Teen Drug Abuse - Prescription Term Paper

Pages: 16 (5056 words)  ·  Bibliography Sources: 8  ·  File: .docx  ·  Level: College Senior  ·  Topic: Sports - Drugs

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g., social class, ethnic and religious influences, neighborhood values); family and peer (e.g., personalities and interaction patterns of parents and peers, child-rearing patterns, peer socialization, and parental/peer modeling of alcohol use); and intra-individual (e.g., genetic predispositions, cognitive and personality variables) (Morrison, et al. 2007). Drinking is seen as influenced directly only by intra-individual factors. These in turn are influenced by the social variables (directly through intimate groups and both indirectly and directly by the sociocultural and community environment). Conversely, drinking behavior is expected to influence intra-individual attributes, which will in turn influence other domains.

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When considering a model for adolescent substance abuse, it is important to incorporate differential effects of factors in relation to the developmental stage of the adolescent. The relative contribution of factors included in interactions and theories vary as youth progress through adolescence and into young adulthood. For example, peer group influences are more important in adolescence than during childhood, whereas parental influences may become increasingly indirect. Similarly, personality characteristics and drug effect expectancies may become more stable with increasing experience with evolving social roles and may consequently have a greater impact on substance abuse during later adolescence. Also, experimentation with substances may markedly alter (expand or contract) opportunities to gain experience with the diverse new roles and tasks unfolding over the course of adolescence.

Abuse and Dependence Concepts

TOPIC: Term Paper on Teen Drug Abuse - Prescription Assignment

Any substance that alters mood, perception, or brain functioning might be considered a drug of abuse (Johnston, et al. 2006). Generally, abused drugs are self-administered to produce a change in affective state or consciousness. All abused substances can lead to psychological dependence, in which the user experiences the subjective feeling of needing the drug to adequately function or to maintain a sense of well-being. Extended use of some drugs can lead to physical dependence, with physiological adaptation to the drug's presence. One aspect of this physical dependence is tolerance: as nervous system cells adapt to the presence of a drug, higher and higher doses of the drug are required to achieve the same effect. Drugs of the same class (based on predominant nervous system effects) usually show cross-tolerance such that if tolerance to a particular drug has developed, it will be evident when another drug of the same class is administered. However, the picture is different if the two drugs are administered at the same time. In this case, the drugs potentiate each other. This is an important concern, as teens frequently use several drugs in concert (Grant, et al., 2005) and such use can and does lead to unintentional overdose and death.

Another important aspect of physical dependence is withdrawal, in which physical symptoms appear when a drug is abruptly removed from the body. There are characteristic symptoms of withdrawal for each drug class. Although the withdrawal syndrome may be less prevalent than among adults (Johnston, et al. 2006), withdrawal symptoms are common (Morrison, et al. 2007). Affective and cognitive features, rather than physiological symptoms, predominate among adolescents during acute withdrawal from multiple substances. Therefore, the clinician should not rely on signs of physical dependence in assessing adolescent drug abuse or dependence.

Isolated instances of adolescent alcohol or drug use do not necessarily imply abuse or dependence. The DSM-IV (Drug Enforcement Administration, 2005) identifies the following problems as indicative of substance dependence: marked tolerance, characteristic withdrawal symptoms, substance use to avoid or relieve withdrawal symptoms, taking the drug in large amounts or over longer periods than intended, desire and/or unsuccessful efforts to cut down on use, a great deal of time spent obtaining, using, and recovering from the substance, giving up or reducing important activities because of substance use, and continued use despite knowledge of problems.

DSM-III-R (Morrison, et al. 2007) criteria for dependence involved possessing any three of the above symptoms persistent over a month long. DSM-IV has changed this to three or more problems occurring at any time in the same 12-month period. The more general diagnosis of substance abuse indicates a maladaptive pattern of use, including continued use despite knowledge of problems or recurrent use in dangerous situations.

