With that said, some research suggests that people who drink alone as teenagers are likely to develop AUD as adults. Similarly, progress monitoring, the periodic and reliable assessment of progress to evaluate and inform treatment, allows clinicians to adapt or problem-solve aspects of treatment in real-time and has shown some promising results . Progress monitoring is a feasible way of identifying individuals who may not be responding to treatment and allows for adaptation of treatment based on an adolescent’s needs.
Determining the degree to which these effects remit or persist with alcohol abstinence or reduced use will be a key next step in this line of work. Findings reported in the WHO Health Behavior in School Children (HBSC) study (Currie et al. 2008), an investigation of multiple health behaviors, including alcohol use, across 23 European countries and North American countries, also indicated global patterns of alcohol use among early adolescents and youth. A more detailed analysis of changes in adolescent drunkenness from HBSC surveys in 1997–1998 and 2005–2006 indicated a significant decrease (25 percent on average) in adolescent drunkenness among 13 of 16 Western countries but a significant increase (40 percent in mean frequency) in adolescent drunkenness what most people don’t understand about alcohol and drug use in 7 Eastern European countries (Kuntsche et al. 2011). A more in-depth presentation of the HBSC surveys is beyond the scope of this article, but more extensive findings on cross-national comparisons are provided by Bendtsen and colleagues (2014), and findings specifically on U.S. national data for 6th through 10th graders who participated in the HSBC study are provided by Brooks-Russell and colleagues (2014). Current, empirically validated treatments, although holding promise for youths, are limited in their context of application and generalizability to the heterogeneity of youths in need of treatment. As noted above, a number of developmental models have been proposed to explain the role of alcohol involvement and problems in youth development.
Similarly in Australia, 2% and 17% of 14 and 17 year olds report binge drinking in the previous week (43). Approximately 13% of adolescents in Africa and 10% of adolescents in South East Asia report past month binge drinking (33). Cross-sectional design studies have established a relationship between adolescent alcohol use, brain development, and cognitive function (4). Considering that it would be highly unethical to randomize youth to different alcohol-using groups, human research is limited to natural observational studies. Prospective, longitudinal designs have been used to help delineate between pre-existing alterations and post-alcohol effects on brain development by assessing youth before they have ever used alcohol or other drugs and continuing to assess them over time as a portion of the participant population naturally transitions into substance use. This design allows for examination of normal developmental neural trajectories in youth who have never used alcohol or drugs during adolescence, and compares their brain maturation to youth who transition into substance use.
- By contrast, in 2000, these respective last 30-day prevalence rates were 22 percent, 41 percent, and 50 percent.
- They also thank the HBSC International Coordination Center (University of St. Andrews, United Kingdom) and the HBSC Data Management Center (University of Bergen, Norway) for their scientific support.
- Cognitive features of adolescence include heightened reward sensitivity, sensation seeking and impulsive action, and diminished self-control to inhibit emotions and behaviors (1, 2).
- Many teens may struggle with mental health problems, or they may have parents, guardians, or siblings who also struggle with addiction or mental illness.
- Being on the lookout for drug paraphernalia and signs and symptoms of drug abuse can help adults recognize at-risk teens.
Family-based therapies are well-established interventions for treating adolescent SUDs, and are particularly effective at promoting treatment attendance and therapeutic alliance, whereas other treatment modalities have shown only mixed success in these areas . Recent evidence has confirmed that utilizing strategies such as parental monitoring and behavioral management, promoting positive relationships, and encouraging self-regulation and stress management are effective in treating adolescent substance use through family-based approaches . It is important to note that previous reviews illustrate that pre-morbid cognitive and neural vulnerabilities predispose some adolescents to initiate, and misuse, alcohol (4, 5). Presently, it is not clear whether neurobiological deficits are the direct results of adolescent alcohol use, irrespective of predispositions, or whether those youth exhibiting vulnerability markers prior to alcohol initiation then experience worse neurobiological outcomes following uptake. Larger prospective longitudinal studies that are currently underway will help disentangle these complex relationships (48, 78). The widespread changes in the organization and functioning of the brain—which continue into a person’s mid-20s—bring about the cognitive, emotional, and social skills necessary for adolescents to survive and thrive.
The number of drinking-and-driving traffic fatalities involving 16- to 20-year-olds also has decreased from 5,244 in 1982 (which accounted for 66 percent of traffic fatalities) to 1,262 in 2010 (which corresponded to 37 percent of traffic fatalities) (Hingson and White 2014; Voas et al. 2012). These U.S. national epidemiologic findings are encouraging in that the historical trends indicate decreases and, in some instances (e.g., traffic fatalities), substantial decreases in alcohol use and adverse consequences among young people. During high school, alcohol use and problem drinking are widespread; after high school, rates of alcohol use and problems increase to lifetime peaks in the early twenties.
Novel rodent findings
While high-volume substance abuse can damage adult brains over time, the brains of adolescents are at much greater risk for stunted growth, developmental abnormalities, and mental illness from drinking less alcohol because these structures are still forming. However, for 16- to 20-year-old male drivers with blood alcohol concentrations of 0.08%, there was a 52-fold increase in single-vehicle fatal crash risk.148 Unfortunately, progress in reducing alcohol-related fatal crashes among adolescents has stalled. The proportions of fatally injured, 16-to 20-year-old drivers with blood alcohol concentrations of ≥0.08% were 29% in both 1995 and 2004. Research on alcohol’s effects on the developing adolescent is still in its infancy, despite the fact that this is the time during which many people begin drinking.
