Substance use disorder in adolescents: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis
- Oscar Bukstein, MD
Oscar Bukstein, MD
- Clinical Professor of Psychiatry
- University of Texas Medical School at Houston, Baylor College of Medicine
- Section Editors
- David Brent, MD
David Brent, MD
- Section Editor — Childhood Mental Disorders
- Professor of Psychiatry, Pediatrics and Epidemiology
- University of Pittsburgh School of Medicine
- Andrew J Saxon, MD
Andrew J Saxon, MD
- Section Editor — Substance Use Disorders
- Professor and Director, Addiction Psychiatry Residency Program, Department of Psychiatry & Behavioral Sciences
- University of Washington
- Diane Blake, MD
Diane Blake, MD
- Section Editor — Adolescent Medicine
- Professor of Pediatrics
- University of Massachusetts Medical School
Substance use is pervasive and endemic among adolescents. By the time adolescents become adults in the United States, almost half will have tried an illicit drug, and over 80 percent will have used alcohol . Most use by adolescents will attenuate over time, but many suffer negative health and social consequences . Some adolescents advance to levels of use and consequences that meet criteria for substance use disorders (SUDs) and are at high risk for its continuation in adulthood.
The general approach to the assessment and treatment of adolescents with SUDs is similar in some respects to adults; however, developmental considerations require an approach tailored to the cognitive, social, and legal status of adolescents.
The epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of substance use and substance use disorder in adolescents are reviewed here. Treatment for SUD in adolescents is described separately, as is tobacco prevention and cessation management in adolescents. (See "Prevention of smoking initiation in children and adolescents" and "Management of smoking cessation in adolescents".)
Substance use is pervasive and endemic among adolescents in the United States, European countries, and other countries (table 1).
Alcohol use — In a 2011 study, up to 90 percent of European students aged 15 or 16 years reported ever having consumed alcohol . Among 10th grade United States students, 47 percent report lifetime alcohol use .
- Use of alcohol, cigarettes, and number of illicit drugs declines among U.S. teens. www.monitoringthefuture.org (Accessed on August 01, 2005).
- Chen K, Kandel DB. The natural history of drug use from adolescence to the mid-thirties in a general population sample. Am J Public Health 1995; 85:41.
- Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Substance Abuse and Mental Health Administration, Rockville, MD 2013.
- National Institute of Alcohol Abuse and Alcoholism (NIAAA). NIAAA council approves definition of binge drinking, NIAAA Newsletter 2004. No. 3, p.3.
- Centers for Disease Control and Prevention (CDC). Fact Sheets - Underage Drinking. http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm (Accessed on July 14, 2016).
- The European school survey project on alcohol and other drugs. The 2011 ESPAD report. www.espad.org (Accessed on August 28, 2015).
- Swendsen J, Burstein M, Case B, et al. Use and abuse of alcohol and illicit drugs in US adolescents: results of the National Comorbidity Survey-Adolescent Supplement. Arch Gen Psychiatry 2012; 69:390.
- SAMSHA. Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. www.samhsa.gov/data/sites/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf (Accessed on August 01, 2015).
- Lopez-Quintero C, Pérez de los Cobos J, Hasin DS, et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend 2011; 115:120.
- National Research Council (US) and Institute of Medicine (US) Research Advances and Promising Interventions. Preventing Mental Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities, O’Connell ME, Boat T, Warner KE (Eds), National Academies Press, Washington DC 2009.
- Couwenbergh C, van den Brink W, Zwart K, et al. Comorbid psychopathology in adolescents and young adults treated for substance use disorders: a review. Eur Child Adolesc Psychiatry 2006; 15:319.
- Armstrong TD, Costello EJ. Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity. J Consult Clin Psychol 2002; 70:1224.
- Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 2010; 49:980.
- Duffy A, Horrocks J, Milin R, et al. Adolescent substance use disorder during the early stages of bipolar disorder: a prospective high-risk study. J Affect Disord 2012; 142:57.
- Schilling EA, Aseltine RH Jr, Glanovsky JL, et al. Adolescent alcohol use, suicidal ideation, and suicide attempts. J Adolesc Health 2009; 44:335.
- Wong SS, Zhou B, Goebert D, Hishinuma ES. The risk of adolescent suicide across patterns of drug use: a nationally representative study of high school students in the United States from 1999 to 2009. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1611.
- Bukstein OG. Conduct disorder and delinquency and substance use disorders. In: Youth Substance Abuse and Co-Occurring Disorders, Kaminer Y (Ed), American Psychiatric Association Publishing, Washington DC 2015. p.81.
