Frequently Asked Questions about Adolescent Drug Use, Part 2

3. How do adolescents become addicted to drugs, and which factors increase risk? 

Addiction occurs when repeated use of drugs changes how a person’s brain functions over time. The transition from voluntary to compulsive drug use reflects changes in the brain’s natural inhibition and reward centers that keep a person from exerting control over the impulse to use drugs even when there are negative consequences—the defining characteristic of addiction.

Some people are more vulnerable to this process than others, due to a range of possible risk factors. Stressful early life experiences such as being abused or suffering other forms of trauma are one important risk factor. Adolescents with a history of physical and/or sexual abuse are more likely to be diagnosed with substance use disorders.

Many other risk factors, including genetic vulnerability, prenatal exposure to alcohol or other drugs, lack of parental supervision or monitoring, and association with drug-using peers also play an important role.

At the same time, a wide range of genetic and environmental influences that promote strong psychosocial development and resilience may work to balance or counteract risk factors, making it ultimately hard to predict which individuals will develop substance use disorders and which won’t.

4. Is it possible for teens to become addicted to marijuana? 

Yes. Contrary to common belief, marijuana is addictive. Estimates from research suggest that about 9 percent of users become addicted to marijuana; this number increases among those who start young (to about 17 percent, or 1 in 6) and among daily users (to 25–50 percent).

Thus, many of the nearly 7 percent of high school seniors who (according to annual survey data) report smoking marijuana daily or almost daily are well on their way to addiction, if not already addicted, and may be functioning at a sub-optimal level in their schoolwork and in other areas of their lives.
Long-term marijuana users who try to quit report withdrawal symptoms including irritability, sleeplessness, decreased appetite, anxiety, and drug craving, all of which can make it difficult to stay off the drug. Behavioral interventions, including Cognitive-Behavioral Therapy and Contingency Management (providing tangible incentives to patients who remain drug-free) have proven to be effective in treating marijuana addiction.

Although no medications are currently available to treat marijuana addiction, it is possible that medications to ease marijuana withdrawal, block its intoxicating effects, and prevent relapse may emerge from recent discoveries about the workings of the endocannabinoid system, a signaling system in the body and brain that uses chemicals related to the active ingredients in marijuana.

Legalization of marijuana for adult recreational use and for medicinal purposes is currently the subject of much public debate. Whatever the outcome, public health experts are worried about use increasing among adolescents, since marijuana use as a teen may harm the developing brain, lower IQ, and seriously impair the ability to drive safely, especially when combined with alcohol.

Parents seeking more information about the effects of marijuana on teens are encouraged to see information offered on NIDA’s Web site: http://www.drugabuse.gov/drugs-abuse/ marijuana.

A new study in the American Journal Of Psychiatry (Volume 171, Issue 6, June 2014) shows that incorporating the web-based educational intervention in the treatment of drug abuse can not only help people stop using drugs, but can also keep them in treatment longer.

• TES is a web-based version of the Community Reinforcement Approach plus Contingency Management, a packaged approach with demonstrated efficacy.  The National Institute on Drug Abuse (NIDA), part of the NIH, funded this study.

TES consists of 62 interactive modules that teach patients how to achieve and maintain abstinence from drug use and includes prize-based motivational incentives to encourage adherence to treatment.  Patients given TES were less likely to drop out of treatment than those in the control group.  Also, the web-based intervention helped patients stay abstinent from drug use, even those who were not abstinent at the beginning of the study.  With such findings, web-based interventions like TES are promising additions to drug abuse treatment.

This approach, which combines skills-oriented counseling and contingency management in an Internet-delivered behavioral intervention, produced high rates of abstinence from drugs and heavy drinking among patients with a good prognosis (those who entered the study with positive urine drug or breath alcohol screen) but doubled the likelihood of abstinence among patients with an otherwise poor prognosis.

Computer-delivered interventions have the potential to improve access to quality addiction treatment care. The objective of this study was to evaluate the effectiveness of the Therapeutic Education System (TES), an Internet-delivered behavioral intervention that includes motivational incentives, as a clinician-extender in the treatment of substance use disorders.

Adult men and women (N=507) entering 10 outpatient addiction treatment programs were randomly assigned to receive 12 weeks of either treatment as usual (N=252) or treatment as usual plus TES, with the intervention substituting for about 2 hours of standard care per week (N=255).

