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Too Much Time on My Hands

Recent surveys have found that substance use and mental health concerns have risen among both teens and adults due to the stressful effects of the pandemic.

Too Much Time on My Hands: The Adolescent's Response to COVID-19

Estimated watch time: 42 mins 

Available credits: none

Presentation Materials:

Welcome to the Community Education Series, hosted by The Recovery Village and Advanced Recovery Systems. Today, our speaker for the event is Dr. Kevin Wandler. Dr. Wandler is the Chief Medical Officer of Advanced Recovery Systems, and he has been instrumental in the opening of all ARS programs since 2013.

He is board-certified in general psychiatry, and he is triple-boarded in addiction medicine by the American Board of Psychiatry, the American Board of Addiction Medicine and the American Board of Preventive Medicine. Dr. Wandler is certified by the International Association of Eating Disorder Professionals and was the president of their board of directors. Dr. Wandler has been working with patients with substance use disorders for over 30 years and eating disorders for over 20 years. Dr. Wandler is a national and international speaker. After the presentation or during the presentation, if you guys have any questions, please put them in the Q&A box or the chatbox. At the end of the presentation, Dr. Wandler will answer all of your questions. With that, I just want to welcome everyone. Dr. Wandler, I’m gonna hand it over to you.

Dr. Wandler:
Thank you so much, Melissa. Welcome, everyone. This is kind of a new format for me as well. Speaking, I’ve done webinars, but this one — this one’s going to be really fun. So, I’m looking forward to it. Since we’re not traveling right now, can’t get out to Florida. This has just kind of taken off on its own. Today, I’m going to be talking about, obviously, the COVID-19 pandemic, the consequences of the pandemic, coping with the pandemic, especially from the viewpoint of adolescence because that’s what the talk is about today. Certainly, some of the consequences that we’re seeing in the youth is depression and anxiety and, of course, alcohol and drug use. Providing support in uncertain times — It’s kind of hard. It’s a real challenge, and we’ll talk a little bit about that.

Since I am an addiction medicine professional, I have to give a small plug for Narcan and Narcan resources at the end of this presentation. I think that if any of you are professionals and you work with patients with opioid use disorders, you really need to have Narcan available and understand how to use it, or at least so you can educate people on that. So, that’s one of my little projects that I’m working with.

So, this slide comes from Johns Hopkins, and this is actually updated as of this morning’s website. August 19, there was over 22 million cases of corona. We have in the United States — notice way on the left. We’re on the top, unfortunately, with 5,000,483 cases. That’s probably, of course, a very low count. It’s probably double or triple that, but we’re almost doubled Brazil and India and Russia and who knows. Tragically, on the right side, you see the global deaths are 781,000-plus, and the U.S. unfortunately leads that as well with the 171,833. Again, those numbers are low, I’m sure. The testing just can’t keep up with the disease process. 

So, what are some of the consequences of this? I mean, what did you know? This pandemic — when COVID-19 first started, there was some guy on the TV. I think his name was Dr. Fauci. He’s on every day — is like a celebrity now, right? And he told us — what did he tell us to do? He said, “Socially distance, wear a mask,” you know? And I don’t think people really believe that it was important. As you can see in the news, some universities are closing after being open a whole week, and they think that the reason for the closure, of course, is lack of social distancing, lack of wearing masks, lack of hand-washing. He said to not be around other people more than 15 minutes if you can help it, and certainly stay six feet or more apart. That’s just not happening with our young people.

I think the other thing that was told to us is to buy all the toilet paper you can buy, right? For it to last one or two years. At least it seemed like that in the beginning when you couldn’t buy Charmin anywhere. Of course, fortunately, that’s settled down. All of the following on this slide are either closed or partially closed. It varies by state, varies by city, it varies by county. The parks, the pools, the beaches — many in Florida were closed and then they were open and then they were closed. Malls were closed, and now they’re partially open. Restaurants — again, it depends where you live. I’m from Arizona, so currently, we can go into restaurants. You can sit outside, but it was 115 degrees yesterday, so guess what? Not very many people are eating outside. Inside? I’m not comfortable doing that at this time.

Schools — we’re going to talk a little bit about that at the end. Obviously, it affects our youth. They’re starting to open up — I know in Florida, there’s some schools opening up. Here in Arizona, some schools tried to open up, but the teachers called in sick, so they weren’t able to. One school district has had three or four days now without being able to open ‘cause there weren’t enough teachers. I don’t think people understand really what the guidelines are for opening, and that’s not the focus of this talk.

But think about that — the anxiety caused by the teenagers and even my six-year-old grandson — about going to school when they don’t even know if they’re going to have it. Parents are losing their jobs because of COVID, adolescents are losing their jobs because of COVID. Certainly, there could be a potential loss of housing because of COVID because you lost your job. So, there’s too much time on everyone’s hands, and as my teenagers when they were younger said, “There’s nothing to do, dad. There’s just nothing to do.” And with COVID, there’s less to do. However, I do want to make a positive statement here.

I will tell you we’ve never done so many puzzles. My wife, I think, is on our 10th or 11th puzzle. Games, family dinners, meals, chores are actually completed, and I can attest to that. I cleaned my office, finally — my home office — after five years. I went through every single box, every single file, and ended up with four boxes of shred that I had to take to the shred facility. Pets are entertained more; I don’t know what they’re going to do when we all go away. People are taking walks, especially even in my neighborhood where it gets warm in the afternoon, but people are out early and it’s a good thing. I mean, there’s some good things here with the pandemic. Maybe it’s too much togetherness, but overall, there are some good things here.

So, ARS did a survey of adults and asked them about their coping with COVID-19. This was a few months back. As you’ll see in the slides, they asked a thousand adults — ages 18 and older — about their drug and alcohol use in the past month. Some questions asked were “respond as you choose,” and so you’ll see at the bottom, those numbers add up to more than 100% because individuals are using more than one substance.

Most respondents said they displayed higher rates of drug and alcohol use — 55% reported an increase in the past month of alcohol consumption alone, with 18% reporting a significant increase, which would be like doubling their normal use; 36% reported an increase in illicit drug use. In the States hardest hit by corona back then — New York, New Jersey, Connecticut and then the East Coast, Massachusetts, Rhode Island — they even had a higher report of increase of alcohol consumption and drug use. The most commonly used medications are, no surprise, alcohol — readily available. Cannabis — in some states, recreational cannabis is readily available, and of course, prescription drugs, such as opioids, benzodiazepines, stimulants and cocaine. So, it’s interesting to see that in a very short period of time, half the people have increased their drug and alcohol use that were surveyed.

