Q&A with Sarah Bagley, MD, Program Director, Departments of Pediatrics and General Internal Medicine
In May 2016, Boston Medical Center (BMC) launched the CATALYST Clinic, a program designed to treat youth ages 24 and under who have substance use disorders, or who have experimented with drugs and alcohol and may be at risk for developing an addiction. According to the National Institute on Drug Abuse (NIDA), 35.3 percent of high school seniors in the U.S. have used alcohol in the past month, 21.3 percent have used marijuana, and 23.6 percent have used illicit drugs, such as heroin and other opioids. Additionally, the Centers for Disease Control and Prevention (CDC) has reported a 108.6 percent increase in heroin use among 18-25 year olds between 2002-2004 and 2011-2013.
BMC's current substance use disorder treatment programs, such as Office-Based Addiction Treatment (OBAT), Project ASSERT and Project RESPECT, which are national models of care, have been in place for more than a decade, which makes BMC well positioned to expand and adapt services to meet the needs of our young patients.
Q. Why did you create a program specifically to treat substance use issues in adolescents and young adults?
A. We created the CATALYST Clinic (Center for Addiction Treatment for AdoLescent/Young adults who use SubsTances) because we know that substance use is common in adolescence and young adulthood. We also know that it is often difficult to find age-appropriate care for patients in this age group. As we move toward decreasing the stigma for addiction treatment, it is more important than ever to increase access to care, including offering substance use treatment services in primary care and general health settings. This way, patients are able to have medical care, pregnancy prevention, screening for sexually transmitted infections and substance use treatment all in one place. The CATALYST Clinic allows us to deliver comprehensive care by a multi-disciplinary team for adolescents and young adults in a general healthcare setting, which can help us identify substance use issues earlier in order to prevent the downstream effects.
Q. Has there been a significant increase in the number of young people with substance use issues in the community over the past year or two?
A. We have repeatedly heard in the community that there is an increase in the number of young people who are seeking treatment for substance use disorders, or who are being identified through outreach. Even in the adult patients we see, when we take a substance use history we learn that their substance use started in early adolescence and that heroin use commonly started around 18 or 19 years old. National data supports these clinical observations, confirming that this is an issue in many communities.
"We learn that their substance use started in early adolescence and that heroin use commonly started around 18 or 19 years old."
Q. When you see young patients in the clinic, are most of them at risk of using substances, or are they already addicted?
A. Patients who are being seen in primary care usually are just starting to use substances, so we try to educate them about the risks involved. In addition to addiction, if they are drinking or using drugs, they also are at risk for engaging in dangerous behaviors including driving under the influence, or risky sexual behavior, such as having unprotected sex.
Q. How long does it take to develop an addiction? While substances misused over a period of time can alter the brain, can young adults be diagnosed with an addiction even if they have only been using/misusing substances for a few months, years?
A. Every person is different in terms of how long it will take to develop an addiction. I have talked to patients who used intermittently for years and then it became more serious, and others who right away it became a real problem. The diagnosis of a substance use disorder is not based on the amount of time a person has been using drugs, but rather on a defined set of criteria that are related to the physiologic effects of the substance, and the impact the substance is having on their lives.
Q. What substances do teens and young adults typical use/abuse?
A. Marijuana and alcohol are the most common substances used by adolescents and young adults.
Q. Does treatment for young adults and adolescents differ from the treatment provided to adults?
A. We know that adolescents and young adults should be trying to establish their independence and establish autonomy -- that is healthy development. Some of that process involves risk taking, and we know that could involve trying illegal substances – and, for some of these adolescents and young adults, that use leads to risky behavior and sometimes addiction. So when thinking about treating this age group, we really need to focus on creating alternatives to substance use that promote continued independence. Another important component of caring for this age group is the importance of family involvement in treatment; adolescents and young adults often have a family or social network that can be key in helping them achieve sobriety.
Q. What advice do you have for parents who think their teenagers/adolescents may be using drugs?
A. Parents need to be able to hear what is going on with their teens. It is very important for them to feel as though they can talk to their parents. But at the same time, parents need to be able to set limits. So although a parent may understand why a teen might try alcohol, it's important that such behavior is not condoned. If parents are concerned that their child is engaged in dangerous behaviors or might be developing an addiction, I would recommend talking to their primary care physician or calling the Massachusetts hotline (1-800-327-5050, or tty 1-800-439-2370) to get more guidance about next steps.
Q. Will minors be prescribed medications such as buprenorphine or naltrexone for their substance use disorder?
A. Yes, patients in the CATALYST Clinic, including those under age 18, will be treated with buprenorphine or naltrexone when indicated. In fact, we have received funding from the state to expand access to medication treatment for opioid use disorders for patients ages 16 to 25.