MINI TRAINING SERIES This resource was developed by the PLYMOUTH YOUTH DEVELOPMENT COLLABORATIVE
Science of Addiction & The Teenage Brain Addiction: Lack of control over a reward seeking behavior in which harm ensues
DOPAMINE is a chemical in your brain that creates feelings of pleasure
"motivation molecule" "reward chemical"
When drugs are misused, the brain becomes flooded with dopamine
"EUPHORIC HIGH"
As a person continues to misuse drugs, their brain adapts to these surges of dopamine that the drugs are imitating and in turn produces less dopamine naturally, causing the individual to not be able to enjoy things that once caused them pleasure.
The reward system of a teenage brain is overdeveloped, while the pre-frontal cortex is underdeveloped (this is responsible for long term decision making/consequences)
Adults ask: "why" Youth ask: "why not"
potency & instant gratification
RISK FACTORS Mental Illness Early use of drugs Social environment Childhood traumas Genes
Alcohol & Underage Drinking Alcohol is the active ingredient in beer, wine and liquor that causes drunkenness. Alcohol is a depressant which means it inhibits the function of the central nervous system.
Why Do Young People Drink?
to celebrate curiosity to feel good
interferes with brain development increases risk of alcohol issues later in life can lead to trouble in school and/or with the law
peer pressure self-pressure media influence
"liquid courage" to cope "party culture"
Consequences increases risky behaviors of Underage impairs judgement Drinking: causes many deaths/injuries
Youth ages 12-20 consume more than 90% of their alcohol by binge drinking (or consuming many drinks on a single occasion) In the US, a "standard drink" contains roughly 14 grams of pure alcohol which is found in:
Mixing Substances
The effects of drinking & taking other drugs (including over-the-counter or Rx medications) can be unpredictable and dangerous. https://pubs.niaaa.nih.gov/publications/UnderageDrinking/Underage_Fact.pdf
Benzodiazepines "Benzos" Benzodiazepines are depressants that are prescribed to induce sleep, relieve anxiety and muscle spasms, and prevent seizures.
Commonly Prescribed Benzos
Xanax ("Bars") Klonopin ("K-Pins") Ativan Valium
A person can overdose on a benzodiazepine. Overdose results in respiratory arrest.
Often benzodiazepines are misused in combination with alcohol/opioids. Mixing two depressants highly increases the likelihood of overdose.
Benzodiazepines are a drug of tolerance. Withdrawal symptoms include anxiety, panic, irritability, insomnia and more.
Symptoms of Use:
Drowsiness Blurred Vision Slurred Speech Dry Mouth Confusion Lack of Coordination
Symptoms of Overdose: Slow, shallow, or stopped breathing Cool, clammy skin Unconsciousness Blue tint around the ears/lips
Narcan (naloxone) will not reverse a benzodiazepine overdose.
Consult with your doctor/pharmacist about risks associated with use before beginning any medication.
Youth Marijuana Use Marijuana refers to the dried leaves, flowers, stems, and seeds from the Cannabis sativa or Cannabis indica plant. The plant contains the mind-altering chemical THC and other similar compounds.
Marijuana is a complex plant that has many ingredients.
THC: Tetrahydrocannabinol
CBD: Cannabidiol
the major psychoactive ingredient in marijuana that is responsible for marijuana's psychological effects
non-psychoactive ingredient in marijuana that works in conjunction with THC to decrease psychoactive effects
WHAT ARE MARIJUANA (THC) CONCENTRATES? A marijuana concentrate is a highly potent THC (Tetrahydrocannabinol) concentrated mass that is sometimes referred to as oil, budder, shatter, dabs, or wax.
WHAT ARE MARIJUANA EDIBLES? Edibles are food products infused with marijuana. Smoking marijuana is the most prevalent method of consumption, but eating marijuana is quickly becoming a popular way to consume the drug.
Research shows that marijuana use can have permanent effects on the developing brain when use begins in adolescence: https://www.cdc.gov/marijuana/factsheets/teens.htm
Negative effects of edibles could include:
difficulty thinking issues problem solving impaired coordination short attention span
While flower potency tends to range between 10-25% THC, a concentrate typically falls between 40-90%
Psychotic episodes Hallucinations Paranoia Panic attacks Impaired motor ability Marijuana negatively affects a number of skills required for safe driving, such as reaction time, coordination, and concentration.
