Academic journal article Public Health Reviews; Rennes

Substance Use and Associated Health Conditions throughout the Lifespan

Academic journal article Public Health Reviews; Rennes

Substance Use and Associated Health Conditions throughout the Lifespan

Article excerpt


Substance use is a major public health concern that affects every level of society. Individuals, families, communities, and overall government spending is impacted by the use of licit and illicit substances. Recent reports estimated that annual costs in the United States are approximately USD $193 billion for illicit drug use,1 USD $223 billion for excessive alcohol use,2 and USD $193 billion for tobacco use.3 These costs include lost wages and productivity, criminal activity, and healthcare expenses. The economic burden aside, public health efforts can benefit from a better understanding of the impact of substance use disorder (SUD) on physical and mental health. Particularly, examining SUDs and the constellation of associated health and mental health problems throughout the lifespan provides a full picture of how variations in drug use patterns and outcomes shift with age, on which the present article will focus.

Adolescence represents a time in biological and social development that is associated with increased risk-taking behaviors; as such, experi- mentation with drugs and alcohol often begins in adolescence.4 Young brains are still changing as synaptic pruning continues into early adult- hood,5 making the possibility for long-term negative effects of substance involvement even more profound. On the other end of the age spectrum, older adults also represent an extremely vulnerable group. The physiological changes that occur as a result of the natural aging process result in an increased use of multiple medications, drug and alcohol sensitivity, and the likelihood of co-occurring health conditions; thus, the risk for and con- sequences of SUDs are magnified.6-8

The purpose of the current review is to synthesize the research findings to date that examine physical and mental health problems associated with substance use at different stages of life. The goal is not to provide an exhaustive list of studies, but to emphasize the changing needs across the lifespan of those suffering from comorbidities in order to inform development of care and future research. In addition to presenting general patterns of alcohol, tobacco, and licit/illicit drug use, common and troublesome medical and psychiatric conditions associated with SUDs among adolescents, adults, and older adults are discussed. While some substances can result in significant consequences that are both acute and chronic (e.g., alcohol), the negative impact of others (e.g., tobacco) are primarily observed only after prolonged use. Finally, recommendations regarding clinical implications and areas for future research are presented.

Developmental Framework and Life Stages

Focal to the current review is the integration of studies across developmental periods which link substance use and health conditions. Biogenetic, psycho- logical, and sociocultural factors vary in influence depending upon proximal (e.g., family, peer group, work setting) and distal (e.g., broader cultural, sociohistorical events such as wars or economic recession) contextual events over the lifespan.9-12 By placing the current literature within a developmental- contextual framework, we highlight what Bronfenbrenner10 terms "ecological transitions." These transitions are characterized as "whenever a person's position in the ecological environment is altered as a result of change in role, setting, or both."10 We have organized the reviewed studies based on life stages marked by major developmental transitions. While specific age groupings may vary somewhat from study to study, the majority of research investigates substance involvement within one of three seminal life stages: adolescence, adulthood, and older adulthood. Table 1 summarizes examples from principal domains of developmental transitions relevant to each of the three life stages.

Substance Use Patterns

Large epidemiological surveys have shown alcohol, tobacco (i.e., cigarettes), and marijuana have the highest prevalence rates across all age groups. …

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