Understanding Adolescent Substance Use

Over the years, as I've delved deeper into my research on the development of decision-making, my empathy toward adolescents has grown significantly. I have come to recognize the complexity of the transitions they undergo during this phase of their lives.

It is crucial to acknowledge that as adults, we often forget the emotions we experienced during middle school and high school, making it challenging to empathize with the teenagers who may confront us, act out, or reject our guidance. Instead of viewing them as "little adults" who defy our rules and instructions, we should remember that they are still in the process of discovering their place in the world. This formidable task can sometimes lead them down perilous paths where they risk getting trapped. One such perilous path is substance use.

Adolescence, spanning from around age 11-12 to approximately age 25, is a crucial period of development in a person's life. During this time, teenagers undergo a myriad of physical, emotional, and cognitive changes as they transition from childhood to adulthood. It's a phase marked by increased autonomy, exploration, and risk-taking behaviors.

Drug and alcohol use among adolescents is a significant concern in the United States, alongside issues like anxiety, depression disorders, and cyberbullying. Vaping products have gained widespread use, a trend that poses a significant threat to the progress made in reducing cigarette smoking among teenagers, who tend to be drawn to vaping because they perceive it as less harmful and more affordable than conventional tobacco products. At the same time, marijuana remains the most widely used illicit (in many places) drug, and alcohol is still the most widely used substance.

Two systems responsible for decision-making mature at different times. Teens are more sensitive to rewards and do not regulate impulses as well as adults.

Source: Isabelle Brocas/ personal collection

One notable aspect of adolescent development is the delayed maturation of the prefrontal cortex—the brain's decision-making and impulse control center. This delay contributes to teenagers' susceptibility to engaging in risky behaviors, including experimenting with drugs and alcohol, primarily driven by the attraction of short-term rewards.

During adolescence, the brain undergoes pruning—a process of eliminating unused connections and strengthening frequently used pathways. The activities and behaviors teenagers engage in during this phase can shape their brain's wiring. Positive activities like sports, academics, or music strengthen constructive connections, while negative behaviors like substance use reinforce harmful connections.

The brain's emotional processing regions mature earlier than the PFC, contributing to teenagers' heightened emotional reactivity and propensity for risky behaviors. The brain's reward circuitry plays a significant role in substance use. Adolescents experience higher activation in response to rewards than adults, which makes them more susceptible to the pleasurable effects of substances like drugs. Repeated drug exposure can disrupt dopamine levels, leading to a reliance on drugs for pleasure and motivation, eventually resulting in addiction.

What Else Contributes to Teen Substance Use?

In addition to brain maturation, various factors contribute to adolescent substance use. First, males tend to have higher rates of illicit drug use than females. However, the prevalence of drug use increases significantly for both genders in high school.

Second, family dynamics, parental education, socioeconomic status, parental approval of substance use, and experiences of physical and sexual abuse can influence adolescent substance use. Furthermore, developmental and psychiatric disorders like ADHD and depression are associated with an increased risk of substance use among adolescents. ADHD, in particular, can delay cognitive development and lead to impulsivity.

Preventing and addressing adolescent substance use requires a multi-pronged approach. Teaching teenagers about the impact of substances on their developing brains can help them make informed decisions. Parents and educators must engage in open discussions about the risks of substance use. Also, encouraging safe, supervised risk-taking is vital, as adolescents naturally seek novel experiences.