10. Substance use across the lifespan Flashcards
What percentage of women drink alcohol during pregnancy?
42%
What can 2-6 year olds not distinguish between?
advertising and information
What percentage of children aged between 4 and 5.5 can recognise alcoholic products?
around 50%
what percentage of parents confessed to tranquilizing their children with sedative drugs?
18%
what percentage of child mistreatment cases involve alcohol?
30-70%
in 2008 how many children were harmed by other people’s drinking?
over 140 000
what is the prevalence of alcohol and drug use in 11-17 year olds?
30% reported drinking in last 12 months
2.6% drinking at risky levels
4.2% of 12-14 year olds using illicit drugs
17.1% of 15-17 year olds using illicit drugs
94% teenagers in Aus seen alcohol advertisements on tv and in print and online
what does drinking contribute to in adolescents?
It contributes to the leading causes of death amongst adolescents- unintention injuries, homicide and suicide
which age group is most likely to have recently used illicit drugs?
18-30 year olds
what age group is most likely to drink at harmful levels on single occasion?
18-24 years
who are more likely to drink 11 or more standard drinks?
late teens and 20s
what percentage of Vic drivers were caught drink driving in late 20s?
almost a third
which age groups is most prevalent to drink at lifetime risky levels?
people in their 40s
who percentage of 30-50 year olds drink lifetime risky levels?
almost 1 in 3
what percentage of Vics caught drink driving between 30 and 50 years old?
52%
what is the prevalence of illicit drugs in unemployed people?
- 6 times more likely to use cannabis
- 4 times more likely to use meth/amphetamines
- 6 times more likely to use ecstasy than employed
how many police-reported incidents of alcohol related domestic violence in Aus?
approx 30 000
what are the a&d issues that impact 0-5 year olds?
FASD
ADD breastmilk
Poisoning
What are the risk factors for a&d issues for 0-5 YOs?
family violence
neglect
single families
who are the influences for a&d for 0-5 year olds?
parents
who are the influences of a&d issues for 6-10 YOs?
parents
teachers
what are the a&d issues that impact 6-10 year olds?
awareness of alcohol
what are the a&d risk factors that impact 6-10 year olds?
advertising
parental use of drugs
family relationships
isolation
who are the influences of a&d issues for 11-17 year olds?
coaches peers teachers parents grandparents siblings
what are the a&d issues that impact 11-17 year olds?
risky driving
steroid use
tobacco
analgesics
what are the a&d risk factors that impact 11-17 year olds?
isolation family relationships leaving school advertising parental use of drugs mental health
who are the influences of a&d issues for 18-30 year olds?
siblings peers coaches parents grandparents
what are the a&d issues that impact 18-30 year olds?
experimental drug use
drink driving
risky drinking
what are the a&d risk factors that impact 18-30 year olds?
unemployment isolation family relationships leaving school advertising parental drug use mental health
who are the influences of a&d issues for 30+ year olds?
peers
employers
GPs
what are the a&d issues that impact 30+ year olds?
alcohol and pregnancy
addiction
risky drinking
drink driving
what are the a&d risk factors that impact 30+ year olds?
trauma family violence family relationships advertising mental health
who are the influences of a&d issues for 50-60 year olds?
peers
GPs
Family
what are the a&d issues that impact 50-60 year olds?
risky drinking
drink driving
cannabis use
what are the a&d risk factors that impact 50-60year olds?
trauma family violence family relationships advertising mental health unemployment
who are the influences of a&d issues for 60-70 year olds?
Peers
GPs
what are the a&d issues that impact 60-70 year olds?
poly drug use
drink driving
risky driving
what are the a&d risk factors that impact 60-70 year olds?
chronic diseases pain management pharmaceutical misuse disease elder abuse
who are the influences of a&d issues for 70+ year olds?
