Skip to content →

Substance Use and Abuse

(10-17-13)

Substance use disorders in youth

When is alcohol and drug use in children and adolescents problematic?

  • terminology: use, abuse, dependence, “biological dependence”, tolerance, withdrawal, “alcoholism”, addicted
    • use
    • abuse, maladaptive pattern of substance use
    • DSM 5 (2013) defines Substance Use Disorders as “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant sustance-related problems.” (p. 483)
      • impaired control over substance use: taking in larger amounts or over longer period of time than intended, failure to regulate substance use despite attempts to do so, spending a great deal of time obtaining/using/recovering from the use of the substance, craving
      • social impairment: failure to fulfill major role obligations at work, school, or home
      • risky use: recurrent use in situations in which it is physically hazardous, use despite knowledge of having recurernt physical or psychological problems; it is not the use but the failure to abstain despite the difficulty it is causing
      • pharmacological criteria
    • DSM 5 identifies ten classes of substance use/abuse/intoxication/withdrawal
      • alcohol
      • caffeine
      • cannabis
      • hallucinogens
      • inhalants
      • opioids
      • sedatives
      • stimulants
      • tobacco
      • other (or unknown)
    • Almost any alcohol use outside of family events and all illicit drug use by children is usually viewed as problematic by health and mental health professionals
  • Evaluation of alcohol and drug use by teenagers is more challenging
    • some alcohol and chemical experiementation may be viewed as “typical” if not desirable
    • many adolescents use mood altering chemicals periodically (usually at a relatively low frequency) with minimal impact on their lives and development
    • even “heavy” episodic alcohol and drug use in adolescence does not predict well continuing substance use problems or adjustment in adulthood for many teens
  • Distinguishing between use and abuse (except by fiat) is often difficult
    • failure to meet academic, social, occupational standards and expectations
    • persistent and recurrent social or interpersonal problems related to substance use
    • CRAFFT Screening Protocol
  • toxicology screens are commonly used in inpatient and outpatient treatment programs, and sometimes in indivdual treatment
    • most illicit drugs dissipate within about 1 to 3 days, except marijuana can be measure up to 7 weeks after last use (Shatkin, 2009)

Etiology of substance abuse and dependence

  • there is a great deal of modeling of chemical regulation of mood in our society
  • there is a great deal of modeling of chemical use as an association of the good life in our society
  • there is increasing evidence of a neurobiological basis for problematic use of substance in some individuals in our society
    • Most illicit drugs and alcohol and nicotine increase dopamine (or mimic dopamine) in the limbic system, one of the principal centers of emotional regulation in the brain. Increases in dopamine within the dopamine neuron synapses with drugs of abuse are 5 to 10 times greater than with natural reinforcers (food, sex, getting an A on an exam); also, drugs like cocaine, amphetamines, and methamphetamine block the reuptake transporter so dopamine stays in the synapse longer than with natural reinforcers (Shatkin, 2009)
    • Dopamine is a neurotransmitter that helps regulate motivation and cognitive behaviors necessary for survival: food intake increases dopamine, sexual behavior increases dopamine, social interaction increases dopamine. There is debate as to weather dopamine/dopamine tracts actually produce pleasure/reinforcement or, alternatively, signal the availability of reinforcement in the environment. Either way, activities that lead to greater dopamine are usually repeated and virtually all drugs of abuse work by elevating dopamine mediated signals in our brain.
    • Many individuals who abuse drugs, such as cocaine, have a lower number of dopamine receptors, especially D2 depamine receptors, in their brain in the limbic system (there is a chicken and egg question here); also dopamine alone does not explain addiction. The number of D2 receptors in macaque monkeys tend to be higher than dominant monkeys once they are within a hierarchy system–brain systems are responsive to environmental influences.

Epidemiology

  • Approximately 8% of adolescents aged 12 to 17 years are considered in need of treatment for alcohol and substance abuse (Shatkin, 2009). DSM 5 gives an estimated 12-month prevalence of alcohol use disorder of 4.6% for 12 to 17 year olds.
    • DSM 5 includes a 2010 report of 44% of 12th-grade students reporting having been “drunk in the past year”
    • Illicit drug use peaks in late adolescence and early adulthood.
    • Age of initial use has consistently been found to be a risk factor for adult abuse and dependence (Chen, Storr, & Anthony, 2009); association with peers who abuse drugs is possibly the most robust predictor of adolescent substance abuse (NIDA, 2008; Rowe, Liddle, Caruso, & Dakof, 2004)
  • Cannabinoids, usually cannabis, are the most widely used illicit psychoactive substance in the U.S. (DSM 5, 2013, p. 512)
    • DSM 5 (p. 512) give a 12 month prevalence rate of approximately 3.4% among 12 to 17 year olds; greater among teenage males (3.8%) than females (3%)

