CHAPTER 20
Substance Misuse by Children and Adolescents
LEARNING OBJECTIVES
After studying this chapter, students should be able to:
•
20.1: Understand the concerns regarding the impact of SUDs in children and
adolescents
•
20.2: Identify why children and adolescents may misuse substances
•
20.4: Review some of the screening and assessment tools used with
children and adolescents
•
20.6: Review the consequences of SUD’s in this age group for various
substances
•
20.7: Understand rehabilitation options for adolescents
CHAPTER OUTLINE
The Problem of Substance Use and Substance Use Disorders in Childhood and Adolescence
A Complicating Factor
Scope of the Problem of Substance Use in Childhood and Adolescence
Childhood Substance Use Patterns
Adolescent Substance Use Patterns
Why Worry About Substance Use Disorders in Childhood and Adolescence?
The Neurological Factor
The “Gateway” Theory
Tobacco Use by Children and Adolescents
Stages of Childhood/Adolescent Smoking
Why Do Children and Adolescents Use Chemicals?
Racial/Ethnic Group Membership
Gender Differences
Parental–Adolescent Relationship Patterns
Siblings
Vocational/Occupational Choices
Adolescent Mood States
Conduct Disorder/Oppositional Defiant Disorder
Peer Group Influences
Telecommunications
Religious Affiliation
Music Selection
Personal Values
Rebellion
Insomnia
Abuse History or Victimization
Employment
Section Summary
Substance Use: How Much and When Does It Become Too Much?
Prevention
Childhood
Adolescents
Stages of Adolescent Substance Use
Adolescent Addiction to Chemicals
Problems in Diagnosis and Treatment of Adolescent SUDs
Screening/Assessment Tools
Screening Instruments
Possible Diagnostic Criteria for Children or Adolescents with Suspected SUDs
Children
Adolescents
Consequences of a Substance Use Disorder in a Child or Adolescent
Alcohol
Benzodiazepines
Cocaine
Hallucinogens
Inhalants
Marijuana
Methamphetamine
Tobacco
Opioids
Other Compounds Misused by Children and Adolescents
Adolescent Rehabilitation Programs
The Special Needs of Adolescent Substance Rehabilitation Programs
Referral Sources
Adolescent Substance Use Treatment: A Cause for Optimism?
Is There a Financial Incentive for Over-Diagnosis?
The Danger of Under-Diagnosis
CHAPTER OVERVIEW
The purpose of this chapter is to acquaint the student with the various forms of exploratory
substance use, and the signs of substance use disorders that are seen in the childhood and
adolescent years. The fact that the individual’s attitudes toward substance use are formed years
DISCUSSION QUESTIONS
Break-Out Discussion #1:
Alcohol: It should not surprise anybody that alcohol is a popular recreational drink among
adolescents. Ignoring its legality for a moment, consider that around 20% of all the alcohol
produced is used by adolescents under the age of 21. From a legal perspective, why is it that
what by what might be loosely called the “alcohol industry” (producers) are allowed to sell 17–
20% of their products to persons for whom its possession and use are illegal?
Questions
1. Should adolescents under the age of 21 be allowed to purchase and use alcohol, and, if so,
under what conditions?
2. What should the legal drinking age be in the United States? Why? Are your arguments based
on statistics or anecdotal evidence?
3. Are you being dispassionate about this argument, or are you allowing your personal feelings
to interfere with your ability to assess this issue?
4. The perception of the stressor can have a big impact on coping with that stressor. Think for a
moment: how many sources of stress did you experience during adolescence? Were any of
these stressors unique to you, or at least only experienced by a limited number of persons? If a
friend, parent, or older sibling were to have assured you that the stressor was survivable, and
offered feedback about how to deal with it, would it have seemed so intense and painful? Did
such feedback increase or decrease any desire you may have had to use chemicals to help
alleviate your pain?