Opioids: Prescription Drugs & Heroin What are opioids?: Pain medications or "narcotics" that work in the receptors of the brain
Commonly prescribed opioids include:
Percocet Oxycodone Vicodin Codeine Morphine
Pinned pupils Drooped, smooth eyelids Sedated nodding movements Slack muscle tone Cool, clammy skin
Chemically, your brain does not know the difference between prescription opioids & heroin People switch from prescription opioids to heroin because it's cheaper & easier to get Low concentration Dry, cotton mouth Face and arm stretching, itching “Dreamy” walk or talk Slow reaction and movement
Naloxone or "Narcan" is a nasal spray that can reverse an opioid overdose & save a life. You can get Narcan at most pharmacies without a prescription.
SIGNS OF AN OVERDOSE INCLUDE:
Signs of opioid misuse or abuse:
Narcan only reverses the effects of opioids Narcan is a temporary solution (30-90 minutes) Narcan is safe & has no potential for abuse
slow, shallow, or no breathing unconscious or non-responsive pale, grey or blue skin snorting or gurgling sounds foaming at the mouth vomiting
RESPOND: 1. Call 911 2. Perform Rescue Breaths 3. Administer Narcan
Vaping & E-Cigarette Use What Is "vaping"?: The act of inhaling and exhaling the aerosol, often referred to as vapor, which is produced by an e-cigarette or similar device.
E-cigarettes or vapes contain "e-liquid" or "e-juice". These liquids come in many different flavors, and often contain both dangerous chemicals as well as nicotine. Vaping devices can also contain THC (a component of marijuana) or other substances.
Popular brands that sell these products
Vuse SMOK Puff Bar & more...
An aerosol containing: Ultrafine particles Cancer causing chemicals Heavy metals (nickel, tin, lead) Volatile organic compounds Nicotine & flavoring (diacetyl)
What is inhaled and exhaled while vaping? Most e-liquids or e-juices contains nicotine
Elf Bar
Nicotine is highly addictive, can harm youth brain development, and can increase risk for future addiction to other drugs.
The vaping industry is using specific tactics to target young people such as sweet flavors, inexpensive pricing, and increased access to products.
Because vaping products are not regulated by the FDA, some e-juices marketed as containing 0% nicotine have been found to contain nicotine.
For more information on how to stop vaping visit smokefree.gov or call 1-800-QUIT-NOW.
Fentanyl Pharmaceutical fentanyl is a synthetic opioid that was created in the early 60s and is primarily used as an anesthetic and pain reliever. Illicitly manufactured fentanyl is responsible for drastic increases in opioid overdose deaths.
When created with laboratory-grade equipment and used by trained professionals, pharmaceutical fentanyl can be therapeutic for many patients receiving medical care.
In 2013 there was a surge in deaths in the United States involving synthetic opioids, or illicitly manufactured fentanyl. In 2017, over 28,000 individuals died of overdoses involving synthetic opioids (not involving methadone).
Common Street Names:
Apache China Girl
China White Dance Fever
How potent is fentanyl? 50 times more potent than heroin 100 times more potent than morphine The photograph to the left was taken at the New Hampshire State Police Forensic Laboratory. On the left is a lethal dose of heroin which is equivalent to about 30 milligrams. On the right is a 3-milligram dose of fentanyl which is enough to kill an average-sized adult male.
How do I respond if somebody is overdosing on fentanyl?
The response during a fentanyl overdose is the same as any other opioid overdose. If you believe someone is experiencing an opioid related overdose you should:
1. Call 911 2. Perform Rescue Breaths 3. Administer Naloxone (Narcan) https://www.pbs.org/newshour/health/fentanyl-deadlier-heroin-single-photo
Adverse Childhood Experiences (ACEs) Study What are ACEs?: Adverse Childhood Experiences, or ACEs, are stressful or traumatic events that can have negative lasting effects on health and well-being.
Examples of ACEs
Physical Abuse Sexual Abuse Emotional Abuse Physical Neglect Emotional Neglect
Intimate Partner Violence Substance Use in Home Mental Illness in Household of children in the U.S. Parental Separation/Divorce have experienced at Incarcerated Household Member least one ACE
The landmark ACE study was conducted at Kaiser Permanente from 1995-1997 with over 17,000 participants. It analyzed the relationship between childhood trauma and social and health consequences later in life.
