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I chose the topic of substance use disorder among teens. It is common to hear about teen drinking but this research will focus more on illegal drugs and risky behaviors. Throughout the years, teens have become more susceptible to trying illegal drugs at a young age. Statistics show that almost 70% of teens have tried alcohol and/or illegal drugs, 40% of those teens have tried nicotine in the form of cigarettes or chewing tobacco, and 20% have used prescription pain medications for nonmedical purposes.  There are many factors that contribute to teen substance abuse disorder. During the teenage years, teens are more likely to be subjected to peer pressure. They often feel the need to “fit in” and will be exposed to harmful substances. The teenage years are also the time of their life where they are experimental. The teen years is when they are learning who they really are and forming their personality. They tend to seek risks in their life which lead to new experiences in order to fulfill their desire of shaping their identity. There are many social and environmental factors that influence a teen to use drugs.  Their neighborhood and community are factors which would determine how accessible the drugs are. Their groups of friends are also factors due to peer pressure and the “need to fit in.” Family factors also play a role in influencing substance abuse among teens.  Dysfunctional families that have a lot of domestic violence, abuse, neglect, mental illnesses, and drugs in the home are all factors that can contribute to teens using drugs. A teen who suffers from untreated mental illness are likely to try illegal substances due to poor impulse control, depression, and anxiety.The prevalence of substance abuse in teens is on the rise and social media plays a big part in this. According to the article published in PMC journal, a study was done to see substance abuse patterns among teens that are using the social media app, Twitter. According to this article, “a total of 79,848,992 tweets were collected from 48 states in the United States from April 2015 to March 2016 through the Twitter app, of which 688,757 were identified as being related to substance use” (Meng, H.-W., Kath, S., Li, D., & Nguyen, Q. C. (2017)Teens are using substances and posting “tweets” about their drug use on social media. The article states that alcohol was most common and it was followed by marijuana use. Teens who abuse substances have a higher risk of engaging in risky behavior. Approximately 90%  of teens today use social media to communicate with their friends and fellow schoolmates, this may be why substance abuse among teens have increased considering that teens are seeing their friends engage in risky behaviors and using drugs. Research shows that 1 in 14 adolescents’ ages 12-17 has used marijuana and even more for alcohol use. Research shows that 64% of adults who are suffering from addiction started abusing drugs at the age of 20 or younger in some cases. Other statistics show that 50 % of users started using inhalants at the age of 15 years, hallucinogens and stimulants at 17 years, and opiates at 18 years (Andersen and Teicher 2009). I think that this issue is important because teens that use drugs in early years have a higher chance of becoming addicts and putting their health and safety at risk. Risky behaviors such as unprotected sex are often associated with adolescent drug use and can lead to unplanned pregnancies and STD’s. Teenagers are very vulnerable and by educating them and attempting to prevent them from substance abuse, the percentage of addicts as an adult will ultimately lower.  Most of the addicts that I work with started using drugs at a young age. The common age to begin experimenting with drugs is between the ages of 12 and 17. Adults who suffer from addiction usually say that they began smoking marijuana in high school and eventually tried “harder drugs” not long after.  From a personal perspective, I have a close acquaintance that is only 14 years old. She has mental health issues with multiple mental health admissions and attempted suicides. She began smoking marijuana, drinking alcohol and having unprotected sex with multiple partners. Not long after that, she was at a party where she then tried Ecstasy. That is a very scary thought knowing that a 14 year old has experimented with many substances and also engaged in risky behaviors such as promiscuous sex. It’s even scarier to know that it was not only her engaging in these activities, it was several of her friends all around the same age as well. A bio-psycho-social perspective on substance use disorder in teens describes that teens are still in their developmental stage in life and are going through physical, cognitive, social and emotional changes.  At this age, teens are learning how to become more independent and are leaning about their personality. This is the age where they find a “click” or peer group and attempt to fit in. They feel the need to be socially accepted. This is where the teen becomes interested in experimenting with harmful substances. Risk taking behaviors at this age are very dangerous and have serious consequences. Unwanted pregnancies, criminal charges, and sexually transmitted diseases are just a few consequences that many teens may face.  