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This article covers the spread of substance use problems in adolescents and some of the currently available scientifically proven behavioral treatments for these conditions.
Three main points need to be highlighted.
• First, experimentation is a normal behavior during adolescence; however, drug use is not, nor is the transition into drug problems. Experimentation with drugs and alcohol is fraught with risks and should be discouraged. Particularly, data suggest that the younger the age that substance use is started, the higher the risk for substance dependence.
• Second, drug use starts primarily as a social behavior, concurrent with the social reorientation from family to peers that takes place during adolescence.
• Third, the adolescent brain undergoes unique changes that contribute to enhancing impulsivity and risk-taking behaviors, which are vulnerabilities for substance use. These behaviors serve to facilitate the transition that adolescents need to accomplish for species survival—leave the nest and confront a new and potentially dangerous world to become independent.
Much work has been dedicated to understanding the neural changes that underlie risk for substance use problems in youths, as well as the effects of drug addiction on the adult brain. (Very little has been done on the adolescent brain.) Implications for treatment that will refine existing effective interventions and provide new therapeutic strategies are yet to come.
In the United States, estimates of adolescent substance use behaviors and attitudes primarily come from 3 population-based national surveys: the Monitoring the Future (MTF) study of 8th, 10th, and 12th graders and linked longitudinal follow-up studies; the National Survey of Drug Use and Health (NSDUH) study of those aged 12 and older; and the Youth Risk Behavior Survey of adolescent students.1-3 These surveys employed different methods and produced slightly different point estimates, yet the trends of adolescent substance use over time are consistent across the surveys. Only the most notable estimates are presented.
Drug use starts at different ages, depending on the type of substances, but generally onset is in adolescence. Findings from the MTF study indicate an earlier start for drugs that are perceived as less harmful or risky and for those that are easily accessible. Earlier start patterns were reported for alcohol, tobacco, and inhalants (more than half of users reported initiation before the end of 9th grade) relative to other illicit drugs, such as cocaine and hallucinogens (fewer than one-third reported initiation before the end of 9th grade).1
Among respondents in the NSDUH study who reported using an illicit drug for the first time in the past year, more than half were younger than 18.2 These estimates of school samples are based on retrospective reports and may not capture those heavier users who dropped out of school.
Adolescent substance use peaked in the mid to late 1990s. This peak was followed by a general decline, despite some geographic and drug-specific epidemics, until around 2008, when the overall decline seems to have stalled. In 2011, according to the MTF study, nearly half of high school seniors reported having used an illicit drug at some point, and 40% had used in the past year (Figure 1), followed by 33% of 10th graders, and 15% of 8th graders. Marijuana was the most prevalent illicit drug. Nearly two-thirds of high school seniors, half of 10th graders, and more than 26% of 8th graders reported taking at least 1 drink in the year before the survey (Figure 2), and more than 42%, 29%, and 10%, respectively, had been drunk.
Patterns of drug use may vary by sex and ethnic group as well as by drug type. Boys tend to report more use than girls, particularly as they get older and for many different drugs.1 Boys may have greater opportunities to initiate drug use than girls; however, when opportunity to use was controlled for, boys and girls were equally likely to use.4 White and Hispanic adolescents tend to report more overall drug use than African American youths; however, differences vary by drug type and school grade.5 Additional details regarding racial and ethnic differences can be found in the respective reports of the 3 surveys.
Dr Chambers is Health Scientist Administrator, Behavioral and Integrative Treatment Branch, National Institute on Drug Abuse (NIDA); Dr Lopez is Branch Chief, Epidemiology Research Branch, Division of Epidemiology, Services, and Prevention Research, NIDA; and Dr Ernst is Head of Neurodevelopment of Reward Systems, National Institute of Mental Health, National Institutes of Health, Bethesda, Md. The authors have no disclosures to report. Sharon Judith Lalo Levy, MD, MPH (peer/content reviewer), also has no disclosures to report.
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