Substance Abuse

Counseling Children and Adolescents - Substance Abuse

Introduction

  • Substance Abuse Overview
      - Substance use among young people creates significant challenges for various stakeholders, including:
        - Parents
        - Schools
        - Medical professionals
        - Mental health professionals
        - Youth
      - Statistics: Approximately 5% of youth met criteria for a substance use disorder in 2014.
      - Counselors play a critical role in prevention and early intervention efforts regarding substance use among youth.

Nature of Substance Use Disorders in Youth

  • Definition: Substance use disorders (SUDs) are characterized by the continued use of substances despite facing significant substance-related problems and negative consequences.
  • Transition to SUD: Recreational use of substances can evolve into substance use disorders over time, particularly if:
      - Substances are utilized as coping mechanisms for emotional distress.
      - There is an increase in both the frequency and quantity of substance use.
      - Biological and psychological factors heighten the individual’s risk for developing an SUD.

Risk Factors

  • Risk factors for developing substance use disorders include:
      - Having biological family members with substance use disorders (SUD).
      - Poor emotional coping strategies.
      - History of trauma experiences.
      - Presence of other mental health disorders.
      - Peer influences encouraging substance use.
      - Deficiencies in social skills and lack of social support systems.
      - Experiences of social rejection.

Etiology of Substance Use Disorders

(1 of 3)
  • Not all youth with risk factors develop SUDs, and not all SUDs affect youth with established risk factors.
  • The biological actions of substances alter the brain’s reward systems and support continued use via intensely rewarding neurochemical releases.
  • Physical and psychological discomfort (withdrawal) may occur post cessation of use after regular consumption.
(2 of 3)
  • Psychological explanations include:
      - The presence of negative emotional states during the transition from childhood to adolescence may increase vulnerability to substance use.
      - Youth may use substances to manage anxiety, stress, or depression temporarily, despite potential long-term consequences.
(3 of 3)
  • Social Influences: Peer networks significantly affect the development of substance use disorders, leading to:
      - Increased exposure to substance use opportunities via social ties.
      - A decrease in parental supervision through adolescence heightening risk factors.
      - Experimentation within social contexts potentially escalating to substance use disorders.

Developmental Considerations

(1 of 3)
  • Substance use concerns the entire biological system, as:
      - Youth brains are still developing, causing a preference for immediate rewards over potential long-term consequences.
      - Youth may exhibit low physiological tolerance for substances, coupled with insufficient knowledge regarding administration routes which complicate harm risk.
      - They experience a higher risk of side effects due to smaller body size and may face negative impacts on physical development and maturation.
(2 of 3)
  • Youth substance use can influence both short- and long-term psychological functioning.
  • Youth vulnerability partly arises from ongoing brain development.
  • The emergence of mental health disorders often coincides with ages when substance use typically initiates.
  • Substance use may exacerbate existing mental health conditions or may be employed to manage symptoms inherent to these disorders.
(3 of 3)
  • Substance use impacts interpersonal dynamics, including:
      - Family and peer relationships - family concern can be a motivating factor for treatment.
      - Alterations in peer associations may enhance support for substance use, increasing legal issues.
      - Family tension can arise from the attention required to manage youth substance use.
      - The substance use may adversely impact social status and academic performance.

Development of Substance Use Disorders

(1 of 3)
  • Factors contributing to the development of SUDs in youth include:
      - Biological and psychological predispositions, including:
        - Personal and family history of substance use.
        - Symptoms of mental health illnesses.
        - Patterns in emotional regulation.
        - Response to stressors.
      - Youth's unawareness of risk factors can lead to increasing frequency and tolerance of substance use over time.
      - Regular use can result in withdrawal symptoms, leading to physical illness upon cessation.
(2 of 3)
  • Peer groups are critical in the development of SUDs, influencing experimentation decisions through:
      - Social acceptance or rejection correlated with peer-group norms.
      - The normalization or pervasive acceptance of substance use in peer circles may hinder decisions to abstain.
      - Misconceptions about substance use-related dangers may be perpetuated through social perceptions.
(3 of 3)
  • Developmental changes from childhood to adolescence elevate risk-taking behaviors and emotional instability.
  • Youths' inability to accurately assess or predict future risk consequences exacerbates susceptibility to SUDs.
      - Under the influence, inhibitions are further lowered, leading to increased risk.
      - A lack of immediate consequences offers a false sense of security regarding substance use dangers.

Long-Term Effects of Substance Misuse

(1 of 2)
  • Biological impacts:
      - Influential on brain development leading to:
        - Emotional instability
        - Reduced self-regulation
        - Impaired ability to delay gratification and weigh consequences.
      - Potential effects on physical growth and maturation.
      - Risks of contracting communicable diseases through certain substance administration routes.
      - Death from excessive doses remains a plausible outcome.
      - Importance for counselors: Physical safety associated risks should be thoroughly discussed with youth regarding substance use.
(2 of 2)
  • Substance use can detrimentally affect:
      - Short-term memory
      - Executive functioning capabilities
      - Performance assessment risks
  • Academic performance may decline, in turn limiting future opportunities.
  • Involvement with the criminal justice system due to substance-related issues can further restrict opportunities and resources.

