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Running head: SUBSTANCE USE AND ABUSE AMONG ADOLESCENTS 1
Substance Use and Abuse Among Adolescents
Emily A. Harding
Liberty University
SUBSTANCE USE AND ABUSE AMONG ADOLESCENTS 2
Abstract
Millions of adolescents experiment with drugs or alcohol each year. It is believed that
adolescents engage in more risky behavior than children or adults because of an underdeveloped
pre-frontal cortex and a developing limbic system, which leads to an imbalance between reason
and emotions. Animal models exploring the development of the adolescent brain has allowed
scientists to understand some of the effects that drugs and alcohol have on an adolescent’s brain.
Several external and internal factors play major roles in determining if adolescents will engage in
drug use. There are a number of barriers that hinder the creation of effective intervention
strategies aimed at preventing adolescent substance abuse. Effective adolescent substance abuse
treatment programs must be developed and maintained, but the real work begins with preventing
adolescents from initially experimenting with drugs through education and modeling a drug-free
lifestyle. Though it appears that the rates of drug abuse are declining, they are still unacceptably
high within this population despite the attempts being made to reduce them.
SUBSTANCE USE AND ABUSE AMONG ADOLESCENTS 3
Substance Use and Abuse Among Adolescents
Millions of people throughout the United States abuse licit and illicit drugs each year;
adolescents are no exception. Adolescents in 8th, 10th, and 12th grades have been studied and
surveyed for decades in an effort to identify the scope of adolescent substance use and to create
interventions specifically tailored to the adolescent population. Adolescents gain access to drugs
through a variety of avenues, including through family members and their peers. Though it
appears that the rates of drug abuse are declining, they are still unacceptably high within this
population despite the attempts being made to reduce them.
Scope of the Problem
Johnston, O'Malley, Miech, Bachman, & Schulenberg (2015) identified a decline in the
prevalence of drug use in 2014 for twenty-eight of the thirty-four drug outcomes among 8th, 10th,
and 12th graders (p. 5). However, their research recognized that drug use and abuse is still
prevalent among these age groups.
Alcohol continues to be the most widely used and abused drug among teenagers, with
66% of high school students having consumed alcohol before graduating high school and 27% of
those students having consumed alcohol before entering 8th grade (Johnston et al., 2015, p. 7).
Additionally, “half (50%) of 12th graders and one in nine (11%) 8th graders in 2014 reported
having been drunk at least once in their life” (Johnston et al., 2015, p. 7). However, there was a
slight decline in reported alcohol use among 8th, 10th, and 12th graders in 2014 from 42.8% to
40.7% (p. 56), “which marked the lowest levels for drunkenness and alcohol use in all three
grades ever recorded by the survey” (Johnston et al., 2015, p. 7).
There was also a decline in the percentage of reported marijuana use among 8th, 10th, and
12th graders (Johnston et al., 2015, p. 5). However, the percentage of adolescents who view
SUBSTANCE USE AND ABUSE AMONG ADOLESCENTS 4
regular marijuana use as a “great risk” to their health and the percentage of adolescents who
disapprove of people engaging in marijuana use also declined, which are indicative of greater
acceptance of marijuana among today’s youth (Johnston et al., 2015, p. 5-6).
A new area of concern is the prevalence of e-cigarette usage among adolescents. In
2014, e-cigarettes had the highest 30-day prevalence and had a significantly lower perceived risk
when compared to other tobacco products (Johnston et al., 2015, p. 8). “Prevalence of e-
cigarette use was 8.7%, 16.2%, and 17.1% in 8th, 10th, and 12th grade, respectively. The
corresponding prevalence for regular cigarette use was 4.0%, 7.2%, and 13.6%” (Johnston et al.,
2015, p. 8). It should be noted that e-cigarettes had the lowest perceived risk for regular use than
any other drug, with an average of only 14.2% of students reporting they felt regular e-cigarette
usage was a “great risk” to their health (Johnston et al., 2015, p. 8).
Psychotherapeutic drugs are continuing to be abused by adolescents. However, the
abuse of most of these drugs has leveled off or declined in 2014 (Johnston et al., 2015, p. 6). “It
seems likely that young people are less concerned about the dangers of using these prescription
drugs outside of medical regimen because they are widely used for legitimate purposes”
(Johnston et al., 2015, p. 6).