In this article, we use the term early adolescence to refer to the age range 12 through 14 (which includes, among others, 8th graders) and youth for the age range 15 through 20; adolescence refers to the entire age range of 12- to 20-year-olds. This article highlights four areas to demonstrate how this period of the lifespan differs from others with regard to alcohol use, its consequences, and the implications for prevention and treatment. The first part examines differences in alcohol use patterns and sensitivity to alcohol for early adolescents and youth the 4 stages of alcoholism for the functioning alcoholic relative to adults. Second, differences between early adolescents and youth and adults are discussed with regard to differences in development, with particular reference to age-normative psychosocial tasks (e.g., puberty, friendship formation) and to brain development that uniquely occurs during this phase of the lifespan. Longitudinal studies with large, diverse, representative samples of youth and a range of detailed measures are key to helping understand the behaviors that convey disadvantages to adolescent and young adult development and outcomes.
Typical Adolescent Brain Development
Given the accessibility and recent advancements of digital technologies, it is believed that these intervention strategies may play a strong role in becoming adjunctive interventions for treating adolescent SUDs. Treatments that are far-reaching, reduce stigma, and increase the discourse of substance use among adolescents are strongly needed, how does abstinence violation effect impact recovery and digital interventions offer a unique treatment strategy to fulfill these roles. However, despite the potential benefits of these interventions, there is also concern that these popular applications may have less than stringent data-sharing policies, leading to shared information from the applications with commercial entities .
White Matter Volume and Integrity
Bisexual youth, sexual-minority females, and younger sexual-minority youth reported the highest rates of alcohol use. In describing patterns of alcohol use among early adolescents (ages 12–14) and youth (ages 15–20), there is both good news and bad news. The good news is that research findings with U.S. national epidemiology data from long-term annual surveys of high-school students, such as the Monitoring the Future surveys, have indicated historical shifts toward overall decreases in levels of alcohol use among early adolescents and youth (Johnston et al. 2013).
Developmental Contexts and Tasks of Late Adolescence
Development of many of these promising interventions has been based on interventions such as MI [77, 82•,83], with the aim of effectively reducing substance use and substance-related cravings and problems through the delivery of automated, personalized text messages [83–85]. Recent studies have found that exercise and yoga may be promising as potential adjunctive therapies, as early studies have indicated that consistent exercise among substance-using adolescents can help improve sleep, establish structure, strengthen relationships, and improve self-perception [64–66]. Treatments which also focus on distress tolerance, mindfulness, and emotional regulation have been promising avenues of research as well, as emotion regulation difficulties often underpin adolescent substance use . Treatment strategies such as exercise, yoga, and mindfulness have limited clinical burden on an adolescent, and could have benefits in a wide variety of other physical and mental health conditions and are therefore recommended despite the limited and emerging evidence presented. Given only modest efficacy of current psychosocial treatments, pharmacotherapy has been explored as a potential complement to the standard of care [46•]. However, there is limited data regarding the efficacy of pharmacotherapy in treating adolescent SUDs; there are currently no FDA-approved pharmacotherapies for adolescent SUDs other than buprenorphine, which has been indicated down to age 16 for opioid use disorder and has demonstrated efficacy and feasibility among treating opioid-using adolescents [47–51].
Academic pressure, low self-esteem, and peer pressure are just a few factors that increase their risk of substance use. If your teen denies using drugs and you think they are lying, communicate the negative consequences of drug and alcohol use. Be clear that you want them to be safe and that experimenting with substances is dangerous—even if it’s just one time. If you are not able to keep the line of communication open with your teen, talk to their healthcare provider.
. Cognitive Behavioral Therapy
Adolescence is a critical developmental phase involving significant physical, cognitive, emotional, social, and behavioral changes. Cognitive features of adolescence include heightened reward sensitivity, sensation seeking and impulsive action, and diminished self-control to inhibit emotions and behaviors (1, 2). This contributes to the high rates of engagement in risky behaviors, including the initiation and escalation of alcohol use. Adolescent-specific brain developments may predispose young people to be particularly vulnerable to the potentially serious and long-lasting alcohol-related consequences (3).
In particular, the timing, sequence, and synchrony of developmentally specific transitions can affect how well youths master new roles, as well as continuities and discontinuities in their behavior. Therefore, developmental models representing a range of theoretical orientations, including systems theory, behavioral genetics, and developmental psychopathology, hold great promise for advancing our understanding of the processes that underlie adolescent changes, including the emergence of alcohol use and abuse. One potential explanation for age-related alterations in alcohol sensitivity could be developmental changes in how rapidly alcohol gets into and out of the system, although this possibility seems unlikely to be able to explain both the attenuated and accentuated sensitivities that adolescents show to different effects of alcohol. Adolescents do tend to have higher metabolic rates than adults, and age differences in alcohol levels are occasionally observed, although such differences are generally insufficient to account for the altered alcohol sensitivity of adolescents. For instance, adolescent rats given a sedative dose of alcohol not only recover in about half the time as do adults given the same dose, but they recover at higher brain levels of alcohol, suggesting that their brains are more resistant to the sedative properties of alcohol (Silveri & Spear, 1998).