1.1 Adolescent development, substance use and mental health

1.1 Adolescent development, substance use and mental health

“Physical, emotional, and social well-being among youth is important for numerous reasons, not the least of which are the long-lasting effects into adulthood. Childhood and adolescence are pivotal developmental stages during which many life-long health behaviours, beliefs and attitudes become established. Therefore, healthy children will likely become healthy adults” (Adlaf, Paglia & Beitchman, 2002, 1).

As they grow and learn, all young people in our society are exposed to and affected by the behaviours and experiences of the adults in their lives. This includes exposure to widespread use of alcohol and other drugs, as well as to the degree of mental health - or in some cases mental health problems - experienced by those adults. In turn, most young people will experiment, at some point, with alcohol and/or other drugs. While the majority will go on to lead healthy, productive lives, many will have experiences that affect their sense of well-being and, in more serious circumstances, that negatively affect their mental health and reduce their ability to function.

Throughout this primer, we use the terms “young people” and “youth” to acknowledge the fact that the broad time period from birth to early adulthood can be affected by the pervasiveness of substance use and mental health problems in our society. Our primary focus, however, is on adolescents.

1.1.1 Adolescent development

Adolescence is a time of opportunity and growth - a time when young people explore their identities and roles. Through this process of experimentation, learning and development, young people “lay down the foundations for physical, psychological and social maturity” (Centre for Addiction and Mental Health (CAMH), 2002a).

Adolescence is also a time when young people take risks that can have long-term effects on their health and well-being. As part of their exploration and experimentation, adolescents often engage in high-risk behaviours such as drinking and driving, unsafe sexual practices and harmful sleeping and eating patterns that can have serious consequences for themselves and others. Some adolescents engage in violence, including, in rare circumstances, homicide or suicide.

Adolescence is, above all, a period replete with significant life changes and emotional upheaval. Entering puberty and making it through high school can be stressful times for young people. For some, this period of transition can lead to emotional and/or behavioural problems and difficulties with school or other areas of life (Adlaf et al., 2002). Among marginalized groups of young people, vulnerability is compounded by factors such as dislocation, racism, sexism, homophobia, poverty, social isolation and street-involvement.

Risk factors make it more likely that individuals will experience poor overall adjustment or negative outcomes such as mental health or substance use problems. Risk factors may include biological, psychological or social factors in the individual, family and environment.

Protective factors reduce the potentially negative effects of risk factors. Protective factors may include biological, psychological or social factors in the individual, family and environment (Braverman, 2001).

The DSM-IV distinguishes between substance abuse and dependence.

Substance abuse refers to:

• use that results in failure to fulfill role obligations at work, school or home and/or legal problems
• use in situations that are physically hazardous
• continuation of use despite persistent social problems.

Substance dependence refers to:

• use that leads to tolerance and/or withdrawal (see section 2.3.2)
• use of large amounts over a long period of time
• unsuccessful efforts to control the use
• a great deal of time spent on drug-use related activities
• reduction of important social, recreational and occupational activities
• continued use despite serious physical or psychological problems (Health Canada, 2002).

1.1.2 Risk and protective factors

Although many adolescents experiment with substances and stop using them relatively quickly, some do remain occasional or recreational users. A few become heavy users. Some young people are at greater risk of developing substance use problems than others.

There is no definitive “cause” of drug use problems among young people, but experts have suggested many reasons why young people who decide to experiment with drugs, go beyond experimentation or transition to regular use.

Within the context of adolescent development, some experimentation with alcohol and other drugs is considered normal. Young people might experiment with substances because:

• Drugs are available and provide a quick, often inexpensive way to have “fun.”
• They are curious and want to find out what the fuss is about.
• Using substances expresses opposition to adult authority and can be part of the process of separation from parents.
• Using substances symbolizes developmental transition (e.g., moving from a less mature to a more mature stage). In some families, the “first drink” is a rite of passage.

Once adolescents have some experience with a drug and know what the effects are, they might continue to use drugs because:

• Drug use becomes a coping mechanism for dealing with anything from poor grades and social rejection to family conflict, family dysfunction and child abuse. Drug users might be trying to quell feelings of anger, frustration, stress, fear of failure or failure itself.
• Drug use can be an attempt to self-medicate symptoms of mental health problems such as depression or anxiety.
• Drug use can demonstrate a personal identity. It can be a way of showing that they are “cool” or have characteristics valued in adolescent culture.
• They might view drug use as a way to gain admission to a peer group.
• They might believe drug use will make others perceive them as adults.
• They feel omnipotent and immortal and therefore not at risk.

Some experts believe that mental health problems are risk factors for substance use (substance use as a self-medicating or coping strategy), but others prefer the suggestion that mental health and substance use problems among young people may emerge from a common pre-existing factor such as stress (Adlaf et al., 2002).

We now know a great deal about the factors that put young people at increased risk for substance use and mental health problems as well as the factors that help protect them. Much of what we have learned suggests there is overlap in both risk and protective factors and their potential outcomes (Offord, Boyle & Racine, 1989).

The more risk factors a young person is exposed to, the more they are at risk. The impact of risk and protective factors depends, in part, on a young person’s stage of development and factors that affect early development can be the most crucial (National Institute on Drug Abuse [NIDA], 1997). Appendix A provides an overview of the often overlapping risk and protective factors that have been linked to substance use and/or mental health problems among young people.

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