Considering the Youth
Youth is defined by the United Nations, as the age between 15 and 24. This period represents a period of remarkable change for individuals, where they must move from a dependence on parent figures to establishing their own identity and independence. This period is characterised by many interacting influences from individual or personal to those related to the social and structural environment. Importantly, this period represents an essential period for brain development, which continues into the early 20’s. The frontal lobe, which is responsible for motor functioning, judgement, creativity, and social understanding is particularly vulnerable during this period. Additionally, there is significant change in neurotransmitter levels during this time, specifically dopamine and serotonin in the limbic system. This means that stimuli that are processed as rewarding or stressful might be experienced more intensely by youth. This suggests a greater vulnerability to common mental disorders as a response to stressful stimuli and to a greater likelihood of engaging in substance use as this feeds into reward-seeking.
The majority of adults who engage in substance use are noted to have begun their relationship with substances in their youth (Nelson et al., 2017). Globally, the population of people who use substances has increased by 20% over the last 10 years to a current number of 292 million people (United Nations Office on Drugs and Crime, 2024). It therefore becomes that much more important to identify or develop and provide interventions geared towards preventing onset of substance use, as well those that provide care for youth with a developing problematic relationship with substances. Importantly, these interventions must be multipronged and responsive to the full context of the individual’s functioning and needs.
We are therefore mindful as the drug demand reduction community of the importance of this period of life in the exposure to substance use and the possible evolution of substance use disorder. Initiation of substance use by youth may be driven by individual factors, factors associated with their social setting incorporating peer and family relationships, and experiences in settings of learning (schools and universities). Substance use patterns amongst youth, which often begin casually as part of efforts towards social connectedness, typically involve alcohol only or alcohol with cannabis or alcohol with cannabis and tobacco, and potentially with other drugs (Halladay et al., 2020). This highlights the importance of putting measures in place to enquire about additional substance use when engaging with youth, particularly as we start to see the increased penetration of synthetic drugs with higher rates of harm, many of which we are yet to fully appreciate. Substance use disorder and mental health comorbidity is common, and the presence of mental disorder may predispose, exacerbate and worsen the course of substance use disorder (Köck et al., 2022). Substance use has been associated with increased propensity to develop a mental health problem as indicated by a greater likelihood to internalise or externalise distressing experiences (Brownlie et al., 2019). This is in contrast to the very low service utilisation noted amongst this population. Older data indicate comorbity rates up to 47.9% for internalising disorders and substance use disorders (O’Neil et al., 2011), with internalising disorders generally preceding substance use and being more likely to be associated with the development of substance use disorder.
The United Nations Office on Drugs and Crime and the World Health Organization have published the International Standards on Drug Use Prevention, which provide resources for implementing evidence-based prevention strategies (United Nations Office on Drugs and Crime and the World Health Organization, 2018). High risk substance use amongst youth can be considered as use that is most likely to result in serious adverse outcomes such as dropping out of school, involvement with the criminal justice system and health sequalae including mental health and death. Management which targeted just the mental health comorbidity has failed to successfully target the substance use disorder, thus highlighting the need for comprehensive individualised case management (Pettinati et al., 2013). In targeting the substance use disorder, brief interventions for youth have shown some promising outcomes, with further evidence that individual multi-contact interventions are more effective than group interventions (Carney & Myers, 2012). The UNODC and WHO have also published International Standards for the Treatment of Drug Use Disorders, with special guidance for programmes geared towards youth and adolescents (World Health Organization and United Nations Office on Drugs and Crime, 2020).
We will engage further on the topic of prevention and treatment for this important population over the coming months. ISSUP will soon be publishing some helpful reading materials to focused on students and youth. On the ISSUP website you will find links to the Global Youth Network, a network focused on adolescents, and a few others where resources and activities are shared on an ongoing basis. On 12 November 2024 ISSUP will host a webinar entitled Unravelling Risk-Taking in Youth: Pathways to Positive Change where the discussion will contextualise the significance of youth and adolescence, explore brain development, biological and psychosocial vulnerabilities, the spectrum of risk behaviours and suggestions for prevention and treatment.
Additional Resources:
References:
Brownlie, E., Beitchman, J. H., Chaim, G., Wolfe, D. A., Rush, B., & Henderson, J. (2019). Early Adolescent Substance Use and Mental Health Problems and Service Utilisation in a School-based Sample. Canadian Journal of Psychiatry, 64(2). https://doi.org/10.1177/0706743718784935
Carney, T., & Myers, B. (2012). Effectiveness of early interventions for substance-using adolescents: Findings from a systematic review and meta-analysis. In Substance Abuse: Treatment, Prevention, and Policy (Vol. 7). https://doi.org/10.1186/1747-597X-7-25
Halladay, J., Woock, R., El-Khechen, H., Munn, C., MacKillop, J., Amlung, M., Ogrodnik, M., Favotto, L., Aryal, K., Noori, A., Kiflen, M., & Georgiades, K. (2020). Patterns of substance use among adolescents: A systematic review. In Drug and Alcohol Dependence (Vol. 216). https://doi.org/10.1016/j.drugalcdep.2020.108222
United Nations Office on Drugs and Crime and the World Health Organization. (2018). International Standards on Drug Use Prevention, Second updated edition. https://www.unodc.org/unodc/en/prevention/prevention-standards.html
Köck, P., Meyer, M., Elsner, J., Dürsteler, K. M., Vogel, M., & Walter, M. (2022). Co-occurring Mental Disorders in Transitional Aged Youth With Substance Use Disorders – A Narrative Review. In Frontiers in Psychiatry (Vol. 13). https://doi.org/10.3389/fpsyt.2022.827658
Nelson, J., Bundoc-Baronia, R., Comiskey, G., & McGovern, T. F. (2017). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health: A Commentary. Alcoholism Treatment Quarterly, 35(4). https://doi.org/10.1080/07347324.2017.1361763
O’Neil, K. A., Conner, B. T., & Kendall, P. C. (2011). Internalizing disorders and substance use disorders in youth: Comorbidity, risk, temporal order, and implications for intervention. In Clinical Psychology Review (Vol. 31, Issue 1). https://doi.org/10.1016/j.cpr.2010.08.002
Pettinati, H. M., O’Brien, C. P., & Dundon, W. D. (2013). Current status of co-occurring mood and substance use disorders: A new therapeutic target. In American Journal of Psychiatry (Vol. 170, Issue 1). https://doi.org/10.1176/appi.ajp.2012.12010112
United Nations Office on Drugs and Crime. (2024). World Drug Report 2024. https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2024.html
World Health Organization and United Nations Office on Drugs and Crime. (2020). International standards for the treatment of drug use disorders: revised edition incorporating results of field-testing.
