Monthly Archives: June 2016

Questions about Medications to Treat Adolescent Drug Use

Questions about Medications to Treat  Adolescent Drug Use

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

13. Are there medications to treat adolescent substance abuse?

Several medications are approved by the FDA to treat addiction to opioids, alcohol, and nicotine in individuals 18 and older. In most cases, little research has been conducted to evaluate the safety and efficacy of these medications for adolescents; however, some health care providers do use these medications “off-label,” especially in older adolescents.

14. Do girls and boys have different treatment needs?

Adolescent girls and boys may have different developmental and social issues that may call for different treatment strategies or emphases.

For example, girls with substance use disorders may be more likely to also have mood disorders such as depression or to have experienced physical or sexual abuse.

Boys with substance use disorders are more likely to also have conduct, behavioral, and learning problems, which may be very disruptive to their school, family, or community. Treatments should take into account the higher rate of internalizing and traumatic stress disorders among adolescent girls, the higher rate of externalizing disruptive disorders and juvenile justice problems among adolescent boys, and other gender differences that may play into adolescent substance use disorders.

How effective is drug abuse treatment for criminal justice-involved individuals?

FREQUENTLY ASKED QUESTIONS (FAQS) About Drug Abuse Treatment for People Involved with the Criminal Justice System.

Reprinted from “Principles of Drug Abuse Treatment for Criminal Justice Populations” by the National Institute on Drug Abuse (in the Public Domain) by Thomas A. Wilson, MA, LCPC & CEO of Tom Wilson Counseling and Telehealth Center.

3. How effective is drug abuse treatment for criminal justice-involved individuals?

Treatment is an effective intervention for drug abusers, including those who are involved with the criminal justice system. However, the effectiveness of drug treatment depends on both the individual and the program, and on whether interventions and treatment services are available and appropriate for the individual’s needs.

To alter attitudes, beliefs, and behaviors that support drug use, the drug abuser must engage in a therapeutic change process, which may include medications to help prevent relapse. Longitudinal outcome studies find that those who participate in community-based drug abuse treatment programs commit fewer crimes than those who do not participate.

Questions About Medications to Treat Adolescent Drug Abuse, Part 7

Questions about Medications to Treat  Adolescent Drug Use

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

13. Are there medications to treat adolescent substance abuse?

Several medications are approved by the FDA to treat addiction to opioids, alcohol, and nicotine in individuals 18 and older. In most cases, little research has been conducted to evaluate the safety and efficacy of these medications for adolescents; however, some health care providers do use these medications “off-label,” especially in older adolescents.

14. Do girls and boys have different treatment needs?

Adolescent girls and boys may have different developmental and social issues that may call for different treatment strategies or emphases.

For example, girls with substance use disorders may be more likely to also have mood disorders such as depression or to have experienced physical or sexual abuse.

Boys with substance use disorders are more likely to also have conduct, behavioral, and learning problems, which may be very disruptive to their school, family, or community. Treatments should take into account the higher rate of internalizing and traumatic stress disorders among adolescent girls, the higher rate of externalizing disruptive disorders and juvenile justice problems among adolescent boys, and other gender differences that may play into adolescent substance use disorders.

Questions about Treating Adolescent Tobacco Use

Questions about Treating Adolescent Tobacco Use

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

12. Is adolescent tobacco use treated similarly to other drug use?  

YesPeople often don’t think of tobacco use as a kind of “drug abuse” that requires treatment, and motives for quitting smoking may be somewhat different than motives for quitting other drugs. But tobacco use has well-known health risks–– especially when begun in the teen years––and the highly addictive nicotine in tobacco can make treatment a necessity to help an adolescent quit. Laboratory research also suggests that nicotine may increase the rewarding and addictive effects of other drugs, making it a potential contributor to other substance use disorders.

Common treatment approaches like Cognitive Behavioral Therapy are now being used to help adolescents quit smoking (and quit using other drugs) by helping them “train their brains” so they learn to recognize and control their cravings and better deal with life stress. Other therapies like Contingency Management and Motivational Enhancement use incentives and motivation techniques to help teens reduce or stop smoking.

Tobacco use often accompanies other drug use and needs to be addressed as part of other substance use disorder treatment. In a recent survey, nearly 55 percent of current adolescent cigarette smokers (ages 12 to 17) were also illicit drug users (by comparison, only about 6 percent of those who did not smoke used any illicit drugs). Also, cigarette smoking can be an indicator of other psychiatric disorders, which can be identified through comprehensive screening by a treatment provider.

How can rewards and sanctions be used effectively with drug-involved offenders in treatment?

FREQUENTLY ASKED QUESTIONS (FAQS) About Drug Abuse Treatment for People Involved with the Criminal Justice System.