GPs
Carers
what are the a&d issues that impact 70+ year olds?
poly drug use
what are the a&d risk factors that impact 70+ year olds?
pharmaceutical misuse
disease
pain management
elder abuse
What are the major domains of developmental transition influencing drug use and physical and mental health conditions?
biological and cognitive
identity and relationships
achievement and responsibility
for adolescents, what are the biological and cognitive influences on substance use and physical and mental health conditions?
pubertal development/hormonal changes - physical appearance begins to look more adult-like
Axon myelination and synaptic pruning - increased ability to perform executive functioning tasks
what are executive functioning tasks?
ability to think abstractly and decision making
for adolescents, what are the identity and relationships influences on substance use and physical and mental health conditions?
increased autonomy from family - less parental control and more independence (driving, moving out)
greater influence from peer groups
increased interest and involvement in sexual and romantic relationships
increased awareness and adherence to gender roles and norms
for adolescents, what are the achievement and responsibility influences on substance use and physical and mental health conditions?
increased personal responsibility in school (less individualised instructor attention in high school and uni)
increased financial autonomy - part-time job, paying some bills
for adults, what are the biological and cognitive influences on substance use and physical and mental health conditions?
sexual maturation and greater hormonal stability
neurocognitive brain maturation, specifically prefrontal cortex - optimal organisation and regulation of cognition and goal-directed behaviour
for adults, what are the identity and relationship influences on substance use and physical and mental health conditions?
greater stability in romantic relationship - marriage
formation and commitment to one’s own family
legal maturity - social decisions based on one’s own beliefs and values rather than legal restriction
for adults, what are the achievement and responsibility influences on substance use and physical and mental health conditions?
full-time work with financial independence and responsibility
intergenerational responsibility - parenting children while caring for ageing parents
for older adults, what are the biological and cognitive influences on substance use and physical and mental health conditions?
hormonal decline leading to decreased reproductive capabilities
decrease in neurocognitive functioning in speed processing and working memory
for older adults, what are the relationship and identity influences on substance use and physical and mental health conditions?
decreased autonomy due to physical and/or cognitive limitations
lessened connection to extended family (e.g. death of spouse and other family members, children move out)
for older adults, what are the achievement and responsibility influences on substance use and physical and mental health conditions?
reduced employment or retirement - increased financial restrictions and fixed income
increased reliance on public assistance
How did Socrates define adolescence?
• “The children now love luxury; they have bad manners, contempt for authority; they show disrespect for elders and love chatter in place of exercise. Children are now tyrants, not the servants of their households. They no longer rise when elders enter the room. They contradict their parents, chatter before company, gobble up dainties at the table, cross their legs, and tyrannize their teachers”.
in adolescence, what are the developmental issues?
puberty
independence
autonomy
social roles
what can influence risk and use levels in adolescence in regarding puberty?
negative affect
sexual activity
neurocognitve skills
what can influence risk and use levels in adolescence in regarding independence?
drivers license
moving out
what can influence risk and use levels in adolescence in regarding autonomy?
financial independence
transition to college
what can influence risk and use levels in adolescence in regarding social roles?
marital status
parenthood
why is there such a focus on adolescence with regards to a&d?
- Adolescence is the most common time for onset of substance use
- Risk taking feature during adolescence
- Use in adolescence mediates use on adulthood
- Adolescent Tx approaches rely on adult Tx approaches
- Use in adolescence mediates use on adulthood
Although adolescent Tx approaches rely on adult Tx approaches, what must be taken into account?
o adolescent drug misuse is different from adult drug misuse
o patterns of use
o assessment
o anticipated effects and consequences of substance use
what does Tx mean?
treatment
how does use in adolescents mediate use in adulthood?
o Adolescent Tx approaches rely on adult Tx approaches social and emotional contexts of use
o risk factors contributing to the onset
o trajectory
o level of skill, experience and realities
what are the sources of prevalence of a&d in adolescents?
- National Drug Strategy Household Survey
- Australian Secondary Schools Students Use of Alcohol in 2005, 2011, 2016
- Australian Secondary School Students Use of Over-the-Counter and Illicit Substances in 2005, 2011 & 2016
when is the initiation of tobacco in adolescents?
14.9
when does regular smoking begin?
