Youth and Drug Abuse

Eric F. Wagner, Ph.D.

Florida International University

United Nations Expert Group Meeting

World Programme of Action for Youth

19-21 May 2008

Frequency of Alcohol Use and Drinking to Intoxication

During Past 12 Months in Youth Across Nations Source: The European School Survey Project on Alcohol and Other Drugs, 2003 ( http://www.espad.org/ )

Marijuana Use Youth Across Nations Source: The European School Survey Project on Alcohol and Other Drugs, 2003 ( http://www.espad.org/ )

lifetime 30-day

NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003.

Age

Age at alcohol, at tobacco, and at cannabis dependence as per DSM IV

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

1.6%

1.8%

5 10 15 21 25 30 35 40 45 50 55 60 65

% i

n e

ac

h a

ge

gro

up

wh

o d

evelo

p

firs

tti

me d

ep

en

de

nc

e THC

ALCOHOL

TOBACCO

Addiction Is A Developmental Diseaseoften starts in childhood and adolescence

Consequences of Teen Substance Use

0 0

116

17 17

11

44

29

15

47

67

77

57

47

25

69

2313

51

11

28

33

0

20

40

60

80

100

% 1+

Symptom of

Alcohol

Disorder

% 1+

Symptom of

Cannabis

Disorder

% Clinical

Behavior

Problems

% Physical

Fight

% Out of

School

% with 1+

ER in the

past year

% Any

Illegal

Activity

% 1+

Arrests

No Past Year Alcohol or Marijuana Use

Weekly Alcohol Use

Weekly Marijuana Use (with Alcohol Use)

Source: Dennis, Godley and Titus (1999) and 1997 NHSDA

Copyright ©2004 by the National Academy of Sciences

Gogtay, Nitin et al. (2004) Proc. Natl. Acad. Sci. USA 101, 8174-8179

Fig. 3. Right lateral and top views of the dynamic sequence of GM maturation over the cortical surface

Brain Maturation continues into the 20’s

Maturation

Sequence:

-Structures that

Underlie

Coordination

& Affect First

-Planning and

Inhibition More

Slowly

Teen Drinking & Brain Activity:

Compensation to Deactivation Hypothesis?

Non-Drinkers Heavy Drinkers

Activatio

nA

ctivatio

nD

eD

e-- a

ctivation

activation

Age 16

Age 20

Compared to adult substance abusers,

adolescent substance abusers…

• briefer history, few medical consequences

• more episodic use

• more polysubstance use

• different developmental challenges

• more co-occurring problems

• greater likelihood of natural recovery

• pressing need for autonomy and individuation

• much less likely to seek treatment

Pediatrics, 2008, “Special Issue on Underage Drinking”sponsored by the U.S. National Institute on Alcohol Abuse & Alcoholism

• adolescent treatment approaches rely on adult treatment approaches

• developmental incongruence of adult-derived methods– adolescent drug abusers are different from adult drug abusers

– normative developmental differences

• in order to be maximally effective, adolescent substance abuse treatment must take into account such developmental realities

• developmental realities include wide divergence in – developmental status,

– anticipated effects and consequences of alcohol and drug use,

– social and emotional contexts of use,

– the risk factors contributing to the onset and trajectory of use

Screening with Brief Intervention Works

• Youth expect and are open to discussing alcohol and drug use (Steiner, 1996. Stern, 2006)

• Screening and brief interventions can reduce alcohol, tobacco and marijuana use (Knight, 2005, McCambridge, 2004, Oze et al., 2003)

• Brief Interventions in emergency rooms can reduce alcohol/drug use and related problems (Monti, et al., 2004)

• Brief Interventions in school settings can reduce alcohol/drug use and related problems (Wagner, 2007)

Science indicates that parents….

� play a vital role in prevention and treatment of adolescent

drug abuse

� do not always understand they have influence

� do not know how to use the influence they have

� are ill-equipped to spot signs of experimentation and

intervene effectively

� do not know how to

� locate treatment and support services

� ask the right questions when seeking help

� support their child through treatment and the recovery process

How Do Parents Influence Youth Drug Use? (adapted from Clayton, 1992; Jacob & Johnson, 1997; Willis & Yaeger, 2003)

family history

parent drug use

parent attitudes

parental monitoring

parent connectedness

parent-child conflict

family stress events

youth drug use

Summary: Youth and Drug Abuse

1. Adolescent alcohol and other drug use is widespread

2. Adolescent substance abuse is a significant public health

concern

3. The peak onset age for substance dependence is late

adolescence

4. Interventions can work, but too few teens get it

5. Few interventions are developmentally congruent

6. Brief interventions are effective, economical, and

developmentally congruent

7. Parents have influence, but need guidance in how to use it

Goals & Targets: Youth and Drug Abuse

• Halve the number of youth who develop alcohol or drug use problems

during adolescence

– Alcohol, marijuana, and tobacco use prevalence among population

aged 15-24 years

– Morbidity and mortality rates associated with adolescent alcohol

and other drug use

– Substance abuse and dependence diagnoses prevalence among

population aged 15-24 years

• Achieve universal access to early intervention services for adolescents

alcohol and other drug users

– Proportion of population of adolescent substance users with access

to intervention or services

– Proportion of parents who are knowledgeable and skilled in

preventing adolescent alcohol and other drug use