In a study that was done in 2010 that tracked the number of teens who have used drugs the results were reported. Forty one percent of high school seniors had consumed alcohol, thirty five percent had used marijuana (6% reported daily use), and twenty one percent used non prescription pain medications. Teen pregnancy rates began to incline and 1 in 4 females have had a sexual transmitted disease. Environmental, biological, and psychosocial factors have been found to be associated with adolescent risky behavior. Environmental factors such as family, peers, school and social media play a role in adolescent risk taking behaviors and substance abuse.  Adolescents usually have a close relationship with their family and their parents influence the behavior of the child.  When parents are non drug users and are providing a nurturing and supportive environment, the child is less likely to engage in risky behaviors and abuse drugs. When parents lack parenting skills and do not monitor their teens behaviors and peers, the teen is more likely to engage in risky activities. Communication between parents and children is especially important because it builds a trusting relationship and this acts as a protective factor. An adolescent’s peers are even more of a risk factor than the family. Peer influence tends to increase through the school years. Peers tend to act together in these risk taking behaviors. Studies show that adolescents are usually part of a peer group when engaging in sexual behavior, drug use and crimes. Social network has become very popular in the recent years. Everything a teen does can now be shared on social media if they choose to. This allows a teen to be a part of a large peer group and have the urge to fit in. Biological factors include genetic predispositions, hormonal influences, the influence of asynchronous pubertal timing, and the brain/central nervous system development (J.M Sales, C.E Erwin Jr., 2013.) Studies have found that genetic predispositions play a role in an adolescent having a substance abuse disorder. If a child has two alcoholic parents, that child is 4 times more likely to develop alcoholism than children of non alcoholic parents (J.M Sales, C.E Erwin Jr., 2013.) Adolescents are experiencing many hormonal changes in their teenage years. Hormonal changes play a role in risk taking behaviors such as promiscuous sex. The sex drive of a teenager increases due to the increased levels of estrogen and testosterone. This is a vulnerable time in a teenager’s life to experiment with risky behaviors. Asynchronous pubertal maturation is when a teenager begins puberty. Teens that mature faster than their peers and look older than they are tend to become a part of older peer groups. They may engage in behaviors that the older group engages in such as smoking, drinking, drugs, and sex.  Brain and central nervous system development also plays a role in risky behaviors. Neuroscience indicates that the brain continues to mature into adulthood. Impulse control is associated with the cognitive control system and it doesn’t mature until adulthood. Teens are at risk for acting on their impulses and not being able to control their desire to experiment with substance abuse or other risky behaviors. Decision making skills are also part of the cognitive control system. If an adolescent’s cognitive control system is not fully matured, they are not able to make responsible decisions. This is where peer pressure comes into play. If a teen is being pressured by their fellow peers, they may not have the mature ability to turn down the offer of trying drugs or other harmful behaviors. Psychosocial factors include the roles of cognition, personality traits, and dispositional characteristics, which they all influence adolescents risk taking behaviors. Traumatic life events in a child’s life may also lead the adolescent to start abusing substances. Traumatic life events include: sexual abuse, emotional or physical abuse, or neglect. Children who experience these types of traumas are at a high risk of drug use, criminal behavior, risky behavior and self-destructive/suicidal behavior. Studies show that children who experience trauma usually have a negative self image and low self esteem. They may feel that the world is not a safe place and suffer from severe emotional pain. The adolescent may experiment with drugs at this time to “deal” with their emotional pain. Adolescents who do not attend therapy after a traumatizing event also have a higher risk of drug use and relapse as an adult. They may suffer from anger, guilt and shame which all lead to serious mental illnesses and cause the adolescent to participate in risky behaviors and substance abuse.Treatment options vary depending on the substance abuse involvement. First an assessment must be completed in order to distinguish the level of care that the adolescent needs. The clinician must then determine which stage of drug use the adolescent is at. Each stage describes different treatment approaches. Stage one is recreational or experimental use. This stage typically doesn’t require intense treatment; it focuses more on education and prevention. Stage two is substance misuse. Teens on this stage have discovered that drugs help them “cope” with their feelings and enjoy the feeling of being high. Education and prevention measures