Adolescent Substance Use Research Articles

Faith Without Works?: Religious Salience, Pious Practices, and Adolescent Substance Use

An abundance of research has revealed that religious salience is negatively associated with delinquent behavior, including illicit substance use. However, absent from prior work is a consideration of whether youths’ participation in personal religious rituals and acts of devotion might amplify the protective effects of religiosity. Theoretically, it may be expected that these private expressions of belief and identity can strengthen religious commitments and reaffirm membership within specific moral communities. Using data from the National Study of Youth and Religion on a nationally representative sample of adolescents ages 13 to 17 ( N = 3,170), these findings reveal that religious salience inhibits cigarette use, alcohol use, drunkenness, and marijuana use, but only among youth who engage in at least some pious practices.

Substance Use Disorders in Adolescents and Young Adults: History and Perioperative Considerations From the Society for Pediatric Pain Medicine.

Substance use disorders (SUDs) are on the rise in children and young adults in the United States. According to reports, over 40 million people aged 12 and older had a diagnosed SUD in 2020.1 A recent report from the Centers for Disease Control and Prevention (CDC) found that overdose death in children aged 10 to 19 years old increased 109% from 2019 to 2021.2 Given the rapidly increasing prevalence of SUD, anesthesiologists will almost certainly encounter children, adolescents, and young adults with a history of recreational drug use or nonmedical use of prescription opioids in the perioperative period. Since the perioperative period can be a particularly challenging time for patients with SUD, anesthesiologists can tailor their perioperative care to reduce rates of relapse and can serve as both advocates and educators for this vulnerable patient population. This article examines the history of SUD and physiology of substance use in children, adolescents, and young adults, including reasons why young people are more susceptible to the addictive effects of many substances. The coronavirus disease 2019 (COVID-19) pandemic impacted many aspects of life, including increased social isolation and shifted dynamics at home, both thought to impact substance use.3 Substance use patterns in the wake of the COVID-19 pandemic are explored. Although current literature is mostly on adults, the evidence-based medical treatments for patients with SUD are reviewed, and recommendations for perioperative considerations are suggested. The emphasis of this review is on opioid use disorder, cannabis, and vaping particularly because these have disproportionately affected the younger population. The article provides recommendations and resources for recognizing and treating adolescents and young adults at risk for SUD in the perioperative period. It also provides suggestions to reduce new persistent postoperative opioid use.

Efficacy of an expanded preoperative survey during perioperative care to identify illicit substance use in teenagers and adolescents.

As illicit substance use can present several perioperative concerns, effective means to identify such practices are necessary to ensure patient safety. Identification of illicit substance use in pediatric patients may be problematic as screening may rely on parental reporting. The current study compares answers regarding use of illicit substances between a survey completed by the patient and the preoperative survey completed by parents or guardians. The study included patients presenting for surgery at Nationwide Children's Hospital, ranging in age from 12 to 21 years. After consent, patients completed a survey of six drop-down questions using an iPad. The six questions involved the patient's history of alcohol, tobacco, marijuana, vaping, and opioid use. The results were compared to the answers obtained from the parents during a preoperative phone call. The study cohort included surveys from 250 patients with a median age of 16 years. Survey data showed a statistically higher reporting of substance use or abuse from the patient study survey in comparison to the routine parental preoperative survey. Alcohol report rates were highest with 69 (27.6%) patients reporting use compared to only 5 parental reports (2%). There was a similar discrepancy in reported rates of vaping use (40 patient reports, 16.0% vs. 11 parental reports, 4.4%) and illicit substance use including marijuana (52 patient reports, 20.8% vs. 11 parental reports, 4.4%). Reported rates of tobacco use were lowest among the survey responses with 12 patient reports (4.8%) and 5 parental reports (2.0%). Identifying illicit substance and tobacco use via a phone survey of parents is inaccurate and does not allow for proper identification of use of these substances in patients ≤21 years of age presenting for surgery. An anonymous 2-min survey completed by the patient more correctly identifies these issues.

