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Wednesday, May 28, 2014

Heroin In Ohio: Known and Unknown Risks For Teens

A total of 680 Ohio residents died from heroin-related overdoses in 2012 -- up 60 percent from 2011 and the most deaths from heroin ever recorded in one year, according to data released April 18, 2014, by the Ohio Department of Health.

What is Ohio's response to the increasing number of heroin deaths and rates of substance abuse among its residents? At least one expert believes it is "piece-meal at best and totally uninformed by what has already been established as evidence-based prevention and treatment practices."

(Zili Sloboda. "Ohio's Response to Drug Abuse Problem Is Not Adequate."  
Mansfield News Journal. May 24, 2014)

Zili Sloboda is a Senior Research Associate at the University of Akron’s Institute for Health and Social Policy. Prior to coming to the University in 1999, she was the Director of the Division of Epidemiology and Prevention Research at the National Institute on Drug Abuse.

According to Sloboda, the National Institute on Drug Abuse (NIDA) has invested in research on the problem of drug abuse, and this research has resulted not only in a better understanding about the origins and pathways of drug use and drug use disorders but also how to effectively prevent drug use and treat drug abuse.

Sloboda says, "NIDA has disseminated the findings from this research with the goal of fostering the implementation of evidence-based practices in local communities. This work has been summarized also by the United Nations Office on Drugs and Crime in a guide and a training program for policy makers around the world. I have shared this information with the Ohio Attorney General’s Office as well as the staff responsible for alcohol and drug abuse services.

Furthermore, these plans were made without input from nationally recognized university-based Ohio drug use researchers at The Ohio State University, Wright State University, Kent State University and Case Western Reserve University.

Sloboda concludes: "It is for this reason that the announcement of the governor’s plan to address drug use in Ohio with non-evidence-based programming was disappointing."

Boy and Girl Next Door

The "shock and awe" of the heroin invasion is undeniable. The drug abuse is impacting mostly white suburban families. The new profile of a heroin user is the average girl or boy next door.

Why? Jacqueline Palmer of Palm Partners Recovery Center
gives some insight into what leads to teens' experimentation with opiates like heroin:

* Peer pressure 
* Low self-esteem 
* Depression 
* Pain
* Trauma 
* Abuse 
* Emotional and Mental Disorders  

Palmer states, "The younger U.S population is seriously at risk for drug abuse due to the physical, emotional and psychological changes pre-teens and teens go through. Mix that with peer-pressure and readily available illegal drugs and we have an epidemic on our hands."

(Jacqueline Palmer. "In The News: Heroin Epidemic in Ohio."   June 8, 2012)

Palmer's list is fairly predictable, isn't it? It is about as broad and deep as teen angst complications related to maturation, social acceptance, sexual exploration, and cerebral development. No doubt the young adults of the 21st century face pressures and tensions unknown to their predecessors. And, the future only promises to get worse as America struggles with education, money, and employment problems.

To me, the key to reducing the cause of teen opiate abuse is responsibility. We have become a nation drugged by our own prescriptions -- the belief that pain is to be avoided at all costs -- and by our own "soft" approach to managing home and loved ones. We don't want to disappoint or impede our own children, so we believe teens are tough and ready to face all key decisions in life. We give them more rights and also allow them greater freedoms than ever before, but should we?

Though today's teenager looks like a mature, beautiful adult, the inner image of stability is grossly overestimated. With a Ferrari body and a Hyundai frontal lobe, a teen is a machine wired and poised to make terrible misjudgments. Simply put, these teens are permitted to skip the scenic route of young innocence and encouraged to run headlong into the fast lane of potentially crippling temptations.

Maia Szalavitz, winner of the American Psychological Associations Division 50 Award for Contributions to the Addictions and the Media Award from the American College of Neuropsychopharmacology, says...

"If you’re the parent of a tween, be warned: your cautious 10-year-old is bound to turn into a wild child in a few short years, with seemingly no regard whatsoever for safety. Indeed, teenagers  have the double the risk of dying compared to their preteen selves.

"Adults have long reckoned with ways to protect adolescents from their own misjudgments. Only recently, however, have researchers really begun to understand how the teen brain is wired and that some of what appear to be teens’ senseless choices may result from biological tendencies that also prime their brains to learn and be flexible.