Treatment

  • treatment of addiction (substance dependence) may involve any of several elements:
    • detoxification (often not necessary with adolescents)
    • inpatient hopsitalization (depending on severity)
    • therapeutic community (programs designed to addicted individual from influence of drug using peers, involve him/her in supportive environment, teach coping skills for dealing with life without drugs)
    • outpatient treatment (most common form of intervention with adolescents with substance use programs)
      • individual treatment
      • group therapy and psychoeducational groups
      • family therapy
    • self-help programs (often 12-step groups modeled on or adapted from AA)
  • treatment of comorbid mental health problems is important
    • internalizing problems (anxiety, depression, low self-esteem)
    • externalizing problems (oppositional and conduct disordered behavior, ADHD)
    • learning problems
    • interpersonal problems (problems of social adjustment and functioning, family conflicts, peer relationships)
  • a number of medications have become available for helping adults with alcoholism and other addictions, none are currently approved by the FDA for use with children or adolescents but are sometimes employed with adolescents
    • acamprosate (Campral) for alcohol abstinence, reduces cravings
    • buprenorphine (Subutex) for opioid dependence
    • disulfiram (Antabuse) for maintenance of sobriety from alcohol
    • methadone (Dolophine or Methadose) for opioid dependence
    • bupropion (Zyban or Buproban) and varenicline (Chantix) for smoking cessation
    • buprenorphine plus naloxone (Suboxone) for opioid dependence
    • nicotine replacements (gum, inhalation, lozenage, nasal spray, patch)

Gateway Drugs

Protective & Risk Factors for Adolescent/Adult Drug Abuse

Predictors of Adolescent Drug Treatment Success

Gateway Drugs

(11-6-12)

  • Smoking (nicotine) & Drinking (alcohol)
  • Marijuana (cannabis)
  • other “illicit” drugs
  • [cocaine, opioid, amphetamines, hallucinogenic, inhalants, phencyclinidine, sedatives, hypnotics, anxiolytics, other]
  • abuse of prescription drugs

The idea that there is a hierarchical relationship apparent in humans’ use of psychoactive chemicals has been considered by various investigators. A typical view is that use of cigarettes and alcoholic beverages provides the initial entry into “drug use” which may then progress to other chemicals. What has been observed is that it is unusual to find someone who uses marijuana who has never either smoked tobacco or drunk alcohol (It is possible to find such people and we should be careful in how literally this model is interpreted.). Similarly, it is unusual to find someone who uses “more serious” drugs, such as cocaine or heroin, who have not used Marijuana. Interestingly, some investigators (Kandel, Yamaguchi, & Chen, 1992) have reported that misuse of prescription drugs is uncommon in individuals who have not previously used drugs of abuse. The potential value of this model, if it continues to receive empirical support, is in the suggestion that targeting the early elements in the chain or hierarchy (tobacco and alcohol use) may be an effective strategy to prevent use of the even more destructive chemicals seen in use later.

Protective & Risk Factors for Adolescent/Adult Drug Abuse

(Kilpatrick et al., 2000; Lynskey, Fergusson, & Heywood, 1998; Newcomb & Felix-Oritz, 1992)

Risk Factors

  • low educational aspirations
  • high perceived adult drug use
  • high perceived peer drug use
  • many deviant behaviors
  • high perception of community support/tolerance for drug use
  • easy availability of drugs
  • physical or sexual assault
  • high novelty/stimulus seeking

Protective Factors

  • high GPA
  • low depression
  • supportive relationships at home
  • many perceived sanctions for drug use
  • high religiosity
  • high self-acceptance
  • high law abidance

Unfortunately, risk factors tend to be stronger predictors than protective factors.

Web References:

Monitoring The Future: http://monitoringthefuture.org/

CRAFFT Screening Protocol

C Have you ever gotten into a Car driven by someone including yourself who was high or using alcohol or drugs?

R Do you ever use alcohol or drugs to Relax?

A Do you ever use alcohol or dugs while you are by yourself or Alone?

F Has a Friend, Family member, or other person every thought you had a problem with alcohol or drugs?

F Do you ever Forget (or regret) things you did while using?

T Have you ever gotten into Trouble while using alcohol or drugs, or done something you would not normally do–for example, break the law, rules, or curfew, or engage in risky behavior?

(Griswold, Aronoff, Kernan, & Kahn, 2008)

Skip to toolbar