Open access

Introductory Chapter: Adolescent Substance Abuse – Risk Factors and Consequences

Written By

Patricia Sampedro-Piquero, Clara Zancada-Menéndez and Román Darío Moreno Fernández

Published: 08 February 2023

DOI: 10.5772/intechopen.108015

From the Edited Volume

Substance Use Disorder - New Research Perspectives in the Diagnosis, Treatment, and Prognosis

Edited by Patricia Sampedro-Piquero, Román Darío Moreno Fernández and Clara Zancada-Menéndez

Chapter metrics overview

140 Chapter Downloads

View Full Metrics

1. Introduction

1.1 Adolescence and substance abuse

People are most likely to begin abusing drugs (including tobacco, cannabis, alcohol, and other illicit substances) during adolescence and young adulthood from ages 10 to 19 [1]. Adolescence is a particularly vulnerable period of neurodevelopment in which the incorrect management of emotional, social, and behavioral changes can lead to an unsuccessful adulthood [2]. Regarding the brain anatomy and function, it is well known that during this period of life the brain is still maturating, being a moment of dynamic specialization of core brain systems, particularly the frontal structures [3]. In fact, the neural plasticity that occurs during this period creates a unique opportunity to influence the behavioral and developmental trajectories [4]. It is also a difficult period in which a high percentage of their decisions rely more on an emotional response or even on the social rewards rather than in a logical response. Therefore, as Hall noted in 1904, adolescence is a period of storm and stress (revised in [5]) because adolescents are characterized by a greater impulsivity, and less control over impulses, behaviors, and emotions, as well as a heightened reward sensitivity [6, 7]. As consequence, these personality, cognitive and behavioral patterns contribute to the emergence of risky and disruptive behaviors, such as drug abuse, which is common in Western countries [8].

This increased propensity to consume drugs is also enhanced by the fact that adolescents tend to be significantly less sensitive to their effects than adults [9]. Hence, adolescents experience less hangover symptoms and negative affect during alcohol withdrawal [10]. Besides, longitudinal studies have also suggested that impulsivity and the lack of inhibitory control could predict early onset drinking and alcohol dependence [11, 12]. On the other hand, alcohol consumption can promote itself impulsive actions by impairing basic inhibitory process [13]. Specifically, adolescents often consumed alcohol in repeated short episodes of heavy intake followed by detoxification and extended periods of abstinence, known as binge drinking (BD) [14]. This drinking pattern consists in drinking 5 or more glasses of alcoholic beverages in short periods of time (2 h) increasing the blood alcohol concentration above 80 mg/dl [15, 16]. Several preclinical and clinical studies have revealed that BD is associated with long-term behavioral and neurobiological impairments along with a risk of dependence in adulthood [17]. Nowadays, it is estimated that 40% of people between the ages of 15 and 24 engage in this pattern of alcohol consumption, which contributes to several medical complications, as well as higher risk of developing alcohol use disorder [18]. Further, the potential role of substance use as a risk factor for adult psychiatric disorders and dependence is remarkable [19]. These negative consequences are due in part to the drugs impact on brain mechanisms and signaling systems, whose maturation mainly happens during adolescence [9]. Thereby, in general, early drug exposure can produce impairments in the brain structure and function, resulting in several emotional, behavioral, and cognitive deficits [20]. For instance, studies have revealed persistent alcohol-induced neurobiological changes within the prefrontal cortex, the hippocampus, and the amygdala integrally involved in governing diverse emotional states [21, 22, 23].

Earlier initiation of substance use in adolescence is associated not only with an increased risk of dependence but also with antisocial behavior and impairments of adaptive functioning, including relationship difficulties, academic failure, unemployment, and mental health issues [24, 25, 26]. Besides, over half of the adolescents receiving treatment will relapse within 1 year of treatment [27], suggesting more accessible and effective programs needed to prevent and treat substance abuse in adolescents. Consequently, there is a need to explore other alternatives to treatment that, alone or in combination with existing ones, representing an improvement in treatment [2829].