are taken at this stage to prevent the teen from continuing their drug abuse. Stage three is where the teens can be accurately diagnosed with “substance use disorder.” Education, therapy, family treatment and twelve step programs are all treatment options at this stage. Stage four is when the teen can be diagnosed with “substance dependency disorder.” Treatment for this stage includes a residential program or inpatient unit as well as therapy, and possibly medication.There are several evidence- based approaches when treating teens with substance abuse disorder. Each approach is unique and designed to concentrate on specific aspects of teen drug use and its consequences for the teen, their family, and the society. These evidence based approaches have been tested to be used short term such as 12-16 weeks but for some cases, treatment needs to be extended. The extension of treatment options is decided on a case by case basis. The clinician should choose an approach that is best suited for the client and their family in order to get the best outcome. The main goal is to get the addict clean, however the approach you take with each individual should be geared to that client’s level of understanding, need for treatment, and severity of the problem. The behavioral approach addresses the teen’s behavior and allows the teen to participate with their recovery. This approach assists with the teen building resilience against the urge to use harmful substances. Incentives may be addressed in therapy to give the teen a motive to not use drugs. Attitude and behaviors are addressed during session to promote change. Therapists also help families with improving their communication and relations with the teen. The teen is educated on specific life skills that they can use to handle stressful situations that may trigger them to use drugs. Some behavioral treatments that are used are group therapy, Cognitive Behavioral therapy (CBT), and Motivational Enhancement Therapy (MET). Group therapy can help a teen stay positive and learn healthier social behaviors so that the teen can live a drug-free life.  CBT focuses on giving the teen coping skills so that they can resist the urge to use. The teens can explore the positive and negative consequences, learn how to think in a positive way, handle stressful life situations, and practice problem solving skills. This therapy will help the teen identify their triggers that cause them to use drugs and replace the drug use with a positive coping skill in order to stay clean. MET is an approach that uses motivational interviewing which will assist the teen with being motivated to participate in treatment and recognize their drug addiction. Family- based approaches involves the family with the teen’s treatment. This is important because unlike adults, teens must live with at least one parent or family member. Family issues may be a large contribution to the substance abuse. By using the family- based approach, the therapist can address family conflict, support, peer network, issues regarding school or work attendance, and mental health disorders. This approach has been tested and proven to be successful in residential facilities as well as intense outpatient facilities.Early intervention may reduce the likelihood of a teen developing a substance use disorder (SUD) later in life.  During the adolescent years, children are just starting to experiment and figure out who they really are.  This is the period of their life where they will be subjected to peer pressure and harmful behaviors that may result in serious consequences. This is also the time in their life that a substance use disorder may begin. The universal prevention approach is utilized to teach adolescents how to handle stressful situations such as peer pressure. This approach is often used in schools and it teaches children to be resilient against peer pressure, increase self esteem, and reduce anxiety that stressful situations may cause. These factors all play a role in teens experimenting with substances. If life skills are taught and utilized, the percentage of teen substance abuse will decrease.  Adolescents who have experienced a traumatic life event have a higher risk of dropping out of drug treatment programs. Studies show that there are several reasons why adolescents may drop out of treatment which are fear of re-experiencing the original trauma, trouble with trusting adults, feelings of hopelessness and worthlessness, and feelings of not being in control since they were once a victim of some type of abuse (Spooner, 1999.) Increased stress and mental illnesses play a role in adolescent substance abuse. The existence of life stress is not the cause of drug use, but the lack of knowledge on how to handle stressful situations may lead to substance abuse. Learning coping skills and stress reduction strategies are important for an adolescent to recover and reduce drug use. Usually coping skills are incorporated with Cognitive-Behavioral therapy which is a commonly used therapy approach to treat addicts.  