The percentage of young adults who said they were abusing cocaine or methamphetamine dropped substantially from 2006 to 2007, according to the 2007 National Survey on Drug Use and Health (NSDUH), published in September 2008. Overall drug abuse, however, remained constant: According to the survey, an estimated 19.9 million Americans age 12 and over used an illicit drug in the previous month. That rate has held steady since 2002.

Illicit Drug Use Among Youths and Young Adults: Youths (age 12 to 17) have lower rates of drug use than young adults (age 18 to 25). Youth rates (open symbols, broken lines) have fallen gradually, while the young adult (filled symbols, solid lines) rates have remained level.

As in past years, young adults (aged 18-25) reported the highest rates of substance abuse. About 20 percent said they abused one or more illicit drugs; 16.4 percent said they abused marijuana, which topped the list of abused drugs in this cohort. Abuse rates for marijuana and most of the other drugs have changed little in the past 6 years. However, the decline in abuse of the stimulants cocaine and methamphetamine in this group runs counter to that pattern. In 2007, for example, 1.7 percent of the young adults reported cocaine abuse, a 23 percent decline from the previous year. Methamphetamine abuse in this age group dropped by a third, to 0.4 percent.

By contrast, 12- to 17-year-olds have reported a steady decline in overall illicit drug use, from 11.6 percent in 2002 to 9.5 percent in 2007. Driving the decline in this cohort has been an 18 percent drop in marijuana use, from 8.2 percent in 2002 to 6.7 percent in 2007. Inhalants are the only drug category that showed no decline among adolescents over that 6-year period, although rates for some drugs have leveled off since 2005.

Rates of drug abuse tend to decline steadily after the age of 25. However, as more baby boomers (people born between 1946 and 1964) enter the 50-59 age range, illicit drug use in that group has risen, jumping from 2.7 percent in 2002 to 5 percent in 2007. "Illicit drug use has historically been more prevalent in the baby boomer cohort. As its members age into the 50-59 age category, the prevalence increases relative to prior cohorts in this age group," says Dr. Marsha Lopez of NIDA's Division of Epidemiology, Services and Prevention Research.

Marijuana remains the most commonly used illicit drug across the survey, with an estimated 14.4 million past-month users. In 2007, roughly 2.1 million people smoked marijuana for the first time, and a similar number started using prescription painkillers for nonmedical purposes; these drugs drew more initiates last year than any other. Of the estimated 6.9 million people who used prescription psychotherapeutic drugs nonmedically, 5.2 million chose painkillers, representing a 16 percent rise in nonmedical use of these drugs since 2004. On a positive note, the 2007 survey found a significant 1-year decline in the nonmedical use of prescribed stimulants.

In 2007, as in previous years, men reported higher rates of past-month illicit drug use than women (10.4 percent versus 5.8 percent). Among ethnic groups, American Indians/Alaska natives had the highest rate of illicit drug use (12.6 percent) of any racial/ethnic group, followed by multiracial individuals (11.8 percent), African-Americans (9.5 percent), whites (8.2 percent), Hispanics (6.6 percent), and Asians (4.2 percent). No group had a significant change from the previous year.

The trends determined by NSDUH for adolescents and young adults are generally consistent with those reported by the NIDA-funded Monitoring the Future survey. (For more information, see NIDA Notes, Volume 21, Number 5, March 2008, page 15). The survey, based on the responses of 67,500 participants, is available online at www.oas.samhsa.gov/NSDUHlatest.htm. Hard copies can be ordered free by calling (800) 729-6686.

Source

Substance Abuse and Mental Health Services Administration, 2008. Results from the 2007 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, DHHS Publication No. SMA 08-4343). Rockville, MD: SAMHSA.

Men and women with alcohol use disorders (AUDs) are 18 times more likely to report nonmedical use of prescription drugs than people who don't drink at all, according to researchers at the University of Michigan. Dr. Sean Esteban McCabe and colleagues documented this link in two NIDA-funded studies; they also discovered that young adults were most at risk for concurrent or simultaneous abuse of both alcohol and prescription drugs.

"The message of these studies is that clinicians should conduct thorough drug use histories, particularly when working with young adults," says Dr. McCabe. "Clinicians should ask patients with alcohol use disorders about nonmedical use of prescription drugs [NMUPD] and in turn ask nonmedical users of prescription medications about their drinking behaviors." The authors also recommend that college staff educate students about the adverse health outcomes associated with using alcohol and prescription medications at the same time.

Two Studies

The authors' first study looked at the prevalence of AUDs and NMUPD in 43,093 individuals 18 and older who participated in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) between 2001 and 2005. Participants lived across the United States in a broad spectrum of household arrangements and represented White, African-American, Asian, Hispanic, and Native American populations. Although people with AUDs constituted only 9 percent of NESARC's total sample, they accounted for more than a third of those who reported NMUPD.

Since the largest group of alcohol/prescription drug abusers were between the ages of 18 and 24, the team's second study focused entirely on this population and involved 4,580 young adults at a large, public, Midwestern university. The participants completed a self-administered Web survey, which revealed that 12 percent of them had used both alcohol and prescription drugs nonmedically within the last year but at different times (concurrent use), and 7 percent had taken them at the same time (simultaneous use).

When alcohol and prescription drugs are used simultaneously, severe medical problems can result, including alcohol poisoning, unconsciousness, respiratory depression, and sometimes death. In addition, college students who drank and took prescription drugs simultaneously were more likely than those who did not to blackout, vomit, and engage in other risky behaviors such as drunk driving and unplanned sex.

Past-Year Nonmedical Use of Prescription Drugs by Past-Year Drinking Status: Prescription drug misuse rises with drinking severity. Increases are most pronounced in adults aged 18-24.

Who, What, and When

The prescription drugs that were combined with alcohol in order of prevalence included prescription opiates (e.g., Vicodin, OxyContin, Tylenol 3 with codeine, Percocet), stimulant medication (e.g., Ritalin, Adderall, Concerta), sedative/anxiety medication (e.g., Ativan, Xanax, Valium), and sleeping medication (e.g., Ambien, Halcion, Restoril). The college study asked about the respondent's use of medications prescribed for other people while the NESARC explored both use of someone else's prescription medications as well as the use of one's own prescription medications in a manner not intended by the prescribing clinician (e.g., to get high).

