Adolescents and Addiction

Addiction is an incredibly complex issue, particularly for adolescents. There is an abundance of evidence that adolescent addiction is impacted by a number of factors including biological, psychological, social, spiritual and cultural issues. One of the most profound studies is the Adolescent Childhood Experiences (ACEs) study [1-4]. The ACEs study is a sweeping investigation of childhood abuse, neglect, and trauma. Adverse childhood experiences, or ACEs, are events that are potentially traumatic that take place in childhood (0-17 years). For instance, experiencing violence, abuse, or neglect, being a witness to violence in the home or neighborhood, or having a family member attempt or die by suicide. Other issues include growing up in a family where the environment is undermined by substance use problems, mental health issues, or instability due to parents separating or a household member going to jail or prison. 

Adverse childhood experiences can lead to lasting negative effects on overall well-being and health as well as educational aspirations. ACEs can increase the propensity for injuries, sexual issues, and chronic diseases and can lead to major causes of death such as heart disease, cancer, diabetes, and suicide. ACEs and other social determinates of health can cause prolonged or toxic stress. ACEs can be impacted by living in a poor neighborhood, racially segregated housing, frequent moving, hunger, and lack of resources such as clothing, money, healthcare, good schools and unstable family relationships, lack of employment and mental stress like anxiety and depression. Some children are also exposed to substance use, domestic violence and poor parenting. 

Screening and teaching social-emotional skills in school using the Screening, Brief Intervention and Referral to Treatment [5] or services as outlined in the piece, “Check Yourself Before You Wreck Yourself” (Journal of Substance Use, December 2022) can lead to creating or strengthening safe and stable relationships at school and home. This strategy can serve to promote social-emotional learning, strengthen school-family relationships, and prevent problem behaviors. The idea behind the screening tool is to promote a safe and nurturing school environment where youth feel secure in sharing their feelings, thoughts, and behaviors to a member of the school counseling team. In this manner, counselors can focus on risk and protective factors at school and at home. 

Hawkins, Catalano, and Miller [6]; Hawkins and Catalano [7] have extensively written and researched risk and protective factors based on individual, family, media, community and school influences. “Check Yourself Before You Wreck Yourself” [8] is an attempt to tease out some of the family, school, and community risk and protective factors that impact our youth in school settings. Family risk factors include challenges related to special needs, youth who feel that they cannot talk to their parents or caregivers about their feelings; youth who start sexual activity; those who engage in delinquent behavior, those who are involved in neglectful or abusive situations, those living with families with low or limited income, single parents or grandparents raising children; parents with poor or limited understanding of child development; poor discipline and punishment; isolated parents and negative communication style; and families that accept violence and aggression. 

Community risk factors include high rates of crime and violence, high rates of poverty and limited educational and economic options, high rates of unemployment, easy availability of alcohol and other substances, low community involvement, limited community activities for youth, unstable housing and frequent moves for families, hunger, and elevated levels of social disorder. Protective factors for youth and young adults include those families that establish stable and safe relationships, have caring adults who are able to take care of basic needs like clothes, food, and shelter, provide supervision and monitoring, problem-solving, and support school requirement and engage in fun and enjoyable activities as a family. Additional research is needed on parent-focused prevention of adolescent risk behavior linked to the impact of risk and protective factors. 

A recent research study by Scheuer and others investigated parent-focused prevention of adolescent health risk behavior in a multisite cluster-randomized trial implemented in pediatric primary care [9]. It has become clear that evidence-based parenting interventions can plan a significant role in reducing adolescent risk behaviors going beyond the “Check Yourself” tool [8]. Guiding Good Choices (GGC) is a 5-session curriculum for parents with adolescents. GGC has been shown to reduce depression, substance use and other risk behaviors. Additional research is needed regarding parent or caregiver evidence-based interventions designed to assist adolescents.

1. Shin SH, McDonald SE, Conley D (2018) Patterns of adverse childhood experiences and substance use among young adults: A latent class analysis. Addict Behav 78: 187-192.
2. Afifi TO, Ford D, Gershoff ET, Merrick M, Grogan-Kaylor A, et al. (2017) Spanking and adult mental health impairment: The case for the designation of spanking as an adverse childhood experience. Child Abuse Negl 71: 24-31.
3. Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, et al. (2017) The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. Lancet Public Health 2: 356-366.
4. Merrick MT, Ports KA, Ford DC, Afifi TO, Gershoff ET, et al. (2017) Unpacking the impact of adverse childhood experiences on adult mental health. Child Abuse Negl 69: 10-19.
5. Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, et al. (2007) Screening, Brief Intervention, and Referral to Treatment (SBIRT): Toward a public health approach to the management of substance abuse. Subst Abus 28: 7-30.
6. Hawkins JD, Catalano RF, Miller JY (1992) Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychol Bull 112: 64-105.
7. Hawkins JD, Catalano Jr RF (1992) Communities That Care: Action for Drug Abuse Prevention. Jossey-Bass, New York, USA.
8. James WH, Randolph D, Pothan WW (2022) Check yourself before you wreck yourself: Qualitative inquiry into risky behaviors and substance use during early-mid-adolescence. Journal of Substance Use.
9. Scheuer H, Kuklinski MR, Sterling SA, Catalano RF, Beck A, et al. (2022) Parent-focused prevention of adolescent health risk behavior: Study protocol for a multisite cluster-randomized trial implemented in pediatric primary care. Contemp Clin Trials 112: 106621.