This paper will discuss Chemical Dependency or Substance Dependency and Substance Abuse in Adolescents; specifically the development, progression and biopsychosocial of dependency and abuse in the adolescent population. The definition of epidemiology and diagnosis will be addressed. Lastly three treatment options including the range of severity will be provided. There is difference between substance abuse and substance dependence. The distinction between the two is characterized by the role they play in a person’s life.
Substance dependence is defined in terms of physiological and behavioral symptoms of substance abuse, and substance abuse in terms of social interaction and consequences. (Wikipedia, 2008) Substance abuse refers to the repeated and excessive use of drugs that are illegal or harmful to the individual and causes significant adverse consequences. Symptoms in adolescents who are abusing and using substances include: “failure to meet family or school obligations, interpersonal conflicts, legal problems.
Other adverse consequences include accidents or injuries, blackouts and risky sexual behavior. (Wikipedia, 2008) Substance dependence is when the frequent and repetitive use of drugs becomes habitual and a physical dependence occurs. Substance dependence in adolescents is identifiable by negative physical symptoms, which usually includes tolerance of the drug (requiring higher doses to achieve the same effect) and withdrawal, symptoms experienced when use of the drug is abruptly discontinued. (Wikipedia, 2008) Adolescents are more venerable than adults to substance abuse due to several developmental factors.
Substance abuse can compromise an adolescent’s psychological and social development in areas such as the formation of a strong self-identity, emotional and intellectual growth, establishment of a career, and the development of rewarding personal relationships, which have already been established in the adult. The Adolescent’s brain is not as developed as an adult’s. Evidence shows that as a result of this, adolescents experience greater feelings of social disinhibition when drinking alcohol or using drugs compared to adults.
The adolescent is less sensitive to the effects of intoxication and consume two to three times as much alcohol for their body weight than adults. (Spear, 2008) Developmental features of younger adolescents are different from those of older adolescents. For example, older adolescents are more capable of abstract thinking and are more likely to openly rebel than younger adolescents. The progression of adolescent substance abuse begins with experimentation, which turns into problem use. Once the adolescent’s use of drugs becomes a problem there is a progression from problem use to the disorder of substance abuse.
As stated earlier, substance abuse leads to substance dependence. It is important to address the biopsychosocial issues around adolescent substance abuse and chemical dependency. In examining the biological, psychological and socials factors the effects of substance abuse and dependency on the adolescent are realized. The three factors interact with one another and produce chemical dependency and substance abuse in the adolescent. The following will discuss each factor individually so that it will be clear how drugs touch all areas; biologically, psychologically and socially of the adolescent’s life.
Adolescent are biologically vulnerable to substance abuse. In the adolescent brain, the centers for judgment and self-control are still developing, resulting in many teens being less than careful about the decisions they make and more open to risk-taking. Drugs are chemicals that enter the brain and mess with the way nerve cells normally send, receive, and process information. Some imitate natural neurotransmitters; for example, narcotic pain relievers mimic the effects of endorphins, the body’s natural “feel-good” chemical.
Or they are similar enough to the brain’s natural chemical messengers that they trick brain receptors into activating nerve cells. Stimulants such as cocaine and methamphetamines cause the neurons to release too much of the neurotransmitters, causing the sensation users describe as the brain “racing. ” And, in one way or another, almost all drugs over stimulate the pleasure center ofthe brain, flooding it with the neurotransmitter dopamine. This produces euphoria, and the heightened pleasure can be so compelling that the brain wants that feeling back again and again.
Unfortunately, with repeated use of a drug, the brain becomes accustomed to the dopamine surges by producing less of it. So the user has to take more of the drug to feel the same pleasure — the phenomenon known as tolerance. There are several psychological factors that exist in the adolescent with substance and chemical dependency disorders. The moods of these adolescents are not stable and they are more prone to depression. They have various emotional and behavioral difficulties.
Adolescents with these disorders also tend to have learning disabilities and psychiatric disturbances. Jorgenson and Salwen, 2008) According to the research of Terry Brown, “Psychological dependence for long term users is more likely; some have mental health problems such as confusion, sleep disorder depression and paranoia. ” (Brown, 2008) Taking drugs also effects the adolescent user’s perception. For example, they think they’re immortal and nothing can kill them. Adolescents socially are notorious conformists. So many want to do what the other kids are doing, or do things that they think will make them look cool.
The adolescents come from family backgrounds that are not stable. There is often mental illness in the family. Adolescents with parents that are substance abusers are more at risk of substance abuse and dependence. The children model the drug abuse behavior of their parents. Adolescents who are suffering emotionally, such as sexual and child abuse, use drugs not so much for the rush, but to escape from their problems. They’re trying to self-medicate themselves out of loneliness, low self-esteem, unhappy relationships, stress, and many other types of problems.
The definition of Epidemiology is the study of incidence, distribution and control of disease in a population. It is also the sum of factors controlling the presence or absence of a disease or pathogen. (Webster, 2004). Substance abuse is a major public health problem that puts millions of adolescents at increased risk for alcohol-related and drug-related traffic accidents, risky sexual practices, poor academic performance, juvenile delinquency, and developmental problems. Adolescent drug abuse remains alarmingly high. Below are important facts from the National Household Survey on Drug Abuse about substance abuse, addiction, treatment, and recovery among adolescents.
