Clinical Issues With Youth

Adolescence is a time of significant physical and psychosocial development. As adolescents develop, they rely increasingly on peers for information and support. They must also learn how to deal with boundaries and begin to integrate various aspects of their identity. Experimentation, exploration, and risk taking characterize adolescence, and many adolescents explore the use of alcohol and drugs. In fact, most adolescents have tried alcohol and drugs at least once by age 18 (Johnston, O’Malley & Bachman, 1995). According to the 1998 National Household Survey on Drug Abuse (Office of Applied Studies, 1999) 21.3 percent of youth ages 12 to 17 years reported using an illicit drug at least once in their lifetime, while a Centers for Disease Control and Prevention (CDC) survey found that more than half of high school students reported having at least one drink during the preceding 30 days(CDC, 1996).

Adolescents who use alcohol and drugs are more likely to engage in sexual intercourse, to have sex at younger ages, and to have more partners; they are less likely to use condoms during their sexual activity than youth who do not use alcohol and drugs (MacKenzie, 1993). Many adolescents report using alcohol before sexual intercourse. Of these, more than half report having five or more drinks before having sex, which impairs their judgment and increases the potential for high-risk behaviors such as anal intercourse (Fortenberry, 1995). Adolescents whouse crack cocaine, in particular, are at high risk for HIV infection. A study of HIV-positive adolescents found that two-thirds of girls and more than half of boys reported using crack; of these, four out of five reported exchanging sex for money, drugs, food, or shelter (Futterman etal., 1993).

Because adolescents are developing physically and psychologically, substance use can impair their intellectual, emotional, and social development. Drug experimentation in adolescence may be a part of their development. However, the transition from use to abuse is a maladaptive response defined by a failure to successfully achieve the developmental tasks of adolescence (Duncan & Petosa, 1994).