- van Emmerik-van Oortmerssen K, van de Glind G, van den Brink W, et al. Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug Alcohol Depend 2012; 122:11.
- Hersh J, Curry JF, Kaminer Y. What is the impact of comorbid depression on adolescent substance abuse treatment? Subst Abus 2014; 35:364.
- Kendler KS, Schmitt E, Aggen SH, Prescott CA. Genetic and environmental influences on alcohol, caffeine, cannabis, and nicotine use from early adolescence to middle adulthood. Arch Gen Psychiatry 2008; 65:674.
- Lynskey MT, Agrawal A, Heath AC. Genetically informative research on adolescent substance use: methods, findings, and challenges. J Am Acad Child Adolesc Psychiatry 2010; 49:1202.
- Hall W, Degenhardt L. Adverse health effects of non-medical cannabis use. Lancet 2009; 374:1383.
- National Institute on Drug Abuse. Drug Facts: Nationwide Trends, 2014. www.drugabuse.gov/publications/drugfacts/nationwide-trends (Accessed on January 15, 2015).
- Grant BF, Stinson FS, Harford TC. Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: a 12-year follow-up. J Subst Abuse 2001; 13:493.
- Merikangas RS, He J, Bustein M, et al. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Study-Adolescent Supplement (NCS-A). J Am Acad Child Psychiatry 2010; 49:980.
- Ellickson PL, Tucker JS, Klein DJ. Ten-year prospective study of public health problems associated with early drinking. Pediatrics 2003; 111:949.
- Tucker JS, Ellickson PL, Orlando M, et al. Substance use trajectories from early adolescence to emerging adulthood: A comparison of smoking, binge drinking, and marijuana use. J Drug Issues 2005; 35:307.
- Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2007; 119:76.
- Centers for Disease Control and Prevention. (2012). Youth risk behavior surveillance--United States, 2011. Morbidity and Mortality Weekly Report, 61(4). http://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf (Accessed on September 27, 2016).
- Volkow ND, Compton WM, Weiss SR. Adverse health effects of marijuana use. N Engl J Med 2014; 371:879.
- Jacobus J, Tapert SF. Effects of cannabis on the adolescent brain. Curr Pharm Des 2014; 20:2186.
- Lev-Ran S, Roerecke M, Le Foll B, et al. The association between cannabis use and depression: a systematic review and meta-analysis of longitudinal studies. Psychol Med 2014; 44:797.
- Boden JM, Fergusson DM. Alcohol and depression. Addiction 2011; 106:906.
- Bright Futures/American Academy of Pediatrics. Recommendations for Preventive Pediatric Health Care - Periodicity Schedule. www.aap.org/en-us/professional-resources/practice-support/Pages/PeriodicitySchedule.aspx (Accessed on February 17, 2017).
- Adolescence. In: Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed, Hagan JF, Shaw JS, Duncan PM (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2008. p.515.
- Promoting Mental Health. In: Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed, Hagan JF, Shaw JS, Duncan PM (Eds), American Academy of Pediatrics, Elk Grove Village, 2008. p.77.
- Knight JR, Sherritt L, Shrier LA, et al. Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Arch Pediatr Adolesc Med 2002; 156:607.
- Center for Adolescent Substance Abuse Research. CRAFFT Screen. http://www.ceasar-boston.org/CRAFFT/screenCRAFFT.php (Accessed on February 24, 2014).
- COMMITTEE ON SUBSTANCE USE AND PREVENTION. Substance Use Screening, Brief Intervention, and Referral to Treatment. Pediatrics 2016; 138.
- National Institute on Alcohol and Alcoholism (NIAAA, 2014). Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide. http://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuide.pdf (Accessed on October 21, 2015).
- Winters KC, Kaminer Y. Screening and assessing adolescent substance use disorders in clinical populations. J Am Acad Child Adolesc Psychiatry 2008; 47:740.
- Martino S, Grilo CM, Fehon DC. Development of the drug abuse screening test for adolescents (DAST-A). Addict Behav 2000; 25:57.
- Tarter RE. Evaluation and treatment of adolescent substance abuse: a decision tree method. Am J Drug Alcohol Abuse 1990; 16:1.
- American Psychiatric Association. Diagnostic and Statistical Manual, 5th ed, American Psychiatric Publishing, Arlington 2013.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
- American Psychiatric Association. Diagnostic and Statistical Manual, Fourth Edition Text Revision (DSM-IV TR), American Psychiatric Publishing, Arlington 2000.
- Chung T, Martin CS. Classification and short-term course of DSM-IV cannabis, hallucinogen, cocaine, and opioid disorders in treated adolescents. J Consult Clin Psychol 2005; 73:995.