallucinations: visual / auditory/ tactile/ taste

• Progression to schizophrenia is common if use persists

• Treat

– Remove source –stop drugs!

– Antipsychotics

Psychosis (cont)• Genetic vulnerability; more common in those with pre-

existing schizoid/ schizoid-type personality disorder & family history of psychosis

–CART (cocaine and amphetamine regulated transcript) system

•CART I

•CART II

•Pro-CART

– Hypothalamic pro-opiomelanocortin (POMC)

– Vesicular acetylcholine transporter (VAChT )

– Choline acetyltransferase (ChAT )

Ecstasy

X-TC, Ekkies, E, Love Drug, Clarity, Essence, Mild Speed, Hug Drug

Ecstasy – (MDMA)• 3,4-methylene-dioxymethamphetamine• “Ecstasy”, “Es”, “Ekkies”• Stimulant with mild hallucinogenic properties• Generally imported• Price ~ $30/pill

– Cost <25c to make• Usually sold as branded pills• How taken:

1. Usually oral2. Crushed and via nose: “snorted”3. Crushed and via anus; “shelved”4. Crushed and via vagina; “shafted”5. Occasionally IV

Ecstasy History

• Patented in 1914 as an appetite suppressant

• In 1970’s Ecstasy used by some psycho-therapists to help patients open up & feel at ease

• Illegal in 1985 (US)• Previously Ecstasy was sold legally in US

in “TX bars” to college students• Flooding of Australian markets initially from

Europe, now from SE Asia

Ecstasy

• Known by numerous names: – XTC, E, Love Drug, X. – Often reflect the stamp on the pill. – Changes frequently +++

• Made in household labs – purity varies

• US: 50% of the pills being sold as Ecstasy had no Ecstasy. Frequently mixed with inert substances, or ketamine, amphetamine or caffeine.

• Ecstasy is generally taken orally in the form of a pill so it takes ~ 15 minutes for effects & lasts for up to 6 hours

• Initial rush of energy and a feeling of euphoria lasting ~ 2 hours.

• Followed by a plateau effect for about 2 hours. During the plateau, users will still feel a pleasurable effect, though less intense and other effects may appear (ie.overheating).

• During this time, user may seek the intense high again. Taking Ecstasy during this plateau is known as boosting or stacking .

Short Term Effects

Physical effects• Dilated pupils• Dry mouth & throat• Tension the lower jaw• Grinding teeth• ⇈ Heart rate and

respiratory rate• Excessive sweating• Dehydration• Hyperhydration &

Hyponatraemia• Cardiovascular & Resp

collapse

Psychological effects– Positive mood change– Disinhibition ++– Increased “empathy”– ↑ “self-esteem”

Long Term EffectsPsychological Dependence

??Physical Dependence

• Extreme Fatigue • ↓ Concentration

• Insomnia• Lead to:

– Kidney failure

– Irregular heart beat– Stroke & vascular

disease

– Seizures

• Confusion• Depression• Anxiety• Aggression• Paranoia• Compulsive Behavior

Volatile Substance Abuse(VSA)

Inhalant AbuseSolvent Abuse

“Sniffing”

VSA

•• ““ The deliberate inhalation of volatile The deliberate inhalation of volatile substances for the purpose of achieving a substances for the purpose of achieving a euphoric stateeuphoric state ””

•• May be:May be:–– Semisolid (Semisolid ( egeg. glue). glue)–– Liquid (Liquid ( egeg. varnish). varnish)–– Gas (Gas (egeg. spray can propellants). spray can propellants)

Volatile Substances

In 2004• 2.4% of YP aged 14-19

– Females (3.0%) vs. Males (1.8%)– Only age group where F>M

2004 National Drug Strategy Household Survey

Common Inhalants

• Aerosols– cooking oil, deodorant, hairspray, spray paint, insect

repellant

• Household Solvents– liquid paper, paint thinner, paint stripper, markers, nail

polish remover, glue, resin

• Fuels– lighter fluid (butane) and petrol

Most commonly used substances are spray paint, butane, deodorant.

