Transcript of Preventing Substance Use and Abuse Among Pregnant and Parenting Teens

Nichole Fisher: Good morning, everyone. Thank you for joining us. I’m Nichole Fisher, Youth Development Coordinator with the Elect Team based at the Center for Schools and Communities. I’ll be your moderator for today. It’s my pleasure to welcome you to today’s session, Preventing Substance Use and Abuse among Pregnant and Parenting Teens.

Today’s session will be facilitated by Stephanie Colvin-Roy. Stephanie has spent over 15 years providing professional development, and prevention education, and youth development. She has developed curriculum incorporating social and emotional learning competencies and resiliency on topics including team- building, alcohol and other drug abuse prevention, cyber addiction, bullying, cyber bullying, diversity, stress and anger management.

Stephanie provides professional development consultation and technical assistance to schools and youth-serving agencies with a focus on social and emotional learning, as the training and organizational development associate, for the Center for the Promotion of Social and Emotional Learning, which is also called CPSEL, at the Center for Schools and Communities.

Again, please note that for today’s webinar, participants will need to have 12 pieces of paper, small pieces of paper ready for an activity, or you can use a couple of sheets of paper that you can use to create columns. It is my great pleasure to welcome Stephanie with us this morning. Stephanie, thank you so much for joining us. The microphone is now yours.

Stephanie Colvin-Roy: Thank you very much, and welcome, everyone. Today’s objectives, we’ll be looking at specifically physical and behavioral characteristics of fetal alcohol spectrum disorder. We’ll be taking a look at specific ways in which we can help pregnant and parenting teens, and how they’re often enabled, and the difference specifically between enabling and helping behaviors. I’ll also be providing toward the end of the presentation some resources, specifically in prevention, as well as some strategies, specifically for pregnant and parenting teens.

In terms of why young people and people in general use substances, it’s basically the same as it ever was. The difference might be that, over the course of the 15 plus years that I’ve been working in prevention, the idea of sort of using to sort of change the way, the thrills and sensations or change the way they feel, which used to be sort of the first types of responses that I would get, particularly from young people.

Now that has shifted slightly, because eventually or initially, when we would have these conversations, those were sort of the first answers, and then, as the conversation would progress, and eventually, somebody might mention this idea of escaping one’s problems might be a reason why someone would use substances. Now, this self-medicative idea is often the first response or among the first responses that I hear when I do this work.

I’m going to be sharing some information with you from the Pennsylvania Youth Survey, which is a survey that is given to 6th, 8h, 10th and 12th graders. The data that you’re going to be seeing throughout the presentation is from the 2015 PAYS youth survey. That is the most recent published data that we have. Just know that the 2017 data is coming. Then, that is done ... That survey is conducted every two years.

Before we move forward, just to sort of give maybe some explanation for why, because I’m always asked why young people tend to self-medicate with substances. If we look at the PAYS data, they ask a lot of questions that are of a mental health concern. In the 2015 PAYS data, we had upwards of 24% or higher young people who responded to questions like, “I feel sad or depressed most days.” Again, on average, it was about 24% of students that would respond to that question. In some of our schools, it was even higher; 16% of this state reporting, students feel that life is not worth it, and 23% think that they are not good at all.

If you do have a type feature that you have access to, this would be an opportunity to just give your thoughts on what you believe the number-one date rape drug is. Nichole will keep track of your responses, and because of time, we will move pretty quickly. But just out of curiosity, any thoughts on what the number-one date rape drug is?

We’re starting get some responses here. The first one and I’m seeing this from a couple of people already is alcohol. That is correct. Every once in a while, when I do this presentation, I get ... Actually, more often than not, I get things like roofies and GHB, and things of that nature. Unfortunately, those things are still used. But it is important to keep in mind that alcohol is still the number-one date rape drug. That is the first substance that we’re going to talk about because it is still the most prevalent substance that our young people are using.

Let’s talk a little bit more specifically about the problems associated with alcohol and specifically the developing adolescent brain. Binge drinking is, for our adolescents, four or more drinks in a sitting for an adolescent male, and three or more for an adolescent female. Those numbers are one higher, if we’re talking about the adult population. When I say, “Over a session,” what that means typically is over a one-hour period, and the ratios are 1 ounce of hard alcohol and the equivalent for other types of alcohol.

