/
Training Module: Conrad N. Hilton Foundation Substance Use Prevention Initiative Training Module: Conrad N. Hilton Foundation Substance Use Prevention Initiative

Training Module: Conrad N. Hilton Foundation Substance Use Prevention Initiative - PowerPoint Presentation

yieldpampers
yieldpampers . @yieldpampers
Follow
344 views
Uploaded On 2020-08-04

Training Module: Conrad N. Hilton Foundation Substance Use Prevention Initiative - PPT Presentation

in partnership with University of California Los Angeles Integrated Substance Abuse Programs Substance Use Adolescent Health and SBIRT Training Objectives By the end of this training participants will be able to ID: 797500

alcohol substance drug brain substance alcohol brain drug sud abuse health amp national disorders dopamine substances risk dependence adolescents

Share:

Link:

Embed:

Download Presentation from below link

Download The PPT/PDF document "Training Module: Conrad N. Hilton Founda..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

Training Module:

Conrad N. Hilton Foundation Substance Use Prevention Initiativein partnership withUniversity of California, Los Angeles Integrated Substance Abuse Programs

Substance Use, Adolescent Health,

and SBIRT

Slide2

Training ObjectivesBy the end of this training, participants will be able to:Describe three ways that substance use can impact the short term health and well-being of adolescents.Explain substance use disorders and their causes

Understand why it is particularly critical to address substance use among adolescentsDescribe two ways other than risk for substance use disorders that substance use puts the long-term health and well-being of adolescents at risk

Describe the SBIRT model

2

Slide3

What Psychoactive Substances Do: Trigger DopamineDopamine is the neurotransmitter released when we do things essential for survival (eat, drink, sex)Pleasure/Well-beingSatiationSedation

Psychoactive drugs’ chemical structures stimulate release of dopamine in different parts of the brain3

Slide4

0

50

100

150

200

0

60

120

180

Time (min)

% of Basal DA Output

NAc

shell

Empty

Box

Feeding

Di

Chiara

2007

FOOD

100

150

200

DA Concentration (% Baseline)

Mounts

Intromissions

Ejaculations

15

0

5

10

Copulation Frequency

Sample

Number

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

Scr

Scr

Bas

Female 1 Present

Scr

Female 2 Present

Scr

Fiorino

1999

SEX

Natural Rewards

and Dopamine

Slide5

Shoblock

2003; Di

Chiara

1987

Effects of Substances on Dopamine Release

0

100

200

300

400

Time After Cocaine

% of Basal Release

DA

DOPAC

HVA

Accumbens

COCAINE

100

150

200

250

0

1

2

3

4hr

Time After Ethanol

% of Basal Release

0.25

0.5

1

2.5

Accumbens

0

Dose (g/kg

ip

)

ETHANOL

Time After Methamphetamine

% Basal Release

METHAMPHETAMINE

0

1

2

3hr

1500

1000

500

0

Accumbens

0

100

150

200

250

0

1

2

3 hr

Time After Nicotine

% of Basal Release

Accumbens

Caudate

NICOTINE

Accumbens

5

Slide6

6

Slide7

When Substance Use Becomes ProblematicNegative impacts of substance use begin to outweigh the benefitsSubstance effects that are unpleasant or harmfulConsequences of things done while intoxicatedImpact on individual, friends/family, or societyHealth impacts

OverdoseSubstance use disordersImpact on mental healthImpact on physical health7

Slide8

The Problematic Aspects of Getting Drunk/High

AlcoholCannabis

Opioids

Stimulants

SedativesInhalants

Mood SwingsXX

X

Impaired Body Movement

X

X

X

X

X

Impaired Cognition, Problem Solving, Judgment

X

X

X

X

X

Memory Problems

X

X

X

X

Drowsiness

X

X

X

X

Anxiety/

Confusion

X

X

X

Paranoia/Panic

X

X

Aggression/

Violence

X

X

X

Psychosis/

Hallucinations

X

X

X

X

8

Slide9

Sexual Risk Substance use increases risky sex behavior and chances of contracting HIV among MSM (Boone 2013; Chesney 1998)Binge drinking associated with unintended pregnancy (Naimi 2003)

Injury RiskAlcohol is involved in 60% of fatal falls and over 60% of fire deaths (D’Onofrio 2008)

Alcohol consumption increases risk of violence-related injury (

Cherpitel 2007)

