Substance Use Disorders in Adolescence

Chapter 15

Sandra A. Brown, Kristin Tomlinson, and Jennifer Winward

SUBSTANCE USE DISORDERS IN ADOLESCENCE

Most commonly used drug with 20% of 8th graders and 42% of 10th graders report being drunk on at least one occasion in their lifetime (MTF; Johnston, O'Malley, Bachman, & Schulenberg, 2010).

Among high school seniors, half report using alcohol in the past 30 days, 31% report being drunk in that time frame, and 28% report 5 or more drinks per occasion during the prior 2 weeks.

Rates of daily drinking remain low (3%), highlighting the heavy, episodic nature of youth involvement with alcohol and other substances.

Nictoine is the second most commonly used drug.Marijuana is the most commonly used illicit drug.

ABUSE AND DEPENDENCE: CRITERIA AND DIAGNOSTIC ISSUES

Indicators of SUDs among adolescents often involve physical, socioemotional, and health changes.

Physical dependence, when physiological and psychological adaptations to the substance occur.

Tolerance is the need to ingest larger amounts of a substance for an effect once obtained at a lower dose.

DSM-IV(2000)Two types of substance use disorders (abuse and

dependence) are characterized by a maladaptive pattern of use and symptoms that result in clinical impairment or distress.

Abuse typically considered less severe and less chronic than dependence.

HISTORICAL CONTEXT AND ETIOLOGICAL FORMULATIONS

Environmental ModelsTheory of planned behavior (TPB)

• Attitudes about using substances, perceived social norms of alcohol/drug use, and self-efficacy for coping in potential use situations influence youths’ intentions to use substances (Ajzen & Fishbein, 1980).

Social learning theory (SLT)• Adolescents develop outcome expectations about the effects of

substance use by observing parents, peers, and/or the media, or by learning about the effects of substance use (Akers, 1977).

HISTORICAL CONTEXT AND ETIOLOGICAL FORMULATIONS

Problem behavior theory (PBT)• A generalist model that considers substance involvement to be one

of a number of deviant behaviors that typically co-occur among adolescents (Jessor & Jessor, 1977).

Domain model• Focus on the interaction of biological, intrapersonal, interpersonal,

and sociocultural factors in jointly influencing adolescent substance use behavior (Huba, Wingard, & Bentler, 1980).

HISTORICAL CONTEXT AND ETIOLOGICAL FORMULATIONS

Behavioral Genetic, Neurobiological, and Integrated PerspectivesMaturation theory

• A heuristic model of the development of early-onset SUDs.• According to this model, deviations in somatic and neurological

maturation, along with stressful and adverse environments, predispose children to difficulties in regulating affect and behavior (Tarter et al., 1999).

Expectancy theory• An alcohol/drug-specific integrative model of youth substance

involvement because it considers multiple system levels of potential influence on youth substance use as well as processes through which these systems interact over time in the context of development (Goldman et al., 1991; Goldman, et al., 2010) .

HISTORICAL CONTEXT AND ETIOLOGICAL FORMULATIONS

Environmental and Genetic Risk FactorsTemperamentChildhood behavior problemsAlcohol and drug expectanciesAge of onsetFamily influencesPeersStressNeurocognitive functioning

HISTORICAL CONTEXT AND ETIOLOGICAL FORMULATIONS

Protective FactorsTemperamental traitsHigh intelligenceSocial supportInvolvement with conventional peersReligiosityLow-risk taking Competence skills Psychological wellness (ALDH2) isoenzyme associated with adverse reactions to

alcohol

DEVELOPMENTAL PATHWAYS TO ABUSE AND DEPENDENCE

Deviance-prone pathwayA parental alcoholism/deviance proneness pathway that operates as a risk

factor for behavioral difficulties among offspring (Zucker et al., 2000).A key feature of this model involves the child’s reduced ability to self-regulate

emotional distress and inhibit behaviors, which elevates risk for the development of substance use problems in adolescence.

Negative affectivity pathwayDeficient regulation of negative affect. This pathway appears to be associated with both exposure to environmental

stressors and temperamental negative emotionality. Enhanced reinforcement pathway

Some youth are less sensitive to the effects of substances and consequently use substances more frequently and/or in greater quantities (Schuckit et al., 2004).

This pathway appears to be genetically influenced and based on physiological response differences to the pharmacological effects of substances.

FUTURE DIRECTIONS FOR PREVENTION

Primary and early intervention effects involving peer leaders, motivational enhancement, improved accuracy of perceived social norms, challenges to outcome expectancies, and social practice appear most promising, particularly if including a motivational interviewing approach (Brown, et al., 2008; Winters & Leitten, 2007).

There is growing appreciation for considering developmental factors in the timing, content and process of effective interventions.

The application of neuroscience findings to interventions.