Anecdotally, it’s not unusual for young people to begin drinking prior to getting to the place that they are planning to party. This term would be referred to as pre- gaming. Often, they will consume a large percentage of straight alcohol over a very short period of time, or they will, in other words, binge. Just for example, they may ... Young people may get a water bottle full of pure Vladimir vodka, so essentially 8 to 16 ounces, primarily of vodka. They may or may not cut that with something else; with a soda or a juice. Often, that is consumed before they even get to whatever activity is that they are planning to go to. That in and of itself is binge ... It’s exceeding binge drinking, before they even engage in the sort of the “fun activity” that they’re headed to.

Some of the trends related to alcohol consumption, just sort of a statistic, young people under the age of 21 are consuming approximately 11% of the alcohol that’s consumed here in the United States. Then, you see some of the alcohol- related trends. We’ll go into some of them.

The ones that may not be familiar, with pre-gaming we just talked about, that’s drinking excessively, typically before you even get to where you’re going. The one that may not be familiar is the pocket shot. This is a plastic pouch. It’s sort of a very sort of generic version of a flask. It’s a plastic pouch that’s filled with alcohol. It can be stashed easily into backpacks or slipped into even sort of a sock or a jacket pocket and things of that nature. The Boozie Bears and the vaporizing, we’ll take a look at in the next couple of slides.

Alco-pops have been on the scene for a while. The idea behind an alco-pop is it’s a soft entry into hard alcohol. This is sort of the way to make alcohol taste good. Who typically ... Just if you wouldn’t mind sort of entertaining me here and using your chat feature again, if I create an alcoholic beverage that looks like the picture in your right-hand corner, this would actually be infused alcohol that somebody created with a candy. But if I was manufacturing a sweet, sugary, attractively packaged and colored alcoholic beverage, who typically might be most attracted to an alco-pop? If you could take a moment to respond to that? We’re getting some ...

Nichole Fisher: I think so. Yes. We have a lot of ... Very quickly answered girls and adolescent males. Young girls.

Stephanie Colvin-Roy: Absolutely. Yeah, so not only is it just our adolescent females or our females in general, but a lot of these things now ... I think, initially, when these alco-pops came onto the scene, it was sort of geared toward the female, the female drinker, and not always just the adolescent, but women in general. Then, there was sort of a shifting toward getting a younger male audience as well. Then, just sort of as a bonus question, who remembers the very first alco-pop to come on the market? This will date some of us in the audience slightly. But who remembers the very first alco-pop? Let’s see if we can get someone to think hard about this one.

Let’s see in the response on this one yet. The very ... Zima [crosstalk 00:11:51]. We have Zima as one. We’re going to hold that for just a second because the very first alco-pop was actually Bartles & Jaymes wine coolers. But Zima was the one that really was, and that came in from ... Lisa? Is that ...

Nichole Fisher: Lisa Pisano, yeah, from Berks County. Stephanie Colvin-Roy: Lisa Pisano from Berks County. Zima was groundbreaking because that one was really sort of the one that came on the scene that was ... You get a lot of bang for your buck with some of these because it was a lot of alcohol, and very sort of appealing to a lot of people because it was sweet; fairly inexpensive.

Now, we have sort of ... We have your Bacardi Silvers, and the hard lemonades, and sort of the sky is the limit. You can be sitting sort of in your lawn chair on a summer’s day and have two or three of these and not really think anything of it. Then, you just get out of your lawn chair or rather fall out of it. That would ... But Zima really was the one that sort of set the stage for the others.

Here are some of the alcohol trends that were talked about on that two slides ago; smoking or inhaling alcohol. An individual can pour alcohol over dry ice and inhale it directly, or with a straw, or make a do-it-yourself vaporizing kit that can be purchased online using bike pumps. The alcohol of choice is poured then into a bottle. The bottle is corked. The bicycle pump needle or a bicycle pump needle is poked through the top of a cork. Air is then pumped into the bottle to vaporize alcohol. Then, the user inhales it.

This is a very quick way to get alcohol into the bloodstream. It also tends to be appealing because it is calorie free. What I will tell you is that there were some bars that were sort of getting on the bandwagon with this inhaled alcohol. It tends to be sort of a big-city type of thing. I don’t know that I’ve ever seen it. But I have heard about it.

Stash, which so ... An example of stash would be the bottom left-hand corner of your screen. There’s a flip-flop ... Reef is a pretty popular flip-flop brand. Reef creates a flip-flop that has a hidden flask in the sole. They also have one that has a little hidden compartment where you can store your money, your keys or your weed.