Poor work performance Financial stress Early initiation of substance use Early initiation of sex Poor academic achievement Cumulative health Issues
46%
The study found that as the number of ACEs increases, so does the risk for the following:
Mental illness Substance use disorders Teen pregnancy Issues during pregnancy Multiple sexual partners Domestic violence Suicide attempts
NEXT STEPS: Inform local decision-making by collecting state and county-level ACEs data Increase awareness of ACEs among community-level prevention efforts Select and implement programs, policies and strategies designed to address ACEs Use ACEs research and local ACEs data to identify groups of people who may be at higher risk for substance use disorders https://www.samhsa.gov/capt/practicing-effective-prevention/prevention-behavioral-health/adverse-childhood-experiences
Resiliency What is resiliency?: Resiliency is the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress. It's the ability to "bounce back" from difficult experiences.
Resilience is not a trait that people either have or don’t have. It involves behaviors, thoughts, and actions that can be learned and developed in everyone.
Does being resilient mean you're always happy?
Resilience isn’t about “toughing it out” or reacting to every setback with a smile. Resilient people still feel sad, angry, or frustrated when faced with a setback. They find ways to move forward, to tackle challenges with creativity, hope, and a positive attitude.
1. Make connections 2. Avoid seeing crises as insurmountable problems 3. Accept that change is a part of living 4. Move toward your goals 5. Take decisive actions 6. Look for opportunities for self-discovery 7. Nurture a positive view of yourself 8. Keep things in perspective 9. Maintain a hopeful outlook 10. Take care of yourself
Developing resiliency is a personal journey. Some or many of the ways to build resilience listed may be appropriate to consider in developing your personal strategy.
If you need more detail around these steps to developing resiliency please visit the American Psychological Association's website (www.apa.org) https://www.apa.org/helpcenter/road-resilience https://www.state.gov/m/med/dsmp/c44950.htm
Neonatal Abstinence Syndrome (NAS) What Is NAS?: Neonatal Abstinence Syndrome (NAS) is a withdrawal syndrome that occurs after a child has been exposed in utero to drugs of dependency.
During pregnancy substances pass from the mother's blood stream through the placenta to the fetus. Substances that cause drug dependency and addiction also can cause the fetus to become dependent.
What are the symptoms of NAS in a newborn?:
Hypertonia Tremors Sneezing Vomiting
What drugs can cause symptoms of NAS?:
Looking for resources on the South Shore of MA?
Alcohol Barbiturates Benzodiazepines & more...
There is limited long term research on this population and best practices in care do not exist beyond the NICU.
Fever Seizures Irritability High Pitched Cry
Research suggests children with NAS are more likely to have fine and gross motor delays, vision and hearing difficulties, and behavioral/cognitive issues.
Opiates
Coordination of medical, educational, and behavioral health services is key to these children reaching their full potential.
To the Moon and Back is a 501 (c)(3) dedicated to supporting children born substance exposed and their caregivers. For more information: 2themoonandback.org |
@tothemoonMA
Nicotine Withdrawal References: smokefreeteen.gov | truthinitative.org | cdc.gov
Whether someone is vaping or smoking traditional cigarettes, our body and brain have to get used to not having nicotine. Nicotine withdrawal is different for everybody. For some people, withdrawal symptoms can make quitting hard or frustrating.
WITHDRAWAL describes the physical and mental symptoms that a person has when they stop or cut back the use of an addictive substance
Common Nicotine Withdrawal Symptoms
Having urges or cravings to smoke Feeling irritated, upset, or down Feeling jumpy, restless, or anxious Having a hard time concentrating Having trouble sleeping Feeling hungrier or gaining weight Feeling anxious, sad, or depressed
Strategies to Help: Ask for help from a doctor or health professional Drink plenty of water throughout the day Keep a consistent sleep schedule Eat healthy snacks if hunger increases Get support from friends and families Be prepared for cravings
You may start experiencing cravings to use nicotine within an hour or two after your last use, and you may have them frequently for the next few days or weeks.
Chewing on sugarless gum, sucking on hard candy, munching on raw carrots, or eating a handful of sunflower seeds can help avoid nicotine use during a craving.
The uncomfortable feelings of withdrawal will fade over time if you avoid using vapes/cigarettes.
As your body adjusts to life without nicotine, you may have mood swings or feel increased anxiety or sadness. If you become depressed or are having extreme sadness, do not ignore these feelings or keep them to yourself. Let someone who cares about you know how you are feeling, and talk to a doctor or another trusted healthcare professional. If you are in an emergency situation call 911.
Support Network When you are quitting nicotine or any addictive substance it is helpful to have a supportive network. Confiding in a friend or family member can help keep you accountable on your journey to living substance free.
