Volume 6 Issue 9 September, 2016
Background: The adolescent substance use has become a major public health concern worldwide including India. World Health Organization estimates say that 25-90% of children have ever used a drug. National household survey from India reports that adolescents constitute around 20% of all current drug users. Majority of the adult drug users initiate substance use during adolescents with ‘Gateway drugs’ like tobacco, alcohol and inhalants which are licit and easily available. Longitudinal studies found that earlier is the age of initiation of substances, greater is the chance of developing substance use disorder in adulthood. Moreover, they are also at a higher risk of lifelong negative consequences that include academic failure, chronic health problems, and violent crime. Substance use is strongly associated with the leading causes of death among US teenagers including motor vehicle crashes, unintentional injuries, homicides and suicides. Substance use also contributes to a large number of other health problems, such as depression, conduct disorder, and unplanned sexual activity. Identification and treatment of substance user adolescent poses challenge on the health system.
Etiology: There are multiple behavioral, environmental and familial risk factors that make adolescents more likely to initiate and continue substance use. It has been shown that as the number of risk factors increases, the likelihood of adolescent substance use greatly increases. Early age of onset of drug use increases risk of drug related problems in future. The risk factors are as follows: a) Behavioral characteristics- Impulsivity, Aggression, Sensation seeking, Inability to delay gratification, Lack of religiosity, Psychopathology; b) Environmental factors include- peer pressure, affiliation with deviant or delinquent peers, easy drug avail- ability and relaxed laws and regulatory policies; c) Familial facto- stressful life events, deficient parental support or supervision, parental and sibling sub-stance use; d) Co-morbidity-psychiatric comorbidities like Attention Deficit Hyperkinetic Disorder, conduct disorder.
Diagnosis: As treatment seeking rate is poor among adolescents, screening for substance use during visit to a physician may improve the rate identification. Screening tools like CRAFT are used routinely for the purpose of screening. The HEADSS acronym is a guide for the psychosocial interview for adolescents that ask about Home, Education, Activities, Drug and Alcohol Use, Sexuality, And Suicide. If the screening indicates a possibility of substance use, an in-depth interview is carried out. Depending upon the presence of various symptoms like craving, withdrawal, tolerance, preoccupation and few other, diagnosis of dependence, harmful use or abuse to a certain substance is made using diagnostic systems like DSM-5 or ICD-10. These are few indicators with which adolescents are referred to a physician by parents or teachers:
- Problems controlling mood and behavior
- Inability to concentrate in the classroom
- Often found drowsy during the classes
- Change in Academic Performance
- Absenteeism
- a change in peer group
- loss of interest in favorite activities
- deteriorating relationships with family members and friends
- changes in eating or sleeping habits
- Weight loss
- Bruises and other marks on arms or other vein-laden areas (neck, behind knees), bloodshot eyes, sniffling nose, dilated pupils, etc.
Management: The treating physician must ensure confidentiality to build up trust with adolescents and to minimize drop-out. The treatment of adolescents with substance abuse should take into account age, sex, ethnicity, cultural background, and readiness to change. It involves a system of professionals like pediatricians, psychiatrists and therapeutic interventions which include pharmacological agents and psychological interventions like motivational interviewing, brief intervention, as well as family and community support.
Dr. Piyali Mandal, Assistant Professor, Department of Psychiatry & National Drug Dependence Treatment Centre, AIIMS, New Delhi. Email: piyum2008@gmail.com
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