Adolescents, Drug and Alcohol Use

Adolescence is a time of many changes—physical, mental, social, and emotional. Most adolescents adapt to these changes in healthy ways. Others experience turmoil and conflict. They become deeply unsettled and confused as they attempt to cope with this time in their lives. This unhappiness and confusion may lead them toward dangerous or deviant behavior, such as drug use. A single episode of drug use does not necessarily lead to further use, but several episodes may lead to ever-increasing use, resulting in abuse and dependence . Continued drug use can have serious consequences, not only during adolescence but into adulthood as well.

Whether a young person continues to use a drug depends on three major factors: age of first use, type of drug used, and reasons for use. Younger adolescents who try one type of drug may go on to sample a number of other substances. An adolescent may start by trying cigarettes, for instance, which can lead to daily smoking of both cigarettes and marijuana. That habit may lead to regular use of multiple drugs, such as weekend drinking and smoking or daily uppers and downers . By late adolescence, this type of drug-taking could become abusive, with the abuser becoming dependent on the drugs he or she is taking. Understanding why adolescents begin to take drugs and why they keep taking them is important so that effective drug abuse prevention programs can be developed.

Trends in Adolescent Alcohol and Drug Use

Every year the Institute for Social Research at the University of Michigan conducts a survey, called "Monitoring the Future: A Continuing Study of American Youth." The survey reveals the behavior and attitudes of nearly 50,000 students around the country. One dramatic finding that has emerged from the "Monitoring the Future" surveys was the decrease in illicit drug use by young Americans between about 1980 and 1992. Unfortunately however, a second dramatic finding was an increase in such use during the 1990s. After reaching a low of 27 percent in 1992, annual use among high-school seniors was back up to 41 percent in 2001. Lifetime use in 2001 was back to 54 percent

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from a low of 41 percent in 1992. The 2001 survey showed that overall drug use among American teens generally remained about the same as in 2000, after a slight decline in the late 1990s.

Increases during the 1990s were particularly sharp among 8th and 10th graders. No data are available before 1991, so longer-term trends are not known, but it is clear that there were significant increases between 1991 and 2001. Among 8th graders in 1991, 11 percent had used an illicit drug in the previous twelve months; that figure increased to 20 percent by 2001. Similarly, among 10th graders, annual use increased from 21 percent in 1991 to 37 percent in 2001.

Marijuana. Marijuana is the most frequently used illicit drug. In 2001, 37 percent of seniors—well over one in three—reported using marijuana in the past twelve months. Among 8th graders, annual marijuana use increased from 6.2 percent in 1991 to 15 percent in 2001 (peaking at 18 percent in 1996). Among 10th graders, annual marijuana use almost doubled between 1991 and 2001, from 17 percent to 33 percent (peaking at 35 percent in 1997).

Inhalants. Although not necessarily illicit drugs, inhalants are sometimes used illicitly for the purpose of getting high. This particular behavior is generally more often seen among younger students than among high-school seniors. In 2001, for example, 4.5 percent of 12th graders reported using inhalants to get high at least once in the past twelve months, compared to 6.6 percent of 10th graders, and 9.1 percent of 8th graders.

Alcohol. In 2001 nearly one-third (30 percent) of high-school seniors reported that they had had five or more drinks in a row at least once during the past two weeks. (Drinking five or more drinks in a row is enough to render the average teenager intoxicated.) The trend over the course of the 1990s was not encouraging, with levels of alcohol consumption increasing slightly over earlier levels. The trends in the 1990s for 8th and 10th graders were also not encouraging: In 2001 levels of heavy drinking were slightly higher than they were in 1991. For example, in 2001, 25 percent of 10th graders reported having had five or more drinks in a row in the past two weeks, compared to 23 percent of 10th graders in 1991.

