Most adolescents with severe substance use disorder (SUD) symptoms continue to have multiple SUD symptoms in adulthood, according to a recent study published by the University of Michigan’s Center for the Study of Drugs, Alcohol, Smoking, and Health (DASH Center) on April 1.
This longitudinal study used data from the Monitoring the Future study, which is an ongoing project about drug use that has surveyed nationally representative samples of U.S. high school seniors each year since 1975. This study included data from 11 cohorts of 5,317 high school seniors who were surveyed from age 18 to age 50.
According to the study, approximately two in every five U.S. adolescents experienced multiple SUD symptoms, and the majority of these adolescents continued to display symptoms in adulthood. The study also found that adolescents with severe SUD symptoms were significantly more likely to report prescription drug use and misuse in adulthood.
The leading author of the study, Sean Esteban McCabe, director of the DASH Center and professor in the Department of Health Behavior and Biological Sciences in the School of Nursing at the University, wrote in an email to The Michigan Daily that their study emphasizes the importance of early screening for adolescents.
“Our findings indicate that early screening that accounts for SUD symptom severity can help identify adolescents at the greatest risk for later prescription drug misuse and SUDs,” McCabe wrote.
McCabe also wrote that health care practitioners should screen adolescents and adults for SUD symptoms to help identify high-risk individuals.
“Health care providers should consider prescribing medications with less misuse potential and prescribing the appropriate amount of medications for the appropriate time period,” McCabe wrote. “Moreover, no patient should be prescribed a controlled medication without being screened for a substance use disorder.”
According to McCabe, it’s essential to educate adolescents about the risks that they might face later in adulthood.
“It may be harmful to tell (adolescents) with severe symptoms that they will (mature out of their disorders),” McCabe wrote. “It is like advising a jar of pickles that they can become cucumbers someday. Our study shows us that severity matters when it comes to predicting risk decades later, and it’s crucial to educate and ensure that our messaging to teens with the most severe forms of substance use disorder is one that’s realistic.”
The researchers in the DASH Center aim to find strategies to keep individuals with past or current SUDs safe when they are prescribed a controlled substance, according to McCabe. One strategy is community-based programs, which reach people who are often missed by traditional substance services.
“Each person should examine their relationship to substances and what they believe about substance use,” McCabe wrote. “The true solution lies far beyond health care providers alone. Everyone plays a role in where we find ourselves as a country in terms of this problem, and everyone can play a role in getting us to a better place.”
Charles Graham, a clinical social worker and psychologist in the Michigan Medicine Department of Child and Adolescent Psychiatry, said this study recognizes the effect of substances on developing brains.
“I think (the study) reinforces what we already know about the influences of substance use in various ways, whether it’s prescribed or done illicitly,” Graham said.
Graham also said therapy could be an important treatment for young people struggling with addiction.
“What we do offer to young people is individual therapy and group therapy that focuses on relapse prevention,” Graham said. “In addition, we offer family therapy because many young people are in the context of families, and it’s hard to provide isolating treatment without including the social context in which young people often are interacting. It helps to educate families about… how addiction may look, so that they can be aware of it and responsive.”
According to Graham, high-risk individuals could use third-party “gatekeepers,” who monitor individuals’ medication use, to help manage their prescribed medications and prevent overuse.
“(Gatekeepers) allow for an additional buffer to help monitor individuals who may be prone to addictive behavior,” Graham said. “When medication is prescribed for people, you automatically are given implied permission to use it. If a person has an addiction issue, it may give them permission without reservation, so it helps to have an additional person around that says, ‘okay, we’re going to lock it away or monitor so that it’s not used abusively.'”
LSA junior Benjamin Fields is in recovery from substance use disorder and currently works at a substance use disorder treatment facility. Fields said the study’s results echo his personal experience and understanding of addiction.
“Recovery from addiction is something that’s ongoing throughout the lifetime. It’s not something that you just snap your fingers, and one day you wake up, and you’re no longer an addict,” Fields said. “People who have had SUDs when they were adolescents are going to continue to be at risk of them as adults. This data is backing up what we would already be feeling.”
Fields said educating adolescents about controlled substances is crucial, and health care practitioners should provide adequate information about the controlled substances they prescribe.
“Education is probably the best thing you could do for young people,” Fields said. “Because you don’t know what you don’t know, and before you realize, you might be hooked on prescription drugs that you never realized were dangerous.”
Fields shared his experience using gatekeepers to keep himself safe. When he was prescribed a medication that can be abused after his wisdom teeth removal two years ago, he gave it to his wife, who knew his history with substances, as a gatekeeper.
“The gatekeeper was there. I was tempted to use it, but as someone in recovery, I didn’t want to have access to it readily,” Fields said. “(A lot of sober people) will give their medication to their sponsor or another sober support that they have.”
Fields said there are lots of mutual aid programs such as Alcoholics Anonymous and Narcotics Anonymous available for people in recovery to help support each other. He also said the awareness of SUD is important to both individuals and communities.
“Everyone should be aware of substance use disorders, and the impacts they can have on the individual but also the family structure and social structure of the community,” Fields said. “It affects everyone, to some degree, whether they realize it or not. So I think it’s important for everyone to just be aware of it.”
LSA senior David Seaman first used substances when he was 12 years old due to a hip injury, but soon after he started to develop substance use disorders. Now in his fifth year of recovery, Seaman said the research results are meaningful to himself and the recovery community.
“For somebody who lives (in) it, (the research results) make sense. I’m glad people are following and making this data available and accessible and being able to make meaningful inferences from it,” Seaman said. “I can say, at least for myself and for a lot of people that I know are also in recovery, we tend to have started from an early age. It’s important information when it comes to how we get early prevention and early screenings.”
Seaman said building trust in relationships with providers and being able to have conversations about substances with them are essential to him.
“Have a relationship with providers so that you are able to ask those questions,” Seaman said. “That should be something culturally within hospitals or care settings so that those conversations can happen.”
Seaman has been in the University’s Collegiate Recovery Program (CRP) for two years. CRP is a campus support service for students in recovery from substance use disorders.
“I came to the CRP after being in recovery for a while, so I had a pretty established support system outside of college in the Ann Arbor community,” Seaman said. “I was really looking for a place on campus where I could recover out loud or just openly be myself and be able to talk about life in college and life at U-M.”
Seaman also said certain college cultures rooted in competition can be toxic to people in recovery, and it’s important to have a space on campus where support is provided.
“There are some aspects of being in college that are not super recovery friendly. There’s a culture (not just) around drinking but also around competition and over valuation on performance,” Seaman said. “Some of those things have benefits, but only if you have the right support. (CRP) on campus is a spot to celebrate individuals and support their recovery. I don’t think my academic achievement and recovery would be as fruitful as it has been if there wasn’t CRP.”
After graduation, Seaman said he hopes to pursue public policy and law, particularly in addiction policy fields. Seaman said there are many resources available on campus through Wolverine Wellness and UHS, and he encouraged people struggling with similar issues to get help.
“If anybody’s struggling or knows anybody who’s struggling, you’re not alone,” Seaman said. “It’s always better to ask for help before things get out of hand.”
Daily Staff Reporter Jingqi Zhu can be reached at jingqiz@umich.edu.