February 20, 2004February 20, 2004

How to Talk Effectively to How to Talk Effectively to Youth at RiskYouth at Risk

Marvin KrankMarvin KrankPrincipal Investigator, Principal Investigator,

Project on Adolescent Trajectories and Project on Adolescent Trajectories and Health (PATH) Health (PATH)

Okanagan University CollegeOkanagan University College

Presentation OverviewPresentation Overview

•• Adolescence as a critical period of riskAdolescence as a critical period of risk•• How to approach youth about drugs and How to approach youth about drugs and

alcoholalcohol•• What you should talk aboutWhat you should talk about

Adolescence as a Window of Adolescence as a Window of RiskRisk

•• Grades 7Grades 7--9 are a time of increasing drugs 9 are a time of increasing drugs and alcohol use, sex and violenceand alcohol use, sex and violence

•• These risk activities are interdependentThese risk activities are interdependent–– Alcohol use predicts other drug useAlcohol use predicts other drug use–– Alcohol use is associated with sex and Alcohol use is associated with sex and

violenceviolence

Grades 7Grades 7--10 are a time of 10 are a time of significant transitions in alcohol usesignificant transitions in alcohol use

Ever Used Alcohol

0%10%20%30%40%50%60%70%80%90%

Seven Eight Nine Ten

Grade

Perc

ent

Male

Female

Intoxication is a big part of Intoxication is a big part of adolescent alcohol useadolescent alcohol use

Ever been drunk

0%10%

20%30%

40%50%

60%70%

Seven Eight Nine Ten

Grade

Perc

ent

Male

Female

Marijuana experimentation grows Marijuana experimentation grows during these years. These data are during these years. These data are consistent with national trends.consistent with national trends.

Ever used Marijuana

0%

10%

20%

30%

40%

50%

60%

Seven Eight Nine Ten

Grade

Per

cent

Male

Female

Other DrugsOther DrugsPercent of Students Ever UsedPercent of Students Ever Used

864545Stimulants

333515Opiates

454126Club Drugs

108813711Inhalants171471199Hallucinogens

10981098

FemaleMale

Hallucinogens are the most used illicit Hallucinogens are the most used illicit drug. Girls seem to be trying more drug. Girls seem to be trying more than the boys.than the boys.

Hallucinogens

0%

5%

10%

15%

20%

Seven Eight Nine Ten

Grade at time of survey

Prop

ortio

n

Male

Female

Female

A small, but significant, percentage of these A small, but significant, percentage of these youth used drugs and alcohol in the past youth used drugs and alcohol in the past weekweek

2%5%4%4%4%5%Inhalants3%3%3%2%2%4%Hallucinogens

20%17%7%20%13%7%Marijuana13%12%5%9%4%4%Cigarettes20%19%8%21%16%10%Drunkenness

29%25%18%36%33%20%AlcoholTenNineEightTenNineEight

FemaleMale

Drug and alcohol use are highly Drug and alcohol use are highly correlatedcorrelated

44.9%44.9%YesYes

2.8%2.8%NoNo

Percent used marijuanaPercent used marijuanaUsed alcoholUsed alcohol

Inducing change and reducing Inducing change and reducing harmharm•• A challenging time of riskA challenging time of risk•• How do we best prepare How do we best prepare

youth to face these risky youth to face these risky decisions?decisions?

•• How many Psychologists How many Psychologists does it take to change a does it take to change a light bulb?light bulb?

Motivational Interviewing:Motivational Interviewing:a contrasting view of a contrasting view of

preventionprevention

•• CollaborationCollaboration

•• EvocationEvocation

•• AutonomyAutonomy

Four General PrinciplesFour General PrinciplesMiller and Miller and RollnickRollnick (2002)(2002)

•• Express empathyExpress empathy–– Acceptance facilitates changeAcceptance facilitates change–– Listen firstListen first

•• Develop discrepancyDevelop discrepancy–– Youth generatedYouth generated–– Discrepancy between what they do and what they Discrepancy between what they do and what they

wantwant•• Roll with resistanceRoll with resistance

–– Avoid arguing Avoid arguing –– Resistance means changing directionsResistance means changing directions

