Adolescent and Young Adult Substance Use and Abuse



Adolescent and Young Adult Substance Use and Abuse


Leslie R. Walker

Erin N. Harrop





KEY WORDS



  • Addiction


  • Adolescent brain development


  • Adolescent research


  • Alcohol


  • Drug dependence


  • Drug use


  • Drug use prevention


  • Generational forgetting


  • Marijuana


  • Risk and protective factors


Adolescent and young adult (AYA) use of alcohol, marijuana, tobacco, and other illicit drugs (AMTOD) is a major public health problem. The last decade has brought a new complexity to drug use in the US with legalization of marijuana for medicinal and/or recreational purposes in a growing number of states. The continued use of prescription and synthetic drugs for recreational purposes continues to be a national concern. In the short term, drug use is associated with significant morbidity and mortality in the AYA population. In the long term, much of the adult morbidity and mortality attributed to AMTOD use can be traced to behaviors that began during adolescence. Alcohol, tobacco, and marijuana are the three drugs most abused by the AYA age-groups. Other drugs wax and wane in popularity and their use, following a predictable pattern. A phenomenon called generational forgetting contributes to the popularity of a particular drug over time. Generational forgetting occurs in the absence of knowledge; otherwise, Drug “X” is perceived as safer than other drugs, and its use increases. As use increases, the drug’s negative effects become more widely known, and use of Drug “X” is perceived as increasingly risky. This increased perception of risk causes the popularity of Drug “X” to wane, leading to Drug X’s replacement by a different drug that is perceived as being of lower risk. Decades later, when the risk of Drug “X” is no longer common knowledge, it again becomes popular.

Advances in neuroimaging techniques and research using animal models of human puberty have elucidated the unique vulnerability of the still-developing AYA brain to the effects of alcohol and other drugs; many observed neural changes in response to drug use might be permanent.1,2 Ongoing research into the brain’s reward circuitry (e.g., the ventral tegmental area, the prefrontal cortex, and the nucleus accumbens) continues to demonstrate that in the brain, drugs of abuse share common pathways and exert their effects through similar mechanisms. For example, the active ingredient in marijuana, Δ9-tetrahydrocannabinol, stimulates the same µ1 opioid receptor as does heroin. Similarly, when rats previously exposed on a chronic basis to a cannabinoid agonist are given a cannabinoid antagonist to produce an acute withdrawal state, they secrete elevated amounts of corticotropin-releasing factor. This same pattern is seen in withdrawal from other drugs of abuse. Given this growing body of research, drug addiction is best viewed as a chronic disease, with relapses being common. However, recent data indicate that treatment of AYAs with drug use disorders is effective.


EPIDEMIOLOGY


Middle and High School Youth

The best data on adolescent substance abuse come from the Monitoring the Future (MTF) study, conducted by the Institute for Social Research at the University of Michigan (www.monitoring-thefuture.org). This school-based study began in 1975, and currently surveys a nationally representative sample of 8th, 10th, and 12th graders. The sample in 2014 consists of 41,600 youth in 377 secondary schools nationwide. Because the anonymous surveys are conducted in schools, MTF data do not reflect drug use by out-of-school youth (including youth who dropout, are homeless, or incarcerated), whose use is typically higher. Declining use of a number of licit and illicit substances is a main finding in 2014. The annual prevalence of drug use declined for 28 of the 34 drug outcomes reported for the combined pool of 8th, 10th, and 12th graders. The most important findings from the 2014 MTF survey are discussed in the following section. Overall trends in drug use among 8th, 10th, and 12th graders have fluctuated since 1975, with peak use in 1981 when 66% of MTF adolescents reported use of an illicit drug in their lifetime. After reaching a low of 29.8% in 1992, lifetime drug use then increased to a peak level of 43.3% in 1997; it then decreased again to a low of 32.6% in 2008. Lifetime illicit drug use then increased steadily to 36.0% in 2013, but then decreased slightly to 34.9% in 2014. The major cause of this decline was a drop in marijuana use. One of the more concerning trends has been in the change of perception of risk of substances in the MTF samples. Along with the increase in use over the last few years, there has been a decline in perceived risk, which can foreshadow future increases in drug use in this cohort. The MTF survey categorizes use across a continuum by asking about lifetime use (ever used), annual use (any use in the last year), 30-day use (a measure of regular use), and daily use. The data are then able to give an estimate of chronicity of use for 8th, 10th, and 12th graders. Figure 63.1 shows trends in lifetime use of various drugs; Table 63.1 shows prevalence of lifetime, annual, past 30 day, and daily use of various drugs for 8th, 10th and 12th graders in 2012.