Despite the relevance and clear influence of personality and neuropsychological factors in the development of substance abuse behaviors, we should not neglect the study of the impact of family dynamics and the social environment in which these young people live as possible predisposing variables. Regarding family factors, some studies have observed that young people who engage in substance abuse perceive a lower quality of family functioning with lower levels of cohesion, flexibility, communication, satisfaction, and a higher degree of disengagement compared with healthy adolescents [30]. Moreover, living in families that are not very flexible, highly disengaged and with communication problems among their members, is also a risk factor, suggesting the importance of prevention programs being based on an integrated approach focused also on improving the family environment. On the other hand, it has been observed that children of parents who also have addiction problems are more likely to present excessive consumption of drugs [31]. Nevertheless, there is also literature that did not find a significant association between parental drug consumption and substance abuse in adolescence [32]. Finally, another important social factor, especially for young people, is their use of social networks. Thus, it has been observed that the content of these is poorly regulated, tending to use marketing tactics based on the vulnerability of young people to the image, social relationships, and their need to fit in with the group [33]. To date, there is little work that has investigated the behavioral profiles of young people with drug-related problems on social networks, although this could have interesting implications for treatment and prevention. Figure 1 summarizes different risk factors involved in substance abuse during adolescence.

Figure 1.

Variables associated with drug abuse during the adolescence and youth.

Therefore, this book presents a comprehensive overview of multidisciplinary issues about adolescence and substance abuse, especially focus on alcohol. It has been written to be consulted by students and professionals of multiple psychological, biological, and social disciplines. Chapters has been also written for academics and researchers on different areas focusing on risk factors related to the onset and maintenance of substance abuse in adolescence, as well as potential of behavioral and pharmacological approaches to prevent and/or reduced the negative consequences involved in substance abuse. Finally, psychological disorders associated with drug abuse are also considered in this book.


