Sociation Today

Risk Factors Associated with Alcohol and Drug Use During Adolescence:
Missing Variables in the Research Field

by

Layla A. Martin

Durham North Carolina Public Schools

     Health habits are often developed during adolescence and these habits tend to define individuals' lifestyles later in life (Harris, Gordon-Larsen, Chantala, and Udry 2006). During adolescence, youth may engage in risky behaviors, such as drinking while driving, engaging in unprotected sex, weapon use, or of particular interest to this study, the use of alcohol and other drugs (Harris, Duncan, and Boisjoly 2002; Steinberg 2007). Drawing from a nationally representative sample of youths ages 13-18-years-old (N=10,123), findings from the National Comorbidity Survey-Adolescent Supplement indicate that 78 percent of U.S. adolescents reported consuming alcohol and 47 percent indicated they drank alcohol on a regular basis. The report also finds that nearly 43 percent of their sample reported drug use, with over 16 percent indicating drug abuse (Swendsen et al. 2012).

    Adolescent substance use is a problem because studies consistently find that it negatively impacts youths' physical and mental health and contributes to emotional distress and interpersonal problems (Newcomb and Bentler 1988). More recently, Volkow, Baler, Compton, and Weiss (2014) find that marijuana use during adolescence is associated with both short and long-term negative consequences, including impaired short-term memory and an increased likelihood of dropping out of high school. In addition to substance use being an individual-level problem, findings from the National Institute on Drug Abuse (2012) suggest that the estimated cost for illicit drugs and tobacco use are approximately $193 billion and $235 billion for alcohol.

    Therefore, because prior literature suggests that adolescent substance use is both an individual and societal problem, in this paper I systematically review previous research to identify risk factors associated with substance use among adolescents, ages 11-18. I am interested in how studies address the impact of age, gender, race, education, family involvement, peer interaction, and history of mental health disorders predicting substance abuse among adolescents living in the United States. My approach will help identify important risk factors that may contribute to adolescent substance abuse, which is important in the development of policy and evidence-based prevention models aimed to benefit adolescents, their families, and society.

Adolescents and Alcohol, Tobacco, and Marijuana Use

The underage consumption of alcohol is common among adolescents (Richter et al. 2016), and Kirby and Barry (2012) argue that this is problematic because most underage drinkers report heavy drinking, consuming five or more drinks in one sitting. The Center of Disease Control and Prevention 2009 Youth Risk Behavior Surveillance System, which monitors youth risk behaviors for students in grades 9-12, reports that nearly 73 percent of students consumed at least one drink in their life (Kirby and Barry 2012). Additionally, studies suggest that adolescents who abuse alcohol are more likely to have problems with alcohol and other drug use as they transition into adulthood (Ramirez, Hinman, Sterling, Weisner, and Campbell 2012).

Stone and Peters (2017) argue that globally, youth begin smoking cigarettes between the ages of 13-15. Sargent et al. (2017) find that adolescents who smoke daily are likely to sustain this behavior into adulthood. Additional studies suggest that experimental smoking is often a strong predictor for becoming an established smoker, and cigarette smoking is one of the most addictive behaviors among adolescents (Sargent et al. 2017). Tobacco is often viewed as a "gateway drug" because of its correlates with an increased likelihood of other drug use, including cocaine, marijuana, and heroin (Johnson, Boles, and Kleber 2008). Other studies find that while tobacco use is decreasing among adolescents and young adults, marijuana use is increasing (Berg et al. 2015). For example, although marijuana use among adolescents fluctuated between the late 1990s and mid-2000s, studies suggest an increase since the 2000s (Johnston 2010). Some scholars argue that the increase in marijuana use may be associated with law and policy changes regarding the legalization of marijuana (Berg et al. 2015).

Reasons for Alcohol and Drug Use during Adolescence

    Studies suggest that parental substance use and their children's use of substances are highly correlated with one another (Hedges 2011). This is problematic because Hedges (2011) estimates that in the United States, there are approximately 8 million children who reside in households with at least one parent who is dependent on or abusing substances. Studies also find that living in a two-parent household helps deter alcohol, tobacco and other drug use (Paxton, Valois, and Drane 2007). This is supported by other studies. For example, Hemovich and Crano (2009) find that adolescents who reside in single-parent households are more susceptible to delinquent behaviors, including drug and alcohol use. The authors argue that this may be because adolescents in single-parent households are less likely to be closely and consistently monitored compared to their peers in two-parent households. Additionally, parents with fewer financial resources, including those on welfare are more likely to have children who use alcohol, tobacco, and other drugs (Hemovich and Crano 2009).

