Study Notes on Chemical Abuse by Children and Adolescents Chapter 23

Chapter Twenty-Three: Chemical Abuse by Children and Adolescents

  • Scientists recognize childhood and adolescence as crucial developmental periods for individuals.

    • These periods build the foundation for transitioning into early adulthood ("Young Adult Drinking," 2006).

  • Research indicates that:

    • Mid-adolescence (around 15 years old) is the most common time for initiating recreational chemical use (Flanagan & Kokotailo, 1999).

    • Substance Use Disorders (SUDs) are most prevalent between ages 18-25 (Substance Abuse and Mental Health Services Administration, 2005).

    • Approximately 7-10% of adolescents will meet the diagnostic criteria for a SUD, but only a fraction get referred for treatment (Kaminer & Bukstein, 2005).

  • Adolescent substance abuse is historically significant:

    • Highly prevalent as early as the 19th century, especially with alcoholism among youth in England (Wheeler & Malmquist, 1987).

    • Social reforms aimed at curbing this behavior drove it underground rather than eliminate it.

    • Evidence from the 21st century indicates long-term consequences of adolescent substance abuse may persist throughout life.

  • Substance abuse rehabilitation professionals must understand:

    • The manifestations of SUDs in youth and treatment methodologies for this population.

The Importance of Childhood and Adolescence in the Evolution of Substance Use Problems

  • Childhood and adolescence are differentiated into substages with specific developmental tasks:

    1. Early Adolescence (approximately age 10-14): Focus on physical development and CNS maturation.

    2. Middle Adolescence (approximately age 15-17): Cognitive development continues amid struggles with self-acceptance.

    3. Late Adolescence (approximate age 18-21): Increased psychosocial exploration and adult role integration (Wunsch, 2007).

  • The timing of drug use affects developmental impact.

    • Drug exposure during critical developmental windows can hinder normal growth.

  • By age 18:

    • 66% of adolescents have tried cigarettes; 13% smoke at least half a pack daily (Kaminer & Tarter, 2004).

    • 8% of 18-year-olds have tried cocaine; 15% have tried inhalants, hallucinogens, or stimulants (Kaminer & Tarter, 2004).

    • 4.3% of high school seniors have abused OxyContin; 9.7% have misused Vicodin (Wunsch, 2007).

    • 75% of high school seniors report alcohol use.

Developmental Neurology and Substance Abuse

  • Adolescence is a crucial period with dynamic CNS development (Parekh, 2006).

  • Limited research exists on the long-term effects of alcohol and drugs on CNS development (Ling, Rawson, & Shoptaw, 2006).

  • Early substance abuse is linked to:

    • Higher risk of future addiction with lower rates of seeking treatment (Rosenbloom, 2005).

    • 15% of alcohol-dependent individuals do so before age 18; 32% develop dependence between 18-20 (Nelson, 2007).

    • Only 20% of alcohol-dependent individuals start dependency after age 30.

Scope of Substance Abuse in Adolescents

Child and Adolescent Chemical Abuse Patterns

  • Alcohol abuse among children/adolescents is often underreported:

    • Nearly 50% of students aged 11-14 admit to alcohol use (Fetro, Coyle, & Pham, 2001).

    • Average age for initial alcohol use is 11.9 years for boys and 12.7 for girls (Alexander & Gwyther, 1995; Morrison, Rogers, & Thomas, 1995).

  • Patterns of alcohol/drug abuse fluctuate over time:

    • In the late 20th century, adolescent substance abuse peaked around 1981, then declined until stabilizing in the early 1990s.

    • Recent estimates indicate 7-10% of older adolescents in the US meet criteria for SUD (Kaminer & Bukstein, 2005).

Adolescent Chemical Abuse Patterns

  • Alcohol is the most popular substance among adolescents (Hogan, 2000).

    • 72% of surveyed 12th graders have consumed alcohol; 5-8% meet diagnostic criteria for Alcohol Use Disorder (AUD) (Johnston et al., 2006a; Parekh, 2006).

    • Adolescents represent 12-20% of the entire US alcohol market, consuming approximately 4.3 million liters each year (Pumariega & Kilgus, 2005; Rosenbloom, 2005).

    • The most commonly consumed alcoholic beverage by adolescents is beer (Rosenbloom, 2005).

    • Rising popularity of hard liquors among teens (CDC, 2007).

