Addiction Medicine: Closing the Gap between Science and Practice

seeking. The lack of fully developed decision-
making and impulse-control skills combined
with the hormonal changes of puberty
compromise an adolescent’s ability to assess
risks and make them uniquely vulnerable to
substance use.^16

Other psychological and social challenges faced
by adolescents--such as the struggle to develop a
sense of identity, feeling less satisfied with one’s
appearance and experiencing peer pressure to
conform--contribute to the risk.^17

Young Adulthood.........................................................................................................

In recent years, researchers have begun to
recognize the developmental stage of young
adulthood--often referred to as emerging
adulthood--as a period of life that is strongly
associated with risky use.^18 Young adults facing
heightened risk include:

 College students--* --while approximately
two-thirds of college students who engage in
substance use began to smoke, drink or use
other drugs in high school or earlier, the
culture on many college campuses permits
and promotes risky use rather than curtailing
it.^19

 Young adults facing work-related stress or
instability in living arrangements, social
relations or academic or career choices.^20
As marriage and parenthood have become
delayed, the phase of life devoted to
academics and career development has
stretched well into the twenties. Young
adults may turn to addictive substances to
relieve these forms of stress and self-
medicate their anxiety and emotional
troubles.^21

Middle and Later Adulthood ........................................................................................

Major life events and transitions increase the
chances that an individual will engage in risky
use of addictive substances.^22 Adults may turn
to risky use when:

• Much of the research conducted on young adults is

based on college student samples.

 Coping with the stresses of child rearing,

balancing a career with family and

managing a household;^23

 Facing divorce, caring for an adult family

member or grandchildren or coping with the

death of a loved one;^24

 Struggling with retirement, the loss of

independent living or financial problems;^25

or,

 Coping with an illness, including increasing

physical ailments such as arthritis or other

forms of chronic pain.^26

Middle aged and older adults who engage in

risky use may be even more vulnerable to the

health consequences of such use since physical

tolerance for alcohol and other drugs declines

with age: the ways in which addictive

substances are absorbed, distributed,

metabolized and eliminated in the body change

as people get older.^27 With regard to alcohol,

several biological factors account for reduced

tolerance. The amount of lean body mass

(muscle and bone) and water in older adults’

bodies decreases as the amount of fat increases,

with less water to dilute the alcohol. Reduced

liver and kidney function slows down the

metabolism and the elimination of alcohol from

the body, including the brain. These factors

allow the effects of alcohol to take hold more

quickly and depress brain function to a greater

extent than in younger people, impairing

physical coordination and cognitive function.^28

The increasing susceptibility to substance-

induced neurotoxicity with age is a growing

concern as the “Boomer” generation, a

population with higher rates of risky use, ages.^29

The interaction of prescribed and other drugs

with alcohol also is of great concern for the

physical and mental health of middle and older

adults who are likelier than younger people to

use prescription and over-the-counter

medications.^30