Take Another Look at Adolescent Drug Use

Think decreases in alcohol and drug use among teens mean the problem is licked?
Think again.

Recent surveys suggest alcohol and illicit drug use by American youth is decreasing. But parents and caregivers, communities, and policymakers should consider this information cautiously, because decreases in the use of alcohol and some drugs are only moderate.

In fact, for several drugs, such as heroin, cocaine, and steroids, use among young people isn't decreasing or increasing. And some reductions only apply to certain types of drugs, particular age levels, or regions of the country, or don't apply equally to girls and boys, whose usage and dependence patterns differ.

Parents, caregivers, communities, and policymakers have to stay informed about current drug trends and continue to educate youth aggressively about the dangers of using alcohol and illicit drugs--with efforts aimed at stopping use before it starts and intervening quickly when alcohol and drug problems occur.

Still a Widespread Problem

Alcohol and illicit drug use among young people remains widespread. Among 8th, 10th, and 12th graders, 54% have tried an illicit drug by the time they finish high school; four out of every five have consumed alcohol before graduating from high school--nearly half by 8th grade.

More teens than ever before report getting drunk monthly, and the gender gap that once existed in teen alcohol use has closed, especially among younger youth. Thirty-five percent of 9th grade girls, compared with 18% of 12th grade girls, say they began using alcohol before age 13. This is of particular concern, since girls are more vulnerable to substance abuse than boys are--girls become addicted faster and are affected by the consequences at a faster rate.

Children under 21 drink 20% of the alcohol consumed in the United States. Even more alarming, a 2002 survey reports that, for the first time, teens find it easier to buy marijuana than beer.

Despite modest decreases in marijuana use by teens in recent years, it's still the most widely used illegal drug among teens and adults. Since 1991, lifetime marijuana use has almost doubled among 8th and 10th graders, and increased by a third among high school seniors. Of the more than 2 million Americans who used marijuana for the first time in 2001, more than 25% were under 15, and nearly 75% were under 18. Marijuana use today starts at younger ages--in 2002, the average age of first-time use was 13.

And the effects of marijuana are more powerful than ever. The marijuana available today has been determined to be as much as five times more potent than marijuana in the 1970s.

Dependence, Treatment, and Recovery

Adolescents who begin using alcohol or drugs typically are not dependent. Impairment occurs as a result of heavier and more frequent use and is likely to result in problems with one's health, school, relationships, and the law. Addiction is influenced by genetics, social and family influences, co-occurring substance abuse and mental health disorders, the chemical makeup of the specific substance, and other factors. Identifying and addressing these factors early is a critical step in prevention and early intervention in alcohol and drug disorders.

Unfortunately, many youth are not identified as having an alcohol or drug problem until they have progressed to abuse and dependence. In the 1990s, the number of youth entering substance abuse treatment increased 50%, but available treatment did not increase. An estimated 1 in 10 adolescents who are addicted to alcohol or drugs receives treatment--many only do so through the juvenile justice system.

Although research on the effectiveness of substance abuse treatment for adolescents is relatively new, significant evidence shows that substance abuse treatment in the general population is both medically and cost-effective. Emerging research is showing that treatment designed specifically for adolescents significantly reduces dependency on alcohol and drugs and results in improved school and psychological outcomes.

Prevention strategies that target teens before they're exposed to alcohol or drugs is key to reducing alcohol and drug use among adolescents. The Center on Addiction and Substance Abuse at Columbia University found that adolescents ages 12 - 16 are 500% more likely than kids of other ages to drink alcohol or use illicit drugs. Waiting until young people enter middle or high school is too late to begin talking to them about the dangers of alcohol and drugs.

Substance abuse and dependence can be acute--with faster onset and shorter duration--as well as chronic. As a result, we need both brief, short-term interventions and more intense treatment and support services for youth with different needs. This is particularly important for girls, who for years have been limited to programs developed with boys in mind, not taking into account girls' unique vulnerabilities and different motivations for using alcohol and drugs.

Research shows that kids with substance abuse issues who receive comprehensive, integrated services drawing on established community networks fare much better than do those who do not receive such services. A community network draws upon resources available within the juvenile justice, child welfare, mental health, and related service systems to create a comprehensive-care approach.

Every treatment program should have a strong aftercare component. Relapse among teens is very common, particularly in the first 90 days following treatment, so posttreatment monitoring and recovery support are essential to long-term recovery. We need to move away from the diagnose-treat-discharge approach and promote a model of treatment that more closely resembles those for other chronic diseases, such as diabetes and asthma.

Initial findings prove what many communities already know--adolescents with alcohol and drug disorders can't be treated in a vacuum if they are to achieve long-term sobriety. Research shows that successful treatment won't happen without treating the environment in which youth live. Rather than placing youth in institutions, away from what is most familiar to them, recovery networks should integrate youths' family, friends, school, neighborhood, and the larger community.

Norah Lovato is Program Manager of Behavioral Health Services for CWLA. For references for statistical information in this article, contact behavioralhealth@cwla.org.
Selecting a Treatment Program
Selecting a treatment program can be difficult for any parent or caregiver. The need to find treatment often happens in crisis situations, where little useful information is available. Here are 10 important questions to ask a treatment program, based on emerging evidence of what works for adolescents who need treatment:

* How does your program assess the unique needs of adolescents?

* How does the program assess the adolescent's problems leading up to treatment?

* How often does the program review and update the treatment plan in light of the adolescent's progress?

* How is the family involved in the treatment progress?

* How do you engage adolescents so they stay in treatment?

* What are the qualifications of program staff, and what kind of clinical supervision is provided for counselors?

* Does the program offer separate groups and same-gender counselors for girls and boys?

* How does the program follow up with the adolescent and family and provide continuing care after treatment is completed?

* What evidence do you have that your program is effective?

* What is the cost of the program?

Source: Treating Teens: A Guide to Adolescent Drug Programs, available from Drug Strategies, 1150Connecticut Avenue NW, Suite 800, Washington DC 20036; 202/289-9070; dspolicy@aol.com; or online at www.drugstrategies.com.
Join the Voices for Recovery
National Alcohol and Drug Addiction Recovery Month highlights the benefits to society of substance abuse treatment, honors the contributions of treatment providers, and promotes the message that recovery from substance abuse is possible. You can help make recovery a reality in your community by joining the annual celebration every September.

The Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT), in conjunction with its national planning partner organizations, has produced a user-friendly toolkit designed to help you plan and implement a successful campaign in your community. The toolkit features helpful resources, event ideas, suggestions, samples on how to reach local media, and fact sheets for key constituency groups and special audiences.

Download the toolkit and other materials, and see what events are planned in communities nationwide, at CSAT's interactive website, www.recoverymonth.gov. Or, for more information, contact

National Clearinghouse for Alcohol and Drug Information
800/729-6686 (toll free)
800/487-4889 (TDD, toll free)
877/767-8432 (Spanish, toll free)
www.samhsa.gov

CSAT
301/443-5052
www.recoverymonth.gov

For confidential information on substance abuse treatment and referral, call SAMHSA's National Helpline:
800/662-HELP (toll free)
800/487-4889 (TDD, toll free)
877/767-8432 (Spanish, toll free)
www.findtreatment.samhsa.gov

Children's Voice Article, September/October 2003

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© 2003