Psychoactive Drugs and Youth
By: Richard William Guerra
One of the most important changes in substance use in the past forty years has been the gradual lowering of the age of drug users. Once believed to simply be a phase of youth, substance use among the nation’s adolescents has come to be recognized as a pervasive problem in 21st century America. Today, drugs and alcohol are commonly used by the youth to avoid stress, drown out emotions and as a shortcut to feeling good. Although this may sound like the status quo, there is a continuous flow of new drugs onto the scene and of older one’s being rediscovered and abused by young people. Inexperience in the youths’ using habits often leads to inappropriate use, drunk driving, intoxication and a number of negative effects on their lives and society at large. Young people maintain the perception of invulnerability to the consequences of drug use, but they are actually far more susceptible to developing lifelong problems with addiction. In this article I will attempt to present some of the more telling trends associated with psychoactive drug use and the youth, the physiological and mental effects of use and addiction on the youth and current efforts to prevent and treat substance abuse in adolescents.
It is important to understand the complex nature of the studies used to examine the realities of substance use among the youth. As more comprehensive research is compiled, it has become more difficult to describe the trends in adolescent drug use, due in large part to cohort effects. Beginning with increases in drug use during the early 1990s, cohort effects (lasting differences between different groups entering secondary school) have emerged. Such cohort effects mean that usage rates (and sometimes attitudes and beliefs about various drugs) reach peaks and valleys in different years for different grades. Factors, such as greater availability of drugs and overall tolerance of use, have also contributed to the instability of such findings. Increases in adolescent drug use have been attributed directly to the effects of a perpetual process labeled generational forgetting or generational replacement. Many drugs have made a comeback years after they first fell from popularity, often because young people’s knowledge of their adverse consequences faded as generational replacement took place. Currently, the perceived risk of LSD, inhalants and ecstasy among 8th, 10th and 12th graders is declining appreciably due to the effects of generational forgetting. Additionally, it has been found that most figures on current or frequent use of illicit drugs in high schools are underreported, with many uses in youth drug surveys minimizing or lying about their use of drugs.
Although there has been a considerable decrease in youth consumption of alcohol, tobacco and marijuana, the absolute numbers remain high. Teen drinking and drunkenness reached historically low levels in 2010, continuing a long term pattern of decline since about 1980. Despite recent declining rates, nearly three quarters of students (71%) have consumed alcohol (more than just a few sips) by the end of high school, and more than one third (36%) have done so by the 8th grade. In fact, more than half (54%) of 12th graders and one sixth (16%) of 8th graders surveyed in 2010 reports having been drunk at least once in their life. Additionally, underage drinkers account for nearly 20% of the alcohol consumed in the United States. It has been estimated that the cost of youth alcohol abuse is more than $58 billion (e.g. $36 billion in violent crime, $18 billion in traffic accidents).
After a dramatic increase in adolescent cigarette smoking in the 1990s, cigarette use has reached the lowest levels recorded in 35 years. Between 1996 and 2009, smoking fell by 69% among 8th graders and 57% among 10th graders. However, this decline came to a halt in 2010 as both 8th and 10th graders showed evidence of an increase in smoking. This may have been a result of the statistics involving both students’ perceived risk and disapproval of smoking cigarettes leveling off a number of years ago. One in five (20%) 8th graders have tried cigarettes and one in fourteen (7%) has already become a current smoker.
Following a long, gradual decline in adolescent marijuana use since the turn of the century, it continued to rise in 2010 in daily, 30-day, annual and life-time prevalence periods for 8th, 10th and 12th graders. Nearly one in sixteen (6.1%) high school seniors today is a current daily, or near-daily marijuana user. In a 2001 report titled Malignant Neglect: Substance Abuse and America’s Schools, the National Center on Addiction and Substance Abuse at Columbia University found that experimentation is not benign: of those students who have ever tried cigarettes, 85.7 % are still smoking in twelfth grade; ever been drunk, 83.3% are still getting drunk; and tried marijuana, 76.4 % are still smoking pot.
