Questions about Medications to Treat Adolescent Drug Use

Questions about Medications to Treat  Adolescent Drug Use

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

13. Are there medications to treat adolescent substance abuse?

Several medications are approved by the FDA to treat addiction to opioids, alcohol, and nicotine in individuals 18 and older. In most cases, little research has been conducted to evaluate the safety and efficacy of these medications for adolescents; however, some health care providers do use these medications “off-label,” especially in older adolescents.

14. Do girls and boys have different treatment needs?

Adolescent girls and boys may have different developmental and social issues that may call for different treatment strategies or emphases.

For example, girls with substance use disorders may be more likely to also have mood disorders such as depression or to have experienced physical or sexual abuse.

Boys with substance use disorders are more likely to also have conduct, behavioral, and learning problems, which may be very disruptive to their school, family, or community. Treatments should take into account the higher rate of internalizing and traumatic stress disorders among adolescent girls, the higher rate of externalizing disruptive disorders and juvenile justice problems among adolescent boys, and other gender differences that may play into adolescent substance use disorders.

Questions about Treating Adolescent Tobacco Use

Questions about Treating Adolescent Tobacco Use

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

12. Is adolescent tobacco use treated similarly to other drug use?  

Yes. People often don’t think of tobacco use as a kind of “drug abuse” that requires treatment, and motives for quitting smoking may be somewhat different than motives for quitting other drugs. But tobacco use has well-known health risks–– especially when begun in the teen years––and the highly addictive nicotine in tobacco can make treatment a necessity to help an adolescent quit. Laboratory research also suggests that nicotine may increase the rewarding and addictive effects of other drugs, making it a potential contributor to other substance use disorders.

Common treatment approaches like Cognitive Behavioral Therapy are now being used to help adolescents quit smoking (and quit using other drugs) by helping them “train their brains” so they learn to recognize and control their cravings and better deal with life stress. Other therapies like Contingency Management and Motivational Enhancement use incentives and motivation techniques to help teens reduce or stop smoking.

Tobacco use often accompanies other drug use and needs to be addressed as part of other substance use disorder treatment. In a recent survey, nearly 55 percent of current adolescent cigarette smokers (ages 12 to 17) were also illicit drug users (by comparison, only about 6 percent of those who did not smoke used any illicit drugs). Also, cigarette smoking can be an indicator of other psychiatric disorders, which can be identified through comprehensive screening by a treatment provider.

Questions about the Role of Medical Professionals in Adolescent Drug Use

Questions about the Role of Medical Professionals in Addressing Adolescent Drug Use  

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

11. What role can medical professionals play in addressing substance abuse (including abuse of prescription drugs) among adolescents?

Medical professionals have an important role to play in screening their adolescent patients for drug use, providing brief interventions, referring them to substance abuse treatment if necessary, and providing ongoing monitoring and follow-up. Screening and brief interventions do not have to be time-consuming and can be integrated into general medical settings.

• Screening. Screening and brief assessment tools administered during annual routine medical checkups can detect drug use before it becomes a serious problem. The purpose of screening is to look for evidence of any use of alcohol, tobacco, or illicit drugs or abuse of prescription drugs and assess how severe the problem is. Results from such screens can indicate whether a more extensive assessment and possible treatment are necessary. Screening as a part of routine care also helps to reduce the stigma associated with being identified as having a drug problem

• Brief Intervention. Adolescents who report using drugs can be given a brief intervention to reduce their drug use and other risky behaviors. Specifically, they should be advised how continued drug use may harm their brains, general health, and other areas of their life, including family relationships and education. Adolescents reporting no substance use can be praised for staying away from drugs and re-screened during their next physical.

 • Referral. Adolescents with substance use disorders or those that appear to be developing a substance use disorder may need a referral to substance abuse treatment for more extensive assessment and care.

• Follow-up. For patients in treatment, medical professionals can offer ongoing support of treatment participation and abstinence from drugs during follow-up visits. Adolescent patients who relapse or show signs of continuing to use drugs may need to be referred back to treatment.

• Consider an Alternative Medication. Before prescribing medications that can potentially be abused, clinicians can assess patients for risk factors such as mental illness or a family history of substance abuse, consider an alternative medication with less abuse potential, more closely monitor patients at high risk, reduce the length of time between visits for refills so fewer pills are on hand, and educate both patients and their parents about appropriate use and potential risks of prescription medications, including the dangers of sharing them with others.

