A major global review of substance use in young people, published last week in the journal Lancet Psychiatry, confirms that adolescence is a critical period for developing substance use related problems which can affect later health outcomes, and highlights the need for more research and better prevention and intervention worldwide. In Australia, alcohol made up the largest burden among young people, with males being most affected. Illicit drug use in Australia accounted for more health harms among young people than in any other region of the world.
The three-part series, led by NDARC Professor Louisa Degenhardt and Professor Wayne Hall of the University of Queensland and co-authored by UNSW Post-Doctoral Research Fellow Dr Emily Stockings, reviewed the evidence for the current nature and patterns of substance use among young people around the world, the potential effects of adolescent substance use later in life, and the effectiveness of prevention, intervention, harm reduction and treatment.
Prevalence and harms
Overall alcohol and illicit drug use account for 14 per cent of the total health harms affecting young people aged 20-24. In this age group in Australasia (Australia, New Zealand and PNG) alcohol and illicit drug use accounted for 22 per cent of health harms and young males in the region suffered more harms from illicit drug use than any other region in the world –10.8 per cent of harms compared with 7.5 per cent in Western Europe and 9 per cent in North America.
The authors note that young adolescence is a period when substance use typically starts and patterns become established, and a large number of adverse health and social outcomes have been associated with substance use. This, the authors argue, makes substance use in young people is an important public health concern and needs to be better understood in order to respond appropriately.
Risk factors which affect the likelihood of use
- Availability of the substances
- Fixed risk “markers” such as being male; parental and sibling and genetics which increase an adolescent’s risk of use
- Individual personality traits such novelty and sensation seeking, oppositional and conduct disorder in childhood
- Social and family context such as poor school performance, parenting style and poor quality parent child relationships
However the authors warn independent of these risk factors “association with antisocial and drug using peers” is the strongest predictor of adolescent use.
Neurobiological significance of early use
An increasing body of research evidence over the last 20 years had established that development continues well into the third decade of life and this has heightened the concern over the impact of adolescent use of alcohol and illicit drugs on cognitive and emotional development.
“A range of studies have suggested that substance ease during adolescence can have a greater neuropsychological effect that substance ease later in life, with some suggestion of an increased sensitivity to neurotoxic effects,” write the authors.
Impact of early use
Substance use during adolescence and young adulthood carries a triple risk, write the authors:
- Adverse health and social effects of both acute intoxication ( binging) and regular heavy use
- Disruption of transitions into adulthood – education; employment and relationships
- Intergenerational impacts on children
Opportunities for prevention
The review found that policy interventions such as taxation, controls on minimum age and availability were found to be effective prevention and harm reduction measures for alcohol use, the authors highlighted but these policy are not available to illicit drugs.
“In view of this, innovations are needed in prevention approaches for illicit drugs and an increased quality of research is needed to identify individualised strategies to reduce the use and harms associated with illicit drug use in young people,” write the authors.
To read the three papers of the series, please click below:
1. Prevention, early intervention, harm reduction, and treatment of substance use in young people
2. Why young people's substance use matters for global health
3. Prevention, early intervention, harm reduction, and treatment of substance use in young people
