Dare to Discuss Drugs Forum Pomperaug High School June 8, 2010 John Hamilton, LMFT,LADC (203)...

Dare to Discuss Drugs ForumDare to Discuss Drugs ForumPomperaug High School Pomperaug High School

June 8, 2010June 8, 2010

John Hamilton, LMFT,LADCJohn Hamilton, LMFT,LADC(203) 858-8028(203) 858-8028

[email protected]@rnpinc.org

New Trends

Binge drinking

Over the counter

Prescription Drugs

Girls competing with boys

Increased purity (heroin and marijuana)

11.7 years old11.7 years old20% greater20% greater1 out of 5 kids1 out of 5 kids38%/19%38%/19%40% chance40% chance70,000 per year70,000 per yearParticipation in HS sportsParticipation in HS sports

National Epidemiologic Survey on Alcohol and Related Conditions, 2003National Epidemiologic Survey on Alcohol and Related Conditions, 2003

AgeAge

Age at tobacco, at alcohol and at cannabis dependence, as per DSM IV

0.00.0

0.20.2

0.40.4

0.60.6

0.80.8

1.01.0

1.21.2

1.41.4

1.61.6

1.81.8

55 1010 1515 2020 2525 3030 3535 4040 4545 5050 5555 6060 6565

% in

eac

h a

ge

gro

up

to

dev

elo

p

% in

eac

h a

ge

gro

up

to

dev

elo

p

firs

t-ti

me

dep

end

ence

firs

t-ti

me

dep

end

ence

THCTHCALCOHOLALCOHOL

TOBACCOTOBACCO

Addiction Is a Developmental Disease starts in childhood and adolescence

Addiction Is a Developmental Disease starts in childhood and adolescence

7070 7575

Grade Alcohol % Marijuana % Any Illicit %

8 20 8 10

10 35 18 21

12 49 22 25

Substance Use by Youth - Prior Month 2002

(Monitoring the Futures, 2003)

Substance Abuse/Dependence rates vary:

3-15%

Can Addiction be Prevented by Can Addiction be Prevented by Delaying Alcohol Onset?Delaying Alcohol Onset?

• Every year use of alcohol is Every year use of alcohol is delayed, the risk of delayed, the risk of developing an alcohol developing an alcohol disorder is reduced. disorder is reduced.

Percentages of Past Year Alcohol Dependence or Abuse Percentages of Past Year Alcohol Dependence or Abuse Among Adults Aged 21 or Older, by Age of First Use Among Adults Aged 21 or Older, by Age of First Use

(SAMHSA)(SAMHSA)

1615

9

4.22.6

0

5

10

15

20

<12 yrs 12-14 yrs 15-17 yrs 18-20 yrs 21+ yrs

Age Started Drinking

Perc

en

t

Adolescence is a period of profound brain maturation.

It was believed that brain development was complete during childhood

The maturation process is not complete until about age 24!!!

• Back of brain matures before to the front of the brain…• sensory and physical activities

favored over complex, cognitive-demanding activities

• propensity toward risky, impulsive behaviors • group setting may promote risk

taking

• poor planning and judgment

Arrested Development

motivation

emotion

judgment

cerebellum

amygdala

nucleus accumbens

Pruning occurs in stages, from back of the brain to the front

prefrontal cortex

physical coordination; sensory processing;

motivation

emotionjudgment

Age 24

physical coordination; sensory processing;

Are adolescents more susceptible Are adolescents more susceptible to alcohol than adults?to alcohol than adults?

• Adult studies suggest that the areas of the Adult studies suggest that the areas of the adolescent brain that are remodeled are adolescent brain that are remodeled are sensitive to the effects of alcoholsensitive to the effects of alcohol

• Four Four pieces of evidencepieces of evidence

Are adolescents more susceptible to Are adolescents more susceptible to alcohol than adults?alcohol than adults?

1.1. Reduced sensitivity to Reduced sensitivity to intoxicationintoxication

2.2. Increased sensitivity to social Increased sensitivity to social disinhibitionsdisinhibitions

4.4. Medicates “hyper excitability”Medicates “hyper excitability”

Increases reinforcing properties

Are adolescents more susceptible to Are adolescents more susceptible to alcohol than adults?alcohol than adults?

Greater deficits

3 Greater adverse effects to Greater adverse effects to cognitive functioningcognitive functioning

How do your kids view your How do your kids view your relationship?relationship?

