In terms of public health, adolescent substance use disorders have far-reaching social and economic ramifications. The numerous adverse consequences associated with teenage drinking and substance use disorders include fatal and nonfatal injuries from alcohol- and drug-related motor vehicle accidents, suicides, homicides, violence, delinquency (Dembo et al., 1991), psychiatric disorders, and risky sexual practices (Jainchill et al., in press). Longitudinal studies have established associations between adolescent substance use disorders and (1) impulsivity, alienation, and psychological distress (Hansell and White, 1991; Shedler and Block, 1990), (2) delinquency and criminal behavior (National Institute of Justice, 1994), (3) irresponsible sexual activity that increases susceptibility to HIV infection (DiClemente, 1990), and (4) psychiatric or neurological impairments associated with drug use, especially inhalants, and other medical complications (SAMHSA, 1996).
Substance use disorders that begin at an early age, especially when there is no remission of the disorder, exact substantial economic costs to society (Children's Defense Fund, 1991). The trend toward early onset of substance use disorders has increasingly resulted in adolescents who enter treatment with greater developmental deficits and perhaps much greater neurological deficits than have been previously observed. Moreover, the risks of traumatic injury, unintended pregnancy, and sexually transmitted diseases (STDs) are high in adolescents in general. Drug involvement that is superimposed on these already high risks has numerous potentially adverse consequences that have not yet been the subject of in depth study beyond basic population studies.
Mortality
Alcohol-related motor vehicle accidents exact a heavy toll on society in terms of economic costs and lost productivity. Nearly half (45.1 percent) of all traffic fatalities are alcohol-related, and it is estimated that 18 percent of drivers 16 to 20 years old--a total of 2.5 million adolescents--drive under the influence of alcohol. According to the Youth Risk Behavior Surveillance System conducted by the CDC, which monitors health risk behaviors among youths and young adults, unintentional injuries, including motor vehicle accidents, are by far the leading cause of death in adolescents, causing 29 percent of all deaths. An estimated 50 percent of these deaths are related to the consumption of alcohol (CDC, 1998).
Juvenile Delinquency and Crime
The link between adolescent substance use and juvenile delinquency is complex. There is a strong and consistent association between conduct disorder and substance use among teenagers (Crowley and Riggs, 1995). Many young people entering the juvenile justice system have a host of problems ranging from impaired emotional, psychological, and educational functioning to physical abuse, sexual victimization, and substance use disorders (Dembo, 1996). A growing trend is that most of the teenagers entering residential treatment for substance use disorders have been criminally active and mandated to treatment by the criminal justice system (Jainchill, 1997).
Drug testing data collected on male juvenile arrestees through the National Institute of Justice (NIJ) confirm a strong and continuing relationship between the extent of drug use and juvenile crime (NIJ, 1997). An additional finding from the data is that the median positive rate for marijuana use among male juvenile arrestees increased from 41 percent in 1995 to 52 percent in 1996.
Developmental Problems
Substance use can prevent an adolescent from completing the developmental tasks of adolescence, such as dating, marrying, bearing and raising children, establishing a career, and building rewarding personal relationships (Havighurst, 1972; Baumrind and Moselle, 1985; Newcomb and Bentler, 1989). Because substance use changes the way people approach and experience interactions, the adolescent's psychological and social development is compromised, as is the formation of a strong self-identity. Adolescents' use of alcohol or drugs may also hinder their emotional and intellectual growth. Some adolescents may use substances to compensate for a lack of rewarding personal relationships. Instead of developing a sense of empowerment from healthy personal development, the substance-using adolescent is likely to acquire a superficial and false self-image as he becomes more deeply entrenched in the drug experience (MacKenzie, 1993). Naturally, treating an adolescent with substance use disorders as early as possible maximizes the opportunity to stem these initially short-term, but potentially long-term, ill effects.
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