Adolescence is a critical period for physical, social, and emotional growth — but it is also a time of increased risk-taking behaviors like substance use. Engaging in these behaviors during this crucial stage of neurological and psychological development may make teens who use substances more vulnerable to substance abuse in the long term and can have significant effects on a teen's health and well-being.
Opioid and prescription drug abuse among teens is on the rise, and with the growing prevalence and availability of new substance-using technologies like cannabis vapes and e-cigarettes, it's more important now than ever for pediatric clinicians to be familiar with the risk factors and challenges common to treating adolescent substance use disorders (SUDs).
Long-standing challenges in preventing substance-related adolescent deaths
The three leading causes of death for adolescents in the United States are motor vehicle accidents, suicide, and homicide. Alcohol and other substances are involved in a sizable number of these largely accidental deaths.
Despite decades of efforts to stem adolescent substance use, the issue remains a significant public health concern. The persisting stigma that is associated with substance use and addiction can prevent adolescents from seeking help and hinder efforts to provide effective prevention and treatment programs. Countering this stigma requires a multi-faceted approach that includes public education, awareness campaigns, and advocacy efforts promoting greater understanding and acceptance of substance use disorders.
Maintaining ongoing monitoring, evaluation, and adaptation of prevention programs is crucial to ensure that they remain relevant and effective in addressing the evolving challenges of substance use among adolescents.
Teens may lack access to effective prevention and treatment programs due to financial, geographic, or social barriers — which can not only prevent adolescents from receiving the care they need but can also exacerbate the risks associated with substance use. Addressing these barriers requires a concerted effort to increase access to prevention and treatment programs, including increasing funding for community-based programs and promoting an overall greater awareness of available resources including harm reduction programs.
Identifying risk and protective factors for substance abuse in teens
Many factors contribute to adolescent substance use, including social and environmental influences, family dynamics, peer pressure, and underlying mental health issues. To address these challenges, it is important for clinicians in pediatric and adolescent medicine to understand the root causes of substance use and to build effective prevention strategies informed by these risk factors.
Individual risk factors include early age of initiation of substance use, peer influence (e.g., associating with substance-using peers), and low academic achievement. Pre-existing mental health conditions such as depressive and anxiety disorders also put teens at risk for substance use, as does having experienced child sexual abuse.
Family risk factors for substance abuse disorders among teens include a family or parental history of substance use, family conflict, and poor family management. The CDC cites other family risk factors, such as:
- Poor parental monitoring
- Favorable parental attitudes toward substance abuse
- Family rejection, such as of sexual orientation or gender identity
Environmental risk factors include poverty, exposure to violence, “lack of school connectedness,” and community disorganization.
Understanding and encouraging the presence of protective factors against adolescent substance use is also important. The CDC created a research-based list of “factors that help buffer youth from a variety of risky behaviors, including substance use,” such as:
- Parental and/or familial engagement
- Family support
- Parental disapproval of substance abuse
- Responsible parental monitoring
- School connectedness
Health risks associated with adolescent vaping, e-cigarette, and cannabis use
Cannabis and nicotine vaporizers, also known as e-cigarettes or vapes, present new challenges in the quest to limit teen substance use. These are battery-powered devices that heat a wax or liquid solution to create an aerosol, which is then inhaled. The solution, also known as “vape juice,” in e-cigarettes often contains nicotine, which is highly addictive and can harm brain development in adolescents. As the CDC explains, “Using nicotine in adolescence may also increase risk for future addiction to other drugs” and has been associated with causing depression in teens.
Nicotine alone is not the only concerning substance in vapes. The aerosol from e-cigarettes contains harmful chemicals that can affect the lungs and respiratory system, including heavy metals, volatile organic compounds (VOCs), and ultrafine particles.
The prevalence of adulterants such as vitamin E in vapes has been suggested as a cause for electronic vape-associated lung injury (EVALI): “Among the patients with EVALI, vitamin E acetate was detected in BAL fluid samples from 48 of 51 (94%).” Flavored vapes have been shown to put teens at risk of lung damage even when they do not contain nicotine or THC.
Though the legalization of medical and recreational cannabis has not been shown to have an impact on adolescent use of the substance — and has even been shown to have had a depressive effect on its rate of use among teens — there is a health risk for teens who still do choose to use cannabis. Teen use of cannabis, vaporized or otherwise, has been associated by researchers with adverse effects, “the most probable [of which includes] a dependence syndrome, increased risk of motor vehicle crashes, impaired respiratory function, cardiovascular disease, and adverse effects of regular use on adolescent psychosocial development and mental health.”
Most recently there is increasing evidence that teen cannabis use is associated with an increased risk of developing schizophrenia and related psychotic disorders. Because research on the impact of cannabis was restricted in the United States for decades, many of the health risks of long-term cannabis use beginning in adolescence are only now being revealed.
As a pediatric clinician, you have a responsibility to understand and be able to talk to adolescent patients about the risks to teens of e-cigarettes, nicotine, and cannabis use. Be prepared to present them with treatment solutions if necessary, including helping teens build a Quit Plan.
