Substance Use and Adolescence .

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Diagram. Recorded PerspectivesTerminologyTypes of SubstancesDiagnoses (DSM-IV)EpidemiologyEtiologyRisk FactorsCourse and PrognosisTreatment. Verifiable Perspective. Since the first incidental disclosure of lager and wine centuries prior, mankind has used substances for their psychoactive propertiesThe identity of the way of life interweaved with and was affected by the medication of decision for that
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Substance Use and Adolescence Edward S. Yuzda, MD, MSc, FRCPC (Psychiatry) Claude Ranger Mental Health Clinic Dec. 9 th/04

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Outline Historical Perspectives Terminology Types of Substances Diagnoses (DSM-IV) Epidemiology Etiology Risk Factors Course and Prognosis Treatment

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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 time

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Terminology Drug vs.Substance Legal versus unlawful Addiction Substance Dependence Biological versus Mental Dependence

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Types of Substances Central Nervous Depressants Alcohol Cannabis Sedative/hypnotics/anxiolytics Opioid analgesics Inhalants (ie. Stick/fuel)

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Types of Substances Central Nervous Stimulants Amphetamines Caffeine Cocaine Nicotine Ecstasy (blended stimulant/psychedelic drug)

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Types of Substances Hallucinogens LSD Mescaline PCP

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Types of Substances Other Gamma hydoxy butyrate (date assault sedate) Nitrite inhalants Nitrous oxide Kava Betel nut Nutmeg Antihistamines Antiparkinsonian drugs

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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 manifestations

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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 effects

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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 issue

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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?)

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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 medications

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Diagnoses (DSM-IV) Substance Use Disorders Substance-Induced Disorders

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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 reliance

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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 reliance

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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/year

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Epidemiology (cont\'d) Male>Female Alcohol utilize : White=Hispanic>Black Marijuana utilize: Black>White

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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%

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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%

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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%

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Epidemiology (cont\'d) Illicit medication use (in recent months) 12 th level – 40% 10 th level – 38% 8 th level – 24%

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Epidemiology (cont\'d) Marijuana use (in recent months) 12 th level – 36% 8 th level – 18% Daily Marijuana utilize 12 th level – 5%

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Epidemiology (cont\'d) LSD use (in recent months) 12 th level – 9% 8 th level – 4%

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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%

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Epidemiology (cont\'d) Heroine use (in recent months) 12 th level – 1% 8 th level – 1.6%

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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%

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Number of individuals age 12 or more established that have utilized illegal medications in the previous month (U.S.) Number of millions Year

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Etiology Psychological Cultural Genetic Neurochemical

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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/emotionality

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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 utilize

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Peer-related Risk Factors Peer substance utilize Favorable companion dispositions to utilize Greater introduction of teenagers to peers instead of guardians

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Community-related Risk Factors Low SE status High populace thickness High wrongdoing rate

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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 utilize

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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 status

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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 impaired

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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 sicknesses

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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 substances

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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 impaired

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Psychiatric Disorders Commonly Associated with Substance utilize scatters Oppositional resistant turmoil Conduct issue ADHD Mood issue Anxiety issue Bulimia nervosa Schizophrenia Personality issue

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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 undertakings

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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 consideration

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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.)

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Treatment (cont\'d) Psychological Twelve stage programs (AA/NA) Motivational talking Cognitive behavioral treatment

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Treatment (cont\'d) Social Residential Programs : add up to control of adole

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