0102030405060708090

100

7thGrade

8thGrade

9thGrade

10thGrade

GreatCould Be BetterBad

There is a perception among many There is a perception among many students that parents contribute to students that parents contribute to the pressures. Many seemed to be the pressures. Many seemed to be seeking acceptance for who they seeking acceptance for who they were rather than for who their were rather than for who their parents wanted them to be.parents wanted them to be.

HONESTYHONESTY

56% of students 56% of students surveyed said they surveyed said they are NOT honest with are NOT honest with their fathers their fathers

Why?Why?““No way! If my dad knew No way! If my dad knew

what I was doing he what I was doing he would flip!” 10would flip!” 10thth, m, , m, privateprivate

““I am honest… just not I am honest… just not when it comes to when it comes to drinking” 8drinking” 8thth, f, private, f, private

““I don’t tell him things if I I don’t tell him things if I know he will get mad know he will get mad about it” 9about it” 9thth, f, public, f, public

HONESTYHONESTY

Only 35% of students Only 35% of students surveyed believes surveyed believes their father is honest their father is honest with them.with them.

This is what they are saying…This is what they are saying…

““My dad lies to me all the My dad lies to me all the time” 9time” 9thth, f, public, f, public

““My dad hides everything My dad hides everything from me” 8from me” 8thth, f, private, f, private

““Yeah, I think my dad is Yeah, I think my dad is honest with me most of honest with me most of the time” 7the time” 7thth, f, public, f, public

If you could, what would you change If you could, what would you change about your relationship with your dad?about your relationship with your dad?

The top 5 answers:The top 5 answers:

5. Trust me more5. Trust me more

4. Be home more4. Be home more

3. Be more 3. Be more understandingunderstanding

2. Spend more time 2. Spend more time togethertogether

1. Communicate more.1. Communicate more.

DA

D2

Rec

epto

r A

vaila

bili

tyD

A D

2 R

ecep

tor

Ava

ilab

ility

CocaineCocaine

AlcoholAlcohol

DA

DA

DA

DA DA DA

DA

Reward Circuits

DA DA DA DA

DA

Reward Circuits

DA

DA

DA

DA DA

DA

Drug AbuserDrug Abuser

Non-Drug AbuserNon-Drug Abuser

HeroinHeroin

MethMeth

Dopamine D2 Receptors are Lower in Addiction

controlcontrol addictedaddicted

Becomes SubordinateStress remains

IndividuallyHoused

GroupHoused

Morgan, D. et al. Nature Neuroscience, 5: 169-174, 2002.

**

S.003 .01 .03 .1

0

10

20

30

40

50

Rei

nfo

rcer

s (p

er s

essi

on)

Cocaine (mg/kg/injection)

Dominant

Subordinate

Becomes DominantNo longer stressed

Isolation Can Change NeurobiologyIsolation Can Change Neurobiology

Effects of a Social Stressor on Brain DA D2 Receptors and Propensity to Administer Drugs

Effects of a Social Stressor on Brain DA D2 Receptors and Propensity to Administer Drugs

NIAAA GuidelinesNIAAA Guidelines

Men-less than 4 drinks Men-less than 4 drinks daily/14 per week totaldaily/14 per week total

Women-less than 3 Women-less than 3 drinks daily/ 7 per weekdrinks daily/ 7 per week

DRINKING PATTERNSDRINKING PATTERNS

Never exceed the daily or Never exceed the daily or weekly limits-1 in 100weekly limits-1 in 100Exceed only the daily Exceed only the daily limit-1 in 5limit-1 in 5Exceed both daily and Exceed both daily and weekly limits -1 in 2weekly limits -1 in 2

Dimensional Diagnosis of Dimensional Diagnosis of AUD: One ApproachAUD: One Approach

Never exceedsdaily limits

• Exceedsdaily limits

• No current sequelae

• Exceedsdaily limits

• Current sequelae

• Daily or neardaily heavydrinking


• Withdrawal

• Daily or neardaily heavydrinking


• Withdrawal• Chronic orrelapsing

None Mild(“At-risk”)

Moderate(Harmful use)

Severe(Dependence)

Chronicdependence

Rehabilitation

Public health perspective of Public health perspective of alcohol use and disordersalcohol use and disorders