Reprinted from “Principles of Drug Abuse Treatment for Criminal Justice Populations” by the National Institute on Drug Abuse (in the Public Domain) by Thomas A. Wilson, MA, LCPC & CEO of Tom Wilson Counseling and Telehealth Center. 
9. How can rewards and sanctions be used effectively with drug-involved offenders in treatment?
The systematic application of behavioral management principles underlying reward and punishment can help individuals reduce their drug use and criminal behavior. Rewards and sanctions are most likely to change behavior when they are certain to follow the targeted behavior, when they follow swiftly, and when they are perceived as fair. It is important to recognize and reinforce progress toward responsible, abstinent behavior. 
Rewarding positive behavior is more effective in producing long-term positive change than punishing negative behavior. Indeed, punishment alone is an ineffective public health and safety intervention for offenders whose crime is directly related to drug use (Leukefeld et al. 2002). Nonmonetary rewards such as social recognition can be as effective as monetary ones. A graduated range of rewards given for meeting predetermined goals can be an effective strategy.
Contingency management strategies, proven effective in community settings, use voucher-based incentives or rewards, such as bus tokens, to reinforce abstinence (measured by negative drug tests) or to shape progress toward other treatment goals, such as program session attendance or compliance with medication regimens. 
Contingency management is most effective when the contingent reward closely follows the behavior being monitored. An intervention tested by CJ-DATS researchers, called “Step’n Out,” used a contingency management approach whereby criminal justice staff monitored specific behaviors (e.g., abstinence, employment searches, and counseling attendance) and rewarded individuals who met agreed-upon goals with social acknowledgement (e.g., congratulatory letter from parole supervisor) and small material incentives (e.g., partial payment for clothes for job interviews). This approach improved parolees’ attendance at integrated community parole and addiction treatment sessions, as well as increased use of treatment and individual counseling services (Friedmann et al. 2009).
Graduated sanctions, which invoke less punitive responses for early and less serious noncompliance and increasingly severe sanctions for more serious or continuing problems, can be an effective tool in conjunction with drug testing. The effective use of graduated sanctions involves consistent, predictable, and clear responses to noncompliant behavior.
Drug testing can determine when an individual is having difficulties with recovery. The first response to drug use detected through urinalysis should be a clinical one—for example, increasing treatment intensity or switching to an alternative treatment. This often requires coordination between the criminal justice staff and the treatment provider. (Note that more intensive treatment should not be considered a sanction, but rather a routine progression in health care practice when a treatment appears less effective than expected.)
Behavioral contracting can employ both rewards and sanctions. A behavioral contract is an explicit agreement between the participant and the treatment provider or criminal justice monitor (or among all three) that specifies proscribed behaviors and associated sanctions, as well as positive goals and rewards for success. Behavioral contracting can instill a sense of procedural justice because both the necessary steps toward progress and the sanctions for violating the contract are specified and understood in advance.

Why should drug abuse treatment be provided to offenders?

FREQUENTLY ASKED QUESTIONS (FAQS) About Drug Abuse Treatment for People Involved with the Criminal Justice System.

Reprinted from “Principles of Drug Abuse Treatment for Criminal Justice Populations” by the National Institute on Drug Abuse (in the Public Domain) by Thomas A. Wilson, MA, LCPC & CEO of Tom Wilson Counseling and Telehealth Center.

2. Why should drug abuse treatment be provided to offenders?

The case for treating drug abusing offenders is compelling. Drug abuse treatment improves outcomes for drug abusing offenders and has beneficial effects for public health and safety. Effective treatment decreases future drug use and drug-related criminal behavior, can improve the individual’s relationships with his or her family, and may improve prospects for employment.

In addition, it can save lives: A retrospective study of more than 30,000 Washington State inmates found that during the first 2 weeks after release, the risk of death among former inmates was more than 12 times that among other residents, with drug overdose being the leading cause.

Outcomes for substance abusing individuals can be improved when criminal justice personnel work in tandem with treatment providers on drug abuse treatment needs and supervision requirements. Treatment needs that can be assessed after arrest include substance abuse severity, mental health problems, and physical health. Defense attorneys, prosecutors, and judges need to work together during the prosecution and sentencing phases of the criminal justice process to determine suitable treatment programs that meet the offender’s needs.

Through drug courts, diversion programs, pretrial release programs that are conditional on treatment, and conditional probation with sanctions, the offender can participate in community-based drug abuse treatment while under criminal justice supervision. In some instances, the judge may recommend that the offender participate in treatment while serving jail or prison time or require it as part of continuing correctional supervision post-release.

Frequently Asked Questions about Adolescent Drug Use, Part 6

Frequently Asked Questions about Adolescent Drug Use, Part 6

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

12. Is adolescent tobacco use treated similarly to other drug use?  

YesPeople often don’t think of tobacco use as a kind of “drug abuse” that requires treatment, and motives for quitting smoking may be somewhat different than motives for quitting other drugs. But tobacco use has well-known health risks–– especially when begun in the teen years––and the highly addictive nicotine in tobacco can make treatment a necessity to help an adolescent quit. Laboratory research also suggests that nicotine may increase the rewarding and addictive effects of other drugs, making it a potential contributor to other substance use disorders.