    Peers also contribute to adolescents use of alcohol, tobacco, and illicit drugs. For example, Flanagan, Fisk, and Gallay (2004) find that among their sample of adolescents between 5th and 12th grades (N=2,659), adolescents who used alcohol, tobacco, or other drugs were more likely to begin or maintain their substance use habits based on the habits of their friends. More recently, using a sample of 937 adolescents from the Adolescent Health Risk Behavior Survey, Meriano et al. (2017) find that higher friend approval of marijuana use was associated with one's own marijuana use.

    In addition to the influence of families and peers, studies consistently show that adolescents with mental health issues are more likely to smoke cigarettes than other youths; however, research is relatively limited that compares non-tobacco users and their mental health status (King, Reboussin, Spangler, Ross, and Sutfin 2017). Because many adolescents with mental health issues do not receive adequate services, self-medicating with alcohol and other drugs is common among youths with both diagnosed and undiagnosed mental health issues (Greenbaum, Prange, Friedman, and Silver 1991). Dunne, Bishop, Avery, and Darcy (2017) argue that the occurrence of substance use and adult mental health issues primarily emerges in adolescence.

Methods

To identify peer-reviewed articles for this literature review, I conduct online searches using search engines such as "NC Live" and "Google Scholar". Keywords used to filter articles included "substance abuse", "substance use", "adolescent", "race", "gender", "peer influence", "family influence", "socioeconomic status", and "substance use impact on mental health" "marijuana use" "tobacco use" "substance use impact" "education and substance use."

The criteria for inclusion in the current study: (1) articles were quantitative, (2) articles addressed environmental factors associated with substance use, (3) articles focused on adolescents, (4) articles included data regarding treatment and prevention programs, (5) articles were published in English, (6) articles collected or used data from a sample from the United States, (7) articles were published in the United States, and (8) articles were published between the years 1996-2013.

Findings

Table 1 provides a list of articles that met the search criteria detailed in the previous section. Articles ranged in publication year from 1998-2013. Articles were published in a variety of different journals, which demonstrates an interdisciplinary interest in adolescent substance use, including Children and Youth Services Review, Journal of Research on Adolescence, Journal of Drug Education, Journal of Youth Studies, Journal of School Health, and the Journal of Primary Prevention.

Table 1: Identified Studies
#	Studies	Authors	Date
1	Predictors of Early Substance Use Among African American and Caucasian Youth from Urban and Suburban Communities	Abbey, A., Jacques, A. J., W., H. J., & Sobeck, J.	2006
2	Identifying Mental Health and Substance Use Problems of Children and Adolescents: A Guide for Child-Serving Organizations.	Administration, S. A.	2011
3	Adolescent substance abuse: National Trends, consequences, and promising treatments	Becker, S.	2013
4	The impact of parental substance abuse on the stability of family reunifications from foster care	Brook, J., & McDonald, T.	2009
5	How Academic Achievement, Attitudes, and Behaviors Relate to the Course of Substance Use During Adolescence: A 6-Year, Multi-wave National Longitudinal Study	Bryant, A. L., Schulenberg, J. E., O'Malley, P. M., Bachman, J. G., & Johnston, L. D	2003
6	Reducing Substance Use Improves Adolescents' School Attendance	Engberg, J., & Morral, A. R.	2006
7	Friends Don't let Friends... Or Do They? Developmental and Gender Differences in Intervening in Friends ATOD Use	Flanagan, C., Elek-Fisk, E., & Gallay, L	2004
8	National Alliance on Mental Illness	Friman, P. C.	1998
9	Where and When Adolescents Use Tobacco, Alcohol, and Marijuana: Comparisons by Age, Gender, and Race	Goncy, E., & Mrug, S.	2013
10	A family affair: Contextual Accounts from Addicted Youth Growing Up in Substance Using Families.	Hedges, K. E.	2011
11	Family Structure and Adolescent Drug Use: An Exploration of Single-Parent Families.	Hemovich, V., & Crano, W. D	2009
12	Alcohol as a Gateway Drug: A study of U.S 12th Graders	Kirby, T., & Barry, A.	2012
13	Is there a Relationship between Family Structure and Substance Use among Public Middle School Students	Praxton, R., Valois, R., & J., D.	2007
14	Peer Influences on Adolescent Alcohol and Other Drug Use Outcomes	Ramirez, R., Hinman, A., Sterling, S., Weisner, C., & Campbell, C.	2012
15	Substance Abuse in Minorities	Sharma, M.	2008
16	Results from the 2002 national survey on drug use and health: Detailed tables.	Substance Abuse and Mental Health Services Administration.	2004
17	Cultural considerations in family-based primary prevention programs in drug abuse	Turner, W. L.	2000

