Oregonian HeadlineOregonian HeadlineMarch 3, 2006March 3, 2006

The Most Vulnerable Victims: The Most Vulnerable Victims: Children of Methamphetamine Children of Methamphetamine

Users Users Plus: An Update on Adolescent Plus: An Update on Adolescent

Substance Abuse TreatmentSubstance Abuse Treatment OPA Spring MeetingOPA Spring Meeting

March 3-4, 2006March 3-4, 2006

Keith Cheng MDMedical Director, Trillium Family Services

Adjunct Associate ProfessorDepartment of Psychiatry

Oregon Health Sciences University

The Most Vulnerable Victims: The Most Vulnerable Victims: Children of Methamphetamine Children of Methamphetamine

UsersUsers

In Utero Exposure to Meth Using ParentsIn Utero Exposure to Meth Using Parents Childhood Exposure Meth Using ParentsChildhood Exposure Meth Using Parents Adolescent Exposure Meth Using ParentsAdolescent Exposure Meth Using Parents

In Utero Exposure In Utero Exposure The effects of prenatal methamphetamine exposure on The effects of prenatal methamphetamine exposure on

the developing fetus have not been well characterized.the developing fetus have not been well characterized. There are conflicting studies, findings are confounded by There are conflicting studies, findings are confounded by

the observations that approximately 80% of the the observations that approximately 80% of the methamphetamine-using women also used nicotine and methamphetamine-using women also used nicotine and alcoholalcohol

Methamphetamine use during pregnancy is associated Methamphetamine use during pregnancy is associated with an increased incidence of premature delivery, birth with an increased incidence of premature delivery, birth weights, head circumference, and placental abruption.weights, head circumference, and placental abruption.

Cases of cardiovascular collapse and seizures have also Cases of cardiovascular collapse and seizures have also been reported in women using methamphetamine during been reported in women using methamphetamine during pregnancy.pregnancy.

Isolated cases of cardiac defects, cleft lip, and biliary Isolated cases of cardiac defects, cleft lip, and biliary atresia have been reported in infants exposed to atresia have been reported in infants exposed to methamphetamine in utero.methamphetamine in utero.

Prenatal Exposure StudySmith et al: (2003) Effects of Prental Methamphetamine Exposure on growth and withdrawal sxs in infants

born at term. Developmental and Behavioral Pediatrics. 24(1):17-23

Study done at UCLA Meth Exposed n=134, Study done at UCLA Meth Exposed n=134, Meth Unexposed n=160Meth Unexposed n=160

Apgar Scores Birth Weight and Length were not Apgar Scores Birth Weight and Length were not significantly different from unexposed controlssignificantly different from unexposed controls

Methamphetamine-exposed infants whose Methamphetamine-exposed infants whose mothers smoked had significantly decreased mothers smoked had significantly decreased growth relative to infants exposed to growth relative to infants exposed to methamphetamine alonemethamphetamine alone

Withdrawal symptoms requiring pharmacologic Withdrawal symptoms requiring pharmacologic intervention were observed in 4% of intervention were observed in 4% of methamphetamine exposed infantsmethamphetamine exposed infants

Childhood ExposureChildhood Exposure“In These Bleak Days: Parent Methamphetamine Abuse and Child “In These Bleak Days: Parent Methamphetamine Abuse and Child

Welfare in the Rural Midwest,” in press Journal of Children and Welfare in the Rural Midwest,” in press Journal of Children and Youth Services ReviewYouth Services Review

Profound neglect and abuse Physical danger resulting from in-

house manufacture of the drug Parents teaching their children

criminal behavior and a paranoid distrust of authority

Childhood ExposureChildhood Exposure

Children becoming surrogate parents Children becoming surrogate parents to younger siblingsto younger siblings

Children Exposed to toxic fumes and Children Exposed to toxic fumes and the danger of explosions or fires the danger of explosions or fires

Children asked to steal items needed Children asked to steal items needed for making the drug or to stand for making the drug or to stand guard, armed with a gun, looking out guard, armed with a gun, looking out for police or other authoritiesfor police or other authorities

Children in State Care

Oregon's Meth Epidemic creates thousands of "orphans," abused and neglected children who fall into the state's care after their parents are arrested

Department of Human Services conducted its first statewide analysis last year, when 5,438 children entered state foster homes, up from 4,906 in 2003.