How Used

• Sprayed into a plastic bag or bottle• Poured into bottles• Direct from container (butane)• Soaked onto a cloth or sleeve (huffing)• Sprayed directly into mouth• ?Sprayed onto bread and eaten• Reports of mothers sedating babies

Onset

• Younger than other drugs• Use is stigmatised even by users of other drugs

– Shaming– Grief and Loss– Cultural issues

• Maximum prevalence between 12-14 • Incarcerated juveniles who use have average

age of initiation of 9.7 years compared to 11-12 years for cannabis

• Rife in sections of the indigenous community

Reasons for misuse

• Lack of meaningful or enjoyable activity • Boredom• Intoxication – cheap alternative to drugs &

alcohol• Inducement by friends to experiment• Shock value• Copy behaviour of adults using alcohol etc.• Lack of a voice in the community• Assert some measure of control

• Escape from stresses– Abuse– Family conflict– School tensions & bullying

• Currently easy to access – but changing• Cheap• Currently not illegal – but changing

– Lack of capacity for police to response– May remove substance from safety reasons but unable to

do more

Prevalence

• Conflicting Data

• 2.4% of YP aged 14-19 (2004 Nat Drug Strategy Surv ey)– Females (3.0%) vs. Males (1.8%)– Only age group where F>M– BUT MAJOR DEMOGRAPHIC IS 10-14

• WHO: Australia amongst highest rate of VSA in the w orld

• Study by Rose,1999 (WA)– concluded that ~20% of school children (aged 12-15 yrs) have

experimented.– WA 15% in past year, 8% past month, 5% past week

Education Qld Survey (2001)

• Prevalence of Volatile Substance Misuse (VSM) higher in lower high school– Yrs 7&8 - ~ 10 % VSM– Yrs 11&12 <1% VSM

• Never indulged– 63% yr.9 males say they have never indulged in

sniffing– 89% yr. 11 males say they have never indulged (rate

has dropped from earlier years because VSM students more likely to drop out of education system and VS Misusers then move onto other substance

• Male > Female

Effects

• Rapidly absorbed into the lungs and transferred to the brain and other organs with high lipid (fat) content– Neurons have a high lipid content– Neurotoxicity results from alterations in

neuronal membranes (not changes in neurotransmitter function per se).

Immediate Effects• Inhalants are central nervous system

depressants with some hallucinogenic properties in higher doses

• Symptom onset occurs within seconds• Intoxication starts after about 5 mins of repeated

inhalation (experienced users can control)• Peak blood levels occur around 15 mins• Signs of intoxication

– slurred speech, – ataxia, – decreased pain sensitivity,– visual disturbances ?? hallucinations

• Some acute reactions are a result of lack of oxygen

Short Term Effects

• Intoxication similar to alcohol (antidepressant effect)• Changes in heart rate• Respiratory depression• Hyperacusis (supersensitive to loud noise)• Anorexia (loss of apetite)• Drowsiness & sedation• Flu-like symptoms

– Sneezing– Coughing– Runny nose– Headaches

• Photosensitivity (supersensitive to bright light)

• Mood instability & loss of inhibition• Mood disturbances

– Depression

– Anxiety

– Paranoia

• Perceptual (esp. visual) disturbances– “Colour” change in observed objects

• Initially Silver or Gold (“Chroming”) halo

• “Black is best”

– Pleasant vs. unpleasant

Immediate Risks

• Heart irregularity/racing– Part due to drug, perhaps also really being chased by

police/peers

• Seizures• Hallucinations• Acute Delirium (confusion re where, when, who)• Accidents may occur due to disinhibition• Suffocation, eg become unconscious while inhaling with

plastic bag over head• Direct damage to upper and lower respiratory tract• Fire / explosion as most of these volatile substances burn

Delayed Effects

Almost all organ systems affected

Psychological and Physical Dependence

Withdrawal• Anxiety & depression• Aggression• Loss of appetite• Dizziness & nausea• Tremors

Patterns of Drug Use; Brisbane Youth Detention

Centre

Patterns of Drug Use in Youth Detention

• Study 1:Lennings & Pritchard (1999) found 90% of young people in detention had some degree of drug/alcohol abuse. – 33% of these believed they had a problem.