Table 2 presents location of the study, total sample size, age or grade-level of participants, racial composition of the study (white/black), and gender composition of the study (male/female). All studies drew from samples within the United States, with some studies indicating general geographic locations. Other indicated more specific locations, such as Detroit, MI, San Francisco, CA, and Tucson, AZ. Nearly 30 percent of the articles (N=5) did not specify their participants' ages or grade-levels. While approximately 41 percent of the studies (N=7) did indicate the specific age range for their sample. Most studies described the racial composition of their sample (N=9), while the other eight articles did not specify the racial composition of their sample. Among the articles, sample sizes ranged from 25 participants to 47,000 participants; however, three articles did not indicate their sample size.

Table 2 also shows that six of the peer-reviewed articles focus on how demographic factors; such as age, gender, and race predict adolescent substance use. Four of the articles focus on educational level predicting substance use. Table 2 also shows that five articles addressed the impact of family factors predicting substance use. The impact of peer relationships was addressed in four of the 17 articles. I also find that two articles focus specifically on mental health as a predictor for adolescent substance use. Table 2 suggests variability regarding the articles' (1) focus, (2) location, and (3) demographic characteristics.

Table 2: Article Characteristics
#	Location	Total (N)	Age or Grade Level	Race	Gender
1	Metropolitan Detroit, MI	81	6^th graders	92% Black 89% White	Not Specified
2	United States		Ages 13-22	Not Specified	Not Specified
3	United States	47,000	Ages 12-17	Not Specified	Not Specified
4	Oklahoma	13,711	Not specified	11% Black 63%White	50% Female
5	United States	1,897	Ages 14-20	11.3% Black 64.5% White	Not Specified
6	United States	1,084	Ages <14-19	Not Specified	Not Specified
7	Northeastern States	2,697	5^th-12^th grade	12% Black 74% White	54% Female
8	United States		Not specified	Not specified	Not Specified
9	Metropolitan Areas	20,055	Ages 10-19	55% Black 44.9% White	Not Specified
10	Tucson, AZ	25	Ages 14-18	12% Black 32% White	100 % Female
11	United States	37,500	8^th-12^th grade	Not Specified	Not Specified
12	United States	14,600	12^th grade	1,799 Black 8,334 White	6,644 Male 7,068 Female
13	Southern States	2,138	6^th-8^th grade	43% Black 57% White	Not Specified
14	San Francisco, CA	419	Ages 13-18	15% Black 50% White	246 Male 138 Female
15	United States	Not Specified	Not Specified	Not Specified	Not Specified
16	United States	Not Specified	Not Specified	Not Specified	Not Specified
17	United States	Not Specified	Not Specified	Not Specified	Not Specified

Discussion and Conclusion

    This article stresses the importance of addressing alcohol and drug use among adolescents. Scholarly research plays a vital role in understanding substance use and abuse, which may aid in the development of programs, policies, and practices that will help promote adolescent health. From a social worker's point of view, it is imperative for individuals working with teenagers and young adults to understand the risk factors associated with early substance use. We know that early substance use is associated with a host of negative consequences even though during the teenage years, youths may feel indestructible. We also know that many of the consequences of substance use are irreversible and may be life-threatening.

    Additionally, this review underscores a gap in the research addressing adolescents use of alcohol and drugs. While I find that many of the articles specifically test the relationship between race and substance use, there was a lack of information regarding specific cultural characteristics that may influence the likelihood that youths will engage in substance use and best practices to treat substance abuse issues. Because the United States is a diverse, multicultural society, treatment programs should be sensitive to the needs of all adolescents. Treatment programs should not only respect different cultures, but they should also draw from the strengths of unique cultural characteristics of different social groups. It is imperative for social workers and other practitioners to be culturally competent when working with youths and their families.

    Understanding how substance use affects adolescents and their families is important for individuals interested in providing advocacy for youths and those concerned in the development of programs and policies targeting adolescents and their families. It is also important for social workers, school administers, teachers, and others working directly with youths and their families to understand how demographic characteristics, relationships with family and peers, and mental health influence the likelihood that adolescents will engage in alcohol, tobacco, and drug use.

    In addition to treating youths' substance abuse issues, more research is needed to address how to prevent substance use, focusing on how to deter self-medicating through use of alcohol and other drugs. Future research should examine how after school activities, community organizations, positive peer-to-peer mentoring, and strong formal and informal support systems may help prevent substance use among adolescents.

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