Case presentation Prevalence rates of substance use for pediatric population in Utah Substance Use as a Spectrum Screening Methods

ods & Techniques Basic Motivation Interviewing Techniques Substance Abuse Referral Sources in Utah

15 year old Caucasian male CC: I wanna stop using. HPI: Brought for residential CD treatment with his bio father. Not court committed to treatment, but DCFS involvement for truancy. No history of mental health treatment, but reports depression symptoms the past year.

Started drinking beer and smoking at 13binge drinking pattern at parties-last use 2 mos ago Marijuana-14 yo- twice/wk then daily use Experimentation- ecstasy, Oxycontin (up to 60mg/day) Heroin- 15 yo- smoking once/wk with friends, then IV use started 6 mos ago Using IV heroin daily prior to admission.

Nonspecific vague complaints of headaches, insomnia,& abdominal pain/vomiting

EGD- Mild chronic gastritis-Prilosec/Reglan Lap cholecystectomy/cholangiogram-no calculi

noted on path report-chronic cholecyctitis Brain MRI with contrast-normalDepakote/Topamax for migraines 2D Bubble echo- normal Sleep study eval No UDS or documented substance use history in chart

Experimentation with substances is common in teens and young adults! Use of alcohol and other drugs is a leading cause of morbidity & mortaility for youth in the US. All substance use involves health risks that can occur long before there is a true drug addiction. Adolescence is a period of neurodevelopmental vulnerability.

Utah Dept of Human Services Substance Abuse and Mental Health http://dsamh.utah.gov/

 Abstinence
Experimentation Limited

Use Problematic Use Abuse Addiction

In the past 12 months, did you:

1) Drink any alcohol (more than a few sips)? 2) Smoke any marijuana or hashish? 3) Use anything else to get high? (Anything else includes illegal drugs, OTC and prescription drugs, and things that you sniff or huff.

0 or 1 on CRAFFT= Brief Advice 2 or more on CRAFFT= Brief Assessment

Tell me more about your alcohol/substance

use. Has it caused you any problems? Have you tried to quit? Why?

Express Empathy with a warm, nonjudgmental stance, active listening, and reflecting back what is said. Develop Discrepancy between the patients choice to drink and his or her goals, values, or beliefs. Roll with Resistance by acknowledging the patients viewpoint, avoiding a debate, and affirming autonomy. Support Self-efficacy by expressing confidence and pointing to strengths and past successes.

People who drink by age 15 are 4 times more likely to develop alcoholism than those who began at 21. Average age of first use 13 years old More than 1/3 of high school seniors see no great risk in consuming 4-5 alcoholic drinks in a day, despite having blackouts. Drinking is often perceived as normal behavior

1. Odyssey House - 801.322.3222 offers residential, outpatient, and an in-home program 2. Wasatch Canyons 801.313.7711 offers residential and day treatment programs 3. Cornerstone Counseling 801.355.2846 offers outpatient treatment 4. ARTEC through Valley Mental Health residential with a dual diagnosis track 801.963.4200 5. Youth Care residential programs 801.657.7095 6. Salt Lake County Substance Abuse Services 801.468.2009 offers substance abuse assessments and referrals 7. ACES Assessment, Counseling, and Educational Services offers outpatient therapy for 16 year olds and older 8. UNI- Acute inpatient hospitalization for detox and Teenscope Day Treatment Program

Pediatricians play a crucial role in early detection of substance use problems. It is important to relay a message of NONUSE through clear and consistent information to patients, parents, & family while maintaining a trusting patient care relationship. Motivational interviewing is helpful to assess readiness for change in a non-judgmental manner. SAMSA/AAP recommend universal screening for substance use, brief intervention, and/or treatment referral become a part of routine health care. Dont hesitate to refer when appropriate.

Alcohol Screening & Brief Intervention for Youth: A Practitioners Guide. NIAAA. NIH Publication No. 11-7805 Committee on Substance Abuse. Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians. Pediatrics Vol. 128; 2011. pp.1330-43. Committee on Substance Abuse. Alcohol Use and Abuse: A Pediatric Concern. Pediatrics Vol. 108 No. 1 July 1, 2001 pp. 185 -189 Griswold, K.S. et al. Adolescent substance use and abuse: recognition and management. Am Fam Physician. 2008 Feb 1; 77 (3):331-6. Shrier, L.A. et al. Substance Use Problems and Associated Psychiatric Symptoms Among Adolescents in Primary Care. Pediatrics Vol 111 No. 6; 2003. pp. 699-705. www.erowid.com Cannabis images