Declines in Adolescent Substance Use After the COVID-19 Pandemic Onset: The Role of Initiation in Grades 7 and 9

PurposeTo examine if the record declines in adolescent substance use after the onset of the COVID-19 pandemic resulted from reduced levels of initiation, defined as any lifetime use. MethodsWe analyzed data from the nationally representative, cross-sectional, annual Monitoring the Future surveys of eighth, 10th, and 12th grade students from 2019 to 2022. Measures included past 12-month use of cannabis, nicotine vaping, and alcohol as well as self-reported grade of initiation of each substance. Analyses are based on randomly selected subsamples of students who received questions on both prevalence and grade of first use, resulting in a total sample size of 96,990 students. ResultsLevels of the past 12-month substance use were markedly lower after the onset of the pandemic, in 2021 and 2022. In eighth and 10th grade, levels were at least one-third lower for cannabis and nicotine vaping and 13%–31% lower for alcohol. In 12th grade, the decreases ranged from 9% to 23%. Lower levels of initiation in seventh grade in 2020-2021 accounted for half or more of the overall prevalence decreases in eighth grade in 2021- 2022. Lower levels of initiation in ninth grade in 2020-2021 accounted for 45% or more of the overall prevalence decreases in 10th grade in 2021-2022. Declines in 12th grade substance use prevalence were not consistently linked to lower initiation in earlier grades. DiscussionMuch of the declines in overall prevalence of adolescent substance use after the onset of the COVID-19 pandemic trace back specifically to declines in substance use initiation in seventh and ninth grades.

Substance familiarity in middle childhood and adolescent substance use

BackgroundChildhood familiarity with (knowledge of) substances is a potentially important, currently understudied adolescent substance use risk factor. We aimed to describe changes in childhood familiarity with substances and to test whether baseline familiarity predicts early adolescent substance use. MethodsUtilizing the Substance Use Module of the longitudinal cohort study, Adolescent Brain Cognitive Development (ABCD; US youth aged 9–10 years followed for 10 years) through Data Release 4 (n=7896; individuals who completed all six assessments in the first three years), we conducted longitudinal mixed models and survival analyses to describe changes in familiarity and to determine the adjusted odds of substance use by age 13 based on number of familiar substances at baseline. ResultsThe sample consisted of 3754 females and 4142 males, aged 9–10 at baseline, with majority White individuals (68.9%). Unconditional time models indicated age significantly predicted familiarity (B=0.08, p<0.001; R2=0.288) with ~3.59 familiar substances at 9 years increasing to ~7.43 substances at 13 years. Family history, home use, peer use, and neighborhood availability predicted familiarity, accounting for 1% of additional variance (R2=0.299; ∆R2=0.011). For each additional familiar substance at baseline, adjusted odds of future use increased 1.28 times (95% CI 1.22, 1.34). ConclusionsThis is the first study to characterize substance familiarity in this age range as a predictor of future substance use. Familiarity increases with age (age being the most predictive indicator). Familiarity at age 9–10 predicts early adolescent substance use. As such, childhood familiarity may represent an easily implemented screening tool for at-risk youth.

Keepin’ It REAL—Mantente REAL in Mexico: Longitudinal Examination of Youth Drug Resistance Strategies and Substance Use Among Early Adolescents

