Physician Focus: Youth and Substance Abuse
By John R. Knight, M.D.Motor vehicle crashes, unintentional injuries, homicides, and suicides account for more than 70 percent of all teenage deaths, and all of them are strongly linked to one thing: substance abuse.
Substance abuse by adolescents is a persistent and growing problem, one that often ends in tragedy. Consider these numbers:
—42 percent of high-school students report current alcohol use; nearly half drink to excess.
—35 percent of motor vehicle deaths result from teens who drink before they drive.
—20 percent of high-school students use marijuana.
—2,500 teens, every day, use a prescription drug to get high, according to The Partnership for a Drug-Free America.
While addiction to alcohol or drugs is rare among young people — only 3 percent of 12-18-year olds meeting the clinical criteria for addiction – a teenager doesn’t have to be addicted to die or have something terrible happen as a result of substance abuse. Too many headlines have been written to prove that point.
Adolescents are at higher risk from substance abuse than adults because of the way their brains respond to those substances.
The brain undergoes major development all through adolescence and continues into the mid- to late 20s. A person develops the capacity for vision, movement, and coordination well before what we call the “executive functions” – self-control, planning, rational decision-making, or judgment. Those critical functions develop last. That’s why it’s so dangerous for adolescents to be using psychoactive substances: they respond differently than adults and are at much greater risk.
Parents should recognize that alcohol is the greatest threat to their teen’s life and health. It’s the most abused and most dangerous of all the drugs, accounting for more deaths than all other drugs combined. Yet, amazingly, more than 30 percent of parents provide alcohol to their teenage children. Why would parents put their children in jeopardy?
Marijuana is the second-most abused drug by teenagers, and its use is increasing, as the movement to adopt “medical marijuana” has led many to assume it’s safe. There is no safe dose. It is also highly addictive psychologically, even though it does not cause physical symptoms of withdrawal.
Marijuana is even more dangerous for teens than people think, because it causes long-term changes in both the structure and function of the brain. The major active ingredient in cannabis – THC or tetrahydrocannabinol – affects judgment, memory, coordination, vision, sensation, and movement. Smoking marijuana has serious toxic effects on the developing brain, so teens who smoke marijuana early and often, then, are changing the structure and function of their brains.
The abuse of prescription drugs, such as painkillers and stimulants – is another growing part of the problem of youth substance abuse. Adolescents look at these substances as medicines, as being safe, but they lose sight of one critical phrase – ‘when used as directed’. Many teens find these pills right in their own home medicine cabinet and take them to “pharming parties,” where drugs are made available to others.
Parents should be alert to the signs and symptoms of substance abuse. Only one-half of parents know of their teenager’s alcohol or marijuana use, and less than one-third know when their child is getting drunk or using more powerful drugs.
One key sign is change – change in dress, behavior, mood, or friends. Decreased performance in school or extracurricular activities and truancy are other clues. Occasionally, the smell of alcohol or marijuana may be present, and in severe cases, money may even be missing. But above all, look for changes, some of them subtle. And if you think your child might be using substances, then he or she likely is using them, and you should consult a health care professional.
My prescription for parents is clear: Tell your teenagers you expect them not to drink until they’re 21 and you expect them not to use drugs. Tell them often. Children do care what parents think. If you give children the message frequently – once a month – then you’re helping to immunize them from substance abuse. Their lives and their futures are at stake.
John R. Knight, M.D., is Director of the Center for Adolescent Substance Abuse Research at Boston Children’s Hospital and Associate Professor of Pediatrics at Harvard Medical School. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org
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