Substance Use and Adolescence Edward S. Yuzda, MD, MSc, FRCPC (Psychiatry) Claude Ranger Mental Health Clinic Dec. 9 th/04Slide 2
Outline Historical Perspectives Terminology Types of Substances Diagnoses (DSM-IV) Epidemiology Etiology Risk Factors Course and Prognosis TreatmentSlide 3
Historical Perspective Since the principal coincidental disclosure of lager and wine centuries back, mankind has used substances for their psychoactive properties The identity of the way of life entwined with and was affected by the medication of decision for that timeSlide 4
Terminology Drug vs.Substance Legal versus unlawful Addiction Substance Dependence Biological versus Mental DependenceSlide 5
Types of Substances Central Nervous Depressants Alcohol Cannabis Sedative/hypnotics/anxiolytics Opioid analgesics Inhalants (ie. Stick/fuel)Slide 6
Types of Substances Central Nervous Stimulants Amphetamines Caffeine Cocaine Nicotine Ecstasy (blended stimulant/psychedelic drug)Slide 7
Types of Substances Hallucinogens LSD Mescaline PCPSlide 8
Types of Substances Other Gamma hydoxy butyrate (date assault sedate) Nitrite inhalants Nitrous oxide Kava Betel nut Nutmeg Antihistamines Antiparkinsonian drugsSlide 9
Alcohol By far the most widely recognized reason for substance related clutters in Canada half of all deadly MVAs include liquor 25% of all suicides include liquor 1.5 oz. Spirits = 5 oz. Table wine = 12 oz. Lager = 3 oz. Invigorated wine (13.6 grams of liquor) Intoxication can prompt to power outages/injury/resilience/psychiatric manifestationsSlide 10
Amphetamine and Amphetamine-Like Drugs Drastic increment in its utilization in 12-17 year olds over the previous decade Largely because of the prominence of the rave culture and originator rave drugs Amphetamine related passings have tripled in the 90\'s Serious psychiatric impacts incorporate crazy side effectsSlide 11
Caffeine Most generally utilized psychoactive substance on the planet Present in pop/OTC pharmaceuticals/chocolate/"enthusiasm" pills Meets criteria for mishandle potential: Positive reinforcer Discriminated from fake treatment Tolerance/withdrawal (yet not perceived by DSM-IV) Largely connected with nervousness issueSlide 12
Cannabis Most basic unlawful substance Earliest recorded utilize (500BC) Analgesic/anticonvulsant/sleep inducing/against glaucoma/craving stimulant 5% of individuals over age 12 have utilized cannabis inside the previous month Use is on the ascent following two many years of lessening Good social medication Controversy exists as to its psychiatric antagonistic impacts (psychosis?/amotivation disorder?)Slide 13
Nicotine A neglected enslavement 1 billion clients overall Second to no other medication in its addictive potential Use has consistently declined in the Western world auxiliary to broad government funded training efforts Its utilization is a hazard calculate for utilization of different medicationsSlide 14
Diagnoses (DSM-IV) Substance Use Disorders Substance-Induced DisordersSlide 15
Substance Use Disorders Substance Abuse Criteria An) A maladaptive example of substance utilize prompting to clinically critical impedance or misery, as showed by any of the accompanying criteria inside a 12 month duration: 1) side effects prompt to an inability to satisfy a noteworthy life part or commitment at work, self-teach 2) Repeatedly exhibits inebriation when occupied with perilous exercises 3) Legal issues 4) cont\'d use in spite of repetitive interpersonal/social outcome B) Never met criteria for substance relianceSlide 16
Substance Use Disorders Substance Dependence Criteria A) Three or more of the accompanying happening whenever amid an inside a 12 month term: Tolerance Dependence Takes bigger amounts for longer circumstances Persistent unsuccessful endeavors to chop down Great arrangement of time spent attempting to procure the substance All of every day exercises are spent attempting to get, utilize or recuperate from the impacts of the substance Cont\'d use regardless of intermittent interpersonal/social issues Specify with/without physiological relianceSlide 17
Epidemiology 37% of individuals answer to having utilized an illegal substance 66% for individuals matured 16-25 15% of individuals more than 28 have a genuine substance utilize issue 2/3 liquor 1/3 different medications 3.3% of 15 year olds meet criteria for substance manhandle or reliance The aggregate cost of substance utilize issues is assessed at $200 billion/yearSlide 18
Epidemiology (cont\'d) Male>Female Alcohol utilize : White=Hispanic>Black Marijuana utilize: Black>WhiteSlide 19
Epidemiology (cont\'d) Use in recent months: Alcohol – 59.6% Nicotine – 27.6% Cannabis– 24.9% LSD – 7.6% Hallucinogens - 10.1% Stimulants – 6.6% Methamphetamine – 3.6% Ecstasy – 3.1% Cocaine – 2.7% Crack – 2.2% PCP – 2.0% Heroin – 1.8% Glue – 1.5%Slide 20
