Addiction Medicine: Closing the Gap between Science and Practice

Screening and early intervention services should
be provided in regular health care settings, but
also can be highly successful when offered in
other venues to individuals at high risk,
including students, those in justice programs and
those in social service settings. To assure that
these health care services are provided, a range
of barriers must be addressed, including
insufficient training of health care and other
professionals and a lack of trained specialty
providers to which patients with addiction can
be referred for treatment; time constraints and
insufficient financial and workforce resources;
and screening tools that may fail to detect cases
of risky use of addictive substances.

The Need for Patient Education, Screening and Intervention throughout the Lifespan ....

For many health conditions, certain
developmental periods are associated with
increased risk of acquiring a disease.^5
Addiction, in most cases, has its roots in
adolescence with the initiation of risky use of
addictive substances,^6 but the onset of risky use
and addiction can occur at any point in the
lifespan. Each life phase presents unique
vulnerabilities that must be recognized, as well
as the basic risk factors (discussed in Chapter II)
that may be present at any time in life.

Childhood and Adolescence ........................................................................................

Adolescence is the critical period for the onset
of substance use and its consequences,* 7 but
signs of risk sometimes can be observed much
earlier. In addition to the overall risks
associated with substance use, children and
adolescents with heightened risk of engaging in
substance use, of experiencing the adverse
consequences of risky use and of developing
addiction include:

 Those with certain genetic predispositions or
structural or functional brain characteristics
that make them more susceptible to
addictive substances;^8

• See Chapter II.

 Young children whose temperaments’ are

more active, impatient, aggressive and non-

conforming than their peers,^9

 Those with behavioral disorders including

oppositional defiant disorder† and conduct

disorder,‡ 10 those who engage in bullying§ 11

and those who have sleep problems;** 12 and

 Children who are maltreated, abused or have

suffered other trauma.^13

As children age, moving through elementary and

middle school--a period that coincides with first-

time exposure to cigarettes and other drugs--they

are presented with increasing academic and

social challenges and responsibilities that

increase their risk of trying addictive substances

and engaging in substance use.^14

During adolescence and into early adulthood the

brain undergoes considerable developmental

changes, explaining why adolescence is such a

risky period for the onset of substance use and

addiction.^15 Hormonal changes that occur

during adolescence also pose a biological risk

for substance use in this age group. The surge in

the female hormone estrogen and the male

hormone testosterone during puberty is

associated with risk taking and sensation

† According to the American Academy of Child and

Adolescent Psychiatry, oppositional defiant disorder

refers to a pattern of disobedient, hostile and defiant

behavior directed toward authority figures. Common

behavioral symptoms include defiance, spitefulness,

negativity, hostility and verbal aggression.

‡ Conduct disorder is diagnosed in youth who exhibit

enormous difficulty following rules and behaving in a

socially-acceptable manner. These children may

bully others, start fights, show aggression toward

animals, steal or engage in sexually inappropriate

behavior.

§ Past-year participation in the following acts: (a) hit

and pushed or threatened another student, (b) called

another student mean names, (c) told another student

you will not like her/him unless she/he did what you

wanted, (d) made people not like another student, (e)

told lies or spread rumors about another student, (f)

not let another student be in your group of friends.

** Mothers’ reports of children and teens having

trouble sleeping and overtiredness.