Last year, roughly 2,750 children -- more than half of all foster cases -- were taken from parents using or making the potent drug, the study found

The Children of Meth,”---Joseph Rose, Oregonian, August 28, 2006

Case Vignette: 3 Admissions for Case Vignette: 3 Admissions for Residential Placement in 1 Week periodResidential Placement in 1 Week period

Ages 7-10 yearsAges 7-10 years All referred from DHSAll referred from DHS All came from emergency foster placementsAll came from emergency foster placements All were abandoned by Meth using mothersAll were abandoned by Meth using mothers All had previous foster placementsAll had previous foster placements All had become too physically aggressive to be All had become too physically aggressive to be

managed in their emergency foster homemanaged in their emergency foster home All had to wait 1-3 months before a new All had to wait 1-3 months before a new

placement could be foundplacement could be found

Adolescent ExposureAdolescent Exposure

No Specific data or publications in peer No Specific data or publications in peer review journalsreview journals

Questions: Are they more likely to use Questions: Are they more likely to use meth themselves? Are they more likely to meth themselves? Are they more likely to drop out of school? Are they more likely to drop out of school? Are they more likely to have a criminal record? Are they more have a criminal record? Are they more likely to require long-term care?likely to require long-term care?

Adolescent Case VignetteAdolescent Case Vignette Ryan 17 year old male referred for admission from OYA for Ryan 17 year old male referred for admission from OYA for

evaluation of psychosisevaluation of psychosis Exposed in utero to meth and other drugsExposed in utero to meth and other drugs Mother continued to use till he was age 5 yrs, “I was brought up Mother continued to use till he was age 5 yrs, “I was brought up

by my sister till I was 8 years then I took care of my mother.”by my sister till I was 8 years then I took care of my mother.” Mother had bilateral bka for complications of diabetesMother had bilateral bka for complications of diabetes Mother died of diabetes when Ryan was 10 yrs, Father died Mother died of diabetes when Ryan was 10 yrs, Father died

from cirrhosis when Ryan was 13 from cirrhosis when Ryan was 13 Had ADHD sxs since first gradeHad ADHD sxs since first grade Started using tobacco and marijuana at age 7 years, Meth at Started using tobacco and marijuana at age 7 years, Meth at

age 13. Hasn’t been in school for two years.age 13. Hasn’t been in school for two years. Used Meth for 2 years says he quit for 4 months till present. “I Used Meth for 2 years says he quit for 4 months till present. “I

decided I wanted a future.”decided I wanted a future.”

Adolescent Case Vignette #2Adolescent Case Vignette #2

Sheila is 15 in custody of DHS, placed in treatment because of runaway Sheila is 15 in custody of DHS, placed in treatment because of runaway behaviors, got caught by police for theftbehaviors, got caught by police for theft

Been living on the streets, supports meth habit through prostitution, has Been living on the streets, supports meth habit through prostitution, has been in OYA custody in the pastbeen in OYA custody in the past

Uses meth IV, rectally, and thru smoking has been using since age 12 Uses meth IV, rectally, and thru smoking has been using since age 12 yrs, has also used cocaine, marijuana, and alcoholyrs, has also used cocaine, marijuana, and alcohol

Father died when Sheila was 5 yrs old in MVAFather died when Sheila was 5 yrs old in MVA Mother recently incarcerated for multiple drug chargesMother recently incarcerated for multiple drug charges Made suicide attempt by overdose in Nov 2005Made suicide attempt by overdose in Nov 2005 Gives history that she used to smoke meth with motherGives history that she used to smoke meth with mother Ran away from last residential placement has hx of multiple residential Ran away from last residential placement has hx of multiple residential

placementsplacements Has not been in school since 7th gradeHas not been in school since 7th grade Has history of sexual and physical abuse, PTSD, MDD, & CDHas history of sexual and physical abuse, PTSD, MDD, & CD