Almost 8% of ED visits in US are attributable to alcohol

(McDonald 2004)35-40% of ED patients have illicit drugs in their system (Vitale 2006)The Problematic Aspects: Bad Decisions9

Slide10

The Problematic Aspects: Bad DecisionsImpaired DrivingBlood Alcohol Content (BAC) of .08: Four times risk of a crashBAC of .15: 12 times risk of a crash

Insufficient numbers to draw conclusions for other substances, but we know they impact reaction time and decision makingCrime26% of victims of violence report attacker seemed like they were under the influence of alcohol/drugs

Over half of jail inmates charged with robbery, burglary, motor vehicle theft report using drugs at time of offense 46-49% of probationers say they used alcohol/drugs at time of offense

National Highway Traffic Safety Administration, ND; Bureau of Justice Statistics ND; Smith 2012

10

Slide11

The Problematic Aspects:OverdoseAlcoholPoisoning occurs when alcohol shuts down areas of the brain that control basic life-support functions (breathing, heart rate)Can cause brain damage and death

StimulantsImpact heart and blood vessels, leading to heart attacks, strokes, seizuresOpioids

Act on part of the brain that regulates breathingCan cause respiratory depression and death

Increased risk when combined with alcohol or sedatives

11

Slide12

12

Slide13

The Not Fun Aspects :Substance Use Disorders (SUD)SUD are medical conditions, not a matter of choice or will

There is no biological test, but recognized through behaviorCompulsive substance useLoss of control over substance use

13

Slide14

Substance Use DisordersSUDs are brain diseasesChanges in brain structure and function40-60% of SUD vulnerability is genetic (alcohol, tobacco)

Environmental factors also play a key role Exposure to substances

Culture/norms

Relationships (family, friends, school, work) Stress and trauma

14NIDA 2010

Slide15

Substance Use DisordersAmerican Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (2013)Describes 11 diagnostic criteria for SUD

Mild SUD: 2-3 criteriaModerate SUD: 4-5 criteriaSevere SUD: 6 or more criteria

Criteria include impulse control, social impairment, risky use, tolerance/withdrawal

15

Slide16

Prolonged Drug Use Changes

The Brain In Fundamental and

Long-Lasting Ways

16

Slide17

We Have Evidence That

These Changes Can Be Both

Functional

and

Structural

AND…

17

Slide18

DA D2 Receptor Availability

control

addicted

Cocaine

Alcohol

Reward Circuits

DA

DA

DA

DA

DA

DA

Drug Abuser

DA

DA

DA

DA

DA

DA

DA

Reward Circuits

DA

DA

DA

DA

DA

Non-Drug Abuser

Heroin

Meth

Dopamine D2 Receptors are Lower in Addiction

18

Slide19

PET Scan of Long-Term Impact of

Methamphetamine

on the Brain

19

Slide20

How Brain Changes Link To BehaviorNeurochemical changes impact the dopamine reward pathway—the wiring that makes us naturally want what we need (e.g. food, water)

Brain changes from prolonged use makes us instinctually crave substances as if we need them to survive

20

Slide21

Prolonged substance use leads to brain changes that impair cognition and memoryMost developed evidence is from stimulants (was of interest when scanning technology developed)Knowledge of other substances is developing

21

Beyond Craving

Slide22

Dopamine Transporters in

Methamphetamine Abusers

p < 0.0002

Normal Control

Methamphetamine Abuser

7

8

9

10

11

12

13

1.0

1.2

1.4

1.6

1.8

2.0

Time Gait

(seconds)

Dopamine Transporter

(Bmax/Kd)

Motor Activity

4

6

8

10

12

14

16

1

1.2

1.4

1.6

1.8

2

Delayed Recall

(words remembered)

Dopamine Transporter

Bmax/Kd

Memory

Volkow

2001.

