Adolescent Substance Abuse

Running head: ADOLESCENT SUBSTANCE ABUSE 1

Adolescent Substance Abuse

Isabella Just

San Jose State University

ADOLESCENT SUBSTANCE ABUSE 2

Adolescent Substance Abuse

Introduction

The United States Department of Health and Human Services found that half of

adolescents have abused illicit drugs at last once by the time they are in the twelfth grade (U.S.

Department of Health & Human Services, 2015). Illicit drug use is “the abuse of illegal drugs

and/or the misuse of prescription medications or household substances” (U.S. Department of

Health & Human Services, 2015). More adolescents have reported drinking alcohol than

smoking cigarettes or using marijuana (U.S. Department of Health and Human Services, 2015).

Four in every ten high schools students have had alcohol in the last month, and two and ten have

participated in binge drinking within two weeks (U.S. Department of Health and Human

Services, 2015). Adolescents can be characterized as being strongly influenced by peers, and

likely to take risks. In 2009, 10 percent of youth ages 12 to 17 reported currently using illicit

drugs, such as marijuana (National Center for Children in Poverty, 2014). Among the youth who

reported illicit drugs: 6.5% were Asian, 10.6% African American, 11.9% American Indian or

Alaskan Native, 15.2% Hispanic/Latino, 16.1% white, and 16.7% multi-racial youth (National

Center for Children in Poverty, 2014).

Risks for Adolescent Substance Abuse

Adolescence is a period where many youth being to experiment with alcohol, tobacco,

and marijuana (Van Ryzin & Dishion, 2014). 998 adolescents and their families were studied in

a controlled family-based intervention to determine how early substance abuse can predict later

substance use disorders (Van Ryzin & Dishion, 2014). Predictors of substance use disorders

include alcohol use, tobacco use, and marijuana use (Van Ryzin & Dishion, 2014). Outcomes of

substance use included nicotine and marijuana dependence, deviant peer affiliation, poor school


functioning, and elevated substance use (Van Ryzin & Dishion, 2014). Van Ryzin and Dishion

(2014) found that by the time an adolescent reached the eight grade 36.5% have experimented

with alcohol, 15.7% have tried marijuana. It was found that early substance use was a predictor

of the later use of nicotine, alcohol, and marijuana through deviant peer affiliation (Van Ryzin &

Dishion, 2014). Substance use in mid-adolescence is also statistically significant for later

dependence (Van Ryzin & Dishion, 2014). Van Ryzin and Dishion (2014) findings indicate that

the social domain is affected at the social level when adolescents chose to partake in drug use

through deviant peer affiliations.

Steen (2010) also indicated that the social domain is affected when adolescents use

substances. Steen (2010) conducted a study on 62,934 adolescents in 64 Florida counties to

determine if community based interventions, neighbors, and abandoned building are positively

correlated with the onset of early substance abuse. Steen (2010), found that the belief in, and

actual ease of access, was linked to increased chances of alcohol, cigarette, and marijuana use

(Steen, 2010). Similarly, the presence of abandoned buildings was associated with increased

odds that an adolescent would consume alcohol, and smoke cigarettes (Steen, 2010). The

findings show that an adolescents’ social domain is affected at the community level. If

adolescents have a social group that allows them to obtain substances easily they are more likely

to use substances. If an adolescent lives in a community that has poor community development

they are more likely to have an environment that fosters substance use.

Richard and colleagues (2010), found that the emotional domain was also affected by

substance abuse. Richard et al. (2010) studied 428 adolescents from two Houston, Texas

suburban high schools to test links between negative appraisal, self-concept, race/ethnicity,

gender and marijuana use. Richard et al. (2010) found that negative appraisal by peer and


teachers was a risk factor for drug use especially for non-Hispanics, but not Hispanics.