• Of those, 70% thought they should have treatment

– >50% young people in detention met criteria for a substance use disorder (Teplin et al., 2002)

Study 2: Reported Substance Use Prior

to Admission to BYDC(Brisbane Youth Detention Centre)

• Chart audit of admissions in the period 1/1/06 – 31/3/06 (209 admissions)

– 174 individual young people– 31 females; 143 males– 78 Indigenous; 96 nonIndigenous– Average age 15.4 years

Study 2- cont.Reported Substance Use Prior

to Admission to BYDCReported Drug/Alcohol Use Prior to Admission

19%

61%

72%

4%0.5%

52%

1%

10%

83%

85%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Toba

cco

Amph

etam

ines

Benzo

diaz

ephin

es

Mar

ijuan

a

Barbitu

rate

s

Othe

r

Solven

ts

Any D

rug

(Not T

obac

co/A

lcoho

l)

Alcoho

l

Any D

rug/

Alcoho

l (Not

Tob

acco

)

Study 2 (cont)Indigenous vs non-indigenous

Indigenous v Non-Indigenous Young people reported D rug/Alcohol Use prior to Admission

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Toba

cco

Amph

etamine

sBen

zodia

zephin

es

Mariju

ana

Barbitu

rate

s

Other

Solvents

Any Dru

g (Not T

obacc

o/Alco

hol)

Alcohol

Any Dru

g/Alco

hol (

Not Tob

acco)

Non-Indigenous Young People

Indigenous Young People

Study 2 (cont)Non-indigenous males

Non-Indigenous Males Reported Drug/Alcohol Use Prio r to Admission

87%

13%

2%

54%

0%4% 4%

55%

79%

88%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Tobacc

o

Ampheta

mines

Benzod

iazeph

ines

Marijuana

Barbitu

rates

Other

Solvents

Any D

rug (

Not Tob

acco

/Alco

hol)

Alcohol

Any D

rug/A

lcoho

l (Not

Tobacco

)

Study 2 (cont)Indigenous males

Indigenous Males Reported Drug/Alcohol Use Prior to Admission

79%

5%0%

55%

0% 2%

35%

71%

62%

83%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Tobacc

o

Ampheta

mine

s

Benzo

diaze

phines

Mari

juana

Barbitu

rate

s

Other

Solvents

Any D

rug

(Not

Tobac

co/A

lcoho

l)

Alcohol

Any D

rug/

Alcoho

l (Not

Tobacc

o)

Study 2 (cont)Non-indigenous females

Non-Indigenous Females Reported Drug/Alcohol Use Pr ior to Admission

81%

24%

0%

43%

0%

10%

14%

48%

76%

81%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Tobacc

o

Amph

etam

ines

Benzo

diazep

hines

Mar

ijuan

a

Barbitu

rates

Other

Solve

nts

Any D

rug

(Not T

obacc

o/Alco

hol)

Alcoho

l

Any D

rug/

Alcoho

l (Not

Tobacc

o)

Study 2 (cont)Indigenous femalesIndigenous females Reported Drug/Alcohol Use Prior to Admission

85.71%

0.00% 0.00%

7.14%

0.00%

42.86%

64.29%

57.14%

85.71%

36%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Toba

cco

Amph

etam

ines

Benzo

diaz

ephin

es

Mar

ijuan

a

Barbi

tura

tes

Oth

er

Solve

nts

Any D

rug

(Not

Tob

acco

/Alco

hol)

Alcoho

l

Any D

rug/

Alcoho

l (Not

Tobac

co)

Study 2 (cont)Summary

• Males higher rates for marijuana ,alcohol

• Females higher rates inhalants , amphetamines

• Non-Indigenous higher rates alcohol , amphetamines

• Indigenous higher rates VSA