If the case is severe enough, the adolescent may also be referred to a psychiatrist to receive medication. It is not recommend for children under the age of 18 to be put on medication strictly for addiction however, medication used to treat anxiety and depression may be useful to help the adolescent cope and overcome their urge to use drugs. Relapse prevention is also important when treating addition. Therapists should assist the adolescent with discovering their triggers that cause drug use. After the triggers are discovered, relapse prevention strategies should be taught so that the adolescent will be able to deal with situations and reduce the urge to use drugs.  Overall, studies show that coping skills and support systems are both protective factors to reduce adolescent substance abuse. By using the skills learned in therapy, adolescents can be more self aware of their emotions, treatment barriers, and create positive social relationships in their life.Research that I have found suggested that drug testing should be permissible in school. This article discussed how drug testing in school is a nationally debatable subject and pointed out reasons as to why it should be done. Some of the positive findings of this study revealed that drug testing in school encourages the adolescent to remain drug free and was a tool for therapeutic monitoring while in treatment for their addiction. The concerns about this approach are the cost, consequences of a positive test and breach of confidentiality. Research indicates that not one specific approach is the “best” for treating adolescents who have substance use disorder. A multisystem approach should be utilized which incorporates treatment and education regarding family issues, peers, school, and community and overall will address the substance abuse problem. In conclusion, it appears that substance use disorder among teens is on the rise. The research that I found was from different years and generations and with each year, it shows an increase in statistics, and new and improved treatment options. I think the one major influence in the rise of teen substance abuse is the access to social media. Years ago, social media was not around and teens could only communicate with peers who they knew from school or the community. Social media gives teens a chance to expand their peer groups. Social media also gives teens the opportunity to post their actions for everyone to see. They feel the need to fit in and be socially accepted and if teens are following negative influences they will be involved with risky behaviors. Another factor I think that contributes to the increase of teens that have a substance use disorder is the family. Today, many children are being raised by grandparents because the parents are suffering from addiction. Genetic factors and social environment play a role in teens using substances. I once was on a home visit for my job and a small child approximately the age of 12 knew all about drugs, her mother being high, what hypodermic needles were, and found her mother shooting up heroine in their bathroom. This child and her younger siblings were being raised by their grandmother who was disgusted at what her daughter was doing in front of her children.  The child knew that her mother’s behavior was wrong, but there is a chance that she will grow up and begin to experiment with substances just as her mother did. This is one story of one family in our area. You hear these stories more often than not nationwide on the news. Education and parental involvement are the two main prevention measures to end teen substance abuse. Some teens do not have the luxury of growing up in an intact family with no family issues and drug-free parents. Early prevention measures need to be taken and utilized. Schools have always promoted drug-free campaigns and “just say no” but I think children should receive a lot more education regarding drug use. Education regarding coping skills, stress management, peer pressure and family issues should be addressed. It may sound terrible to teach an eight year old about the severity of drug use, but I think starting the education at a younger age would help to stop teen drug use. Adolescents seem to be experimenting at a younger age than decades ago. I can recall back when I was in 5th or 6th grade, me and my peers wouldn’t even know where to find drugs. Nowadays, twelve year olds know where to go and how to obtain illegal substances whenever they want.  Parental involvement also needs to be increased. Most parents probably do monitor their children’s social media but I think children still get away with too much on the internet. Parents should also be educated to watch for signs of teen drug abuse. If they suspect their child of doing drugs, they need to know what step to take next and where to go to receive help. It is important to learn about mental illnesses and community resources. Schools in my area today have a program called “Belmont County Schools Staying Clean.” This program teams up with local restaurants and other establishments that provide incentives for children to remain abstinent from drug use. Adolescents are not forced to be in this program, but the ones who do sign up are recognized for it. They are also drug tested every so often to ensure that they are remaining clean and can receive their incentive for not doing drugs. After reading many articles regarding teen substance abuse, I believe that it is extremely important to educate children, parents and communities and keep promoting preventive measures as much as possible.

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