ADOLESCENTS AND DRUG USE

As individuals pass through adolescence, they undergo many physical, cognitive, social, and emotional changes. Most learn to adapt to these changes in healthy ways. For others, turmoil, conflict, and deviant behavior lead to upheaval and disorganization as they attempt to cope. Drug use as a behavior may serve many functions in this attempt to cope, and it can have many consequences. A single episode of drug use does not necessarily lead to further use—but several episodes may lead to ever increasing use, with abuse and dependence the result.

Use of a drug, age of first use, and reasons for use are all factors related to continued drug use. Early adolescents who try one type of drug may venture on to sample a diverse number of substances. This can lead to regular use of certain drugs (e.g., daily cigarette or Marijuana smoking); it may become part of a pattern of multiple drug use (e.g., weekend drinking and smoking or daily uppers and downers) that by late adolescence becomes dependence or abuse. Factors related to initiation and progression into other drug phases—regular drug use, abuse, and dependency—or into the use of multiple drugs are important to understand in order to develop appropriate Prevention programs aimed at reducing all drug use—whether legal or illicit.

REASONS FOR DRUG USE

For both pharmacological and psychological reasons, an adolescent who tries a particular type of drug is more likely to use that substance again if he or she enjoys the drug's effects. However, if unpleasant experiences are associated with the use, trying it again is less likely.

Because the body becomes accustomed to the effect of a drug, often the drug amount will need to be increased in order to obtain an effect. This phenomenon is known as tolerance, and once tolerance to a drug develops, the level of drug use may escalate into larger and larger doses. Continued use of drugs may also occur because of unpleasant symptoms—withdrawal—that may appear as the drug (e.g., heroin, nicotine, caffeine) begins to wear off. To avoid these withdrawal symptoms, a user may feel compelled to establish a regular pattern of use, possibly resulting in physical dependence.

The way a drug is used is also a factor in developing tolerance and physical dependence. For example, an adolescent who sniffs Cocaine may find that the amount he or she has to inhale to get the desired effects becomes enormous. Because of this, the user may switch to injecting the cocaine instead of inhaling it. This new route of administration exposes the user to a more potent form of the drug as well as to increased medical complications.

Other reasons that adolescents continue using a particular drug may be socially and environmentally driven. Teenagers looking for peer acceptance or wanting to appear "cool" or mature might decide to use drugs. For example, although the use of Tobacco and Alcohol is illegal for adolescents, it is both legal and socially acceptable for adults. Ad-Vertising, the media, and role models portray drinking and smoking as desirable. Associating and socializing with peers who are using drugs provides an opportunity for access to drugs that can encourage experimentation and ongoing use.

Researchers have investigated the influence of parents and the family environment on children's alcohol and drug use, dysfunctional patterns of coping, and delinquent activity. In one study, a large group of New Jersey adolescents was interviewed by phone at two different times, three years apart. Between 1979 and 1981, 1,380 subjects aged 12, 15, and 18 were interviewed. Three years later, 95 percent of them (1,308 subjects) were interviewed again. The interviews included topics of family harmony and cohesion, parenting styles, and the attitudes and behaviors of parents. The results showed that the alcohol consumption of the younger children was influenced by the alcohol use and attitudes of the parent of the same gender as the child. Older adolescents, though, were most strongly affected by the father's alcohol use. Parental hostility and lack of warmth toward the children was associated with use of drugs and alcohol among adolescents (Johnson & Pandina, 1996).

A national household sample of 4,023 adolescents aged 12 to 17 years was interviewed by telephone about substance use, victimization experiences, familial substance use, and posttraumatic reactions to identify risk factors for substance abuse or dependence. A major finding was that adolescents who had been physically assaulted or sexually assaulted, who had witnessed violence, or who had family members with alcohol or drug use problems had increased risk for current substance abuse or dependence (Kilpatrick et al., 2000).

Data from the Centers for Disease Control and Prevention Youth Risk Behavior Survey (YRBS) was used from 4,800 subjects to examine the relationship between adolescents' employment and substance abuse behaviors. The study concluded that among public high school students with extracurricular jobs, those who worked above 15 hours per week appeared to have an increased risk for substance abuse (Valois, 2000).

A study that examined the effects of family structure and family environments on the initiation of illicit drug use among a sample of Hispanic, African American, and white adolescent boys found large differences in family structure among the three groups. African American adolescents reported the lowest incidence of illicit drug use initiation, and the weakest effects of family structure and environment on substance use. Deteriorating changes in family environments were stronger predictors of the initiation of drug use among Hispanic immigrants than nonimmigrants, and family socioeconomic status was a predictor for immigrant Hispanics only. For all groups, the accumulation of family risk factors was a stronger predictor of illicit drug initiation than family structure (Gil, 1998).

