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

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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.

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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.

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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

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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.

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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.

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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

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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.

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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.

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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

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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.

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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

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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

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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.