22

Slide23

Control

> MA

4

3

2

0

1

23

Slide24

MA >

Control

5

4

2

0

1

3

24

Slide25

Brain Activity and Long-Term Use of Other SubstancesAlcoholMay lead to shrinking of brain, deficiencies in fibers that carry information between brain cells. Deficits in frontal lobes (learning, memory) and cerebellum (movement, coordination) Marijuana

For individuals with dependence, lower dopamine release in the striatum, leading to greater emotional withdrawal and inattention (National Institute on Drug Abuse

OpioidsStructural and functional changes in brain regions associated with mood, impulse control, motivation

25

National

Institute on Alcohol and Alcoholism, 2004; National Institute on Drug Abuse 2016; Upadhay 2010

Slide26

The brain shows distinct changes after

substance use

that can persist

long after

use

has stopped

SUDs are

chronic

brain

disorders

26

Slide27

PET Scan of Long-Term Meth Brain Damage

27

Slide28

Substance Use and Mental HealthSelf-medication for mental health problemsImpact substances have on brain and social functioningMany MH disorders are rooted in same parts of brain, same neurotransmitters impacted by psychoactive substances

Common risk factorsGeneticsEnvironment (esp. trauma)

Mertens

2003, Flynn 2008 , NIDA 2012, SAMHSA 2010

Slide29

Substance Use and Mental HealthMH DISORDER

SUD POPULATIONNON-SUD POPULATION

Depression

28.51%

2.74%

Anxiety16.87%2.22%Major Psychoses

6.56%

0.38%

43% of people with SUD have a co-occurring mental health disorder

Approx. 70% of people in SUD treatment have a co-occurring mental health disorder

Weiss 1992, Robinson 2011, Martins 2011, SAMHSA 2010

29

Slide30

Substance Use and Physical HealthBehavioral risksMore tobacco use: breathing problems/cancerInjections: collapsed veins, infections Intoxication leads to more risky sex behaviorsViolence (pharmacological, systemic)Poverty

Underutilization of healthcare services

30

Boles 2003, McCoy 2001, NIDA 2012b

Slide31

Substance Use and Physical HealthDirect medical consequences Effects on heart rateDecreases lung functioningStomach inflammationLiver damageKidney damage/failure

Increased blood pressure/stroke1/3 of people with SUD have a chronic physical condition or disease31

NIDA 2012b,

Reif

2011

Slide32

Substance Use Disorders Shorten LifePeople who receive publicly-funded SUD services live 26.1 years less than the general populationNearly 2/3 of excess death due to medical causes

Oregon Department of Human Services 200832

Slide33

What does this mean for the people with whom you work?

Slide34

Most Substance Use Starts in the Teen/Young Adult Years

67%

1.5%

5.5%

<12

12-17

18-25

>25

26%

First Marijuana Use, (Percent of Initiates

)

Slide35

Gogtay

2004; National Institute on Drug Abuse 2007.

Brain Development

Ages 5-20 years

MRI scans of healthy children and teens compressing

15 years of brain development (ages 5–20).

Red indicates more gray matter, blue less gray matter.

Neural connections are pruned

back-to-front.

The prefrontal cortex ("executive" functions), is last to mature.

35

35

Slide36

The Interaction between the Developing Nervous System and Substances of Abuse Leads to:

Difficulty in decision making

Difficulty understanding the

consequences of

behavior

Increased vulnerability to memory

and attention

problems

This can lead to:

Increased experimentation

Alcohol and drug addiction

Fiellin

2008

.

36

36

Slide37

Young Brains Are Different from Older BrainsAlcohol and drugs affect the brains of adolescents and young adults differently than they do adult brains Adolescent rats are more sensitive to the memory and learning problems than adults

Conversely, they are less susceptible to intoxication (motor impairment and sedation) from alcoholThese factors may lead to higher rates of dependence in these groups

Hiller-

Sturmhöfel 2004

37

37

Slide38

Later Onset Substance Use and SUD RiskEarly onset substance use predicts development of SUD The later adolescents start using, the less likely they are to develop SUD

Alcohol: During adolescence, odds of dependence decrease 14% for every year of delayed first useDrugs: Odds of dependence decrease 4-5% for every year of delayed first use

Grant 1997, 1998

38

Slide39

We Can’t Treat Our Way Out of This Public Health CrisisApprox. 21.5 million Americans have SUDTraditionally we wait for people to get sick, then

treat themOnly 11% of people with SUD get specialty careOnly 5% of adolescentsEarly detection and prevention are

public health strategies to address SUD

Given the key role of adolescence in the development of SUD, people who work with adolescents can be the

front line in preventing SUD

Center for Behavioral Health Statistics and Quality 201539

Slide40

SBIRT:A Population Approach to Prevention/Early InterventionScreening a population to identify individuals who are using substances in a risky or unhealthy way