  1. 1. Nawi AM, Ismail R, Ibrahim F, Hassan MR, Manaf MRA, Amit N, et al. Risk and protective factors of drug abuse among adolescents: A systematic review. BMC Public Health. 2021;21:2088
  2. 2. Steinberg L. Cognitive and affective development in adolescence. Trends in Cognitive Sciences. 2005;9:69-74
  3. 3. Vijayakumar N, Op de Macks Z, Shirtcliff EA, Pfeifer JH. Puberty and the human brain: Insights into adolescent development. Neuroscience and Biobehavioral Reviews. 2018;92:417-436
  4. 4. Spear LP. The adolescent brain and age-related behavioral manifestations. Neuroscience and Biobehavioral Reviews. 2000;24:417-463
  5. 5. Arnett JJ. Adolescent storm and stress, reconsidered. American Psychologist. 1999;54:317-326
  6. 6. Casey BJ. Beyond simple models of self-control to circuit-based accounts of adolescent behavior. Annual Review of Psychology. 2015;66:295-319
  7. 7. Rømer D, Reyna VF, Satterthwaite TD. Beyond stereotypes of adolescent risk taking: Placing the adolescent brain in developmental context. Developmental Cognitive Neuroscience. 2017;27:19-34
  8. 8. Degenhardt L, Stockings E, Patton G, Hall WD, Lynskey M. The increasing global health priority of substance use in young people. The Lancet Psychiatry. 2016;3:251-264
  9. 9. Spear LP. Effects of adolescent alcohol consumption on the brain and behaviour. Nature Reviews. Neuroscience. 2018;19:197-214
  10. 10. Lees B, Meredith LR, Kirkland AE, Bryant BE, Squeglia LM. Effect of alcohol use on the adolescent brain and behavior. Pharmacology, Biochemistry, and Behavior. 2020;192:172906
  11. 11. Ernst M, Luckenbaugh DA, Moolchan ET, Leff MK, Allen R, Eshel N, et al. Behavioral predictors of substance-use initiation in adolescents with and without attention-deficit/hyperactivity disorder. Pediatrics. 2006;117:2030-2039
  12. 12. Rømer Thomsen K, Callesen MB, Hesse M, Kvamme TL, Pedersen MM, Pedersen MU, et al. Impulsivity traits and addiction-related behaviors in youth. Journal of Behavioral Addictions. 2018;7:317-330
  13. 13. de Wit H. Impulsivity as a determinant and consequence of drug use: A review of underlying processes. Addiction Biology. 2009;14:22-31
  14. 14. Chung T, Creswell KG, Bachrach R, Clark DB, Martin CS. Adolescent binge drinking. Alcohol Research. 2018;39:5-15
  15. 15. Alessandrini G, Ciccarelli R, Battagliese G, Lombardo G, De Rosa F, Messina MP, et al. Interdisciplinary Study Group CRARL - SITAC - SIPaD - SITD - SIPDip. Treatment of alcohol dependence. Alcohol and the young: Social point of view. Rivista di Psichiatria. 2018;53:113-117
  16. 16. Gunzerath L, Faden V, Zakhari S, Warren K. National Institute on Alcohol Abuse and Alcoholism report on moderate drinking. Alcoholism, Clinical and Experimental Research. 2004;28:829-847
  17. 17. Jones SA, Lueras JM, Nagel BJ. Effects of binge drinking on the developing brain. Alcohol Research: Current Reviews. 2018;39:87-96
  18. 18. Lannoy S, Billieux J, Dormal V, Maurage P. Behavioral and cerebral impairments associated with binge drinking in youth: A critical review. Psychologica Belgica. 2019;59:116-155
  19. 19. Stoddard SA, Eisman A, Aiyer S, Zimmerman MA. The transition from adolescence to adulthood and associated substance use/abuse. Adolescent Medicine: State of the Art Reviews. 2013;24:611-620
  20. 20. El Marroun H, Klapwijk ET, Koevoets M, Brouwer RM, Peters S, Van't Ent D, et al. Alcohol use and brain morphology in adolescence: A longitudinal study in three different cohorts. The European Journal of Neuroscience. 2021;54:6012-6026
  21. 21. Jadhav KS, Boutrel B. Prefrontal cortex development and emergence of self-regulatory competence: The two cardinal features of adolescence disrupted in context of alcohol abuse. The European Journal of Neuroscience. 2019;50:2274-2281
  22. 22. Sakharkar AJ, Kyzar EJ, Gavin DP, Zhang H, Chen Y, Krishnan HR, et al. Altered amygdala DNA methylation mechanisms after adolescent alcohol exposure contribute to adult anxiety and alcohol drinking. Neuropharmacology. 2019;157:107679
  23. 23. Walker CD, Kuhn CM, Risher ML. The effects of peri-adolescent alcohol use on the developing hippocampus. International Review of Neurobiology. 2021;160:251-280
  24. 24. Behrendt S, Wittchen HU, Höfler M, Lieb R, Beesdo K. Transitions from first substance use to substance use disorders in adolescence: Is early onset associated with a rapid escalation? Drug and Alcohol Dependence. 2009;99:68-78
  25. 25. Guttmannova K, Hill KG, Bailey JA, Lee JO, Hartigan LA, Hawkins JD, et al. Examining explanatory mechanisms of the effects of early alcohol use on young adult alcohol dependence. Journal of Studies on Alcohol and Drugs. 2012;73:379-390
  26. 26. Slade T, Chapman C, Swift W, Keyes K, Tonks Z, Teesson M. Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: Systematic review and metaregression. BMJ Open. 2016;6:e011827
  27. 27. Ramo DE, Brown SA. Classes of substance abuse relapse situations: A comparison of adolescents and adults. Psychology of Addictive Behaviors. 2008;22:372-379
  28. 28. Macht V, Crews FT, Vetreno RP. Neuroimmune and epigenetic mechanisms underlying persistent loss of hippocampal neurogenesis following adolescent intermittent ethanol exposure. Current Opinion in Pharmacology. 2020;50:9-16
  29. 29. Sampedro-Piquero P, Moreno-Fernandez RD, Begega A, López M, Santín LJ. Consequences of alcohol use in early adolescence on emotional and cognitive status of mice in the late adolescence and adulthood: Focus on neuroadaptations in GR, CRF and BDNF. Addiction Biology. 2022;27:e13158
  30. 30. Laghi F, Bianchi D, Pompili S, Lonigro A, Baiocco R. Binge eating and binge drinking behaviors: The role of family functioning. Psychology, Health & Medicine. 2021;26:408-420
  31. 31. Skala K, Walter H. Adolescence and alcohol: A review of the literature. Neuropsychiatry. 2013;27:202-211
  32. 32. Cable N, Sacker A. Typologies of alcohol consumption in adolescence: Predictors and adult outcomes. Alcohol and Alcoholism. 2008;43:81A9O
  33. 33. Rounsefell K, Gibson S, McLean S, Blair M, Molenaar A, Brennan L, et al. Social media, body image and food choices in healthy young adults: A mixed methods systematic review. Nutrition Diet. 2020;77:19-40

Written By

Patricia Sampedro-Piquero, Clara Zancada-Menéndez and Román Darío Moreno Fernández

Published: 08 February 2023