Epidemiology (cont\'d) Alcohol use (in recent months) 12 th level – 79.2% 10 th level – 71.8% 8 th level – 55.3% Alcohol "Plastered" (in recent months) 12 th level – 61.8% 10 th level – 48.5% 8 th level – 26.8% Alcohol \'standard utilize\' 12 th level – 30.2% 10 th level – 24.0% 8 th level – 15.6%Slide 21
Epidemiology (cont\'d) Cigarette use (in recent days) 12 th level – 34% 10 th level – 30% 8 th level – 21% Daily utilize 12 th level – 22.2%Slide 22
Epidemiology (cont\'d) Illicit medication use (in recent months) 12 th level – 40% 10 th level – 38% 8 th level – 24%Slide 23
Epidemiology (cont\'d) Marijuana use (in recent months) 12 th level – 36% 8 th level – 18% Daily Marijuana utilize 12 th level – 5%Slide 24
Epidemiology (cont\'d) LSD use (in recent months) 12 th level – 9% 8 th level – 4%Slide 25
Epidemiology (cont\'d) Amphetamine use (in recent months) 12 th level – 10% 8 th level – 9% Methamphetamine use (in recent months) 12 th level – 2.8% Ecstasy use (in recent months) 12 th level – 5%Slide 26
Epidemiology (cont\'d) Heroine use (in recent months) 12 th level – 1% 8 th level – 1.6%Slide 27
Epidemiology (cont\'d) Cocaine use (in recent months) 12 th level – 4.9% 8 th level – 3% Crack use (in recent months) 12 th level – 2.1% 8 th level – 1.8%Slide 28
Number of individuals age 12 or more established that have utilized illegal medications in the previous month (U.S.) Number of millions YearSlide 29
Etiology Psychological Cultural Genetic NeurochemicalSlide 30
Individual-related Risk Factors Early time of onset Presence of early adolescence behavioral issues Poor scholastic execution Risk-taking practices Favorable convictions about substance utilize Shorter abilities to focus Increased impulsivity Increased peevishness/emotionalitySlide 31
Family-related Risk Factors Favorable convictions about substance use in guardians Parental resistance of substance utilize Lack of closeness and connection amongst pre-adult and parent Lack of teach/supervision by parent Parental substance utilizeSlide 32
Peer-related Risk Factors Peer substance utilize Favorable companion dispositions to utilize Greater introduction of teenagers to peers instead of guardiansSlide 33
Community-related Risk Factors Low SE status High populace thickness High wrongdoing rateSlide 34
Natural History Most young people attempt "portal" medications, (for example, cigarettes or liquor) which are legitimate and more available such "door" sedates then can prompt to illegal medication utilizeSlide 35
Evaluation of a substance utilize issue Evaluation incorporates: Substance-utilize related practices Observation of other psychiatric issues School/professional working Family working Social competency Leisure exercises Medical statusSlide 36
Clinical markers of a substance utilize issue Psychosocial/behavioral Change in school execution Involvement in illicit exercises Sexual carrying on (ie. Prostitution) Increased requests for cash Change in companion gather/contribution Driving impairedSlide 37
Clinical pointers of a substance utilize issue (cont\'d) Medical Frequent wounds Suicide endeavors Sudden weight changes Chronic respiratory side effects Gastrointestinal grumblings Insomnia Infections Anxiety Depression Sexually transmitted sicknessesSlide 38
Clinical markers of a substance utilize issue (cont\'d) Historical Parental utilize Estrangement from family Poor quality relations in the family Abuse/disregard Psychiatric issue Early time of first utilization of substancesSlide 39
Clinical pointers of a substance utilize issue (cont\'d) Psychosocial behavioral Change in school execution Involvement in unlawful activies Sexual carrying on (ie. Prostitution) Increased requests for cash Change in companion bunch/inclusion Driving impairedSlide 40
Psychiatric Disorders Commonly Associated with Substance utilize scatters Oppositional resistant turmoil Conduct issue ADHD Mood issue Anxiety issue Bulimia nervosa Schizophrenia Personality issueSlide 41
Course and Prognosis Most teenagers who utilize substances don\'t go ahead to create issues Levels of utilization frequently crest in late immaturity Life occasions, for example, profession fulfillment, training, marriage, parenthood tend to diminishing substance use Despite such maturational procedures, substance utilize can disturb the capacity of youths to arrange these undertakingsSlide 42
Treatment Young and socially stable patients have a superior anticipation Treatment can be isolated into four stages: Assessment and referral Detoxification and withdrawal administration Active treatment Continuing considerationSlide 43
Treatment (cont\'d) Biological Supportive restorative measures Treatment of withdrawal manifestations Replacement pharmacological treatments (ie. Methadone) Treat psychiatric co morbidities (ie. sorrow/ADHD/and so forth.)Slide 44
Treatment (cont\'d) Psychological Twelve stage programs (AA/NA) Motivational talking Cognitive behavioral treatmentSlide 45
Treatment (cont\'d) Social Residential Programs : add up to control of adole
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