Such categorical distinctions are useful, though the DSM-IV criteria are based on adult symptoms. Recent studies of DSM-IV abuse and dependence criteria among adolescents suggest a stage or sequence model at the development of substance dependence (Worden & Slater, 2009). Further, because youth experiencing alcohol and/or drug related problems who are entering treatment do not uniformly meet criteria for DSM-IV abuse or dependence diagnosis, an alternative diagnostic structure ultimately may be advantageous for youth. Examination of contingencies and the topography of substance involvement and typical negative consequences may be more useful in the evaluation process of substance-abusing teens. For example, the nature of the responsibilities of adolescents varies from that of adults, and many manage to avoid drug-related interference with activities typically to diagnose adults. On the other hand, even socially acceptable substance use by adults (e.g., social drinking) is illegal for adolescents, and a gradual deterioration in performance and participation in school are common consequences of involvement. A careful consideration of drug use and its impact (e.g., on school, family, emotional and social functioning) is called for.

Although there are no pathognomonic symptoms of drug use or abuse, clinicians are often asked to help parents or responsible institutions assess potential drug problems among adolescents. In general, increasing the knowledge of authorities with regard to symptoms of intoxication, withdrawal, and abuse/dependence for commonly used drugs is the first step in this process. The second step is to identify abnormal behaviors and their time course that give rise to concern for the youth. Because drug abuse may produce psychiatric symptoms (e.g., depression, anxiety, mania, delusions, and paranoia), drug problems are often misdiagnosed as psychiatric disorders. Abrupt symptom onset and marked alterations in symptoms (e.g., mood extremes) suggest that drug use may be involved.

The following section summarizes effects of the predominant substances of abuse for youth. Several cautionary notes are in order, however. As previously noted, physiological withdrawal symptoms are less pronounced among adolescents. Most street drugs are not pure and a portion do not contain the supposed major substance (Drug Enforcement Administration, 2005). Also, physical and behavioral effects of a drug can vary a great deal with factors such as health, length of use, dose, and environment. Finally, adolescent drug abusers commonly use more than one substance, thereby complicating the clinical picture.

Counseling and Treatments via Prescription

For many years following the findings of the DoH, American doctors could prescribe all manner of substances to those addicted to drugs with virtual impunity. Indeed, the first controls on the prescribing behavior of doctors only came into force during the 1960s due, in the main, to the over-prescription of heroin, leading to large quantities of licit drugs being diverted into the illicit drug market. While this legislation may have curbed the autonomy of some doctors, it was not a serious problem for the majority, due to the fact that during the 1960s and into the early 1970s the numbers of problematic drug users were relatively small, and those being treated were often referred to specialist services. This meant that the vast majority of doctors, especially general practitioners (GPs), rarely, if ever, saw a drug addict. The outcome of this scenario was that the issues of how, when and why to prescribe for drug addicts never became a pressing question for the majority of doctors.

However, as has been documented (Ajzen, 2010), the number of problematic drug users 'surged' during the late 1970s and into the 1980s, leading to the then DHSS encouraging GPs to become more involved with problematic drug users. Clearly, this placed GPs in a predicament, as many of them had never been asked to deal with a group that some see as 'problem patients' and, perhaps crucially, at that time too few medical undergraduates had received even basic education in treating problematic drug users (Centers for Disease Control and Prevention, 2006). As a result, many GPs were left isolated and lacking advice or direction. Those who would accept drug addicts as patients were sometimes inundated with addicts, all demanding treatment. Some GPs quickly became disillusioned; many made injudicious prescribing policies; many more simply retreated behind long-held prejudices (Johnston, et al. 2006).

Given the rise in recreational drug culture and a concomitant growth in problematic use, this situation could not be allowed to continue. This was recognized in the DHSS (1982) report Treatment and Rehabilitation. In turn, two years later the DHSS published Guidelines of Good Clinical Practice in the Treatment of Drug Misuse (Worden & Slater, 2009). These were updated and renamed in 1991, appearing as Drug Misuse and Dependence: Guidelines on Clinical Management (Morrison, et al. 2007) and were again up-dated in 1999. It is to the 1999 document that attention now turns.

The DoH guidelines

Robertson (2008:325) emphasizes the importance of the 2006 revisions and notes their timeliness, claiming that there was a real and pressing need for the 1999 review owing to the fact that with [t]he demise of the… [END OF PREVIEW] . . . READ MORE

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