Adolescent Development, Substance Use, Current Trends

Adolescent Development,Substance Use, Current TrendsDiana PadillaFebruary 2021

2SAMHSA DisclaimerThe development of these training materials was supported by grantTI082504 (PI: M. Chaple) from the Center for Substance AbuseTreatment, Substance Abuse and Mental Health ServicesAdministration (SAMHSA), United States Department of Health andHuman Services. The contents are solely the responsibility of theNortheast and Caribbean Addiction Technology Transfer Center, and donot necessarily represent the official views of SAMHSA.

3Purpose of SAMHSA’s Technology Transfer CentersThe purpose of the Technology Transfer Centers (TTC) program is todevelop and strengthen the specialized behavioral healthcare andprimary healthcare workforce that provides substance use disorder(SUD) and mental health prevention, treatment, and recovery supportservices.Help people and organizations incorporate effective practices intosubstance use and mental health disorder prevention, treatment andrecovery services.

10 Regional CentersHHS RegionsREGION 10REGION 8REGION 1REGION 5REGION 2REGION 3REGION 9REGION 4REGION 6REGION 74

6GoalProvide a review of mental health correlates of teenage stressand substance use, within the context of social distancingduring a pandemic and other life stressors.

7Common Adolescent Problems Growth and development School related challenges Childhood illnesses that continue into adolescence, mentalhealth disorders Consequences of risky or illegal behaviors, including injury,legal consequences, pregnancy, infectious diseases, andsubstance use disorders

8Mortality, Morbidity, and Social Problems Behaviors that contribute to unintentional injuries and violence Tobacco use Alcohol and other substance use Sexual behaviors related to unintended pregnancy and sexuallytransmitted infections (STIs), including HIV infection Unhealthy dietary behaviors Physical inactivityThese behaviors, as well as obesity, overweight, and asthma, frequently arerelated, are established during childhood and adolescence, and extend intoadulthood.Center for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Surveillance Summaries / Vol. 67 / No. 8, June 15, 2018, YouthRisk Behavior Surveillance - United States, 2017

9Development and Behavioral Challenges Can exercise poor judgment: finding it difficult to think throughconsequences Engage in increased risk-taking and inappropriate behavior Act on impulse and emotions rather than logical and practicality Can misunderstand subtle social cues: this can lead tomiscommunication Misinterpret expectations and misread facial expressions Have a limited attention span and a different concept of time Lack the inhibitions of adulthood

10Pandemic Related Youth Challenges Change in regular routines Break in continuity of learning Missing significant life events Loss of security and safetyCOVID-19 Parental Resources Kit - Adolescence, Social, Emotional, and Mental Well-being of Adolescents during ce.html

11Risk Factors for Mental IllnessAlmost all adolescents and teens experience periods ofmoodiness, crankiness, and/or angst, but there are certainindicators that could demonstrate the presence of a moreserious issue including Becoming socially withdrawn Pervasive moodiness, lasting more than a few days Dramatic changes in eating habits (including changes inweight) Ongoing anger, irritability, or hopelessness

12Adolescent Mental Illness 50% of all lifetime cases of mental illness will develop by age14, and 75% by age 24. The most common mental health disorders in adolescentsand teens are, anxiety disorders, stress-related disorders,mood disorders, obsessive-compulsive disorders, eatingdisorders, and disruptive-behavioral disorders (i.e.attention-deficit/hyperactivity disorder or oppositional what-causes-mental-illness-adolescence/

13Neglect and Abuse Neglect disrupts attachment and changes thedevelopment of the brain Lack of empathy Creates frustration and angerTeenage Anxiety a Rapidly Growing Mental Health Concern, Retrieved January 2020 iety/

14Anxiety DisordersAffects 32% of 13 to18 year-olds and characterized by feelingsof excessive uneasiness, worry, and fear Emotional changes Social changes Sleep disturbances Poor school performance Panic attacksCommon Mental Health Disorders in Adolescents, content created by Office of Adolescent Health, last reviewed on May 1, /common-disorders/index.html

15DepressionAffects about 13% of 13 to17 year-olds, impacting on thoughts, feelings, dailyactivities, eating, sleeping. To be diagnosed with depression, the symptoms must be present for atleast two weeks.Some symptoms include: Persistent sad, anxious, or “empty” mood Feelings of hopelessness, or pessimism Irritability Feelings of guilt, worthlessness, or helplessness Loss of interest or pleasure in hobbies and activities Decreased energy or fatigue

16Others Include Attention-hyperactivity Deficit Disorder (ADHD) Eating disorders Co-occurring disorders Self injury: offers relief, (feelings are getting out),trying to stop feeling painful emotions, like rage,loneliness, or hopelessness, or distraction

17Zoom FatigueCoping with pandemic andstaying connected to lovedonesWeariness and burnout ofoverusing technology

18Teen StressA "pile-up" of many stressful life events in a small amount oftime, or ongoing, day-to-day stresses and strains are harder onadolescents than major life events. Problems with peers (including "romances") Family issues or problems with parents School-related problems or pressures Their own thoughts, feelings, or behaviors (feelingdepressed or lonely, getting into trouble because of theirbehavior)

19Risk Assessments The Rapid Assessment for Adolescent Preventive Services (RAAPS)is one risk screening tool recommended by the Society for AdolescentHealth and Medicine. The Child and Adolescent Needs and Strengths (CANS) is a multipurpose tool developed to support care planning and level of caredecision-making, to facilitate quality improvement initiatives, and toallow for the monitoring of outcomes of services.

