Time to Act: Helping parents deal with teens and drugs

Parents are always looking for help on how to parent when it comes to teens and drugs. Well, the new tool from drugfree.org, called Time To Act, may provide just the help parents want.

The tool has separate sections for parents who fear their kids may be trying drugs or for those who know for sure.

Check it out, it’s a great tool that can help a lot in terms of educating, guiding, and informing parents who are having trouble with teens, drugs, and parenting. NIDA also has a new tool called Family Checkup, developed by the Child and Family Center at the University of Oregon, that is aimed at helping parents communicate effectively with their kids when it comes to drugs.

More than anything, research has shown us that communication around the topic of teens and drugs and even more generally communication between parents and their kids about taboo topics, can be effective for reducing problems and for finding help sooner (see here for smoking related research).

Teens and drugs: Drug use statistics and treatment that works

Here are some drug use statistics:

  • Over 80% of teens engage in some form of deviant behavior (1).
  • Over 50% of high-school seniors admit to having used drugs (2).
  • Only 10%-15% of the population develop drug addiction problems related to their drug use (1).

The question is:

If the majority of teens experiment with drug use, and so few eventually develop drug addiction problems, should we be focusing on something other than stopping kids from trying drugs? Continue reading “Teens and drugs: Drug use statistics and treatment that works”

Treating alcohol withdrawal with benzodiazepines – Safe if mindful

Alcohol withdrawal can lead to some pretty horrible side effects

Contributing co-author: Andrew Chen

Alcohol withdrawal can be extremely unpleasant (see here for an overview). Symptoms vary from person to person, but most people will experience some negative symptoms of alcohol withdrawal if they try to stop drinking after long term use.

Mild to moderate symptoms include headache, nausea, vomiting, insomnia, rapid heart rate, abnormal movements, anxiety, depression, and fatigue. Severe symptoms of alcohol withdrawal include hallucinations, fever, and convulsions (known as DT’s or delirium tremens). Most people undergoing alcohol detox do not require hospitalization, but in severe cases, hospitalization may be necessary (1). Since their introduction in the 1960s, benzodiazepines have been the drug of choice for treating severe cases of alcohol withdrawal.

Benzodiazepines, or benzos for short, are a class of psychoactive drugs that work to slow down the central nervous system by activating GABA receptors. This provides a variety of useful tranquilizing effects. Aside from relieving symptoms of alcohol withdrawal, benzodiazepines are also commonly prescribed to treat insomnia, muscle spasms, involuntary movement disorders, anxiety disorders, and convulsive disorders.

The most common regimen for treating alcohol withdrawal includes 3 days of long-acting benzodiazepines on a fixed schedule with additional medication available “as needed.” (2)

The two most commonly prescribed benzos are chlordiazepoxide and diazepam. Chlordiazepoxide (Librium) is preferred for its superior anticonvulsant capabilities while diazepam (Valium) is preferred for its safety against overdose with alcohol. Short-acting benzos like oxazepam and lorazepam are less frequently used for treating alcohol withdrawal (1).

Compared to other drugs, benzos are the safest and most effective method for treating difficult alcohol withdrawal. However, benzodiazepines do come with their own potential for dependence and abuse. Ironically, symptoms of benzodiazepine withdrawal are quite similar to those of alcohol withdrawal. Tapering off dosage is the best way to prevent serious withdrawal symptoms. To avoid such complications, benzodiazepines are only recommended for short-term treatment of alcohol withdrawal.

In short

Benzos can be very useful for helping long terms alcoholics deal with the difficult withdrawal symptoms that can accompany the detox period. Just be mindful so as not to find yourself right back where you started.

Citations:

1. Williams, D., McBride, A. (1998) The drug treatment of alcohol withdrawal symptoms: A systematic review. Alcohol & Alcoholism. 33(2), 103-115

2. Saitz, R., Friedmn, L. S., Mayo-Smith, M.F. (1996) Alcohol withdrawal: a nationwide survey of inpatient treatment practices. 10(9), 479-87

Negative self-talk and addiction recovery

Everyone has internal beliefs about what they are, or aren’t, good at. For many these have become an implicit reality – facts about life that are rarely examined and never questioned. The “gravity” of our lives.

Negative self talk is often unecessarily self-defeatingWhen I review these internal beliefs with clients, especially those in early recovery but also others who don’t have trouble with addiction per se, we often find that they are packed full of negative self-beliefs and self-talk. Phrases like “I’m impatient/rude/stupid,” “I’m not good at doing _____,” or “I can’t handle _____” are so commonplace in psychotherapy circles that restructuring them can often become the focus of many sessions. And negative self-beliefs are a huge source of shame, and you know how I feel about that.

Inevitably these negative self-beliefs and the associated shame are often the remnants of past experience, whether personal or “other” inflicted. Poor performance in some childhood activity, ridicule by peers, or harsh words from misguided parents can lead to seemingly permanent imprints on the world-view of the young, and then the older. Ironically, even seemingly self-assured views like “I am in control of my life” can become defeating when they turn into “I am a failure because I can’t handle this on my own.” We get that one a lot in addiction treatment from clients who think that they are weak because they’ve found themselves needing help. Again, this thought pattern leads to shame and often resistance to receiving the necessary addiction help.

As usual, a big part of dealing with these issues, from both a cognitive behavioral therapy (CBT) point of view and a humanistic one, is to examine their sources and test their appropriateness. It’s rare that these statements prove universally true and it’s even more infrequent that they turn out to have no connection to a small set of past hurts that happened long ago. In recovery from addiction, I often have clients look at how many other things in life they’ve needed help with – learning how to read, how to play sports, or how to do well at their job. We’re constantly relying on others for help, but when it comes to our psychological functioning we believe that we should be masters regardless of our level of training – a belief that I see as having no basis. But then again, I am a psychologist…

How to break negative self-talk and self-belief cycles

For readers who want to test their own beliefs and the existence of their own negative self-talks it helps to keep a written journal. Make a list of such negative self-beliefs that you are already aware of and try to be as aware as possible of negative self-talk as it happens over the course of one whole day. Write those down too. Now, using a whole line on a piece of paper (or a spread-sheet if you want to be super organized about this) create little spaces (columns) to write down a single situation in which those thoughts and beliefs come up for you in everyday life. In the nest column put down an objective assessment of what actually happened. In the last column write a short assessment of how close your initial internal dialog was to the “truth.”

Let’s use an example – Imagine getting an upset email from your boss that brings up your good old “I’m never going to succeed” negative self-belief. When you go to your journal and find the line for that specific negative belief you write “got upset email from boss” in column one and “boss was upset that I forgot to send out update email yesterday as expected” in column two. Now examine your current level of functioning at work in light of this specific mistake, past work occurrences, and the very near future.

If you’ve been held back from advancement repeatedly and been scolded, fired, or nearly fired for forgetting these sorts of things in the past, the belief might be a sign that you need to become active about finding ways to improve on this sort of forgetfulness in the future. But if such occurrences are relatively rare and haven’t caused negative consequences at work or other environments, then it sounds like the belief is an exaggeration of a much less frightening reality along the lines of “I don’t always perform perfectly at work.” I don’t know about you, but that sort of internal belief I can live with.

Now go on and do your homework – or are you a slacker?!

Saving lives made easy – Treating opiate overdose with intranasal naloxone

oxycodone-addiction-big1Contributing co-author: Andrew Chen

Imagine that you and your friend have been using heroin (or another opiate). A few hours go by and you notice your friend is progressively becoming more and more unresponsive. You check on him and find that his breathing is shallow, his skin is cold, and his pupils are constricted. You recognize these as signs of opiate overdose and call for help. Now what?

Well… If you had some naloxone around, you might be able to treat the overdose and save your friend’s life before the paramedics even arrive.

Naloxone hydrochloride (naloxone) is the standard treatment for opioid overdose. Naloxone works by blocking opioid receptors, thereby removing opioid agonists, such as heroin or oxycodone, from those same receptors. As a result, the overdose is reversed and death is prevented.

What makes naloxone great is that it has no potential for abuse. In fact, it makes the user feel pretty crappy.

Naloxone is typically delivered through an injection, which makes it pretty much useless in many situations. However, it can also be delivered using an intranasal spray device. This intranasal form of naloxone is getting lots of attention recently because it is relatively easy to administer.

In 2006, The Boston Public Health Commission (BPHC) implemented an overdose prevention program, providing training and intranasal naloxone to 385 individuals deemed likely to witness an overdose. These individuals were often family members of opiate users or drug-using partners.

15 months later, the BPHC conducted a follow-up:

  • Contact was made with 278 of the original participants.
  • 222 reported witnessing no overdoses during the 15-month span.
  • 7 had their naloxone stolen, lost, or confiscated.
  • 50 reported witnessing at least one overdose during the 15-month span. Together, these 50 individuals reported a total of 74 successful overdose reversals using intranasal naloxone!