Use &Problems

Modality

None

1º Prevention2º Prevention

ModerateSevere

Chronic

Disease Management

Rehabilitation

Continuum of Care for Continuum of Care for AddictionsAddictions

Use &Problems

Modality

None

1º Prevention2º Prevention

ModerateSevere

Chronic

Disease Management

Facilitatedself change

Heavy drinking only

Chronic

Disease Management

Briefmotivationalcounseling

Medicalmanagement +pharmacotx or CBI

Specializedremission-orientedtreatment

Increased quantity, frequency & consequences of alcohol use

Harmful drinking Dependence

Extended ContinuumExtended Continuum

INCREASED INCREASED EXPOSURE TO EXPOSURE TO BOTH STRESS AND BOTH STRESS AND SUBSTANCES SUBSTANCES INCREASES RISKINCREASES RISK

GeneticsGeneticsGeneticsGenetics

EnvironmentEnvironmentEnvironmentEnvironment

Gene/Gene/EnvironmentEnvironmentInteractionInteraction

Gene/Gene/EnvironmentEnvironmentInteractionInteraction

DRUGSDRUGS

BRAIN BRAIN MECHANISMSMECHANISMS

BEHAVIORBEHAVIOR

ENVIRONMENTENVIRONMENT

HISTORICALHISTORICAL

ENVIRONMENTALENVIRONMENTAL

- previous history- previous history- expectation- expectation- learning- learning

- social interactions- social interactions- stress- stress- conditioned stimuli- conditioned stimuli

- genetics- genetics- circadian rhythms- circadian rhythms- disease states- disease states- gender- gender

PHYSIOLOGICALPHYSIOLOGICAL

Drug Addiction:Drug Addiction:A Complex Behavioral and Neurobiological DisorderA Complex Behavioral and Neurobiological Disorder

RESILIENCYRESILIENCY

SOCIAL COMPETENCESOCIAL COMPETENCE

PROBLEM SOLVING SKILLSPROBLEM SOLVING SKILLS

AUTONOMYAUTONOMY

SENSE OF PURPOSESENSE OF PURPOSE

RISK AND PROTECTIVE RISK AND PROTECTIVE FACTORSFACTORS

Risk FactorsRisk Factors DomainDomain Protective Protective FactorsFactors

Sensation-seekerSensation-seeker IndividualIndividual Successful studentSuccessful student

Child of drug userChild of drug user Bonds with familyBonds with family

No supervisionNo supervision FamilyFamily Consistent disciplineConsistent discipline

Parent/sibling drug useParent/sibling drug use Anti-drug family rulesAnti-drug family rules

Pro-drug use normPro-drug use norm SchoolSchool Anti-drug use normAnti-drug use norm

Availability of drugsAvailability of drugs High academicsHigh academics

Crime/povertyCrime/poverty CommunityCommunity Consistent anti-drug Consistent anti-drug messagemessage

No afterschool programsNo afterschool programs Strong law enforcementStrong law enforcement

CRAFFTCRAFFT

CarCar

RelaxRelax

AloneAlone

Family or FriendsFamily or Friends

ForgotForgot

TroubleTrouble

Demographics of prescription drug misusers

In 2006, a study sponsored by a Partnership for a Drug-Free America (PDFA) that 1 in 5 teens misuse prescription drugs. This finding is significant as youth believe that painkillers are a “safer” way to get high as opposed to illicit drugs.

The Partnership Attitude Tracking Study found that 62% of youth reported access to “powerful painkillers” at home while 52% reported that prescription drugs were “available everywhere”.

(Join Together, 2006)

Prescription Drug AbuseIn 2002, an estimated 6.2 million people –

2.6% of the population aged 2 and older were currently (in last month) using prescription drugs non-medically (up from 4 million in 1999)

Pain relievers – 2.6 million users

Sedatives/tranquilizers – 1.3 million users

Stimulants – 4 million users

NIDA Research Report Series – Prescription Drugs: Abuse and Addiction Trends in prescription drug abuse

Reported Non-Medical Prescription Drugs of Abuse (2005)

S edatives

S timulants

TranquilizersPainkillers

4,700,000

1,800,000

1,100,000

272,000

(Substance Abuse and Mental Health Services Administration [SAMHSA], 2005)


Among adolescents and young adults, prescription drug abuse is highest nationally among young adults aged 18-25 years old.