• Youth age 16 to 17, have the second highest rate (16. 4 percent) of current illicit drug use in the country. The highest rate (19. 9 percent) is found among young people age 18 to 20.
• Although consumption of alcoholic beverages is illegal for people under 21 years of age, 10. 4 million current drinkers are age 12 to 20. Of this group, nearly half (5. 1 million) engage in binge drinking, including 2. 3 million who would also be classified as heavy drinkers. In 1998, 10% of adolescents age 12 to 17 reported using an illicit drug at least once during the past month. About 1 in 12 youth (8. 3 %) in this age group are current users of marijuana, the most frequently used illicit drug, and 19. 1 % are current users of alcohol.
• In 1998, 56% of youth age 12 to 17 reported that marijuana is easy or fairly easy to obtain. Other illicit drugs that are perceived as easy or fairly easy to obtain include cocaine (reported by 30% the these youth), crack (29%) and heroin (21%). By the time the adolescents reach age 17, more han half (56%) knows a drug dealer.
According to the DSM IV, a diagnosis for substance abuse is the maladaptive pattern of behavior occurring within one year, leading to clinically significant impairment as manifested by one or more of the following symptoms including: Neglect of Activities — Important social, occupational or recreational activities are given up or reduced because of substance use. Harmful Use — Substance use in situations in which it is physically hazardous. Despite Problems — Continued use despite recurrent social or interpersonal problems. DSM-IV, 2004) According to the DSM IV, a diagnosis for substance dependence includes the following symptoms: Tolerance — Need for markedly increased amount of the substance to achieve intoxication or desired effect, or continued use of substance that produces an diminished effect. Withdrawal — Negative physiological side effects experienced by a person who has become physically dependent on a substance upon decreasing the substance’s dosage or discontinuing its use. Impaired Control — Persistent desire or unsuccessful effort to cut down or control substance use.
Neglect of Activities — Important social, occupational or recreational activities are given up or reduced because of substance use. In addition there is a great deal of time spent in activities necessary to obtain the substance. Another factor that is a part of the diagnosis for substance dependence is the continued use despite knowledge of having a persistent or recurrent physiological problem that is exacerbated by the substance. (DSM-IV, 2004)Recovery from addiction is dependent on the availability of treatment and may require multiple courses of treatment.
When an adolescent enrolls in treatment he can successfully overcome substance abuse and chemical dependence and develop more effective coping skills, often preventing further problems. In treatment, adolescents must be approached differently from adults because of developmental issues, differences in values and belief systems, environmental considerations such as strong peer influences, and educational requirements. Treatment approaches should also account for age, gender, ethnicity, cultural background, family structure, cognitive and social development, and readiness for change.
Younger adolescents have different developmental needs than older adolescents, and treatment approaches should be developed appropriately for different age groups. Treatment should involve family members because family history may play a role in the origins of the problem and successful treatment cannot take place in isolation. Treatment options can vary. Brief interventions, which involve screening, anticipatory guidance, and psycho educational interventions, are primarily appropriate for adolescents in the low-to-middle range of the severity continuum (SAMHSA, 2007).
Treatment may also include various intensities of outpatient treatment, as well as 24-hour intensive inpatient care for adolescents requiring a high level of supervision. Inpatient care generally includes detoxification–a 3- to 5-day program with intensive medical monitoring and management of withdrawal symptoms. Residential treatment is a long-term model that includes psychosocial rehabilitation among its goals. The duration for residential treatment can range from 30 days to 1 year and is especially beneficial for adolescents with coexisting personality and substance abuse disorders.
Therapeutic communities are intensive and comprehensive treatment models. Although originally developed for adults, they have been modified successfully to treat adolescents with the most severe alcohol or substance use disorders for whom long-term care is indicated. The community itself is both therapist and teacher in the treatment process. The core goal is to promote a holistic lifestyle and identify behaviors that can lead to alcohol and substance abuse that need to be changed. The community provides a safe and nurturing environment within which adolescents can begin to experience healthy living.
Duration within the community is typically 12 to 18 months. (SAMSHA, 2007) During the final phase of treatment, providers work with adolescents to develop an aftercare plan to make sure they don’t start drinking again. Continuing care programs are structured and time-limited outpatient care that helps the adolescent reduce his or her risk for relapse.
Self-help groups may be valuable adjuncts to the treatment program during the recovery process. Group homes that offer transitional living arrangements with different levels of specificity of treatment planning and staff supervision may also provide an environment for successful recovery Self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen are valuable adjuncts to outpatient services and residential programs for teenagers during the recovery process, both during and after primary treatment. Self-help groups offer positive role models, new friends who are learning to enjoy life free from substance use, people celebrating sober living, and a place to learn how to cope with stress and other relapse triggers. Many adolescents involved with these 12-step programs have a fellow member serve as a sponsor to provide guidance and help in times of crisis or when the urge to return to drinking becomes overwhelming.
Treatment programs can also include family therapy to bring about positive changes in the way family members relate to each other by examining the underlying causes of dysfunctional interactions (SAMHSA, 2007). This type of therapy may help decrease family conflict and improve effectiveness of communication. Family members, both parents and youth, can learn how to listen to one another and solve problems through negotiation and compromises. Alcohol treatment may be stalled until coexisting conditions are addressed.
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