The participants were then asked why. Why were they using more drugs? And they said, “Just to cope with stress.” The majority — 53% — to relieve boredom. It certainly was an adjustment, wasn’t it? In March and April for those. I travel for my job because I live in Phoenix. My office is in Fort Lauderdale at our corporate headquarters, and so I travel a lot to all of our facilities across the United States, and that was a real shock not traveling anymore. Certainly, trying to cope with mental health symptoms, such as anxiety or depression. What we never know is what came first — chicken or egg here? Is there more depression and anxiety because of COVID? Because of drug and alcohol use? We’ll never know for sure; we need to treat it all, though. Others report just using substances more for recreational reasons or to treat pain, or that was part of their routine. So again, 53% were trying to cope with stress, and there’s certainly a lot of it.

What do the results mean? Well, the survey results indicate that many people could be turning to drugs and alcohol to cope with the pressures created by corona. Again, is it just an increased uptake of their substance use disorder that maybe they already had, or is it really due to depression and anxiety? I think early on, it was more just quote-unquote “stress,” but I think over time, some of that stress has led to real — now five months or more — significant mental health issues, and so we need to keep an eye on that, those of you that are health care professionals.

So, how is COVID affecting teens? Well, the top part is pretty much the same as for adults because guess what? The parks are still closed, the pools are still closed, the malls are starting to open up but you’re supposed to socially distance, and Fauci said to stay home, don’t go out. The restaurants are still closed or partially closed. A lot of teenagers lost their jobs, especially those in the food and restaurant industry and/or in the retail industry. High school graduates — many aren’t going to college in the fall. Some colleges aren’t having college.

The fall is now. In some areas, college has already started, and then I think Notre Dame and I think University of North Carolina Chapel Hill have already closed for a few weeks because the COVID just went rampant. It’s interesting to see how people are unable to socially distance. I say they’re not able — they’re choosing not to. School closures, of course, the obvious is loss of education and loss of social interaction. Many young people I know were very involved in sports and other extracurricular activities, such as band and cheer, which is a sport, and things like that. So, that’s also hard because that’s a social area that can be a very positive social interaction. At least where I live, many of the sports have really been canceled for the time being. 

What things I don’t think about — because our family was fortunate enough not to need the resources — was lack of food. My grandson went to kindergarten last year; he’s now six, but he was five then. He got two meals a day at school. I mean, I think almost all of the schools here and in Arizona, or at least in the Phoenix Metro area, provide meals. So, he liked the food, which is surprising ‘cause he doesn’t like much, but he liked having his breakfast and his lunch at school every day. Even if he needed it, which he didn’t, he could have brought food home for the weekend. With schools being closed, those resources are really limited, and they do affect a lot of individuals that are really dependent on that food to feed their young ones.

The other one is lack of mental health services. This is really interesting to me; I think I have a slide on this coming up. Well, I’ll go back, but the mental health services in schools in 2014 showed that 13% of adolescents received some sort of mental health service at the school. That’s approximately 3 million adolescents, and about a third of that 3 million — or a million adolescents — only receive mental health services from the school. They don’t receive services elsewhere, and that’s just mental health services. I know we have some family friends that have very special needs children, where they actually get some physical therapy services, speech therapy services, all kinds of different services from the school, and they’re not receiving those. And that’s just something that was not on my radar, actually, when I was putting this presentation together.

Another survey we did about a month later: We asked a thousand — ARS did this survey — asked a thousand American adults ages 18 and older about the effect of COVID on their children. Look at these numbers — 94% of parents say COVID interrupted the daily lives of their children. Well, that’s kind of a “duh.” You know, school stopped just like that for most areas in March and April. So, of course that would interrupt daily life. Ninety-five percent said the pandemic disrupted planned summer activities. So, it’s one thing to have school gone in April or May, but then come summer, June, July, August. There was camps, there was vacations, kids just getting together, and pretty much that has been eliminated. Seventy-four percent of parents say that COVID has impacted their child’s mental health. That’s three-fourths, with 27% reporting a significant impact. 

And then, when asked about the attitudes on returning to school — again, this is a couple of months old now because schools are opening up. The results are really — you know, they had concern, confusion, uncertainty about returning to school either now or next month when most schools were opening, and about two-thirds were very anxious about going back to school. Even my grandson was anxious about going back to school, and they still haven’t figured it out here in Arizona. But his school district isn’t going to right now. They’re still closed. He was doing tele-education when they closed the schools, and so we’ll see. Again, he’s in kindergarten or first grade now, so different than like a high school senior trying to learn physics online. It could be a problem.

This is the data from that study with the parents. Again, what most parents said is that 85% of these symptoms were new for their child or at least newly identified. For children with a history of mental health, a third said symptoms are worse than previously. So, you look down here, and the symptoms these parents noticed were anxiety or nervousness, depression and loneliness, anger and agitation and sleep issues. Now, some of you may just say, “This is kind of a normal kid,” but again, this is a change that parents are noting. And teenagers are moody; sometimes they’re anxious, sometimes they complain about loneliness. So, all of that can happen, but I think that it’s more than that. And we’re seeing that, and you’ll see on a slide coming up. I use this graph again to compare it with symptoms of substance use disorder, which, again, is the kind of the point of this presentation today from COVID and from social isolation.

So, what does substance use look like for adolescents during the COVID pandemic? This is interesting; this came from the Journal on Adolescent Health, July 18, 2020. All this data, of course, is all new. Their point in this journal article was that yes, adolescent substance use overall has increased — primarily for alcohol and cannabis use. Almost 50% of adolescents are engaging in what they call solitary substance use. That means they’re using their drugs of choice at home by themselves. That usually is indicative of a couple of things, and the data will show at the bottom of the slide that, overall, it’s associated with poor mental health and coping when people isolate to use drugs by themselves. But if the family is very conservative with allowing visitation, etcetera, which they should be, then some of these kids have no other way to use substances.

However, look at the second bullet here — 31.6% or 32% are using substances with peers by way of technology. So, I guess you get on a Zoom call and you get drunk together. I don’t know, you get on a Zoom call and you get high together — obviously separate, but together. They’re socializing while they’re getting high, drunk, stoned, whatever. About 24% — and this is the scary one — were using face-to-face substance use, which is generally how adolescents and adults get together with each other. Well, the problem with this is they are probably sharing drugs, sharing paraphernalia, not wearing masks, not keeping six-foot apart. I mean, they’re in the same room together. They could be sharing cigarettes, joints, certainly not washing their hands, etcetera. So, that’s a large concern if 24% of kids that are using are doing face-to-face; they could easily spread COVID

We have a continuum model. The point of this is really for alcohol and drug consumption and alcohol and drug problems. You start with non-use, you go to misuse, abuse and full-blown addiction. The time from non-use to addiction can be years or it can be weeks, and so it really depends on the drug, on the person, on their availability of the drug. Many factors involved with that.