The proportions of adolescents using any illicit drug other than marijuana had been declining since 2001 but leveled in 2010. Use of most of these illegal drugs is at or below peak levels, however, misuse of prescription or OTC drugs has continued at an alarmingly high rate amongst the nation’s youth, now identified as “Generation RX.” The share of 12th graders in 2010 reporting use of any psychotherapeutic prescription drugs (amphetamines, sedatives, tranquilizers and narcotics other than heroin) without medical supervision in 2010 was 21.6% Prescription drugs now constitute a larger part of the overall US drug problem, with abuse by teens now exceeding abuse levels for many street drugs. Teen abuse of prescription opiod pain medications increased more than 540% in the early 2000’s alone. It is likely that this resurgence among youth is due to a decrease in concern about the dangers of using these drugs outside of medical regimen, a result of the introduction of the advertising of these drugs directly to the consumer. There has been an increase in popularity of “pharm parties” where young people bring prescription drugs they have raised from their parent’s medicine cabinets, and act known as “grazing.” The 2004 Partnership Attitude Tracking Study found that teens who abused prescription drugs were 21 times more likely than those who didn’t to abuse cocaine, 12 times more likely to do heroin, 5 times more likely to abuse marijuana and twice as likely to use alcohol. One particular consequence of this may be an increase in the amount of young people arrested while under the influence of drugs. The percentage of male juvenile arrestees testing positive for any drug except alcohol went from 22% in 1990 to 48% to 65% in selected cities in 2005. The percentage of all substance abuse treatment admissions aged 12 or older that reported any pain reliever abuse increased more than fourfold between 1998 and 2008, from 2.2 to 9.8%. “At least half of the people who come to our door now are 25 and younger,” Steve Wilke, executive director of the Endeavor House, an addiction treatment center in New Jersey, said to the Asbury Park Press.
The introduction of new drugs helps perpetuate the nation’s drug abuse troubles, particularly with the youth. Over the past few years, synthetic drugs such as K-2, Spice, Bath Salts and other designer drugs produced by so called “bathtub chemists”, like the hyper potent psychedelic “2-C family”, have become increasingly popular with teenagers. “Synthetic drugs don’t generally show up on drug tests and that’s made it popular with young adults,” Barbara Carreno, a spokesperson for the Drug Enforcement Agency told Shine.Yahoo.com. Additionally, the spread of these new illicit drugs can be attributed to the “viralization” of word of mouth. According to data obtained by the American Association of Poison Control, half of those exposed to the drug 2C-E (“Smiles”) in 2011 were teenagers and the drug was blamed for the death of a Minnesota teen and the overdose of eleven others. With the rise of these new drugs, it is important to note that more research is needed to determine the potential health or addiction risks from the use of these synthetic compounds.
Early onset drug use is the single best predictor of future drug problems in an individual. Those individuals who experiment with substances before the age of 12 are much more likely to develop addiction problems than those who wait until they are 18 or 19, while those who delay their first use until after the age of 25 rarely develop chemical dependency. “Addiction has shown to be essentially a form of ‘learning’,” Francis Jensen, a neurologist at Children’s Hospital in Boston, said in an interview with NPR.org, “After all, if the brain is wired to form new connections in response to the environment and potent psychoactive drugs suddenly enter that environment those substances are tapping into a much more robust habit-forming ability that adolescents have compared to adults.”
Adolescents’ psychological immaturity is due in part to the fact that their brain develops at a much slower pace than was previously thought. The neural insulation (the fatty coating called myelin, or “white matter”) that strengthens nerve cell connections between a young person’s frontal lobes and the rest of their brain is not completely developed until their mid-20s. Spotty or thin myelin leads to inefficient communication between one part of the adolescent’s brain and another. It is of particular importance that parts of the brain’s reward/reinforcement pathway, including the ventral medial prefrontal cortex that coordinates executive functioning and impulse controls, are effected by this sluggish connection. Decreased activity in the left ventral medial prefrontal cortex has been observed in both chemical dependency and impulse control disorders. Therefore, the part of the youth’s brain that is the last to be connected is the piece that governs judgement. This affects temporal processing, the ability to make and carry out long term planning, and as well as delay discounting, the modern term used to describe an inability to delay gratification. The adolescent brain lacks the insight to recognize the consequences of their behavior that are not immediate. Their immature prefrontal cortex leads directly to a sort of hardwiring of risk taking. Their perception of the potential benefits of substance use outweighs the risks even as it has been shown that teens actually tend to overestimate the true risks of their actions. “In the developing brain, neurons are growing and changing, synapses are forming,” Dr. Jeffrey Brosco, a professor of pediatrics at the University of Miami’s Miller School of Medicine, told CNN.com, “When there’s a lot of change in any part of the body, particularly the brain, that usually means it’s more vulnerable to environmental influences.”