Adolescents were more at risk for drug use if they have been negatively appraised by their peers

(Richard et al., 2010). The emotional domain of the adolescent is affected at the social level. If

an adolescent believe that peers see them as substance abusers, they are at higher risk of

becoming a substance abusers.

In addition, Hartman et al. (2013) conducted a study on 777 adolescents from the

Colorado Twin Registry at two points in time to determine if Cloninger’s theory that low harm

avoidance, low novelty seeking, low reward dependence, and low persistence predicted early

substance problems. Hartman et al. (2013) found that risk factors that predict cigarette use

include: harm avoidance, novelty seeking, persistence, and sex variables (Hartman et al., 2013).

Lower harm avoidance, higher novelty seeking, and lower persistence increases the risk for early

cigarette use (Hartman et al., 2013). Risk for early alcohol use includes higher levels of novelty

seeking and lower persistence (Hartman et al., 2013). Factors that were not significant for early

alcohol use included harm avoidance, reward dependence, and sex (Hartman et al., 2013). Risk

factors for initiation of illicit substances include lower levels of harm avoidance, higher levels of

novelty seeking, and lower persistence (Hartman et al., 2013). Risk factors for early substance

experimentation include higher levels of novelty seeking, low levels of persistence, and low

levels of harm avoidance (Hartman et al., 2013). Later substance dependence can be predicated

by higher levels of novelty seeking, lower levels of harm avoidance, lower levels of reward

dependence, and lower levels of persistence (Hartman et al., 2013). The risks of early substance

experimentation align with the idea that adolescents have an imaginary audience, and personal

invincibility. Risks of adolescent substance use surround the idea the adolescents believe they

are invincible. As Hartman et al. discuss, adolescents will use substances if they do not believe


they need to avoid harm, and want to participate in novel experiences. Novelty seeking,

persistence, harm avoidance, and reward dependence are apart of the cognitive domain. Before

the age of 25 adolescents brains are not fully developed and their decision-making abilities are

affected.

In general the risk factors for substance abuse fall under the social domain at the social

level. This is because adolescents are making personal choices of who to associate with and what

actions to take part in. An adolescent’s focus on an imaginary audience and the importance they

place on their peers also accounts for the influence of the social domain on substance abuse.

Protective Factors for Adolescent Substance Abuse

Due to the severity of the risks associated with adolescent substance abuse, it is important

to analyze the protective factors. Adolescents who possess a set of protective factors are less

likely to use substances. Ronel and Levy-Cahana (2011) interviewed 19 adolescents who had

either a father or mother or both, who were current substance abusers. The participants were

further divided based on the degree to which their lives had been negatively affected by their

parent(s) habit, or if they had been users themselves (Ronel & Levy-Cahana, 2011). Ronel and

Levey-Cahana (2011), wanted to determine how having a parent who is substance dependent

affects the growth of an adolescent. The presence of protective factors can minimize the risk

posed by a weak substance-dependent parent (Ronel& Levey-Cahana, 2011). Ronel and Levy-

Cahana (2011) found that a sense of strength, aversion to the parent’s substance dependence,

positive significant family figures, the desire to protect siblings from substance dependence, and

the hope for a better future are protective factors. A sense of strength relative to the weak

substance-dependent can provide adolescents with the strength to choose a different path than

that of their parents (Ronel & Levy-Cahana, 2011). Aversion to the parent’s substance


dependence developed from the examination of their parent(s) situation (Ronel & Levy-Cahana,

2011). Having another significant family figure filled the void of a strong powerful parent

(Ronel & Levy-Cahana, 2011). Ronel and Levy-Cahana (2011) found that the need to protect

siblings from substance abuse occurred even if the adolescents were a substance abuser

themselves. By possessing one of more of these protective factors an adolescent is protected at

the individual and family level. A strong support system can compensate for having a weak

substance dependent parent. The protective factors identified by Ronel and Levy-Cahana (2011)

can provide protection in the emotional domain by providing a strong support system, and a

sense of strength.