To enroll in This is Quitting text DITCHVAPE to 88709. Are you a parent of a young person who vapes? Parents can text QUIT to 847-278-9715 to sign up to receive text messages designed specifically for parents of kids who vape.
Narcan (Naloxone) References: National Institute on Drug Abuse
What is Narcan?: Narcan is a medicine that is used to reverse the effects of an opioid overdose. Narcan is an opioid antagonist, meaning it pops the opioids off the brain’s opioid receptors, displacing the opioids in the brain, taking its place.
Narcan only responds to opioids, some common examples include: hydrocodone (Vicodin®) oxycodone (OxyContin®, Percocet®) heroin fentanyl
How to respond to an opioid overdose: Check for signs of an overdose Stimulate the person (name call/sternal rub) Call 911 If unresponsive give two rescue breaths if you are comfortable doing so Administer Narcan Continue rescue breathing and stay with the person until help arrives. Place person in recovery position if you need to leave.
SIGNS OF AN OPIOID OVERDOSE: Narcan is used to respond to an opioid overdose
-Slow, shallow or no breathing -Unconscious and unresponsive -Pale, blue or gray skin -Snoring or gurgling noises -Will not respond when stimulated
Administering Narcan: Spray the container up one nostril and continue rescue breathing. Look for improved signs of life: Person breathes Person’s color improves Person becomes conscious It will take 2-3 minutes for the Narcan to have an effect. Continue rescue breathing. If there is no response after 3-5 minutes, give another dose of Narcan. Repeat if necessary.
IMPORTANT INFORMATION TO KNOW: Narcan has limited to no negative side effects and has no potential for abuse Narcan will have no effect on someone who does not have opioids in their system After 30-90 minutes the opioids can re-engage in the receptors and a person can re-overdose (call 911 first) Narcan should be stored in a cool dry place and you should be aware that naloxone has an expiration date Fentanyl is showing up in other drugs such as cocaine/pills etc.- it is important for anyone who uses drugs to have Narcan If you are interested in getting your own Narcan free of cost, connect with local Community Narcan Programs: Plymouth County Outreach 774-434-5072 | Plymouth COPE 508-591-3870 Plymouth Recovery Center 774-776-3515 | PCO Hope 385 Court St. Unit 101
Xylazine References:The Commonwealth of Massachusetts
What is Xylazine?: Xylazine, also known as “tranq” is a long-acting, sedative medication that is not an opioid. Xylazine is used as a veterinary sedative that is not approved for use in humans.
On the street, it appears as a brown or white powder and is increasingly being found in combination with opioids such as fentanyl and heroin, or cocaine.
Effects of Xylazine: Unresponsiveness/decreased consciousness Low blood sugar Low blood pressure Slowed heart rate Reduced breathing
Massachusetts is seeing an increase of Xylazine in the local drug supply.
Drug suppliers will add xylazine to extend the effects of fentanyl or other substances. In many cases, people are not aware that xylazine is in the drugs they are buying and using.
Because Xylazine is often found in combination with other sedative drugs like opioids, there is an increased risk for overdose or death.
Xylazine use may cause skin and soft tissue wounds. These wounds tend to be on legs and arms, sometimes away from the site of injection, and appear to worsen more quickly than other skin wounds.
WHAT TO DO IF YOU SUSPECT A XYLAZINE OVERDOSE: Administer naloxone & begin rescue breathing if you are comfortable doing so While naloxone will not reverse the effects of Xylazine, it is able to reverse the effects of the opioids it is mixed with and should still be administered Be aware: patients experiencing Xylazine-related overdose may not immediately respond to naloxone administration - you should call 911 as soon as possible Scan here for more information on Xylazine
Talking with Adolescents: Substance Use There is a lot to remember when you're talking to your middle or high school aged students around using substances. Although this conversation can feel overwhelming, here are some tips and tricks from Harvard Medical School's Health Blog:
We may want our children to be abstinent, but what do we do if they are not?
Make Your Values and Your Expectations Clear Stay "In the Know" around Substance Use & Current Trends
While caregivers can and should communicate clearly that non-use is the best decision for the developing youth brain and overall health, it is nearly impossible to control every aspect of young people’s lives. There is no one-size-fits-all approach to successful discussions with teens around substance use, but these tips may be helpful:
Conversations around substance use should happen early and often. Using phrases like “be smart” or “make good decisions" leaves room for misinterpretation. Try your best to be specific in your expectations: Ex: “You can go out with your friends tonight, but I do not want you using drugs or alcohol." Trends around substance use are constantly changing and evolving. Staying current can help you to identify substance use. In addition, knowledge around substance use can spark preventative conversations with adolescents and create a more clear explanation around why you're concerned.
