Commentary
Addressing the Critical Health Problem of Adolescent Substance Use Through Health Care, Research, and Public Policy

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Abstract

The use of addictive substances—tobacco, alcohol, and other drugs—during adolescence interferes with brain development and increases the risk of serious health and mental health conditions, including addiction. Yet, adolescents live in a culture in which family, social, community, and media influences regularly bombard them with pro-substance use messages, creating an environment in which substance use is considered an expected behavior, rather than a considerable health risk. To prevent the significant harm that falls to teens and young adults because of substance use, The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia) undertook a study to explore how adolescent brain development relates to the risk of substance use and addiction; the cultural influences that create an environment in which substance use is considered normative behavior; individual factors that make some teens more disposed to substance use and addiction; and evidence-based prevention and treatment strategies for addressing this problem. The recently published report Adolescent Substance Use: America's #1 Public Health Problem concludes that risky substance use is a major public health problem that can be ameliorated through evidence-based public health measures, including education about the disease and its risk factors, screenings, and clinical interventions, and that addiction can be treated and managed effectively within routine health care practice and specialty care.

Section snippets

Adolescent Brain Development Is Strongly Linked to Substance Use Risk

The initiation of substance use during adolescence is driven, in part, by biological factors. Addiction is a progressive and complex brain disease [10] that disrupts the functioning and structure of the areas of the brain responsible for pleasure, decision making, self-control, and survival, including motivation, risk and reward assessment, pleasure seeking, impulse control/inhibition, emotion, learning, memory, and stress control [11], [12]. Because the adolescent brain, particularly the

Cultural Factors Drive Adolescent Substance Use

Although biology is a powerful influence, cultural and environmental factors play a critical role in setting the stage for adolescent substance use. Mixed messages generated by peers, family members, and communities regarding the acceptance of use; school environments and policies that contribute to student use; the widespread availability of tobacco, alcohol, marijuana, and controlled prescription drugs; pervasive advertising of addictive products; and media portrayals of substance use as

Individual Challenges Heighten the Risk of Substance Use and Addiction

Some adolescents face personal circumstances or challenges that make them more susceptible to initiating substance use and more likely to progress from experimentation to addiction. A family history of substance misuse or addiction [36], [53]; adverse childhood events, such as abuse, neglect, or other forms of trauma [54]; mental health disorders [55], [56], [57]; certain temperament traits [58], [59], [60], such as low self-esteem [61], [62]; having experienced peer victimization or bullying

Costly Health and Social Consequences of Risky Substance Use

Adolescent substance use is the largest preventable [70]—and most costly—public health problem in the United States [71], [72], [73], [74], [75], [76]. Its consequences are staggering in both the short and long term. The medical and health consequences include increasing the risk for mental and physical health problems, including addiction; death from substance-related accidents, homicides, and suicide; and engaging in other dangerous behaviors, such as risky driving, unsafe sex, and violence.

Integrating Substance Use Prevention/Intervention and Addiction Treatment Into Health Care Practice

Like other public health problems, adolescent substance use can be prevented through evidence-based public health interventions designed to modify individual behaviors and reduce exposure to factors that encourage or increase the risk of use. The negative health consequences of adolescent substance use can be averted by identifying use and intervening early. Once manifested, the disease of addiction, like most other diseases with a behavioral component, can be treated effectively with both

Conclusion

Adolescent substance use is a widespread public health problem threatening the health, safety, and success of our youth and increasing their lifetime risk of the disease of addiction. Like other public health problems, it occurs frequently throughout the population, is driven by biological and cultural factors, and is linked to serious health and mental health outcomes. Many adolescents already suffer from addiction—a progressive brain disease with behavioral components—for which effective

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    Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.