16 -19 yrs ~ rare 20+
what is the prevalence of tobacco use among female adolescents?
o More have ‘ever smoked’
o Initiation at earlier age
o more likely to continue smoking
what predicts future smoking behaviour in secondary school students?
intention to smoke
what are the major determinants of tobacco use among adolescents?
o social factors (peer/parent smoking) and
o emotional problems (anxiety, depression)
o rather than an addiction to nicotine
which gender smoked more in the past year in 2ndary school?
females
what is the trend of tobacco use in the past year with age?
increases with age
which gender smoked tobacco in the past seven days in secondary schoolers?
females from 14-15 years
males from 16-17 years
which gender smoked more than 100 cigarettes in their lifetime in secondary schoolers?
12-13 years - males
14-15 years - females
16-17 years - males (by a significant number)
what is the trend in 12-15 year olds who had smoked in the past week between 1984 and 2014?
decreased from 20% but increased in 190s until 1996, and decreased until 2014
what is the trend in 16-17 year olds who had smoked in the past week between 1984 and 2014?
decreased from 30% until 1990 then increased until 1999 and then decreased rapidly until 2008 then slight increased in 2011 and then decrease
what rapidly increases the level of risk of alcohol related harm?
age
what is the lifetime use of alcohol by age 19?
60%
how do majority of adolescents use alcohol?
infrequently - binge or risky for short-term harms
which gender in adolescents drink at greater levels of risk?
females
who tends to drink more frequently on a weekly basis in adolescents?
males
what do younger adolescents prefer to drink?
spirits
what do older males prefer to drink?
beer
what do older females prefer to drink?
wine
what contributes to alcohol risks in adolescents?
low awareness/understanding of harms associated with excessive alcohol use
what sort of harm do adolescents face as a result of alcohol consumption?
short term harms - hangovers, amnesia
what percentage of adolescents report alcohol aggression or sexual risk taking?
20%
what is the trend in lifetime use of alcohol in Aus secondary school student from 1999-2014?
slight decrease
in 2014 which gender had higher lifetime alcohol use in secondary school?
females
what is the trend of secondary schoolers that have never consumed alcohol between 1999-2014?
from approx 10% and increased to 32%
which gender is more likely to have consumed alcohol in the past month in secondary school?
females
when does secondary students drinking status begin to change?
in grade 10
what are the drinking statuses?
non-drinkers
moderate drinkers
risky drinkers
which drinking status is most prevalent in year 11 and 12?
risky drinkers
which drinking status is least prevalent in year 11 and 12
non-drinkers
which gender in secondary school is more likely to be a singly occasion risky drinker?
males
which drink type is most commonly consumed by all ages and genders?
premixed spirits
what is the second most commonly consumed drink by male adolescents?
beer
what is the least consumed drink in adolescents?
alcoholic energy drink
which gender/age is mostly intends to get drink most times/every time they drink?
16-17 yo males
what is the main negative outcome experienced by current drinkers after drinking alcohol in the past 12 months for 12-17 year old females?
tried smoking and vomited
what is the main negative outcome experienced by current drinkers after drinking alcohol in the past 12 months for 12-17 year old males?
vomited
what is the most common negative outcome experienced by current drinkers after drinking alcohol in the past 12 months for 12-17 year olds?
vomiting
what analgesics substances were reported to be extremely highly used in students?
Disprin, Panadol or Nurofen
what percentage of students had never used Disprin, Panadol or Nurofen ?
5%
what fraction of students had used analgesics in the past month?
2/3
what is the main reason for analgesic use in students?
help ease the pain associated with a headache/migraine (52%).
who was the main source of anaglesics for students?
parents
at all ages, which gender is more likley to use analgesics in their lifetime?
females
which age/gender used analgesics 10 times or more in the past year the most?
17 year old females
what is the most common reason to use analgesic?
headache/migraine
what is the most commonly used illicit drug?
cannabis
what percentage of students aged 12-17 use cannabis sometime in their life?
16%
what percentage of 12 and 17 year olds have reported using cannabis in their lifetime and what does this imply?
4% of 12-year-olds and 31% of 17-year-olds
The proportion of use increased with age
what is the age of initiation of cannabis use?
15 (20+ = 19 years)
what are heavy cannabis users more likely to experience?
a range of difficulties: Hazardous situations; Legal, social, interpersonal; LT cognitive impairment (Ashton 2002); Respiratory side effects (Hall 1998); Precipitation to psychosis (Hall and Degenhardt 2000); Depression
what percentage of regular users of cannabis develop dependence in adulthood?
approx 10%
which gender in adolescents is more likely to use cannabis?
males
what is the prevalence of inhalant use with respect to age?