Questions about Adolescent Drug Use and Mental Health

Questions about Adolescent Drug Use and Mental Health 

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

7. How do other mental health conditions relate to substance use in adolescents? 

Drug use in adolescents frequently overlaps with other mental health problems. For example, a teen with a substance use disorder is more likely to have a mood, anxiety, learning, or behavioral disorder too. Sometimes drugs can make accurately diagnosing these other problems complicated.

Adolescents may begin taking drugs to deal with depression or anxiety, for example; on the other hand, frequent drug use may also cause or precipitate those disorders. Adolescents entering drug abuse treatment should be given a comprehensive mental health screening to determine if other disorders are present.

Effectively treating a substance use disorder requires addressing drug abuse and other mental health problems simultaneously.

8. Does treatment of ADHD with stimulant medications like Ritalin® and Adderall® increase risk of substance abuse later in life? 

Prescription stimulants are effective at treating attention disorders in children and adolescents, but concerns have been raised that they could make a young person more vulnerable to developing later substance use disorders. On balance, the studies conducted so far have found no differences in later substance use for ADHD-affected children who received treatment versus those that did not.

This suggests that treatment with ADHD medication does not affect (either negatively or positively) an individual’s risk for developing a substance use disorder.

Questions about Adolescent Prescription Drug Use

Questions about Adolescent Prescription Drug Use

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

5. Is abuse of prescription medications as dangerous as other forms of illegal drug use?

Psychoactive prescription drugs, which include opioid pain relievers, stimulants prescribed for ADHD, and central nervous system depressants prescribed to treat anxiety or sleep disorders, are all effective and safe when taken as prescribed by a doctor for the conditions they are intended to treat. However, they are frequently abused— that is, taken in other ways, in other quantities, or by people for whom they weren’t prescribed— and this can have devastating consequences.

In the case of opioid pain relievers such as Vicodin® or OxyContin®, there is a great risk of addiction and death from overdose associated with such abuse. Especially when pills are crushed and injected or snorted, these medications affect the brain and body very much like heroin, including euphoric effects and a hazardous suppression of breathing (the reason for death in cases of fatal opioid overdose).

In fact, some young people who develop prescription opioid addictions shift to heroin because it may be cheaper to obtain. ADHD medications such as Adderall® (which contains the stimulant amphetamine) are increasingly popular among young people who take them believing it will improve their school performance. This too is a dangerous trend. Prescription stimulants act in the brain similarly to cocaine or illegal amphetamines, raising heart rate and blood pressure, as well as producing an addictive euphoria.

Other than promoting wakefulness, it is unclear that such medications actually provide much or any cognitive benefit, however, beyond the benefits they provide when taken as prescribed to those with ADHD.

6. Are steroids addictive and can steroid abuse be treated? 

Some adolescents—mostly male—abuse anabolic-androgenic steroids in order to improve their athletic performance and/or improve their appearance by helping build muscles. Steroid abuse may lead to serious, even irreversible, health problems including kidney impairment, liver damage, and cardiovascular problems that raise the risk of stroke and heart attack (even in young people). An undetermined percentage of steroid abusers may also become addicted to the drugs—that is, continuing to use them despite physical problems and negative effects on social relations—but the mechanisms causing this addiction are more complex than those for other drugs of abuse.

Steroids are not generally considered intoxicating, but animal studies have shown that chronic steroid use alters the same dopamine reward pathways in the brain that are affected by other substances. Other factors such as underlying body image problems also contribute to steroid abuse.

Moreover, when people stop using steroids, they can experience withdrawal symptoms such as hormonal changes that produce fatigue, loss of muscle mass and sex drive, and other unpleasant physical changes. One of the more dangerous withdrawal symptoms is depression, which has led to suicide in some people discontinuing steroids. Steroid abuse is also frequently complicated by abuse of other substances taken either as part of a performance-enhancing regimen (such as stimulants) or to help manage pain-, sleep-, or mood-related side effects (such as opioids, cannabis, and alcohol).

Because of this complicated mix of issues, treatment for steroid abuse necessarily involves addressing all related mental and physical health issues and substance use disorders simultaneously. This may involve behavioral treatments as well as medications to help normalize the hormonal system and treat any depression or pain issues that may be present. If symptoms are severe or prolonged, hospitalization may be needed.