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.

Questions about Adolescent Drug Use and Addiction

Questions about Adolescent Drug Use and Addiction

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

3. How do adolescents become addicted to drugs, and which factors increase risk? 

Addiction occurs when repeated use of drugs changes how a person’s brain functions over time. The transition from voluntary to compulsive drug use reflects changes in the brain’s natural inhibition and reward centers that keep a person from exerting control over the impulse to use drugs even when there are negative consequences—the defining characteristic of addiction.

Some people are more vulnerable to this process than others, due to a range of possible risk factors. Stressful early life experiences such as being abused or suffering other forms of trauma are one important risk factor. Adolescents with a history of physical and/or sexual abuse are more likely to be diagnosed with substance use disorders.

Many other risk factors, including genetic vulnerability, prenatal exposure to alcohol or other drugs, lack of parental supervision or monitoring, and association with drug-using peers also play an important role.

At the same time, a wide range of genetic and environmental influences that promote strong psychosocial development and resilience may work to balance or counteract risk factors, making it ultimately hard to predict which individuals will develop substance use disorders and which won’t.

4. Is it possible for teens to become addicted to marijuana? 

Yes. Contrary to common belief, marijuana is addictive. Estimates from research suggest that about 9 percent of users become addicted to marijuana; this number increases among those who start young (to about 17 percent, or 1 in 6) and among daily users (to 25–50 percent).

Thus, many of the nearly 7 percent of high school seniors who (according to annual survey data) report smoking marijuana daily or almost daily are well on their way to addiction, if not already addicted, and may be functioning at a sub-optimal level in their schoolwork and in other areas of their lives.
Long-term marijuana users who try to quit report withdrawal symptoms including irritability, sleeplessness, decreased appetite, anxiety, and drug craving, all of which can make it difficult to stay off the drug. Behavioral interventions, including Cognitive-Behavioral Therapy and Contingency Management (providing tangible incentives to patients who remain drug-free) have proven to be effective in treating marijuana addiction.

Although no medications are currently available to treat marijuana addiction, it is possible that medications to ease marijuana withdrawal, block its intoxicating effects, and prevent relapse may emerge from recent discoveries about the workings of the endocannabinoid system, a signaling system in the body and brain that uses chemicals related to the active ingredients in marijuana.

Legalization of marijuana for adult recreational use and for medicinal purposes is currently the subject of much public debate. Whatever the outcome, public health experts are worried about use increasing among adolescents, since marijuana use as a teen may harm the developing brain, lower IQ, and seriously impair the ability to drive safely, especially when combined with alcohol.

Parents seeking more information about the effects of marijuana on teens are encouraged to see information offered on NIDA’s Web site: http://www.drugabuse.gov/drugs-abuse/ marijuana.

Questions about Adolescent Drug Use

Frequently Asked Questions About 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.

1. Why do adolescents take drugs?

Adolescents experiment with drugs or continue taking them for several reasons, including:

• To fit in: Many teens use drugs “because others are doing it”—or they think others are doing it—and they fear not being accepted in a social circle that includes drug-using peers.

• To feel good: Abused drugs interact with the neurochemistry of the brain to produce feelings of pleasure. The intensity of this euphoria differs by the type of drug and how it is used.

• To feel better: Some adolescents suffer from depression, social anxiety, stress-related disorders, and physical pain. Using drugs may be an attempt to lessen these feelings of distress. Stress especially plays a significant role in starting and continuing drug use as well as returning to drug use (relapsing) for those recovering from an addiction.

• To do better: Ours is a very competitive society, in which the pressure to perform athletically and academically can be intense. Some adolescents may turn to certain drugs like illegal or prescription stimulants because they think those substances will enhance or improve their performance.

• To experiment: Adolescents are often motivated to seek new experiences, particularly those they perceive as thrilling or daring.

2. What drugs are most frequently used by adolescents?

Alcohol and tobacco are the drugs most commonly abused by adolescents, followed by marijuana. The next most popular substances differ between age groups. Young adolescents tend to favor inhalant substances (such as breathing the fumes of household cleaners,glues, or pens; see “The Dangers of Inhalants,” page 15), whereas older teens are more likely to use synthetic marijuana (“K2” or “Spice”) and prescription medications—particularly opioid pain relievers like Vicodin® and stimulants like Adderall®.

 In fact, the Monitoring the Future survey of adolescent drug use and attitudes shows that prescription and over-the-counter medications account for a majority of the drugs most commonly abused by high-school seniors.

The Most Commonly Abused Drugs by High School Seniors (Other than Tobacco and Alcohol)

1. Marijuana
2. Amphetamines (Adderall)
3. Prescription Painkillers (Vicodin, Oxycontin)
4. Cough Medicine
5. Tranquilizers
6. Hallucinogens
7. Sedatives
8. MDMA (Ecstasy)
9. Salvia