Brief Intervention to change behaviors and attitudes of individuals who are putting their health at risk with substance use. Sometimes this is one intervention, sometimes a few sessionsReferral to Treatment

for individuals who require specialty care (behavioral, pharmacological treatments)

40

Slide41

41

Identify adolescents with SUD and link them with specialty care

(about 5% of adolescents)

Educate adolescents who are using substances

(

approx

11.5% using alcohol, 9.4% using drugs) motivate behavior

change)

What SBIRT Can Accomplish

Slide42

Take Away PointsAdolescents are vulnerable to impacts of psychoactive substances Prevention and early intervention for SUD is about more than just substance useReducing risky behaviors and consequences

Reducing mental health and physical problems associated with substance useDecreasing substance use in adolescence can decrease prevalence of SUD in entire US population

4. Service providers who treat adolescents are in prime position to deliver prevention and early intervention services to address the public health crisis of substance use

5. The SBIRT model can be used to identify adolescents who are using substances in a risky manner and facilitate positive change.

42

Slide43

Questions? Comments?43

Slide44

WORKS CITEDBoles, S. M., & Miotto, K. (2003). Substance abuse and violence: A review of the literature. Aggression and violent behavior

, 8(2), 155-174.

Boone MR, Cook SH, Wilson P. (2013). Substance use and sexual risk behavior in HIV-positive men who have sex with men: an episode-level analysis.

AIDS Behavior 17L1883-1887

.

Bureau of Justice Statistics (ND). Drugs and Crime Facts. http://www.bjs.gov/content/dcf/duc.cfm#to Accessed December 10, 2016. Center for Behavioral Health Statistics and Quality (2015). Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. (HHS Publication No. SMA 15-4927, NSSDUH Series H-50).Cherpitel CJ. (2007) . Alcohol and injuries: a review of international emergency room studies since 1995. Drug and Alcohol Review

26:208-214.

DiChiara

G,

Bassareo

V. (2007) Reward system and addiction: what dopamine does and does not do.

Current Opinions in Pharmacology

7(1):69-76.

DiChiara

G.,

Imperato

A.,

Mulas

A. (1987). Preferential stimulation of dopamine release in the mesolimbic system: a common feature of drugs of abuse. In

Sanlder

M,

Feurstein

C,

Scatton

B (

eds

).

Neurotransmitter

interactiosn

in the basal ganglia.

New York: Raven Press, p. 171-182.

D’Onofrio

G et al. (2008). Brief intervention for hazardous and

harrmful

drinkers in the emergency department.

Annals of Emergency medicine 51(6): 742-750.

Fiellin, D. A. (2008). Treatment of adolescent opioid dependence: no quick fix. 

JAMA, 

300(17), 2057-2059.

Fiorino DF, Phillips AG. (1999). Facilitation of sexual behavior and enhanced dopamine

effluc in the nucleus

accumbens of male rats after D-amphetamine-induced behavioral sensitization.

Journal of Neuroscience 19(1): 456-463.

Flynn, P. M., & Brown, B. S. (2008). Co-occurring disorders in substance abuse treatment: Issues and prospects. Journal of substance abuse treatment

, 34

(1), 36-47.Gogtay

, N., et. al. (2004). Dynamic mapping of human cortical development during childhood through early adulthood. Proceedings of the National Academy of Sciences, 101

, 8174-8179.Grant, B. F., & Dawson, D. A. (1997). Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. 

Journal of substance abuse, 

9, 103-110.

Grant, B. F., & Dawson, D. A. (1998). Age of onset of drug use and its association with DSM-IV drug abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. 

Journal of substance abuse, 

10(2), 163-173.

Hiller-Sturmhofel, S., &

Swartzwelder, H. S. (2004). Alcohol's effects on the adolescent brain: what can be learned from animal models. 

Alcohol Research and Health, 

28(4), 213.

Martins, S. S., & Gorelick

, D. A. (2011). Conditional substance abuse and dependence by diagnosis of mood or anxiety disorder or schizophrenia in the US population. 

Drug and alcohol dependence, 119

(1), 28-36.McCoy, C. B.,

Metsch, L. R., Chitwood, D. D., & Miles, C. (2001). Drug use and barriers to use of health care services. Substance use & misuse, 36(6-7), 789-804.McDonald AJ, Wang N, Camargo CA. (2004). US emergency department visits for alcohol-related diseases and injuries between 1992 and 2000. Archives of Internal Medicine . 164:531-537.