"Take teens’ perception of risk. It’s certainly different from that of adults, but not in the ways you’d expect. Research shows, for instance, that teens tend to wildly overestimate certain risks — of things like unprotected sex and drug use — not to lowball them as one would predict. So, it may be that teens’ notorious risk-taking behavior stems not from some immunity to known risks, but rather, as a new study now suggests, from their greater tolerance to uncertainty and ambiguity — that is, unknown risks."

(Maia Szalavitz. "Why the Teen Brain Is Drawn to Risk." Time. October 2, 2012)

Please, read this very carefully: According to a prominent study published in Proceedings of the National Academy of Sciences (Agnieszka Tymula), "Relative to adults, adolescents engage more in unknown risks than they do in known risks."

This research implies that "if the risks are known, adolescents engage [in risk-taking] less than adults do, but if they are unknown, this is reversed."

The difference in engaging in risky behaviors? Unlike teens, adults tend to focus on the end result and the consequences. Studies confirm that teens think about risks differently: playing Russian roulette, for example, by using their prefrontal cortex. They use quantitative reasoning and take about twice as long as adults do before responding, while adults immediately have a negative reaction to such risks, stemming intuitively from the insula, and almost automatically say no.

Maybe this different brain "wiring" helps teens leave the nest as it increases their desire to be more exploratory.

Valerie Reyna, professor of human development and psychology at Cornell University, has studied how teaching “gist”-based reasoning can help teens avoid dangerous sexual choices, finding that teens who are taught to focus on potential, catastrophic negative outcomes, rather than the odds, make fewer risky sexual decisions and have fewer partners.

Tymula suggests that allowing teens opportunities to safely experiment — for example, a simulator that shows sober teens what drunk driving is like — could also help, by making an unknown risk seem more real and known. Allowing teens the opportunity to take risks in a safe context could also help them develop expertise that underlies gist-based thinking.

While adults tend to prefer the certainty of misery to the misery of uncertainty, as family therapist Virginia Satir once put it, the same may not be true for teens.

To me, risk-taking teens will always be a constant in our culture. The responsibility factor is that parents, guardians, and young people must work together to structure controlled, exciting opportunities to allow teens to experience uncertainty in small stages in order to build decision-making skills.

No longer is it wise to "assume" the environment is relatively safe for those with immature perceptions -- and, that, unfortunately, is an environment affecting all teens, no matter how studious or well-intentioned. It is imperative that all caretakers of teens work together to restore innocence and to monitor progress in how they intend to react to unknown risks.

I hate opiate drug abuse. At the same time, I realize our greatest natural resource, the young people of America, are falling victim to this unthinkable heroin scourge in record numbers. Are they smarter than that? You better believe it -- in their minds and in the minds of many adults they are. But are they mature enough to weather the epidemic of drug abuse with all of its risks? Hell no.

Why? Nature made the brains of children and adolescents excitable. Their brain chemistry is tuned to be responsive to everything in their environment. After all, that's what makes kids learn so easily.

"Addiction has been shown to be essentially a form of 'learning,'" neurologist Francis Jensen, Chair of the Department of Neurology in the Perelman School of Medicine at the University of Pennsylvania says. "After all, if the brain is wired to form new connections in response to the environment, and potent psychoactive drugs suddenly enter that environment, those substances are tapping into a much more robust habit-forming ability that adolescents have, compared to adults."

    (Richard Knox. "The Teen Brain: It's Just Not Grown Up Yet." NPR. March 1, 2010)

How about organizing some great, group hiking, camping, canoeing, go-carting, fishing, hunting, and caving experiences? The list for possible chaperoned adventures goes on and on. So many things can offer youngsters relatively safe but exciting learning experiences that require problem solving. Teaching teenagers the difference between "unknown" and "known" risks requires diligent, sustained efforts, but I can't believe the payoff would be enormous.

Tough love -- do we all have the responsibility to teach it? I believe so. Perhaps the mutual affection that would result from caring for families and for mutual friends on these little risky adventures would well serve a teen alone and faced with an important, potentially deadly decision. After all, whether to take heroin is ultimately a risk that the teen is bound to confront in these drug-riddled times.

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