ADOLESCENT
SUBSTANCE USE
P E M A C H O D E N,
CLINICAL NURSE,
P S Y C H I AT R Y, J D W N R H .
OBJECTIVES
Define Psychoactive Substance.
Explain different classification of substance and
its action.
List negative consequences of drug use.
Describe risk and protective factors of
adolescent substance use.
Explain patterns of substance use in
adolescents.
Describe assessment and intervention of
different patterns of substance use
Management of acute symptoms of substance
use
DEFINITION
Any substance which when consumed affect
the way people see, hear, taste, smell, think,
feel and behave is known as psychoactive
substance.
ACTIVITY
What substances are used by young people in
your community?
Substance Mode of use
CLASSIFICATION OF PSYCHOACTIVE SUBSTANCES
1. Depressants- E.g. Alcohol,
Benzodiazepines(N10).
Effects- Slurred speech, dis-inhibited
behavior, unsteady gait.
Withdrawal symptoms- Tremors, shaking,
nausea/vomiting, increased heart rate and
blood pressure, seizures, agitation,
confusion, hallucinations
CLASSIFICATION OF PSYCHOACTIVE SUBSTANCES
CONTD
2. Stimulants- Cocaine, Nicotine,
Amphetamines
Effects- Dilated pupils, increased blood
pressure and heart rate, excited, euphoric,
hyperactivity, rapid speech, racing thoughts,
disordered thinking, paranoia, aggressive,
erratic, violent
Withdrawal symptoms- Fatigue, increased
appetite, depressed, irritable mood Watch out
for suicidal thoughts.
CLASSIFICATION OF PSYCHOACTIVE SUBSTANCES
3. Opioids- Tramadol, Morphine, Codeine, SP
Effects- Pinpoint pupils, drowsiness and falling
asleep, decreased awareness, slow speech.
Withdrawal symptoms- Dilated pupils,
anxiety, nausea/vomiting/diarrhea, abdominal
cramps, muscle aches and pains, headaches,
runny eyes and nose, yawning, hair standing
up on arms, increased heart rate and blood
pressure
CLASSIFICATION OF PSYCHOACTIVE SUBSTANCES
4. Hallucinogens- Cannabis.
Effects- Normal pupils, red conjunctivae,
delayed, responsiveness, euphoria,
relaxation.
Withdrawal symptoms- Depressed or labile
mood, anxiety, irritability, sleep disturbance
(there may not be any clearly observable
features).
CLASSIFICATION OF PSYCHOACTIVE SUBSTANCES
5. Inhalants/Volatile substances- Dendrite,
Glue.
Effects- Dizziness, disorientation, euphoria,
light-headedness, mood, hallucinations,
delusions, in-coordination, visual
disturbances, anxiolysis, sedation.
Withdrawal symptoms- Increased
susceptibility to seizures.
Negative Consequences of Drug use
1. Physical Consequences.
2. Psychosocial Consequences.
Negative Consequences of Drug use Contd.
Physical consequences:-
Trauma (e.g. falls, road traffic accident,
drowning), overdose (accidentally taking too
much due to inexperience), blackouts, increase
likelihood of other risky behaviour (e.g. Unsafe
driving under the influence of substances, using
other substances).
Blood-borne infections (e.g. HIV, hepatitis) and
local infections (e.g. abscess, phlebitis).
Damage to body organs (e.g. liver, lungs, nerves).
The harmful consequences can affect
others (e.g. second-hand smoke, road traffic
accidents, violence).
Negative Consequences of Drug use Contd.
2. Psychosocial consequences :-
Family dysfunction (e.g. family
tension/violence, parental absence, lack of
boundaries),
social withdrawal of the young person,
learning difficulties and school failure, job and
income loss, violence towards family, friends
or others, and crimes committed in order to
obtain substances.
Feelings of anxiety, memory and concentration
problems, psychotic episodes (fixed false
ideas, hallucinations), depression, and suicide.
CAUSES OF ADOLESCENT SUBSTANCE USE
1. Risk Factors- Increases the likelihood of
substance use.
2. Protective factors- Decreases the
likelihood of substance use
CAUSES OF ADOLESCENT SUBSTANCE USE
Risk and protective factors can occur in 5
areas
Individual
Family
Peer group
School
Community.
CAUSES OF ADOLESCENT SUBSTANCE USE
1. The Individual
RISK FACTORS
Low personal expectations and low self-esteem
Personal stress, feelings of hopelessness, distress,
depression
Abused as a child
Expected positive outcomes of substance use.
PROTECTIVE FACTORS
No tolerance for unacceptable behaviour
Positive attitude towards health
Religious belief or sense of spirituality
Positive orientation to school, participation in school
and community activities
Expected negative outcomes of substance use.
CAUSES OF ADOLESCENT SUBSTANCE USE
2. The Family
RISK FACTORS
Role models for risk behaviour in the family
Availability of substances in the home
Tension/violence in the family
Poverty.
PROTECTIVE FACTORS
Parents as role models for conventional and healthy
behaviour
Parents provide boundaries, controls and regulations
Parental expectations for academic achievement
Parental presence and support in the home.
CAUSES OF ADOLESCENT SUBSTANCE USE
3. Peer group
RISK FACTORS
Friends and peers as role models for
problem behaviour
Greater influence of friends than of parents.
PROTECTIVE FACTORS
Peer role models for conventional and
healthy behaviour
Peer disapproval of problem behaviour
Peer controls against risky behaviour.
CAUSES OF ADOLESCENT SUBSTANCE USE
4. The School
RISK FACTORS
School role models for problem behaviour
Harassment by other students
Stress and poor safety in school.
