youth and drug abuse · 2008-05-23 · youth and drug abuse eric f. wagner, ph.d. florida...
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Youth and Drug Abuse
Eric F. Wagner, Ph.D.
Florida International University
United Nations Expert Group Meeting
World Programme of Action for Youth
19-21 May 2008
Frequency of Alcohol Use and Drinking to Intoxication
During Past 12 Months in Youth Across Nations Source: The European School Survey Project on Alcohol and Other Drugs, 2003 ( http://www.espad.org/ )
Marijuana Use Youth Across Nations Source: The European School Survey Project on Alcohol and Other Drugs, 2003 ( http://www.espad.org/ )
lifetime 30-day
NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003.
Age
Age at alcohol, at tobacco, and at cannabis dependence as per DSM IV
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
1.4%
1.6%
1.8%
5 10 15 21 25 30 35 40 45 50 55 60 65
% i
n e
ac
h a
ge
gro
up
wh
o d
evelo
p
firs
tti
me d
ep
en
de
nc
e THC
ALCOHOL
TOBACCO
Addiction Is A Developmental Diseaseoften starts in childhood and adolescence
Consequences of Teen Substance Use
0 0
116
17 17
11
44
29
15
47
67
77
57
47
25
69
2313
51
11
28
33
0
20
40
60
80
100
% 1+
Symptom of
Alcohol
Disorder
% 1+
Symptom of
Cannabis
Disorder
% Clinical
Behavior
Problems
% Physical
Fight
% Out of
School
% with 1+
ER in the
past year
% Any
Illegal
Activity
% 1+
Arrests
No Past Year Alcohol or Marijuana Use
Weekly Alcohol Use
Weekly Marijuana Use (with Alcohol Use)
Source: Dennis, Godley and Titus (1999) and 1997 NHSDA
Copyright ©2004 by the National Academy of Sciences
Gogtay, Nitin et al. (2004) Proc. Natl. Acad. Sci. USA 101, 8174-8179
Fig. 3. Right lateral and top views of the dynamic sequence of GM maturation over the cortical surface
Brain Maturation continues into the 20’s
Maturation
Sequence:
-Structures that
Underlie
Coordination
& Affect First
-Planning and
Inhibition More
Slowly
Teen Drinking & Brain Activity:
Compensation to Deactivation Hypothesis?
Non-Drinkers Heavy Drinkers
Activatio
nA
ctivatio
nD
eD
e-- a
ctivation
activation
Age 16
Age 20
Compared to adult substance abusers,
adolescent substance abusers…
• briefer history, few medical consequences
• more episodic use
• more polysubstance use
• different developmental challenges
• more co-occurring problems
• greater likelihood of natural recovery
• pressing need for autonomy and individuation
• much less likely to seek treatment
Pediatrics, 2008, “Special Issue on Underage Drinking”sponsored by the U.S. National Institute on Alcohol Abuse & Alcoholism
• adolescent treatment approaches rely on adult treatment approaches
• developmental incongruence of adult-derived methods– adolescent drug abusers are different from adult drug abusers
– normative developmental differences
• in order to be maximally effective, adolescent substance abuse treatment must take into account such developmental realities
• developmental realities include wide divergence in – developmental status,
– anticipated effects and consequences of alcohol and drug use,
– social and emotional contexts of use,
– the risk factors contributing to the onset and trajectory of use
Screening with Brief Intervention Works
• Youth expect and are open to discussing alcohol and drug use (Steiner, 1996. Stern, 2006)
• Screening and brief interventions can reduce alcohol, tobacco and marijuana use (Knight, 2005, McCambridge, 2004, Oze et al., 2003)
• Brief Interventions in emergency rooms can reduce alcohol/drug use and related problems (Monti, et al., 2004)
• Brief Interventions in school settings can reduce alcohol/drug use and related problems (Wagner, 2007)
Science indicates that parents….
� play a vital role in prevention and treatment of adolescent
drug abuse
� do not always understand they have influence
� do not know how to use the influence they have
� are ill-equipped to spot signs of experimentation and
intervene effectively
� do not know how to
� locate treatment and support services
� ask the right questions when seeking help
� support their child through treatment and the recovery process
How Do Parents Influence Youth Drug Use? (adapted from Clayton, 1992; Jacob & Johnson, 1997; Willis & Yaeger, 2003)
family history
parent drug use
parent attitudes
parental monitoring
parent connectedness
parent-child conflict
family stress events
youth drug use
Summary: Youth and Drug Abuse
1. Adolescent alcohol and other drug use is widespread
2. Adolescent substance abuse is a significant public health
concern
3. The peak onset age for substance dependence is late
adolescence
4. Interventions can work, but too few teens get it
5. Few interventions are developmentally congruent
6. Brief interventions are effective, economical, and
developmentally congruent
7. Parents have influence, but need guidance in how to use it
Goals & Targets: Youth and Drug Abuse
• Halve the number of youth who develop alcohol or drug use problems
during adolescence
– Alcohol, marijuana, and tobacco use prevalence among population
aged 15-24 years
– Morbidity and mortality rates associated with adolescent alcohol
and other drug use
– Substance abuse and dependence diagnoses prevalence among
population aged 15-24 years
• Achieve universal access to early intervention services for adolescents
alcohol and other drug users
– Proportion of population of adolescent substance users with access
to intervention or services
– Proportion of parents who are knowledgeable and skilled in
preventing adolescent alcohol and other drug use