Adolescence is a period of identity formation in
which new activities, including social, emotional, and sexual
relationships, are experienced. Legal and illicit substances are
frequently used during adolescence: approximately 72% of U.S. teens and 65.2% of students in Brazil
reported having tried alcohol. Alcohol and drug use tends to increase
in late adolescence and early adulthood, but decreases as individuals
age (tobacco use is an exception, tending to remain in adulthood), a
phenomenon called maturing out.
However, substance use may lead to academic issues and move adolescents
away from activities important to their cognitive and emotional
development - for example, it hinders vocational choices and interferes
with the development of skills to deal with emotions. According to the World Health Organization (WHO),
1.7 million teenagers worldwide lose their lives every year, mostly
because of traffic accidents, suicide and homicide, often associated
with the consumption of alcohol or other drugs.
Investing in prevention
is an essential aspect of delaying initial contact with alcohol and
drugs, since early experimentation is associated with higher odds of
shifting to regular use and dependence.
The objective of the present article is to provide data on the
prevalence of general substance use in adolescence, assess the risk and
protective factors involved in the etiology of substance use disorder
(SUD) in this population, and address its clinical aspects, diagnosis,
prevention, and treatment.
Epidemiology
According to the United Nations Office on Drugs and Crime (UNODC),
it is estimated that between 153 and 300 million people aged 15 to 64
years used illicit substances at least once in 2010, which corresponds
to 3.4 to 6.6% of the world population in this age group. The UNODC also
estimates that 12% of this population (15.5 to 38.6 million) is
composed of problematic drug users, including individuals with addiction
and other SUDs.
Furthermore, illicit drug use accounted for roughly
99,000 to 253,000 deaths worldwide in 2010, which represents 0.5 to 1.3%
of all causes of death. These numbers increase further if legal drugs,
especially alcohol and tobacco, are also taken into account. WHO
estimates that 2.5 million people die annually because of harmful use of
alcohol, whereas 5.4 million deaths are caused by tobacco use.
In the United States, the use and abuse of alcohol occurs on average
at 14 years of age, and the use of other drugs, at age 15. In late
adolescence, 78.2% of adolescents have consumed alcohol and 42.5% have
already used at least one illicit drug.
In a study involving elementary and high school students from 27
Brazilian state capitals, the prevalence of drug use was 22.5%. The
proportion of users increases with age, but it is worrisome that 12.7%
of students aged 10 to 12 years have already used some psychoactive
substance at least once in their lives.
Alcohol is the most commonly used substance by youth worldwide, and initiation of alcohol consumption is occurring at increasingly early ages. In 2004, the average age at first drug use among Brazilian students was 12.5 years for alcohol, 12.8 for tobacco, 13.9 for cannabis, and 14.4 for cocaine. This information is important to the implementation of preventive strategies, which should begin around the age of 10 and focus on alcohol and tobacco, with the goal of delaying first exposure to drugs.
In Brazil, alcohol is the most commonly consumed and abused drug during the life course, followed by tobacco and cannabis. Although 66% of teenagers surveyed have declared themselves teetotal, 13% had a pattern of heavy alcohol consumption, 10% consumed alcohol 1-3 times per month, and 5% reported binge drinking or drinking to the point of intoxication. Another alarming fact is that among adolescent binge drinkers, 45% binge at least once a month and 18% once a week or more. In short, a minority of teenagers exhibit a high frequency and intensity of alcohol use.
The United States has the highest rates of binge drinking, drug use, and violent deaths in the Western world, and binge drinking accounts for 90% of all alcohol consumed by people under 21 in the country. Around 37.9% of U.S. high school girls use alcohol, of whom 54.6% reported binge drinking (19.8% of all students).
In Europe, the average rate of lifetime alcohol use is 88%; England, where the frequency of binge drinking in high school girls was 54%, leads the European ranking.
Use of alcohol and tobacco during youth is a predictor of their use in adulthood and of substance-related disorders.
In a systematic review of the literature on the use of alcohol and tobacco by adolescents aged 10 to 19 years, Barbosa Filho et al. found that the prevalence of current tobacco use (at the time of survey or in the preceding month) ranged from 2.4 to 22.0%, averaging 9.3%. In a study about smoking among adolescents aged 13 to 15 years in the Brazilian cities of Florianopolis, Curitiba, and Porto Alegre, the authors found a predominance of smoking behavior in girls compared to boys.
