Substance Abuse Among Adolescents

Abstract

Substance use and dependence are among the most prevalent causes of adolescent morbidity and mortality in the United States. This paper provides a review of differences between adolescent and adult substance abuse, prevention and treatment approaches, and future potential directions and needs for more effective programming in the treatment of adolescent substance abuse ¹ and dependence on psychoactive substances.

¹ The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.

Keywords:

• dependence
• substance misuse
• substance abuse disorder

Notes

¹ The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.

² Treatment can be briefly and usefully defined as a planned, goal-directed change process of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bound (by culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual help–based (like AA and NA), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever type—which aren't also used with non–substance users. In the West, with the relatively new ideology of “harm reduction” and the even more recent “quality-of-life” (QOL) model, there are now new sets of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Editor's note.

³ The reader is referred to Hill's criteria for causation, which were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated. [Hill, A. B. (1965). The environment and disease: Associations or causation? Proceedings of the Royal Society of Medicine, 58, 295–300.] Editor's note.

⁴ A caveat is necessary for this often-posited concept and process. It is useful, perhaps, as a literary metaphor or shorthand code which suggests imagewise moving through a range of complex, dynamic albeit linear processes to an often-occurring outcome in which cause and effect is not predicted. It is a misleading term when particular drugs, whatever their status (licit/illicit), and pharmacology are empowered, and the user is in some manner disempowered. Editor's note.

⁵ The often-used nosology “drugs of abuse” is both unscientific and misleading in that (1) it mystifies and empowers selected active chemicals into a category whose underpinnings are neither theoretically anchored nor evidence-informed and which is based upon “principles of faith” held and transmitted by a range of stakeholders representing a myriad of agenda and goals; (2) it disempowers the actual or potential users (populations-at-risk); and (3) active chemical substances of any types—“drugs”—are used or misused; living organisms can be and are all-too-often abused. Editor's note.

⁶ The reader is reminded that prior to the relatively recent medicalization of types of substance use and users and prior to the publication of the DSM criteria and its “substance use disorder” (SUD) nosology the same drug users were categorized as being immoral sinners and then as being criminals. This process and its outcomes are not semantic issues. Indeed a paradox has been created; SUD is posited to be a chronic disease, albeit “recovery” from it is assessed through abstinence and (re)lapses and not through periods of remission—the global criteria for other chronic diseases. Editor's note.

⁷ The distinction between “prevention” and “treatment” needs to be delineated in terms of its dimensions and not just semantically given the public health traditions of primary, secondary, and tertiary prevention, which focus on outreach and early case findings to initial treatment to active and more comprehensive treatment. Editor's note.

⁸ The relatively recent contribution to the literature of the concept of “through care” reminds treatment planners, implementers, and evaluators to be sensitive to the total structure of the treatment process which includes pretreatment, treatment, and posttreatment dimensions. A lack of any one of these generic processes, or components, can and does diminish the potential as well actual processes and outcomes. Editor's note.

⁹ The term “community” and more specifically “therapeutic community” have become policy buzzwords which have been attached to a diverse range of ideas and initiatives. They both can and do mean various things to a range of individual and systemic stakeholders. “Shared geography,” as an often-regarded simplistic, common denominator, minimizes the range of other “sharing” and mutual help–based options which range from actual objects to beliefs, values, membership in, identification with, association with, from a micro to a globalized macro level. Editor's note.

¹⁰ Two caveats are necessary. “Drugs” of whatever types and potencies don't “do”; there are pharmacological actions distinct from the “drug experience.” Secondly, indicators as well as contraindicators for selecting any treatment technique are related to theories, generalizable evidence, stakeholder agenda and goals, “principles of faith,” and resource realities at the time in specific places that may at times capitalize on chance decisions. Editor's note.

¹¹ This process is a normative characteristic during the teen period of development, continues for many people throughout their lives, and is exhibited and expressed internationally in cultures which permit this to occur. Editor's note.

¹² The reader is reminded that the concept of “treatment matching” during an era of budgetary cuts is more of a conceptual one than an actually viable process. Editor's note.