Trillium ExperienceTrillium Experience

Psychiatric Residential and Intensive Community Psychiatric Residential and Intensive Community Based Programs--Not a substance abuse Based Programs--Not a substance abuse treatment centertreatment center

Average Range 350-450 ITS level admissions Average Range 350-450 ITS level admissions per year the past 4 yrsper year the past 4 yrs

Four years ago-admissions for children known to Four years ago-admissions for children known to have “Meth” using parents approximately have “Meth” using parents approximately relatively uncommon, “Monthly admissions”relatively uncommon, “Monthly admissions”

Currently seems that these admissions are more Currently seems that these admissions are more common, “Weekly”common, “Weekly”

Trends in Use Trends in Use (from MTF Study)(from MTF Study)

Use of amphetamines rose in last half of Use of amphetamines rose in last half of 1970s and peaked in 1981 with 26% use1970s and peaked in 1981 with 26% use

After 1981 there was a steady decline After 1981 there was a steady decline ended in 1992ended in 1992

Use peaked in the lower grades in 1996 Use peaked in the lower grades in 1996 and 1997and 1997

There has been a slow drop off since the There has been a slow drop off since the mid 1990mid 1990

No significant Changes in 2004No significant Changes in 2004

Trends in UseTrends in Use

Use of amphetamines rose in last half of Use of amphetamines rose in last half of 1970s and peaked in 1981 with 26% use1970s and peaked in 1981 with 26% use

After 1981 there was a steady decline After 1981 there was a steady decline ended in 1992ended in 1992

Use peaked in the lower grades in 1996 Use peaked in the lower grades in 1996 and 1997and 1997

There has been a slow drop off since the There has been a slow drop off since the mid 1990mid 1990

No significant Changes in 2004No significant Changes in 2004

Perceived RiskPerceived Risk

Overall changes in perceived risk have Overall changes in perceived risk have been less strongly correlated with changes been less strongly correlated with changes in usage of other drugsin usage of other drugs

However the perceived risk has been However the perceived risk has been rising the past several years possibly rising the past several years possibly accounting for the decline in use that accounting for the decline in use that occurred in 2003 with 12th gradersoccurred in 2003 with 12th graders

DisapprovalDisapproval

Disapproval rates have been high 70% - Disapproval rates have been high 70% - 87% throughout the life of the study87% throughout the life of the study

From 1981 to 1992 disapproval rose From 1981 to 1992 disapproval rose gradually as use steadily declinedgradually as use steadily declined

Disapproval then fell back 6-7 percentage Disapproval then fell back 6-7 percentage points for a few years and the use rate points for a few years and the use rate rose slightedrose slighted

AvailabilityAvailability

In 1975 when MTF started amphetamines had a In 1975 when MTF started amphetamines had a reported high level of availabilityreported high level of availability

The level fell 10% in 1977The level fell 10% in 1977 Drifted back up in 1980, then jumped sharply in Drifted back up in 1980, then jumped sharply in

19811981 Declined slowly till 1991, when there was a Declined slowly till 1991, when there was a

modest rise then seem to stabilize during the modest rise then seem to stabilize during the late 90slate 90s

There has been further decline during the first There has been further decline during the first year few years of this decadeyear few years of this decade

More Oregon Youth being treated for More Oregon Youth being treated for Methamphetamine AbuseMethamphetamine Abuse

The Oregon Department of Human Services The Oregon Department of Human Services said that over the past five years the number said that over the past five years the number of meth treatment admissions for boys under of meth treatment admissions for boys under age 17 has grown steadily, and has age 17 has grown steadily, and has skyrocketed 57 percent among girls. skyrocketed 57 percent among girls.

