23/08/2017 Why this title? • Becoming an adult requires a leap much Rollercoaster as getting into a rollercoaster • Car, with peers, trusting society as a structure, an unknown course with twists The ups and downs of youth substance use and turns Dr Karen Fisher • Many different designs to choose Substances Can lead to more • Can threaten intense ride personal safety Shift the continuum • Require models of and trajectories care to responsive towards adulthood and fluid to the shifts and Can challenge the deviations of the structure safety tracks Current learnings Outline • What research says on treatment • Opportunistic frequent screening • The problem of causation • Barriers to access continue to confound • Implementation into prevention • Availability where youth are • Heterogeneity and models of care • Newer mediums offer new possibilities • Adult to scale –does not work 1
23/08/2017 And… How to target intervention • Debate over length of time for treatment • Decision must refer to continuum of use • Over what the goals of treatment are • Must include the likely harms of the substance • The problem of “normatives” • Needs understanding of pattern of use • Intensely individual • Must occur within a broader context of • Unidimensional outcomes fail health Health transformed • Sequelae into adulthood from the experiences in childhood and adolescence – sensitive periods • Inequities and exclusions • Lack of connectedness yet never more connected Global peer groups Associations not causations • Immersion in peer group potent • May not predict best practice interventions • Digital disruption • Neglects evolving contexts • Globalised, diverse world • Gender • New patterns of work • Substance use is a “wicked problem” • Different patterns of adulthood 2
23/08/2017 Inpatient or outpatient What we have • Dependency is • Inpatient stay • 15 beds often not the issue cannot simply • Passionate and dedicated youth service duplicate adult • Outpatient allows • Opportunity to ensure individualized treatment to scale the time frame treatment plans suggested by • How does this work? research Going up… • The use of methamphetamine and substances giving the chance for intense elevation • Settings: ED, community health centres and access through centralised intake Challenges • Symptoms hard to • Medications not manage within the tested on youth built environment • “scattering”, of a hospital irritability, mood • Confounded by instability and broader societal vulnerability trends 3
23/08/2017 New psychoactive substances Cannabis • Access is very • Shift rapidly with • The issues with synthetic different to health knowledge • Contradictory public health messages previous too often gained • Lengths of stay may not target the true retrospectively • New independence peak of withdrawal from the anonymity • Effects and harms temporally bound of virtual markets Alcohol • Youth listened • AND WE GOT IT WRONG • Need to refocus and highlight the different effects on young people • Role socio-culturally • Not dependence Youth- transition • Not static • Usage reflects this • The need for constant checking in on their needs, dreams, and goals • The importance of hope 4
23/08/2017 The Enemy Outside Not moral panic Tools of a Jedi Human rights • HEADSS • Reflect on the importance of substance misuse in our children and adolescents • SBIRT lives • Screening regularly no matter where • Recognition in UN documents • Opportunistic intervention and shift the • Fullest potential for each individual message 5
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