PurposeThis study examined if culturally and linguistically adapted versions of a US-developed adolescent substance use prevention intervention, keepin’ it REAL (kiREAL), for Mexico increases the use of drug resistance strategies and if increased use of resistance strategies subsequently leads to a reduction in the frequency of substance use (i.e., alcohol, cigarette, marijuana, and inhalants). MethodsStudents (N = 5,522, 49% female, age range = 11–17) in 36 middle schools across three cities in Mexico were randomized into three conditions: (1) Mantente REAL (MREAL), the culturally adapted version, (2) kiREAL-S, the linguistically adapted version, and (3) Control. Using survey data collected at four time points, random intercept cross-lagged path analyses tested the direct and indirect effects of MREAL and kiREAL-S compared to Control. ResultsAt time 2, the number of drug resistance strategies used by students increased in both MREAL (β = 0.103, p = .001) and kiREAL-S (β = 0.064, p = .002) compared to Control. However, only MREAL lead to less frequent use of alcohol (β = −0.001, p = .038), cigarettes (β = −0.001, p = .019), marijuana (β = −0.002, p = .030), and inhalants (β = −0.001, p = .021) at time 4, mediated through increased use of drug resistance strategies. DiscussionThis study provides evidence that MREAL and kiREAL-S are successful in spurring use of the drug resistance strategies that are the core component of the intervention. Only MREAL achieved long-term effects on substance use behaviors, the ultimate objective of these interventions. These findings provide support for the value and importance of rigorous cultural adaptation of efficacious prevention programs as a necessary condition for enhancing prevention benefits for participating youth.

Does Narrative Quality Matter During Implementation of a School-Based Prevention Intervention? A Test of Narrative Engagement Theory

Narratives play a powerful role in sharing meaning and making sense of experiences. Specifically, health narratives convey storylines, characters, and messages about health-related behaviors and provide audiences with models for healthy behaviors, prompting audiences’ health-related reflections and decision-making. Narrative engagement theory (NET) explains how personal narratives can be integrated into interventions to promote health. This study utilizes NET to test direct and indirect effects of teachers’ narrative quality on adolescent outcomes during a school-based substance use prevention intervention that includes narrative pedagogy and an implementation strategy. Observational coding of teacher narratives in video-recorded lessons along with self-report student surveys (N = 1,683) were subjected to path analysis. Findings showed significant direct effects of narrative quality on student engagement, norms (i.e. personal, best-friend injunctive, and descriptive norms), and substance use behavior. The analysis also yielded support for indirect effects of narrative quality on adolescent substance use behavior via student engagement, personal norms, and descriptive norms. Findings highlight important issues related to teacher-student interaction during implementation and contributes implications for adolescent substance use prevention research.

Associations Between Gender-Specific Substance Use Patterns and Mental Health Among Adolescents in the Republic of Korea: A Latent Class Analysis.

Although gender differences in adolescent substance use are complex and substance use accompanies mental health problems, most previous studies have focused on gender-specific association between single substance use and mental health. This study aimed to investigate gender-specific substance use patterns and to examine their association with mental health characteristics. Nationally representative data from the Korea Youth Risk Behavior Survey collected in 2018 were analyzed. To identify substance use patterns among male adolescents (n = 30,463) and female adolescents (n = 29,577), multiple-group latent class analysis was conducted using eight substance use indicators. In addition, we conducted a latent class analysis with covariates to examine the association between substance use patterns and mental health characteristics. Among both gender samples, the four-class model best fit the data: nonusers (86.4%), frequent smokers (2.9%), risky drinkers (7.1%), and heavy tobacco and alcohol users with lifetime heated tobacco product use (3.6%) for male adolescents, and nonusers (89.8%), frequent smokers (0.5%), risky drinkers (8.0%), and heavy tobacco and alcohol users with a drunkenness episode (1.7%) for female adolescents. Depression, suicidal plans, and suicidal attempts predicted the latent class model for both genders. In addition, stress level predicted the latent class model for female adolescents. The findings indicate that homogeneous patterns of substance use by gender are differentially associated with mental health problems. Therefore, health professionals should develop interventions tailored to gender-specific substance use patterns, taking into account the mental health characteristics of each pattern.

A Call to Prioritize Integrated Suicide Interventions in Adolescent Substance Use Treatment

ABSTRACT Substance use is identified as a risk factor for suicidal thoughts and behaviors among adolescents. Scholars have developed and investigated the feasibility, acceptability, and effectiveness of combined suicide and substance use interventions for adolescents psychiatrically hospitalized following a suicidal crisis who also have co-occurring substance use problems. However, little research has been done to develop and investigate the effectiveness of combined suicide and substance use interventions within outpatient substance use settings for adolescents. Because social workers are well-positioned to deliver integrated interventions, greater focus is needed on teaching and implementing integrated substance use and suicide interventions at an individual and institutional level.

