Transcript Child and Adolescent Psychopathology

Substance Use
Disorders in
Adolescence
Chapter 15
Sandra A. Brown, Kristin Tomlinson, and Jennifer
Winward
SUBSTANCE USE DISORDERS IN
ADOLESCENCE
 Most commonly used drug with 20% of 8th graders
and 42% of 10th graders report being drunk on at least
one occasion in their lifetime (MTF; Johnston, O'Malley, Bachman, &
Schulenberg, 2010).
 Among high school seniors, half report using alcohol in
the past 30 days, 31% report being drunk in that time
frame, and 28% report 5 or more drinks per occasion
during the prior 2 weeks.
 Rates of daily drinking remain low (3%), highlighting
the heavy, episodic nature of youth involvement with
alcohol and other substances.
 Nictoine is the second most commonly used drug.
 Marijuana is the most commonly used illicit drug.
ABUSE AND DEPENDENCE: CRITERIA
AND DIAGNOSTIC ISSUES
 Indicators of SUDs among adolescents often involve
physical, socioemotional, and health changes.
 Physical dependence, when physiological and
psychological adaptations to the substance occur.
 Tolerance is the need to ingest larger amounts of a
substance for an effect once obtained at a lower dose.
 DSM-IV(2000)
 Two types of substance use disorders (abuse and
dependence) are characterized by a maladaptive pattern of
use and symptoms that result in clinical impairment or distress.
 Abuse typically considered less severe and less chronic than
dependence.
HISTORICAL CONTEXT AND
ETIOLOGICAL FORMULATIONS
 Environmental Models
 Theory of planned behavior (TPB)
• Attitudes about using substances, perceived social norms of
alcohol/drug use, and self-efficacy for coping in potential use
situations influence youths’ intentions to use substances (Ajzen &
Fishbein, 1980).
 Social learning theory (SLT)
• Adolescents develop outcome expectations about the effects of
substance use by observing parents, peers, and/or the media, or by
learning about the effects of substance use (Akers, 1977).
HISTORICAL CONTEXT AND
ETIOLOGICAL FORMULATIONS
 Problem behavior theory (PBT)
• A generalist model that considers substance involvement to be one
of a number of deviant behaviors that typically co-occur among
adolescents (Jessor & Jessor, 1977).
 Domain model
• Focus on the interaction of biological, intrapersonal, interpersonal,
and sociocultural factors in jointly influencing adolescent substance
use behavior (Huba, Wingard, & Bentler, 1980).
HISTORICAL CONTEXT AND
ETIOLOGICAL FORMULATIONS
 Behavioral Genetic, Neurobiological, and
Integrated Perspectives
 Maturation theory
• A heuristic model of the development of early-onset SUDs.
• According to this model, deviations in somatic and neurological
maturation, along with stressful and adverse environments, predispose
children to difficulties in regulating affect and behavior (Tarter et al., 1999).
 Expectancy theory
• An alcohol/drug-specific integrative model of youth substance
involvement because it considers multiple system levels of potential
influence on youth substance use as well as processes through which
these systems interact over time in the context of development
(Goldman et al., 1991; Goldman, et al., 2010) .
HISTORICAL CONTEXT AND
ETIOLOGICAL FORMULATIONS
 Environmental and Genetic Risk Factors
 Temperament
 Childhood behavior problems
 Alcohol and drug expectancies
 Age of onset
 Family influences
 Peers
 Stress
 Neurocognitive functioning
HISTORICAL CONTEXT AND
ETIOLOGICAL FORMULATIONS
 Protective Factors
 Temperamental traits
 High intelligence
 Social support
 Involvement with conventional peers
 Religiosity
 Low-risk taking
 Competence skills
 Psychological wellness
 (ALDH2) isoenzyme associated with adverse reactions to
alcohol
DEVELOPMENTAL PATHWAYS TO
ABUSE AND DEPENDENCE
 Deviance-prone pathway
 A parental alcoholism/deviance proneness pathway that operates as a
risk factor for behavioral difficulties among offspring (Zucker et al., 2000).
 A key feature of this model involves the child’s reduced ability to selfregulate emotional distress and inhibit behaviors, which elevates risk for
the development of substance use problems in adolescence.
 Negative affectivity pathway
 Deficient regulation of negative affect.
 This pathway appears to be associated with both exposure to
environmental stressors and temperamental negative emotionality.
 Enhanced reinforcement pathway
 Some youth are less sensitive to the effects of substances and
consequently use substances more frequently and/or in greater
quantities (Schuckit et al., 2004).
 This pathway appears to be genetically influenced and based on
physiological response differences to the pharmacological effects of
substances.
FUTURE DIRECTIONS FOR
PREVENTION
 Primary and early intervention effects involving
peer leaders, motivational enhancement, improved
accuracy of perceived social norms, challenges to
outcome expectancies, and social practice appear
most promising, particularly if including a
motivational interviewing approach (Brown, et al., 2008;
Winters & Leitten, 2007).
 There is growing appreciation for considering
developmental factors in the timing, content and
process of effective interventions.
 The application of neuroscience findings to
interventions.