Break-Out Discussion #2:
Developmental changes in childhood and adolescence are tied to the individual’s age, but not
synonymous with the aging process. This statement, which is also made in your text, would
appear to be a contradiction—however, it is true. The cognitive style of the individual changes
as the child ages. The concept of object permanence, which is so automatically a part of the lives
There are numerous other examples of this apparent contradiction. Height tends to increase as
the child ages, but height is not perfectly correlated with age. Some children reach growth
plateaus and remain at about the same height for an extended period of time before bursting
forth in a growth spurt, while others maintain a more or less steady rate of growth that might
Questions
1. Can you identify other developmental characteristics that are not synonymous with age?
2. Could not the individual’s first intentional use of alcohol or illicit drugs be an example of how
developmental changes in childhood and adolescence are tied to the individual’s age, but not
synonymous with the aging process? When you were a certain age, did your friends indulge in
the use or misuse of a specific compound? Did you join or avoid them? Why?
KEY CONCEPTS AND TERMS
White matter: A region of the brain comprised of nerve cells responsible for the relay of
information. The cortex is often referred to as “gray matter” after its appearance after death. In
contrast to this, the other neurons in different regions of the brain assume a white color
following death.
Ventral striatum: Region of the brain involved in the integration of signals from the amygdala
(emotional responses) with regions of the brain such as the hippocampus (memory functions)
and cognitive/executive functions carried out by the prefrontal cortex regions of the brain
Amygdala: A region in the brain that is shaped like an almond, located in each temporal lobe.
This region is thought to be involved in the process of attaching emotional context to memory
and modulating emotional responses to external reality. This includes behaviors centered on the
process of obtaining reward(s), and the anxiety and panic responses
Hippocampus: A region of the brain that is thought to be involved in processing sensory
information, as well as the formation and retrieval of memories. In normal healthy adults, it
Cortisol: Enzyme normally found in the body, which is found at higher levels during times of
stress. It is often referred to as a stress-fighting compound because of this
Obstructive sleep apnea: Condition in which the airway becomes blocked during sleep for
longer than 10 seconds. The sleeping person must then struggle to reopen the airway, often
through gasping, snorting, or coughing. This is a medical problem that should be addressed by a
physician if it is suspected to exist
Mnemonic: Something that aids memory. A mnemonic device might be a series of letters that
remind a person such as a health care professional to address certain issues. For example, the
letters “A-B-C” remind the health care professional to check the patient’s airway, breathing, and
circulation, immediately
Endocannabinoids: One of a family of compounds bound within the brain or body where
molecules of compounds found in marijuana bind. These natural, or endogenous, cannabis-like
compounds carry out essential functions such as guiding the growth of neural cells in the cortex
in utero and after birth, regulation of the immune system, and so on
LO/STANDARDS CORRELATION CHART
A-head
LO
Standard—CACREP
The Problem of Substance
Use and Substance Use
Disorders in Childhood
and Adolescence
Scope of the Problem of
Substance Use in
Childhood and
Adolescence
20.1:
Understand
the concerns
regarding the
impact of
SUDs in
children and
adolescents
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and
behavior
Why Do Children and
Adolescents Use
Chemicals?
20.2: Identify
why children
and
adolescents
may misuse
substances
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and
behavior
3f: systemic and environmental factors
that affect human development,
functioning, and behavior
Why Worry About
Substance Use Disorders
in Childhood and
Adolescence?
Tobacco Use by Children
and Adolescents
Substance Use: How Much
and When Does It Become
Too Much?
20.3:
Understand
the levels of
concern for
adolescent
substance
misuse
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and
behavior
3f: systemic and environmental factors
that affect human development,
functioning, and behavior
Screening/Assessment
Tools
20.4: Review
some of the
screening and
tools used
with children
and
7e: use of assessments for diagnostic
and intervention planning purposes
Possible Diagnostic
Criteria for Children or
Adolescents with
Suspected SUDs
20.5:
Understand
diagnostic
considerations
for children
7e: use of assessments for diagnostic
and intervention planning purposes
Consequences of a
Substance Use Disorder in
a Child or Adolescent
20.6: Review
the
consequences
of SUD’s in
this age group
for various
substances
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and
behavior
3f: systemic and environmental factors
that affect human development,
functioning, and behavior
Adolescent Rehabilitation
Programs
20.7:
Understand
rehabilitation
options for
adolescents
5h: developmentally relevant
counseling treatment or intervention
plans