Substance Abuse in Adolescence

Dr Amit SenSenior Consultant Child/Adolescent

Psychiatrist

Child & Adolescent Mental Health ProgramSitaram 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• Availability-

Marketed/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Mood swings, depression, panic reaction• Lying, stealing, promiscuity• Altered sleep & appetite• Poor hygiene• Withdrawn, lack of interests• Preferences for dress, music, movies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 = 4:1Impairment 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 DisordersPersistent patterns of behaviours• Aggressive

– Fighting or bullying– Cruelty to animals/people– Severe tempers

• Dissocial– 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 Responsible

RespectRespect

Root ValuesRoot Values

RelationshipRelationship

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

Non-Negotiable

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