Helping Teens and Young Adults Recover from Addiction

Petros Levounis, MD, Director of the Addiction Institute of NY Dan Medeiros, MD, Director of the Child and Family Institute November 16, 2011

www.monitoringthefuture.org Data from 2010 Lifetime Use Eighth grade cigarettes alcohol Been drunk marijuana Other illegal drugs 20.0% 35.8% 16.3% 17.3% 10.6% Tenth grade 33.0% 58.2% 36.9% 33.4% 16.8% Twelfth grade 42.2% 71.0% 54.1% 43.8% 24.7%

www.monitoringthefuture.org Data from 2010 Use in last 30 days

Eighth grade cigarettes alcohol Been drunk marijuana Other illegal drugs 7.1% 13.8% 5.0% 8.0% 3.5%

Tenth grade 13.6% 28.9% 14.7% 16.7% 5.8%

Twelfth grade 19.2% 41.2% 26.8% 21.4% 8.6%

www.monitoringthefuture.org Data from 2010 Daily Use

Eighth grade cigarettes alcohol drunk Binge drink last 2 weeks marijuana 2.9% 0.5% 0.2% 7.2% 1.2%

Tenth grade 6.6% 1.1% 0.3% 16.3% 3.3%

Twelfth grade 10.7% 2.7% 1.6% 23.2% 6.1%

Substance Dependence
Maladaptive pattern of use, leading to impairment or distress, occurring in same 12 month period, at least 3 criteria: 1) Tolerance 2) Withdrawal 3) Substance often taken in larger amounts or over longer period than intended 4) Persistent desire or unsuccessful efforts to cut down/control use 5) Lots of time spent in activities to obtain drug, use the drug, or recover from the drug 6) Important social/occupational/recreational activities given up/reduced because of drug use 7) Use despite knowing physical/psychological problem is caused by/exacerbated by the substance

Substance Abuse
Maladaptive use of substance leading to significant impairment/distress, within 12 month period, at least one: 1) 2) 3) 4) Recurrent drug use resulting in failure to fulfill major obligations at work, school, or home Recurrent drug use in situations which are physically hazardous Recurrent drug-related legal problems Continued use despite having physical/psychological problem caused by/exacerbated by the substance

Does my teen have a drug problem?

Relationships with family Relationships with peers Dating relationships School performance Job performance Physical effects Emotional effects Issues with the law

Readiness for treatment

Pre-contemplation Contemplation Determination/Pre-action Action Maintenance Relapse

Spice and K2 Products

Numerous brands
Spice Spice Diamond Spice Gold K2, K2 Blonde XXX Black Box Smoke n Skulls Zombie

Cannabis substitute implied in marketing

Bath Salts Product Overview

Numerous brands, Plant Food, Stain Remover
Cloud 9 Ivory Wave Super Coke Mtv Energy-1 (NRG1) TranQuility White Lightning Charge Plus

Not for human consumption Stimulant inconsistently implied in marketing

Synthetic Stimulants: Bath Salts

$20-$30 per packet/jar Cathinone derivatives
Mephedrone MDPV Methylone Khat Plant

Inter/Intra-product variability
Other stimulants Lidocaine/benzocaine

Major Concern

SYNERGY 1+1=3
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Problem #1
The explosion of prescription opioids:      Oxycodone (OxyContin) Hydrocodone (Vicodin) Hydromorphone (Dilaudid) Fentanyl (Duragesic) Methadone

 RESPIRATORY DEPRESSION
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The Prescription Opioids Epidemic

Primary non-heroin opiate admission rates (Per 100,000)

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The Prescription Opioids Epidemic

Primary non-heroin opiate admission rates (Per 100,000)

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The Prescription Opioids Epidemic

Primary non-heroin opiate admission rates (Per 100,000)

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The Prescription Opioids Epidemic

Primary non-heroin opiate admission rates (Per 100,000)

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The Prescription Opioids Epidemic

Primary non-heroin opiate admission rates (Per 100,000)

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The Prescription Opioids Epidemic

Primary non-heroin opiate admission rates (Per 100,000)

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Prescription Painkillers 1999-2010

20

Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, November 1, 2011

The Prescription Opioids Epidemic: The Root of the Disaster

21

N Engl J Med, January 10, 1980.

Problem #2
The stimulant surge:  Amphetamines
Methylphenidate (Ritalin) MDMA (Ecstasy) Crystal Methamphetamine

 Cocaine  Some older antidepressants  And now Bath Salts as well  SEROTONIN SYNDROME
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Natural Rewards and Dopamine Levels

200

DA Concentration (% Baseline)

Food

Sex
200 150

% of Basal DA Output

150

100 Empty 50 Box Feeding 0 0 60 120 180

100

Female Present

Time (min)

Sample 1 2 Number

Adapted from: Di Chiara et al., Neuroscience, 1999 Adapted from: Fiorino & Phillips, J Neuroscience, 1997

Effects of Drugs on Dopamine Levels

1100 1000 900 % of Basal Release 800 DA 700 600 500 400 300 200 100 0 0 1 2 3 4 5 hr

AMPHETAMINE

Adapted from: Di Chiara & Imperato, Proceedings of the National Academy of Sciences USA, 1988; courtesy of Nora D Volkow, MD.

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25

Courtesy of www.streetdrugs.org.

Methamphetamine

26

Courtesy of The Addiction Institute of New York, www.AddictionInstituteNY.org.

Pseudoephedrine

27

Courtesy of The Addiction Institute of New York, www.AddictionInstituteNY.org.

28

Courtesy of www.streetdrugs.org

Problem #3
The sex and drugs combination:  Sildenafil (Viagra)  Crystal Methamphetamine

 HIV TRANSMISSION

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Crystal, Sex, and the Internet

The Perfect Storm Sex, both virtual and real, both safe and unsafe, is only a click away

32

Levounis P, Ruggiero JS: Outpatient management of crystal methamphetamine dependence among gay and bisexual men: How can it be done? Primary Psychiatry 13, 75-80, 2006

Primary Prevention

33

Courtesy of Daniel L. Carlson, Crystal Meth Working Group (HIV Forum), www.hivforumnyc.org.

Secondary Prevention

34

Courtesy of Daniel L. Carlson, Crystal Meth Working Group (HIV Forum), www.hivforumnyc.org.

35

Courtesy of Daniel L Carlson, Crystal Meth Working Group (HIV Forum), www.hivforumnyc.org.

People Recover

36

Volkow et al: J Neuroscience, 2001

Thank You

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