Chemical and the Chemical and the NeonateNeonate

Chapter 20Chapter 20

Fetal Alcohol Exposure and the Fetal Alcohol Exposure and the BrainBrain

describes a pattern of birth defects found in children of describes a pattern of birth defects found in children of mothers who consumed alcohol during pregnancymothers who consumed alcohol during pregnancy

Today, FAS remains the leading known preventable Today, FAS remains the leading known preventable cause of mental retardation cause of mental retardation

Behavioral and neurological problems associated with Behavioral and neurological problems associated with prenatal alcohol exposure may lead to poor academic prenatal alcohol exposure may lead to poor academic performance as well as legal and employment difficulties performance as well as legal and employment difficulties in adolescence and adulthood in adolescence and adulthood

Despite attempts to increase public awareness of the Despite attempts to increase public awareness of the risks involved, increasing numbers of women are risks involved, increasing numbers of women are drinking during pregnancy (NIAAA drinking during pregnancy (NIAAA National Institute National Institute on Alcohol Abuse and Alcoholism)on Alcohol Abuse and Alcoholism)

Scope of the ProblemScope of the Problem

A period of special vulnerabilityA period of special vulnerability 60% of the blood that the fetus receives 60% of the blood that the fetus receives

from the umbilical cord is processed by the from the umbilical cord is processed by the liver before it proceeds to the rest of bodyliver before it proceeds to the rest of body

In the US:In the US: 19% of women will use alcohol19% of women will use alcohol 20% smoke cigarettes20% smoke cigarettes 5.5% use illicit drugs5.5% use illicit drugsAt some point during pregnancyAt some point during pregnancy

Definitions and IncidenceDefinitions and Incidence

FAS is defined by four criteria: maternal drinking FAS is defined by four criteria: maternal drinking during pregnancy; a characteristic pattern of during pregnancy; a characteristic pattern of facial abnormalities; growth retardation; and facial abnormalities; growth retardation; and brain damage, which often is manifested by brain damage, which often is manifested by intellectual difficulties or behavioral problems (3). intellectual difficulties or behavioral problems (3). When signs of brain damage appear following When signs of brain damage appear following fetal alcohol exposure in the absence of other fetal alcohol exposure in the absence of other indications of FAS, the condition is termed indications of FAS, the condition is termed "alcohol-related neurodevelopmental disorder" "alcohol-related neurodevelopmental disorder" (ARND) (3). NIAAA(ARND) (3). NIAAA

Specific Cognitive and Behavioral Specific Cognitive and Behavioral Impairments Impairments

Attention.Attention. Visual-Spatial LearningVisual-Spatial Learning spatial spatial

relationships among objects relationships among objects Verbal Learning Verbal Learning language and memory language and memory Reaction Time Reaction Time how quickly the brain how quickly the brain

processes informationprocesses information Executive Functions Executive Functions (i.e., activities that (i.e., activities that

require abstract thinking, such as planning require abstract thinking, such as planning and organizing).and organizing).

Other effectsOther effects

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fetal alcohol spectrum disorders fetal alcohol spectrum disorders (FASDs)(FASDs)

has emerged to address the need to has emerged to address the need to describe the spectrum of disorders related describe the spectrum of disorders related to fetal alcohol exposure. It is an umbrella to fetal alcohol exposure. It is an umbrella term describing the range of effects that term describing the range of effects that can occur in an individual whose mother can occur in an individual whose mother drank alcohol during pregnancy. These drank alcohol during pregnancy. These effects can include physical, mental, effects can include physical, mental, behavioral, learning disabilities, or a behavioral, learning disabilities, or a combination of these, with possible lifelong combination of these, with possible lifelong implications. implications.

FASFAS

FAS is a permanent condition. It affects FAS is a permanent condition. It affects every aspect of an individual’s life and the every aspect of an individual’s life and the lives of his or her family. However, FAS is lives of his or her family. However, FAS is 100% preventable—if a woman does not 100% preventable—if a woman does not drink alcohol while she is pregnant. drink alcohol while she is pregnant.

Is there any safe amount of Is there any safe amount of alcohol to drink during alcohol to drink during

pregnancy?pregnancy? There is no known safe amount of alcohol that a There is no known safe amount of alcohol that a

woman can drink during pregnancy. There is woman can drink during pregnancy. There is also no safe time during pregnancy to drink also no safe time during pregnancy to drink alcohol. Alcohol can have negative effects on a alcohol. Alcohol can have negative effects on a fetus in every trimester of pregnancy. Therefore, fetus in every trimester of pregnancy. Therefore, women should not drink if they are pregnant, women should not drink if they are pregnant, planning to become pregnant, or could become planning to become pregnant, or could become pregnant (that is, sexually active and not using pregnant (that is, sexually active and not using an effective form of birth control). an effective form of birth control).

