This is a first in a series of upcoming newsletters on substance use in youth.
Substance use among teenagers remains a pervasive and multifaceted issue, eliciting concern from healthcare professionals, educators, and parents alike. Adolescence, a period marked by rapid physiological, psychological, and social changes, is often associated with experimentation and changes in behavior and personality, including the experimental use of substances such as alcohol, tobacco, and illicit drugs. While some teens may use experimentally and then discontinue use, others may develop patterns that progress towards lifelong addiction. Also, even the experimental use of substances can be dangerous, as in the case of the recent rise in accidental fentanyl overdoses in teens. This article is part of a series that will take a deeper dive into teen substance use and potential treatment options.
Epidemiology
Approximately 2% of teenagers will develop full criteria for an Alcohol Use Disorder (tolerance, dependence, withdrawal), while approximately 4% will develop full criteria for an Illicit Drug Use Disorder. While these percentages may seem small initially, in a high school of 2000 teens, this would equate to approximately 80 teenagers whose use is so severe and so regular that it causes tolerance, dependence, and withdrawal. Rates of use without dependence, or “experimental use,” is much higher, with approximately 30% of 12th graders reporting “any illicit drug use in the past year.” While this type of use may initially seem less dangerous, fentanyl overdoses are increasing in teens, and thus even single use or binge use can be dangerous (National Institute on Drug Abuse).
Psychological Factors
One significant contributor to adolescent substance use is the presence of psychological distress, including conditions such as trauma, depression, anxiety, and stress. Adolescents experiencing emotional turmoil may turn to substances as a coping mechanism to alleviate their symptoms. The self-medication hypothesis suggests that individuals use substances to manage negative emotional states, albeit with unintended consequences to their body (Khantzian, 2013). For instance, a study published in the Journal of Adolescent Health found a positive correlation between depressive symptoms and the use of substances such as alcohol and marijuana among teenagers (Hussong et al., 2017). The tendency to self-medicate can lead to a cycle of dependence, exacerbating the initial psychological issues, and adding additional traumas, negative life events, and decreased self-esteem along the way.
Social and Environmental Influences
The social environment plays a crucial role in shaping adolescent behavior, including substance use. Peer pressure or fear of missing out is often cited as a primary driver, where adolescents may engage in substance use to gain social acceptance or avoid ostracism (Piko & Kovács, 2010). Teens may use on social media as a way of projecting an image online. Additionally, familial factors, such as parental substance use and lack of supervision, significantly impact teenagers’ propensity to experiment with substances. Adolescents who perceive low parental monitoring or who have parents that use substances are more likely to engage in similar behaviors (Ryan et al., 2010).
Moreover, the socio-economic environment can influence substance use. Adolescents from disadvantaged and underserved backgrounds may face increased exposure to environments with intergenerational trauma and other barriers, increasing the use of substances (Patrick et al., 2020). In so called “food deserts,” it can be easier to find alcohol, tobacco, cannabis, and drugs than it can be to find fresh fruits and vegetables. Conversely, teenagers from families with greater means might still use substances as a means of coping with academic and social pressures, or from a feeling of disconnect with others when their parents and siblings may be unavailable due to family and career obligations. For example, “a sense of emptiness” has anecdotally been cited as a reason for use, and thus, teenagers feeling a genuine sense of meaning, a positive connection to their family and community, social and cultural supports, spiritual supports, and therefore a strong sense of identity may be at far lower risk for the development of a substance use disorder.
Neurobiological Factors
Adolescence is a critical period for brain development, particularly in regions associated with decision-making, impulse control, and reward processing. The underdeveloped prefrontal cortex, responsible for executive functions, coupled with a highly responsive reward system, renders adolescents more susceptible to risky behaviors, including substance use (Casey et al., 2008). To use a driving metaphor, a highly responsive reward system “pushes the gas pedal” while an underdeveloped prefrontal cortex “lets the foot off the brakes.” The heightened sensitivity to rewards can amplify the perceived benefits of substance use, overshadowing the potential long-term consequences. This neurobiological framework helps explain the propensity for experimentation and the difficulty in abstaining from substance use once initiated. Moreover, the neurotransmitters (dopamine, serotonin, norepinephrine, cannabinoids, opioids, etc.) that are released produce a highly euphoric effect; however, each subsequent use provides a smaller effect, rendering the use “chasing the high” they first felt but never able to achieve it. Meanwhile, their resting state neurotransmitters have been depleted, resulting in irritability and withdrawal.