Cocaine. The use of cocaine among adolescents also increased in the 1990s, and by 2001 annual cocaine use among high-school seniors reached 4.8 percent. In the 2001 survey, several illicit drugs showed a slight decline in use over the previous two years, including heroin (in forms that are not injected), LSD, powdered cocaine, and crack. Crack cocaine first appeared in the early 1980s and became a significant factor among the illicit drugs in the mid-1980s. The use of crack cocaine increased during the 1990s, with 3.7 percent of 12th graders having tried it at least once, according to the 2001 survey. These numbers are below peak levels in the 1980s.

Other Drugs. There have also been significant increases in adolescents' use of anabolic steroids and the drug ecstasy. The 2001 report also noted that teen tobacco smoking continued to decline sharply, but was still well above rates of the early 1990s. Drugs that showed little change in use included amphetamines, tranquilizers, heroin, and the so-called "club drugs": Rohypnol, GHB, and ketamine.

The Reasons and Risk Factors for Drug Use

Many factors determine whether teenagers are likely to engage in harmful behaviors such as drug-taking.

Family Life. Researchers have investigated the influence of parents and home life on children's alcohol and drug use. A survey of 12,118 teenagers found that teenagers who felt close to their parents and siblings, teachers, and classmates were less likely to engage in risky behaviors. In another study, a large group of New Jersey adolescents was interviewed by phone at two different times, three years apart. Between 1979 and 1981, 1,380 subjects aged 12, 15, and 18 were interviewed. Three years later, 95 percent of them (1,308 subjects) were interviewed again. The interviews included topics of family harmony and closeness, parenting styles, and the attitudes and behaviors of parents. The greatest influence on whether younger children drank alcohol seemed to be the alcohol use and attitudes of the same gender parent. Older adolescents, though, were most strongly affected by the father's alcohol use. Children with hostile and emotionally cold parents were more likely to use drugs and alcohol than were those who described a warmer relationship with their parents.

In other research, 4,023 adolescents aged 12 to 17 years were interviewed by telephone about their own and their family members' substance use and their experiences of being victims of violence. Adolescents had a greater risk for substance abuse or dependence if they had been physically or sexually abused, or had family members with alcohol or drug-use problems.

Physical Factors. An adolescent who tries a particular type of drug is more likely to use that substance again if he or she enjoys the drug's effects. If the drug produces unpleasant effects, trying it again is less likely. Once an adolescent tries a drug and likes it, other factors determine whether he or she will continue to use it. Tolerance and withdrawal are two of the most important factors.

As the body becomes used to the effect of a drug, the person needs to take more of it to obtain the same effect. This is known as tolerance , and once tolerance to a drug develops, larger and larger doses are required. When the effect of a drug (such as heroin, nicotine, or caffeine) begins to wear off, the user may experience unpleasant symptoms. This is known as withdrawal . To avoid these withdrawal symptoms, a user may feel the need to take the drug on a regular basis.

Social Life. The social and emotional needs of adolescents also influence drug use. Teenagers looking for peer acceptance or wanting to appear "cool" might decide to try taking drugs, beginning a path toward continuing use. Teenagers also want to be seen more like adults, with the freedom to do what adults do. By using tobacco or alcohol—illegal for adolescents, yet both legal and socially acceptable for adults—the adolescent seeks an adult image. Adolescents are exposed to advertising on television and in magazines for beer, wine, and cigarettes that portrays drinking and smoking as desirable. They may want to emulate celebrities such as movie or pop stars who are seen smoking or drinking in the media. Once adolescents begin using drugs—for any of these reasons—they may find that they are unable to stop.

The Drug-Use Sequence

Using one drug often leads to the subsequent use of another. Typically, drug use begins with alcohol or cigarettes. The next drug of use is typically marijuana, and occasional drinking may develop into problem drinking . Next in the sequence are other illicit drugs. Cocaine use tends to follow marijuana use, with crack-cocaine use occurring after cocaine use. In other words, it is likely that someone who smokes crack has already tried tobacco, alcohol, marijuana, and cocaine. Many adolescents who use drugs in one category, however, do not necessarily progress to drug use in a higher category, and many stop before the drug use becomes a habit.