The National Institute on Drug Abuse’s Monitoring the Future survey in 2005 found that 12 graders reported using OxyContin and Vicodin without a prescription.

This is a concern since youth who use other drugs are likely to abuse prescription medications.

38

Prescription drug use in AmericaThe National Surveys on Drug Use and Health (NSDUH) asked non-medical users of prescription-type psychotherapeutic drugs regarding how they obtained the drugs they recently used non-medically.

In 2005, the most prevalent source from which recently used drugs were obtained among non-medical users of prescription-type drugs was "from a friend or relative for free.

Among persons aged 12 or older who used pain relievers non-medically in the past 12 months, 59.8% reported that the source of the drug the most recent time they used was from a friend or relative for free.

(Substance Abuse and Mental Health Services Administration [SAMHSA], 2005)


Men and women have similar rates of non-medical use of prescription drugs. Gender differences in prescription drug abuse can be observed among girls aged 12-17 years old.

Women are at increased risk of abusing benzodiazepines.

(National Institute on Drug Abuse [NIDA], 2005)

TRIscience

addiction

Rx Opiate UserRx Opiate User

White

Rural, suburban

Higher SES

Heroin UserHeroin User

Minority

Urban

Lower SES

41

Commonly used prescription drugs

The most commonly abused prescription drugs can be classified in three classes:

– Opioids

– Central Nervous System (CNS) depressants

– Stimulants


Commonly used prescription drugs

– Opioids are mostly used to treat pain.Some examples of opioids are codeine, morphine, and opium.

– Central nervous system (CNS) depressants are used to treat anxiety and sleep disorders.

Some examples of CNS depressants are flunitrazepam, barbiturates, and benzodiazepines.

– Stimulants are prescribed to treat the sleep disorder narcolepsy and attention-deficit hyperactivity disorder (ADHD).

Some examples of stimulants are cocaine, methamphetamine, and amphetamines.

42


Preventing prescription drug abuse/misuse

Increasing the role of the physician

Prescription drug abuse prevention is a is an important part of patient care.

Nearly 70 percent of Americans (191 million people) - visit a health care provider, such as a primary care physician, at least once every 2 years.

Accurate screening and increases in medication should be careful monitored by physicians as well as the patient receiving the medication.


Warning signs of potential prescription drug abuse

You take more pain medication than your doctor has prescribed.

You request prescriptions from multiple doctors.

You use alcohol or other medications to increase the effects of the pain medication.

You take pain medication to deal with other problems, such as anxiety or stress.

Your doctor, friends or loved ones express concern about your use of pain medication.

(The Mayo Clinic, 2006)

School-based prevention

Among school-age children and adolescents who may be at risk of non-medical use of pharmaceuticals, McCabe, Teter, & Boyd

(2004) suggest that physicians, parents, pharmacists, school nurses, social workers, counselors, and principals be educated about the prescription drug misuse.

Other school administrators such as school nurses, social workers, etc. can help monitor which students are prescribed medications and may be at risk for prescription drug diversion.

McCabe, S.E., Teter, C.J., & Boyd, C.J. (2004). The use, misuse, and diversion of prescription stimulants among middle and high school students. Substance Abuse & Misuse, 93, 7, 1095-1116.

Why is heroin use growing?– Lower price– Longer “high”– Increasing purity

Nasal inhalation

– Increased availability– Reduced social stigma around use– Opiate prescriptions leading to heroin use

Oxycodone, hydrocodone, & codeine

The Heroin Epidemic

Major reduction in Alcohol and Cocaine admissions from 1996 to 2002

Heroin increases significantly over the same period

68

50

37

56

41

48

30

35

40

45

50

55

60

65

70

1996 2002

AlcoholCocaineHeroin

The Heroin Epidemic

DMHAS – Connecticut & UConn

Getting Better: A Study of Addiction Services in Connecticut

Admission Statistics – Self-Identified problem substance at admission to treatment

Opioid Withdrawal SeverityS

ever

ity o

f W

ithdr

awal

Days Since Last Opiate Dose

0

5 10 15

Heroin

Buprenorphine

Methadone

Contingency management reduces drug useOpioids

(Bickel et al., 1997; Preston et al., 1998)

Cocaine(Higgins et al., 1991, 1993, 1994; Silverman et al.,

1996)

Benzodiazepines(Stitzer et al., 1992)

Marijuana (Budney et al., 1991, Budney et al., 2000)

Nicotine (Stitzer & Bigelow, 1984; Roll et al., 1996)

Dysfunctional Family

There is no such thing as a dysfunctional family. All behavior is adaptive and has a function.