In 2003 the state Office of Mental Health and In 2003 the state Office of Mental Health and Addiction Services reported that more than Addiction Services reported that more than 1,700 children were treated for 1,700 children were treated for methamphetamine misuse in the state. Of methamphetamine misuse in the state. Of that number, more than 1,000 were girls, up that number, more than 1,000 were girls, up from 630 in 1999, and 742 were boys, up from 630 in 1999, and 742 were boys, up from 600from 600

An Update on An Update on Adolescent Adolescent

Substance Abuse Substance Abuse TreatmentTreatment

SUD AssessmentSUD Assessment

History & MSEHistory & MSE SUD Assessment ScalesSUD Assessment Scales Drug TestingDrug Testing Risk Factor AnalysisRisk Factor Analysis

History/MSE/PEHistory/MSE/PE Because substance-using youth commonly keep their substance-using Because substance-using youth commonly keep their substance-using

behaviors covert, there is a need to gather information from multiple behaviors covert, there is a need to gather information from multiple sources, including parents, siblings, teachers, caseworkers, peers if sources, including parents, siblings, teachers, caseworkers, peers if available.available.

Polysubstance use by adolescents is the rule rather than the Polysubstance use by adolescents is the rule rather than the exception; therefore, adolescents often present with multiple SUD exception; therefore, adolescents often present with multiple SUD diagnoses. Determine how many psychoactive substances are being diagnoses. Determine how many psychoactive substances are being used, and how available they are to the youth.used, and how available they are to the youth.

Determine whether there is substance use or abuse occurring by other Determine whether there is substance use or abuse occurring by other members in the home or whether there is a lack of rules against members in the home or whether there is a lack of rules against substance use by juvenile members of the family.substance use by juvenile members of the family.

Determine who are the youth’s peers and associates and whether they Determine who are the youth’s peers and associates and whether they use substances or are involved in conduct-disordered and where the use substances or are involved in conduct-disordered and where the youth uses substances. Does he or she use alone or tend to be with youth uses substances. Does he or she use alone or tend to be with groups of certain people and settings?groups of certain people and settings?

Be sure to assess for other psychiatric disorders, as there is a high Be sure to assess for other psychiatric disorders, as there is a high level of comorbidity, and many symptoms of SUD can mimic level of comorbidity, and many symptoms of SUD can mimic psychiatric symptoms.psychiatric symptoms.

SUD Assessment InstrumentsSUD Assessment Instruments

Substance Abuse Rating Instruments can Substance Abuse Rating Instruments can be helpful in screening for SUDs and for be helpful in screening for SUDs and for monitoring treatment response. “Lie monitoring treatment response. “Lie scales” can be especially helpful in scales” can be especially helpful in identifying youths that deny their identifying youths that deny their substance usesubstance use

There are now several adolescent There are now several adolescent assessment instruments such as: assessment instruments such as: CRAFFT, SASSI, PESQ, and ADI CRAFFT, SASSI, PESQ, and ADI

CRAFFT QuestionsCRAFFT Questions (2 or more “yes” answers suggests a serious (2 or more “yes” answers suggests a serious

problem & warrants further evaluation)problem & warrants further evaluation)

Have you ever ridden in a Have you ever ridden in a CCar driven by someone ar driven by someone who was high or had been using alcohol or drugswho was high or had been using alcohol or drugs

Do you drink or take drugs to Do you drink or take drugs to RRelaxelax Do you ever drink or take drugs while you are Do you ever drink or take drugs while you are

AAlone?lone? Do you ever Do you ever FForget things you did while using orget things you did while using

alcohol or drugsalcohol or drugs Do you Do you FFamily and amily and FFriends ever tell you that you riends ever tell you that you

should cut down on your use?should cut down on your use? Have you gotten into Have you gotten into TTrouble from drinking or rouble from drinking or

taking drugs?taking drugs? Kay DL: (2004) Office recognition and management of adolescent substance Kay DL: (2004) Office recognition and management of adolescent substance

abuse. Curr Opin Pedia 16:532-541abuse. Curr Opin Pedia 16:532-541

Drug TestingDrug Testing

Use of urine drug screens can be helpful Use of urine drug screens can be helpful in identifying SUDs in youth that are skilled in identifying SUDs in youth that are skilled in hiding their drug use from adults. in hiding their drug use from adults. However, a single negative drug screen However, a single negative drug screen does not rule out drug use, abuse, or does not rule out drug use, abuse, or dependence; and a single positive drug dependence; and a single positive drug screen does not establish an SUDscreen does not establish an SUD

