Adolescent Substance Use: Patterns & Causes

Types of Substance Use

• Experimenters use substances occasionally, no more than once a month, without dependence, commonly alcohol or marijuana
• Experimenting in high school correlates with better adjustment compared to abstainers
• Adjustment is better when experimenting at a normative age, around 16, with peers who share traits and engage in similar, age-appropriate activities
• Frequent users use substances repeatedly, potentially leading to dependence, at least once a week
• Hard-drug users chronically use substances, which interferes with daily life and well-being
• Abstainers avoid drugs in any form

Prevalence of Substance Use in Adolescents

• Alcohol and marijuana are the most common substances used by adolescents
• Tobacco use is decreasing while vaping and e-cigarette use is increasing
• Other substances, such as prescription drugs, cocaine, and hallucinogens, are less common but still present

Causes of Substance Use (Risk Factors)

Biological Factors

• Genetic predisposition can increase the likelihood of developing substance use problems
• Adolescents with impulsive, risk-taking personalities are more prone to experimentation

Psychosocial Factors

• Distant, hostile, or conflicted family relationships in early adolescence are a risk factor
• Parental substance use increases adolescent risk
• Adolescents are more likely to engage in drug abuse if they are around others who do
• Lack of parental monitoring or inconsistent discipline contributes to risky behaviors

Peer influence

• Having friends who use substances is a strong predictor of use
• Adolescents tend to overestimate how much their peers use substances

School and Community Factors

• Poor academic performance correlates with higher substance use
• Low neighborhood supervision increases risk

Contextual Factors

• Availability of drugs, community norms, enforcement of laws, and media portrayal all contribute
• Greater drug availability makes use more likely
• Permissive laws make use more likely

Psychological Factors

• Personality traits like anger, impulsivity, inattentiveness, and sensation-seeking play a role
• Individuals exhibiting these traits are more likely to engage in substance abuse

Consequences of Substance Use

Short-Term Effects

• Impaired judgment and risky decision-making
• Increased likelihood of accidents, such as car crashes and injuries
• Risky sexual behavior and exposure to STDs

Long-Term Effects

• Higher risk of substance dependence in adulthood
• Poorer academic and occupational outcomes
• Increased likelihood of mental health issues such as depression and anxiety

Comorbid Problems

• Externalizing problems include delinquency and aggressive behavior
• Psychosocial problems turn symptoms outward
• Internalizing problems include depression and social withdrawal
• Psychosocial problems turn symptoms inward

Predictors and Consequences of Substance Abuse

• Frequent users of alcohol, tobacco, or other drugs score lower on psychological adjustment measures
• Psychological maladjustment may manifest as school problems, distress, depression, dangerous/deviant behaviors, and risky sexual activity
• Drug abuse and these maladjustments influence each other
• Adolescent substance abuse has long-lasting effects into adulthood

Protective Factors

• Positive mental health, including high self-esteem and absence of depression
• High academic achievement
• Engagement in school
• Close family relationships with warm, positive interactions
• Involvement in religious activities

Prevention and Treatment of Substance Use and Abuse

Approaches to Prevention

• Enforce strict legal age limits for alcohol, tobacco, and marijuana
• Limiting access makes use less likely
• Government efforts focus on underage access
• Increasing prices and restricting availability
• Community and school programs promote drug-free activities
• Engaging in non-drug activities makes substance use less appealing
• Parental education on monitoring and supervision

Addressing potential users

• Programs teach coping skills and decision-making
• Efforts focus on increasing self-esteem, employment, and social skills
• Encouraging positive peer relationships
• Educating and enhancing psychological resilience
• Showing ways to resist peer pressure

Types of Treatment for Substance Abuse

Behavioral Interventions

• Cognitive-behavioral therapy (CBT) helps adolescents recognize triggers and develop healthier coping strategies
• Motivational Interviewing encourages reflection on consequences of substance use

Family-Based Treatments

• Parent training programs improve monitoring and discipline
• Family therapy addresses communication and conflict resolution

School and Community-Based Interventions

• Programs provide alternative activities like sports and mentorship
• Peer-led interventions counteract social pressure

Pharmacological Treatments

• Medications exist for nicotine and opioid addiction, but are rarely used in adolescents
• Medication use for youth is controversial

Effectiveness of Treatment

• Family and school-based interventions are more effective than punitive approaches
• Long-term engagement and education programs show better results than short-term interventions
• Promising programs combine social competence training (resisting peer pressure) with community-wide interventions

Causes of Antisocial Behavior

Types of Antisocial Behavior

• Authority-related conflicts: disobedience, truancy
• Covert behaviors: lying, stealing, property damage
• Overt aggression: bullying, violent acts