In modern American society, young people’s’ need to reach adulthood is as relaxed as it has ever been. They are increasingly encouraged and able to stay home after high school, put off entering the workforce and stay in school until they are 25 or older. By avoiding handling and solving financial, emotional and social problems, the youth delay important stages of maturation. Substance use often encourages young people to avoid life’s conflicts. When young people drink or take drugs to control emotional turmoil, they do not appreciate the collateral psychological effects of solving problems with a substance. Adolescents who use marijuana weekly reported that they were almost six times likelier to cut class or skip school than those who do not. Much of the alcohol and other drug use in high schools is experimental, social or habitual with bouts of abuse. Most students have not had enough time for addiction to occur, however, the frequency of inappropriate use is more likely. During 2008, nearly one tenth (8.8%) of all drug related emergency department visits made by adolescents aged 12 to 17 involved suicide attempts with pharmaceuticals being involved in 95.4 percent of those.
Considering the instability of the various trends and physiological factors regarding adolescent psychoactive drug use, development of effective prevention and treatment techniques can be especially difficult. A number of environmental conditions can put some adolescents more at risk for substance abuse than others including: being exposed to peer group tolerance or encouragement of drug use; instability or abuse at home; and being in a school that has no policies, detection procedures or referral services for uses. The challenge for prevention specialists is to develop programs that clearly identify such risks and teach adolescents to deal with them while enhancing the protective elements that promote healthy lifestyles and personal accomplishments. Researchers Steven Glenn, PH. D and Richard Jessor, Ph.D., have determined that there are four determinants that help children avoid drug use: a strong sense of family participation and involvement, an established personal postion about drugs and alcohol, strong spiritual sense and community involvement, and attachment to a clean and sober adult role model. Due to the adolescent’s immediate temporal horizon, it is also clear that programs should set goals that are achievable in a short period of time and continually reinforced.
The school environment plays an undeniable part in influencing drug and alcohol use. Young people are much less willing to accept guidance or intervention from adults but are more willing to listen to their peers. This reinforces the need for specific youth-directed programs in school that encourage peer interaction and guidance to other youth. Student assistance programs are particularly important during the tertiary level of prevention, meant for students who have already developed a problem with drugs. The honesty of peers in teenage 12-step anonymous meetings (ex. Alateen), counseling and social service programs, and on peer intervention teams seems most effective in getting through to other students who are abusing drugs.
Despite the historically taboo nature of adolescent substance use, it is never too early to start educating children on the realities of drugs, alcohol and addiction. Primary prevention strategies should be implemented as young as possible to prevent or at least minimize drug experimentation and use. They must be customized not only for specific age groups but also for ethnicity, gender, culture and other particular factors that will get the information across. One danger of primary prevention with adolescents is focusing on punitive measures using drug testing and zero-tolerance policies rather than emphasizing personal development. A life skills program taught in grades 7 to 10, Life Skills Training, focuses on increasing social skills and reducing peer pressure to drink. An evaluation of Life Skills Training showed a decrease in the frequency of drinking and excessive drinking. Despite modest results, resistance education programs, such as DARE (Drug Abuse Resistance Education) are widely used to teach self-esteem, decision-making skills and peer resistance training to fifth or sixth graders. Normative education strategies have proven to be successful in correcting misconceptions about the prevalence, acceptability and supposed benefits of alcohol and drug use among peers.
Additionally, perceived benefits and perceived adverse outcomes that young people come to associate with substances are often specific to each drug. This is why prevention must occur drug by drug, because young people will not necessarily generalize the adverse consequences of one drug to the use of others. It is important that substance abuse education and primary prevention programs continue through high school and into college. Adolescent brain development contributes to the necessity for more than a limited one-year attempt at convincing students to abstain from drugs and alcohol.
In addition to prevention at schools, family-focused prevention is essential to influence the adolescent’s perception of the acceptability of drug and alcohol use. Multidimensional family therapy (MDFT) involving individual therapy and family therapy has proven to be most effective in treating adolescent substance use, with parental involvement being the key. A 2005 study by the Partnership for a Drug Free America indicates that parents who have repeated discussions with their children about the risks of illicit drugs and who set clear rules do make a difference in adolescent drug use. Programs such as parental skills training through the school, reduction in parental use of drugs or alcohol in front of children, and greater positive participation of parents in their children’s lives have a great influence on children’s behavior.
Now more than ever, it is important to become conscious of the use and abuse of substances amongst adolescents. Due to the gradual development of their minds, the youth will continue to struggle against the allure and dangers of drugs and alcohol. Trends concerning the relationship between psychoactive drugs and the youth have proven to be effective tools in understanding its history and repercussions. As society becomes more aware of the costs of drug and alcohol use and abuse on adolescents’ lives, the need to develop flexible education and prevention programs will continue to intensify.