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ADOLESCENT USE

Adolescent patterns of substance use may differ from those of adults. As discussed in the introduction section, adolescent brain development is still in progress and includes greater risk-taking behavior. Experimentation with substances is common among adolescents, yet initial and intermittent exposure may progress to persistent and maladaptive use without identification of use and intervention. In many instances, social use involves excess or “binge” use of substances, particularly alcohol. This pattern of use differs from that noted among adults. The progression from regular to problem use may be difficult for the provider to note without significant probing into changes in school performance, difficulties in peer or parental relations, or other indicators. Co-morbidity is also commonly associated with substance use disorders in both adolescents and adults (see Key Principles section) and should be considered, as appropriate, as part of adolescent substance abuse treatment.

Scope and patterns of use:
In 2012, 34.1 percent of 8th, 10th, and 12th graders reported lifetime use of any illicit drug. (1)

These levels largely reflect the use of marijuana, which is the illegal drug most abused by teens. In 2010, more than 21 percent of 12th graders were current marijuana users (i.e., used in the 30 days prior to the survey). However, declines in marijuana use appear to have stalled, remaining stable over the past 5 years, as its perceived risk has decreased. (1)
Prescription drug abuse by adolescents is also a serious concern. In fact, prescription or over-the-counter drugs account for most of the frequently abused substances among high school seniors, with 1 in 12 high school seniors reporting non-medical use of Vicodin in the past year and 1 in 20 reporting past year use of OxyContin in 2010. (1)

Risk and protective factors:
There are both risk and protective factors that may influence the use of substances by adolescents. Prevention strategies that decrease risk factors and enhance protective factors have been shown to prevent drug use and associated problems. Family influences (i.e., attachment, supervision, and discipline), opportunities and rewards for positive social involvement, and early success in school have been found to be protective for substance use in adolescents. (14, 15) The potential impact of specific risk and protective factors varies with age. Family factors have a greater impact on a younger child, whereas peer factors are more significant for older teens.

Risk Factors
Substance use is common in adolescents who present to emergency departments for evaluation and treatment of trauma, experience school problems or academic failure, and are involved in the criminal justice system.

Toxicology results of adolescents admitted to one Level 1 trauma center for evaluation and management after motor vehicle crashes indicated that almost 60 percent tested positive for commonly abused drugs (marijuana, cocaine, amphetamines, methamphetamines, or opiates) or alcohol. More patients tested positive for drug use than tested positive for alcohol. (16)

Recent studies have noted that students who have deteriorating school performance show an increase in drug use during the same time period. Academic disengagement as marked by dropping grades is often related to drug use during adolescence. Prevention initiatives aimed at keeping teens engaged in school may have protective benefits against the escalation of drug use. (17, 18)

U.S. Department of Justice reports indicate that the number of juvenile court cases involving drugs doubled between 1991 and 2004, and drug offense cases accounted for 12 percent of the delinquency caseload in 2004 compared with 7 percent in 1985.(19) Teens, who account for approximately 8 percent of substance abuse treatment admissions, are frequently referred by the criminal justice system (34.9 percent) rather than by healthcare providers, including substance abuse treatment providers (12.5 percent). (20, 21)

Protective Factors
Families, educators, and communities have been identified as having key roles in the prevention of substance use disorders in children and adolescents.

Families can provide protection from later drug abuse when there is a strong bond between children and parents, parental involvement in children’s lives, and clear limits and consistent discipline.

Educators can strengthen learning and bonding to school by addressing aggressive behaviors and poor concentration—risks associated with later onset of drug abuse and related problems.

Community leaders can work with civic, religious, law enforcement, and other government organizations to enhance antidrug norms and pro-social behaviors. Strategies to strengthen communities may involve instituting new policies like the drug-free school concept, or improve community practices, such as asking for proof of age to buys cigarette

For more information about prevention, see NIDA’s Preventing Drug Abuse among Children and Adolescents (In Brief). For additional information on drug abuse and addictive disorders, please go to the National Institute on Drug Abuse’s NIDAMED Web site: http://www.drugabuse.gov/nidamed/.