So, what I like about this — well, I don’t like this slide because I don’t like the data it shows. But what I like about it is it shows that if alcohol use begins very young (11, 12, 13, you know, we’re talking junior high time), the chance of those individuals who start drinking, say, at age 11 — and again, think about that at sixth grade, seventh grade — it goes to 13.5% can develop substance abuse and almost 16% can develop substance dependence. If an individual waits until they’re 20 or 21 — now, with the ages have changed for drinking legally — only 2% develop abuse and 1% develop dependence. Alcohol use before age 15, compared to after 21, you’re four times more likely to develop an alcohol use disorder. So, obviously from this slide, the earlier drinking starts, the earlier any drugging starts, the more rapid the progression of the disease. Again, look at the difference between before 15 and after 21; it’s profound. Are adolescents more susceptible to alcohol than adults? Absolutely. They can get intoxicated much quicker. They certainly have an increased sensitivity to social disinhibition, greater adverse effects to cognitive functioning, so definitely more susceptible to alcohol.

This slide is busy. It comes from a study that’s been going on called Monitoring the Future study, and it’s from the University of Michigan. They’ve been looking at this for years. Unfortunately, the data is only as recently as 2014, so it’s about six years behind. And this is the purpose of this slide — because it is very busy — is just to show you what drugs are primarily used by young people, eighth graders versus 12th graders. So, if you look at this, alcohol isn’t on here and tobacco products are not on here, which is a problem ‘cause they’re very high. For eighth graders, their No. 1 illicit drug of choice is marijuana or hash cannabis — about 12% when this study was done. 

And then for 12th graders, seniors, marijuana is also No. 1 but it’s closer to 35%, but then again, eighth graders — think about eighth graders; they can’t drive, they have less social contacts. So, their No. 2 drug is inhalants, and I’ll be talking a little bit about that. No. 3 is synthetic marijuana and then cough medicine — huge drug of abuse or misuse for young people. You can buy cough medicine, you can buy many other, like, cold and flu products over the counter without a prescription, and these can be readily found by these eighth graders to use. You go back over to the 12th graders. Again, Adderall becomes No. 2. They probably get it from their eighth grader siblings, and again, synthetic marijuana. And now, we’re seeing Vicodin and tranquilizers and the cough medicine is there also and sedatives, and the percentages are higher for the seniors all the way through.

So, I think it’s important to know a little bit about the inhalants. I was really surprised they call — I mean, inhalants can be a lot of different things. I’m going to read off a list of different ones. I had a patient a few years back; he started huffing, as they called it, with dusters. Dusters would be the product; it’s in a can and you use it to clean your keyboard and different electronics. It gets the dust off. Well, he would have a plastic bag. He would put some of the product inside the plastic bag, he’d spray it in and then he’d inhale it, and he became dependent on it very quickly. In college, he actually passed out driving down the road from using too much of the dusters and ended up getting hospitalized, and that’s when I met him. And he said that it was the easiest drug in the world to get because he would just go to OfficeMax or Staples or whatever office product store and he’d buy cases of it at a time. And nobody said boo to him; nobody cared.

Anyhow, it caused some significant cognition problems because he used it for years, as well as some liver problems, which probably resolved — they were getting better before he left us. But other inhalants that are used — I mean, you’d be surprised how many are in your home paint thinners, dry cleaning fluid, gasoline, lighter fluid, felt tip markers. Remember the smell of those? How powerful that is? Glue — not Elmer’s glue, but more powerful, stronger stuff. Nail polish remover, spray paint, hairspray, butane lighters, whipped cream dispensers, cleaning products. I mean, young people can huff just about anything, and most of us have some of those products in our home. So, I think it’s really just something to think about. Of course, as I mentioned, the over-the-counter meds in the medicine cabinets. So, OfficeMax, under the kitchen sink, in the garage may be where young people can get their inhalant drugs.

Prescription drugs — you think a little bit tougher to get, but if you look at this slide, 53% of individuals got opiates, prescriptive opiates, from friends or relatives. Almost 11% bought from a friend or relative, 4% took without asking. We also had a family friend; she was a grandma. Her grandson, she found out later, stole all of her Percocet. She didn’t know it ‘cause she only took a couple pills a month when her arthritis and her degenerative disc disease would flare up, or she was going to go somewhere and wanted to be able to participate more actively in the entertainment. And once she realized it was gone, eventually — it took a while, but she found out that her grandson had stolen grandma’s Percocet. So anyhow, it was a problem for her. But you can see at the very bottom here, only 17.3% get it prescribed by the one doctor. So, that’s kind of interesting.

The point of that slide is for us is: Make sure we lock up all of our prescriptions and over-the-counter cough syrups, etcetera, from friends and/or family members. Vaping — this is in the news all the time. Last year, it was causing a significant problem with respiratory issues because some of the products bought on the streets actually contain oil, and oil in your lungs do not work well. So, no matter what, if someone is going to vape or use these cigarettes, they should be bought at a store. They certainly should not be bought by youth or young adults or pregnant women, and certainly not by adults who don’t use currently tobacco products.

What was interesting on August 11 of this year, just a few weeks ago, the Journal of Adolescent Health Research from Stanford University showed that teens and young adults who vape had a five times higher risk of developing COVID-19. And if they vaped in the last 30 days, it’s almost seven times greater risk. So, another reason for our young people not to vape. The bottom point says that for adults trying to quit smoking, they should use evidence based-treatments; vaping isn’t a good substitute. Most of our patients or friends certainly can get tobacco cessation products in the store; they’re all non-prescriptive, but you can even get them for free. I mean, most every state has a tobacco council with the health department. So, check there for resources and they can probably get gum and patches and lozenges without any cost to them at all, and all the handouts and support that they would want or need during that time.

On the right is the slide I showed earlier; on the left, it shows what addiction can masquerade as. Affective disorders, anxiety disorders, personality disorders, organic neurologic disorders — it really can look like all mental health conditions. So, there’s a book out called DSM-5, and certainly the psychiatric people having to make diagnoses use this book. There’s 11 different criteria, and depending on the number you have, you might have a substance use disorder, and it ranks it from mild to severe. For 30-plus years I’ve been — I mean, I use DSM-5. Obviously, we use it at work because we need to have an accurate diagnosis for insurance purposes. But I use my own definition, which is: If it causes a problem, anything on this slide, it’s a problem. If one alcoholic beverage a day causes a problem with your relationships or social self or physical self or school or job, then it’s a problem — it’s that simple. One a day, five a day, obviously the more you’re using, the more problems you will have, but a problem is a problem. So, really trying to encourage, and with young people, many of them don’t have jobs. But school is their job and/or their occupation, and we want them to be able to get through high school so they’re able to go on with some sort of further education.

So, if we went back to February of this year and we were having this discussion on adolescent substance use, I’d be talking about all these prevention factors for substance use disorder. Well, one is supportive time with the family. Clearly, I think it’s important that families are tuned in, they spend time together, they have dinners together, supervision is reasonable, there’s fair rules, fair boundaries. And of course, you’re trying to lock your teenager down from going out and not socially distancing. With some families, they may be around their children 24/7 because they’re working from home now as well, and so maybe there’s too much time together. Normally, I would say have your loved one affiliate with non-using peers or find good role models from school. That’s a problem with COVID. Connect with school activities, sports, that’s a problem with COVID. Other social skills, dancing, dating, going out with friends, hiking, that’s a problem with COVID.