Some of the most notable findings across all three grades were slight decreases in lifetime and annual illicit drug use and the prevalence of alcohol and marijuana use. Both alcohol and marijuana are illicit for this age-group. It is also important to note that for all other measured reports of illicit drug use, the overall combined use rates are much more consistent than is the rate of use of a particular drug by year or decade. This again illustrates generational

forgetting and the perceived risk of particular drugs waxing and waning over time. However, it also illustrates that the number of youth interested in other illicit drugs remains relatively stable over time (see Fig. 63.1).








TABLE 63.1 Prevalence of Use of Various Drugs for 8th, 10th, and 12th Graders, 2012



Lifetime

Annual

Past 30 days

Daily



8th

10th

12th

8th

10th

12th

8th

10th

12th

8th

10th

12th


Approximate weighted N =

15,100

15,000

13,700

15,100

15,000

13,700

15,100

15,000

13,700

15,100

15,000

13,700


Any Illicit Drug

18.5

36.8

49.1

13.4

30.1

39.7

7.7

18.5

25.2

–

–

–


Any Illicit Drug other than Marijuana

8.7

14.9

24.1

5.5

10.8

17.0

2.5

5.0

8.4

–

–

–


Any Illicit Drug Including Inhalants

25.1

40.0

50.3

17.0

31.5

40.2

9.5

19.3

25.2

–

–

–


Marijuana/Hashish

15.2

33.5

45.2

11.4

28.0

36.4

6.5

17.0

22.9

1.1

3.5

6.5


Synthetic Marijuana

–

–

–

4.4

8.8

11.3

–

–

–

–

–

–


Inhalants

11.8

9.9

7.9

6.2

4.1

2.9

2.7

1.4

0.9

–

–

0.1


Hallucinogens

2.8

5.2

7.5

1.5

3.5

4.8

0.6

1.2

1.5

–

–

0.1

Hallucinogens, Adjusted

–

–

7.9

–

–

–

–

–

1.8

–

–

–

LSD

1.3

2.5

3.8

0.8

1.7

2.4

0.3

0.5

0.8

–

–

0.1

Hallucinogens other than LSD

2.3

4.5

6.6

1.3

3.0

4.0

0.5

0.9

1.3

–

–

0.1


PCP

–

–

1.6

–

–

0.9

–

–

0.5

–

–

0.1


Ecstasy (MDMA)