PROTECTIVE FACTORS
Student-peer disapproval of problem behaviour
School regulations and controls
Perceived teacher expectations for school behaviour
Perceived student norms for school behaviour
Availability of school activities
Perceived parental involvement in school.
CAUSES OF ADOLESCENT SUBSTANCE USE
5. The Community
RISK FACTORS
Advertising/promotion, e.g. events in the
community sponsored by the tobacco / alcohol
industry
Illegal substances available in the community
Community gang activities
Poverty and poor safety in the community.
PROTECTIVE FACTORS
Community disapproval of problem behaviour
Community social controls
Community resources for young people (sports,
recreation and art activities, etc.).
PATTERNS OF SUBSTANCE USE
1. Hazardous use.
2. Harmful use.
3. Dependence.
PATTERNS OF SUBSTANCE USE
Hazardous use
This is the most common pattern for young
people
Curiosity, desire for a new experience
Age at first use may determine long-term
use
No guarantee of “safe use”
Usually does not see substance use as a
problem.
PATTERNS OF SUBSTANCE USE
Harmful use
is damaging to physical and/ or mental
health
has negative effects on normal life
PATTERNS OF SUBSTANCE USE
Dependence:-
1. Craving
2. Loss of control
3. Withdrawal
4. Tolerance
5. Preoccupation
6. Use despite harmful effects
INTERVENTION
1. Treat acute symptoms:-
a. Opioid intoxication/withdrawal
b. Depressant intoxication/withdrawal
c. Stimulant intoxication/withdrawal
2. Hazardous use and Harmful use:-
d. Psychoeducation.
e. MI
3. Dependence:-
f. Psychoeducation
g. Treat withdrawal/acute symptoms.
h. Detox
i. Refer/MI
INTERVENTION FOR ACUTE SYMPTOMS
Patient walks in
Assess for Acute symptoms
Stimulant Alcohol or
Opioid Alcohol
intoxication: other
overdose Intoxication
Dilated pupils, sedative
unresponsive/ Smell of
excited, strange withdrawal
minimally alcohol,
behavior, Tremor,
responsive, slurred
aggressive/viole sweating,
slow heart speech,
nt behavior, increased HR,
rate, pinpoint altered level
increased HR, BP, agitation,
pupils of
disordered seizure,
confusion consciousness,
1. IV, IM, thinking
1. ABC
Nasal, SC 1. 5-10 mg 1. 10-20 mg
2. Resp
0.2-4mg Diazepam, diazepam
Support
Naloxone IV/PO 2. 5-10 mg
3. IV
2. 2. 5-10 mg IM Haloperidol
rehydratio
Respirator Haloperidol IM/Po
n
y support
REFER
INTERVENTIONS IN ABSENCE OF ACUTE
SYMPTOMS
Patient walks in
Assess and determine Pattern of use
No Use Harmful/
1. Emphasize Hazardous use Dependence
health 1. Psychoeducatio 1. Psychoeducati
benefits of not n on
using 2. MI 2. Detox
Psychoactive (Motivational 3. Referral/
substance Interviewing) Rehab
PSYCHO-EDUCATION
1. Psychoeducation:-
G. A. T. H. E. R
PSYCHO-EDUCATION
1. G- Greet
2. A- Assess
3. T- Tell
Ask permission to give information
Discuss dangers/problems with substance use
Give information on preventing/reducing/
stopping substance use (Triggers and mgt)
Respond to concerns/ questions.
PSYCHO-EDUCATION
4. H- Help
Help the young person to decide what to do
about substance use.
Encourage the young person to identify
possible options.
Discuss the possible outcomes of the options.
The young person makes a decision on action.
PSYCHO-EDUCATION
5. E= Explain
Identify other possible options.
Explain the young person’s responsibility to
make the action happen.
Identify other sources of support.
Provide supplies or services.
PSYCHO-EDUCATION
6. R= Return Visit/Refer
Schedule a return visit.
Refer for other services.
End the session with a positive message
MOTIVATIONAL INTERVIEWING
Based on 5 Principles:
1. Express Empathy
2. Develop Discrepancy
3. Avoid arguments
4. Roll with resistance
5. Support Self-Efficacy.
MI (MOTIVATIONAL INTERVIEWING) CONTD.
Uses 4 skills: OARS
1.Open ended questions
2. Affirmations
3. Reflective listening
4. Summarise.
“Change talk”: Recognize benefits of change
MI (MOTIVATIONAL INTERVIEWING) CONTD.
1. Based on TTM of change
a. Pre-contemplation
b. Contemplation
c. Determination/Preparation
d. Action
e. Maintenance
f. Relapse
MI (MOTIVATIONAL INTERVIEWING) CONTD
Action with young substance user at the
pre-contemplation stage
Raise awareness of the risks
Provide information
Discuss ways in reducing the risk and harm
of substance use.
MI (MOTIVATIONAL INTERVIEWING) CONTD.
Action with young substance user at the
contemplation stage
Continue to raise awareness of the risks
Assist in making informed choices
Acknowledge the perceived positives of use
and the perceived negatives of change
Avoid too much focus on“action”
Aim to tip the balance in favour of change
MI (MOTIVATIONAL INTERVIEWING) CONTD.
Action with young substance user at
preparation and action stage
Assessment
Advise on options
Assist in making a plan
Assist in maintaining motivation
Relapse prevention.
MI (MOTIVATIONAL INTERVIEWING) CONTD>
Action with young substance user at the
relapse stage
Prepare for possible relapse
Support to renew decision for change
Support to identify and try different
strategies.
Questions