So, what can families do? It’s hard to necessarily get Johnny out of his environment. The last thing you want to do is send Johnny or Janie off to grandma’s house, who may be more elderly or may have some health issues, and get COVID and have a serious consequence. Finding alternative sources of pleasure can be a problem of COVID. You know, Netflix — thank God it’s around, but I’m kind of getting tired of it. I think we’ve binge-watched two or three series now, which was kind of fun or was in March, but it’s now August, soon September. And I dunno, it just keeps going and going. I could have watched Game of Thrones probably five times, the entire series, by now. Balancing stress, the problem with COVID and seeking mental health issues, even treatment for mental health is/was a problem. 

When we started this, Melissa mentioned in the opening that we do have teleservices. Well, we didn’t in early March; the first week of March, we did not have teleservices. We were working on it; it was one of my goals for the company to get up some telehealth options, and we didn’t have them then. And we suddenly blew into this, and there’s some really exciting things coming. It connected with us — go to our website. We have an app, we have a whole education program coming out that you can do on your phone. I mean, we’re really excited about what we’re developing going forward, trying to be able to meet the needs. And you wouldn’t believe how young people especially loved telehealth. They talk more in telehealth than they do in face-to-face sessions. So, it’s been a real rewarding experience, and as Melissa mentioned, we do have — for the adolescents — we have telemental health and tele-substance use disorder services. Naturally, in order for us to provide services, our staff have to be licensed in the state where the individual’s residing. So, we’re not able to provide services to Michigan because we don’t have anyone licensed in Michigan, at least that I’m aware of.

So, as health professionals, we should begin to screen early. Nine may be a little early, but if you think nine — you may go to 11 — and really, that’s important time. You saw my earlier slides, how someone who starts drinking at age 11 is significantly more likely to develop an alcohol use disorder or other substances use disorders than someone who starts when they’re late teens or 20. If you can interview without parents, then consider the dangers of maintaining confidentiality when risk behaviors exist. There are comprehensive screens available, and so it’s important to look at that. 

One in three children starts drinking by the end of eighth grade. That’s why we need to start early — eight is 13. So, 50% of high school students have used illicit drugs in their lifetime. And drinking is associated with three top causes of death among adolescents. Unintentional injury — that’d be, like, car crashes, homicides and suicides. And of course, it can be a marker for other unhealthy behavior. I have zero tolerance for drinking and driving and, as parents, if you have a young one, you should too.  Zero tolerance under the age of 21; there needs to be appropriate consequences if they’re drinking and driving. I do not want to be killed by your young one.

So, questions for parents or therapists asked, do you have any — of your adolescent — do you have any friends who drank beer, wine or any drink containing alcohol in the past year? Do you have friends who smoke or vape marijuana in the past year? Any drinking or using cannabis by friends, of course, could be a concern. What about have you ever had more than a few sips of beer, wine or drink containing alcohol, or have you ever smoked or vaped marijuana in the past year? Again, the number of drinking days per year is really more significant, unless all your drinking days are binge drinking — like, drinking four or more beverages a day. And of course, any drinking is a high risk, ages 13 to 18 or even up to 21.

Here’s one of the screens that’s available. It’s called the CRAFFT, which is an acronym — I’m not going to read through all of this. But basically, you’ve got driving a car, using drugs to relax or drinking or drugs when you’re alone — 50% are using alone, right? Do you ever forget things you did while you were using drugs?  Does your family or friends ever tell you you should cut down, and have you ever gotten into trouble while you were using drugs? If you answer yes to just two or more of these, further investigation needs to be looked at. What doesn’t work: Confrontation really isn’t good. Your goal is really to have a second session with your potential patient, unless intervention for care is needed. The young person is already needing, like, hospitalization? Then confrontation does work. Education alone doesn’t work either. You need a mix. You need family therapy, group therapy, some nudging, motivational interviewing.

What does work — again, all can be challenging with COVID. We are open for hospitalization in Sebring, Florida. And at all of our facilities, we do have heavy screening upfront for a potential for COVID. But 12-step models are very important, even for the young people — a motivational enhancement or motivational therapies with incentives. You know, you don’t give someone a new car. You may give them more screen time for being clean and sober. You’d be realistic with your incentives. And cognitive behavioral therapy, of course, because as we saw, there’s so much co-occurring disorders going on.

Okay, now it’s time for my brief Narcan education. In the middle of this slide, you see something called Evzio, and there’s an arrow and it says, “Pull device up.” Anyhow, that is for a shot. But if you do pull off the lid, it actually has instructions and it shows you how to give a shot of Narcan. Next to it is a demonstration of nasal Narcan. Narcan and naloxone are the same thing. Narcan’s a brand name; naloxone is the generic. You see on the top is a box that says, “Contains two,” and generally that’s how you buy that. You get a two-pack of nasal Narcan or that Evzio because these days, with the overflooding of fentanyl in so much of the pills or heroin out there, it can be deadly. Oftentimes, you’ll need to give two doses of this medication — life-saving medication.

Here’s some signs that people are high. Their pupils could be constricted and appear very small; the muscles are kind of droopy. They may be nodding out. They could be itching, speech is slurring. If you’re worried that someone is too high, don’t leave them alone. If they’re still conscious, walk them around, keep them awake, monitor their breathing. You don’t need to give Narcan until they’re passing out. Symptoms of the overdose are loss of consciousness, unresponsiveness to stimulus, you’re shaking them or they’re awake but unable to respond to you. Certainly, they could be turning purplish-blue, and for darker-skin individuals, grayish or ashen. Vomiting, body limp, fingernails are also turning blue or purplish-black. Pulse is very slow, erratic. That’s a symptom of an overdose, and you definitely need to be giving the medication.

This website, projectopioid.org — again, projectopioid.org. If you go there, it says, “Request free naloxone now,” and they will send you two doses of naloxone. But in reality, you can go to any pharmacy and buy it. It does cost money, and I’m sure there’s agencies through the health department where you can get free Narcan. I think it costs $40, $50 for two doses, so it’s cheap and it can save lives.

At the end of the day, my message is: Non-use is as normal as experimental use. Unfortunately for these kids, you saw the numbers earlier — how many are using. Use always equals risk, risk isn’t evenly distributed, addiction is very real. So, delay, delay, delay nicotine, alcohol, drug use, and keep calm and carry naloxone!

Thank you for watching this video. We hope you enjoyed the presentation.

Objectives and Summary:

The COVID-19 pandemic has caused widespread stress and poor mental health throughout the United States, causing many to turn to drugs or alcohol as a way to cope. In this community education webinar, Kevin Wandler, MD takes a deeper look at the teen and adult response to COVID-19 and why it may be occurring.