The researchers found that the more alcohol a person drank and the younger he or she started drinking, the more likely he or she was to report NMUPD. Compared with people who did not drink at all, drinkers who did not binge were almost twice as likely to engage in NMUPD; binge drinkers with no AUDs were three times as likely; people who abused alcohol but were not dependent on alcohol were nearly seven times as likely; and people who were dependent on alcohol were 18 times as likely to report NMUPD.

While the majority of the respondents in both studies were White (71 percent in NESARC and 65 percent in the college group), an even higher percentage of the simultaneous polydrug users in the college study were White males who had started drinking in their early teens. The NESARC study also found that Whites in general were two to five times more likely than African-Americans to report NMUPD during the past year. Native Americans were at increased risk for NMUPD, and the authors indicated that this subpopulation should receive greater research attention in the future.

Dr. McCabe emphasizes that many people who simultaneously drink alcohol and use prescription medications have no idea how dangerous the interactions between these substances can be. "Passing out is a protective mechanism that stops people from drinking when they are approaching potentially dangerous blood alcohol concentrations," he explains. "But if you take stimulants when you drink, you can potentially override this mechanism and this could lead to life-threatening consequences."

Dr. James Colliver, formerly of NIDA's Division of Epidemiology, Services and Prevention Research, offers perspective on these studies. "Prescription sedatives, tranquilizers, painkillers, and stimulants are generally safe and effective medications for patients who take them as prescribed by a clinician," Dr. Colliver states. "They are used to treat acute and chronic pain, attention deficit hyperactivity disorder, anxiety disorders, and sleep disorders.

"The problem is that many people think that, because prescription drugs have been tested and approved by the Food and Drug Administration, they are always safe to use; but they are safe only when used under the direction of a physician for the purpose for which they are prescribed."

Sources

McCabe, S.E., et al. The relationship between pastyear drinking behaviors and nonmedical use of prescription drugs: Prevalence of co-occurrence in a national sample. Drug and Alcohol Dependence 84(3):281-288, 2006. [Abstract]

McCabe, S.E., et al. Simultaneous and concurrent polydrug use of alcohol and prescription drugs: Prevalence, correlates, and consequences. Journal of Studies on Alcohol 67(4):529-537, 2006. [Abstract]

Patients aged 15 to 24 of a public sexually transmitted disease clinic who had a substance abuse disorder (SUD) were two to three times as likely as those without an SUD to report multiple sexual partners and inconsistent condom use during the past year. Overall, 43 percent of the 448 patients who participated in the Pittsburgh clinic study had an alcohol or marijuana use disorder, and these young people also were 70 percent more likely to be diagnosed with a sexually transmitted disease during their visit.

Source

Cook, R.L., et al. Alcohol and drug use and related disorders: An underrecognized health issue among adolscents and young adults attending sexually transmitted disease clinics. Sexually Transmitted Diseases 33(9):565-570, 2006

U.S.-Born Hispanic Women Have More Drug Problems Than Immigrants

Among 19- to 21-year-old Hispanic women in South Florida, those born in the United States face a higher risk of drug addiction than immigrants, according to a recent study by Dr. R. Jay Turner and colleagues. The U.S.-born women reported more acculturation, measured as preference for English over Spanish, and greater exposure to stressful events, both of which were associated with increased risk for addiction. The gap in acculturation between the two groups accounted for 40 percent of the risk difference; a high score on either acculturation or stress exposure was associated with a nearly three-fold increase in the odds of addiction, compared with low scores on those measures (evaluated at one standard deviation above and below average). The investigators speculate that cultural influences help protect foreign-born Hispanic young women from stress. Native-born and immigrant young men reported similar levels of stress exposure and had similar rates of addiction.

Drug and Alcohol Dependence 83(1):79-89, 2006. [Abstract]

Latino Parent Training

Men and women who completed a parent-training program adapted for Latino culture reported improvements in effective parenting practices and their children's (aged 13 years, on average) behavior compared with those who did not receive the intervention. Children whose parents received the program also reported that they were less likely to abuse tobacco, marijuana, and other drugs in the future. The parents also said their children's behavior improved.

Drs. Charles R. Martinez and J. Mark Eddy of the Oregon Social Learning Center randomly assigned 73 Spanish-speaking Latino parents (90 percent were of Mexican heritage) to participate in Nuestras Familias: Andando Entre Culturas (Our Families: Moving Between Cultures) or to receive no intervention. During each of 12 weekly 2.5-hour sessions, participants in the intervention group discussed developing effective family communication, bridging cultures, being positive, and encouraging success using appropriate discipline and limit setting, and practiced parenting techniques in role-play.

Journal of Consulting and Clinical Psychology 73(5):841-851, 2005. [Abstract]

African-Americans are less likely than European-Americans and Latinos to begin smoking in early adolescence or report dependence on illicit drugs during young adulthood. In a 10-year study, Dr. William Vega at the University of Medicine and Dentistry of New Jersey and Dr. Andres Gil at Florida International University monitored smoking and progression to other drug abuse in 1,208 students, starting at age 11 and ending at age 20. Among participants who began smoking in early adolescence, African-Americans were least likely to report that they still smoked or that they abused or were dependent on illicit drugs as young adults. European-Americans were most likely to still be smoking as 20-year-olds, and U.S.-born Latinos most likely to report abuse or dependence on drugs other than marijuana. These relationships held when the researchers factored in the influences of gender, socioeconomic status, education, parental smoking, and early alcohol use.

Addiction 100(9):1358-1369, 2005.

From 2002 through 2008, among adolescents aged 12 to 17, girls' rates of lifetime ecstasy use were higher than boys'. This pattern contrasts with that for marijuana, which boys used in higher percentages than girls during this period. The higher prevalence of ecstasy use among girls persisted when the researchers separated out the effects of household income, ethnicity, and population density of youths' areas of residence. The researchers analyzed annual data from the National Survey on Drug Use and Health. The number of adolescents who participated varied by year and ranged from 17,429 to 19,430.