Urine Drug Screen Urine Drug Screen DetectionDetection

Alcohol 6-10 hoursMarijuana & Hashish 1 day – 5 weeksAmphetamines 1-2 daysCocaine 1-4 daysCodeine, Morphine, Heroin,Opium

1-2 days

LSD 8 hoursPhencyclidine 2-8 daysOral Anabolic Steroids Up to 3 weeksInjected Anabolic Steroids Up to 3 months

Risk Factor AnalysisRisk Factor Analysis Chaotic home environmentChaotic home environment Parental Substance AbuseParental Substance Abuse Parental Mental IllnessParental Mental Illness Ineffective ParentingIneffective Parenting Lack of Parental involvement/supervisionLack of Parental involvement/supervision Failing School PerformanceFailing School Performance Poor Social Coping SkillsPoor Social Coping Skills Association with Conduct Disordered PeersAssociation with Conduct Disordered Peers Perceived parental/peer/community approval of Perceived parental/peer/community approval of

drug usedrug use

SUD TreatmentSUD Treatment

Traditional TreatmentsTraditional Treatments Peer Deviancy TrainingPeer Deviancy Training Limitations of Psychoeducational Limitations of Psychoeducational

InterventionsInterventions Medications Medications Community Based InterventionsCommunity Based Interventions

Traditional TreatmentsTraditional Treatments

AlateenAlateen Narcotics AnonymousNarcotics Anonymous Group TherapyGroup Therapy Individual Therapy/CounselingIndividual Therapy/Counseling

Peer Deviancy TrainingPeer Deviancy TrainingDishion, T.J., McCord, J., & Poulin, F. (1999). When interventions harm: Peer groups and problem behavior. American Psychologist, 54, 755-764

Dishion: at Oregon Social Learning Center @ UODishion: at Oregon Social Learning Center @ UO 158 youth grades 6 to 8 studied 83 boys, 75 girls in 12 week 158 youth grades 6 to 8 studied 83 boys, 75 girls in 12 week

program to reduce problem behaviorsprogram to reduce problem behaviors Three study groups: peer only, parent and peer groups, self Three study groups: peer only, parent and peer groups, self

study, and no intervention control groupstudy, and no intervention control group All study group showed improvement after 12 weeksAll study group showed improvement after 12 weeks Peer only groups exhibited significantly worse behaviors after Peer only groups exhibited significantly worse behaviors after

one year, and three year followup, than similar at risk youths one year, and three year followup, than similar at risk youths who were given prevention materials to study on their own or who were given prevention materials to study on their own or who had no interventions at allwho had no interventions at all

For peer only group a 75% higher rate of delinquencyFor peer only group a 75% higher rate of delinquency

MedicationsMedications

Evidence for use in children specifically for Evidence for use in children specifically for SUDs: Meager to date, mostly case SUDs: Meager to date, mostly case reports of small sample size studiesreports of small sample size studies

Treatment of comorbid disorders can help Treatment of comorbid disorders can help prevent development of SUDprevent development of SUD

Needs to be in combination with other Needs to be in combination with other interventionsinterventions

The Evidence with ADHD TreatmentThe Evidence with ADHD Treatment

Biederman, J., et al. Pharmacotherapy of Biederman, J., et al. Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance attention-deficit/hyperactivity disorder reduces risk for substance use disorder. use disorder. PediatricsPediatrics 104(2):e20, 1999 104(2):e20, 1999

56 boys with ADHD who were being treated with either stimulants or 56 boys with ADHD who were being treated with either stimulants or TCAs at the beginning of the study, 19 boys with ADHD who were TCAs at the beginning of the study, 19 boys with ADHD who were not receiving any medications, and 137 boys without ADHD. All boys not receiving any medications, and 137 boys without ADHD. All boys were Caucasian and were followed for 4 years and then evaluated were Caucasian and were followed for 4 years and then evaluated for abuse of or dependence on marijuana, alcohol, hallucinogens, for abuse of or dependence on marijuana, alcohol, hallucinogens, stimulants, or cocaine. At the time of evaluation, the boys were at stimulants, or cocaine. At the time of evaluation, the boys were at least 15 years old.least 15 years old.