An Urgent Need for School-Based Diversion Programs for Adolescent Substance Use: A Statewide Survey of School Personnel

PurposeThere has been growing interest in reserving punishment as a last resort to address substance use in schools. However, there is significant variability in adoption of alternative approaches. This study reported school personnel's perceptions of diversion programs, identified characteristics of schools/districts that currently have diversion programs, and defined barriers of implementation of diversion programs. MethodsOne hundred fifty six school stakeholders from Massachusetts' K-12 schools, including district administrators, principals and vice principals, school resource officers, guidance counselors, and nurses, completed a web-based survey in May–June 2020. Participants were recruited through e-mail distributed via professional listservs, direct school outreach, and community coalitions. The web survey queried beliefs, attitudes, and actions that schools take regarding substance use infractions as well as perceived barriers to implementing diversion programs. ResultsParticipants endorsed strong beliefs that punishment was an appropriate school response for student substance use, particularly for nontobacco-related infractions. Despite these personal beliefs, diversion programs were rated as more effective but less commonly used than punitive approaches (37% of respondents reported having diversion programs in their schools/districts vs. 85% used punitive approaches) (p < .03). Punishment was more likely to be used to respond to cannabis, alcohol, and other substances compared to tobacco (p < .02). Primary barriers of implementing diversion programs included funding, staff training, and parental support. DiscussionBased on school personnel perceptions, these findings lend further support for a transition away from punishment and toward more restorative alternatives. However, barriers to sustainability and equity were identified that warrant consideration when implementing diversion programs.

Variables Escolares y Consumo de Drogas en la Adolescencia y Adultez: un Estudio Retrospectivo

Drug use and gambling are major problems in today’s society. Many studies have found that school variables are related to drug use and gambling, but the persistence of such relationships in adulthood is still little-known. Therefore, the aim of this study was to discover if these school variables are related to substance use and gambling in both adolescence and adulthood through a retrospective study. A sample of 416 people resident in Spain between 18 and 50 years old was used. Results showed that having a good academic performance and a positive school environment act as protective factors for substance use. A high rate of truancy and disruptive classroom behaviors are risk factors for drug use and gambling. This relationship not only appears in adolescence, it also continues into adulthood. Results can be used for better prevention and intervention against drug use and gambling.

New Validity Evidence of the Global Appraisal of Individual Needs-Short Screener for Evaluating Internalizing/Externalizing Behaviors in Spanish Adolescents.

The Global Appraisal of Individual Needs (GAIN-SS) is a screening instrument evaluating internalizing/externalizing behaviors. This study examines the validity evidence of the GAIN-SS in Spanish adolescents and explores sex differences in its performance. Participants were 1,547 Spanish adolescents from the community (females = 48.2%, mean [SD] age = 15.20 [0.74]). A cross-sectional online assessment was used to evaluate past-month substance use and gambling involvement. Problems associated to these behaviors were assessed using the GAIN-SS, the South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA), and the Rutgers Alcohol Problem Index (RAPI). Factor analyses were conducted to examine the internal structure of the GAIN-SS. Results revealed four subscales accounting for 47.03% of the variance related to externalizing (EDScr), internalizing (IDScr), substance use disorders (SDScr), and crime/violence problems (CVScr). Concurrent validity was supported through significant correlations between the GAIN-SS subscales, alcohol-related problems, and gambling behavior, with the exception of the IDScr. Past-month gamblers or substance users evidenced higher scores in the CVScr. Females reported more internalizing symptoms, whereas males reported higher scores in CVScr. The GAIN-SS is a valid screener for substance use and gambling in Spanish adolescents. Sensitivity of the GAIN-SS to sex differences suggests that it may be useful to design gender-sensitive interventions.