TES consists of 62 computerized interactive modules covering skills for achieving and maintaining abstinence, plus prize-based motivational incentives contingent on abstinence and treatment adherence. Treatment as usual consisted of individual and group counseling at the participating programs. The primary outcome measures were abstinence from drugs and heavy drinking (measured by twice-weekly urine drug screens and self-report) and time to dropout from treatment.

Compared with patients in the treatment-as-usual group, those in the TES group had a lower dropout rate and a greater abstinence rate. This effect was more pronounced among patients who had a positive urine drug or breath alcohol screen at study entry (N=228).

Internet-delivered interventions such as TES have the potential to expand access and improve addiction treatment outcomes. Additional research is needed to assess effectiveness in non-specialty clinical settings and to differentiate the effects of the community reinforcement approach and contingency management components of TES.

Tom Wilson Counseling Online Alcohol Classes currently uses similar evidenced based practices inclusing cognitive behavioral techniques, motivational enhancement therapy and stages of change theory.

Frequently Asked Questions About Adolescent Drug Use

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

1. Why do adolescents take drugs?

Adolescents experiment with drugs or continue taking them for several reasons, including:

• To fit in: Many teens use drugs “because others are doing it”—or they think others are doing it—and they fear not being accepted in a social circle that includes drug-using peers.

• To feel good: Abused drugs interact with the neurochemistry of the brain to produce feelings of pleasure. The intensity of this euphoria differs by the type of drug and how it is used.

• To feel better: Some adolescents suffer from depression, social anxiety, stress-related disorders, and physical pain. Using drugs may be an attempt to lessen these feelings of distress. Stress especially plays a significant role in starting and continuing drug use as well as returning to drug use (relapsing) for those recovering from an addiction.

• To do better: Ours is a very competitive society, in which the pressure to perform athletically and academically can be intense. Some adolescents may turn to certain drugs like illegal or prescription stimulants because they think those substances will enhance or improve their performance.

• To experiment: Adolescents are often motivated to seek new experiences, particularly those they perceive as thrilling or daring.

2. What drugs are most frequently used by adolescents?

Alcohol and tobacco are the drugs most commonly abused by adolescents, followed by marijuana. The next most popular substances differ between age groups. Young adolescents tend to favor inhalant substances (such as breathing the fumes of household cleaners,glues, or pens; see “The Dangers of Inhalants,” page 15), whereas older teens are more likely to use synthetic marijuana (“K2” or “Spice”) and prescription medications—particularly opioid pain relievers like Vicodin® and stimulants like Adderall®.

 In fact, the Monitoring the Future survey of adolescent drug use and attitudes shows that prescription and over-the-counter medications account for a majority of the drugs most commonly abused by high-school seniors.

The Most Commonly Abused Drugs by High School Seniors (Other than Tobacco and Alcohol)

1. Marijuana
2. Amphetamines (Adderall)
3. Prescription Painkillers (Vicodin, Oxycontin)
4. Cough Medicine
5. Tranquilizers
6. Hallucinogens
7. Sedatives
8. MDMA (Ecstasy)
9. Salvia

Understanding Pretrial Diversion

A criminal conviction for an alcohol or drug offense, whether misdemeanor or felony, can create an avalanche of unintended consequences that often ends with individuals becoming further enmeshed in the legal system which can prevent them from being a productive member of the community. Tom Wilson Counseling Center specializes in online alcohol and drug abuse education for participants who have qualified for a pretrial diversion program in any state.

Pretrial diversion programs afford individuals an opportunity to address their behavior without resulting in a criminal conviction. These diversion programs may occur as early as street-level law enforcement intervention, or as late as court involvement, but the distinguishing characteristic is that there will not be a conviction recorded in an individual’s record.

Many pretrial diversion defendants are referred for alcohol and substance abuse intervention, with low risk offenders sent to less intensive programs while higher risk offenders are sent to more intensive programs, such as outpatient treatment. Since most programs are admistered by prosecuting Attorneys, community probation supervision personnel are often tasked with identifying the higher risk offenders (who will need more intensive intervention). Most participants in the pretrial diversion program are low risk or medium risk offenders, and have the highest completion rate of their online alcohol drug education classes, and their diversion requirements.

Out-of-state offenders in pretrial diversion programs are usually referred to online alcohol drug education programs that  meet court requirements and provide the quickest way to help them avoid a black mark on their legal record.  