Developmental Pathways

• Life-Course-Persistent Offenders begin antisocial behavior in childhood and continue into adulthood
• Adolescence-Limited Offenders begin and end delinquent/violent behaviors during adolescence

Life-Course Persistent Offenders

Characteristics

• Psychologically troubled
• Mostly males
• From poor backgrounds
• Disproportionately from homes with divorce
• Often have hostile, inept, or neglectful parents
• Aggression and antisocial behavior is identifiable early in childhood
• Have self-regulation problems
• More likely to suffer from ADHD
• Display impulsivity and poor self-regulation/self-control
• Tendency toward Callous-Unemotional traits
• Lack empathy and are likely to develop antisocial personality disorder
• Show blunted response to emotional and physical stimuli
• Less likely to empathize
• Score lower on intelligence/neuropsychological tests; perform poorly in school
• Display tendency to suffer from hostile attributional bias
• Interpret ambiguous interactions as deliberately hostile

Adolescent-Limited Offenders

Causes

• Poor parenting, including problems in school
• Affiliation with antisocial peers
• School problems lead to antisocial peer affiliation

Risk Factors for Antisocial Behavior

Family Environment

• Poor parental monitoring/inconsistent discipline
• Parental conflict, divorce, exposure to violence

Peer Influences

• Associating with delinquent peers increases risk
• Adolescents may engage in criminal activity for social status

School and Neighborhood Factors

• Low academic achievement/school disengagement
• High-crime neighborhoods with limited supervision

Prevention and Treatment of Externalizing Problems

Preventative Approaches

• Early Childhood Interventions, such as Head Start, provide early education and support
• Parent training improves discipline and supervision
• School-Based Interventions include anti-bullying/conflict resolution programs
• Social-emotional learning programs build self-regulation skills
• Community-Based Programs include after-school programs that provide structure and role models
• Mentorship programs connect at-risk youth with responsible adults

Treatment of Life-Course Persistent Offenders

• Prevent disruption in early family relationships in ages 3-4
• Head off early academic problems
• Improve transitions from school to work
• Evaluations of some interventions are encouraging, including evidence-based practices and multisystemic family therapy
• Working both with the individual and the family

Treatment of Adolescent-Limited Antisocial Behavior

• Teach adolescents to resist peer pressure and settle conflict without aggression
• Train parents to monitor children effectively
• Encourage prosocial behavior through school and community intervention
• Deter teenagers from further delinquency by taking it seriously

Treatment Approaches

Cognitive-Behavioral Therapy

• Helps adolescents manage anger and impulsivity
• Encourages problem-solving and self-control

Family Therapy

• Addresses dysfunctional family dynamics
• Strengthens parental authority and improves communication

Juvenile Justice System Interventions

• Use rehabilitation-focused approaches rather than punitive measures
• Alternative sentencing programs emphasize education and therapy

Causes of Depression and Internalizing Disorders

Diathesis-Stress Model

• A combination of genetic predisposition (diathesis) and environmental stressors leads to depression
• Some adolescents are biologically vulnerable and develop symptoms when exposed to stress

The Diathesis

Two categories of predispositions

• Problematic patterns of neuroendocrine functioning, related to brain and nervous system activity
• Biological predisposition makes it difficult to regulate emotions, increasing susceptibility to depression/psychological problems
• Cognitive style of depressed individuals
• Tendencies toward hopelessness, pessimism, and self-blame can lead to depression

The Stress

Stressors

• Adolescents from families with high conflict, low cohesion, and/or divorce
• Unpopular adolescents, poor peer relations, bullied, or have friends who are depressed
• Adolescents report more chronic/acute adversity, such as loss of a parent, maltreatment, and/or poverty
• Break up of romantic partner is a common trigger of major depression's first episode

Risk Factors for Depression

Biological Factors

• Family history of depression increases risk
• Neurotransmitter imbalances

Psychosocial Factors

• High conflict/lack of emotional support in family environment
• Peer issues (bullying, social exclusion)
• Cognitive patterns such as pessimistic thinking and low self-efficacy

Gender Differences

• Girls are twice as likely as boys to experience depression
• Increased rumination (thinking about negative thoughts) and sensitivity to interpersonal stress in females contribute to higher rates

Treatment and Prevention of Internalizing Problems

Treatment Approaches

• Cognitive-behavioral therapy (CBT) teaches adolescents to change negative thought patterns and is effective for depression/anxiety
• Interpersonal Therapy (IPT) focuses on improving relationships/social skills and helps deal with interpersonal conflicts
• Medication (SSRIs) is used for moderate-severe depression and must be carefully managed due to side effects

Prevention Strategies

• School-Based Mental Health Programs use early identification/intervention to prevent escalation, and teach coping/stress management skills
• Parental Education encourages open communication/emotional support
• Reducing Stigma involves promoting mental health awareness/normalizing help-seeking