20Question6 out of 10 young people believe that the casual use ofelectronic cigarettes does no or little harm

Use of E-cigarettes In February of 2020, a total of2807 hospitalizations associatedwith lung injury and e-cigaretteshappened or ended in death inthe US. Among diseases in the UnitedStates, 78% developed in peopleunder the age of 35, the CDCreported, with an average age of24.CDC, Outbreak of Lung Injury Associated with E-cigarette Use or Vaping, February 28, 2020,https://www.cdc.gov/tobacco/basic 1

22How E-cigarettes WorkLa BATERÍA alimenta eldispositivoBOCA Permite ala usuaria inhalarel aerosalATOMIZADOR calienta ele-líquido en un aerosalCARTUCHOalmacena el e-líquido"E-cigs", "e-hookahs", "mods","vaporizers", "vaporizers", "tank systems"

23E-cigarettes and Vapers Vaping is the act of inhaling and exhaling steamfrom an e-cigarette or similar device. The actual device used for vaping is a smallbattery-powered device that heats the e-liquidinto an inhalable vapor, similar to how steamforms. E-liquids come in varieties of flavors and levels ofnicotine or without nicotine. There are a wide range of options when it comesto devices, electronic liquids, tank systems andbatteries.CDC, Smoking and Tobacco Use, About Electronic Cigarettes (E-Cigarettes), September 9,2020, https://www.cdc.gov/tobacco/basic information/e-cigarettes/about-e-cigarettes.html

24Aerosol Inhalers In addition to nicotine, e-cigarettes may contain harmful andpotentially harmful ingredients, including Ultrafine particlesthat can be inhaled deep into the lungs. Flavorings such as diacetyl, a chemical related to seriouslung diseases Volatile organic compounds Heavy metals, such as nickel, tin and lead Vitamin E acetate identified in bronchoaveolar wash liquidsimples.Know the Risks, Youth and Young Peoplehttps://e-cigarettes.surgeongeneral.gov/

25Caramel Flavors68% of e-cigarette users in high school use flavorsMentholAlcoholCandyFruitChocolateSweetMMWR, Notes from the Field: Use of Electronic Cigarettes and Any Tobacco ProductAmong Middle and High School Students – United States, 2011-2018.

26Tobacco Tobacco use accounts for 80% ofpreventable deaths in the US. 23.2% of Hispanic high schoolstudents use e-cigarettes. Young people who use ecigarettes may be more likely tosmoke regular cigarettes in thefuture.

More Consequences Bad breathSmelly clothes and hairProblems keeping up in sportsIncreased risk of injury and shorter healing timeIncreased risk of disease

28MarijuanaIn the 1960s-70s, average THC concentrations were 1-2%, nowreaching 20%.

29MarijuanaMarijuana Lit: Fact based information to assist you in providing SUD services, ana-lit

30Brain Changes

31Early Use of Substances 9 out of 10 people who use nicotine, alcohol or othersubstances before age 18 are at risk of substance usedisorder Each year that substance use is delayed during theadolescent brain development period, the risk of addictionand substance abuse decreasesNational Center on Addiction, CASA, Teen Substance Use, April 14, 2017, ion/teenage-addiction

32Substance Use and Trauma 1 in 4 children and adolescents in the U.S. experience atleast one potentially traumatic event before age 16 1 in 5 adolescents between the age of 12 and 17 areinvolved in abusive/dependent or problematic use of illicitdrugs or alcohol.TRAUMAUSO DESUSTANCIAS

33Luka’s Case "I was selling my clothes," said Kinard, a 15-year-old highschool sophomore. "I'd buy shoes, sell them, go out and buy cheap shoes, sellthem. I was doing everything I could to get money." Luka Kinard knew his vaping habit was out of control when itstarted costing him 150 a week.

34Signs of Vaping Behavior Find unusual or unknown items. Vaping devices usually comewith detachable parts. Behavioral changes, mood swings, agitation Difficulty breathing Poor performance Sweet fragrances Weight loss Mouth sores, abnormal cough

35Critical Aspects of Clinical Care Culturally appropriate Reported trauma Stating Person-centered Support Learning to hear youth

365 Tips to Stop Know the facts Be ready to quit smoking Form a support team Download the app Consider counseling

37Academic Impact of Substance Use

38Warning Signs of Substance Use Alcohol, smoke or other chemical odorson your child’s or their friends’ breath orclothing Obvious intoxication, dizziness orbizarre behavior Sudden weight gain or loss Loss of interest in usual activities orhobbies Changes in dress and grooming School problems such as declining orfailing grades, poor attendance andrecent discipline problems Changes in choice of friends Trauma or frequent injuries Frequent arguments, sudden moodchanges and unexplained violentactions Runaway and delinquent behavior Depressed mood or talk about depressionor suicide; suicide attempts Changes in eating and sleepingpatternsNational Center on Addiction, CASA, Teen Substance Use, April 14, 2017, ion/teenage-addiction

39Adolescent SUD and Domain-Level Factors Individual: genetic, early childhood temperament, psychiatricsymptoms and disorders, history of trauma exposure Family and parent: family dysfunction, parent-teen relationship,parental substance use, parental psychiatric disorders, parentalinvolvement, monitoring, permissibility relating to adolescent druguse, sibling drug use Environment/community: involvement with substance-using orantisocial peers, peer pressure, media promotion, access to alcoholand other drugs, poverty, exposure to community violenceChristopher J. Hammond, MD, PhD, Pravesh Sharma, MD, Psychiatric Times, Treatment Strategies for Substance Use Disorders in Adolescents: A Clinical Review,June 30, 2017, cents-clinical-review