Frequently Asked Questions About Adolescent Drug Use

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

1. Why do adolescents take drugs?

Adolescents experiment with drugs or continue taking them for several reasons, including:

• To fit in: Many teens use drugs “because others are doing it”—or they think others are doing it—and they fear not being accepted in a social circle that includes drug-using peers.

• To feel good: Abused drugs interact with the neurochemistry of the brain to produce feelings of pleasure. The intensity of this euphoria differs by the type of drug and how it is used.

• To feel better: Some adolescents suffer from depression, social anxiety, stress-related disorders, and physical pain. Using drugs may be an attempt to lessen these feelings of distress. Stress especially plays a significant role in starting and continuing drug use as well as returning to drug use (relapsing) for those recovering from an addiction.

• To do better: Ours is a very competitive society, in which the pressure to perform athletically and academically can be intense. Some adolescents may turn to certain drugs like illegal or prescription stimulants because they think those substances will enhance or improve their performance.

• To experiment: Adolescents are often motivated to seek new experiences, particularly those they perceive as thrilling or daring.

2. What drugs are most frequently used by adolescents?

Alcohol and tobacco are the drugs most commonly abused by adolescents, followed by marijuana. The next most popular substances differ between age groups. Young adolescents tend to favor inhalant substances (such as breathing the fumes of household cleaners,glues, or pens; see “The Dangers of Inhalants,” page 15), whereas older teens are more likely to use synthetic marijuana (“K2” or “Spice”) and prescription medications—particularly opioid pain relievers like Vicodin® and stimulants like Adderall®.

 In fact, the Monitoring the Future survey of adolescent drug use and attitudes shows that prescription and over-the-counter medications account for a majority of the drugs most commonly abused by high-school seniors.

The Most Commonly Abused Drugs by High School Seniors (Other than Tobacco and Alcohol)

1. Marijuana
2. Amphetamines (Adderall)
3. Prescription Painkillers (Vicodin, Oxycontin)
4. Cough Medicine
5. Tranquilizers
6. Hallucinogens
7. Sedatives
8. MDMA (Ecstasy)
9. Salvia

What is the (Real) Cost of Pretrial Justice? Here’s the answer: 

More Days in Jail = Higher Risk of Crime

(Originally published in the Public Welfare Foundation’s Newsletter)

Jails are very expensive to build and maintain, but they are often seen as worth the investment since they keep criminals off the street. However, many communities are surprised to find that when they look at who is actually in their jail, the population is predominately low-level, non-violent defendants who simply could not post their bond. In the short term, the community incurs the cost of incarcerating these individuals unnecessarily, but the long-term costs may be more significant. New research from the Laura and John Arnold Foundation has shown that incarceration itself is correlated with an increased likelihood that low risk defendants will commit future crimes. In (Lowenkamp, C.T., VanNostrand, M, and Holsinger, A. (2013). The Hidden Costs of Pretrial Detention. New York: Laura and John Arnold Foundation.

In terms of the costs of new crime and victimization, as well as the cost of incarceration itself, communities benefit from either not incarcerating these individuals in the first place, or releasing them as quickly as possible from jail. 

An Effective and Efficient Solution

Fortunately, the science of pretrial justice offers an answer that protects public safety and minimizes costs. By assessing the risk defendants pose to public safety, and the likelihood that they will return to court, judges are able to make informed decisions as to who needs to be in jail, and who can safely stay in the community. A continuum of community supervision options can also allow communities to best respond to the risk that a defendant poses—and at a fraction of the cost of a jail bed.
Time is of the essence, however, and pretrial policy must also address system efficiency. As shown in National Association of Pretrial Services Agencies. (2014) The Patient Protection and Affordable Care Act and the Pretrial System: A “front door” to health and safety. Retrieved on May 20, 2014 from Holder, E. (2011). Attorney General Eric Holder speaks at the the Arnold Foundation research, unnecessary nights in jail have a real public safety cost, so systems must carefully consider how law enforcement makes arrest and booking decisions, and how courts, jails, and pretrial services agencies screen and hold or release defendants.

In addition, the Patient Protection and Affordable Care Act (ACA) creates a unique opportunity for the pretrial system to connect defendants to health services in the community. Often, jails become de facto providers of physical and behavioral health services, at a very high cost, and upon release defendants frequently relapse due to lack of care. To break the vicious cycle, several communities have begun enrolling defendants in Medicaid, allowing them to access physical and behavioral health services in the community, receive services at a lower cost than through the jail, and ideally avoid future arrest and conviction.