Common treatment approaches like Cognitive Behavioral Therapy are now being used to help adolescents quit smoking (and quit using other drugs) by helping them “train their brains” so they learn to recognize and control their cravings and better deal with life stress. Other therapies like Contingency Managementand Motivational Enhancement use incentives and motivation techniques to help teens reduce or stop smoking.

Tobacco use often accompanies other drug use and needs to be addressed as part of other substance use disorder treatment. In a recent survey, nearly 55 percent of current adolescent cigarette smokers (ages 12 to 17) were also illicit drug users (by comparison, only about 6 percent of those who did not smoke used any illicit drugs). Also, cigarette smoking can be an indicator of other psychiatric disorders, which can be identified through comprehensive screening by a treatment provider.

Questions about the Role of Medical Professionals in Adolescent Drug Use

Questions about the Role of Medical Professionals in Addressing Adolescent Drug Use  

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

11. What role can medical professionals play in addressing substance abuse (including abuse of prescription drugs) among adolescents?

Medical professionals have an important role to play in screening their adolescent patients for drug use, providing brief interventions, referring them to substance abuse treatment if necessary, and providing ongoing monitoring and follow-up. Screening and brief interventions do not have to be time-consuming and can be integrated into general medical settings.

• Screening. Screening and brief assessment tools administered during annual routine medical checkups can detect drug use before it becomes a serious problem. The purpose of screening is to look for evidence of any use of alcohol, tobacco, or illicit drugs or abuse of prescription drugs and assess how severe the problem is. Results from such screens can indicate whether a more extensive assessment and possible treatment are necessary. Screening as a part of routine care also helps to reduce the stigma associated with being identified as having a drug problem

• Brief Intervention. Adolescents who report using drugs can be given a brief intervention to reduce their drug use and other risky behaviors. Specifically, they should be advised how continued drug use may harm their brains, general health, and other areas of their life, including family relationships and education. Adolescents reporting no substance use can be praised for staying away from drugs and re-screened during their next physical.

 • Referral. Adolescents with substance use disorders or those that appear to be developing a substance use disorder may need a referral to substance abuse treatment for more extensive assessment and care.

• Follow-up. For patients in treatment, medical professionals can offer ongoing support of treatment participation and abstinence from drugs during follow-up visits. Adolescent patients who relapse or show signs of continuing to use drugs may need to be referred back to treatment.

• Consider an Alternative Medication. Before prescribing medications that can potentially be abused, clinicians can assess patients for risk factors such as mental illness or a family history of substance abuse, consider an alternative medication with less abuse potential, more closely monitor patients at high risk, reduce the length of time between visits for refills so fewer pills are on hand, and educate both patients and their parents about appropriate use and potential risks of prescription medications, including the dangers of sharing them with others.

Online Thinking Errors Classes

Online Thinking Errors classes have been developed to improve decision-making, problem solving and Conflict Management at Tom Wilson Counseling and Telehealth Services. 

These innovative cognitive-behavioral skills training classes are also referred to as Cognitive Self-Change or Thinking Errors classes. They are designed to meet requirements of courts, probation and parole, universities and colleges and emphasize pro-social decision making and positive behavior change.

These classes are self-directed over the internet and available anytime of day or night, with strict security, confidentiality and attendance monitoring. 

Why do people involved in the criminal justice system continue abusing drugs?

FREQUENTLY ASKED QUESTIONS (FAQS) about Drug Abuse Treatment for People Involved with the Criminal Justice System.

Republished from the National Institute on Drug Abuse (in the Public Domain) by Thomas A. Wilson, MA, LCPC & CEO of Tom Wilson Counseling and Telehealth Center.  

1. Why do people involved in the criminal justice system continue abusing drugs?

The answer to this perplexing question spans basic biological, psychological, social, and environmental factors. The repeated use of addictive drugs eventually changes how the brain functions. Resulting brain changes, which accompany the transition from voluntary to compulsive drug use, affect the brain’s natural inhibition and reward centers, causing the addicted person to use drugs in spite of the adverse health, social, and legal consequences.

Addictive drugs cause long-lasting changes in the brain. Craving for drugs may be triggered by contact with the people, places, and things associated with prior drug use, as well as by stress. Forced abstinence (when it occurs) is not treatment, and it does not cure addiction. Abstinent individuals must still learn how to avoid relapse, including those who may have been abstinent for a long period of time while incarcerated.

Potential risk factors for released offenders include pressures from peers and family members to return to drug use and a criminal lifestyle. Tensions of daily life—violent associates, few opportunities for legitimate employment, lack of safe housing, and even the need to comply with correctional supervision conditions—can also create stressful situations that can precipitate a relapse to drug use.

Research on how the brain is affected by drug abuse promises to teach us much more about the mechanics of drug-induced brain changes and their relationship to addiction. Research also reveals that with effective drug abuse treatment, individuals can overcome persistent drug effects and lead healthy, productive lives.