Genetic Predisposition
Genetic factors also play a significant role in the likelihood of substance use among teenagers. Studies have identified specific genetic variations that can increase susceptibility to substance dependence. For example, variations in genes encoding dopamine receptors and transporters have been linked to increased risk of addiction (Ducci & Goldman, 2008). Adolescents with a family history of substance use disorders are at higher risk, indicating a hereditary component (up to 40-70% heritable). The interplay between genetic predisposition and environmental triggers creates a complex landscape where both nature and nurture contribute to substance use behaviors, and this explains why some teens use briefly and experimentally while others develop potentially lifelong substance use disorders.
Media and Cultural Influences
The portrayal of substance use in media and popular culture can significantly influence adolescent attitudes and behaviors. Glamorization of alcohol, tobacco, and drugs in movies, television shows, and social media can create a perception of substance use as socially desirable and relatively harmless (Strasburger et al., 2010). Adolescents are particularly vulnerable to media influence, given their developmental stage and the importance they place on social identity and acceptance. Exposure to substance use in media can normalize these behaviors and reduce the perceived risks associated with them.
Preventive Measures and Interventions
Addressing substance use among teenagers requires a multifaceted approach, incorporating preventive measures and targeted interventions. Educational programs that focus on enhancing awareness of the risks associated with substance use, promoting healthy coping mechanisms, and building resilience can be effective. Family-based interventions that foster open communication, improve parental monitoring, and address familial substance use are crucial in mitigating risk factors (Kumpfer et al., 2010).
Moreover, community-based initiatives that provide safe recreational activities and support networks for adolescents can reduce the allure of substance use. Alternative peer groups who are sober are an absolute must for teens to achieve sobriety or even harm reduction, as is the necessity for a home environment without substances present. This requires a culturally-sensitive, inter-generation, and family-centered approach that prioritizes empathy and compassion rather than shame, judgment, and stigma. Healthcare professionals play a vital role in early identification and intervention, employing screening tools and providing counseling and resources to at-risk youth.
Conclusion
Substance use among teenagers is a complex phenomenon influenced by a convergence of psychological, social, neurobiological, genetic, and cultural factors. Understanding these underlying causes is essential for developing effective prevention and intervention strategies. By adopting a holistic approach that addresses the multifaceted nature of adolescent substance use, healthcare providers, educators, and families can work together to mitigate this pervasive issue and promote healthier developmental trajectories for adolescents.
References
- Casey, B. J., Jones, R. M., & Hare, T. A. (2008). The adolescent brain. Annals of the New York Academy of Sciences, 1124(1), 111-126.
- Ducci, F., & Goldman, D. (2008). Genetic approaches to addiction: genes and alcohol. Addiction, 103(9), 1414-1428.
- Hussong, A. M., Ennett, S. T., Cox, M. J., & Haroon, M. (2017). A systematic review of the link between stress, substance use, and adolescent development. Journal of Adolescent Health, 61(3), 288-294.
- Patrick, M. E., Schulenberg, J. E., Martz, M. E., Maggs, J. L., O’Malley, P. M., & Johnston, L. D. (2020). Socio-economic status and substance use among US adolescents: Findings from a nationally representative sample. Addiction, 115(8), 1467-1477.
- Strasburger, V. C., Jordan, A. B., & Donnerstein, E. (2010). Health effects of media on children and adolescents. Pediatrics, 125(4), 756-767.
AUTHOR:
Shawn Singh Sidhu, M.D., DFAPA, DFAACAP
Medical Co-Director, Vista Hill Foundation