During this webinar, the viewer will:
  1. Receive an overview of the COVID-19 pandemic
  2. Understand the consequences of the COVID-19 pandemic
  3. Be informed on the ARS survey of “How Adults Cope With COVID-19”
  4. Learn how COVID-19 is affecting teens
  5. Learn about mental health in school systems
  6. Understand the impact of COVID-19 on your health

Presentation Materials:

Welcome to the Community Education Series, hosted by The Recovery Village and Advanced Recovery Systems. Today, our speaker for the event is Dr. Kevin Wandler. Dr. Wandler is the Chief Medical Officer of Advanced Recovery Systems, and he has been instrumental in the opening of all ARS programs since 2013.

He is board-certified in general psychiatry, and he is triple-boarded in addiction medicine by the American Board of Psychiatry, the American Board of Addiction Medicine and the American Board of Preventive Medicine. Dr. Wandler is certified by the International Association of Eating Disorder Professionals and was the president of their board of directors. Dr. Wandler has been working with patients with substance use disorders for over 30 years and eating disorders for over 20 years. Dr. Wandler is a national and international speaker. After the presentation or during the presentation, if you guys have any questions, please put them in the Q&A box or the chatbox. At the end of the presentation, Dr. Wandler will answer all of your questions. With that, I just want to welcome everyone. Dr. Wandler, I’m gonna hand it over to you.

Dr. Wandler:
Thank you so much, Melissa. Welcome, everyone. This is kind of a new format for me as well. Speaking, I’ve done webinars, but this one — this one’s going to be really fun. So, I’m looking forward to it. Since we’re not traveling right now, can’t get out to Florida. This has just kind of taken off on its own. Today, I’m going to be talking about, obviously, the COVID-19 pandemic, the consequences of the pandemic, coping with the pandemic, especially from the viewpoint of adolescence because that’s what the talk is about today. Certainly, some of the consequences that we’re seeing in the youth is depression and anxiety and, of course, alcohol and drug use. Providing support in uncertain times — It’s kind of hard. It’s a real challenge, and we’ll talk a little bit about that.

Since I am an addiction medicine professional, I have to give a small plug for Narcan and Narcan resources at the end of this presentation. I think that if any of you are professionals and you work with patients with opioid use disorders, you really need to have Narcan available and understand how to use it, or at least so you can educate people on that. So, that’s one of my little projects that I’m working with.

So, this slide comes from Johns Hopkins, and this is actually updated as of this morning’s website. August 19, there was over 22 million cases of corona. We have in the United States — notice way on the left. We’re on the top, unfortunately, with 5,000,483 cases. That’s probably, of course, a very low count. It’s probably double or triple that, but we’re almost doubled Brazil and India and Russia and who knows. Tragically, on the right side, you see the global deaths are 781,000-plus, and the U.S. unfortunately leads that as well with the 171,833. Again, those numbers are low, I’m sure. The testing just can’t keep up with the disease process. 

So, what are some of the consequences of this? I mean, what did you know? This pandemic — when COVID-19 first started, there was some guy on the TV. I think his name was Dr. Fauci. He’s on every day — is like a celebrity now, right? And he told us — what did he tell us to do? He said, “Socially distance, wear a mask,” you know? And I don’t think people really believe that it was important. As you can see in the news, some universities are closing after being open a whole week, and they think that the reason for the closure, of course, is lack of social distancing, lack of wearing masks, lack of hand-washing. He said to not be around other people more than 15 minutes if you can help it, and certainly stay six feet or more apart. That’s just not happening with our young people.

I think the other thing that was told to us is to buy all the toilet paper you can buy, right? For it to last one or two years. At least it seemed like that in the beginning when you couldn’t buy Charmin anywhere. Of course, fortunately, that’s settled down. All of the following on this slide are either closed or partially closed. It varies by state, varies by city, it varies by county. The parks, the pools, the beaches — many in Florida were closed and then they were open and then they were closed. Malls were closed, and now they’re partially open. Restaurants — again, it depends where you live. I’m from Arizona, so currently, we can go into restaurants. You can sit outside, but it was 115 degrees yesterday, so guess what? Not very many people are eating outside. Inside? I’m not comfortable doing that at this time.

Schools — we’re going to talk a little bit about that at the end. Obviously, it affects our youth. They’re starting to open up — I know in Florida, there’s some schools opening up. Here in Arizona, some schools tried to open up, but the teachers called in sick, so they weren’t able to. One school district has had three or four days now without being able to open ‘cause there weren’t enough teachers. I don’t think people understand really what the guidelines are for opening, and that’s not the focus of this talk.

But think about that — the anxiety caused by the teenagers and even my six-year-old grandson — about going to school when they don’t even know if they’re going to have it. Parents are losing their jobs because of COVID, adolescents are losing their jobs because of COVID. Certainly, there could be a potential loss of housing because of COVID because you lost your job. So, there’s too much time on everyone’s hands, and as my teenagers when they were younger said, “There’s nothing to do, dad. There’s just nothing to do.” And with COVID, there’s less to do. However, I do want to make a positive statement here.

I will tell you we’ve never done so many puzzles. My wife, I think, is on our 10th or 11th puzzle. Games, family dinners, meals, chores are actually completed, and I can attest to that. I cleaned my office, finally — my home office — after five years. I went through every single box, every single file, and ended up with four boxes of shred that I had to take to the shred facility. Pets are entertained more; I don’t know what they’re going to do when we all go away. People are taking walks, especially even in my neighborhood where it gets warm in the afternoon, but people are out early and it’s a good thing. I mean, there’s some good things here with the pandemic. Maybe it’s too much togetherness, but overall, there are some good things here.

So, ARS did a survey of adults and asked them about their coping with COVID-19. This was a few months back. As you’ll see in the slides, they asked a thousand adults — ages 18 and older — about their drug and alcohol use in the past month. Some questions asked were “respond as you choose,” and so you’ll see at the bottom, those numbers add up to more than 100% because individuals are using more than one substance.

Most respondents said they displayed higher rates of drug and alcohol use — 55% reported an increase in the past month of alcohol consumption alone, with 18% reporting a significant increase, which would be like doubling their normal use; 36% reported an increase in illicit drug use. In the States hardest hit by corona back then — New York, New Jersey, Connecticut and then the East Coast, Massachusetts, Rhode Island — they even had a higher report of increase of alcohol consumption and drug use. The most commonly used medications are, no surprise, alcohol — readily available. Cannabis — in some states, recreational cannabis is readily available, and of course, prescription drugs, such as opioids, benzodiazepines, stimulants and cocaine. So, it’s interesting to see that in a very short period of time, half the people have increased their drug and alcohol use that were surveyed.