Then, in the right-hand corner, we have alcohol powder. It’s powdered alcohol or dry alcohol. It’s a product generally made or it’s a powder that then can be reconstituted with water. Then, the powder can become an alcoholic drink. There is a lot of controversy around this. Researchers have expressed concern because of the misuse that can happen around powdered alcohol. There is some sort of legal, not legal, depending on where you go. This is something that most likely would need to be purchased over the Internet.

Then, on this slide, you have some pictures of some current trends that unfortunately have shown up quite a bit in schools across our nation. I do want to mention, and you’ll hear me say it again, I am not advocating for any one substance at all. However, when you begin combining drug classifications and, in this instance, I’m going to be talking about combining alcohol, a depressant, with caffeine, a stimulant.

Any time you begin to combine drug classifications, that becomes the recipe for disaster. With this one, caffeine and alcohol, stimulant plus depressant, never a good plan, because of basically the mixed message that it’s sending your central nervous system. Your brain doesn’t know whether it should be waking up or slowing down.

The pictures that you’re seeing here, the gummy bears would be ... A representation of gummy bears or any gummy candy that can be soaked in alcohol. What I should tell you there is you would have to consume an exorbitant amount of gummy candies to get drunk. However, when we see this behavior happening with a young person, that is absolutely a red flag and a concerning behavior. This was something or is something that we have seen that Student Assistance Teams have been alerted to in high schools across the state of Pennsylvania.

Skittle-infused vodka, so that’s your bottom right corner. We saw that picture earlier. Then, the little shot glass of the green liquid at the top of the screen, that would be an example of Jolly Rancher-infused alcohol. Then, the old standby, which is still being consumed in many bars, Red Bull mixed with alcohol.

I always add caffeine and the concerns around caffeine to presentations when I’m talking about risks to our adolescents, simply because, or not simply because, but we tend to underestimate the concern around caffeine. Caffeine does create neurotransmitters in the brain that basically then make the brain susceptible to other substances. It is a drug and is a drug that shouldn’t be taken for granted. Energy drinks combine both caffeine and B vitamins.

B vitamins in excess can be a concern, especially for young people. B2, B6 and B12, along with other herbs, are found in a lot of the energy drinks. Though in moderation can be healthy, in excess ... B2, recommended daily amount of B2 is between 1.2 mg and 1.3 mg. But in excess, B2 can cause things like nausea; vomiting; fatigue; low blood pressure.

B6, which is 1.3 mg or 1.2 mg, would be recommended daily allowance; in excess can cause suicidal ideation; severe fatigue; low blood sugar; significant mood swings; headaches; heart palpitations. Excessive amounts of B12, the recommended daily amount of that would be 2.4 mg; can cause kidney damage, bloating, nausea, loss of appetite, panic attacks and tingling in the right side of the body.

The amount of these vitamins in all of the energy drinks or the majority of them tend to be 2% to 3% to 4% more than you would need in a day. Powdered caffeine that you see on the right, becoming increasingly popular for people to add the amount of caffeine that they want to add, and that can be extremely dangerous.

Again, just a reminder, that when we’re combining a stimulant and a depressant or any other combination of drug classification, it can be extremely dangerous. Ingesting alcohol and energy drinks can be associated with decreased awareness of physical and mental impairment caused by the alcohol, without reducing actual impairment. This is a particular concern for young people who have a baseline of less mature judgment.

Adding energy drinks to alcohol tends to increase the rate of absorption through its carbonation and dilution of the alcohol, and keep a person awake longer, allowing ingestion of greater volumes of alcohol. At low-blood alcohol levels, caffeine appears to decrease some of the impairment from alcohol. But at higher blood alcohol levels, caffeine does not appear to have modifying effects, either physical or mental impairment induced by alcohol.

The picture that you see on your slide is called a Jagerbomb. This is a popular way to combine alcohol and energy drinks. It comprises a measure of alcohol, or the Jagermeister dropped into a glass of Red Bull, which is then consumed as a shot. This drink delivers an alcohol-sugar-caffeine fix that can be consumed with high frequency among adolescents and adults for that matter.

The next substance that we’re going to talk about is cannabis. You may know of that substance by the other terms that you see on the slide. Cannabis is the correct terminology. We tend to call it weed or marijuana here in the States. But if we were doing this presentation anywhere else in the world, we would call it what it is. I believe that when we do a topic like this, we should be credible to what the substance actually is, and that is calling it by its real name, which is cannabis.