Cocaine and methamphetamine abuse has seen a decline over the past five years with
annual prevalence of use for all three grades combined at 1.6% and 0.8%, respectively (Johnston
et al., p. 56).
Patterns, Signs, and Symptoms of Addiction
Morrison (1990) identifies three stages of addiction that can be observed when an
adolescent is struggling with substance use and abuse: Early Addiction, Intermediate Addiction,
and Advanced Addiction (p. 544). It is important to note, however, that not every adolescent
SUBSTANCE USE AND ABUSE AMONG ADOLESCENTS 5
who experiments with drug use will further their experimenting and progress to any of these
three stages; they are to be seen as guidelines to aid in the recognition of drug abuse among
adolescents.
In the Early Addiction stage, adolescents begin experimenting with drug use because of
peer pressure or because they have approval from their substance-abusing parents to experiment
with drug use at home (Morrison, 1990, p. 544). Once the teen has begun experimenting, “use in
the early stages of addiction becomes more regular, with the teen putting more mental and
physical energy into obtaining and ingesting drugs and alcohol” (Morrison, 1990, p. 544).
Adolescents move from the Early Addiction stage to the Intermediate Addiction stage
when they begin experiencing negative repercussions as a result of their substance use and abuse,
including problems at school, increased conflict with family members or friends, or the
beginnings of physical/emotional deterioration (Morrison, 1990, p. 544). The Intermediate
Addiction stage is also marked by adolescents’ increased state of denial, which “permits them to
believe the lie of control over chemical use” (Morrison, 1990, p. 544).
Advanced Addiction is marked by more obvious external repercussions, such as the
adolescent becoming involved with the law or conspicuous changes in his/her physical
appearance (Morrison, 1990, p. 544). Unfortunately, “it is not uncommon for parents not to
recognize that their teen is even involved in drugs until the disease has progressed to an
advanced level” (Morrison, 1990, p. 544).
Physiological Differences in Adolescents
The adolescent brain undergoes significant changes that put this population at a higher
risk of experimenting with drug use and other new experiences. It is currently understood that
adolescent brains experience growth and development in a parietal-to-frontal (back-to-front)
SUBSTANCE USE AND ABUSE AMONG ADOLESCENTS 6
direction (Gogtay et al., 2004, p. 8174). Changes occur in the limbic system first, which leads to
changes in the reward center (Steinberg, 2004, p. 54). These changes cause adolescents to seek
out higher levels of stimulation to attain the level of pleasure they once experienced at lower
levels of stimulation (Steinberg, 2004, p. 54). The pre-frontal cortex region of the brain remains
underdeveloped while the limbic system grows, which leads to an imbalance between reasoning
and emotions (Arria & Winters, 2011, p. 21). Generally speaking, when an adolescent is faced
with highly emotional situations, the limbic region will supersede the pre-frontal cortex, resulting
in poor decision-making (Bava & Tapert, 2010, p. 406) and increased likelihood of risk-taking.
Arria & Winters (2011) write, “Given the unique neurodevelopmental processes taking place
during adolescence, trying out new experiences and taking risks (including drug use) is more
likely among teenagers than among children and adults” (p. 21).
Animal Models
When studying the effects of drug use and abuse on the brain in the adolescent
population, it is common to examine the effects of a drug in a controlled environment on animal
models because it “permits the use of research strategies that would not be ethical with humans,
and animals are affected by drugs in ways that are comparable to humans” (Arria & Winters,
2011, p. 22)
Burke & Miczek (2014) conducted an experiment in rodents testing the relationship
between stress in adolescence and drugs of abuse. They recognized that behaviors, dopamine
systems, corticotropin-releasing factor (CRF), and the hypothalamic-pituitary-adrenal (HPA)
axis all reach final maturation during adolescence (Burke & Miczek, 2014, p. 1573). Their
research concluded that “stress during adolescence increases amphetamine- and ethanol-
stimulated locomotion, preference, and self-administration under many conditions” but “the
SUBSTANCE USE AND ABUSE AMONG ADOLESCENTS 7
influence of adolescent stress on subsequent cocaine and nicotine-stimulated locomotion and
preference is less clear” (Burke & Miczek, 2014, p. 1557). This study identified the need for
continued research on the exact roles of dopamine systems, CRF, and the HPA axis “in
adolescent stress cross-sensitization to abused drugs” (Burke & Miczek, 2014, p. 1573).
