Challenge & Change. Presentation to National Drugs Conference of Ireland November Denis Murray 2011

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1 Adolescent Addiction Service Provides Support and Treatment in Relation to Alcohol and Drug Use For Young People and Families from Ballyfermot, Clondalkin, Palmerstown, Lucan and Inchicore. Challenge & Change Presentation to National Drugs Conference of Ireland November 2011 Denis Murray 2011

2 Introduction Overview of Adolescent Addiction Service Referrals Drug use trends Participation in education Approaches to intervention Case examples Reflection

3 Adolescent Addiction Service Provides Support and Treatment in Relation to Alcohol and Drug Use For Young People and Families from Ballyfermot, Clondalkin, Palmerstown, Lucan and Inchicore. Advice Support Assessment Family Therapy/Counselling Professional Consultation Medication (if required) Contact: Bridge House Cherry Orchard Hospital Dublin 10 Phone / Referrals accepted from : Family members,professionals and Young People 3

4 Adolescent Addiction Service Established 1997 as a structured 12 week outpatient detoxification programme (involving methadone prescription) for under 18yr olds who were experiencing problems in relation to heroin use. Operated out of Fortune House Clinic, Cherry Orchard Hospital. Why an Adolescent Addiction Service? HRB report showing 33% increase in drug users presenting to services For opiate users 65% between 15-19yrs Increase in prevalence of Hepatitis C antibodies among those under age 18yrs Adolescents are different and have specific developmental needs Family involvement in treatment essential Denis Murray 2011

5 Challenges Presented Programme too rigid based on adult model with expectation of rapid detoxification No established social/aftercare supports Service not giving sufficient consideration to issue of adolescent development Staff team drawn from adult service and did not have experience of working with young people Societal attitude to Adolescent Drug Use and Methadone Engaging with families (100% parent/guardian contact) Participant profile; developmental stage, level of substance use, drug dealing, criminal activity, educational achievement, relationship with other group members and substance use within families Denis Murray 2011

6 PROGRAMME STRUCTURE Young People And Families Adult Drug Users Current Structures 1997/99 Rapid Assessment Clinical Meeting Referral Young Person OP Detox Adult OP Detox In Patient Detox Waiting List Family Therapist 2004 Separation Therapy/Medical Inclusion Alcohol Individual Care Plan Family Community GP Family Therapist Nurses GP Nurses Other Significant People Structured Twelve Week Out- Patient Detox Child Adolescent Psychiatrist D enis Murray 2011

7 Denis Murray 2011

8 The primary presentations of 6,950 cases were recorded by gender and age. For the purpose of the audit only one disorder/problem was entered for each case

9 Drug Use Comparison Primary Drug Use Average Age 1998 = 16.5yrs 2010 = 15.5yrs Percentage Female 1998 = 36.5% 2010 = 27% 1998 Parents = 4 IVDU = 6 Denis Murray 2011

10 120 Intervention Medical Medical Active Drug Use Drug Free Non-Medical Non - Medical E X P E C T A T I O N A L A P P R O A C H Four parents in group under age 17yrs Six young people Injecting heroin Four young people homeless 21 had family members engaged in heroin Use Denis Murray 2 011

11 Participation in Education Completed Junior Cert 4th yr 5th yr Out of Ed Alt Ed NACD Report 2010; Highlights that early school leavers and young people who opt out of mainstream education show higher levels of substance use. It is proposed that positive relationships with teachers and involvement of parents is a major protective factor in school retention and reduced drug use.

12 Motivational Interviewing Relati nship Solution Focused CRAFT Family Systems Theory Relationship Brief Therapy MDFT FFT CBT Research (Duncan and Miller, 2000 ) suggests that therapeutic approach accounts for less than 15% of success and that most of the variance for therapy ou tcome is covered by the common ground between all therapies: client resourcefulness and chance events that produce change (40%); client-therapist relationship and experience of therapy as empathic, collaborative and affirmative (30%); client expectation & hope for change (15%). When we include family members and significant others in process we get a multiplier effect. Denis Murray 2011

13 CASE EXAMPLE Ant abuse Referral AMH CAMS Warrenstown Youth Project 15.5 Drug Use Heroin Benzo Cocaine Alcohol 4 12 Completed LCA Social Work Adolescent Addiction Service Time Line 3.5yrs Denis Murray Tallaght Hospital X 3 St James Hospital X 1 Out Of Hours Service

14 In treatment on methadone Violent Relationship 19 Drug Use Heroin Benzo Cocaine Alcohol CASP Aislinn Centre CDTF (funding) YSTU CUMAS Youthreach SCHOOL AAS CAMS Social Work CASE EXAMPLE Denis Murray

15 16 CAMS RIP * *** * Suicide Threats/Assault Internet Abuse Outpouring Of Grief Anxiety/Distress/Guilt Sleep Disturbance Community Worker Short term Benzo Prescription Console AAS GP Community Suicide Family Suicide Denis Murray 2011

16 Alcohol Abuse after years of sobriety Sober attending AA Professional Employed Heroin Use & BENZO 1 2 Heroin Use Heroin Use Heroin Use Individual Sessions 21 With FT 24 IP Detox EMPLOYER IP Detox Coolmine Therapeutic Community IP Detox REHAB Keltoi Community Project College Soilse LISA Group OP Stabilisation Youth reach Work OP DEOX Remained Education NO DRUG USE ACRG Talk to YPP Group Time Line = Two and a half years CDVEC CASP AAS Rowlagh Parish Case Example Denis Murray

17 D enis Murray 2011 Challenges in a Changing Environment Identify young people who are most at risk of developing drug use problems or associated activity Introduce protective/preventative interventions to support young people and families within local community (build capacity & resilience) Show less tolerance for alcohol & cannabis use (stated by YPP Youthreach) Prioritise inter agency working ( respecting boundaries & maintaining confidentiality) Be aware of the malign consequences of Government policies in order to avoid separating peoples problems from their social and economic context Br ie f Intervention R e duce Risk by Increasing Pr o tective & Preventative In t erventions

18 Thank you for your attention. Questions? Denis Murray 2011

19 CASE EXAMPLE Drug Free Residential Placement Further Education Independent Living Community of Origin Substance Use M o v e H o u s e Primary School CAMH (1) Age 9 CAMH (2) Age 10 Court Secondary School Age 11/12 Temporary Accommodation Social Work Time Line = 2.7yrs Denis Murray Adolescent Addiction Service 15.7 Indebted Substance Use Alcohol age 11 Cannabis age 12 Benzo age 13 Cocaine age 14 Ketamine age 15 Ecstasy age 15 Zimmovane age 14/15 (Prescribed) Family Home Attacked Hospital Out Of Hours EWO M o v e H o u s e JLO Age 14/15 Sleeping Rough Counselling Service Age 12/13 CAMH (3) Age14 Education Project Age 14/15

20 Adolescent Addiction Service Established 1997 as a structured 12 week outpatient detoxification programme (involving methadone prescription) for under 18yr olds who were experiencing problems in relation to heroin use. Operated out of Fortune House Clinic, Cherry Orchard Hospital. Why an Adolescent Addiction Service? HRB report showing 33% increase in drug users presenting to services For opiate users 65% between 15-19yrs Increase in prevalence of Hepatitis C antibodies among those under age 18yrs Adolescents are different and have specific developmental needs Family involvement in treatment essential Denis Murray 2011

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