Source:

Wu, P., et al. Ecstasy use among U.S. adolescents from 1999 to 2008. Drug and Alcohol Dependence 112(1-2):33-38, 2010. (Abstract)

Some people smoke a few cigarettes now and then, while others smoke 30, 40, or more per day. NIDA-supported research now suggests that smokers' differences in tobacco consumption reflect, in part, differences in the functional efficacy of one subtype of nicotinic acetylcholine receptor (nAChR).

The new animal research, by Dr. Paul Kenny and colleagues at Scripps Research Institute in Jupiter, Florida, indicates that the nAChR subtype that incorporates the α5 structural subunit (termed α5* nAChR) promotes an aversive state in response to nicotine that increases in strength as blood concentrations of the drug rise. Among the evidence: Eliminating the α5 subunit greatly increased the amount of nicotine that animals would self-administer.

The new findings may explain previous observations that people who have a gene variant that results in a less functional version of α5* nAChR are far more likely to become dependent on nicotine than those with the normal version. The results open up the possibility that medications to stimulate the activity of α5* nAChRs might help smokers smoke less, reducing their risk for addiction and other consequences of exposure to tobacco.

A Tale of Two Pathways

As anyone who has inhaled tobacco for the first time has experienced, nicotine's effects are not all rewarding; some can be extremely unpleasant. A smoker's motivation to light up depends on the balance between anticipation of the rewarding effects and aversion to the noxious ones. The balance tilts more toward aversion as nicotine concentrations in the blood rise.

Dr. Kenny's team theorized that each smoker's rate of tobacco consumption depends on his or her tipping point, and that the tipping point, in turn, depends on how strongly two opposing brain pathways respond to nicotine. One, the reward pathway, which links the ventral tegmental area (VTA) to the nucleus accumbens (NAc), responds to nicotine stimulation by generating pleasurable feelings and motivation to repeat the experience. The other, the medial habenula-interpeduncular pathway (MHb-IPN), encodes states of aversion, thereby opposing the effects of the VTA-NAc reward systems and limiting further nicotine intake.

New research on the adolescent brain provides support for laws, existing in some locales, that prohibit teen drivers from having peers as passengers. Drs. Laurence Steinberg and Jason Chein at Temple University in Philadelphia offered adolescents, young adults, and adults monetary rewards for “driving” around a computer-simulated track. In the simulation, traffic lights appearing at frequent intervals turned yellow as the cars approached, forcing risk-reward choices. The driver might save time by proceeding through, but doing so would risk a collision and cause more delay than stopping and waiting for green.

The adolescents, but not the older participants, chose the risky option significantly more often when they knew two of their friends were watching. Functional magnetic resonance imaging demonstrated that the friends’ presence heightened activity in the teens’ ventral striatum and orbitofrontal cortex—brain regions that predict and assess the value of reward. This social effect was especially pronounced when the teens made risky decisions to proceed through the yellow light. As the friends did not say anything to influence the drivers’ behaviors, the researchers concluded that the presence of peers is sufficient in itself to make risks feel more worthwhile to teens.
Developmental Science 14(2):F1–F10, 2011. Abstract Available

Illicit drug use continued at elevated rates in 2010, after rising in 2009 to its highest level since 2002, according to the latest National Survey on Drug Use and Health (NSDUH). Nearly 9 percent of Americans aged 12 and older—an estimated 22.6 million people—reported using illicit drugs in the month prior to the survey.

The survey, released in September 2011, showed that marijuana use was the major driver of the higher rates over the past 2 years; past-month marijuana use rose from about 6.1 percent in 2008 to 6.9 percent—representing about 17.4 million people—in 2010.

Cause for Concern A rise in marijuana use drove up overall illicit drug use from 2008 to 2010, while use of cocaine fell and use of hallucinogens

The survey also disclosed that use of cocaine fell from 0.7 percent in 2008 to 0.6 percent in 2010, extending a favorable trend that began in 2006–2007. Use rates for hallucinogens and prescription drugs used nonmedically were similar to those for 2008 and 2009.

Rates of illicit drug use in 2010 varied by age, with the highest (21.5 percent) among young adults, aged 18 to 25, and the lowest (1.1 percent) among seniors, aged 65 and older. 

Rates of alcohol use in 2010, including binge and heavy drinking, were similar to those for 2009. But drinking among adolescents, aged 12 to 17, declined from 14.7 percent in 2009 to 13.6 percent in 2010. Adolescents also reported a decline in the use of tobacco products, from 11.6 percent in 2009 to 10.7 percent in 2010.

Among the other findings in 2010:

• Illicit drug use was more prevalent among unemployed adults aged 18 and older (17.5 percent) than among adults employed full-time (8.4 percent) or part-time (11.2 percent).
• Illicit drugs with the highest levels of past-year dependence or abuse were marijuana (an estimated 4.5 million people), pain relievers (1.9 million), and cocaine (1 million).
• Only 11.2 percent of people who were found to need substance abuse treatment received such treatment in a specialty facility.

The 2010 results are based on responses from 67,500 civilians nationwide who do not live in institutions. The annual NSDUH survey is sponsored by the Substance Abuse and Mental Health Services Administration.

Source

Substance Abuse and Mental Health Services Administration, 2011. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration.

El abuso y uso no médico de medicamentos de prescripción es un problema grave de salud pública en los Estados Unidos. Aunque la mayoría de las personas toman los medicamentos de prescripción de manera responsable, se calcula que unas 52 millones de personas (el 20 por ciento de las personas de 12 años y mayores) han consumido medicamentos de prescripción por razones no médicas al menos una vez en su vida, y los jóvenes tienen una representación importante en este grupo. De hecho, el Estudio de Observación del Futuro (MTF, por sus siglas en inglés) del Instituto Nacional sobre el Abuso de Drogas (NIDA, por sus siglas en inglés), encontró que en el 2010 uno de cada 12 estudiantes de la secundaria reportó uso no médico, en el año anterior, del analgésico de prescripción Vicodina y uno de cada 20 reportó haber consumido OxyContin de manera indebida, lo cual hace que estos analgésicos estén entre los medicamentos que más abusan los adolescentes.