Research shows that adolescents experience decreased sensitivity to the effects of alcohol
(Spear, 2002, p. 426), which allows them to consume excess amounts without immediately
experiencing the negative effects. Animal studies indicate that adolescent rats experienced less
hindrance in their motor functioning and less sedation than adult rats after the same amount of
alcohol was administered to each age group (Arria & Winters, 2011, p. 22). Despite the apparent
outward decreased sensitivity, however, permanent damage to the pre-frontal cortex, working
memory brain region, basal forebrain, and neocortex occurs if the adolescent is repeatedly
exposed to alcohol (Arria & Winters, 2011, p. 22).
Factors Influencing Rate of Substance Use and Abuse in Adolescents
There are a variety of internal and external factors that influence the rate of substance use
and abuse in adolescents. External factors include environmental variables, such as ease of
access to licit and illicit drugs, and social variables, such as peer pressure or growing up with
parents who use and abuse drugs (Sussman, Skara, & Ames, 2008, p. 1803). It is assumed that if
an adolescent has relatively easy access to a drug, he/she is more likely to experiment with drug
use than if he/she did not have immediate access to a particular drug. Additionally, if an
adolescent feels pressured by his/her peers to experiment with drug use, or if an adolescent’s
peers or parents are substance users, the adolescent is more likely to engage in drug use because
of the perceived pressure he/she is experiencing from his/her peers or parents. Internal factors
SUBSTANCE USE AND ABUSE AMONG ADOLESCENTS 8
include “physiological susceptibility…personality correlates of neurobiological processes…
explicit cognitions…and implicit cognitions” (Sussman et al., 2008, p. 1803-1804).
Factors identified by Lener, Anderson, & Ivanov (2014) specifically related to adolescent
cocaine or methamphetamine abuse include “exposure to drug abuse at an earlier age, psychiatric
history, criminal history, family history of drug abuse, and personality traits such as impulsivity
and risk-taking behavior” (p. 342). It can be argued, however, that these factors can also be
applied to abuse of other drugs by adolescents.
Barriers to Identification/Treatment of Adolescents
Several barriers exist in the identification and treatment of substance abuse in the
adolescent population, including the accuracy of drug use surveys, the impulsive tendencies of
adolescents, the prevailing attitude among adolescents of being the exception to the rule when
faced with the possibility of sustaining serious consequences for their risky behavior, and the
continuing availability of new designer drugs.
The current information available on adolescent substance abuse is limited to the surveys
that are given to 8th, 10th, and 12th graders around the country. Although the information gathered
has been exceptionally helpful in identifying drug use trends among students in these grade
levels, the information is only accurate if the students are willing to be honest with their drug use
experiences and their attitudes toward drug use. Adolescents may answer dishonestly about their
experiences with drugs if they do not want to take the risk in receiving substantial consequences
for the illegal drug use they report on a survey evaluated by adults. Additionally, their attitudes
toward the use of specific drugs may be influenced by peers who are using or abusing
substances.
SUBSTANCE USE AND ABUSE AMONG ADOLESCENTS 9
Because of the back-to-front growth and development that occurs in the brain during
adolescence, youth are more willing to take risks even if they know the consequences associated
with those risks. For example, if a 15-year-old male and a 30-year-old male were presented with
the opportunity to go skydiving, the 15-year-old male would be more likely to ignore the hazards
associated with jumping out of an airplane and act impulsively to gain the sense of euphoria that
accompanies the high level of stimulation. The 30-year-old man, however, would be more likely
to contemplate the risks associated with skydiving and make an educated decision based on the
facts that are available.
When youth are faced with the decision to engage in risky behavior, such as drug use,
many convince themselves that they are the exception to the rule in order to justify their actions.
In the case of experimenting with drugs and alcohol, they believe they will be able to try the
substance, experience the effects, and walk away whenever they want, never becoming addicted;
sadly, that is not always the case. When adolescents believe they are an exception to the rule of
addiction, they are more likely to ignore the warnings associated with drug use because they
have decided in their minds that those warnings do not apply to them.