•• Support selfSupport self--efficacyefficacy–– Support responsible decisionSupport responsible decision--makingmaking–– Youth must make the decisionYouth must make the decision

Some Traps to AvoidSome Traps to Avoid

•• Question Question -- Answer trapAnswer trap•• Taking sides Taking sides •• Expert trapExpert trap•• Labeling trapLabeling trap•• Blaming trapBlaming trap

Some Positive MethodsSome Positive Methods

•• Ask open questionsAsk open questions•• Give time for thoughtGive time for thought•• Listen reflectivelyListen reflectively•• Affirm responsesAffirm responses•• Summarize Summarize

These are designed to generate talk and These are designed to generate talk and thoughtthought

They pay attention to the They pay attention to the messenger: always tell the truthmessenger: always tell the truth““Despite the struggling, I got through my polio Despite the struggling, I got through my polio

shots, and now of course Ishots, and now of course I’’m glad I did. But the m glad I did. But the shots shots diddid hurt. The lesson that a lot of Boomers hurt. The lesson that a lot of Boomers learned from this experience was this: Grownlearned from this experience was this: Grown--ups, sometimes with the best intentions, will ups, sometimes with the best intentions, will look you right in the eye and lie. And they look you right in the eye and lie. And they hadnhadn’’t even t even startedstarted talking to us about drugs.talking to us about drugs.””

Dave Barry Turns 50Dave Barry Turns 50 (1998)(1998)

Be Positive, Not NegativeBe Positive, Not Negative

•• ““I am not a crookI am not a crook”” -- Richard Nixon (1972)Richard Nixon (1972)Thereby convincing us all that he was in fact Thereby convincing us all that he was in fact

a crook!a crook!

•• Our researchOur research tells us why we should not tells us why we should not give information about the myths of give information about the myths of alcoholalcohol or deny the positive effects of or deny the positive effects of drugs and alcohol. drugs and alcohol.

Summary: How to Approach Kids Summary: How to Approach Kids when Talking about Drugswhen Talking about Drugs

•• Listening firstListening first•• Four principlesFour principles

–– Be understanding and try to see things from their Be understanding and try to see things from their perspective perspective ““That must be difficultThat must be difficult””

–– Present facts contrary to what they might be told Present facts contrary to what they might be told ““Did Did you know that marijuana interferes with males sex you know that marijuana interferes with males sex hormoneshormones””

–– DonDon’’t confront or challenge, work around the issuet confront or challenge, work around the issue–– Be supportive and positive; itBe supportive and positive; it’’s your decisions your decision

•• Be positive, be prepared and tell the truth Be positive, be prepared and tell the truth ––www.nida.nih.govwww.nida.nih.gov, , www.ouc.bc.ca/pathwww.ouc.bc.ca/path

Age and Stage Age and Stage AppropriateAppropriate

Meet Individuals Where They Meet Individuals Where They AreAre•• NonNon--usersusers

•• ExperimentersExperimenters•• UsersUsers

•• Parents handoutsParents handouts

What Should You Talk What Should You Talk About?About?

•• Facts about how drugs workFacts about how drugs work•• Why people take drugsWhy people take drugs•• Some facts they should consider Some facts they should consider

when making decisions about using when making decisions about using drugsdrugs

•• Oh yes and try to make it fun!Oh yes and try to make it fun!

For example: What we are going to For example: What we are going to talk about today?talk about today?•• How drugs influence the How drugs influence the

body and brainbody and brain•• How they change the way How they change the way

we experience the world we experience the world around us and how we around us and how we feelfeel

•• Why people use themWhy people use them•• What you should know to What you should know to

make informed choicesmake informed choices

Drugs Effect the Drugs Effect the BrainBrain

•• The brain is the organ The brain is the organ in the body that in the body that govern thoughts, govern thoughts, feelings and actions.feelings and actions.