Refer to breakout sessions for Refer to breakout sessions for other drugsother drugs

CocaineCocaine AmphetamineAmphetamine OpiateOpiate MarijuanaMarijuana CigarettesCigarettes

Special PopulationsSpecial Populations

CHAPTER 21CHAPTER 21

Hidden FacesHidden Faces

WomenWomen ElderlyElderly HomosexualsHomosexuals DisabledDisabled Ethnic MinorityEthnic Minority

Buzz SessionBuzz Session

Count your points only if your group answers Count your points only if your group answers the following:the following:

1. scope of the problem1. scope of the problem

2. Impact of the use of chemicals2. Impact of the use of chemicals

3. Treatment considerations3. Treatment considerations

4. What are the barriers you think that an 4. What are the barriers you think that an individual in your identified group faces in individual in your identified group faces in treatmenttreatment

Chapter 23Chapter 23

CHEMICAL USE BY CHILDREN AND CHEMICAL USE BY CHILDREN AND ADOLESCENTSADOLESCENTS

CONSEQUENCESCONSEQUENCES

WHAT ARE SOME OF THE LIFE LONG WHAT ARE SOME OF THE LIFE LONG CONSEQUENCES OF CHILDHOOD OR CONSEQUENCES OF CHILDHOOD OR ADOLECENT DRUG/ALCOHOL USE?ADOLECENT DRUG/ALCOHOL USE?

ProblemProblem

80% of 18 yr. olds have used alcohol at 80% of 18 yr. olds have used alcohol at least onceleast once

4% use regular4% use regular 66% of 18 yr. olds have tried cigarettes66% of 18 yr. olds have tried cigarettes 13% smoke at least ½ pack per day13% smoke at least ½ pack per day

Special vulnerabilitySpecial vulnerability

Those that use in adolescence are at Those that use in adolescence are at greater risk to become addictedgreater risk to become addicted

16% of children who experiment with 16% of children who experiment with marijuana before that age of 12 will go on marijuana before that age of 12 will go on to use heroin, compared to only 8% of to use heroin, compared to only 8% of those whose first marijuana exposure is those whose first marijuana exposure is after the age of 12after the age of 12

Attachment bonds help protect them from Attachment bonds help protect them from addictionsaddictions

ControversyControversy

Some believe any use is a serious Some believe any use is a serious problemproblem

Others believe that “experimental” use is a Others believe that “experimental” use is a part of adolescencepart of adolescence

What do you think?What do you think?

Page 305Page 305

Scope of the problemScope of the problem

Estimate nationally that 800,000 Estimate nationally that 800,000 adolescents between 12 and 17 are adolescents between 12 and 17 are thought to be addicted to an illicit drugthought to be addicted to an illicit drug

Alcohol is popular-parental denialAlcohol is popular-parental denial 45% of older than 12 admit to using 45% of older than 12 admit to using

alcohol at least once in the past 30 daysalcohol at least once in the past 30 days

Why worry?Why worry?

Brain still developingBrain still developing ““Gateway” drug theoryGateway” drug theory

Tobacco UseTobacco Use

Avg. age a smoker begins is age 12Avg. age a smoker begins is age 12 Which are regular smokers at age 14Which are regular smokers at age 14 In US avg. of 6,000 adolescents start In US avg. of 6,000 adolescents start

smoking every day, ½ become daily userssmoking every day, ½ become daily users 1997 major lawsuit1997 major lawsuit Parental influenceParental influence Victimization theoryVictimization theory RebellionRebellion

Tweed (1998) symptoms of Tweed (1998) symptoms of adolescent SA problemadolescent SA problem

Weight lossWeight loss Nasal irritationNasal irritation Frequent colds or allergiesFrequent colds or allergies HoarsenessHoarseness Chronic coughChronic cough Unexplained injuriesUnexplained injuries Needle tracksNeedle tracks Social withdrawalSocial withdrawal PromiscuityPromiscuity Fights Fights Hiding bottles.drug paraphernaliaHiding bottles.drug paraphernalia Selling possessionsSelling possessions Legal problemsLegal problems Drastic change in sleep patternsDrastic change in sleep patterns

Problems with diagnosisProblems with diagnosis

Standards for diagnosis and treatment are Standards for diagnosis and treatment are primitive and there is little research doneprimitive and there is little research done

Referrals for evaluation often come from juvenile Referrals for evaluation often come from juvenile court system, schools court system, schools

Many of the evaluations are done by the Many of the evaluations are done by the treatment center and not an independent treatment center and not an independent evaluatorevaluator

Adolescents tend to have immature view of life, Adolescents tend to have immature view of life, fatalistic-misinterpreted by treatment staff as fatalistic-misinterpreted by treatment staff as “denial”“denial”

DiagnosisDiagnosis

Stages page 314Stages page 314 Criteria page 317Criteria page 317