DRUG-USE SEQUENCE

The use of one drug is often related to the subsequent use of another. Typically, drug use begins with alcohol and cigarettes, which are followed by marijuana and other illicit drugs. This typical sequence of drug use was established in the 1970s (Kandel & Faust, 1975) and was found to continue into the 1990s, in different populations and in different ethnic and cultural groups. Problem drinking typically fits into the pattern between ongoing marijuana use and the use of other illicit drugs (Donovan & Jessor 1983).

Cocaine use tends to follow marijuana use, with crack-cocaine use occurring after cocaine use (Kandel & Yamaguchi, 1993). For example, it is likely that someone who smokes Crack has already tried tobacco, alcohol, marijuana, and cocaine. Many adolescents who use drugs in one category, however, do not necessarily progress to drug use in a "higher" category; many stop before becoming involved in further use or habitual use.

An important factor in the progression through the sequence of drug use is age of onset or initiation. The use of alcohol and cigarettes typically—but not always—begins at an earlier age than does the use of illicit drugs. Adolescents who progress to using illicit drugs such as crack generally begin smoking and drinking earlier than those who do not. Early drug use (before age fifteen) is highly correlated with the development of drug and alcohol abuse in adulthood (Robins & Przybeck, 1985).

Studies of adult populations provide additional support for a connection between regular adolescent drug use and later, further drug use. For example, illicit drug use during adolescence and early adulthood has been found to occur more often in adults who have used psychotherapeutic medicines (e.g., tranquilizers, sedatives) (Trinkoff, Anthony, & Muñoz, 1990). Studies of people going to drug-treatment centers often demonstrate that these people are not only entering treatment for use of substances such as cocaine or heroin but that they are also addicted to caffeine, tobacco, and/or alcohol, the very substances they first started using.

MULTIPLE-DRUG USE

The use of one type of drug may lead to experimenting with other drugs as users add to or find substitutes for their original drug of choice. Some of this progression may be an effect of maturation—that is, of drug-using adolescents moving on to other drugs as they grow older—or it may be attributable to the cost and availability of different types of drugs, introduction to new substances by drug-using peers, or drug-seeking behavior in which individuals continue trying different drugs until they achieve the desired effect. Polydrug (multiple-drug) use can also occur when people try to counteract the effect of one drug by the use of another—for example, by taking tranquilizers (which relieve symptoms of anxiety) in order to counteract the anxiety-producing effects of cocaine.

RESEARCH METHODS

Much of the most useful data for studies of adolescent drug use are collected either by self-administered questionnaires or during interviews. Often the questionnaires are given out in classrooms for students to complete anonymously. This type of study, which obtains data from all respondents at the same time, is known as a cross-sectional survey, and it provides important clues about how the use of different substances relates to such factors as age, gender, and ethnicity. In the drug-sequencing studies, researchers collect information as to whether a substance was used and the age of the person at the time of first use. Then, using a statistical technique called Guttman scaling, they combine each drug category and the ages of first use for the entire sample to establish a predominant sequence of use, by age, for the different substances.

Longitudinal cohort study is the term used for the study design whereby researchers test the progression of drug users to stronger substances. In these studies, people are interviewed or given a questionnaire to fill out repeatedly over time. For example, the same youths may be contacted annually to provide information on their drug use during the year. Although this method may help establish the correct timing and order of drug-use initiation for any given individual, it is a very difficult approach because of the cost and time involved in tracking people for many years.

Since illegal drug use has an antisocial connotation, people may underreport their use, although some teenagers may exaggerate reports of their drug use to create an impression. The biggest hurdle in studying drug use is obtaining accurate information. Reports are assumed to be honest and correct, based on the respondents' memory. Researchers try to promote honesty and accuracy by providing memory aids (e.g., pictures of drugs) as well as by assurances of anonymity and confidentiality.

Another concern of researchers is that reports of drug use will be affected by the way the population is sampled or by those participating. For example, a survey conducted in an inner-city public school may not reflect all adolescents. High school dropouts who are not in class when the data are collected and students enrolled in private schools may have levels of drug use that are different from those of students attending public schools.