El abuso de ciertos medicamentos de prescripción, entre ellos, los opioides, los depresores del sistema nervioso central (SNC) y los estimulantes, puede conducir a una variedad de efectos adversos para la salud, incluyendo la adicción. Casi el 14 por ciento de los que reportaron el uso no médico de un medicamento de prescripción en el año anterior a la encuesta cumplieron con los criterios de diagnóstico para el abuso o la dependencia de estos medicamentos. Las razones de la alta prevalencia de abuso de medicamentos de prescripción varían según la edad, el género y otros factores, pero probablemente incluyen el hecho de que son más disponibles.

El número de recetas para algunos de estos medicamentos ha incrementado dramáticamente desde principios de la década de los noventa (vea las gráficas). Por otra parte, otros factores que probablemente contribuyen a este problema son la cultura de consumo en que las personas están dispuestas a “tomar una pastilla para lo que les pase” y la percepción de que los medicamentos de prescripción hacen menos daño que las drogas ilícitas. El problema es urgente: el número de muertes no intencionales por sobredosis que involucran analgésicos opioides se ha cuadruplicado desde 1999 y, en el 2007, superó el número total de muertes por heroína y cocaína.

El NIDA espera cambiar esta situación aumentando el conocimiento del público sobre este problema y promocionando investigaciones adicionales sobre el abuso de medicamentos de prescripción. Éste no es un problema nuevo, pero sí es un problema que merece una nueva mirada. Es imprescindible que, como nación, estemos conscientes de las consecuencias asociadas con el abuso de estos medicamentos.

Nora D. Volkow, M.D.
Directora
Instituto Nacional sobre el Abuso de Drogas

Opioid-addicted youths benefit from extended opioid maintenance therapy, reports NIDA's Clinical Trials Network (CTN). In a study by Dr. George Woody of the Delaware Valley Node of the CTN, the Penn/VA Addiction Treatment Research Center, and the Penn Center for AIDS Research in Philadelphia, participating 15- to 21-year-olds who received drug counseling and 12 weeks of therapy with buprenorphine and naloxone abused a wide range of drugs less often than others who received only counseling and a 2-week detoxification regimen.

Although buprenorphine-naloxone is an approved medication for people age 16 and over, until now clinicians have had little research to guide them on its use in teens and young adults. A common approach, offering only short-term medication and counseling to young people, is based partly on the expectation that youths, with their shorter duration of addiction, do not require extended medication-assisted treatment, as many adults do. However, the CTN findings suggest that risk of relapse following detoxification and the potential benefit of extended buprenorphine-naloxone therapy are similar in youths and adults. The findings are timely: Rates of opioid abuse among young people have risen during the past 10 years, increasing the need for effective treatments for this population.

Extended Buprenorphine-Naloxone Treatment Helps Young Opioid Abusers: Opioid-addicted 15- to 21-year-olds who received counseling and continued buprenorphine-naloxone for 12 weeks with a dose taper in weeks 9-12 abused fewer opioids than others who received counseling and a 2-week detoxification. They continued to submit more opioid-negative urine specimens throughout a year of followup.

The study included 152 outpatients from rural and urban community-based, CTN-affiliated treatment programs in Delaware, Maine, Maryland, New Mexico, and North Carolina. On average, the participants were 19 years old and had abused opioids for 1.5 years at the start of the study. Fifty-five percent primarily abused heroin, the majority by injection; about 35 percent primarily abused painkillers; and 10 percent abused multiple opioids. The researchers used randomization procedures to assign approximately equal numbers of participants to receive either a detoxification treatment of 2 weeks of outpatient buprenorphine-naloxone (up to 14 mg/day for 3 days, followed by a tapering of the dose) or extended treatment of 12 weeks of buprenorphine-naloxone (up to 24 mg/day for 9 weeks, followed by dose tapering that ended in week 12). All patients were scheduled to receive their clinics' standard counseling interventions in one individual session and one group session per week for 12 weeks, with more sessions available if necessary.

The impacts of the two interventions diverged quickly. At the first assessment, 2 weeks after the end of the detoxification regimen, 74 percent of the participants in the extended-maintenance group and 39 percent of those who had received only detoxification submitted opiate-free urine samples (see graph above). A similar gap continued through week 8 but narrowed to 57 percent versus 49 percent at the 12-week assessment and widened again to 60 percent versus 25 percent at the final assessment, which took place 1 year after the start of therapy. Extended therapy still yielded superior results at every assessment when the researchers tallied any missed visit as a positive urine sample. Patients in the extended therapy group also stayed in drug counseling longer, required less additional addiction treatment, reported less injection drug use, used less cocaine, and smoked less marijuana.

"The results of our study suggest that there is no hurry to stop providing buprenorphine-naloxone, an effective medication, regardless of a patient's short duration of opioid abuse," says Dr. Woody. "In my experience as a clinician, most opioid abusers—adolescent or adult—prefer to get off medication eventually. When to stop medication is an individual decision that depends on a patient's response to treatment, his or her commitment to achieving full remission without medication, and whether he or she has attained a sustained period of abstinence and a stable overall living situation."

Clinicians need additional long-term evaluation of opioid addiction treatments for young people—including intensive behavioral therapy, buprenorphine-naloxone, and the opioid-blocking medication naltrexone—to identify the regimens that are most effective over the long haul, Dr. Woody says.

Dr. Betty Tai, director of NIDA's Center for Clinical Trials Network, says that Dr. Woody's findings suggest that "extended treatment with buprenorphine-naloxone is safe and effective and expands the treatment options for adolescents and young adults who are addicted to opioids, including prescription painkillers."

Source

Woody, G.E., et al. Extended vs. short-term buprenorphine-naloxone for treatment of opioid-addicted youth: A randomized trial. JAMA 300(17):2003-2011, 2008. [Full Text (PDF, 193KB)]

Two recent studies found differences in behavior between young adults attending college and their peers. Dr. Carlos Blanco of Columbia University in New York and colleagues report that in 2001-2002, one fifth of the Nation's college students had met the clinical criteria for a diagnosis of alcohol abuse disorder within the past 12 months, compared with 17 percent of their noncollege peers. In contrast, drug and nicotine dependencies were more common among nonstudents (7 percent versus 5 percent; 21 percent versus 15 percent). The researchers based their estimates on data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), the largest nationally representative survey of substance abuse and mental health disorders to include college-age students and their noncollege peers. Their analysis linked the difference in alcohol abuse rates to sociodemographic factors that differentially affected the two groups and to recent stressful life events. Fewer than 10 percent of the survey participants with drug or alcohol problems reported having utilized treatment resources, and only half as many college as noncollege individuals reported doing so. The researchers say that their findings, reported in the Archives of General Psychiatry, highlight the need for more alcohol abuse screening and intervention, especially on college campuses.