This substance is used primarily by smoking; sometimes in a pipe or a water pipe. It can be loosely rolled into cigarettes. Some users will slice open and hollow out cigars, replacing the tobacco with marijuana, to make what are called blunts. Joints and blunts ... Joints would be small rolled cigarettes; may be laced with other substances including things like PCP, mixing it with other sort of just herbs or substances in general. Smoking, however, is not the only way to get high. It’s becoming increasingly more popular to look at some of the other things that we’re going to be seeing in just the next few slides.

Lots of debate about whether or not it is ... Whether or not cannabis is addictive in nature; whether or not ... To what degree. I do want to just stress that when we are talking about the adolescent brain, there are some points that I do want to share with you. What we do know, and this research is coming from the US Department of Health and Human Services, in addition to the National Institute, at the National Institute of Drug Abuse and Prevention, regular ... Or cannabis may hinder our short-term memory; affect perceptions and reaction over time.

Regular cannabis users can develop what’s called dependence syndrome. The risk of this is around one in ten of all cannabis users and one in six when they begin using in adolescents. Regular cannabis users double their risks of experiencing psychotic symptoms and disorders, especially if there is a personal family history of psychotic disorders, and if they begin using in their mid-teens. You’re going to sort of hear this repetitive pattern. If we can prolong or offset, keep young people from using this cannabis for longer periods of time, then the risk associated with cannabis use is significantly diminished. Regular adolescent cannabis users have lower educational attainment than non- using peers. But we do not know whether this link is causal. Regular adolescent cannabis users are more likely to use other illicit drugs. Again, we don’t know if this is causal. Cannabis use in adolescents approximately doubles the risk of being exposed, I’m sorry, diagnosed with schizophrenia or reporting psychotic symptoms in adulthood.

Then, some other trends that we’re seeing increasing concern with are cannabis in the form of wax, oil and concentrates. Concentrates are extracted resins from greafy, I’m sorry, from green leafy cannabis, which can raise the THC content from the standard street levels of 15% THC to upwards of 60% to 80%. Cannabis use during adolescents is of a particular concern. This is due specifically to the neuronal and synaptic pruning, the maturation of the neurotransmitters and the natural cannabinoid receptors that we have and neurotransmitters in the brain. Problems with brain function; changes in brain structure over time.

These are some pictures of the sort of the newer or more common forms of concentrated cannabis that are being used. There’s some slang terms associated with it ... Dabs, wax, oil, butter, amber, honey, oil, BHO or shatter. In the top left corner, you’re seeing an example of the wax; to the right, amber or shatter; bottom left, butter; and then, an oil resin, I’m sorry, an oil concentrate in the bottom right.

Hashish, dried compressed resin, is secreted from the cannabis plant. Hash oil is an oil extract that’s often used when vaping. The THC level in shatter, again, or amber, that’s the one in the top right, may reach upwards of 90% in THC content. These new forms of, or not so new anymore, forms of cannabis, may make up 40% of the cannabis that’s sold today.

Then, marijuana edibles or cannabis edibles are becoming increasingly popular. This is where we tend to see overdose happen. It used to be that overdose was just basically unheard of. If somebody was smoking weed, you just never heard of somebody overdosing. Now, we have had more than one incident. First, it was like the first overdose. Then, you’re hearing more and more. The reason for overdose now is because of the edibles. This is how it works.

If you’re smoking cannabis, it takes a relatively short period of time for that drug to get into the bloodstream and for the effects to happen with the individual. It’s basically getting into the bloodstream, and within a couple of minutes, they’re beginning to feel the effects.

If someone is consuming a brownie, or a cookie, or a lollipop, or whatever the case may be, they may have a brownie, and it’s 15 minutes later, it’s 20 minutes later, and they’re like, “I got nothing. I’m feeling nothing.” They go back to the pan of brownies. They have themselves another one. Another 15, 20 minutes goes by, and they’re still like got nothing. They go back for the third brownie. Now, all three brownies, or at least two of the three, have now hit their system. Now, they’re not feeling so good. This is why we’re seeing overdose related to ingesting cannabis.

Then, we do still have synthetic versions of marijuana. This particular ... In some ways, it almost seems inaccurate to call this particular product marijuana because really it isn’t. It may be ... What tends to happen with what they call synthetic weed or synthetic marijuana is it is a synthetic drug or a man-made drug that’s sprayed onto plant material, often looks like a potpourri or looks like dried herbs, and you really often don’t know what the heck you’re getting.

