Youth Substance Abuse Still a Serious Problem

Substance abuse by adolescents is a persistent and growing problem, one that often ends in tragedy. Consider these numbers:

• 42{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of high-school students report current alcohol use, and nearly half drink to excess.
• 35{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of motor-vehicle deaths result from teens who drink before they drive.
• 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of high-school students use marijuana.
• 2,500 teens, every day, use a prescription drug to get high, according to the Partnership for a Drug-Free America.

While addiction to alcohol or drugs is rare among young people — only 3{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of 12- to 18-year-olds meet the clinical criteria for addiction — a teenager doesn’t have to be addicted to die or have something terrible happen as a result of substance abuse. Too many headlines have been written to prove that point.

Adolescents are at higher risk from substance abuse than adults because of the way their brains respond to those substances.

The brain undergoes major development all through adolescence, continuing into the mid- to late 20s. A person develops the capacity for vision, movement, and coordination well before what we call the ’executive functions’ — self-control, planning, rational decision making, and judgment. Those critical functions develop last. That’s why it’s so dangerous for adolescents to be using psychoactive substances: they respond differently than adults and are at much greater risk.

Parents should recognize that alcohol is the greatest threat to their teen’s life and health. It’s the most abused and most dangerous of all the drugs, accounting for more deaths than all other drugs combined. Yet, amazingly, more than 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of parents provide alcohol to their teenage children. Why would parents put their children in jeopardy?

Marijuana is the second-most-abused drug by teenagers, and its use is increasing, as the movement to adopt ’medical marijuana’ (see cover story) has led many to assume it’s safe. There is no safe dose. It is also highly addictive psychologically, even though it does not cause physical symptoms of withdrawal.

Marijuana is even more dangerous for teens than people think, because it causes long-term changes in both the structure and function of the brain. The major active ingredient in cannabis — THC, or tetrahydrocannabinol — affects judgment, memory, coordination, vision, sensation, and movement. Smoking marijuana has serious toxic effects on the developing brain, so teens who smoke marijuana early and often are actually changing the structure and function of their brains.

The abuse of prescription drugs, such as painkillers and stimulants, is another growing part of the problem of youth substance abuse. Adolescents look at these substances as medicines, as being safe, but they lose sight of one critical phrase — ’when used as directed.’ Many teens find these pills right in their own home medicine cabinet and take them to ’pharming parties,’ where drugs are made available to others.

Parents should be alert to the signs and symptoms of substance abuse. Only one-half of parents know of their teenager’s alcohol or marijuana use, and less than one-third know when their child is getting drunk or using more powerful drugs.

One key sign is change — change in dress, behavior, mood, or friends. Decreased performance in school or extracurricular activities and truancy are other clues. Occasionally, the smell of alcohol or marijuana may be present, and in severe cases, money may even be missing. But above all, look for changes, some of them subtle. And if you think your child might be using substances, then he or she likely is using them, and you should consult a health care professional.

My prescription for parents is clear: tell your teenagers you expect them not to drink until they’re 21 and not to use drugs. Tell them often. Children do care what parents think. If you give children the message frequently — say, once a month — then you’re helping to immunize them from substance abuse. Their lives and their futures are at stake. Learn how to keep your teenager safe in just 15 minutes by visiting www.teen-safe.org. –

Dr. John R. Knight is director of the Center for Adolescent Substance Abuse Research at Boston Children’s Hospital and associate professor of Pediatrics at Harvard Medical School. This article is a public service of the Mass. Medical Society.