While the number of teenagers experimenting with alcohol or other drugs has stabilized, the number of high school students who smoke marijuana daily, who binge drink and who get drunk is unacceptably high. In fact, for the first time, daily marijuana use exceeds daily tobacco cigarette use among 12th-graders, and the perception of marijuana use as risky continues to decline.
This is particularly concerning given marijuana’s potential adverse effects on the developing teenage brain. It is easy to become paralyzed in the face of discouraging information and the already large and growing size of the problem. But we cannot afford inaction: Too much is at stake and too much is changing.
Like other chronic illnesses with social, biological and environmental determinants, substance use disorders are best addressed with a full continuum of care, including wellness and prevention, early intervention, treatment and continuing care, and recovery support services. There are concrete action steps that — when used collaboratively by parents, treatment providers, teachers, researchers and insurers — should begin to bring about needed change for youth at various stages of the drug use continuum: those at risk for a substance use disorder, those who have a substance use disorder and those recovering from a substance use disorder. By addressing the basic components of care considered for all other chronic illnesses, there are systematic opportunities to transform the adolescent treatment system for substance use disorders (SUD).
One way to offset the harmful consequences of adolescent SUD is to prevent it from developing in the first place. To this end, approaching SUD prevention through proactive and preventive wellness practices has the potential to reduce the incidence — and ultimately prevalence — of adolescent SUD. Wellness programs encompass the individual in their entirety, resulting in ideal levels of emotional, social and physical health.
Wellness initiatives are most commonly accessed through commercial health insurance plans and by employers with adult participants, and they serve dual purposes: to promote healthy lifestyles while lowering overall long-term health care costs. Many employers promote wellness programs that are largely based around efforts like stress management, exercise, smoking cessation and disease prevention. They often offer rewards to employees for participating (e.g., attending health education courses and seminars, regularly working out at gyms, maintaining healthy levels of blood pressure and body mass index). In exchange for program participation, employees not only improve their personal health outcomes, they also earn rewards such as cash, discounts on fitness activities and products, and vacation days. In the most basic sense, healthier employees also require less medical care, and lower medical care costs save employers money.
This basic premise of wellness programs — that individuals are more likely to make healthy lifestyle changes when given incentives — has been applied to adolescent populations as well. Using the same wellness program model, payers have created inventive programs targeted toward adolescents — most notably regarding obesity and Type 2 diabetes. Like obesity and Type 2 diabetes, adolescent SUD is preventable and often leads to significant short- and long-term health-related costs. Hence, obesity and Type 2 diabetes initiatives can provide guidance on how wellness approaches can be integrated into health systems and used to address alcohol and other drug use among teens.
Prevention of substance use disorders through wellness programs, especially among adolescents with alcohol or other drug use risk factors, with emerging disease presence and during transitional risk periods of adolescence, fits into each one of the following Affordable Care Act (ACA) provisions that encourage prevention/wellness and public health, including:
- The Prevention and Public Health Fund to support screenings, prevention, wellness and public health activities.
- No-cost preventive health services within health plans subject to the ACA.
- The National Prevention and Health Promotion Strategy that includes building healthy and safe communities, expanding wellness and prevention in clinical and community settings, empowering people to make healthy choices and eliminating health disparities.
Additionally, since family members of individuals with SUD have increased risks of physical illness, emotional stress and employment absenteeism, it would behoove employers to provide coverage for healthy lifestyle services and health-promoting activities for dependents with alcohol and other drug use risk factors or emerging SUD disease presence.
An obesity-focused toolkit offered by the National Business Group on Health could serve as an educational and benefit design model that could be adapted to address alcohol and other drug use.
With this national wellness strategy (that addresses other preventable diseases) in place, our field must work to ensure that children and youth are at the forefront of these efforts and that SUD wellness and prevention are included in state plans and the federal strategy.
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.