WHAT WORKSMotivational Enhancement Therapy (MET)

Motivational Incentives (Contingency Management)

Matrix Model (Stimulants)

Seeking Safety Model (Women and Trauma)

Relapse Prevention (Marlatt)

Cognitive Behavioral Therapy

Evidence Based Adolescent Treatment

BSFT-Brief Strategic Family Therapy (Szapocznick)MST-Multisystemic Therapy (Henggeler)MDFT-Multidimensional Family Therapy (Little)

What Does Not Work

Confrontation -confrontation is only effective if it is perceived as concern . It assumes a therapeutic relationship.

(The goal of the first session is to have a second session)Substance abuse education aloneGroup therapy and residential treatment with some adolescent populations

Stages Of Change Pre-Contemplation (Denial)

(“I’m Only Here Because …”) Contemplation (Ambivalence)

(“I’m Not Sure What To Do”) Preparation (Early Recovery)

(“I’ve Cut Back A Little Already”) Action (Treatment Ready)

(“I’ll Do What It Takes”) Maintenance (Relapse Prevention)

(“This Isn’t As Easy As I Thought”)

Match Tx To “Stages Of Change”

Where is your child at?

Where are you at?

Where is the rest of the family at?

Where is the community at?

H=WH=W - - - - - -- - - - - -

S DS D

ENJOY YOR ENJOY YOR MATE MORE MATE MORE THAN YOUR THAN YOUR CHILDRENCHILDREN

The greatest gift a father can give to The greatest gift a father can give to his children is to love their mother and his children is to love their mother and the greatest gift a mother can give to the greatest gift a mother can give to her children is to love their father.her children is to love their father.

This is where kids learn intimacy This is where kids learn intimacy and dignity and respectand dignity and respect

All your statements with your All your statements with your teens should start with “I know teens should start with “I know I can’t stop you from……at this I can’t stop you from……at this party – however, if you do this, party – however, if you do this, this will happen”this will happen”Consequences must be Consequences must be reasonable and enforceablereasonable and enforceable

Meet your kids Meet your kids

where they are atwhere they are at

IF YOU MEET YOUR KIDS IF YOU MEET YOUR KIDS WHERE THEY ARE YOU WHERE THEY ARE YOU

WILL ALWAYS WALK WILL ALWAYS WALK AWAY WITH AWAY WITH

COMPASSION AND NEW COMPASSION AND NEW UNDERSTANDINGUNDERSTANDING

ALWAYS ASSESSALWAYS ASSESS

ABILITYABILITY

WILLINGNESSWILLINGNESS

THE TWO JOBS OF THE TWO JOBS OF CHILDRENCHILDREN

RECEIVE LOVERECEIVE LOVE

LEARNLEARN

INDIVIDUATIONINDIVIDUATION

SEPARATIONSEPARATION

AUTONOMYAUTONOMY

COOPERATIONCOOPERATION

TRUSTTRUST

VS VS

FAITHFAITH

EVERYONE MAKES THE BEST EVERYONE MAKES THE BEST DECISIONS AVAILABLE TO THEM AT DECISIONS AVAILABLE TO THEM AT THE TIME WITH THE CHOICES THE TIME WITH THE CHOICES AVAILABLE TO THEM.AVAILABLE TO THEM.

CONTROLCONTROL

vs.vs.

INFLUENCE INFLUENCE

EVERY TIME YOU EVERY TIME YOU ENGAGE IN A CONFLICT ENGAGE IN A CONFLICT WITH YOUR CHILD WITH YOUR CHILD

YOUR CHILD MISSES AN YOUR CHILD MISSES AN OPPORTUNITY OPPORTUNITY

Higher levels of family conflict were Higher levels of family conflict were associated associated

with high levels of peer with high levels of peer

antisocial activity.antisocial activity.

________NIDA NIDA

Anxiety of parents will influence Anxiety of parents will influence the anxietythe anxiety

of your teens.of your teens.

________John GottmanJohn Gottman

Greatest problem is that Greatest problem is that

parents were afraid ofparents were afraid of

stating their beliefs andstating their beliefs and

feelings.feelings.

