Substance Use Disorder (SUD) is a treatable mental health condition characterized by impaired control over substance use, whether it involves legal or illegal drugs, alcohol, or medications. It often coexists with other mental health disorders such as anxiety, depression, and ADHD. The overlap between SUD and these disorders can be attributed to shared risk factors—like genetics and traumatic-medication behaviors, and changes in brain structure caused by substance use.
Adolescence is a critical period marked by risk-taking behaviors that can lead to early substance use, significantly increasing the likelihood of developing SUD later in life. Research indicates that 10% of 8th graders, 20% of 10th graders, and 34% of 12th graders reported alcohol consumption in the past 30 days in 2020. The rise of vaping has also transformed the landscape of adolescent substance use; 20% of adolescents have reported ever vaping cannabis, with daily cannabis use reaching 6.9% among 12th graders, the highest level since 1991. While overall adolescent substance use has declined, certain populations—particularly Black and Hispanic youth, those from lower socioeconomic backgrounds, and LGBTQ+ adolescents—continue to experience higher rates of substance use and related issues.
Connection between Mental Health and Substance use
Substance abuse and mental health conditions often co-occur, a combination known as a dual diagnosis or co-occurring disorder. Managing both conditions is challenging, as untreated mental health issues can worsen substance abuse, and increased substance use can exacerbate mental health symptoms. Co-occurring disorders are more common than many realize, with significant percentages of those with severe mental illness or substance abuse issues experiencing both. Ignoring these intertwined issues typically leads to deterioration, but recovery is possible with the right support and treatment, allowing individuals to regain stability and well-being.
Substance Use Among Adolescents: An Overview
Nicotine
Almost 90% of adults who smoke combustible tobacco began before age 18, and 99% had tried smoking by age 26. While high school cigarette use declined from 15.8% in 2011 to 4.6% in 2020, nicotine use remains a concern. Healthcare providers can assist adolescents who are not ready to quit by exploring their motivations for smoking and offering tailored harm reduction strategies, including behavioral health treatment for mood relief and "abstinence" challenges. Adolescents with nicotine use disorders and co-occurring mental health issues are less likely to quit, but behavioral treatments like cognitive behavioral therapy have shown promise in supporting
Cannabis
Cannabis use among adolescents has remained stable over the past decade, with 6.5%, 16.6%, and 21.1% of 8th, 10th, and 12th graders respectively reporting use in the past 30 days in 2020. Daily use among 12th graders reached 6.9%. The potency of cannabis products, particularly the increase in delta-9-tetrahydrocannabinol (THC) levels from 4% in 1995 to 14% in 2019, raises concerns about adverse effects such as anxiety and hallucinations. HCPs can help adolescents manage cannabis use by educating them about withdrawal symptoms and supporting strategies to reduce consumption.
Vaping
Vaping has become a prevalent method of substance use among adolescents. The use of e-cigarettes has surged, with 43.6% of high school students vaping at least 20 days a month in 2021. This rise is concerning due to the association between vaping and transitions to combustible tobacco products. HCPs should explore motivations for vaping and encourage reductions in use while addressing safety concerns related to driving after vaping.
Alcohol
Although past 30-day alcohol use decreased among adolescents, it was still reported at 7%, 13%, and 26% among 8th, 10th, and 12th graders in 2021. Binge drinking patterns indicate that adolescents consume higher quantities per occasion compared to adults. HCPs should provide guidance on safe alcohol use practices and develop protective behavioral strategies to mitigate risks associated with drinking.
Opioids
The opioid overdose epidemic has significantly impacted adolescents, with overdose-related deaths tripling from 2019 to 2021. American Indian and Alaska Native adolescents experienced the highest rates. Harm reduction strategies for adolescents with opioid use disorder, including medication-assisted treatment and naloxone distribution, are crucial to reducing morbidity and mortality.
Moving Beyond "Just Say No"
Psychologists are developing new, evidence-based approaches to combat rising substance misuse and overdose rates among teens, moving away from traditional abstinence-only programs like “Just Say No” and D.A.R.E., which have proven largely ineffective. Instead, they advocate for a holistic approach that incorporates harm reduction and supportive, non-stigmatizing education. Modern programs emphasize understanding both the benefits and risks of substance use, enabling teens to make informed choices while respecting their need for autonomy. They also adapt to changing drug use trends, focusing on the increasing popularity of cannabis and psychedelics, as well as the risks associated with fentanyl-contaminated supplies. The "Just Say Know" strategy empowers teens with knowledge and decision-making skills, aiming to reduce risks linked to substance misuse and overdose, ultimately promoting sensible choices rather than total abstinence.
Conclusion
Current prevention strategies primarily focus on primary prevention, aimed at preventing initial substance use, yet there is an urgent need for secondary and tertiary prevention efforts for those already engaged in substance use. Secondary prevention emphasizes early identification of at-risk youth, while tertiary prevention offers treatment options for those with SUD. By incorporating harm reduction principles into these frameworks, healthcare providers can equip adolescents with strategies to minimize the negative impacts of substance use without necessitating complete abstinence. This patient-centered approach recognizes the complexities of adolescent behavior and promotes safer choices, potentially leading to more effective recovery outcomes. Consistent messaging that reassures adolescents and their caregivers— emphasizing that most peers do not engage in substance use—can be beneficial. For those adolescents who do use substances, healthcare providers (HCPs) should be prepared to offer tailored advice focused on reducing harm and validating their experiences. By fostering an environment of support and understanding, we can better address the complex needs of adolescents and ultimately promote healthier choices and outcomes.
References
1.Substance Use and Co-Occurring Mental Disorders. (n.d.). National Institute of Mental Health (NIMH).
2.Abrams, Z. (n.d.). More teens than ever are overdosing. Psychologists are leading new approaches to combat youth substance misuse. https://www.apa.org. https://www.apa.org/monitor/2024/03/new-approaches-youth-substance-misuse
3.Winer, J. M., Yule, A. M., Hadland, S. E., & Bagley, S. M. (2022). Addressing adolescent substance use with a public health prevention framework: the case for harm reduction. Annals of Medicine, 54(1), 2123–2136. https://doi.org/10.1080/07853890.2022.2104922