PREVENTION IMPLICATIONS

Adolescent drug use must be considered in relation to the normal developmental challenges of adolescence. Because individuals use drugs in different ways for many reasons, no single prevention program will be effective with all groups at all ages. Understanding the factors that determine the link between the usage of one drug to the usage of another has important policy implications for developing prevention and educational programs. The sequential nature of drug use, as it is now understood, would indicate that prevention efforts targeted toward reducing or delaying adolescents' initiation into use of alcohol and cigarettes would reduce these adolescents' use of marijuana and other drugs. Similarly, efforts targeted toward reducing adolescents' marijuana use might reduce the rates of these adolescents' progression to "higher" stages of drug involvement. Prior drug use is a risk factor for progression; that is, the use of one drug may increase the likelihood of use of another drug, but it is not in itself a cause of further progression.

Data from the National Longitudinal Study on Adolescent Health reveal that there are many factors that determine whether teenagers will be predisposed to engage in harmful behaviors. The survey of 12,118 teenagers found that teenagers who felt close to their parents and siblings, teachers, and classmates were less likely to engage in risky behaviors. (Resnick, 1997)

Educating young people on the dangers of drugs has had some measurable success. A school-based series of classes on the dangers of anabolic steroid use appeared to help reduce steroid use among teenage athletes. Researchers evaluated seven weekly, 50-minute classes that gave 702 teenage football players comprehensive education in the dangers of steroids and alternatives to their use. This intervention improved the athletes' ability to drop steroid use when compared to a group of 804 athletes who just received a pamphlet about steroids. Athletes often use steroids to boost their performance, but the drugs can have dangerous side effects. (Goldberg, et al., 1996)

TRENDS

The annual survey of nearly 50,000 students around the country, "Monitoring the Future," conducted at the Institute for Social Research at the University of Michigan, reported in 1999 that, after declining in recent years, drug use among American teens generally held steady. However, there were slight increases in adolescents' use of anabolic steroids and the drug ecstasy. The report also noted that teen tobacco smoking dropped slightly but was still well above rates of the early 1990s. Drugs that showed little change in use included marijuana, amphetamines, hallucinogens, tranquilizers, and heroin. The only significant decline was in the use of crack cocaine among eighth and tenth graders, after several years of gradually increasing use. The Michigan study had been tracking high school seniors for 25 years and following eighth and tenth graders for the previous nine years. The survey included 45,000 students from 433 schools across the country. Researchers pointed out that drug use rates were down from the peak levels in overall illicit drug use by American teenagers that were reached in 1996 and 1997.

(See also: Conduct Disorder and Drug Use ; Coping and Drug Use ; High School Senior Survey )

BIBLIOGRAPHY

Donovan, J. E., & Jessor, R. (1983). Problem drinking and the dimension at involvement with drugs. American Journal of Public Health, 73, 543-552.

Gil, A. G., et al. (1998). Temporal influences of family structure and family risk factors on drug use initiation in a multiethnic sample of adolescent boys. Journal of Youth and Adolescence, 27, 373.

Goldberg, Linn, et al. (1996). Effects of a multidimensional anabolic steroid prevention intervention: The Adolescents Training and Learning to Avoid Steroids (ATLAS) Program. JAMA, The Journal of the American Medical Association, 276, 1555.

Johnson, V., & Pandina, R. J. (1991). Effects of the family environment on adolescent substance use, delinquency, and coping styles. American Journal of Drug and Alcohol Abuse, 17, 71.

Kandel, D. B., & Faust, R. (1975). Sequences and stages in patterns of adolescent drug use. Archives of General Psychiatry, 32, 923-932.

Kandel, D. B., & Yamaguchi, K. (1993). From beer to crack: Developmental patterns of drug involvement. American Journal of Public Health, 83, 851-855.

Kilpatrick, D. G.; et al. (2000). Risk factors for adolescent substance abuse and dependence: Data from a national sample. Journal of Consulting and Clinical Psychology, 68, 19.

Resnick, M. D., et al. (1997). Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. JAMA, The Journal of the American Medical Association, 278, 823.

Robins, L.N., & Przybeck, T. R. (1985). Age of onset of drug use as a factor in drug and other disorders. In N. Kozel & E. Adams (Eds.), Cocaine technical review. Rockville, MD: National Institute on Drug Abuse.

Trinkoff, A. M., Anthony, J. C., & MuÑoz, A. (1990). Predictors of the initiation of psychotherapeutic medicine use. American Journal of Public Health, 80, 61-65.

Valois, R. F. (2000). Association between employment and substance abuse behaviors among public high school adolescents. JAMA, The Journal of the American Medical Association, 283, 180.

Vise, D. A., & Adams, L. (1999). Study indicates teen drug use may be leveling off; Researchers see resurgence of 'ecstasy' among older youths in annual survey. The Washington Post, A, 2:1.

Alison M. Trinkoff

Carla L. Storr

Revised by Mary Carvlin