2.0

5.0

7.2

1.1

3.0

3.8

0.5

1.0

0.9

–

–

0.1


Salvia

–

–

–

1.4

2.5

4.4

–

–

–

–

–

–


Cocaine

1.9

3.3

4.9

1.2

2.0

2.7

0.5

0.8

1.1

–

–

0.1

Crack

1.0

1.4

2.1

0.6

0.8

1.2

0.3

0.4

0.5

–

–

0.1

Other Cocaine

1.6

3.0

4.4

1.0

1.8

2.4

0.3

0.7

1.0

–

–

0.1


Heroin

Any Use

0.8

1.1

1.1

0.5

0.6

0.6

0.2

0.4

0.3

–

–

0.1

With A Needle

0.6

0.7

0.7

0.4

0.4

0.4

0.2

0.2

0.3

–

–

0.1

Without A needle

0.5

0.8

0.8

0.3

0.4

0.4

0.1

0.2

0.2

–

–

0.1


Narcotics other than Heroin

–

–

12.2

–

–

7.9

–

–

3.0

–

–

0.2

OxyContin

–

–

–

1.6

3.0

4.3

–

–

–

–

–

–

Vicodin

–

–

–

1.3

4.4

7.5

–

–

–

–

–

–


Amphetamines

4.5

8.9

12.0

2.9

6.5

7.9

1.3

2.8

3.3

–

–

0.3

Ritalin

–

–

–

0.7

1.9

2.6

–

–

–

–

–

–

Adderall

–

–

–

1.7

4.5

7.6

–

–

–

–

–

–

Methamphetamine

1.3

1.8

1.7

1.0

1.0

1.1

0.5

0.6

0.5

–

–

–

Crystal Methamphetamine (Ice)

–

–

1.7

–

–

0.8

–

–

0.4

–

–

0.2


Bath Salts (Synthetic Stimulants)

–

–

–

0.8

0.6

1.3

–

–

–

–

–

–


Seductive (Barbiturates)

–

–

6.9

–

–

4.5

–

–

2.0

–

–

0.1

Seductive, Adjusted

–

–

7.2

–

–

4.5

–

–

2.1

–

–

0.3

Methaqualone

–

–

0.8

–

–

0.4

–

–

0.3

–

–

0.3


Tranquilizers

3.0

6.3

8.5

1.8

4.3

5.3

0.8

1.7

2.1

–

–

0.1


Any Prescription Drug


–

21.2

–

–

14.8

–



–

–

–


Over-the-Counter Cough/Cold Medication

–

–

–

3.0

4.7

5.6

–

–

–

–

–

–


Rohpnol

1.0

0.8

–

0.4

0.5

1.5

0.1

0.2

–

–

–

–


GHB

–

–

–

–

–

1.4

–

–

–

–

–

–


Ketamine

–

–

–

–

–

–

–

–

–

–

–

–


Alcohol

Any Use

29.5

54.0

69.4

23.6

48.5

63.5

11.0

27.6

41.5

0.3

0.1

2.5

Been Drunk

12.8

34.5

54.2

8.5

28.2

45.0

3.4

14.5

28.1

0.1

0.4

1.5

Flavored Alcoholic Beverages

23.5

46.7

60.5

17.0

37.8

45.0

3.5

14.5

28.1

0.1

0.4

1.5

Alcoholic Beverages Containing Caffeine

–

–

–

10.9

19.7

25.4

–

–

–

–

–

–

5+ Drinks in a Row in Last 2 wk

–

–

–

–

–

–

–

–

–

5.1

15.5

23.7


Cigarettes

Any Use

15.5

27.7

39.5

–

–

–

4.9

10.8

17.1

1.9

5.0

9.3

1/2 Pack+/Day

–

–

–

–

–

–

–

–

–

0.6

1.5

4.0


Kreteks

–

–

–

–

–

3.0

–

–

–

–

–

–


Tobacco using a Hookah

–

–

–

–

–

18.3

–

–

–

–

–

–


Small Cigars

–

–

–

1.0

1.6

1.6

–

–

–

–

–

–


Dissolvable Tobacco Products

–

–

–

2.4

6.9

7.9

–

–

–

–

–

–


Snuff

8.1

15.4

17.4

–

–

–

2.8

6.4

7.9

–

–

–


Smokeless Tobacco

1.2

1.3

1.8

0.6

0.8

1.3

0.3

0.4

0.9

–

–

–


Trends in annual prevalence of an illicit drug use index for 8th, 10th, and 12th graders. (From Johnston LD, O’Malley PM, Bachman JG, et al. Monitoring the Future national survey results on drug use, 1975-2012: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan, 2013. Available at http://www.monitoringthefuture.org/pubs/monographs/mtf-vol1_2012.pdf. Accessed February 3, 2014.)

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