prevention and treatment for adolescent substance abuse and criminal conduct

234 Pages·2011·4.67 MB·English

TASMANIAN YOUTH CONFERENCE
20 May, 2011
Working With Youth At-Risk of
AOD Abuse and Criminal Conduct
Tramsheds Conference Centre
Launceston
Harvey Milkman, Ph.D
.
Professor, Department of Psychology
Metropolitan State College of Denver
email: [email protected]
Tel: [phone]
PREVENTION AND TREATMENT FOR
ADOLESCENT SUBSTANCE ABUSE AND CRIMINAL CONDUCT
Part I
• Adolescent Development
• Pathways to Delinquency, Substance Abuse
and Crime
• The Cognitive-Behavioral Revolution
• Evidence-Based Practices for Treating
Adolescents
• Working with Female Adolescents
• Dealing with Gangs
• Co-Occurring Disorders
• Exemplary Treatment Approaches
Adolescent Psychological Development
From: (Pediatrics in Review. 2008;29:161-168. doi:10.1542/pir.29-5-161)
2008 American Academy of Pediatrics, Hazen,E., Schlozman, S., Beresin, E
• Although adolescence is widely believed to be an inevitable time of turbulence
and trouble, most teenagers progress through this period of life with few obvious
emotional or behavioral difficulties.
• Given a great deal of individual and cultural variability (e.g., an Asian youth who
begins to question his or her parents values may be viewed by the West as healthy
and normal adolescent development, and by his parents as pathologic and
dangerous), the most useful definition of adolescence is not by age norms, rather
by the developmental tasks characteristic of this age.
• Although we can describe specific domains of adolescent development (i.e.,
physical, cognitive, psychological, and moral) such constructs exist in constant flux,
interacting with each other, and do not occur in isolation (e.g., physical changes
have a major impacton the social and emotional functioning and the boundaries
between developmental domains are notalways distinct). Brain development
during adolescence corresponds to the development of new cognitive capabilities
that, in turn, are involved in shifts in emotionalregulation and processing.
TASKS OF ADOLESCENT DEVELOPMENT
Physical
•Growthspurt
•Growth of pubic and body hair
•Growth and maturationof reproductive organs
Boys:
Increased muscle mass
Onset ofsperm production
Girls:
•Development of female body shape,including breast development
•Menarche
Social and Emotional
•Emotionalseparation from parents
•Greater sense of personal identity
•Identificationwith a peer group
•Exploration of romantic relationships anda sense of one's sexuality
Cognitive
•Increased capacityfor abstraction and advanced reasoning
•Greater impulse control
•Moreeffective assessment of risk versus reward
•Improved use andmanipulation of working memory
•Improved language skills
•Increasedcapacity to self-regulate emotional states
Moral
•Usuallya shift from preconventionalto conventional level of moralityin Kohlberg's theory
•Greater ability to take others’perspectives
•Morality less concrete and rule-based, more focusedon role obligations and how one is perceived by others
•Mayquestion values of parents and institutions
Physical Development
• Physical changes in puberty are attributed to an increased pituitary sensitivity to
gonadotropin- releasing hormone, leading to increased gonadal androgens and
estrogens, thus bringing about rapid changes in height, weight, body shape and genital
development.
• Girls in the US typically begin the physical changes of puberty between 8 and 13, with
the development of breast buds, followed by additional breast development;
enlargement of the ovaries, uterus, labia, and clitoris; and thickening of the vaginal
mucosa. Menarche typically follows 2 to 2 ½ years after breast buds with a mean age of
13.
• Boys in the US typically lag behind girls in most noticeable physical signs of puberty.
Testicular enlargement usually begins around 12 and is followed by the growth of pubic
hair and growth of the penis.
• For both sexes rapid growth in weight and height follows the onset of puberty, usually
beginning distally in the hands and feet before moving proximally to the arms and legs
and finally to the trunk. Height can outpace the growth of muscle mass, thus
contributing to period of awkwardness for some teens. On average, girls meet their
peak in growth velocity around 12, two years before boys.
Physical Development (cont.)
The timing of puberty is influenced by:
• Health and nutritional status (e.g., obesity has been shown to correlate with earlier onset
of puberty in girls and delayed onset in boys; onset of menarche before the age of nine is
rising in the US as is the average age of puberty compared to 30 years ago.
• Ethnicity (e.g., African American girls enter puberty slightly earlier than European American
girls).
The psychological impact of variations in the timing of puberty differs by sex:
• Early developing males have greater self-confidence and are likely to have greater
academic, athletic and social success than their peers and especially when compared to
late developing males.
• Early pubertal development in girls is correlated with lower self-esteem and heightened
concern over body-image.
Adequate sleep is essential for health development during adolescence:
• About 9 to 9 ½ hours per night.
Several factors contribute to inadequate sleep during adolescence:
• hormonal changes,including melatonin secretion, cause a relative sleepphase delay, with a
natural tendency toward later onset of sleepand later waking times.
• Such biological changes correspond to increased academic and social demands.
• In addition to fatigue and impaired performance in class inadequate sleep may increase the
risk of health problems such as obesity.
Emotional and Social Development
Epigenetic Model – Erik Erikson
• Emotional development is a series of crises where individuals must complete
difficult, sometimes conflicting tasks in order to maintain a developmental
trajectory.
• Developmental challenges are binary crises that force the individual to choose a
more adaptive (desirable) emotional stance (e.g., infancy is described as trust
versus mistrust -- if infants do not learn to trust the world to care for them, they
will develop a suspicious and paranoid stance when moving along the
developmental trajectory).
• Adolescence is a period of identity formation and role diffusion: An incoherent
sense of self and values will result in the lack of as sense of identity.
• A second separation from adult caretakers -- first separation occurs when the
younger child attains the motor and cognitive ability to move away from the
parents’ constant watch.
Emotional and Social Development (cont.)
From: Theory of Psychological Belonging : Noam G. The psychology of belonging:
reformulating adolescent development. Adolesc Psychiatry. 1999;24 :49 –68
• Adolescence is less concerned with identity formation that group cohesion ( e.g., the
middle school child places a high priority on popularity is in the midst of a normal
developmental stage.
• Successful membership within groups sets the stage for later confidence to move
throughout different groups.
• Healthy early adolescence ischaracterized by identity with specific group values and
norms.
• Healthy later adolescence is characterized by increasingcomfort with one's capacity to
choose among many different groupsand to endorse selectively the values that have
particular relevanceto the individual.
• Clinical implications: Any attempt to counsel younger adolescents must take into account
increased susceptibility to peer pressure as a meansof maintaining group identity; older
adolescents generallyrespond more readily to challenges to resist peer pressure forthe
sake of forming their own unique sense of identity.
Horizontal Conformity
The Deviant Career