This product may change the very next time that you use it, even if it’s a similar brand. It’s often consumed ... Similar in price to cannabis between $30 and $40 for a gram bag. It tends to be laced with other psychoactive compounds. Really, the effects of this tend to be stimulant in nature. Often, the effects from it are negative in nature. There are a lot of young people who have reported that this really is not a fun way to get high.

This slide from the National Institute on Drug Abuse is just a sort of a representation of, as we have sort of within our society, and it’s not just exclusive to the United States, although this slide is. This is the sort of the perception as we talk about legalization for medical use, and I’m certainly not coming out as saying someone that’s against that, because I’m just quite frankly not against that if it’s really helping in certain conditions to ease pain.

But in terms of recreational use and even in terms of talking about it, there’s a lot of complacency around it. It’s very much in the news, and so because of that, the perception that cannabis is harmful, our young people just simply, many of them feel that it is not. You can see that as the perception that a substance is not harmful, as that perception increases, then the use tends to go up.

We’re going to quickly move through some of the data, because you will have these slides available, so you can study them in more detail later. I can also give you access to places where you can print out the state, Pennsylvania Youth Survey, if you are interested. Again, we’ll be looking at the 2015 data because that is the published data that is most readily available. Then, if you’re interested in your specific area, I can give you some resources about how you might obtain that for your particular location.

This first slide is looking at alcohol use in 2015 over a 30-day period. Then, also, binge drinking rates, and again, we talked about the binge drinking rates. They did not actually bring that down to the four for an adolescent male and three for an adolescent female. They’re actually using the numbers of five and four; so five, adolescent male; four, adolescent female; which is a little bit misleading, in my opinion. These are the dates ... Do we have questions? Do I need to stop?

Nichole Fisher: No. Nothing. Stephanie Colvin-Roy: Then, these are the data for cannabis use over a 30-day period and over a lifetime use. I do want to mention that we have been doing the Pennsylvania Youth Survey data for a number of years; and since the 2013 data, the numbers for both alcohol and marijuana have been dropping.

Tobacco use, what we are seeing across the state and actually really pretty much across the United States in general, the actual use of tobacco through cigarettes has decreased. But young people are spending; are increasing their use of other forms of tobacco, I’m sorry, of nicotine consumption. We’ll look specifically at those nicotine delivery products in the next slide.

I do want to mention that nicotine is one of the most addictive drugs that you can consume. It’s another one that is very underestimated. Some people say, “It is as addictive as heroin.” Other people say, “More so.” Anyone out there who has kicked that habit? Good for you, because this is just not one that is easily ...

When they say that a drug is more addictive than another, what that basically means is that even if you do not have a predisposition to addiction, maybe there’s no family history of it, what that means is that if I were to put a nicotine patch on every one of you out there for the next couple of days, and then, I was to deprive you of it, for the majority of us, it would be ... We would really be wearing that nicotine patch. That’s simply because certain drugs are much more potent regardless of who you are or how you are made up.

These are some of the statistics for vaping. That’s the inhaling of nicotine through the pipes you saw in the other page versus cigarettes and smokeless tobacco. In terms of the prescription drugs, on the far left, you’ll see the opioids. This is how young people, how our adolescents typically are introduced to heroin. They may never get to heroin. But this is typically how our young people make the segue from one to the other opiates.

Your things like Percocet, oxycodone, that category of drug, they tend to be about a dollar a milligram. It is very ... If you become addicted to an opiate, it is very hard to maintain a habit that may be upwards of $30 a pill. If you become addicted to it, it is not hard to fathom why they might then need to move toward heroin. You can get high for $5 to $10.

Opioids are pain medications. Their use creates a euphoric rush; pain relief. It causes constricted pupils; sleepiness. Overdose causes respiratory depression. It basically suppresses our central nervous system. It can lead to coma or death.

Sedatives, those are the center pill box or pill bottle that you see. Those are the benzodiazepines. Those are things like Xanax; Valium. They also include the sleep aids. They cause relaxation; drowsiness; dizziness; lack of coordination; slurring of words. Overdose, again, it suppresses that central nervous system; can lead to coma or death. The benzodiazepines are one of two drugs that actually can cause death in withdrawal. A lot of times, people think that withdrawal from heroin will lead to death. You will wish you were dying. But withdrawal from heroin, certainly overdose, but withdrawal from heroin will not cause you to die. Withdrawal, if you are dependent on a benzodiazepine, like Xanax or Valium, if you are truly dependent and you do not get it, if they cannot step you down off of it, it can kill you. The other drug is alcohol.