Early Screening for Adolescent Substance Use Promotes Social Justice

Early Screening for Adolescent Substance Use Promotes Social Justice

‘Please Don’t Do This to Us’: TV Show Illustrates Importance of Families in SUD Care of Youth

‘Please Don’t Do This to Us’: TV Show Illustrates Importance of Families in SUD Care of Youth

Risk & protective factors for youth substance use across family, peers, school, & leisure domains

BackgroundAdolescent substance use has long been a global public health issue. In this study, we explored developmental contexts that correspond with risk and protective factors associated with adolescent substance use. The developmental contexts of interest are the family domain, school domain, peer domain, and structured leisure domain. The leisure domain is of particular interest as it often corresponds with risk and protective factors different from those associated with the other domains. The purpose of this study was to assess whether the identified domains are associated with adolescent alcohol use and cannabis use. MethodsThis study used previously collected adolescent health and behavior surveillance data from (N = 3,407) 7th-12th graders in a Northeastern state in the fall of 2019. The data were used to assess whether the identified domains are associated with adolescent alcohol use and cannabis use. We analyzed each outcome variable using separate multiple regression models. ResultsIn our model, the peer domain, specifically peer substance use behaviors and peer norms, were the strongest factors associated with substance use. Family and structured leisure offered similar levels of protection against substance use. ConclusionsImplications for utilizing the peer and leisure developmental contexts to prevent adolescent substance use and recommendations for further research and investment are discussed.

The Role of Socialization Contexts on Adolescent Substance Use across Racial and Ethnic Groups.

This review summarizes theories and empirical work regarding socialization contexts contributing to substance use across marginalized adolescents. Future directions and recommendations to minimize the perpetuation of racial stereotypes are provided. Neighborhoods high in social cohesion may offset substance use risk. Promoting school connectedness via increased support from teachers and peers could reduce school-based discrimination and enhance feelings of belongingness. The influence of peers on substance use engagement largely differs across racial groups and level of acculturation. Family cultural values emphasizing respect, obedience, and collectivism offer protection from substance use. Despite lower prevalence rates of adolescent substance use within racial/ethnic groups, rates of negative consequences due to substances are far greater compared to White adolescents. Transcultural factors (e.g., strong family ties), as well as culture-specific factors, should be leveraged to delay the onset of substance use and prevent negative sequelae resulting from substance use initiation.

Sex differences in emotion- and reward-related neural responses predicting increases in substance use in adolescence

Adolescent substance use is a significant public health problem and there is a need for effective substance use preventions. To develop effective preventions, it is important to identify neurobiological risk factors that predict increases in substance use in adolescence and to understand potential sex differences in risk mechanisms. The present study used functional magnetic resonance imaging and hierarchical linear modeling to examine negative emotion- and reward-related neural responses in early adolescence predicting growth in substance use to middle adolescence in 81 youth, by sex. Adolescent neural responses to negative emotional stimuli and monetary reward receipt were assessed at age 12–14. Adolescents reported on substance use at age 12–14 and at 6 month, and 1, 2, and 3 year follow-ups. Adolescent neural responses did not predict initiation of substance use (yes/no), but, among users, neural responses predicted growth in substance use frequency. For girls, heightened right amygdala responses to negative emotional stimuli in early adolescence predicted growth in substance use frequency through middle adolescence. For boys, blunted left nucleus accumbens and bilateral ventromedial prefrontal cortex responses to monetary reward predicted growth in substance use frequency. Findings suggest different emotion and reward-related predictors of the development of substance use for adolescent girls versus boys.

Pandemic-Related Changes in the Prevalence of Early Adolescent Alcohol and Drug Use, 2020–2021: Data From a Multisite Cohort Study