•• Drugs work by Drugs work by changing how the changing how the brain talks to itself brain talks to itself and the outside worldand the outside world

Some Important Regions of the BrainSome Important Regions of the Brain

1-2 Min 3-4 5-6

6-7 7-8 8-9

9-10 10-20 20-30

Your Brain on Drugs: Your Brain on Drugs: CocaineCocaine

Drugs as Psychological ToolsDrugs as Psychological Tools

•• Because drugs directly affect the brain, Because drugs directly affect the brain, drugs can be used to change how we drugs can be used to change how we think, feel and act think, feel and act

•• Exercise: Exercise: –– What do you think would happen to you if What do you think would happen to you if

you drank a moderate amount of alcoholyou drank a moderate amount of alcohol

Outcome ExpectanciesOutcome Expectancies

PositivePositive

•• Fun Fun •• Talk Talk •• RelaxRelax•• SexySexy

NegativeNegative

•• SickSick•• Fall downFall down•• Fight Fight •• SadSad

Alcohol Outcome Expectancies

22.5

33.5

44.5

5

7 8 9 10 11 12

Grade

Scor

e

PositiveexpectancyscoreNegativeexpectancyscore

People take drugs because they expect People take drugs because they expect that drugs have positive effectsthat drugs have positive effects•• Drugs do produce Drugs do produce

positive effectspositive effects•• People who take People who take

drugs expect drugs expect favourable outcomes favourable outcomes at least in the short at least in the short termterm

•• They anticipate They anticipate positive consequencespositive consequences

Incentive motivationIncentive motivation

So what wrong with taking drugs So what wrong with taking drugs for positive effects?for positive effects?

Three reasons to think Three reasons to think carefully about using carefully about using drugsdrugs

–– Drugs artificially Drugs artificially stimulate the brainstimulate the brain

–– False expectationsFalse expectations–– Drugs can have Drugs can have

serious negative serious negative consequencesconsequences

Why would chemical stimulation of Why would chemical stimulation of the reward centre be bad? the reward centre be bad?

•• Replace natural rewardsReplace natural rewards•• Replace appropriate coping Replace appropriate coping behavioursbehaviours•• Lead to obsessive behaviors and addictionLead to obsessive behaviors and addiction

•• What is important in your life? What is important in your life?

•• Balancing balloonsBalancing balloons

FalseFalse ExpectationsExpectations

•• What you think is not what you getWhat you think is not what you get•• Some of the effects that we believe are Some of the effects that we believe are

caused by drug use are actually caused by caused by drug use are actually caused by our expectancies.our expectancies.

•• Often our expectancies are the opposite of Often our expectancies are the opposite of actual drug effectsactual drug effects

Some exercises around the effects Some exercises around the effects of alcoholof alcohol

•• Balanced placebo Balanced placebo -- challenging challenging expectanciesexpectancies

•• Biphasic dose response curve Biphasic dose response curve –– more isnmore isn’’t t betterbetter

•• Gender differencesGender differences•• Performance effectsPerformance effects

Balanced Placebo DesignBalanced Placebo Design

•• Demonstration of drug Demonstration of drug expectancy effectsexpectancy effects

•• Placebo effects are Placebo effects are often as strong as the often as strong as the drug effectsdrug effects

•• Sometimes the effects Sometimes the effects are in the opposite are in the opposite directionsdirections

A = given alcohol A = given alcohol E = expect alcoholE = expect alcohol --EEGiven Given

PlaceboPlacebo

AAA+EA+EGiven Given

AlcoholAlcohol

Told Told PlaceboPlacebo

Told Told AlcoholAlcohol

Which is more difficult?Which is more difficult?

•• Driving a car orDriving a car or•• Interacting with Interacting with

other peopleother people

•• You know you You know you shouldnshouldn’’t drink t drink and driveand drive

•• Should you trust Should you trust your judgment on your judgment on other things while other things while drinkingdrinking

Drugs can have serious negative Drugs can have serious negative consequencesconsequences

•• Induce negative or Induce negative or risky psychological risky psychological statesstates

•• Interfere with our Interfere with our goalsgoals

•• Serious side effectsSerious side effects

Induce negative or risky Induce negative or risky psychological statespsychological states

•• Impairment Impairment •• Anxiety and Anxiety and

impulsivityimpulsivity•• AggressionAggression

Interfere with our goalsInterfere with our goals

•• Regret actionsRegret actions•• Long term consequencesLong term consequences•• Sacrifice long term goals for short Sacrifice long term goals for short

term pleasureterm pleasure

•• What are some of the possible social What are some of the possible social consequences of drug use?consequences of drug use?