The participants were then asked why. Why were they using more drugs? And they said, “Just to cope with stress.” The majority — 53% — to relieve boredom. It certainly was an adjustment, wasn’t it? In March and April for those. I travel for my job because I live in Phoenix. My office is in Fort Lauderdale at our corporate headquarters, and so I travel a lot to all of our facilities across the United States, and that was a real shock not traveling anymore. Certainly, trying to cope with mental health symptoms, such as anxiety or depression. What we never know is what came first — chicken or egg here? Is there more depression and anxiety because of COVID? Because of drug and alcohol use? We’ll never know for sure; we need to treat it all, though. Others report just using substances more for recreational reasons or to treat pain, or that was part of their routine. So again, 53% were trying to cope with stress, and there’s certainly a lot of it.

What do the results mean? Well, the survey results indicate that many people could be turning to drugs and alcohol to cope with the pressures created by corona. Again, is it just an increased uptake of their substance use disorder that maybe they already had, or is it really due to depression and anxiety? I think early on, it was more just quote-unquote “stress,” but I think over time, some of that stress has led to real — now five months or more — significant mental health issues, and so we need to keep an eye on that, those of you that are health care professionals.

So, how is COVID affecting teens? Well, the top part is pretty much the same as for adults because guess what? The parks are still closed, the pools are still closed, the malls are starting to open up but you’re supposed to socially distance, and Fauci said to stay home, don’t go out. The restaurants are still closed or partially closed. A lot of teenagers lost their jobs, especially those in the food and restaurant industry and/or in the retail industry. High school graduates — many aren’t going to college in the fall. Some colleges aren’t having college.

The fall is now. In some areas, college has already started, and then I think Notre Dame and I think University of North Carolina Chapel Hill have already closed for a few weeks because the COVID just went rampant. It’s interesting to see how people are unable to socially distance. I say they’re not able — they’re choosing not to. School closures, of course, the obvious is loss of education and loss of social interaction. Many young people I know were very involved in sports and other extracurricular activities, such as band and cheer, which is a sport, and things like that. So, that’s also hard because that’s a social area that can be a very positive social interaction. At least where I live, many of the sports have really been canceled for the time being. 

What things I don’t think about — because our family was fortunate enough not to need the resources — was lack of food. My grandson went to kindergarten last year; he’s now six, but he was five then. He got two meals a day at school. I mean, I think almost all of the schools here and in Arizona, or at least in the Phoenix Metro area, provide meals. So, he liked the food, which is surprising ‘cause he doesn’t like much, but he liked having his breakfast and his lunch at school every day. Even if he needed it, which he didn’t, he could have brought food home for the weekend. With schools being closed, those resources are really limited, and they do affect a lot of individuals that are really dependent on that food to feed their young ones.

The other one is lack of mental health services. This is really interesting to me; I think I have a slide on this coming up. Well, I’ll go back, but the mental health services in schools in 2014 showed that 13% of adolescents received some sort of mental health service at the school. That’s approximately 3 million adolescents, and about a third of that 3 million — or a million adolescents — only receive mental health services from the school. They don’t receive services elsewhere, and that’s just mental health services. I know we have some family friends that have very special needs children, where they actually get some physical therapy services, speech therapy services, all kinds of different services from the school, and they’re not receiving those. And that’s just something that was not on my radar, actually, when I was putting this presentation together.

Another survey we did about a month later: We asked a thousand — ARS did this survey — asked a thousand American adults ages 18 and older about the effect of COVID on their children. Look at these numbers — 94% of parents say COVID interrupted the daily lives of their children. Well, that’s kind of a “duh.” You know, school stopped just like that for most areas in March and April. So, of course that would interrupt daily life. Ninety-five percent said the pandemic disrupted planned summer activities. So, it’s one thing to have school gone in April or May, but then come summer, June, July, August. There was camps, there was vacations, kids just getting together, and pretty much that has been eliminated. Seventy-four percent of parents say that COVID has impacted their child’s mental health. That’s three-fourths, with 27% reporting a significant impact. 

And then, when asked about the attitudes on returning to school — again, this is a couple of months old now because schools are opening up. The results are really — you know, they had concern, confusion, uncertainty about returning to school either now or next month when most schools were opening, and about two-thirds were very anxious about going back to school. Even my grandson was anxious about going back to school, and they still haven’t figured it out here in Arizona. But his school district isn’t going to right now. They’re still closed. He was doing tele-education when they closed the schools, and so we’ll see. Again, he’s in kindergarten or first grade now, so different than like a high school senior trying to learn physics online. It could be a problem.

This is the data from that study with the parents. Again, what most parents said is that 85% of these symptoms were new for their child or at least newly identified. For children with a history of mental health, a third said symptoms are worse than previously. So, you look down here, and the symptoms these parents noticed were anxiety or nervousness, depression and loneliness, anger and agitation and sleep issues. Now, some of you may just say, “This is kind of a normal kid,” but again, this is a change that parents are noting. And teenagers are moody; sometimes they’re anxious, sometimes they complain about loneliness. So, all of that can happen, but I think that it’s more than that. And we’re seeing that, and you’ll see on a slide coming up. I use this graph again to compare it with symptoms of substance use disorder, which, again, is the kind of the point of this presentation today from COVID and from social isolation.

So, what does substance use look like for adolescents during the COVID pandemic? This is interesting; this came from the Journal on Adolescent Health, July 18, 2020. All this data, of course, is all new. Their point in this journal article was that yes, adolescent substance use overall has increased — primarily for alcohol and cannabis use. Almost 50% of adolescents are engaging in what they call solitary substance use. That means they’re using their drugs of choice at home by themselves. That usually is indicative of a couple of things, and the data will show at the bottom of the slide that, overall, it’s associated with poor mental health and coping when people isolate to use drugs by themselves. But if the family is very conservative with allowing visitation, etcetera, which they should be, then some of these kids have no other way to use substances.

However, look at the second bullet here — 31.6% or 32% are using substances with peers by way of technology. So, I guess you get on a Zoom call and you get drunk together. I don’t know, you get on a Zoom call and you get high together — obviously separate, but together. They’re socializing while they’re getting high, drunk, stoned, whatever. About 24% — and this is the scary one — were using face-to-face substance use, which is generally how adolescents and adults get together with each other. Well, the problem with this is they are probably sharing drugs, sharing paraphernalia, not wearing masks, not keeping six-foot apart. I mean, they’re in the same room together. They could be sharing cigarettes, joints, certainly not washing their hands, etcetera. So, that’s a large concern if 24% of kids that are using are doing face-to-face; they could easily spread COVID

We have a continuum model. The point of this is really for alcohol and drug consumption and alcohol and drug problems. You start with non-use, you go to misuse, abuse and full-blown addiction. The time from non-use to addiction can be years or it can be weeks, and so it really depends on the drug, on the person, on their availability of the drug. Many factors involved with that.