Inhalant use was related to age – with use decreasing significantly from the youngest to the oldest students – 19% of 12-year-old students had ever used and 10% for those aged 17 years
which gender used inhalants more between 12-15 yo?
females
which gender used inhalants more in 15 yo?
males
what was the commonality of use of other illicit drugs apart from cannabis in adolescents?
uncommon
what did ecstacy replace as the second most used illicit substance in adolescents?
hallucinogens (LSD, acid, trips, magic mushrooms, datura, angel’s trumpet)
what percentage of 12-17 year olds have used ecstacy in their life time?
3%
what is the trend of the age of initiation for tobacco?
slightly increasing from 1998-2010
what is the trend of the age of initiation for alcohol?
17 in 1995 then dropped to 13.5 in 1998 and slowly increased until 2010
what is the trend of the age of initiation for cannabis?
16yo in 1995 slight decrease until 2001 and slight increase until 2010
what is the age of initiation for cocaine in 2010?
just above 19
what is the age of initiation for hallucinogens? for cocaine in 2010?
18.5
what is the trend for age of initiation for hallucenogens between 1995-2010?
slight decrease until 2001 then major increase until 2010
what is the age of initiation for ecstacy and meth in 2010?
18
what are the \ risk factors for substance use in secondary school?
low involvement in activities with adults
perceived high level of community drug use
community disadvantage and disorganisation
availability of drugs
positive media portrayals of drug use
parental
not completing school
peers who use drugs
delinquency
sensation seeking and adventurous personality
favourable attitude towards drug use
what are the parental risk factors for a&d use in secondary schoolers?
adolescent conflict
favourable attitudes to drug use
parental a&d problems
parental rules permitting drug use
what are he protective factors for a&d use in secondary schoolers?
attachment to family
low parental conflict
parental communication and monitoring
religious involvement
what is the impact of substance abuse on psychological development?
it interferes with the ideal trend of developmental potential. Rather than an ideal linear increase in developmental potential, substance abuse causes the developmental potential to plateau at the age of 15
how does alcohol produce its effects?
by altering actions of neurotransmitters.
o modifies actions of two major neurotransmitters – GABA and glutamate
o these found throughout the brain – hence alcohol has widespread effects on behaviour – i.e., intoxication
which parts of the brain does alcohol have a greater effect on?
greater effect on developing areas of the brain, compared to those fully developed – evidence suggests that the damage could be permanent
which areas of the brain does alcohol affect that undergoes major changes in adolescents?
hippocampus and the prefrontal area with the Hippocampus suffering the worst damage
what does the hippocampus deal with?
memory and learning
which area of the brain undergoes the most change during adolescents?
prefrontal area
how could teen drinking impact the prefrontal area of the brain?
drinking could cause severe changes, affecting the formation of adult personality and behaviour
who are way more likely to experience complete absence of memory with no possible retrieval after alcohol consumption and why?
young people due to effects of high alcohol concentrations on brain centres related to memory (particularly the hippocampus
why are young people able to drink for longer than adults?
due to adolescents being less susceptible to sedation effects.
why are adolescents less susceptible to the sedation effects of alcohol?
o brain mechanism of this effect not known, likely that it has to do with GABA
o GABA system implicated in alcohol’s sedative and motor-impairing effects
o final levels of GABA receptors are not reached until early adulthood - adolescents have fewer GABA receptors on which alcohol can act
o reach a certain age (i.e., early 20s), you just can’t quite drink the way you used to
what is the treatment for alcohol abuse in adolescents?
it is dual focus:
- immediate issue
- development of insight into functions of drug use, personal strengths and new ways of coping
what are treatment methods of alcohol abuse for adolescents?