Other Substances Abused

  • Marijuana is the most commonly abused illicit substance, with 42% of seniors admitting use (Johnston et al., 2006a).

  • Other substances include:

    • Inhalants

    • Benzodiazepines

    • Opioids (often diverted from legitimate sources) (Wunsch, 2007).

    • Use of heroin or prescribed narcotics is rising among adolescents (Marsch et al., 2005).

  • Less common abuse of hallucinogens, with only 8.3% of high school seniors admitting use (7.8% for hallucinogens other than LSD) (Johnston et al., 2006a).

  • Of those entering treatment, 23% have abused CNS stimulants (Croft, 2006).

College Student Substance Abuse

  • College years mark a transition from adolescence to early adulthood, characterized by increased risk-taking behaviors (Arnett, 2000).

  • Alcohol remains the predominant substance used by college students, leading to hazardous behaviors and serious consequences.

    • Over 90% consider drinking integral to their social life; 44% engage in binge drinking (Saffer, 2002; Wu et al., 2007).

  • Adolescents make up a significant portion of substance abuse statistics, with implications for public health and safety.

Consequences and Cost of Underage Drinking

  • Underaged drinking leads to numerous adverse social and health consequences:

    • Contributes to morbidity and mortality rates among youth related to numerous factors, including accidents and violence (Kaminer & Bukstein, 2005).

  • Economic impact of underage drinking:

    • Cumulative cost of underaged drinking hits $3 per drink, compared to a mere 10¢ generated in tax revenue (Miller et al., 2006).

Impact of Substance Abuse on Brain Development

  • Studies reveal adolescents' brains are more susceptible to alcohol-related damage compared to adults (Tapert et al., 2004). Areas like the hippocampus remain vulnerable (DeBellis et al., 2000).

  • Recovery from alcohol abuse may reflect cognitive decline, supporting the case for lasting effects of adolescent substance use.

The Gateway Drug Theory

  • The notion of gateway drugs suggests certain substances lead to use of harder drugs:

    • Alcohol and tobacco are often seen as precursors to further drug use (Walker et al., 2004).

    • Study conducted on rats suggests prior exposure to marijuana increases the likelihood of later heroin use (Ellgren et al., 2006).

    • However, counter-research argues that early alcohol and nicotine use is more predictive (Rosenbloom, 2005).

Tobacco Abuse by Children/Adolescents

  • Adolescents may begin smoking as young as 12, with many becoming regular smokers by 14 (Hogan, 2000).

  • Daily, an estimated 3,000 children/adolescents start smoking (Pumariega & Kilgus, 2005).

  • The addictive effects of nicotine are exacerbated in developing brains (Strauch, 2003).

Reasons for Substance Abuse in Adolescents

  • Key motivations:

    1. To feel grown up

    2. To rebel against authority

    3. To fit into peer groups

    4. To relax and feel good

    5. Out of curiosity (Hogan, 2000).

  • Substance abuse in adolescents often linked to underlying emotional distress such as depression or social stressors (Cleary & Shinar, 2001; Joshi, 1988).

Peer Group and Relationship Influences

  • Peer groups can significantly influence substance use patterns, acting either as risk or protective factors (Ross, 2002). Peer approval can often supersede pharmacological benefits of substances (Oetting, 1999).

  • Parental behavior is also crucial:

    • Engagement and emotional support from parents lead to lower rates of chemical use among children/adolescents (Kaminer & Bukstein, 2005).

Diagnosis of Substance Use Disorders

  • Adolescents often show complex behaviors and symptoms indicative of SUDs.

  • Various tools exist for assessing substance abuse:

    • Examples include CRAFFT, CAGE, and AUDIT, although many adult tools do not translate well to adolescent populations (Parekh, 2006).

  • The need for refined diagnostic criteria specific to adolescents is evident given the differences in their developmental context and reactions to substances.

Treatment Needs

  • Special considerations in treating adolescents:

    • Developmental appropriateness of the program, family inclusion, attentiveness to co-existing issues like psychiatric disorders, and cultural sensibility in treatment (Bukstein, 1994; 1995).

  • Effective treatment centers not only focus on abstinence but also cover broader health and life skills addressing a wide range of needs.

Conclusion

  • Adolescents often remain hidden victims of substance abuse:

    • The interplay of peer pressure and family influence shapes substance use behaviors.

    • Future research should focus on identifying risk factors and developing effective, ethical treatment methodologies.