In a survey of 834 youths, college freshmen reported lower rates of risky sexual behavior 6 months after high school graduation than same-age youth who were not attending college. About 23 percent of the college students reported inconsistent condom use during the past month, compared with 35 percent of their noncollege peers; 15 percent said they had engaged in casual sex during the same period (versus 29 percent), and 5 percent reported high-risk sex (versus 16 percent). Jennifer A. Bailey of the University of Washington in Seattle and colleagues report in the Journal of Adolescent Health that the college students had lower rates "largely because they were more likely to do well in school and less likely to use drugs and to engage in sexual risk behaviors during high school." Prevention efforts in high school "should result in reductions in the prevalence of risky sexual behaviors in the transition to adulthood," they conclude.

Source

Archives of General Psychiatry 65(12):1429-1437, 2008. [Full Text (PDF, 118KB)]
Journal of Adolescent Health 42(6):573-579, 2008. [Full Text (PDF, 111KB)]

Developer: Drexel University College of Medicine and University of Pennsylvania School of Medicine

Curriculum resource type: Didactic

Method used: Web-based videos and instructional text

Intended audience: Medical students (years 1¬–4), residents in primary care specialties, and practicing physicians in primary care specialties

Implementation time: 1.5-2 hours

Additional components: References; NIDA treatment guidelines

Educational objectives:

• Understand the risk factors that predispose children and adolescents to substance use disorders and the protective factors that lead to resilience and limit substance abuse and addiction
• Learn the skills necessary to conduct a primary inquiry about substance use with an adolescent patient and obtain a substance use history
• Recognize substance abuse and addiction in adolescent patients
• Demonstrate how to engage adolescent patients in preventive strategies and treatment for substance abuse or addiction

Evaluation tools: Behavior skills checklist and learner assessment questions

Curriculum resource description: Adolescence is a time of significant physical, psychological, social, emotional, and intellectual development. In addition, adolescents’ abilities to control their impulses and plan for the future are still developing, causing many teens to be more adventurous than adults and possibly increasing their willingness to take chances and engage in risky behaviors, such as drug use. However, drug and alcohol use during adolescence can be particularly risky and increase risk for problems with attention, learning, and working memory, as well as increase the risk for future problems with substance abuse and addiction.

Research shows that most teens do not use drugs, but drug use does occur frequently among adolescents and is often identified among teens who are experiencing interpersonal and family conflicts, school difficulty or failure, criminal activity, or some psychiatric disorders. Although the majority of teens who use drugs do not become addicted, even limited substance use can have a significant impact on a teen’s relationship with family, peers, school, and community. Physicians can master communication skills that help elicit accurate information to identify and assess teens who are using drugs and may be experiencing problem drug abuse.

This educational module about the clinical assessment of substance abuse disorders in adolescents presents written text and instructional videos that provide the knowledge and skills needed in the screening, evaluation, and referral to treatment of adolescents with substance use disorders. In addition, the module is designed to help physicians and other health care practitioners address stigma about providing clinical care to adolescents with substance use disorders.

Key words: adolescent; drug abuse; drug addiction; substance abuse; risk factors; prevention

A journal commentary by Harvard researcher and NIDA grantee Bertha K. Madras stresses the importance of a large scale longitudinal study to better assess the effects of marijuana use on human brain development and function. Dr. Madras notes research that suggests regular marijuana use that begins in youth “blunts” the brain’s normal responses; results in increased anxiety and restlessness; and contributes to a high degree of negative emotionality. She calls for an integrative approach of brain imaging combined with behavioral and cognitive measurements, optimally beginning in early adolescence (before marijuana use begins) through three decades of life. The commentary can be found at: www.pnas.org/content/111/33/11915.extract?sid=418eff65-8460-49f1-8788-0b71e6b84dc2.

It is important to note that a large longitudinal cohort study on the effects of substance use on the human brain during early adolescence into young adulthood is in development at NIDA, with a solicitation expected to be posted early next year. More information can be seen here: http://grants.nih.gov/grants/guide/notice-files/NOT-DA-14-014.html.

For more information, contact the NIDA press office at media@nida.nih.gov or 301-443-6245.

Illicit drug use has been rising steadily among college-aged young adults, mostly driven by increases in marijuana use. In addition, the non medical use of stimulants, including Adderall and Ritalin, has more than doubled in the past few years. This section features the most recent Monitoring the Future national survey results on drug use in this age group, as well as other links of interest to educators; dorm supervisors; counselors; clinicians and researchers who work with this age group, as well as the students themselves and their parents.

View Full Infographic

Learn more about:

• Commonly Abused Drugs

Thinking about a career in Addiction Science?

• Summer Internship Program at the NIH
• Drugs & Health Blog: Colleges Offer Addiction Science Programs So Students Can Help Tackle Drug Addiction

Everything You Wanted to Know About Marijuana

 

• How does marijuana use affect your brain and body?
• Marijuana Research at NIDA
• NIDA's role in providing marijuana for research
• Health Effects

Changing Marijuana Laws and NIDA Research

Watch video (7:07)

Prescription Drugs & Cold Medicines

Prescription Drug Abuse Research Report

• What is Prescription Drug Abuse
• DrugFacts: Cough and Cold Medicine Abuse
• Emerging Trends - "Sizzurp", "Purple Drank"
• Prescription Stimulants (Abuse) Health Effects
• Prescription Sedatives, sleeping pills*, or anxiolytics (Abuse) Health Effects
• Prescription Opioids (Abuse) Health Effects
• Over-the-counter Cough/Cold Medicines (Dextromethorphan or DMX) Health Effects

Use of illicit drugs, including marijuana, has been rising steadily among college-aged young adults. In addition, non-medical use of stimulants, including Adderall and Ritalin, has more than doubled in the past few years. The National Institute on Drug Abuse (NIDA) has created a new section on its website featuring the most recent Monitoring the Future (MTF) national survey results on drug use among students enrolled full time in a 2- or 4-year college as well as young people of the same age group not attending college. It also includes links of interest to parents, educators, dorm supervisors, counselors, clinicians and researchers who work with this age group. Additional resources include infographics, statistics and trends, treatment guides, information about careers in addiction science as well as related videos, publications, articles, and other relevant materials.

