special populations research paper

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

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


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


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)


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


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


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.


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


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


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


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.


References

Arria, A., & Winters, K. C. (2011). Adolescent brain development and drugs. The Prevention

Researcher, 18(2), 21+. Retrieved from http://go.galegroup.com.ezproxy.liberty.edu:

2048/ps/i.do?id=GALE

%7CA254755150&v=2.1&u=vic_liberty&it=r&p=AONE&sw=w&asid=42d09933b1c8a

b4ebddd39c7797a91cb

Bava, S., & Tapert, S. F. (2010). Adolescent brain development and the risk for alcohol and

other drug problems. Neuropsychology Review, 20(4), 398-413.

doi: http://dx.doi.org/10.1007/s11065-010-9146-6

Burke, A. R., & Miczek, K. A. (2014). Stress in adolescence and drugs of abuse in rodent

models: Role of dopamine, CRF, and HPA axis. Psychopharmacology, 231(8), 1557-80.

doi: http://dx.doi.org/10.1007/s00213-013-3369-1

Calles, Joseph L, Jr, M.D. (2014). Novel drugs of abuse. International Public Health

Journal, 6(3), 261-267. Retrieved from

http://search.proquest.com/docview/1625577281?

accountid=12085

Gogtay, N., Giedd, J. N., Lusk, L., Hayashi, K. M., Greenstein, D., Vaituzis, A. C., …

Thompson, P. M. (2004). Dynamic mapping of human cortical development during

childhood through early adulthood. Proceedings of the National Academy of Sciences of

the United States of America, 101(21), 8174–8179. doi:10.1073/pnas.0402680101

Johnston, L. D., O'Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E.

(2015). Monitoring the Future national survey results on drug use: 1975-2013:

Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research,


The University of Michigan, 90pp.

Lener, M., M.D., Anderson, S. A., PhD., & Ivanov, I., M.D. (2014). Illegal stimulant

abuse. International Journal of Child and Adolescent Health, 7(4), 339-353. Retrieved

from http://search.proquest.com/docview/1655269992?accountid=12085

M, D. S. (2004). GETTING RELUCTANT SUBSTANCE ABUSERS TO ENGAGE IN

TREATMENT/SELF-HELP: A REVIEW OF OUTCOMES AND CLINICAL

OPTIONS. Journal of Marital and Family Therapy, 30(2), 165-82. Retrieved from

http://search.proquest.com/docview/220943747?accountid=12085

Morrison, M. A. (1990). Addiction in adolescents. Western Journal of Medicine, 152(5), 543–

546.

Spear, L. P. (2002). The adolescent brain and age-related behavioral manifestations.

Neuroscience and Biobehavioral Reviews, 24, 417-463. doi: 10.1016/S0149-

7634(00)00014-2

Steinberg, L. (2004), Risk taking in adolescence: What changes, and why?. Annals of the

New York Academy of Sciences, 1021: 51–58. doi: 10.1196/annals.1308.005

Sussman, S., Skara, S., & Ames, S. L. (2008). Substance abuse among adolescents. Substance

Use & Misuse, 43(12/13), 1802-1828.

special populations research paper

Documents