PurposeEvaluate changes in early adolescent substance use from May 2020 to May 2021 during the coronavirus disease 2019 pandemic using data from a prospective nationwide cohort: the Adolescent Brain Cognitive Development Study. MethodsIn 2018–2019, 9,270 youth aged 11.5–13.0 completed a prepandemic assessment of past-month alcohol and drug use, then up to seven during-pandemic assessments between May 2020 and May 2021. We compared the prevalence of substance use among same-age youth across these eight timepoints. ResultsPandemic-related decreases in the past-month prevalence of alcohol use were detectable in May 2020, grew larger over time, and remained substantial in May 2021 (0.3% vs. 3.2% prepandemic, p <.001). Pandemic-related increases in inhalant use (p = .04) and prescription drug misuse (p < .001) were detectable in May 2020, shrunk over time, and were smaller but still detectable in May 2021(0.1%-0.2% vs. 0% pre-pandemic). Pandemic-related increases in nicotine use were detectable between May 2020 and March 2021 and no longer significantly different from prepandemic levels in May 2021 (0.5% vs. 0.2% prepandemic, p = .09). There was significant heterogeneity in pandemic-related change in substance use at some timepoints, with increased rates among youth identified as Black or Hispanic or in lower-income families versus stable or decreased rates among youth identified as White or in higher-income families. DiscussionAmong youth ages 11.5–13.0 years old, rates of alcohol use remained dramatically reduced in May 2021 relative to prepandemic and rates of prescription drug misuse and inhalant use remained modestly increased. Differences remained despite the partial restoration of prepandemic life, raising questions about whether youth who spent early adolescence under pandemic conditions may exhibit persistently different patterns of substance use.

Testing the cannabis gateway hypothesis in a national sample of Spanish adolescents

BackgroundThe gateway hypothesis holds that the use of legal substances (i.e., tobacco and alcohol) increases the risk of initiating in cannabis use which, in turn, increases the chances of using other illegal substances. The validity of this hypothesis has been the subject of intense debate in recent years, finding sequences with a different order. Moreover, this pattern has been scarcely studied in Spain, where characteristics related to cannabis use are meaningfully different to other countries. This study aims to examine the gateway effects of cannabis towards other legal and illegal substances in Spanish adolescents. Material and methodsData were obtained from the Ministry of Health in Spain, through a representative survey of addictive behaviors of 36,984 Spanish adolescents (Mage = 15.7, SD = 1.2, 51.4% females). ResultsLifetime cannabis use increased the likelihood of later legal substance use, both tobacco (OR = 2.0; 95%CI 1.81, 2.22) and alcohol (OR = 1.93; 95%CI 1.61, 2.31), as well as illegal substances (OR = 5.36; 95%CI 4.80, 5.98) and polysubstance (OR = 18.24; 95%CI 14.63, 22.73). Early age of cannabis use onset significantly increased the likelihood of subsequent legal and illegal substance use (ORs between 1.82 and 2.65). ConclusionsThese findings confirm and expand the available evidence on cannabis as a gateway substance. These results can help to drive preventive strategies for substance use in Spanish adolescents.

Caregiver Engagement in Outpatient Treatment for Adolescents in Community Settings: Construct and Predictive Validity of Family Therapy Techniques.

Caregiver engagement and participation in community-based outpatient treatment services for adolescents is generally poor, which is problematic given the integral role of caregivers prescribed by evidence-based treatments across orientations. The current study explores the psychometric and predictive properties of a set of caregiver engagement techniques distilled from family therapy, used by community clinicians in routine care. It highlights relational engagement interventions and adds to growing work distilling core elements of family therapy. The study examined caregiver engagement techniques observed in 320 recorded sessions and outcome data from 152 cases treated by 45 therapists participating in one of three randomized trials investigating delivery of family therapy for adolescent behavior problems in community settings. Construct and predictive validity of caregiver engagement coding items were analyzed to understand the degree to which they cohered as a single factor and predicted outcomes in predictable ways. Results demonstrated item reliability and construct validity of a Caregiver Engagement Techniques factor. Greater use of these techniques was associated with decreased adolescent substance use. Unexpected results suggested greater use of techniques was associated with worsening internalizing symptoms and family cohesion per youth-report only. Post-hoc analyses revealed additional complexities in the association between engagement techniques and outcomes. Caregiver engagement practices tested in the current study represent a unified treatment factor that may contribute to positive therapeutic outcomes for adolescents in some clinical domains. Further research is needed to understand predictive effects.