Public Health Aspects of Substance Use and Abuse in Adolescence

By Greydanus, Donald E.; Reed, William J. et al. | International Public Health Journal, October 1, 2016 | Go to article overview

Public Health Aspects of Substance Use and Abuse in Adolescence


Greydanus, Donald E., Reed, William J., Hawver, Elizabeth K., International Public Health Journal


Introduction

The United States SAMHSA (Substance Abuse and Mental Health Services Administration) directs a survey every year of the US population (non-military, non-institutionalized) who are 12 years of age and older (1). The publications is called NSDUH (National Survey of Drug Use and Health) and its 2013 report noted that 24.6 million Americans 12 years of age and older used illicit drugs in that they had used an illicit drug during the month prior to the survey (1). Racial disparities in illicit drug use are being identified by various studies (2,3).

It is important that clinicians who are caring for adolescents be directly involved in teaching their patients how to prevent the use and abuse of drugs (Table 1); clinicians can also remain active in the management of substance abuse disorders, if it develops in their patient (4-11). Adolescent exposure to illicit drugs can lead to a lifetime of medical and psychiatric effects (7). The impact of illicit drugs, when taken during pregnancy, can be devastating to the fetus and the child (12). Drug addiction involves mesocorticolimbic circuitry dysfunction and can be a lifelong problem, especially from cannabis, cocaine, nicotine, alcohol, and ecstasy (13). A number of factors are involved in drug addiction, including the role of serotonin, ghrelin, and other factors that are under study (14, 15). Death from the use of illicit drugs continues, as is seen with the use of heroin, amphetamines, inhalants, and others (16).

Screening for substance abuse (17) is critical because the neuro-psychiatric changes caused by some drugs (i.e., Ecstasy) may be irreversible and there have been reports of acute psychosis following marijuana and phencyclidine (PCP). One should also consider the likelihood of co-morbid conditions (see Table 2) in any adolescent or young adult with a history of continuing or repeated substance abuse; these conditions include ADHD, especially when associated with or secondary to a learning disorder where treatment is protective. Risk factors for drug abuse are reviewed in Table 3, while Table 4 considers non-specific indicators of drug abuse and Table 5 outlines protective factors for drug abuse. Screening tests may be helpful, such as the CRAFFT questions for alcohol use. The role of prescription medication dependence must be considered also by clinicians (18).

A major contribution that the primary care clinician can provide is to establish a medical home for all youth including those with substance use (19). The success of management is partially based on the underling genetics of addiction for a person, especially with opioid, alcohol, and cocaine dependence (20). Straightforward talk with teens about drug use is important in the screening process, though the teenager's estimates are often lower than the actual use. The clinician can work with the community in supporting community-based drug abuse prevention programs. Models of treatment are available ranging from brief to intensive management (21). Attention to improving sleep dysfunction in those with substance dependence and depression is an important goal in overall management of these person (22).

Adolescents generally progress from initial drug use to more serious drug use behavior in a pattern that is recognizable (see Table 6). At first, there is curiosity about drugs, though no drug use may be occurring. A need for acceptance by some peer group along with a low self-esteem may lead to experimentation with some drugs-often the "gateway" drugs- tobacco, alcohol and/or marijuana.

At some point the euphoria some drugs deliver is felt by the adolescent, typically at weekend parties or when combined with other substances. In some youth, there develops a state of actively seeking out the euphoria of drug use with widening of the types of drugs used (i.e., cocaine, Ecstasy, heroin, others), using personal drug paraphernalia, buying and/or stealing drugs on a regular basis, and becoming more dependent on one or more drugs. …

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