Then, on the right, the amphetamines. These are things like the ADHD medications. These are your Adderalls; Ritalins. They cause alertness. They’re stimulants; alertness in concentration; excitability; euphoria; appetite loss; insomnia. In overdose, they cause extreme agitation; paranoia; panic; et cetera.

Then, we have over-the-counter drugs. The ones that tend to be abused the most are the cough suppressants; anything with dextromethorphan; Coricidin. In overdose, they cause hallucination, nausea, vomiting, confusion, dizziness, drowsiness, extremely dangerous, and the high tends to last a very long time.

Heroin, a highly illegal addictive drug. It can be injected, snorted or smoked. Its drug classification is a narcotic. It is also a sedative. It’s a processed form of morphine; a painkiller. It comes from the seed pod of the poppy, which you see in the right corner of your slide. It is related to opium. It’s usually white or a brownish powder. It also can be black and sticky; referred to as black tar. It’s sometimes cut with powdered milk; cornstarch; quinine; strychnine which is a poison. Some of our slang terms are H, smack, junk, horse, china white, black tar, fix, dope and nod.

Fentanyl is the most potent opiate that is on the market for human use. It is highly addictive and dangerous when it’s used illicitly. A very small amount ingested or absorbed through your skin can be fatal. Often, when you hear about a large number of overdoses happening in a particular area, it tends to be that it’s heroin that has been laced with fentanyl.

Then, unfortunately, we have something even stronger, and that is carfentanil. This was first synthesized in the 1970s. It was produced for commercial applications as a general anesthetic for large animals, most specifically for elephants. It was never created or intended for human use. It was one of the most potent opiates known. The quantitative potency is approximately 10,000 times that of morphine and 100 times that of fentanyl.

According to the National Institute on Drug Abuse, when opiates are consumed, they enter the bloodstream. They activate the neurotransmitter receptors in the brain’s reward system. Opiates reach the opiate receptors; release the hormone dopamine; and then, dopamine, which acts as an excitatory transmitter, is what produces these feelings of pleasure and satisfaction. Then, when the heroin wears off, the feel of fears feels much worse than they did before they took the drug. These are some of the effects that people feel from heroin. Then, these are the effects when someone is coming off of heroin. Just know that these are excruciating. It’s why people tend to want to move; want to use again. Again, I said, “You can’t die from the withdrawal of heroin.” But people feel like they’re dying. The actual use during 6th, 8th, 10th and 12th grade, very low for heroin use. But you’ll see on the right, the prescription narcotics, which is sort of the segue into, or how they may get into heroin later, those numbers unfortunately are creeping up.

The tranquilizers on the left, 30-day use and lifetime use numbers, again, those are the things like Xanax and the sleep aids. But with our young people, it’s not the sleep aids; it’s the Xanax and Valium; more often not. Then, the stimulants or the ADHD drugs are on the right. As you’re looking at this data, this is not prescribed. These are when they take them without a doctor’s prescription.

In terms of pregnancy and alcohol, effects have been detected in terms of a fetal alcohol syndrome. Effects have been detected at moderate levels of alcohol consumption. Second-trimester effects tend to be lower academic achievements; problems with spelling, reading and math skills. Six percent of alcoholic women have fetal alcohol exposure, I’m sorry, fetal alcohol syndrome. Fetal alcohol syndrome risk for children born after another sibling has been exposed is as high as 70%. Often, we see patterns.

There are a variety of treatment options that do not have to be specific to pregnant women. Some meetings are women-only, and that may be beneficial. If you’re working with a teen, a pregnant teen, and they are consuming alcohol or are using another substance, it may be helpful for them to go to a meeting that is women-only. The motivation to change is a key factor in successful treatment. Often, treatment options for pregnant women will include child care and support services.

Generally, treatment facilities are not going to turn someone away, and assistance is available, especially for specific populations. There will most likely be a requirement for total abstinence, or we’ll work with women toward total abstinence. After a baby is born, stress may be a trigger for relapse. It’s very important that there’s support after the baby is born. Alcohol and other substance may affect breast milk.

