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Teen Drug Abuse - Prescription or Not
Differences between nonalcoholic offspring of alcoholics (family history positive, FHP) and matched offspring of nonalcoholics (family history negative, FHN) have been identified on a variety of behavioral, cognitive, and neurological measures. Compared to FHN teens, FHP adolescents and young adults demonstrate more disturbed school careers, impulsivity, rebelliousness, and nonconformity (National Survey on Drug Use and Health, 2006); poorer neuropsychological performance (Worden & Slater, 2009); and significantly lower amplitude in P300 brain waves, which are believed to measure selective attention (Cicero, et al. 2005). Further, following ingestion of alcohol, sons of alcoholics report less body sway and less subjective intoxication (Grant, et al., 2005), higher levels of flushing (McBride, 2011), and decreased P300 amplitudes when performing difficult tasks (Foster, et al., 2009).
Not all individuals with a family history of alcohol dependence become alcohol and/or drug abusers, however, and genetics alone cannot account for the transmission of alcoholism and drug abuse (Grant, et al., 2005). Among both FHP and FHN adolescents, a number of potential environmental and personal factors moderate alcohol and drug use.
Environmental Risk Factors Modeling
Environmental factors may operate independently as well as in interaction with biological factors in producing risk for the development of substance abuse (Grant, et al., 2005). The effects of modeling and social reinforcement on the initiation of adolescent alcohol and drug use seem indisputable (Worden & Slater, 2009). For example, the majority of adolescents drink alcohol for the first time with parents or relatives at home (National Survey on Drug Use and Health, 2006), and parental modeling has a significant impact on the adolescent's attitude toward alcohol (Foster, et al., 2009). Further, peer support and instruction are responsible for a substantial portion of initial adolescent marijuana use (McBride, 2011) as well as decisions to continue to use after initiation (Foster, et al., 2009).
Family environment also appears to be related to adolescent substance use. Children who report a lack of closeness, support, and affection from their parents are more likely to begin to use drugs and to maintain the abuse of those drugs (Grant, et al., 2005). Other family factors associated with adolescent substance abuse include parent-adolescent conflict (Fishman & Kreis, 2007) and lack of family cohesiveness (Worden & Slater, 2009). Reiger, et al., (2008) summarized the available evidence by noting three major areas of disturbance among families of adolescent problem drinkers: parental deviance or antisocial behavior, parental disinterest and lack of involvement with their child; and lack of affectionate and supportive interaction between parents and children. Conversely, a positive, loving bond between parent and child is linked to a reduced likelihood of the child's drug use (McBride, 2011). Thus, family functioning appears to be important in initiation of substance use and progression from use to abuse.
Although most studies documenting a relationship between stressful life events and alcohol or drug abuse have been conducted with adults, psychosocial stress is also associated with adolescent alcohol and drug abuse (McBride, 2011s). Higher levels of stress may actually precipitate alcohol and drug abuse by adolescents (Cicero, et al. 2005). A significant correlation between the extent of life stress experienced by the family and adolescent substance abuse has been found, even after controlling for substance-related stress (National Survey on Drug Use and Health, 2006). Further, in a series of studies (McBride, 2011), Brown found that adolescents in drug abuse treatment and nonabusing teens with an alcoholic parent have more negative life experiences, and subjectively rated those events as less desirable, than nonabusing teens from nonalcoholic families.
Over the past two decades, research has established that the availability of social relationships is related to health status, personal adjustment, and social behavior, including risk for adolescent alcohol and drug abuse. In the absence of adequate social supports, modeling, and reinforcing alternative coping efforts, some teens begin to use alcohol and other drugs to cope with stress (Foster, et al., 2009). Adolescents with a substance abusing parent may be especially likely to use drugs as a coping technique. The combined experience of parental alcohol abuse and dysfunctional social modeling may lead to inadequacies in social functioning, including impaired ability or willingness to solicit support from persons within and outside the family (McBride, 2011). Additionally, adolescents with social support networks composed of alcohol or drug abusers not only acquire behavior patterns consistent with their resource network, but also develop beliefs and values consistent with a drug-use lifestyle.
