In Part 1 we reviewed the prevalence and screening for substance use disorders in Native American youth. In Part 2, we will review more about assessment for substance use and co-occurring mental health disorders in Native American youth. Early intervention can dramatically reduce morbidity and mortality.
As healthcare providers, we know about the potential harmful effects of regular cannabis use, particularly during the teen years. There can be negative effects on IQ and pre-frontal cortex development. Regular cannabis use can worsen underlying psychiatric symptoms like anxiety/depression as well as psychosis. There is concern related to high potency cannabis products and potential contamination with more potent drugs.
In terms of alcohol use in teens, there is an overall reduction in teen drinking but adolescents are more likely to engage in binge drinking. It is therefore important to ask specific details about a teen’s drinking pattern, including asking about any use and amount in a single sitting. Alcohol can be used to self-medicate for depression, anxiety and sleep disturbance. Genetic predisposition can play a vital role in terms of risks in developing alcohol use problems.
Once substance use has been identified, risk stratification can be helpful in deciding what level of intervention is needed. Risk stratification should take into consideration the amount and frequency of use as well as level of impairment from the use. Experimental use without impairment would be considered low risk. Regular use with school or social impact would be considered moderate risk. Polysubstance use with loss of control over the use and withdrawal when not using as well as legal or safety concerns would be considered high risk.
It can sometime be challenging to help the person see that there is a problem with their substance use. Motivational interviewing (MI) can help in these situations. MI starts with an open discussion that first emphasizes the benefits of using, without judgement, and with curiosity, enthusiasm, and validation. Once the client has been able to discuss benefits, they often offer downsides on their own or are more willing to consider downsides (even if the downside is just getting in trouble at school/home). The next step is to find examples of the client engaging in successful behavior change in the past and highlight those as evidence that the client can change. The stages of change can be used to assess readiness.
Substance use commonly co-occurs with other mental health concerns, including but not limited to: anxiety, depression, PTSD, ADHD, learning disabilities, school refusal/truancy. It is vital to assess for these during the evaluation and treat them at the same time as treating the substance use concern. Research has shown that this reduces the risk of relapse.
AUTHOR:
Charmi Patel Rao MD, DFAACAP
Medical Director, Vista Hill Foundation
Voluntary Assistant Clinical Professor, UCSD Department of Psychiatry