Chapter 37. Substance-Related Disorders in Adolescents

Abstract

Adolescence is a unique stage of human development. The World Health Organization defines an adolescent as an individual between the ages of 10 and 19 years; however, many suggest that a broader age range would be more appropriate. Sawyer et al. ( 2018) proposed the age range of 10–24 years, given that brain development continues into the early 20s and that a broader age range may be more reflective of societal structure. Although there are differing views on exact age ranges, adolescence is universally seen as the transitional period between childhood and adulthood that encompasses extensive biological, psychological, and social changes. The biological changes in adolescence are at least in part driven by changes in the endocrine system and secretion of hormones. The onset of puberty can be seen as a signal of the start of adolescence, although puberty alone does not define adolescence. Changes during this time include physical growth and development of secondary sex characteristics. Unique changes in the brain, including synaptic pruning, myelination, and a decrease in the gray matter volume, also occur during adolescence (Sawyer et al. 2018; Spear 2013). Psychosocial changes include development of higher-level reasoning skills, moral development, an increase in ability to use abstract thinking, an increase in the desire for autonomy, a focus on the development of identity, an increase in empathy, and an increasing importance placed on peer relationships (World Health Organization 2014). Substance use has the potential to both affect and be affected by the changes noted above during adolescence. Therefore, it is imperative to consider substance use disorders (SUDs) in adolescence within the lens of development and with the expectation that there can be significant differences in substance use and/or disorders in adolescents compared with adults. This chapter highlights some of the unique issues surrounding substance use and SUDs in this population. Many adolescents use substances to at least some extent, with 47.8% using any illicit drug and 58.5% using alcohol by grade 12 (Miech et al. 2018). Although most adolescents do not meet criteria for an SUD, there are reasons for concern with any level of use during this developmental stage, suggesting that clinical strategies should be employed across the spectrum of use. For individuals seeking treatment for non-substance-related psychiatric disorders, psychoeducation should include reviewing the effects that substance use may have on mood, anxiety, and/or other disorders. Substance use in adolescents is heterogeneous and highly prevalent, with a potential for both acute and chronic adverse outcomes. There are unique challenges to targeting substance use in adolescence, but there also are unique opportunities to intervene to increase the likelihood of positive outcomes that have the potential to impact the longer-term life trajectory.

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