Drug abuse in adolescents

& many other things

Scenario
• A distraught mother sees you regarding her 16 year old daughter . Since the
beginning of the year, she noticed a change in the daughter behaviour. She ( the
daughter) has a small groups of friend that she likes to hang with , and she has
been staying out late with them. Her mother has confronted her daughter about
whether or not she is using controlled substances and her daughter response has
been anger and refusal to discuss this further.
• 1. What do you think about this mothers worries
• 2. Discuss your concerns
• 3. How will you manage this
1. What do you think about this mothers worries
• Multi level question – need to answer on several
layers
• Need to answer
1a. Patient comes in with someone else’s problem , what to do?
1b. The medical aspects of someone else problem, what to do?
1c. Patient obviously has a problem with someone else’s
problem, what to do?
1a. Worried about someone else problem
• Patient comes to you with someone else’s medical problem.
• Commonly seen in general practice in …..
• Adolescents
• Elderly
• Mental ill
• How to deal with this ?
• Ideas, concern and expectations interaction.
• Listen to the story, try to elicit the symptoms, summarise for them the red flags, tell
them what the ddx might be, name their emotions and so on….
• Need real patient to come in eventually
1b. Medical aspect of someone’s else problem
• Usage of controlled substances
• Mostly commonly abused controlled substance in Singapore are …..
• methamphetamine, cannabis and heroin.
• new psychoactive Substances (NPS) and inhalants added recently
• Spice, K2, Bath Salts, Kronic, Bromo-Dragonfly mephedrone , BZP and TMPP
• Behaviour change
• Organic in nature ?
• Adolescents who have untreated major depressive disorders, ADHD, or schizophrenia,
for example, may use mood-altering substances to treat unpleasant feelings of dysphoria
and low self-esteem
• Other cases of behaviour change?
• Unhealthy family relationships
• Lack of communication, care & concern, no meaningful family time
• Lack of role models
• Parents own questionable behaviour
1c. Mother’s problem with someone’s problem
• Mother is concerned enough to care.
• What is the cause?
• What can she do?
• Cause
• Likely multifactorial
Causes
• Why do teenagers use controlled substances
• Self
• Underdeveloped brain, underlying mental illness
• Early aggressive behaviour, reliving stress/painful emotions, curiosity
• Poor social coping skills
• Family
• Unhealthy family relationships, ineffective parenting
• Lack of role models ( caregiver commit crimes , addiction ), or mental illness.
• Society
• Peer influence ( a.k.a 猪朋狗友) who use drugs,
• Early peer rejection,
• Perception that drug taking is common and acceptable
• Often multifactorial
Your concerns / How to manage
• You have 2 patients now
• The mother and potentially the daughter
• Mother
• ICE/ ICE interactions - therapeutic
• Important to let mother know the possible causes
• Therapeutic / Screening / education
• Support groups – BRIDGE family under NAMS
• Daughter
• Will be good if she can come in.
• CRAFFT screening interview – probability is abusing drugs
• DAST –A ( drug abuse screening test – adolescent ) for severity
For the Mother
• Bridge family
• To help you understand about addiction treatment and to develop coping skills to improve your
well-being while supporting you on how to manage the addicted person.
• How to guide your loved one into treatment, to remain in treatment and continue treatment
using effective communications and methods

• Useful hotlines
For the daughter : CRAFF