Substance Abuse in Children and Adolescents1
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There are many reasons why teenagers use drugs. Some do it as a form of rebellion against authority. Others may be trying to fit in with a group of friends who use drugs. They may do it out of curiosity, because it feels good, or because it provides relief from unpleasant emotions and makes them feel better.
Teens, and even older children, may use "legal" substances like tobacco, alcohol, glue, gasoline, diet pills, over-the-counter cold remedies, or prescription pain killers (like OxyContin®). Some may then go on to use illegal drugs like marijuana, LSD, cocaine, heroin, PCP, methamphetamine, or Ecstasy.
Substance use becomes substance abuse when a person continues to use drugs or other substances even when it leads to serious personal consequences like family problems, losing friends, getting expelled from school, losing a job, or getting into legal trouble. Some people continue to use drugs because they want to. Others become psychologically or physically dependent on them.
Dependence (also called "addiction") is considered by some to be a kind of brain disorder in which chemical changes in the brain that result from taking drugs make using drugs difficult to resist. As the dependence worsens, not using the substance can cause restlessness, inability to sleep, or nausea. People who are dependent on drugs can even feel driven to commit crimes like break and enter, theft from family members, shoplifting, or even armed robbery to get money to buy them.
Teens are often injured or die when swimming or driving after drinking or using other drugs. Injecting drugs can lead to serious liver disease, HIV-AIDS, tetanus (a potentially fatal disease that causes muscle spasms), or blood poisoning. Inhaled drugs like cocaine can "burn" a hole inside the nose, or cause heart attacks or strokes.
Even though it may not seem as "toxic" as other drugs, for some people marijuana can lead to serious effects requiring long-term treatment.
Use of marijuana can cause some vulnerable teenagers to hear voices or see things that aren't there, have trouble thinking clearly, or have thoughts that don’t make sense to other people. Teens have also begun using an extremely addictive drug called "crystal meth." While methamphetamine is a prescribed medication that is used legitimately to treat ADHD or other conditions, crystal meth is a type of methamphetamine that is "cooked up" using toxic substances like paint thinner, drain cleaner, or the lithium from batteries. When smoked or inhaled, it can lead to irregular heartbeat, damage to brain blood vessels that can cause strokes, severe depression, or symptoms of Parkinson’s Disease. Many young children are neglected or abused by their addicted parents. Crystal meth use is a growing problem in North America, but in comparison to other drugs, its use is still fairly rare.
However, alcohol and tobacco, both legal substances, can cause even greater harm to physical health and social development than many illegal substances. Cigarette smoking is a major cause of death from heart disease, stroke, cancer, and lung disease in adults. Early, continued use is associated with depression and anxiety during adolescence and with poor academic and social-emotional outcomes in adulthood. Nicotine is a highly addictive substance and quitting is very difficult.
Teens who binge drink (have more than 5 drinks one after another) are more likely than teens who don’t binge to do badly at school, be a victim of dating violence, attempt suicide, or do other things that put their health at risk, like having unprotected sex.
Substance abuse affects not only involved individuals but society as a whole, causing lowered productivity, increased crime rates, and increasing numbers of homeless people on our streets.
What’s normal and what’s not?
It’s not unusual for a teenager to try alcohol, tobacco, or other drugs occasionally. However, if the drug use is chronic and causes personal or family problems, it can be a sign of something more serious, like a mental health problem.
How common is substance abuse?
Among students in grades 7 to 12, alcohol and tobacco are the most frequently used legal substances, while pot is the most commonly used illegal drug. Only 2% of children and teens are frequent users of other illegal drugs, such as stimulants like methamphetamine, hallucinogens (other than LSD or PCP), cocaine, or Ecstasy.
What causes substance abuse?
Children and adolescents with AD/HD, Oppositional Defiant Disorders, or Conduct Disorder are more likely to use drugs or sniff gasoline or glue. Teens using substances may have depression or fear social situations. Some have post-traumatic stress disorder - a type of anxiety related to early history or current experience of physical or sexual abuse. Substance use is also frequently seen in adolescents with bulimia or with schizophrenia.
Drug use and mental health problems seem to go together, but no one knows which comes first. Some kids who are anxious or depressed use drugs to try to make themselves feel better. On the other hand, it is possible that using the drugs makes teens experience those feelings. When teens feel bad about themselves or feel they don’t fit in anywhere, they may find a like-minded group of friends who use drugs. Not knowing how to resist peer pressure, or choosing not to resist it, increases the likelihood of substance abuse. Teens who had no friends in middle childhood also seem to be more likely to abuse drugs or other substances during adolescence.
Teens are at risk if they are exposed to drinking and drugs or domestic violence in the home, or if their parents have mental health problems. Children and teens who befriend substance-using peers are more likely to use drugs and other substances themselves. Growing up in a poor or crime-ridden neighbourhoods also contributes to substance abuse in children and teens.
How long does substance abuse last?
Some older children and teens try illicit drugs only once or, at most, a few times. A smaller group may become chronic users of cocaine, heroin, tobacco, or alcohol, and need long-term treatment. Substance abuse that begins in late childhood or early adolescence tends to persist and is more severe in adulthood. Adults who started using tobacco as teenagers are also more likely to have depression, poor physical health, and reduced income compared to their non-smoking peers, and have fewer years of education.
What treatment is effective?
Prevention is the best way to deal with substance abuse. It is important to know that some treatments, like group therapy with other young people who have committed crimes, may cause more harm than good by increasing drug use or antisocial behaviour.
Programs that include all or some of the following components seem to work best:
- Medications or cognitive behavioural therapy (CBT) that address underlying mental health problems.
- Family therapy used in addition to other treatments to reduce family conflict.
- Interventions that help increase motivation to stay in recovery.
Long-term follow up of any treatment is recommended because substance use is a chronic disorder. Testing teenagers for drug use at home or in the schools is not recommended because it can falsely identify a teen as a drug user when, in fact, the test is unreliable. Testing without the teen’s knowledge is a betrayal of trust and could harm the his/her relationship with the parent. Testing in the school may be a violation of civil rights. Screening for drug use should be used only if there are good programs and treatment facilities available to treat what is really a physical or psychological illness. It should not be used to punish teens, who are being harmed by their drug use.
Substance abuse is a common problem among teens, and it can cause serious consequences. Treatment does work well if the problem is found early but prevention is the best solution.
Canadian Centre on Substance Abuse provides information and supports research
Guides from Health Canada on talking to young persons about substance abuse.
This information pamphlet was developed by the Centre of Knowledge on Healthy Child Development with support from CIBC World Markets Children's Miracle Foundation. The Centre of Knowledge on Healthy Child Development is a project of the Offord Centre for Child Studies, a leader in helping kids grow and thrive. Go to www.knowledge.offordcentre.com for more information on how to identify, prevent and treat child and youth mental health problems.
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1This webpage is a reproduction of an information pamphlet entitled Substance Abuse in Children and Adolescents which was developed by the Centre of knowledge on Healthy Child Development. It has been reproduced with their permission.
The Centre of Knowledge on Healthy Child Development is a project of the Offord Centre for Child Studies, a leader in helping kids grow and thrive. Go to www.knowledge.offordcentre.com for more information on how to identify, prevent and treat child and youth mental health problems.