NIH/Risky Adolescent Behavior StudyNIH/Risky Adolescent Behavior Study

Cut the roof off in yourCut the roof off in your

home and look at what home and look at what

is going on.is going on.

Reasonable parenting – Reasonable parenting – –based on who your child is not based on who your child is not

who you think they should bewho you think they should be–show them how much you care show them how much you care

before you show them how before you show them how much you knowmuch you know

ListenListen

Understand Understand

Take serious Take serious

AffirmAffirm

Do what the Do what the relationship allows relationship allows

for the momentfor the moment

THE MORE YOU SHOW YOUR THE MORE YOU SHOW YOUR HUMANESS, THE MORE YOU HUMANESS, THE MORE YOU ARE LOVABLEARE LOVABLE

ReframeReframe

(changing your lens)(changing your lens)

Reframe in Reframe in

positive terms positive terms

what your child is what your child is

really telling you.really telling you.

See your child’sSee your child’s

behavior as information, behavior as information,

he or she is giving youhe or she is giving you

an opportunity to learn.an opportunity to learn.

What was the lastWhat was the last good conversation yougood conversation you had with your child?had with your child?

What were you doing?What were you doing?

DEPERSONALIZEDEPERSONALIZE

BE NICE AND BE NICE AND FORGIVEFORGIVE

(STAY THE ADULT)(STAY THE ADULT)

Externalize Externalize

and and

Depersonalize Depersonalize

the problemthe problem

Your child is Your child is

not the problemnot the problem

The problem The problem

is the problemis the problem

Mental HealthMental Health

–LovableLovable

–CapableCapable

–ConnectedConnected

Most kids respond to Most kids respond to incentives – Win/Win – earned incentives – Win/Win – earned rewardsrewards

Some kids respond to negative Some kids respond to negative consequenceconsequence

(if they perceive the (if they perceive the consequences as fair)consequences as fair)

Have your kids participate in their Have your kids participate in their respective consequencesrespective consequences

-Empowers your kids-Empowers your kids

-Reduces possible power struggle-Reduces possible power struggle

-Increases ownership in the -Increases ownership in the outcomeoutcome

Tailor intervention based on Tailor intervention based on your relationship with your your relationship with your child and your child’s child and your child’s relationship with alcohol and relationship with alcohol and drugsdrugs

STRIKE WHILE THE STRIKE WHILE THE IRON IS COLD!IRON IS COLD!

WHO BELIEVED IN WHO BELIEVED IN YOU?YOU?

( HOW DID YOU KNOW?)( HOW DID YOU KNOW?)

What messages do you give What messages do you give your kids that you believe in your kids that you believe in them, have faith in them?them, have faith in them?

ASK YOUR KIDSASK YOUR KIDSHow am I doing as your parent?How am I doing as your parent?

What am I doing well?What am I doing well?

What could I do better?What could I do better?

What are the messages I give What are the messages I give you that tell you I believe in you?you that tell you I believe in you?

More QuestionsMore Questions

Do you feel you can tell me Do you feel you can tell me anything?anything?(and if not what am I doing that is (and if not what am I doing that is getting in the way)getting in the way)

Do you feel I am honest with you?Do you feel I am honest with you?

Do you feel you know me?Do you feel you know me?

More QuestionsMore Questions

Is there anything you want to Is there anything you want to know about me (such as what know about me (such as what I was like in high school?)I was like in high school?)

Does what I do now (or what I Does what I do now (or what I did in high school) influence did in high school) influence your decisions today?your decisions today?

Always offer hope and faith Always offer hope and faith and be willing to do whatever it and be willing to do whatever it takes to improve your takes to improve your relationship with your childrelationship with your child

WEBSITESwww.drugabuse.gov (NIDA) www.samhsa.gov (Substance Abuse and Mental Health Administration)www.salis.org (Substance Abuse Librarians and Information Specialists)www.promisingpractices.net (Promising Practices Network on Children, Families and Communities)www.JoinTogether.org (Join Together)

Dare to Discuss Drugs Forum Pomperaug High School June 8, 2010 John Hamilton, LMFT,LADC (203)...

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Transcript of Dare to Discuss Drugs Forum Pomperaug High School June 8, 2010 John Hamilton, LMFT,LADC (203)...