Serious side effectsSerious side effects

•• Accidental injuriesAccidental injuries•• Health effectsHealth effects

–– AcuteAcute–– Long termLong term

•• Mental health Mental health problemsproblems

•• NeurotoxicityNeurotoxicity

Alcohol Use and OutcomesAlcohol Use and Outcomes

0.280.140.120.080.04Carried weapons

1.701.120.980.920.59Physically harmed someone else

0.210.090.060.020.05Hospitalized

0.960.830.780.690.54Physical injuries

In the Past Week

In the Past

Month

In the Past Year

More than a Year AgoNever

Drank alcohol

Long Term Effects of Long Term Effects of EcstacyEcstacy

•• DepressionDepression

•• Lack of Lack of

coordinationcoordination

•• TremorsTremors

•• Liver damageLiver damage

•• Heart attacksHeart attacks

•• ToleranceTolerance

•• AddictionAddiction

Long Term Damage and DepressionLong Term Damage and Depression

Final PointsFinal Points

•• No challenging, factual and empoweringNo challenging, factual and empowering•• Balance positive with negativeBalance positive with negative•• Age and stage appropriateAge and stage appropriate

Health OutcomesHealth Outcomes

0.4%0.3%0.7%6.1%92.5%Hospitalized

3.8%2.9%8.9%33.5%51.0%Physical injuries

0.6%0.7%3.3%32.1%63.3%Visited the doctor

8.3%7.9%14.6%28.8%40.4%Backaches

4.1%5.1%14.2%42.7%33.9%Stomach-aches

8.3%7.1%19.4%32.7%32.5%Headaches

Most Days

More than

Once a Week

About Once a Week

About Once a Month

Never/ Seldom

Alcohol and Health OutcomesAlcohol and Health Outcomes

1.671.591.380.981.13Difficulties sleeping0.210.090.060.020.05Hospitalized0.960.830.780.690.54Physical injuries0.610.450.340.270.35Visited the doctor1.271.070.910.810.61Felt dizzy1.471.30.990.880.92Backaches1.221.070.990.810.91Stomach-aches1.431.391.281.191.05Headaches

In the Past Week

In the Past

Month

In the Past Year

More than a Year AgoNever

Drank alcohol

Problem Problem BehavioursBehaviours

1%2%In foster care10%14%Warned or detained by police10%6%Ran away from home37%32%Skipped school22%36%School detention5%9%Suspended out of school8%14%Suspended in school

24%20%Stayed out all night without parent permission17%21%Stole something outside of home15%17%Stole at home8%21%Carried a weapon out of school5%13%Carried a weapon in school

23%41%Damaged propertyFemaleMale

Gender

General Problems and Alcohol UseGeneral Problems and Alcohol Use

31%18%11%14%5%Stole at home

39%24%13%12%4%Stole something outside of home

49%35%25%15%11%School detention

29%10%5%8%3%Warned or detained by police

53%36%24%25%14%Damaged property

49%28%13%12%3%Stayed out all night without parent permission

62%47%29%19%11%Skipped school

In the Past Week

In the Past

Month

In the Past Year

More than a

Year AgoNever

Weapon CarryingWeapon Carrying

28%14%12%8%4%Out of school

18%7%5%3%4%In school

In the Past Week

In the Past

Month

In the Past Year

More than a Year AgoNever

Drank alcohol

Suspension and Suspension and RunawayRunaway

17%8%6%3%2%Ran away from home

24%12%4%7%3%Suspended in school

17%6%2%7%2%Suspended out of school

In the Past Week

In the Past

Month

In the Past Year

More than a Year AgoNever

Drank alcohol