- Engagement & development of a therapeutic relationship
- Comprehensive biopsychosocial assessment
- A motivational and empowering approach
- Building protective factors & reducing risk factors
- Education about drug abuse, dependence & harm reduction
- Involving family & significant others
- Promoting and strengthening relationships with at least one positive adult
- Support experiential learning opportunities
- Optimising life choices and opportunities
- Consider use of medications
- Age-appropriate and accessible
- Ensuring safety
- Continuity of care and follow up
what are the services available for treatment for adolescents?
o Outpatient services - individual and family
o Day patient - groups
o Residential services - withdrawal, rehabilitation
what can use in adolescents predict?
use in adulthood
the earlier the initiation of drug use leads to….
higher use and more harmful alcohol use (Christchurch cohort)
what does taking any type of drug increase?
likelihood of taking another type of drug
what do structural equation approaches measuring poly drug use show ?
show that drug use at 13/14 is an unique and important predictor of drug use and adjustment problems at 21/22 and 25/26
what is a strong predictor of drug use in later life?
drug use in early life
what does the rate of drug use typically decline with?
age
when does morbidity and mortality associated with alcohol and tobacco use become common?
after age 50
wha are the definitional problems of misuse?
underuse, overuse, erratic use
what are the confounds of substance use in elderly?
o Definitional problems of misuse: underuse, overuse, erratic use
o Few studies have focused on elderly populations
o Inappropriate diagnostic criteria and screening tools
what is the major cause of drug-related mortality?
tobacco - 15 000 deaths per annum
which gender smokes more in elderly?
males, but difference is decreasing
who does tobacco related morbidity impact most and now?
impact on elderly men e.g. cancers and cardiovascular disease common after the age of 50
who has lower consumption of alcohol than the general population?
elderly
what percentage of people aged 60+ drink daily?
17%
what are light patterns of alcohol use?
protective - est prevented 5000 deaths per annum
who is harmful and hazardous use of alcohol more common in elderly?
males
what are the harms of alcohol use in the elderly?
Falls, diseases of the gastrointestinal, cardiovascular and central nervous systems
what is the prevalence of illicit drug use in elderly
low
what does illicit drug use in elderly include?
illegal drugs, prescriptions/over counter used for illicit purposes, ‘other’ used inappropriately
who have continued illicit drug use?
baby boomers - they have higher age-matched cohorts to previous generations
what does use of multiple prescription medications increase with?
age
what is the prevalence of prescription medication in elderly people?
3 times as frequent as general population with the use of over the counter medications being more extensive
what is the prevalence of pharmaceutical drug use among elderly people?
Proportion who reported using pharmaceuticals in the previous week or month was generally higher in the older age groups, with 1.5% of those aged 60 or older reporting using in the past week and 2.6% using in the past month
why are benzodiazepines frequently prescribed and who to?
to women for anxiety; depression; insomnia
what percentage of hospital admissions in the elderly related to?
medication problems
what is prescribed drug in elderly people related to?
considerable morbidity
what is a major cause of falls in elderly people?
Interaction with alcohol and other medications
what are the effects of ageing on substance misuse?
- Biological variables
- Gender
- Psychosocial variables
- Psychiatric co-morbidity
- “Maturing out” theory
what are the major risk factors of a&d use for older age people?
loneliness and reduced social support
continuation of high levels of non-problematic use
retirement - SES, sense of role, unrealistic expectations
negative life events
health
what are specific issues to check in elderly people who are thought to consume alcohol or other drugs?
o falls and accidents o nutritional adequacy o family problems and social isolation o medical problems o ability to attend to activities of daily living o fitness to drive a car o Poly-pharmacy
what are the best practice approaches to address the needs of older people with regards to a&d use?
- Early identification of issues in primary care settings
- Maintenance of social connections
- Promotion of community inclusion, positive environments and full and active lives
- Age appropriate treatment components
- Longer treatments
- Physically accessible services (hand rails, appropriate seating, transport etc)
- Outreach and home visits
- Workforce development to enable care for more complex co-morbidities.
what is a treatment consideration or strategy?
Avoid prescribing to help cope with stressful life events
o Explore other ways of managing stressful events
o Prescriptions used as a short-term strategy only
o Recommended to use only short-acting drugs (e.g., SSRI’s rather than benzodiazepines)
what is a common use of suicide for the elderly/
prescribed sedative drugs (with/without alcohol)