For more information on NIDA’s College-Age and Young Adults web page, go to:
http://www.drugabuse.gov/related-topics/college-age-young-adults

For more information on the MTF Survey among College-Aged and Young Adults, go to: http://ns.umich.edu/new/releases/22362-college-students-use-of-marijuana-on-the-rise-some-drugs-declining and http://monitoringthefuture.org//pubs/monographs/mtf-vol2_2013.pdf

Using the most sophisticated driving simulator of its kind to mirror real-life situations, new research shows that marijuana use impairs one measure of driving performance. People driving with blood concentrations of 13.1 µg/L THC – the main psychoactive ingredient in marijuana – showed increased weaving within the lane, similar to those with 0.08 breath alcohol, the threshold for impaired driving in many states. Drinking alcohol and smoking marijuana had an additive effect, so that drivers using both substances weaved within lanes even if their blood THC and alcohol concentrations were below the impairment thresholds for each substance alone. Alcohol, but not marijuana, increased the number of times the car actually left the lane and the speed of weaving. The National Institute on Drug Abuse, the Office on National Drug Control Policy, and the National Highway Traffic Safety Administration funded the study.

THC concentrations drop rapidly during the time required to collect a blood specimen in the U.S., generally within two to four hours. Oral fluid (saliva) tests for THC can be performed roadside without this long wait. However, oral fluid THC showed a two to five fold greater variability than blood tests. This indicates that while oral fluid may be an effective screening tool for detecting recent marijuana use by a driver, it may not be a precise measure of the level of impairment.

In the study, more than 50 percent of participants controlled their marijuana inhalations (called titration) so they had consistent blood THC peak concentrations, regardless of the percentage of THC in the marijuana (2.9% vs. 6.7%). This shows that past driving studies based on cannabis dose rather than blood THC may have missed the importance of dose titration. In addition, it was found that low amounts of alcohol significantly increased peak THC concentrations.

To view the paper (published in Drug and Alcohol Dependence), go to: http://www.sciencedirect.com/science/article/pii/S0376871615003142. To learn more about drugged driving, go to www.drugabuse.gov/publications/drugfacts/drugged-driving.

For more information, contact the NIDA press office at media@nida.nih.gov or 301-443-6245.

The following are facts and statistics on substance use in the United States in 2013, the most recent year for NSDUH survey results. Approximately 67,800 people responded to the survey in 2013.

Illicit Drug Use*

Illicit drug use in the United States has been increasing. In 2013, an estimated 24.6 million Americans aged 12 or older—9.4 percent of the population—had used an illicit drug in the past month. This number is up from 8.3 percent in 2002. The increase mostly reflects a recent rise in use of marijuana, the most commonly used illicit drug.

Marijuana use has increased since 2007. In 2013, there were 19.8 million current users—about 7.5 percent of people aged 12 or older—up from 14.5 million (5.8 percent) in 2007.

Use of most drugs other than marijuana has stabilized over the past decade or has declined. In 2013, 6.5 million Americans aged 12 or older (or 2.5 percent) had used prescription drugs nonmedically in the past month. Prescription drugs include pain relievers, tranquilizers, stimulants, and sedatives. And 1.3 million Americans (0.5 percent) had used hallucinogens (a category that includes ecstasy and LSD) in the past month.

Cocaine use has gone down in the last few years. In 2013, the number of current users aged 12 or older was 1.5 million. This number is lower than in 2002 to 2007 (ranging from 2.0 million to 2.4 million).

Methamphetamine use was higher in 2013, with 595,000 current users, compared with 353,000 users in 2010.

Most people use drugs for the first time when they are teenagers. There were just over 2.8 million new users of illicit drugs in 2013, or about 7,800 new users per day. Over half (54.1 percent) were under 18 years of age.

More than half of new illicit drug users begin with marijuana. Next most common are prescription pain relievers, followed by inhalants (which is most common among younger teens).

Drug use is highest among people in their late teens and twenties. In 2013, 22.6 percent of 18- to 20-year-olds reported using an illicit drug in the past month.

Drug use is increasing among people in their fifties and early sixties. This increase is, in part, due to the aging of the baby boomers, whose rates of illicit drug use have historically been higher than those of previous generations.

Alcohol

Drinking by underage persons (ages 12 to 20) has declined. Current alcohol use by this age group declined from 28.8 to 22.7 percent between 2002 and 2013, while binge drinking declined from 19.3 to 14.2 percent and the rate of heavy drinking went from 6.2 to 3.7 percent.^†

Binge and heavy drinking are more widespread among men than women. In 2013, 30.2 percent of men and 16.0 percent of women 12 and older reported binge drinking in the past month. And 9.5 percent of men and 3.3 percent of women reported heavy alcohol use.

Driving under the influence of alcohol has also declined slightly. In 2013, an estimated 28.7 million people, or 10.9 percent of persons aged 12 or older, had driven under the influence of alcohol at least once in the past year, down from 14.2 percent in 2002. Although this decline is encouraging, any driving under the influence remains a cause for concern.

Tobacco

Fewer Americans are smoking. In 2013, an estimated 55.8 million Americans aged 12 or older, or 21.3 percent of the population, were current cigarette smokers. This reflects a continual but slow downward trend from 2002, when the rate was 26 percent.

Teen smoking is declining more rapidly. The rate of past-month cigarette use among 12- to 17-year-olds went from 13 percent in 2002 to 5.6 percent in 2013.