Treating ADHD with medications appeared to reduce the tendency Treating ADHD with medications appeared to reduce the tendency to abuse drugs and alcohol. While 75 percent of the unmedicated to abuse drugs and alcohol. While 75 percent of the unmedicated ADHD boys had started abusing these substances in the previous 4 ADHD boys had started abusing these substances in the previous 4 years, this was true of only 25 percent of the medicated ADHD boys years, this was true of only 25 percent of the medicated ADHD boys and 18 percent of the boys without ADHD. The researchers and 18 percent of the boys without ADHD. The researchers calculated that treating ADHD with medications reduced the risk of calculated that treating ADHD with medications reduced the risk of substance abuse or dependence by 84 percent.substance abuse or dependence by 84 percent.

Long-term Stimulant Treatment Long-term Stimulant Treatment and Brain Sizeand Brain Size

Individuals with ADHD had significantly Individuals with ADHD had significantly smaller brain volumes in all regionssmaller brain volumes in all regions

Compared with controls, previously Compared with controls, previously unmedicated children with ADHD unmedicated children with ADHD demonstrated significantly smaller total demonstrated significantly smaller total cerebral volumes and cerebellar volumecerebral volumes and cerebellar volume

Unmedicated children with ADHD also Unmedicated children with ADHD also exhibited smaller total white matter volumes exhibited smaller total white matter volumes compared with controls compared with controls and with medicated children with ADHD

Castellanos FX, Lee PP, Sharp W et al. (2002), Developmental Castellanos FX, Lee PP, Sharp W et al. (2002), Developmental trajectories of brain volume abnormalities in children and adolescents trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. JAMA 288(14):1740-1748.with attention-deficit/hyperactivity disorder. JAMA 288(14):1740-1748.

Difference in amounts used Difference in amounts used between addict and patientbetween addict and patient

““Eightball” Eightball” (eighth of an (eighth of an ounce) = 3.5 ounce) = 3.5 gramsgrams

““Baggie or Teena” Baggie or Teena” (sixteenth of an (sixteenth of an ounce) = 1.75 ounce) = 1.75 gramsgrams

Desoxyn Desoxyn (methamphetamine)(methamphetamine)

10 - 40 mg/day10 - 40 mg/day 50 - 100 x’s larger 50 - 100 x’s larger

Dose difference Dose difference between Meth between Meth Addict and Patient Addict and Patient being treated for being treated for ADHDADHD

Long-term effects Long-term effects of Amphetamines on the Brainof Amphetamines on the Brain

Descriptions from NIDA WebsiteDescriptions from NIDA Website Intense paranoiaIntense paranoia Visual and auditory hallucinations, and Visual and auditory hallucinations, and Out-of-control rages that can be coupled Out-of-control rages that can be coupled

with with Extremely violent behaviorExtremely violent behavior Withdrawal syndrome sxs include: Withdrawal syndrome sxs include:

depression, anxiety, fatigue, paranoia, depression, anxiety, fatigue, paranoia, aggression, and an intense craving for the aggression, and an intense craving for the drug.drug.

Case Vignettes: Antabuse Case Vignettes: Antabuse

17 year old Asian female17 year old Asian female Drinking not part of the Drinking not part of the

family culturefamily culture History of success in History of success in

academicallyacademically Many in peer group used Many in peer group used

drugs and etohdrugs and etoh Wanted to stop after Wanted to stop after

psychiatric admission for psychiatric admission for suicide attemptsuicide attempt

Did not want parents Did not want parents involved in treatmentinvolved in treatment

17 year old Hispanic17 year old Hispanic Drinking part of the culture Drinking part of the culture

of some family membersof some family members Marignally engaged in Marignally engaged in

schoolschool Many in peer group used Many in peer group used

drugs and etohdrugs and etoh Wanted to stop etoh after Wanted to stop etoh after

psychiatric admission for psychiatric admission for suicide attemptsuicide attempt

Allowed parents to be Allowed parents to be involved in treatmentinvolved in treatment

