Academic journal article International Journal of Child Health and Human Development

Substance Abuse and Adolescence

Academic journal article International Journal of Child Health and Human Development

Substance Abuse and Adolescence

Article excerpt

Introduction

Substance abuse is a major public health dilemma of adolescents throughout the world and is an issue that must be dealt with by clinicians, society, and countries in the world (1-11). The neurobiology that underlies drug addiction is complex and only now becoming understood with modern research on how these drugs disrupt neurotransmission involving dopamine, serotonin, and other neurotransmitters (12). Addiction involves many complex interactions with neurotransmitter systems including serotonergic, cholinergic, glutamatergic, GABAergic, and opioidergic pathways. Neuroimmune signaling seems to be a key underpinning of addiction and co-morbid depression. GABA (gamma-aminobutyric acid) is the key inhibitory transmitter in the cerebral cortex and research is identifying chemicals that inhibit GABA transporters (GAT 1-4) that may become important tools in the pharmacologic management of addiction.

Current and new research into the reward circuitry of the brain that causes the euphoria desired by addicts will lead to novel approaches to management (12,13). Medications with effects on glutamatergic transmission are under research as well, such as acamprosate and topiramate that will be mentioned later. Research is also identifying the vulnerability of the changing adolescent brain to addictive drugs due to an innate need of many adolescents to thrill seeking behavior with limited frontal lobe behavioral control (14). High rates of adolescent pregnancy and concomitant drug abuse during pregnancy highlight a serious problem in American youth as well as adults (15). This underscores the need for intense efforts in prevention principles in the approach to youth and drugs of addiction. Emerging research in pharmacogenetics will allow clinicians in the future to match available pharmacotherapeutic agents with individual genetic profiles.

This paper reviews basic pharmacologic approaches dealing with abuse of alcohol, tobacco, marijuana, hallucinogens, heroin, cocaine and date rape drugs (see table 1). Inhalant drugs include such chemicals as paint thinners or solvents, gasoline, airplane glue, art or office supply solvents, gases (from butane lighters, whipping cream aerosols, deodorant sprays, others), ether, chloroform, nitrites (amyl nitrite, butyl nitrite) and others. These drugs are popular with young adolescents.

Substance abuse disorders are associated with death in adolescents and young adults from suicides, homicides, and motor vehicle accidents (16,17). A number of co-morbid illnesses may be seen with drug abuse, as noted in table 2. Protective factors for substance abuse are considered in Table 3, while substance abuse risk factors are listed in table 4; nonspecific markers for substance abuse are noted in table 5. Stages of drug abuse are reviewed in table 6. The epidemiology of substance abuse for high school students in the United States from 1991 to 2009 are reviewed in figures 1-3, based on the Centers for Disease Control and Prevention Youth Risk Behavior Surveillance (YRBS) data (11,18). Figure 4 reviews data from the 2003 ESPAD (The European School Survey Project on Alcohol and Other Drugs) report (19). The lifetime prevalence for any substance abuse in adolescents is 10-12%.

Alcohol

Alcohol is among the most abused substances worldwide that has widespread acceptance by adolescents and adults.

Alcohol use is universally promoted by advertisements in miscellaneous media, such as movies, television, magazines, and others. American youth first try alcohol at age 12 and the lifetime prevalence of high school seniors (ages 17 to 18 years ) is over 80%. Binge drinking (5 or more alcoholic drinks in males versus 4 or more in females) is found in 1 of 6 of 14 year olds versus one-third of high school seniors.

A person who begins drinking alcohol as a young teenager is four times more likely to develop alcohol dependence than someone who waits until adulthood to use alcohol. …

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