Substance Dependence/Abuse and Treatment

Rates of alcohol dependence/abuse declined from 2002 to 2013. In 2013, 17.3 million Americans (6.6 percent of the population) were dependent on alcohol or had problems related to their alcohol use (abuse). This is a decline from 18.1 million (or 7.7 percent) in 2002.

After alcohol, marijuana has the highest rate of dependence or abuse among all drugs. In 2013, 4.2 million Americans met clinical criteria for dependence or abuse of marijuana in the past year—more than twice the number for dependence/abuse of prescription pain relievers (1.9 million) and nearly five times the number for dependence/abuse of cocaine (855,000).

There continues to be a large "treatment gap" in this country. In 2013, an estimated 22.7 million Americans (8.6 percent) needed treatment for a problem related to drugs or alcohol, but only about 2.5 million people (0.9 percent) received treatment at a specialty facility.

*Note that the terms dependence and abuse as used in the NSDUH are based on diagnostic categories used in the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); in the newly published Fifth Edition (DSM-V), those categories have been replaced by a single Substance Use Disorder spectrum.

Learn More

For complete NSDUH findings, visit: www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.htm#3.1.2

For more information about drug use among adolescents, visit: www.drugabuse.gov/publications/drugfacts/high-school-youth-trends

This publication is in the public domain and may be used or reproduced in its entirety without permission from NIDA. Citation of the source is appreciated.

*"Illicit" refers to use of illegal drugs, including marijuana according to federal law, and misuse of prescription drugs.

^† Binge drinking is five or more drinks on the same occasion. Heavy drinking is binge drinking on at least five separate days in the past month.

Reposting a blog from the Collaborative Reseach on Addiction (CRAN) site by Nora Volkow (Director, NIDA), George Koob (Director, NIAAA), Alan Guttmacher (Director, NICHD), Bob Croyle (Director, Division of Cancer Control and Population Sciences, NCI), Thomas Insel (Director, NIMH), and William Riley (Director, OBSSR).

©Shutterstock/William Perugini

Today the Adolescent Brain Cognitive Development (ABCD) Study officially gets underway, as the National Institutes of Health award 13 five-year grants to U.S. research institutions that will spearhead the landmark project over the first half of its roughly 10-year duration. Researchers at these institutions will follow approximately 10,000 children, recruited initially at age 9 or 10 (i.e., before they are likely to have started using drugs), conducting behavioral interviews and gathering neuroimaging, genetic, and other health data at periodic intervals until they are young adults. The data gathered will enable researchers to assess the effects of different patterns of alcohol, tobacco, and drug use (including no use) on the developing brain, on mental health, and on outcomes like academic achievement, as well as a wide range of other factors affecting young Americans’ life and health.

The teen years are the period of highest risk for substance use and for the development of other behavioral disorders, and they are also a period when the brain is changing dramatically. A study of this scope will yield an unprecedented amount of detailed information about how the brain develops and how its development is affected by a multitude of factors alone and in combination with each other. It will allow us to look not only at exposure to substances including nicotine, alcohol, and marijuana and other drugs but also at mental illnesses, the effects of brain traumas from injuries, and influences of other environmental factors like family and peer influences, and socioeconomic status. The inclusion of genetic data will give us crucial information about genes’ influence on adolescent development and on vulnerability to mental illness and the effects of substance use.

The study will do much to fill the large existing gaps in our knowledge about the brain-developmental effects of many substances. Current high levels of underage binge drinking and increased intensity of binge drinking in adolescents are causes of significant concern, for example, and this study will clarify how various levels of alcohol exposure, as well as alcohol use in combination with other substances, affect the developing brain. Given the changing laws around marijuana in some states that will likely make this drug more accessible to youth, a similarly nuanced picture of marijuana’s effects is also crucial to acquire. Although cigarette use among adolescents has declined, the surge in use of e-cigarettes (which deliver nicotine and other chemicals to the user) and other tobacco products like little cigars, makes it very important to learn more about the impact of nicotine and tobacco use on the adolescent brain, including how their use affects the brain’s response to other drugs. The ABCD study will also provide crucial insight into the developmental effects of new synthetic cannabinoids (“herbal incense”) and synthetic cathinones (or bath salts), about which we have practically no knowledge at this point.

The large number of teens that the ABCD study hopes to recruit and retain for its decade-long duration will not just yield vast amounts of data on the effects of substance use but will also greatly clarify our picture of normal healthy brain development. It is important to remember that most young people never develop drug or alcohol problems, and only about half use an illicit drug before leaving high school. High-risk groups will be oversampled in order to ensure that enough data on substance users are collected. But the ABCD study data on typically developing, healthy adolescents with minimal or no substance use exposure will also be extremely valuable for comparison, both in this and future studies. These data will be a great contribution to science, as currently no normal imaging standards for adolescents exist to enable researchers to make such comparisons.

The 13 grants issued today will fund a Coordinating Center, a Data Analysis and Informatics Center, and 11 research project sites. It is an exciting moment for addiction research. A decade from now, we will understand the effects of substance use on development with a precision that, today, we can barely imagine.

What are hallucinogens?

Hallucinogens are a diverse group of drugs that alter perception (awareness of surrounding objects and conditions), thoughts, and feelings. They cause hallucinations, or sensations and images that seem real though they are not. Hallucinogens can be found in some plants and mushrooms (or their extracts) or can be human-made. People have used hallucinogens for centuries, mostly for religious rituals. Common hallucinogens include the following:

Blotter sheet of LSD-soaked paper squares that users take by mouth
Photo by DEA

• Ayahuasca is a tea made from one of several Amazonian plants containing dimethyltryptamine (DMT), the primary mind-altering ingredient. Ayahuasca is also known as Hoasca, Aya, and Yagé.
• DMT is a powerful chemical found in some Amazonian plants. Manufacturers can also make DMT in a lab. The drug is usually a white crystalline powder. A popular name for DMT is Dimitri.
• D-lysergic acid diethylamide (LSD) is one of the most powerful mood-changing chemicals. It is a clear or white odorless material made from lysergic acid, which is found in a fungus that grows on rye and other grains. LSD has many other names, including Acid, Blotter, Dots, and Yellow Sunshine.
• Peyote (mescaline) is a small, spineless cactus with mescaline as its main ingredient. Peyote can also be synthetic. Buttons, Cactus, and Mesc are common names for peyote.
• 4-phosphoryloxy-N,N-dimethyltryptamine (psilocybin) comes from certain types of mushrooms found in tropical and subtropical regions of South America, Mexico, and the United States. Other names for psilocybin include Little Smoke, Magic Mushrooms, Purple Passion, and Shrooms.