So, what I like about this — well, I don’t like this slide because I don’t like the data it shows. But what I like about it is it shows that if alcohol use begins very young (11, 12, 13, you know, we’re talking junior high time), the chance of those individuals who start drinking, say, at age 11 — and again, think about that at sixth grade, seventh grade — it goes to 13.5% can develop substance abuse and almost 16% can develop substance dependence. If an individual waits until they’re 20 or 21 — now, with the ages have changed for drinking legally — only 2% develop abuse and 1% develop dependence. Alcohol use before age 15, compared to after 21, you’re four times more likely to develop an alcohol use disorder. So, obviously from this slide, the earlier drinking starts, the earlier any drugging starts, the more rapid the progression of the disease. Again, look at the difference between before 15 and after 21; it’s profound. Are adolescents more susceptible to alcohol than adults? Absolutely. They can get intoxicated much quicker. They certainly have an increased sensitivity to social disinhibition, greater adverse effects to cognitive functioning, so definitely more susceptible to alcohol.

This slide is busy. It comes from a study that’s been going on called Monitoring the Future study, and it’s from the University of Michigan. They’ve been looking at this for years. Unfortunately, the data is only as recently as 2014, so it’s about six years behind. And this is the purpose of this slide — because it is very busy — is just to show you what drugs are primarily used by young people, eighth graders versus 12th graders. So, if you look at this, alcohol isn’t on here and tobacco products are not on here, which is a problem ‘cause they’re very high. For eighth graders, their No. 1 illicit drug of choice is marijuana or hash cannabis — about 12% when this study was done. 

And then for 12th graders, seniors, marijuana is also No. 1 but it’s closer to 35%, but then again, eighth graders — think about eighth graders; they can’t drive, they have less social contacts. So, their No. 2 drug is inhalants, and I’ll be talking a little bit about that. No. 3 is synthetic marijuana and then cough medicine — huge drug of abuse or misuse for young people. You can buy cough medicine, you can buy many other, like, cold and flu products over the counter without a prescription, and these can be readily found by these eighth graders to use. You go back over to the 12th graders. Again, Adderall becomes No. 2. They probably get it from their eighth grader siblings, and again, synthetic marijuana. And now, we’re seeing Vicodin and tranquilizers and the cough medicine is there also and sedatives, and the percentages are higher for the seniors all the way through.

So, I think it’s important to know a little bit about the inhalants. I was really surprised they call — I mean, inhalants can be a lot of different things. I’m going to read off a list of different ones. I had a patient a few years back; he started huffing, as they called it, with dusters. Dusters would be the product; it’s in a can and you use it to clean your keyboard and different electronics. It gets the dust off. Well, he would have a plastic bag. He would put some of the product inside the plastic bag, he’d spray it in and then he’d inhale it, and he became dependent on it very quickly. In college, he actually passed out driving down the road from using too much of the dusters and ended up getting hospitalized, and that’s when I met him. And he said that it was the easiest drug in the world to get because he would just go to OfficeMax or Staples or whatever office product store and he’d buy cases of it at a time. And nobody said boo to him; nobody cared.

Anyhow, it caused some significant cognition problems because he used it for years, as well as some liver problems, which probably resolved — they were getting better before he left us. But other inhalants that are used — I mean, you’d be surprised how many are in your home paint thinners, dry cleaning fluid, gasoline, lighter fluid, felt tip markers. Remember the smell of those? How powerful that is? Glue — not Elmer’s glue, but more powerful, stronger stuff. Nail polish remover, spray paint, hairspray, butane lighters, whipped cream dispensers, cleaning products. I mean, young people can huff just about anything, and most of us have some of those products in our home. So, I think it’s really just something to think about. Of course, as I mentioned, the over-the-counter meds in the medicine cabinets. So, OfficeMax, under the kitchen sink, in the garage may be where young people can get their inhalant drugs.

Prescription drugs — you think a little bit tougher to get, but if you look at this slide, 53% of individuals got opiates, prescriptive opiates, from friends or relatives. Almost 11% bought from a friend or relative, 4% took without asking. We also had a family friend; she was a grandma. Her grandson, she found out later, stole all of her Percocet. She didn’t know it ‘cause she only took a couple pills a month when her arthritis and her degenerative disc disease would flare up, or she was going to go somewhere and wanted to be able to participate more actively in the entertainment. And once she realized it was gone, eventually — it took a while, but she found out that her grandson had stolen grandma’s Percocet. So anyhow, it was a problem for her. But you can see at the very bottom here, only 17.3% get it prescribed by the one doctor. So, that’s kind of interesting.

The point of that slide is for us is: Make sure we lock up all of our prescriptions and over-the-counter cough syrups, etcetera, from friends and/or family members. Vaping — this is in the news all the time. Last year, it was causing a significant problem with respiratory issues because some of the products bought on the streets actually contain oil, and oil in your lungs do not work well. So, no matter what, if someone is going to vape or use these cigarettes, they should be bought at a store. They certainly should not be bought by youth or young adults or pregnant women, and certainly not by adults who don’t use currently tobacco products.

What was interesting on August 11 of this year, just a few weeks ago, the Journal of Adolescent Health Research from Stanford University showed that teens and young adults who vape had a five times higher risk of developing COVID-19. And if they vaped in the last 30 days, it’s almost seven times greater risk. So, another reason for our young people not to vape. The bottom point says that for adults trying to quit smoking, they should use evidence based-treatments; vaping isn’t a good substitute. Most of our patients or friends certainly can get tobacco cessation products in the store; they’re all non-prescriptive, but you can even get them for free. I mean, most every state has a tobacco council with the health department. So, check there for resources and they can probably get gum and patches and lozenges without any cost to them at all, and all the handouts and support that they would want or need during that time.

On the right is the slide I showed earlier; on the left, it shows what addiction can masquerade as. Affective disorders, anxiety disorders, personality disorders, organic neurologic disorders — it really can look like all mental health conditions. So, there’s a book out called DSM-5, and certainly the psychiatric people having to make diagnoses use this book. There’s 11 different criteria, and depending on the number you have, you might have a substance use disorder, and it ranks it from mild to severe. For 30-plus years I’ve been — I mean, I use DSM-5. Obviously, we use it at work because we need to have an accurate diagnosis for insurance purposes. But I use my own definition, which is: If it causes a problem, anything on this slide, it’s a problem. If one alcoholic beverage a day causes a problem with your relationships or social self or physical self or school or job, then it’s a problem — it’s that simple. One a day, five a day, obviously the more you’re using, the more problems you will have, but a problem is a problem. So, really trying to encourage, and with young people, many of them don’t have jobs. But school is their job and/or their occupation, and we want them to be able to get through high school so they’re able to go on with some sort of further education.