A child’s strength comes from their cultural background as well as their emotional traits.

Telezer and colleagues (2013), conducted a study on importance of family connection and family

support of 385 adolescent Mexican-Americans. Telzer et al. (2013) aimed to determine how

family obligation values and assistance could be a source of protection against substance abuse

in adolescent Mexican-Americans. Results showed that an adolescents family obligation values

were protective from deviant behaviors, and disclosure (Telzer et al., 2013). Additionally, Telzer

et al. (2013) found that cigarette use, marijuana use, and alcohol use was lower in adolescents

who had higher adolescent family obligation values. Family obligations were associated with

lower substance use because adolescents were more likely to disclose information to their

parents and socialize with fewer deviant peers (Telzer et al., 2013). Family assistance behavior

was not found to be protective against marijuana or other illicit drug use (Telzer et al., 2013). In

addition low family conflict is associated with lower marijuana use (Telzer et al., 2013). Telzer

and colleagues (2013) found that factors in the emotional domain such as family strength and

behavior could be protective against substance use, deviant peer association, and disclosure. At


the family level an adolescent can be protected from illegal drug use, nicotine, and deviant peer

associations (Telzer et al., 2013).

Overall, protective factors for adolescent substance use fall in the emotional domain. An

adolescents who possess a support system, and individual strength are at a lower risk for

substance use (Ronel & Levy-Cahana, 2011). Adolescents who have a strong sense of family

obligation are also at lower risk for substance use (Telzer et al., 2013). The family system serves

as a crucial protective mechanism against adolescent substance use.

Developmental Outcomes Associated With Adolescent Substance Abuse

Adolescents’ brains are still cognitive developing as they gain decision-making abilities,

social skills, foresight, and abstract reasoning (Thoma et al., 2009). If an adolescent consumes or

uses substances there are hindering the developmental process and can cause long-term negative

developmental outcomes. Thoma et al. (2009) aimed to evaluate how alcohol and marijuana

effects the neuropsychological functioning of adolescents. 48 adolescents ages 12 to 18 were

studied: 15 who did not use substances and had no family history of substance use disorder, 14

who did not use substances but had a family history of substance use disorder, and 19

adolescents who were diagnosed with alcohol abuse or dependence (Thoma et al., 2009).

Adolescent substance use was associated with regression of memory, processing spend,

executive functioning and attention (Thoma et al., 2009). Specifically, the percent of days using

marijuana was associated with negative memory performance (Thoma et al., 2009).

Additionally, a higher number of drinks per day, was negatively association with executive

functioning and attention (Thoma et al., 2009). Percent of drinks per day was not significant on

the neuropsychological functions of adolescents (Thoma et al., 2009). Because the brain is

continuing to develop in adolescents, the cognitive domain is greatly affected when an


adolescent uses substances such as marijuana and alcohol. This affects the adolescent at the

individual level, because they will have lower levels of cognitive functioning in the future.

Communities and families are also affected, because lower cognitive functioning can be

associated with lower graduation rates and therefore fewer job prospects.

Lower gradation rates and less job opportunities can be linked to high juvenile

delinquency. Adolescents’ delinquency outcomes can be associated with their gender and race

(Welch-Brewer et al., 2011). Welch-Brewer et al. (2011) conducted a longitudinal study over a

three-year period on 6,900 probation cases in a Midwest county juvenile court population.

Research has shown that youth who are apart of the juvenile justice system have higher rates of

mental health issues and substance abuse (Welch-Brewer et al., 2011). Few studies however

have studied the effects of gender and race on juvenile court outcomes (Welch-Brewer et al.,

2011). Welch-Brewer and colleagues (2011) found that within their population 26 percent of

males and females used substances. A substance use disorder was a significant predicator of the

number of probation services (Welch-Brewer et al., 2011). Males with a substance use disorder

had one additional probation service, and females received an additional 2.4 probation services

(Welch-Brewer et al., 2011). Substance use disorder also predicted the amount of court offenses

in males, with 1.8 times more court offenses than none users (Welch-Brewer et al., 2011).