Some hallucinogens also cause users to feel out of control or disconnected from their body and environment. Common examples include the following:

Ketamine
Photo courtesy of Wikimedia Commons/CC0

• Dextromethorphan (DXM) is a cough suppressant and mucus-clearing ingredient in some over-the-counter cold and cough medicines (syrups, tablets, and gel capsules). Robo is another popular name for DXM.
• Ketamine is used as a surgery anesthetic for humans and animals. Much of the ketamine sold on the streets comes from veterinary offices. While available as an injectable liquid, manufacturers mostly sell it as a powder or as pills. Other names for ketamine include K, Special K, or Cat Valium.
• Phencyclidine (PCP) was developed in the 1950s as a general anesthetic for surgery. It’s no longer used for this purpose due to serious side effects. While PCP can be found in a variety of forms, including tablets or capsules, liquid and white crystal powder are the most common forms. PCP has various other names, such as Angel Dust, Hog, Love Boat, and Peace Pill.
• Salvia divinorum (salvia) is a plant common to southern Mexico and Central and South America. Other names for salvia are Diviner's Sage, Maria Pastora, Sally-D, and Magic Mint.

Salvia
Photo courtesy of Wikimedia Commons/CC0

How do people use hallucinogens?

People use hallucinogens in a wide variety of ways, as shown in the following chart:

Text Description of Chart

How do hallucinogens affect the brain?

Research suggests that hallucinogens work at least partially by temporarily disrupting communication between brain chemical systems throughout the brain and spinal cord. Some hallucinogens interfere with the action of the brain chemical serotonin, which regulates:

• mood
• sensory perception
• sleep
• hunger
• body temperature
• sexual behavior
• muscle control

Other hallucinogens interfere with the action of the brain chemical glutamate, which regulates:

• pain perception
• responses to the environment
• emotion
• learning and memory

Short-Term Effects

The effects of hallucinogens can begin within 20 to 90 minutes and can last as long as 6 to 12 hours. Salvia's effects are more short-lived, appearing in less than 1 minute and lasting less than 30 minutes. Hallucinogen users refer to the experiences brought on by these drugs as "trips," calling the unpleasant experiences "bad trips."

Along with hallucinations, other short-term general effects include:

• increased heart rate
• nausea
• intensified feelings and sensory experiences
• changes in sense of time (for example, time passing by slowly)

Specific short-term effects of some hallucinogens include:

• increased blood pressure, breathing rate, or body temperature
• loss of appetite
• dry mouth
• sleep problems
• mixed senses (such as "seeing" sounds or "hearing" colors)
• spiritual experiences
• feelings of relaxation or detachment from self/environment
• uncoordinated movements
• excessive sweating
• panic
• paranoia—extreme and unreasonable distrust of others
• psychosis—disordered thinking detached from reality

Long-Term Effects

Little is known about the long-term effects of hallucinogens. Researchers do know that ketamine users may develop symptoms that include ulcers in the bladder, kidney problems, and poor memory. Repeated use of PCP can result in long-term effects that may continue for a year or more after use stops, such as:

• speech problems
• memory loss
• weight loss
• anxiety
• depression and suicidal thoughts

Hallucinogens can cause severe visual disturbances.
Photo by Steve Johnson/CC BY/

Though rare, long-term effects of some hallucinogens include the following:

• Persistent psychosis—a series of continuing mental problems, including:
  • visual disturbances
  • disorganized thinking
  • paranoia
  • mood changes
• Flashbacks—recurrences of certain drug experiences. They often happen without warning and may occur within a few days or more than a year after drug use. In some users, flashbacks can persist and affect daily functioning, a condition known as hallucinogen persisting perceptual disorder (HPPD). These people continue to have hallucinations and other visual disturbances, such as seeing trails attached to moving objects.
• Symptoms that are sometimes mistaken for other disorders, such as stroke or a brain tumor

What are other risks of hallucinogens?

Other risks or health effects of many hallucinogens remain unclear and need more research. Known risks include the following:

• Some psilocybin users risk poisoning and possibly death from using a poisonous mushroom by mistake.
• High doses of PCP can cause seizures, coma, and death, though death more often results from accidental injury or suicide during PCP intoxication. Interactions between PCP and depressants such as alcohol and benzodiazepines (prescribed to relieve anxiety or promote sleep—alprazolam [Xanax^®], for instance) can also lead to coma.
• Some bizarre behaviors resulting from hallucinogens that users display in public places may prompt public health or law enforcement personnel intervention.
• While hallucinogens' effects on the developing fetus are unknown, researchers do know that mescaline in peyote may affect the fetus of a pregnant woman using the drug.

Are hallucinogens addictive?

Evidence indicates that certain hallucinogens can be addictive or that people can develop a tolerance to them. Use of some hallucinogens also produces tolerance to other similar drugs.

For example, LSD is not considered an addictive drug because it doesn't cause uncontrollable drug-seeking behavior. However, LSD does produce tolerance, so some users who take the drug repeatedly must take higher doses to achieve the same effect. This is an extremely dangerous practice, given the unpredictability of the drug. In addition, LSD produces tolerance to other hallucinogens, including psilocybin.

On the other hand, PCP is a hallucinogen that can be addictive. People who stop repeated use of PCP experience drug cravings, headaches, and sweating as common withdrawal symptoms.

Scientists need more research into the tolerance or addiction potential of hallucinogens.

How can people get treatment for addiction to hallucinogens?

There are no government-approved medications to treat addiction to hallucinogens. While inpatient and/or behavioral treatments can be helpful for patients with a variety of addictions, scientists need more research to find out if behavioral therapies are effective for addiction to hallucinogens.

Learn More

For more information about hallucinogens, please visit:

www.drugabuse.gov/drugs-abuse/hallucinogens

www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts