National Addiction Treatment Week

7 Things to Know About Adolescents, Addiction, and Addiction Treatment

7 Things to Know About Adolescents, Addiction, and Addiction Treatment

 

What does the medical community need to know about treating addiction in adolescents?

Contributing Experts:

Marc Fishman, MD, DFASAM, is an addiction medicine specialist in youth treatment, co-occurring disorders, and addiction medication treatment. He leads Maryland Treatment Centers and is a Johns Hopkins University School of Medicine Department of Psychiatry faculty member.

Marla Kushner, DO, FSAHM, FACOFP, DFASAM, has a family medicine practice in Chicago with a focus on adolescent and addiction medicine. She is also the medical director for the Arch program at Insight Behavioral Health in Chicago and the school-based health centers.

 

  1. How do brains of adolescents differ from those of adults?
    • Adolescent brains are different because they are still developing. The amygdala, responsible for immediate reactions, develops early, while the frontal cortex, which controls reasoning, develops later. Learn more: https://youtu.be/EpfnDijz2d8
    • Adolescents brains and minds are different from adults – more impulsiveness and excitement seeking, more difficulty delaying gratification, more trouble with executive function (strategy for the future) and inhibitory control (putting on the brakes). This difference makes them particularly vulnerable to risk behaviors including substance use.
    • If drug or alcohol use occurs during this brain development phase it may disrupt the development of the adolescent. Many adults who start using drugs or alcohol as adolescents find that they are playing catch up in how they mature. This may affect their relationships and impair their functioning.

 

  1. Do drugs and alcohol affect the brains of adolescents in different ways than adults?
    • Adolescents who try substances are more likely to experience stronger subjective upside and weaker subjective downside, compared to adults. They are more likely to progress from casual or recreational use to loss of control, experience substance-related problems and develop use disorders, both as adolescents and then persistent into adulthood.
    • For more information about underage drinking visit: Underage Drinking | CDC

 

  1. What are perceived risks from substance use among adolescents?
    • Fortunately, adolescents have high perceptions of risk & harm from binge drinking, cigarettes, heroin and cocaine. Unfortunately, adolescents have relatively low perceptions of harm from cannabis and e-cigarettes. And low perception of risk is associated with higher rates of initiation and use.
    • It’s important to understand that when the perceived risk of a drug goes down that the use of that drug will start to increase. We have seen that with marijuana.

 

  1. How can primary care providers play a role in treating addiction?
    • Primary care providers can help their adolescent patients weigh the pro’s and con’s of substance-use, encourage honesty, keep the conversation going over time.
    • Educate youth and parents about the harms of substances. Not everyone gets major problems, but many do; it’s a gamble not worth taking.
    • It is helpful for the primary care provider, as the expert and trusted advisor, to take a clear stand that teen use is harmful for health. This won’t damage relationships any more than a clear stand about condoms and seat belts.
    • For severe case, a clinician can refer to an addiction medicine specialist. Begin here for a search: Find an addiction medicine specialist
    • If primary care providers see any of the following indicators, they should refer the patient to an addiction specialist: regular use of a substance, antisocial behaviors, major health effects, major consequences, social role impairment, or use of “harder” substances.
    • Physicians can familiarize themselves with addiction treatment practice guidelines found at: https://bit.ly/2wWpWGh
    • How should I respond when a young person or parent says “…it’s no big deal…everyone is doing it…?” Actually, not everyone is doing it: 58% of HS seniors have not used substance in the past month, and 31% have never used in their lifetimes ( Levy et al. Trends in Substance Nonuse by High School Seniors: 1975–2018. Pediatrics. 2020.)
    • Primary care physicians, especially family doctors, may identify a parent or other family member of a teen with a substance use disorder and address this early with the teen as a preventative issue. Start asking age-appropriate questions early for prevention and screening for use on every encounter.
    • Helpful screening tools include:

CRAFFT https://crafft.org/;

BSTAD https://www.drugabuse.gov/ast/bstad/#/

S2BI https://www.drugabuse.gov/ast/s2bi/#/

  • Understanding the definition of addiction is another helpful way for clinicians to recognize addiction in their patients. https://bit.ly/2PFFTpT
  • Helpful courses on screening adolescents for addiction and communicating with them are found at ASAM’s e-learning center: https://elearning.asam.org/screening-assessment

 

  1. How many addiction medications are available to treat adolescents?
    • Buprenorphine for opioid addiction is approved for ages 16 and above. All addiction medications approved in adults can be used effectively off-label in teens of all ages. Extended release naltrexone is another option for opioids. While all meds have potential side effects, there is no evidence that addiction medications confer any special risks based on age. Parents or clinicians can consult an addiction medicine specialist who works with adolescents to discuss options.
    • It is important to prescribe naloxone to all families of teens misusing opioids and to teach them how to use it. It comes in an injectable, nasal spray or auto injection form. It’s important that families understand that if the teen has overdosed on opioids, naloxone will reverse it quickly. It will not harm the teen if that is not the reason they are unconscious.

 

  1. What are effective addiction treatments and interventions for adolescents?
    • Treatment can range from family-based interventions to in-patient care. One way to start is to find an addiction medicine specialist and make an appointment to discuss treatment options. https://asam.ps.membersuite.com/
      directory/SearchDirectory_Criteria.aspx
    • Start with an assessment. Work with an addiction specialist and/or a reputable program. The most important first step is enhancing motivation and promoting treatment engagement. Families should look for treatment providers that will include and welcome them as collaborators. Treatment for opioid addiction should include medication.
    • Some helpful resources include:
      • https://teens.drugabuse.gov/
      • https://drugfree.org/

 

  1. If I am just beginning to learn about evidence-based addiction treatment and am concerned I have patient who has or might be at risk for addiction, where should I start looking for reliable resources?