However, it was found that substance use disorder did not predict the time in detention, a felony

conviction, or time on probation (Welch-Brewer et al., 2011). The cognitive domain is affected

when adolescent choose to use substances because it affects their decision-making abilities.

Wrong decisions can lead to convictions that place them in the juvenile court system. Their poor

decisions affect the community because tax dollars have to be used to place adolescents under

arrest and house them in he juvenile justice system.


An adolescent’s decision to use substances will greatly affect the brains development.

Research shows that the community is affected when adolescents use substances. Communities

have to use resources to fund the juvenile court system and address the poor decisions

adolescents under the influence make.

Conclusion

Adolescents who use substances hinder their cognitive development and increase their

rates to juvenile delinquency. Adolescent substance use is associated with regression of memory,

processing spend, executive functioning and attention (Thoma et al., 2009). A substance use

disorder was found to be a significant predicator of the number of probation services (Welch-

Brewer et al., 2011). Risk for adolescent substance abuse are centered around the social

domain. Adolescent who associate with deviant peers, have easy access to substances and

alcohol. Adolescents were also at risk if peers or authority figures had a negative appraisal of

them (Hartman et al., 2011). Low persistence, low harm avoidance, and high novelty seeking is

also associated with higher risk of substance abuse. Protective factors were largely apart of the

emotional domain. Adolescents who had the strength to choose a different lifestyle than that of

their parents, and had a sibling to protect was less likely to abuse substances themselves (Ronel

& Levey-Cahana, 2011). An adolescent’s family obligation was protective, because they were

less likely to interact with deviant peers and more likely to disclose information to their parents

(Telzer et al., 2013). In order to encourage protective factors and reduce risk factors, adolescents

should be informed on the long-term negative developmental outcomes associated with

substance use, as well as the risks associated with having a substance dependent parent. An

adolescent who electively choses to be sober can be assisted through interventions that

incorporate their family, community, and is strength driven.


Proposed Intervention for Adolescent Substance Abuse

Substance use in adolescence is malleable. If programs are created that promote

protective factors reduce risk factors, adolescent individuals can avoid the juvenile justice

system. By the age of 17, 50 percent of adolescents have used or consumed some form of

substances (U.S. Department of Health & Human Services, 2015). 40 percent of adolescents had

drank alcohol in the past month, 20 percent have consumed excessive alcohol in the past two

weeks (U.S. Department of Health & Human Services, 2015). Ten out of every 100 adolescents

ages 12 to 17 currently use illicit drugs (National Center for Children in Poverty, 2014). 26

percent of adolescents in the juvenile justice system use drugs, which is associated with one

additional probation if male and 2.4 times more probations if female (Welch-Brewer, 2011).

Male adolescents who use substances are 1.8 times more likely to receive a court offense than

non-using male adolescents (Welch-Brewer, 2011). Additionally, early substance use is a

predictor of the later use of nicotine, alcohol, and marijuana through deviant peer affiliation (Van

Ryzin & Dishion, 2014). Substance use in mid-adolescence is also statistically significant for

later substance dependence (Van Ryzin & Dishion, 2014). 75 percent of adolescents with

substance use disorder have some other mental health problem therefore it is important to target

mental health issues in substance abuse interventions (Horigian, 2013).

Brief Strategic Family Therapy (BSFT) is an intervention that addresses systematic

interactions that are associated with behavioral problems (Horigian, 2013). The program

addresses the root of the problem interactions in the family system over a four-month period with

eight additional sessions (Horigian, 2013). A session often involves multiple family members

and includes an analysis of all the individuals’ microsystems (Horigian, 2013). The program was

also successful because the location was flexible to the individuals needs (Horigian, 2013). The


program was composed of individual and/or group therapy, parent training, family therapy, and

case management (Horigian, 2013). The intervention however, did not take place over a long

enough time period. The four-month period had positive outcomes, but no follow up interviews

were conducted to determine if the outcomes were lasting. The program also lacked pre

treatment interviews.

