Substance Abuse in Young Adults:

Substance Abuse in Young Adults: Issues to be Addressed by a Nurse Practitioner in Primary Care Settings

Young adulthood can be a turbulent period in many people's lives when new roles are assumed, careers and started and relationships forged. For instance, according to Mcconaughy and Wadsworth, "The transition from adolescence to adulthood usually involves many lifestyle changes, including moving out of the parents' home, completing school, starting a job or career, managing one's own finances, forming an intimate relationship with a partner, and raising a family" (p. 202). During the young adulthood phase of the life cycle, the oat-sowing process left over from adolescence may not yet be complete and youthful exuberance still holds sway over many of the long-term healthcare considerations and the threat of involvement with law enforcement authorities in ways that contribute to ongoing experimentation with legal and illegal substances. It is not surprising, then, that the incidence and prevalence of substance abuse disorders is inordinately high among this segment of the population, and these issues and others related to the treatment of young adults for substance abuse disorders are discussed further below.

Epidemiologic features. According to the World Health Organization (WHO), "The task of drug abuse epidemiology is to better understand patterns and trends in drug use. Although alcohol, tobacco and other drugs differ in many important respects, including their legal status, they nonetheless share important characteristics: they are all psychoactive substances with the potential for creating dependency and they can cause very significant public health problems and widespread social harms" (p. 19). The WHO cites the enormous profits available in the drug trade as well as increased global production levels in recent years as contributing to the prevalence of substance abuse patterns, but also emphasizes that, "Many social, economic and political factors have contributed to the global spread of alcohol and other drugs" (p. 19).

Incidence and prevalence. Substance abuse by young adults remains a problem across the country, and the research to date indicates that the incidence and prevalence rates for this segment of the population have remained steady in recent years. Currently, more than 16 and a half million Americans, aged 12 years and over, are considered to have a substance abuse or dependence disorder (Salyers, Ritchie, Cochrane & Roseman, 2006). In addition, approximately 33% of patients who present with psychiatric disorders have a corresponding history of substance drug abuse, and 50% of patients with substance abuse disorders also experience symptoms that are sufficiently severe to justify diagnosis with another mental disorder; these rates that are reflective of the paramount need for the provision timely and meaningful healthcare services for this population (Salyers et al., 2006). Estimated U.S. population lifetime prevalence rates were 22.5% for any non-substance abuse mental disorder, 13.5% for alcohol dependence-abuse, and 6.1% for other drug dependence-abuse. Among those with a mental disorder, the odds ratio of having some addictive disorder was 2.7, with a lifetime prevalence of about 29% (including an overlapping 22% with an alcohol and 15% with another drug disorder) (Regier, Farmer, Rae, Locke, Keith, Judd & Goodwin, 1990). The useful of the treatment data for accurately estimating the prevalence of substance abuse, though, is constrained by the proportionately few individuals who enter treatment (Hubbard, 2006).

Risk factors. Although there are different risk factors associated with different substances, the U.S. Substance Abuse & Mental Health Services Administration reports that young adults are at particular risk of abusing alcohol: "Alcohol is the most widely used substance of abuse among America's youth. Alcohol contributes to the three leading causes of death among 12-20-year-olds (unintentional injury, homicide and suicide)" (para. 1). The studies to date have shown that people who begin drinking alcohol before they are 15 years of age are six times more likely to develop problems with alcohol as adults than people who began drinking alcohol when they were 21 years or older (National survey shows, 2010). In fact, Windle (2003) emphasizes that, "National surveys of adolescents, college students, and other young adults in the United States reveal high rates of alcohol use among these age groups as well as high rates of dangerous drinking practices such as binge drinking and daily drinking" (para. 2). Indeed, fully 40.1% of college students reported binge drinking (i.e., consuming five or more drinks in a row) during the 2-week period preceding the survey (Windle, 2003). In addition, Duroy, Schmidt and Perry (2003) emphasize that, "Youths leaving drug treatment programs and returning to difficult living and neighborhood situations have been shown to be at increased risk for relapse within the days and months following outpatient and residential treatment completion" (p. 801). According to Green (2006), "Research on how gender influences substance use and substance-abuse-related problems has established clear differences between women and men in several important areas. Women typically consume less alcohol than men when they drink, drink alcohol less frequently, and are less likely to develop alcohol-related problems than men. Similarly, women are less likely than men to use illicit drugs and to develop drug-related problems" (p. 55).

Relationship between alcohol/substance abuse and physical/mental health issues. According to the World Health Organization's (WHO) Guide to Drug Abuse Epidemiology (2000), "Psychoactive substances cause problems that result from complex interactions between: (a) substances with diverse, toxic, psychotropic and addictive properties; (b) individuals with varied vulnerabilities and resiliency; and (c) complex sociocultural environments" (p. 117). For young adults with an alcohol or other substance abuse disorder, the likelihood of suffering from the other addictive disorder was seven times higher than in the general population; among individuals who had an alcohol disorder, 37% had a corresponding comorbid mental disorder (Regier et al., 1990). The most significant mental-addictive disorder comorbidity rate was identified among those who suffered from drug disorders besides alcohol disorders; more than half (53%) of this population has been shown to suffer from a mental disorder (Regier et al., 1990). In addition, those who have been treated for their disorders in specialty mental health and addictive disorder clinical settings have been shown to be at much higher risk of having comorbid disorders, with those being incarcerated suffering the highest levels of mental disorders (Regier et al., 1990).

CLINICAL EVALUATION BY NURSE PRACTITIONER

General considerations. The disease model that typifies most current treatment approaches to substance abuse can help address many of the common misconceptions that persist and pave the way for meaningful change. For instance, according to the National Institute on Drug Abuse (2010), "One very common belief is that drug abusers should be able to just stop taking drugs if they are only willing to change their behavior. What people often underestimate is the complexity of drug addiction -- that it is a disease that impacts the brain and because of that, stopping drug abuse is not simply a matter of willpower" (Understanding drug abuse and addiction, para. 1).

Identification of patterns of alcohol/substance abuse among young adults.

Young men tend to drink more and engage in other substance-abusing behaviors more than their female counterparts but there are some different patterns involved in the progression of the disease process among young women as well (Green, 2006). For instance, Green (2006) notes that, "When women do develop substance abuse problems, they tend to develop them faster than men do. For example, although women tend to be older than men, on average, when they begin a pattern of regular drunkenness, women's drinking-related problems (e.g., loss of control over drinking, negative consequences of drinking) appear to progress more quickly than those of men" (p. 56).