Personal Risk Factors: Temperament and Personality
The major personality correlates of adolescent drug use cluster into rebelliousness, autonomy striving, liberalism, willingness to try new experiences, and independence. Other personality or temperament characteristics associated with substance use include high sensation seeking, low self-esteem, low impulse control (Worden & Slater, 2009), behavioral disinhibition (National Survey on Drug Use and Health, 2006) and nonconventionality (Drug Enforcement Administration, 2005). Longitudinal studies (McBride, 2011) suggest that these characteristics precede drug use and act as risk factors for alcohol and drug abuse.
Adolescent substance abuse is associated with a variety of deviant behaviors, including several forms of psychopathology (Grant, et al., 2005). For example, alcohol- and drug-abusing adolescents commonly display symptoms of depression, including suicidal ideation, anxiety, and anger. Further, adolescent alcohol and drug abuse often appears as one of a constellation of disruptive problem behaviors. Researchers (Drug Enforcement Administration, 2005) have found a relationship between drug consumption and criminality, including stealing, assault, and malicious damage. The association of substance abuse and conduct disorder -- type behaviors persists even when deviant acts related to substance use (e.g., stealing while under the influence) are excluded (McBride, 2011).
Another personal variable that predicts onset of adolescent substance involvement and progression to problematic use is effect expectancies. Alcohol expectancies consist of those effects attributed to alcohol that the individual anticipates experiencing when drinking. Alcohol effect expectancies play a mediational role in the development of use patterns by influencing drinking decisions (Morrison, et al. 2007). These anticipated consequences, acquired through multiple sources (i.e., peers, family, media, personal experiences) explain in part the process whereby distal risk factors (e.g., family history of alcoholism) influence evolving drinking behavior of youth. Expectancies of adolescents (particularly global positive effects, social changes, and enhancement of cognitive and motor performance) are most closely related to teen drinking patterns (National Survey on Drug Use and Health, 2006) and predict alcohol abuse as adolescents mature (Worden & Slater, 2009). Although expectancy research on other drugs of abuse such as marijuana and cocaine is less developed, evidence to date suggests that drug effect expectancies are also linked to personal drug use patterns (Morrison, et al. 2007).
Interactionist Theories of Adolescent Substance Abuse
Adolescent alcohol and drug abuse has been conceptualized from a number of different perspectives; the most prevalent models consider the development of substance abuse as a complex process with many interacting risk factors, including biological predisposition, environmental risks, and personal vulnerabilities (McBride, 2011). Support for the interactionist perspective comes from the pioneering work of Jessor and colleagues (Johnston, et al. 2006), who view alcohol and drug involvement as one of a series of problem or deviant behaviors of adolescents. Their problem behavior theory holds that adolescent problem behavior, including problem drinking and drug use, can be explained by three major sources of psychosocial variation: personality (e.g., lower value on academic achievement, higher value on independence; greater alienation, less religiosity); perceived environment (e.g., less parental control, greater friends' approval and lower parental disapproval of problem behavior); and behavior patterns (e.g., higher actual involvement in various problem behaviors). Within this framework, the problem behaviors have consistently been found to have high rates of co-occurrence, and the best predictors of future problem behaviors appear to be combinations of motivationally oriented personality and situational variables. Further, teens who mature out of problem drinking as young adults demonstrate a change in personal and environmental factors toward greater conventionality (Johnston, et al. 2006).
A second interactive developmental theory of substance involvement (Grant, et al., 2005) specifies that biological, interpersonal, intrapersonal, and sociocultural characteristics influence personal behavior directly or indirectly (McBride, 2011). The biological influences consist of genetically determined characteristics as well as the status of the organism (e.g., acute or chronic states of health or illness). Psychological status, cognitive style, and personality traits constitute the intrapersonal system. Features of the interpersonal system influencing substance involvement include intimate support, modeling factors, social reinforcement, and one's sense of identity and belonging. Finally, the sociocultural domain molds social expectations and sanctions and environmental stressors. A dimension of time is implicit in the framework, such that various patterns of causal influence can be expected at different stages of use (e.g., initiation vs. maintenance vs. abuse vs. cessation vs. relapse) and at different stages of development before, during, and after adolescence.
The third major developmental interactionist position (Ajzen, 2010) has primarily been used to understand adolescent alcohol use but can be extrapolated to account more generally for substance involvement. Zucker and his colleagues have delineated a model including direct and indirect influences: sociocultural and…[continue]
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