Strengths Oriented Family Therapy (SOFT) includes pre-treatment motivational sessions

with parents, specific solution focused language, and an assessment of the strengths of the

individual (Smith et al., 2006). The intervention is family based and involves skill training for

each member of the family system (Smith et al., 2006). A pre-treatment interview was

conducted with the youth and parent individually to determine the strengths of the youth and

develop a solution plan (Smith et al., 2006). The interventions addressed all relevant ecological

factors (Smith et al., 2006). The intervention also included the development of a relapse

prevention program that included the family and the patient (Smith et al., 2006). The program

lasted ten weeks, 30 hours, five sessions included both the family and the patient (Smith et al.,

2006). Weaknesses of the intervention include no follow up interviews therefore there is no

indication of how long the patients remained sober.

In order to limit risks and promote protective factors aspects of both SOFT, BFST, and

7C can be used to create a program that is lasting, targets the problem early, and includes all

relevant ecological factors. The Transactional Model of development can be clearly linked to a

substance abuse treatment program. The Transactional Model of development addresses the

individual, the context and how they interact. The model address proximal influences such as

family communication, and peer associations. The model also addresses distal influences such

as the community structure, school, and the family’s socioeconomic status. Horigian (2013)


utilizes this model by finding the causal relationship between mental health disorders, and

substance abuse disorders. Both factors interact at both the proximal and distal levels. By

combining the strengths of SOFT, BSFT, and 7C the proposed program will be composed of a

pre-interview and a post-interview both at the time of completion and six months later.

By incorporating the family involvement from SOFT, BSFT, and 7C family obligation

values can be enhanced, which are associated with lower substance use and less deviant peer

associations (Telzer et al., 2013). The risk of deviant peer associations can be eliminated with

higher parent disclosure (Telzer et al., 2013). To address the risk of accessibility of drugs the

program can work with the individuals ecological system to ensure that the source of the drug or

alcohol is eliminated before the individual re-integrates into the community. The SOFT program

will be integrated to address the risk of low harm avoidance, low persistence, and high novelty

seeking (Hartman et al., 2013). Addressing these factors will also reduce later adult substance

dependence (Hartman et al., 2013). The SOFT model will also be incorporated to include

strength enhancement to protect against the presence of a substance dependent parent, and allow

the individual to choose a different pathway (Ronel & Levy-Cahana, 2011). The program will

take place over a six-month period in a location that meets the patient’s needs. Therapists will be

masters students studying childhood trauma and the affect on developmental outcomes.

Therapists will provide care in the individual’s primary language, and take an etic perspective.

Every other week parents will meet with the assigned therapist to discuss any concerns and make

sure the program is being implemented properly into the home environment. Therapists will also

meet with the individuals teachers to make sure they are aware or the ongoing treatment, and are

told to report any suspicious activities. To ensure the patient is remaining sober the therapist will

conduct a check-up six-months after the completion of the program.


References

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Hartman, C., Hopfer, C., Corley, R., Hewitt, J., & Stallings, M. (2013). Using Cloninger's

temperament scales to predict substance‐related behaviors in adolescents: A prospective

longitudinal study. The American Journal On Addictions, 22(3), 246-251.

Horigian, V. E., Weems, C. F., Robbins, M. S., Feaster, D. J., Ucha, J., Miller, M., & Werstlein,

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Telzer, E. H., Gonzales, N., & Fuligni, A. J. (2014). Family obligation values and family

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Welch-Brewer, C. L., Stoddard-Dare, P., & Mallett, C. A. (2011). Race, substance abuse, and

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http://www.hhs.gov/ash/oah/adolescent-health-topics/substance-abuse/illicit-and-non-drug-use.html

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