These are some of the characteristics of babies born with fetal alcohol spectrum disorder. Not all children with FASD are alike, however. The symptoms vary from mild to severe. Early identification is the first step to improve prognosis. It is not curable. But again, early intervention can be very successful. These are the most common physical characteristics. But not all children with FASD have physical characteristics.

What we do tend to see more characteristically are the behavioral characteristics. These behavioral characteristics are typically due to the brain injury that takes place in utero. Some children have more behavior problems than others. Some are severely affected and may need support throughout their lifetime. When working with these youth, these children are very literal. Being very specific with them is very important. Use the same words for important instruction and rules. Being consistent, repeating instructions and routines are very important.

These are some subtle symptoms that a young person that you’re working with may be having problems with chemical abuse or substance abuse. Some of these tend to be indicators of mental health concerns as well. Then, these are more pronounced indicators of both substance abuse or mental health concerns.

Then, the next slide, other indicators of substance abuse. If you have your papers in front of you, we are going to do a brief activity. We’re going to have to go through it relatively quickly. Then, I will fly through the last couple of slides, which are resources for you.

If you would gather your 12 pieces of paper in front of you and put those into four stacks, with three pieces of paper per stack, and if you do not have the stacks, then you can simply use one or two pieces of paper, and you’re going to need to create four columns. In those four columns, you’re going to be writing three things in each of the columns.

In your first stack of three papers or Column 1, I’d like you to write down names of three people who you care about, so one person on each of the pieces of paper; or if you’re writing in columns, number one to three, one person for each. Stack 2 or Column 2, write down three things or possessions that you value. For this one, I’d like to think about, if you had to leave your home very quickly, and someone said, “You can only take three things with you. Which three things would you grab?” One on each piece of paper or one on each line in Column 3, I’m sorry, Column 2.

Then, in Stack 3, write down three activities that you enjoy doing; one on each piece of paper; or in Column 3, one on each line. Then, lastly, on Stack 4 or Column 4, write down three personal characteristics, talents, abilities or attributes, personal attributes that you feel good about; one on each piece of paper or one on each line in Column 4.

I’m going to read a series of scenarios to you. I want you to imagine that you are one of the adolescents that you work with. You don’t have to pick a specific child; a young person. But I want you to sort of put yourself in the position of a young person that you might work with or come in contact with.

The first thing I’d like you to think about, you’re an adolescent, and you’ve been invited to a party. You come home after curfew. You’re smelling of alcohol. Your parents or caregivers are waiting up for you. Now, you’re in trouble. One of your possessions is taken away as punishment. I’d like you to choose one thing from Stack or Column 2 and remove it. If you have a piece of paper in Stack 2, I’d like you to pick one, tear it up and get rid of it. If you’re using a paper with columns, I’d like you to scratch one out. Scenario 2, you’ve come home after a Friday night football game. You and a friend are going over to another friend’s house. Their parents aren’t home and alcohol is available. You decide to drink a lot. The next morning, you’re hung- over. You’re not feeling well. You’re not able to participate in your favorite activities. I’d like you to tear up one of your activity papers; one of the things that you enjoy doing; and one of your personal attribute characteristics. I’d like you to tear up one thing from Stack 3 and one thing from Stack 4, or cross out one thing from Column 3 and one thing from Column 4.

Scenario 3, drinking has become one of your favorite things to do. You’re spending more and more time doing it. You’re now looking forward to drinking every weekend. You feel like you have it under control. It’s not a problem. I’d like you to tear up one person paper and one personal attribute paper. Tear up one thing from your Stack 1 or cross out something; a person on Column 1. I’d like you to cross out or tear up something from Stack or Column 4.

Now, Scenario 4, you now find yourself drinking every day. There are serious consequences happening in your life. You’re suspended from school. You’re stealing money to support your drinking. You’re fighting with your friends and family. I’d like you to tear up or cross out a person from Stack 1 or Column 1. I’d like you to tear up or cross out one thing from your personal attribute for Column, Stack 4.

Scenario 5, on your way home from a weekend of partying, you’re picked up for a DUI. Tear up one of your possessions and one of your activity; so Stack 2 and Stack 3. Tear up or cross out one from Column 2, Stack 2; one from Column 3, Stack 3.

Lastly, you are now completely at the mercy of your drinking. Your life has gotten completely out of control because of your alcohol use. I’d like you to fan out the remaining papers that you have left. I’d like you to randomly take two away. If you have slips of paper, I’d like you to just close your eyes and randomly take two away. If you have columns in front of you, I’d like you to just pick two and just scratch them out.

