The blind side of addiction: A call for increased awareness of developmentally informed youth addiction scholarship

The etiology and pathogenesis of substance use disorders are of bio-psycho-socioecological origin. The emergence of addiction within a particular individual occurs when there is an encounter between a person's biological vulnerability and environmental influences—an encounter that starts very early in life, if not even in utero.¹ Given the importance of early human life experiences on the onset and trajectories of substance use disorders, it is pivotal to understand, prevent, and treat addiction from a developmentally informed perspective.

The 17th International Society of Addiction Medicine (ISAM) conference was held in October 2015 in Dundee, Scotland, with attendance of delegates drawn from 6 continents. The focus of the conference was “Addiction: From Biology to Recovery.” The program also incorporated the 14th conference of the Centre for Addiction Research and Education Scotland. Over 100 leading experts in addiction medicine spoke at the conference. Support for the conference came from the World Health Organization (WHO), the US National Institute on Drug Abuse (NIDA), and the European Monitoring Centre for Drugs and Drug Addiction. A broad array of addiction topics were addressed, including plenary sessions devoted to the neurobiological mechanisms of addiction, addiction as a disorder of choice, and human immunodeficiency virus (HIV) and co-occurring infections. Abstracts from the 2015 annual meeting of ISAM are available in this issue of Substance Abuse journal (see Supplemental Material). Additionally, this issue of Substance Abuse journal also contains abstracts from the 2015 annual meeting of the Association for Medical Education and Research in Substance Abuse (AMERSA).²

The products from the 2015 ISAM and AMERSA conferences describe cutting-edge research in the field. As such, Substance Abuse journal is proud to publish these abstracts, but we would also like to use this opportunity to call attention to what we believe to be a “blind spot” of addiction scholarship. Specifically, we were struck by the paucity of new research focused on youth addiction and substance use. For example, highly popular and controversial discussions on the liberalization of the legal status of medical and recreational marijuana have often neglected to note its epidemiological trends in youth or address the clear deleterious effects of the substance on youths' physical and mental health and their intellectual and academic well-being.^3–6 Furthermore, presentations on co-occurring psychiatric disorders often fail to address age of onset or the impact of age on treatment outcomes, an area of research that is increasingly prominent.⁷

Why has the crucial public health issue of youth addiction not been made more prominent? Perhaps our medical education system has not adequately addressed addictive behaviors, addictions, and co-occurring psychiatric disorders among youth. For example, reports on performance of pediatricians who customarily see youth for periodic checkups and address their medical needs have not been encouraging. Fewer than half of the pediatricians surveyed reported screening adolescents for use of tobacco, alcohol, and other drugs, and fewer than a quarter acknowledged feeling comfortable conducting a comprehensive assessment, and offering or making referral for treatment.⁸ The reasons for these troubling figures have been summarized as follows: insufficient time, lack of training to manage positive screens, need to triage competing medical problems, lack of treatment resources, unfamiliarity with screening tools, and tenacious parents (who may not readily leave the room). The last argument manifests a lack of training in how to communicate effectively with anxious parents. There are no similar reports addressing how prepared general practitioners, family physicians, or child and adolescent psychiatrists feel regarding substance use disorders. However, there is no reason to expect them to be better trained than pediatricians.

Based on our own clinical and teaching experience, the quantity and quality of training devoted to the screening and assessment of youth substance use, abuse, and dependence in medical schools and various residency programs is often insufficient.⁹ Addiction-related training is likely more scarce in pediatric residency programs.^10–12 In medical training, little, if any, training is given on how to screen and assess for substance involvement and related problems, and on what tools are available to assist with this process. Prevention and treatment training are also compromised in many other health services programs at the undergraduate and graduate levels. Fortunately, a few pediatric residency programs have taken the challenge to improve addiction-related education for their pediatric residents.^13,14

However, we also seek to draw the attention of our colleagues who have been practicing in the field for quite some time and therefore may not be exposed to emerging trends in training. As such, we urge scholars, educators, and clinicians in our field to “catch up” with the literature on youth addictive behaviors and youth substance use disorders. For example, future ISAM and AMERSA meetings should aim to devote more space to youth addictive behaviors and journals should publish and promote work in this area.

Substance Abuse journal has devoted considerable space for adolescent addiction publications, starting with an adolescent-themed special issue in December 2014.¹⁵ The vast number of quality articles submitted for this special issue necessitated the publication of adolescent special sections throughout 2015. Additionally, our “2014 Best Manuscript” award was given to Drs. Black and Chung for their investigation of the mechanisms underlying successful treatment of youth substance use disorders.¹⁶ Our aim has been to increase the level of conversation around the issue of age-appropriate treatment recommendations. Unfortunately, it is our impression that many addictionologists—whether they are addiction scientists, educators, or clinicians—are skeptical of the need for this avenue of research. Substance Abuse journal continues to be interested in publishing high-quality work in the scholarly domain of youth addiction and substance use.

In summary, the future of effective interventions lies in understanding the early developmental pathways of our clients into addictive behaviors. We advocate, in a clarion call, for more research in addiction and its consequences from in utero to adulthood. Substance Abuse journal will continue to solicit and promote articles devoted to this topic because we believe it is time for both scholars (investigators and educators) and clinicians to open their eyes to the significant public health issue of youth addiction.

Supplemental material

Abstracts from the International Society of Addiction Medicine (ISAM) 2015 annual meeting in Dundee, Scotland, are available as supplemental material that can be accessed on the publisher's Web site.

Acknowledgments

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the authors affiliated institutions, the Department of Veterans Affairs, or the United States government. The authors declare that they have no conflicts of interest.