Each year at prom and graduation time, many families allow alcohol use at celebratory parties for their underage children with the view that they will be safe in those surroundings and may even learn responsible drinking. In light of the medicalization, legalization and decriminalization of marijuana, it seems that the U.S. public has become much more tolerant of what many consider benign substance use in society.
In fact, we are frequently asked: Is adolescent substance abuse that big a deal when adolescents just drink and smoke weed? The answer is a resounding yes: Use and abuse of substances by American teenagers is a big deal.
First, alcohol and marijuana are not benign substances, particularly on the developing adolescent brain. At a most basic level, the adolescent brain is more susceptible to the addictive effects of substances, making use a risky proposition. Marijuana, alcohol and all other drugs of abuse show diverse neurotoxic effects, adversely affecting brain development and maturation in the areas related to motivation, memory and learning, and inhibition.
Substance use disorders are routinely associated with a costly combination of social, physical, mental and public health problems.
Substance use disorders are strongly associated with the three leading causes of death among youth — accidents, homicide and suicide — and significantly contribute to unwanted pregnancy, school dropout, violence and delinquency. Since the brain continues to develop through age 25, it is not surprising that substance use during the formative years results in meaningful and often long-term consequences on brain development, brain functioning and IQ.
It also directly contributes to the development of a host of chronic medical conditions including but not limited to asthma, depression, sexually transmitted infections — including HIV — and increases the risk for psychosis. The association of substance use disorder with these and other medical conditions, such as liver problems and breast disease, leads to early mortality.
In addition to these medical and psychiatric consequences, substance use disorder itself, as well as its sequelae, results in multiple short- and long-term functional deficits across numerous life domains (e.g., relational, educational, vocational, financial). In fact, a recent study found that adolescent drug use was predictive of these adverse outcomes out to 50 years of age.
The short- and long-term costs of adolescent substance use are enormous. Given that those who begin use prior to age 15 are five times more likely to have a substance use disorder later in life, the personal and public health burdens and their associated costs can follow substance-abusing adolescents throughout their lifetime.
Accidents and unintentional injury, infectious diseases, child abuse and neglect, crime, homelessness and unemployment are just some of the societal problems brought about by substance abuse. Furthermore, health, social and safety problems extend to family members and peers, and occur among families regardless of socioeconomic status with widespread impact.
For example, family members of substance-using individuals have increased risks of physical illness, financial problems, legal difficulties, decreased marital satisfaction, domestic violence, interpersonal conflict, impairment in psychological and interpersonal functioning and stress.
Because a substance use disorder is a progressive disease, when untreated or undertreated the human and financial costs compound over a lifetime. It is estimated that substance use disorders cost the United States $468 billion each year. Given that substance use disorders often originate during adolescence, it is not surprising that these costs are driven by those who began use when they were young. The significant human costs (e.g., violence, high school dropout) and accompanying financial costs limit the quality of life for the youth, their family, their community/neighborhood and society.
Adolescence is a time of growth and great potential but it is also a time of risk-taking and experimentation with drugs and alcohol, which can quickly get out of hand. At no other time in human development is the risk for developing a substance use disorder so high. And the consequences of substance use disorders in youth are significant, cumulative and far-reaching in human and financial terms.
As adults help children navigate the often tricky waters of this developmental period, especially regarding substance use and its varied consequences, being armed with accurate information is their best line of defense. With prom and graduation season already underway, many parents will face the decision of whether or not to allow underage teens to drink alcohol in their homes. The National Institutes of Health-funded resource “Underage Drinking In The Home” offers a state-by-state outline of the legal liabilities for adults who serve alcohol to minors.
This discussion, in addition to other proposals to advance quality interventions for adolescents who use, abuse or are dependent upon alcohol and other drugs, can be found in the Treatment Research Institute’s “Paving the Way to Change” report, a project made possible through support from the Bridge Foundation.
Kathleen Meyers, Ph.D., is a senior investigator with the Treatment Research Institute and a recognized leader in the assessment and treatment of adolescent substance use disorders, delinquency and co-morbidity. Meyers is the author of the Comprehensive Adolescent Severity Inventory, a multidimensional assessment instrument for youth with co-morbidity, which is widely used throughout the United States, Canada and abroad.