With each passing year, discoveries are being made about new designer drugs that are
hitting the market. These drugs are technically legal because they have been modified to be
slightly different from their illegal counterparts, but they are just as dangerous, and they are
available to adolescents across the United States. Sadly, “by the time that legislation is amended
to outlaw certain compounds, untold youth have tried them and placed themselves at risk for
experiencing adverse effects, some of which may be serious or permanent” (Calles, 2014, p.
265). While law enforcement officials and lawmakers work to address the legality of these
harmful substances, new designer drugs are being manufactured to circumvent the legislation
SUBSTANCE USE AND ABUSE AMONG ADOLESCENTS 10
being developed (Calles, 2014, p. 265). Because youth are more likely to learn of the new
designer drugs before adults can warn them of the dangers associated with experimental use of
the new substances, the adolescent population is more likely to pay the consequences because
they are more willing to take the risks.
Special Treatment Needs
When engaging the adolescent population in treatment of substance abuse, parents,
educators, youth pastors, health professionals, and therapists must take into consideration the
adolescents’ level of education. Additionally, when a therapist or health professional is assisting
an adolescent through treatment, he/she must address the adolescent’s motivation for initiating
drug use. For example, an adolescent may initiate drug use as a result of peer pressure or as an
effort to escape conflict in his/her home life. Regardless of the motivation, therapists and health
professionals have the responsibility to guide the adolescent through addressing, coping, and
overcoming the motivations to continue drug use.
Effective Treatment Methods
The primary goal of any treatment facility or therapist should be to assist substance
abusers in overcoming their addictions by giving them the tools they will need to remain
substance-free. The following are three examples of adolescent substance abuse treatment
methods that have reported high involvement and retention rates: the Parent-Focused Attendance
Intervention, The Intensive Parent and Youth Attendance Intervention and the Strategic
Structural Systems Engagement option (M., 2004, p. 170-171).
Largely based on the Community Reinforcement Training (CRT) approach, the Parent-
Focused Attendance Intervention, incorporates youth engagement in a short period of time (M.,
2004, p. 170-171). When the adolescent’s legal guardian calls the treatment facility, the staff
SUBSTANCE USE AND ABUSE AMONG ADOLESCENTS 11
member briefly explains the treatment process then schedules an intake appointment within 2 to
7 days after the phone call takes place (M., 2004, p. 171). The parent and the adolescent are
strongly encouraged to attend the intake appointment together (M., 2004, p. 171). The Intensive
Parent and Youth Attendance Intervention involves the same protocol used in the Parent-Focused
Attendance Intervention, but motivational reminder phone calls are made to the parent and the
adolescent 2 to 3 days before the intake appointment (M., 2004, p. 171). “Results were that 89%
of the adolescents in the Intensive Parent and Youth condition showed up for the intake
appointment, while 60% of youth in the Parent-Focused condition did so” (M., 2004, p. 171)
The Strategic Structural Systems Engagement (SSSE) program adds family involvement
to the adolescent’s intervention and treatment plan (M., 2004, p. 179). The SSSE gives
therapists six levels of engagement to choose from, based on the level of resistance they
experience from the caller, when they receive a call about a potential client (M., 2004, p. 170).
Two studies were conducted to test the effectiveness of the program. In the first study of 108
Hispanic adolescent drug abusers, “after an average of 2.5 ‘contacts’ (telephone talks, home
visits, office sessions), SSSE attained a 93% success rate” (M., 2004, p. 170). In the second
study of 193 Hispanic adolescent drug abusers, “family therapy + SSSE (which averaged 5.3
contacts) successfully engaged 81% of its cases” (M., 2004, p. 170).
Conclusion
It is understood that drug use among the adolescent population continues to be an area of
concern that needs to be addressed. Although the rates of substance use has slowly declined in a
majority of drug categories, millions of young lives are negatively affected each year when
adolescents choose to experiment with drug use. The advancements in neuroscience have
provided significant findings on how the adolescent brain develops, but further research needs to
SUBSTANCE USE AND ABUSE AMONG ADOLESCENTS 12
be done focusing on how the adolescent brain is affected by drugs and alcohol. Effective
adolescent substance abuse treatment programs must be developed and maintained, but the real
work begins with preventing adolescents from initially experimenting with drugs through
education and modeling a drug-free lifestyle.
SUBSTANCE USE AND ABUSE AMONG ADOLESCENTS 13
References
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