This finding is similar to those reported in other countries surveyed by WHO, except in Europe. Although the risk of onset of tobacco use by adolescents is higher when parents are smokers, there are other family factors associated, such as parenting practices of low acceptance and low behavioral control of children. In addition to the implications of tobacco use on adolescent health, it bears noting that concomitant use of tobacco and cannabis is common.
Cannabis is the most widely used illicit substance worldwide, with 119 million to 224 million users. A 2005 survey found that cannabis was the illicit drug with the highest rate of lifetime use among Brazilian adolescents aged 12 to 17 (4.1%), followed by solvents (3.4%).
Among students of public schools, the proportion of cannabis use was even greater (5.9%), but solvent use was most common overall (15.5%). Socioeconomic and cultural factors associated with this low-income population may explain the higher proportion of solvent users, as solvent consumption is higher in underdeveloped and developing countries. It is noteworthy that the prevalence of self-reported drug use may be underestimated because of the difficulty of measuring illegal behaviors.
The use of energy drinks has also been measured in recent epidemiological surveys. These drinks are widely consumed in combination with alcohol to increase their excitatory effect. Among Brazilian students, the lifetime prevalence of energy drink consumption (combined or not with alcohol) was 12%.
Alcohol is the most commonly used substance by youth worldwide, and initiation of alcohol consumption is occurring at increasingly early ages. In 2004, the average age at first drug use among Brazilian students was 12.5 years for alcohol, 12.8 for tobacco, 13.9 for cannabis, and 14.4 for cocaine. This information is important to the implementation of preventive strategies, which should begin around the age of 10 and focus on alcohol and tobacco, with the goal of delaying first exposure to drugs.
In Brazil, alcohol is the most commonly consumed and abused drug during the life course, followed by tobacco and cannabis. Although 66% of teenagers surveyed have declared themselves teetotal, 13% had a pattern of heavy alcohol consumption, 10% consumed alcohol 1-3 times per month, and 5% reported binge drinking or drinking to the point of intoxication. Another alarming fact is that among adolescent binge drinkers, 45% binge at least once a month and 18% once a week or more. In short, a minority of teenagers exhibit a high frequency and intensity of alcohol use.
The United States has the highest rates of binge drinking, drug use, and violent deaths in the Western world, and binge drinking accounts for 90% of all alcohol consumed by people under 21 in the country. Around 37.9% of U.S. high school girls use alcohol, of whom 54.6% reported binge drinking (19.8% of all students).
In Europe, the average rate of lifetime alcohol use is 88%; England, where the frequency of binge drinking in high school girls was 54%, leads the European ranking.
Use of alcohol and tobacco during youth is a predictor of their use in adulthood and of substance-related disorders.
In a systematic review of the literature on the use of alcohol and tobacco by adolescents aged 10 to 19 years, Barbosa Filho et al. found that the prevalence of current tobacco use (at the time of survey or in the preceding month) ranged from 2.4 to 22.0%, averaging 9.3%. In a study about smoking among adolescents aged 13 to 15 years in the Brazilian cities of Florianopolis, Curitiba, and Porto Alegre, the authors found a predominance of smoking behavior in girls compared to boys.
This finding is similar to those reported in other countries surveyed by WHO, except in Europe. Although the risk of onset of tobacco use by adolescents is higher when parents are smokers, there are other family factors associated, such as parenting practices of low acceptance and low behavioral control of children. In addition to the implications of tobacco use on adolescent health, it bears noting that concomitant use of tobacco and cannabis is common.
Cannabis is the most widely used illicit substance worldwide, with 119 million to 224 million users. A 2005 survey found that cannabis was the illicit drug with the highest rate of lifetime use among Brazilian adolescents aged 12 to 17 (4.1%), followed by solvents (3.4%).
Among students of public schools, the proportion of cannabis use was even greater (5.9%), but solvent use was most common overall (15.5%). Socioeconomic and cultural factors associated with this low-income population may explain the higher proportion of solvent users, as solvent consumption is higher in underdeveloped and developing countries. It is noteworthy that the prevalence of self-reported drug use may be underestimated because of the difficulty of measuring illegal behaviors.
The use of energy drinks has also been measured in recent epidemiological surveys. These drinks are widely consumed in combination with alcohol to increase their excitatory effect. Among Brazilian students, the lifetime prevalence of energy drink consumption (combined or not with alcohol) was 12%.
In the United States, about 6% of adolescents and young adults use energy drinks daily.
Use of anabolic steroids has also increased, reaching 6.6% of
adolescent males in Brazilian high schools; the risk of use is two- to
threefold higher among boys compared with girls,
and is most likely among sponsored athletes. The average age at first
use is 14 years, but use before the age of 10 has been reported.
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