Ask & Listen, but Resist the Urge to Lecture
As adults we sometimes want to deliver wisdom based on our own experiences. However, teens who feel like their point of view is valued may be more willing to engage in a conversation. Consider asking a question like, “Tell me, what do you know about marijuana?” For more information, research "active listening" .
If Your Child Has Used Substances, Try to Explore the "Why"
Teens may use substances to help manage anxiety, relieve stress, distract from unpleasant emotions, or connect socially with peers. Being curious about those reasons can help them feel less judged. It may also give you a window into your teen’s underlying struggles, help them develop insight into their own behavior, and point to problems that may need professional support.
Know How and When to Intervene
There are many signs that may indicate a young person is using a substance. These may include recognizing drug paraphernalia, noticing emotional distancing, or a general decrease in old interests or personal appearance. It is important to connect your child to professional treatment when appropriate. A pediatrician can be a great starting point for this information.
Resources: Harvard Health Publishing | Harvard Medical School
Talking with Adolescents: Substance Use What's Their Why?
Adolescence can be a time of living in the moment, and (due to a developing brain) there isn't much consideration around the consequences that may follow. Although it might be hard, take a moment to reserve judgment and understand the why behind drug/alcohol use. If you are able to better understand the dynamics behind use, the closer you will be to a solution.
From a young age, youth are exposed to substance use in a variety of ways. This may include watching friends or family members use recreationally or through the media.
Misinformation: Youth may get their education around a substance from an unreliable source. They may be assured by this individual that the risks are minimal. This is why it is so vital for parents and guardians as well as other caring adults to have this conversation with youth early and often.
This might sound like youth saying they use:
"To Feel Good"
To get high For a thrill/excitement Instant gratification
To celebrate To make friends/fit in
This might sound like youth saying they use:
"To Feel Better"
"To Do Better"
To avoid boredom Due to lack of confidence Because of peer pressure Due to stress Due to loss/grief
To cope with mental health issues (anxiety, depression etc.) Adverse Childhood Experience (ACES)
This might sound like youth saying they use: As a study aid As "liquid courage" As an athletic performance enhancers
Regardless of the "why" behind use, there is always hope for a healthy future.
Talking with Adolescents: Substance Use What They Have to Say
Our coalition teamed up with High Point Prevention Services to conduct focus groups with high school aged students. They were asked questions focused on substance use prevention efforts and what they feel is most effective with adolescents. This resource reflects the feedback that they provided.
have the conversation
keep it "real"
Many youth find it hard to remember moments when adults had conversations with them about the negative consequences of using substances. If they did have any memory of these conversations, they were before middle school. These conversations should happen frequently and on an ongoing basis.
Youth can quickly determine if an adult is being authentic and genuine with them. Being honest and direct with youth during conversations can make a big difference. Be transparent about the impact substance use can have on your brain and body.
no one explains why we should "just say no"
it's helpful if the person has lived experience
It's not helpful to hear a simple "don't do it (drugs/alcohol)" without someone explaining why. Learning about the impact of substance use, including long term consequences, is important to include in prevention messaging.
Youth value hearing personal stories from people in long term recovery from substance use disorder. In addition, the more individualized you can make this discussion to the group you're addressing, the stronger the message will be.
less slides, more conversation Substance use learning opportunities that are most impactful encourage conversation. It's important to give youth the platform to share their opinions and experiences. Youth find it helpful to use visuals such as video clips and images as well.
"talk to me like I am you" Deliver prevention messaging in the same way you would want to hear it. Language, tone, and timing are key; resist your urge to lecture. If a young person feels as though an adult is "condescending" during this conversation, they are less likely to hear what that person has to say.
"Kids don't care how much you know until they know how much you care."
ENGAGE, CONNECT, & EMPOWER TO ADDRESS SUBSTANCE USE.
@ PLYMOUTH AREA PREVENTION COLLABORATIVE @CARVER CARES @MIDDLEBORO MATTERS
@PLYMOUTH_AREA_PREVENTION @WAREHAMCONNECTS @PYDCPLYMOUTH
@WAREHAM CONNECTS @PYDC PLYMOUTH
WWW.OPIOIDOVERDOSEPREVENTION.ORG
email: plymouthareaprevention@gmail.com