Classification of Substance Use Disorders

  • The DSM-5 classifies substance use disorders according to:
      - Specific substance involved
      - Severity of reported symptoms which may range from mild to severe
  • Key domains assessed:
      - Impaired control
      - Social impairment
      - Risky use patterns
      - Pharmacological responses
  • Diagnosis requires at least two symptoms present over a 12-month period.
  • Includes analysis of substance-related disorders such as:
      - Intoxication
      - Withdrawal
      - Substance-induced disorders.

Assessment of Substance Use Disorders

  • Assessment procedures generally begin with substance use screening.
  • In-depth assessments may proceed based on initial screenings, incorporating:
      - Interviews
      - Standardized assessment tools
      - Gathering collateral data
  • Overall objective:
      - Determine risk degree
      - Ascertain appropriate care levels
      - Identify relevant intervention types
  • Continuous monitoring of any co-occurring mental health disorders is vital throughout the assessment process.

Assessing Needed Levels of Care

(1 of 2)
  • ASAM Assessment:
      - Evaluation should encompass an analysis of:
        - Intoxication and withdrawal risk
        - Biomedical conditions and their complications
        - Psychological, emotional, or cognitive conditions
        - Youth’s readiness to change
        - Potential for relapse, continued use, or persistent problems
        - Recovery and living environment
(2 of 2)
  • Levels of Care Offered**:
      - Outpatient treatment
      - Intensive outpatient treatment
      - Partial hospitalization treatment
      - Residential treatment
      - Inpatient treatment
  • The level of care selected should aim to provide necessary services within the least restrictive environment.

Legal and Ethical Considerations

  • Conflicts may arise between 42 CFR and HIPAA regarding parental access to minor substance use records.
      - 42 CFR: Federal law shielding substance use treatment records from release without client consent, specifically requiring minors to provide written consent for records release.
  • When youth refuse to authorize parental access to records, consultation and supervision become essential.

Counseling Interventions: Developmental Considerations

  • Therapy selection should account for growth across physical, emotional, and social domains.
  • Effective strategies typically include:
      - Increased structure and support
      - Consistency in therapy
      - Tangible rewards for progress
      - Small, attainable goals and target behaviors
  • Family involvement is essential in promoting similar processes at home and addressing family impacts due to youth substance use.

Family Involvement and Support

  • Families experiencing the consequences of youth substance use commonly face:
      - Fear
      - Anger
      - Frustration
      - Concerns about financial implications and legal issues
  • The family system as a whole requires care and support whether the youth is engaged in treatment for SUD or not.

Prognosis

  • Prognosis is highly reliant on:
      - Types of interventions administered
      - The effectiveness of preventing high-risk substance use
  • Early intervention plays a crucial role in aiding youth with risk factors, thus decreasing the likelihood of developing SUDs.
  • Treatment proves beneficial, especially when initiated promptly and supported effectively by family, peers, schools, and communities.

Integrated Treatment Components

  • Treatment recommendations should be tailored based on:
      - Client readiness for change
      - Cultural background
      - Identified strengths and needs
      - Severity of consequences and symptoms experienced
  • Treatment components may also be influenced by agency requirements within criminal justice, school systems, or social services.
  • Effective treatment necessitates consultation, coordination, and integration of care elements to promote optimal functioning for youth.

Detoxification

  • Certain substances necessitate medical supervision during withdrawal for safe transitioning:
      - Depressants (e.g., alcohol, benzodiazepines) pose life-threatening withdrawal risks if high-dose use is habitual.
      - Other substances might result in physical withdrawal symptoms that require appropriate detoxification measures.
      - Counselors must also address psychological symptoms accompanying the shift from use to nonuse, even if avoiding physical withdrawal.

Individual and Group Counseling

  • Effective methods for addressing youth substance use disorders incorporate:
      - Cognitive Behavioral Therapy (CBT)
      - Behavioral therapy and contingency management
      - Motivational enhancement therapy
      - Psychoeducation
      - Group therapy
      - Participation in 12-step programs and facilitation.

Integrating Family Into Treatment

  • Family involvement can be fostered via:
      - Psychoeducation initiatives
      - Family therapy approaches, including:
        - Brief strategic family therapy
        - Family behavior therapy
        - Multidimensional therapy
        - Multisystemic therapy.

Community-Based Interventions

  • Community-based treatment approaches that encourage systemic collaboration include:
      - Adolescent Community Reinforcement Approach
      - Recovery High Programs
  • Such interventions align with the unique requirements of youth and promote significant improvements when collaborative efforts occur across systems.

Psychopharmacotherapy

  • Clinical data on the efficacy of medication for youth substance use disorders remains limited.
  • Guidance derives primarily from adult SUD research.
  • Medical professionals must make informed medication decisions considering associated risks and benefits.
  • Medications potentially aid in easing withdrawal symptoms, curtailing relapse risks, and assisting in maintenance of abstinence.