Substance Abuse

Since the early 1990’s, drug and alcohol use among high school teenagers has doubled in the United States. More alarmingly, drug and alcohol use among middle school children is increasing. The Office of the Inspector General in an article titled, Youth and Alcohol: A National Survey (Drinking Habits, Access, Attitudes, and Knowledge), reports that between ages 12 and 13 most students take their first alcoholic drink. Furthermore, most studies report that alcohol is one of the gateways to drug abuse and dependence.

There are many reasons for drug experimentation, use, abuse and dependence. On this site, an attempt will be made to provide the definitions for the following terms:

• Substance (Drug) Misuse
• Substance Abuse
• Substance Dependence

Although comprehensive information will not be provided on this matter, a general explanation will be provided in regards to some of the reasons why students may choose to abuse drugs. Additionally, there will be a brief discussion of some of the signs that may be an indication of drug abuse. If you would like comprehensive information regarding Substance Abuse, please refer to the links provided. Furthermore, if you have a concern that your student may be abusing drugs, please go the ‘Referrals’ link to consult a professional who can provide you more information and support.

Definition of Terms
Substance (Drug) Abuse
Substance Dependence

Reasons for Substance Abuse
Signs of Substance Abuse
Referrals
Resources

Substance (Drug) Abuse

Before having a discussion on drug abuse, one must first understand the difference between “Drug Misuse” and “Drug Abuse.” Drug misuse refers to “the unintentional or inappropriate use of prescribed or non-prescribed medicine resulting in impaired physical, mental, emotional or social well-being (Carroll, p. 8).” Examples of Drug misuse include using another person’s prescription to alleviate your own symptoms, not following the recommended dosage for prescribed medication, or using a prescribed medication after it has expired. The term drug abuse on the other hand, refers “to the deliberate, continuous use of mind-changing chemical substances (usually for reasons other than legitimate medical purposes) that results in any degree of physical, mental, emotional, or social impairment of the user, the user’s family or society (Carroll, p. 8).” Notice that the definition does not focus on whether or not the substance is legal, but rather on the intent of the use of the chemical or substance.

The American Psychiatric Association (APA) further defines substance abuse in the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) as follows:

1. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
   1. recurrent substance use resulting in failure to fulfill major role obligations at work, school, or home
   2. recurrent substance use in situations in which it is physically hazardous (e.g., driving under an automobile or operating a machine when impaired by substance use)
   3. recurrent substance related legal problems (e.g., arrests for substance related legal problems)
   4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused by the effects of the substance (e.g. arguments about the consequences of intoxication, physical fights)
2. The symptoms have never met the criteria for Substance Dependence for this class of substance.

Substance Dependence

The American Psychiatric Association also differentiates Substance Abuse from Substance Dependence. The key differentiating factor is whether or not the user has developed a tolerance for the substance. The following is the criteria for Substance Dependence as set by the APA in the DSM-IV:

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

1. tolerance, as defined by either of the following:
1. a need for markedly increased amounts of the substance to achieve intoxication or desired effect
2. markedly diminished effect with the continued use of the same amount of substance
2. withdrawal, as manifested by either of the following:
1. the characteristic withdrawal syndrome
2. the same (or closely related substance) is taken to relieve or avoid withdrawal symptoms
3. the substance is often taken in larger amounts or over a longer period than was intended
4. there is a persistent desire or unsuccessful efforts to cut down or control substance use
5. a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects
6. important social, occupational, or recreational activities are given up or reduced because of substance use
7. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol)

Reasons for Substance Abuse

There aren’t simple answers as to why some individuals abuse drugs while others don’t. Some individuals have a physiological disposition toward addiction and addictive behaviors, while others abuse drugs to deal with social or emotional issues. This section will only focus on some of the social and emotional factors that may lead to adolescent drug abuse.

Group Acceptance

It is commonly known that adolescence is a time for self-discovery. Much of an individual’s identity formation develops during early adolescence and young adulthood. It is during this time that a teenager is more susceptible to drug abuse. For many teenagers, identity is dependent on peer acceptance and as a consequence, the teenager may engage in risky behavior, such as drinking or drug abuse in order to gain acceptance into the peer group. Since drug use is often illegal, the co-participation in a secretive activity usually fosters a bond of conspiracy that that further strengthens the group’s attitude toward drug use and enables the continuation of drug abuse.

Stress/Anxiety Reduction

Adolescents are faced with many stressors that stem from school, relationships (sex), and the future in general. In order to escape or reduce the stress or anxiety some adolescents may turn to alcohol or drug abuse. This faulty coping method may not only lead to drug abuse, but may also lead to drug dependence.

Pleasure

Some individuals use drugs just to feel good. An individual is more likely to continue to abuse drugs if the individual perceives a positive experience during or after the drug use. The drug use is then said to be reinforced by the pleasurable experience. Individuals who fall in to this category may use drugs for excitement, to escape boredom, or to relieve stress.

Self-Medication

Serious problems at home or school often times exhausts an adolescent both psychologically and physically. In order to escape from his or her problems, the adolescent may self-medicate by abusing drugs.

Independence

In an attempt to assert independence and form his or her own identity, an adolescent may turn to drugs in order to rebel against parental expectations and societal norms. However, it is these desires for independence that may lead the adolescent to seek membership in a group that will support his/her need to break away from the family or “society.” Oftentimes the adolescent is unable to understand this paradox, which consequently will lead him/her to adopt the new identity and behaviors of the drug using group.

Signs of Substance Abuse

The following signs may indicate substance abuse:

• Avoids old friends (A change in friends)
• Ambiguous about whereabouts/friends
• Slipping grades
• Change in attitude toward school
• Lack of interest in personal hygiene
• Lethargic Behavior
• Mood Changes
• Withdrawal
• Interest in drug paraphernalia or items that promote drug and drug abuse such as hats, t-shirts, literature, stickers, etc.
• Change in attitude towards alcohol and tobacco
• Bloodshot eyes
• Abnormal use of eye drops or breath sprays
• Irregularity in sleeping habits (Sleeping too much or too little)
• Change in appetite (Not eating or eating too much)
• Overly concerned about privacy

Although some of these signs observed individually may be typical of adolescent behavior, a combination of several of signs may be indicative of a problem. If you suspect that your child may have a drug problem, please visit the referral site and seek professional consultation.