Each person is left with one piece of paper. I’d like you to think about, and because of time, we won’t process this. But I will certainly stay on for anyone that does want to talk about it and process it because it can be a little bit intense for some people, even when it’s not ... Often, I do this, and we play the adults that we are. But I wanted you to be able to maybe think about replicating this for the youth that you work with. Some people asked if you could have it, and yes, you can. I will send it to you. Just sort of reach out to me, and we’ll make sure that you can get it.

But as we move forward in, if I could have another like three minutes of your time, and I’ll highlight the most important things for what we have left. But I want you to think about how hard was it for you to choose three people that you like a lot; the possessions that you like; the activities and the attributes. Then, what was the most difficult for you to get rid of; for you to tear up or cross out? Then, how did it feel as you tore up paper after paper? Were some things harder to lose than others? How was it different when you just randomly, at the end, took something away? How does this activity show the consequences of what abuse and addiction might look like?

These are the hallmarks of addiction. It is a disease. It is not a choice. Something to keep in mind, when we’re talking about our adolescents, is they get addicted stronger, deeper and faster than adults, and the effects last longer. If they get high during the weekend, the brain can be affected for days. Alcohol, marijuana, temporarily sedate the brain, but they can permanently damage the teenage brain.

I will provide you with some additional information at each of the stages of the continuum of addiction. But I do just want to leave you with a little bit more helping and enabling that’s on it. This particular slide, the seven C’s of addiction, I’m sorry, the seven C’s, this can be very valuable for the young people that you’re working with who may be in co-dependent relationships.

At the end of our slide, or the slide show, you’re going to see, in the end of your packets, you’re going to see some resources for a co-dependency kit for early childhood professionals. That can be very beneficial because, very often, young people, particularly if they’ve come from a home where there is substance abuse, they will repeat those patterns in their relationships.

Being able to sort of remind themselves that they did not cause what’s happening, they can’t cure it or control it. This applies to mental health concerns as well, and people that may be involved with it are suffering from mental health. But what they can do is take care of themselves by communicating feelings and making healthy choices.

This is a resource, RethinkingDrinking.NIAAA.NIH.gov, to help work specifically with the young people on how to increase their refusal strategies. Then, there are some specific information on avoiding fear tactics with young people and why fear tactics do not work.

The relationship between fear and arousal, motivation, information, processing and self-protective action, basically, there’s a distinction between fear arousal and threat perception. Evidence tells us that fear arousal, in other words, if we use scare tactics, it prompts denial in an individual, and that undermines precautionary motivation. It can be effective when paired with mental rehearsal of recommendation precaution. Low fear often will motivate precaution. High fear will instigate defensive process.

These are some other strategies that you’ll see in that resource that I provided to you. Protective factors, these come from the Search Institute, which build resiliency. Then, these are the resources where all of these strategies came from or some, or rather additional, that the resources that you saw before, the actual place that they came from, are listed on the actual slide.

For anyone who is interested in processing that activity a little bit further, I will stay on the line a little bit longer. If there are specific things like the directions to the activity that we did together, I can certainly, if you reach out to me at my e- mail address down there at the bottom of this slide, I am more than happy to get that to you as well, and also just talk to you about some modifications in different ways of doing that with young people and also way to do that with adults. I thank you very much. I do apologize for taking a little bit extra of your time this morning.

Nichole Fisher: Thank you so much, Stephanie. I just wanted to comment really quickly and piggyback on what Stephanie said, which is, a couple of you have asked questions about the activity that she used, which I think is powerful enough for us as adults. But I can’t imagine we know how the manipulatives and having the hands-on visual of losing things and putting and taking things away could be very powerful for our youth. I think the activity would be very valuable for you working with them as well.

If you do want more information that you don’t actually have accessible to you, please do feel free to e-mail Stephanie at the e-mail address that you see in front of you. Also, the PowerPoint that you saw today is available on the Handouts slide or our Handouts section right there, before you do logout. You should have that also available to you in the future. This will be archived on our website.

If anyone has any questions or you want to stick around, please feel free to ask them now. We’ll hang out here for a couple of minutes, just in case, anyone does want to ask anything. But for now, I just want to thank Stephanie on behalf of Elect across the state for being with us today and offering such valuable information. For everyone who is finished for today, you can go ahead and leave any time you’re ready. But thank you so much for your time today and do the evaluation when it comes out via e-mail. Thank you so much.