The use of alcohol and cigarettes typically—but not always—begins at an earlier age than does the use of illegal drugs. Adolescents who progress to illicit drugs, such as crack, generally begin smoking and drinking earlier than those who do not. Research indicates that a person who begins using drugs before the age of 15 is very likely to abuse drugs and alcohol as an adult.

Studies of adults show that regular adolescent drug use is connected to further drug use later in life. For example, there is a good chance that an adolescent who smokes crack will become an adult who takes therapeutic drugs such as tranquilizers and sedatives. Studies of people participating in drug-treatment centers often reveal that these people not only need treatment for use of substances such as cocaine or heroin, but that they are also addicted to caffeine, tobacco, and/or alcohol—the very substances they first started using.

Adolescents who take drugs may move on to other drugs as they grow older. They may seek different drugs that cost less or are easier to obtain, or keep trying different drugs to get the effect that they want. Often, peers introduce each other to new substances. Multiple-drug use also occurs when an individual tries to counteract the effect of one drug with the effect of another. For example, cocaine may produce feelings of anxiety, so the user will then take tranquilizers to calm down.

Prevention Programs

Given our understanding of how drug use follows a sequence, prevention programs should try to reach adolescents before their first use of alcohol and cigarettes. Ideally, this would help prevent their later use of marijuana and other drugs. For adolescents who have already smoked marijuana, prevention programs must aim to reduce the chance that these adolescents will go on to try other drugs.

Educating young people about the dangers of drugs is an important tool in prevention. For example, teenage athletes sometimes take anabolic steroids to improve their performance on the field. A school-based series of seven weekly classes on the dangers of anabolic steroids appeared to help reduce anabolic-steroid use among 702 teenage athletes. The athletes also learned about safe alternatives to anabolic steroids. In another group of 804 athletes, who were simply given a pamphlet about anabolic steroids, the reduction of their levels of drug use was less successful.

The Consequences of Substance Abuse

Although drugs can sometimes make one feel good for a few minutes or hours, extensive research has shown that young people who abuse drugs or alcohol often suffer long-term, harmful consequences as a result. These harmful consequences are sometimes irreversible, and can negatively affect a person's health for the rest of her or his life. In some cases, even a single, one-time use of a drug (for example, ecstasy) can cause long-term—and perhaps permanent—damage to a young person's brain or other organs. Studies have also shown that, in general, teenagers who abuse drugs and/or alcohol are more likely than others to:

• have behavioral and academic problems at school
• be involved in criminal acts and traffic accidents
• become sexually active at earlier ages, have unprotected sex, and contract sexually transmitted diseases
• suffer from depression and other psychiatric disorders
• become victims of violent crimes
• be killed by drowning, fire, suicide, and homicide.

see also Addiction: Concepts and Definitions; Prevention; Prevention Programs; Risk Factors for Substance Abuse; Users.

THE IMPACT OF ILLICIT DRUG USE

Using illicit drugs can harm the abuser's body, but can also hurt the user in other ways:

The use of alcohol and other drugs is a major cause of teenager deaths, ranging from motor vehicle crashes to homicides to suicides.

In the college environment, students with average grades of Ds or Fs drink three times as much as those who earn As.

Nearly one in two college students who were victims of crimes said they were drinking or using other drugs when they were victimized.

Sexually active teens who have more than five drinks are three times less likely to use condoms, and so risk becoming pregnant and/or infected by HIV and other sexually transmitted diseases.

SOME STATISTICS ABOUT ALCOHOLISM

If you live or lived with an alcoholic, you are not alone:

Seventy-six million Americans, about 43 percent of the U.S. adult population, have been exposed to alcoholism in their families.

Almost one in five adult Americans (18 percent) lived with an alcoholic while growing up.

Roughly one in eight American adult drinkers is an alcoholic or experiences problems due to the use of alcohol. The cost to society is estimated at more than $166 billion each year.

There are an estimated 26.8 million children of alcoholics in the United States. Some research suggests that over 11 million are under the age of 18.