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  • Addiction Recovery for Young Adults: It's Complicated
    Pipeline Art

    Michael Fishman

    At the National Collegiate Recovery Conference Wednesday at Kennesaw State University, Michael Fishman, Director of the Young Adult Program at Talbott Recovery Campus in Atlanta, neatly summed up everything he had learned in 22 years of treating addiction in young adults. The recurring theme of his keynote address: It’s complicated.

    “Most young adults are generally poly-substance abusers,” he said.

    They aren’t just using marijuana; they’re also drinking, Fishman says. It’s not just opioids, it’s opioids and anti-depressants or any other combination. And that complicates the picture for doctors trying to get to know their patient’s true diagnosis.

    “The drugs and alcohol may mask the underlying pathology,” Fishman said. Withdrawal symptoms, he added, “cloud the picture,” as do toxicity and detox.

    Additionally, many young adults suffering from addiction are also suffering from mental illness of some kind, what Fishman calls “dual-diagnosis.” Depression and anxiety are common in substance abusers and the addiction may begin as an attempt to self-medicate, which Fishman says doesn’t work.

    “Ask any young person who self-medicates how that’s working out for them,” he said with a laugh.

  • Introducing an Evidence-Based, Time- and Cost-Efficient Assessment for Adolescents: CHAT

    To help organizations seeking a time- and cost-efficient assessment for adolescents, Inflexxion developed the Comprehensive Health Assessment for Teens, or CHAT, which has been found to be both valid and reliable in research funded by the National Institute on Drug Abuse (NIDA).

    The CHAT format is based on the ASI-MV Connect, a self-administered, multimedia version of the Addiction Severity Index (ASI) developed by Dr. A. Thomas McLellan. A number of treatment centers, such as the Center for Drug-Free Living in Orlando, Florida, are using the ASI-MV Connect as part of the NIATx campaign to streamline their assessment procedures [PDF].

  • Use, Abuse, Dependence - Who Decides?

    adolescent-substance-abuse-assessment-not-all-science-checkboxI often hear people refer to the distinction between drug "use" and drug "abuse" as if it were an immutable, medical fact. A review of recent history suggests otherwise. Just as the American Psychiatric Association once viewed homosexuality as a mental disorder, the meaning of "substance use disorder" has evolved over time. The definitions we use today are partly a social construction, subject to changing mores, values, and even our political culture.

    As readers of this blog certainly know, social service professionals use a variety of screening and assessment instruments to detect drug problems. Many tools still rely on the underlying logic of the American Psychiatric Association's Diagnostic and Statistical Manual, or DSM.

    The DSM is widely endorsed, but few policymakers and other nonclinicians appreciate how much it has evolved. Consider this passage from the DSM 1980 edition:

  • Marijuana Debate Turns Serious

    It's remarkable how suddenly the debate over marijuana legalization has moved from the fringes to mainstream.

    Decriminalizing possession of small amounts of pot (but not its cultivation and sale) has been implemented in Massachusetts, and is being considered in Chicago, Rhode Island, and other communities.

  • Effective Mental Health Screening in Juvenile Justice - 10 Key Steps: a Webinar

    juvenile-mental-health-screenings-self-portrait-of-teen.jpgYouth Today tipped me off to an upcoming one-hour webinar on conducting mental health screenings and assessments in the juvenile justice system.

    It's sponsored by The Council of State Governments' Justice Center and will be held June 30, from 3pm - 4pm EST. Among other things, the webinar will "showcase '10 steps' that have proven to be necessary for effective implementation of mental health screening in juvenile justice settings."

    Follow the links to register.

    *Photo copyright Adam Foster | Codefor; reposted under Creative Commons license.

  • Integrating the GAIN ABS System with an Electronic Record System like WITS

    [As adolescent treatment providers invest in eletronic medical record systems, a natural question arises: how do we integrate our assessment tool into our new record system? Dr. Michael Dennis, creator of the GAIN, has some answers. --Ed.]

    This post is a little technical, so here's the bottom line: we will be happy to work with individual treatment providers or with vendors to customize their systems to integrate GAIN data into their electronic medical records. (Scroll to the bottom of this post for contact information.)


    During the past 3 years, Chestnut Health Systems has collaborated with the Center for Substance Abuse Treatment (CSAT) and over 30 agencies to revise the Global Appraisal of Individual Needs (GAIN) instrument and software to allow it to better integrate with the growing number of electronic medical records systems. Several people have asked us to give a brief update on the status of what we have done so far in this area.

  • Teen Suicides in Justice System Often Unknown to State Regulators

    Youth Today reports that the number of juveniles in the justice system who commit suicide while confined is higher than anyone thought -- worse yet, their deaths often go unreported to state authorities.

    We know this because the Office of Juvenile Justice and Delinquency Prevention (OJJDP) commissioned a report, Characteristics of Juvenile Suicide in Confinement. Though the report was completed in 2004, it was only released yesterday. The author blames former top OJJDP administrator, J. Robert Flores for the delay. 

    One takeaway: youth entering detention should be given mental health assessments as soon as possible. Over half of the youth who killed themselves in detention did so within the first six days, and only 35% had received a mental health assessment by then. Stands to reason that a youth's alcohol and drug use should also be assessed at the same time.

  • The Enduring Gateway Myth

    In my work with juvenile justice agencies and drug treatment professionals, I still hear people call cannabis (or marijuana) a "gateway" drug. This is one of those notions that just won't go away despite the availability of good information that disproves it.