So, if we went back to February of this year and we were having this discussion on adolescent substance use, I’d be talking about all these prevention factors for substance use disorder. Well, one is supportive time with the family. Clearly, I think it’s important that families are tuned in, they spend time together, they have dinners together, supervision is reasonable, there’s fair rules, fair boundaries. And of course, you’re trying to lock your teenager down from going out and not socially distancing. With some families, they may be around their children 24/7 because they’re working from home now as well, and so maybe there’s too much time together. Normally, I would say have your loved one affiliate with non-using peers or find good role models from school. That’s a problem with COVID. Connect with school activities, sports, that’s a problem with COVID. Other social skills, dancing, dating, going out with friends, hiking, that’s a problem with COVID.

So, what can families do? It’s hard to necessarily get Johnny out of his environment. The last thing you want to do is send Johnny or Janie off to grandma’s house, who may be more elderly or may have some health issues, and get COVID and have a serious consequence. Finding alternative sources of pleasure can be a problem of COVID. You know, Netflix — thank God it’s around, but I’m kind of getting tired of it. I think we’ve binge-watched two or three series now, which was kind of fun or was in March, but it’s now August, soon September. And I dunno, it just keeps going and going. I could have watched Game of Thrones probably five times, the entire series, by now. Balancing stress, the problem with COVID and seeking mental health issues, even treatment for mental health is/was a problem. 

When we started this, Melissa mentioned in the opening that we do have teleservices. Well, we didn’t in early March; the first week of March, we did not have teleservices. We were working on it; it was one of my goals for the company to get up some telehealth options, and we didn’t have them then. And we suddenly blew into this, and there’s some really exciting things coming. It connected with us — go to our website. We have an app, we have a whole education program coming out that you can do on your phone. I mean, we’re really excited about what we’re developing going forward, trying to be able to meet the needs. And you wouldn’t believe how young people especially loved telehealth. They talk more in telehealth than they do in face-to-face sessions. So, it’s been a real rewarding experience, and as Melissa mentioned, we do have — for the adolescents — we have telemental health and tele-substance use disorder services. Naturally, in order for us to provide services, our staff have to be licensed in the state where the individual’s residing. So, we’re not able to provide services to Michigan because we don’t have anyone licensed in Michigan, at least that I’m aware of.

So, as health professionals, we should begin to screen early. Nine may be a little early, but if you think nine — you may go to 11 — and really, that’s important time. You saw my earlier slides, how someone who starts drinking at age 11 is significantly more likely to develop an alcohol use disorder or other substances use disorders than someone who starts when they’re late teens or 20. If you can interview without parents, then consider the dangers of maintaining confidentiality when risk behaviors exist. There are comprehensive screens available, and so it’s important to look at that. 

One in three children starts drinking by the end of eighth grade. That’s why we need to start early — eight is 13. So, 50% of high school students have used illicit drugs in their lifetime. And drinking is associated with three top causes of death among adolescents. Unintentional injury — that’d be, like, car crashes, homicides and suicides. And of course, it can be a marker for other unhealthy behavior. I have zero tolerance for drinking and driving and, as parents, if you have a young one, you should too.  Zero tolerance under the age of 21; there needs to be appropriate consequences if they’re drinking and driving. I do not want to be killed by your young one.

So, questions for parents or therapists asked, do you have any — of your adolescent — do you have any friends who drank beer, wine or any drink containing alcohol in the past year? Do you have friends who smoke or vape marijuana in the past year? Any drinking or using cannabis by friends, of course, could be a concern. What about have you ever had more than a few sips of beer, wine or drink containing alcohol, or have you ever smoked or vaped marijuana in the past year? Again, the number of drinking days per year is really more significant, unless all your drinking days are binge drinking — like, drinking four or more beverages a day. And of course, any drinking is a high risk, ages 13 to 18 or even up to 21.

Here’s one of the screens that’s available. It’s called the CRAFFT, which is an acronym — I’m not going to read through all of this. But basically, you’ve got driving a car, using drugs to relax or drinking or drugs when you’re alone — 50% are using alone, right? Do you ever forget things you did while you were using drugs?  Does your family or friends ever tell you you should cut down, and have you ever gotten into trouble while you were using drugs? If you answer yes to just two or more of these, further investigation needs to be looked at. What doesn’t work: Confrontation really isn’t good. Your goal is really to have a second session with your potential patient, unless intervention for care is needed. The young person is already needing, like, hospitalization? Then confrontation does work. Education alone doesn’t work either. You need a mix. You need family therapy, group therapy, some nudging, motivational interviewing.

What does work — again, all can be challenging with COVID. We are open for hospitalization in Sebring, Florida. And at all of our facilities, we do have heavy screening upfront for a potential for COVID. But 12-step models are very important, even for the young people — a motivational enhancement or motivational therapies with incentives. You know, you don’t give someone a new car. You may give them more screen time for being clean and sober. You’d be realistic with your incentives. And cognitive behavioral therapy, of course, because as we saw, there’s so much co-occurring disorders going on.

Okay, now it’s time for my brief Narcan education. In the middle of this slide, you see something called Evzio, and there’s an arrow and it says, “Pull device up.” Anyhow, that is for a shot. But if you do pull off the lid, it actually has instructions and it shows you how to give a shot of Narcan. Next to it is a demonstration of nasal Narcan. Narcan and naloxone are the same thing. Narcan’s a brand name; naloxone is the generic. You see on the top is a box that says, “Contains two,” and generally that’s how you buy that. You get a two-pack of nasal Narcan or that Evzio because these days, with the overflooding of fentanyl in so much of the pills or heroin out there, it can be deadly. Oftentimes, you’ll need to give two doses of this medication — life-saving medication.

Here’s some signs that people are high. Their pupils could be constricted and appear very small; the muscles are kind of droopy. They may be nodding out. They could be itching, speech is slurring. If you’re worried that someone is too high, don’t leave them alone. If they’re still conscious, walk them around, keep them awake, monitor their breathing. You don’t need to give Narcan until they’re passing out. Symptoms of the overdose are loss of consciousness, unresponsiveness to stimulus, you’re shaking them or they’re awake but unable to respond to you. Certainly, they could be turning purplish-blue, and for darker-skin individuals, grayish or ashen. Vomiting, body limp, fingernails are also turning blue or purplish-black. Pulse is very slow, erratic. That’s a symptom of an overdose, and you definitely need to be giving the medication.

This website, projectopioid.org — again, projectopioid.org. If you go there, it says, “Request free naloxone now,” and they will send you two doses of naloxone. But in reality, you can go to any pharmacy and buy it. It does cost money, and I’m sure there’s agencies through the health department where you can get free Narcan. I think it costs $40, $50 for two doses, so it’s cheap and it can save lives.

At the end of the day, my message is: Non-use is as normal as experimental use. Unfortunately for these kids, you saw the numbers earlier — how many are using. Use always equals risk, risk isn’t evenly distributed, addiction is very real. So, delay, delay, delay nicotine, alcohol, drug use, and keep calm and carry naloxone!

Thank you for watching this video. We hope you enjoyed the presentation.

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