PreventionPrevention

Psychoeducational LimitationsPsychoeducational Limitations

The DARE StoryThe DARE Story School programs should also enhance School programs should also enhance

academic and social competenceacademic and social competence Education should focus on self-control, Education should focus on self-control,

emotional awareness, communication, emotional awareness, communication, social problem-solving, and drug social problem-solving, and drug resistance skillsresistance skills

Prevention ProgramsPrevention Programs

Examples of evidence based practice: Examples of evidence based practice: Multisystemic Therapy (MST), Multisystemic Therapy (MST), Incredible Years, Incredible Years, Strengthening Families ProgramStrengthening Families Program Project ChrysalisProject Chrysalis

Scott Henggler’s MSTScott Henggler’s MST Developed in the late 1970s to address several limitations Developed in the late 1970s to address several limitations

of existing mental health services for serious juvenile of existing mental health services for serious juvenile offenderoffender

MST interventions aim to attenuate risk factors by building MST interventions aim to attenuate risk factors by building youth and family strengths (protective factors) on a highly youth and family strengths (protective factors) on a highly individualized and comprehensive basisindividualized and comprehensive basis

MST is a family-based treatment model. The treatment plan MST is a family-based treatment model. The treatment plan is designed in collaboration with family members and is, is designed in collaboration with family members and is, therefore, family driven rather than therapist driventherefore, family driven rather than therapist driven

MST services are delivered in the natural environment (e.g., MST services are delivered in the natural environment (e.g., home, school, community)home, school, community)

The typical duration of home-based MST services is The typical duration of home-based MST services is approximately 4 months, with multiple therapist-family approximately 4 months, with multiple therapist-family contacts occurring each weekcontacts occurring each week

Local MST program offered through “Options” Local MST program offered through “Options” 503.335.5975503.335.5975

NIDA Focus on PreventionNIDA Focus on Prevention

Analysis of Risk FactorsAnalysis of Risk Factors Prevention programs should enhance Prevention programs should enhance

protective factors and reverse or reduce protective factors and reverse or reduce risk factorsrisk factors

An emphasis on Family Interventions and An emphasis on Family Interventions and Parental Management TrainingParental Management Training

NIDA Prevention Principles NIDA Prevention Principles Programs Should:Programs Should:

Enhance protective factors and reverse or Enhance protective factors and reverse or reduce risk factorsreduce risk factors

Address all forms of drug abuse, alone or in Address all forms of drug abuse, alone or in combinationcombination

Address the type of drug abuse problem in the Address the type of drug abuse problem in the local community, target modifiable risk factors local community, target modifiable risk factors and strengthen identifiable protective factorsand strengthen identifiable protective factors

Be tailored to address risks specific to Be tailored to address risks specific to population or audience characteristics like age, population or audience characteristics like age, gender, or ethnicitygender, or ethnicity

NIDA Prevention Principles for Family & NIDA Prevention Principles for Family & School Prevention Programs Should Also:School Prevention Programs Should Also:

In family based prevention programs, enhance In family based prevention programs, enhance family bonding, relationships & include parenting family bonding, relationships & include parenting skills training and enforcement of family rulesskills training and enforcement of family rules

Be designed to intervene as early as preschool Be designed to intervene as early as preschool to address risk factors such as aggression, poor to address risk factors such as aggression, poor social skills & academicssocial skills & academics

In school age children target academic and In school age children target academic and social emotion learning and self control skillssocial emotion learning and self control skills

In adolescent school programs enhance In adolescent school programs enhance academic and social competence and drug academic and social competence and drug resistance skillsresistance skills

NIDA Prevention Principles for NIDA Prevention Principles for Community Programs Should:Community Programs Should:

Be aimed at key transition pointsBe aimed at key transition points Combine two or more effective programsCombine two or more effective programs Reach populations in multiple settingsReach populations in multiple settings Adapt to match community norms or Adapt to match community norms or

differing cultural elementsdiffering cultural elements Be long-term with repeated interventions. Be long-term with repeated interventions.

Research shows that benefits from early Research shows that benefits from early programs diminish without followup programs diminish without followup programs at a later ageprograms at a later age