44

Slide45

WORKS CITEDMcDonald AJ, Wang N, Camargo CA. (2004). US emergency department visits for alcohol-related diseases and injuries between 1992 and 2000. Archives of Internal Medicine .

164:531-537.Mertens, J. R., Lu, Y. W.,

Parthasarathy

, S., Moore, C., & Weisner

, C. M. (2003). Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: comparison with matched controls. 

Archives of Internal Medicine, 163(20), 2511-2517.Naimi, T. S., Lipscomb, L. E., Brewer, R. D., & Gilbert, B. C. (2003). Binge drinking in the preconception period and the risk of unintended pregnancy: implications for women and their children. Pediatrics, 

111

(Supplement 1), 1136-1141.

National Institute on Alcohol Abuse and Alcoholism (2004). Alcohol’s Damaging Effects on the Brain.

Alcohol Alert 63

. http://pubs.niaaa.nih.gov/publications/aa63/aa63.htm Accessed January 10, 2017.

NIDA. (2007).

Drugs Brains, and Behavior: The Science of Addiction

(NIH Pub No. 07-5605). Downloaded from

http://www.drugabuse.gov/ScienceofAddiction

.

National Institute on Drug Abuse (2012) What are Co-Occurring Disorders? https://teens.drugabuse.gov/blog/post/what-are-co-occurring-disorders. Accessed July 22, 2016.

National Institute on Drug Abuse (2012b) Medical Consequences of Drug Abuse https://www.drugabuse.gov/related-topics/medical-consequences-drug-abuse. Accessed January 22, 2016.

National Institute on Drug Abuse (2016) Brain dopamine release reduced in severe marijuana dependence. https://www.drugabuse.gov/news-events/news-releases/2016/03/brain-dopamine-release-reduced-in-severe-marijuana-dependence accessed January 10, 2017.

National Highway Traffic Safety Administration (ND).

Drug and alcohol crash risk study

available http://www.nhtsa.gov/Driving+Safety/Research+&+Evaluation/Alcohol+and+Drug+Use+By+Drivers Accessed December 10, 2016.

Oregon Department of Human Services, Addiction and Mental Health Division (2008)

Measuring Premature Mortality Among Oregonians.

Reif

, S., Larson, M., Cheng, D. M.,

Allensworth

-Davies, D.,

Samet

, J., &

Saitz

, R. (2011). Chronic disease and recent addiction treatment utilization among alcohol and drug dependent adults. 

Substance abuse treatment, prevention, and policy

6

(1), 1.

Robinson, J.,

Sareen

, J., Cox, B. J., & Bolton, J. M. (2011). Role of self-medication in the development of comorbid anxiety and substance use disorders: a longitudinal investigation. 

Archives of General Psychiatry, 68

(8), 800-807.Shoblock

, J. R., Sullivan, E. B., Maisonneuve, I. M., & Glick, S. D. (2003). Neurochemical and behavioral differences between d-methamphetamine and d-amphetamine in rats. 

Psychopharmacology, 

165(4), 359-369.Smith PH,

Homish GO,

Leonaard KE, Cornelius JR. (2012). Intimate Partner Violence and Substance Use Disorders: Findings from the National Epidemiological Survey on Alcohol and Related Conditions. Psychology of Addictive Behaviors 26(2): 236-245.

Substance Abuse and Mental Health Services Administration (2010)

Integrated Treatment for Co-Occurring Disorders Evidence-Based Practices (EBP) Available at http://store.samhsa.gov/product/Integrated-Treatment-for-Co-Occurring-Disorders-Evidence-Based-Practices-EBP-KIT/SMA08-4367

Upadhyay, J.,

Maleki, N., Potter, J., Elman, I.,

Rudrauf, D., Knudsen, J., ... & Anderson, J. (2010). Alterations in brain structure and functional connectivity in prescription opioid-dependent patients. 

Brain, 

133(7), 2098-2114.

Vitale S, van de Mheen

D. (2006). Illicit drug use and injuries: A review of emergency room studies. Drug and Alcohol Dependence 82

1-9. Weiss, R. D., Mirin, S. M., & Griffin, M. L. (1992). Methodological considerations in the diagnosis of coexisting psychiatric disorders in substance abusers. 

British Journal of Addiction, 

87(2), 179-187.

45