The BPHC program is not the only example of successful use of naloxone in opiate overdose prevention programs. Similar programs have popped up in Chicago, New York, San Francisco, Baltimore, and New Mexico.

Unlike injections, using a nasal spray isn’t rocket science. All of the participants in the BPHC program were trained by non-medical public health workers, which makes the idea relatively cheap. As the data shows, the participants were able to effectively recognize an opiate overdose and administer intranasal naloxone. By targeting at-risk populations and providing proper training, distribution of intranasal naloxone can help in saving lives.

For more information, check out our post Addiction and the brain part IV – Opiates

Citation:

Doe-Simkins, M., Walley, A.Y., Epstein, A., & Moyer, P. (2009) Saved by the nose: Bystander-administered intranasal naloxone hydrochloride for opiod overdose. American Journal of Public Health. 99(5)

Influential factors in college drinking

Co-authored by: Jamie Felzer

What influences students’ college drinking decisions?

  • Do friends peer pressure them?
  • Do they do it because they are bored?
  • Do they drink to relieve depression or anxiety?

Researchers recently tried to answer these questions by surveying college students…

65% of the participants reported having at least one drink in the past three months. It was astonishing that the typical number of drinks in a week was 10.5 and on a weekend was 7.3 average drinks. These numbers included drinkers and nondrinkers and was the average (meaning around half the people had more drinks as those had less). This indicates that college drinking is far more extreme than drinking happening outside of the college setting.

3 main influential factors for someone’s decisions in college drinking and to what extent:

  • If their close friends were drinking,
  • How drunk they thought they were, and
  • Their drinking intentions.

Interestingly enough, the more students thought others on their campus approved of drinking, the less they tended to drink. We recently reported similar misconceptions about students, their peers and marijuana use. Typically, if people intend to get drunk they use less protective factors (see here for a previous post about these) such as pacing or eating or keeping track of what they were drinking. Friends’ drinking was the best predictor of drinking habits in all cases.

You can tell a lot about a person by watching their friends, so watch who you surround yourself with. Those who think favorably of drinking tend to think they can drink more before reaching intoxication and also tend to hang out with others who do the same. However, these people are the ones that need the most intervention yet are the most difficult to change.

Those who socialize with a wide variety of people typically are lighter drinkers and tend to respond better to treatment immediately as well as have fewer problems further down the line. The heavier drinkers benefit more from motivational interventions focusing on their attitudes toward drinking.

Regardless of stereotypes, ethnicity, weight and gender did have an effect on any of these findings. It was peoples’ closest friends that were the most significant factor in influencing all aspects of college drinking.

Citation:
Examining the Unique Influence of Interpersonal and Intrapersonal Drinking Perceptions on Alcohol Consumption among College Students. Journal of Studies on Alcohol and Drugs. Volume 70, 2, March 2009

More money more problems? Rich teens and drugs

Teens raised in affluent homes display the highest rates of depression, anxiety, and drug abuse according to a recent article in Monitor on Psychology, the APA‘s monthly magazine.

One of our recent posts dealt with some of the issues unique to teens and drugs. In addition to the issues we’d already mentioned, the article named a number of reasons for the high prevalence of mental-health issues among affluent teens. Among them were an increasingly narcissistic society, overbearing parents, and an common attitude of perfectionism.

Each of these reasons are likely contributors to the prevalence of mental health and drug abuse issues among upper-middle-class (and above) teens. Still, as far as I’m concerned, the main take home message of the article is this:

Money truly doesn’t buy happiness – Rich teens and drug use.

While drug abuse research often focuses on the lower socioeconomic strata these recent findings indicate that being financially stable offers little in the way of protection from some of the most common psychological difficulties.

Thankfully, the researchers cited in the article gave some simple advice to parents:

  • Give children clear responsibilities to help around the house.
  • Take part in community service (to unite the family and reduce narcissism).
  • Reduce TV watching (especially of reality TV shows that glorify celebrity and excess).
  • Monitor internet use.
  • Stop obsessing about perfect grades and focus instead on the joy of learning for its own sake.

I couldn’t agree more with these recommendations. Having taught a number of classes myself, I have witnessed the ridiculous inflation in students’ expectations of top grades. I think it’s time we turned attention back to the family and reintroduce some of the basic skills that many addicts find themselves learning much too late… Often in recovery.