Adolescent Substance Abuse

Abstract

Adolescence is a stage in which young children are transitioning into adulthood and during this time there are challenges that can be encountered that can impact development. Prior to reaching adulthood substance abuse is an issue that many adolescents are faced with.  The National Institute on Drug Abuse (2014), states that nearly 70 percent of high school students will have consumed alcohol by the time they become seniors, 50 percent will have engaged in the use of illegal drugs, almost 40 percent tried smoking a cigarette on more than one occasion, and a little over 20 percent experimented with prescription drugs for recreational use.  There are many factors that influence adolescent substance abuse and it is a serious problem that can affect cognitive, physical and social development and providing a breakdown of those factors will allow the opportunity to identify successful intervention techniques.

  Substance Abuse

The act of ingesting, inhaling, or injecting something that can be detrimental to the health of an individual, “usually for psychoactive (mood-altering) purposes” (Wulffson, 2015) is known as substance abuse.  Alcohol, tobacco, prescription drugs and medications purchased over-the counter are commonly used products that are legal substances and cocaine, marijuana, hallucinogens, methamphetamine, and heroin are illegal substances.  Substance abuse is a problem that has been increasing amongst our youth and efforts have been made to gain a better understanding on the issue by examining biological and environmental factors that could be contributing factors in adolescents deciding to experiment with substances.  The National Survey on Drug Use and Health performed a study in 2014 stated that approximately 27 million Americans 12 years of age and older was reportedly used illegal substances within one month of the survey being conducted.  Therefore, it is imperative that an explanation on how adolescents develop substance abuse issues is provided.

During the adolescent years, the human brain is experiencing major changes that involve their “emotional/social network outpace development of the cognitive-control network” (Berk, 2014, p. 368) and because of these changes they are more than likely to engage in risky behavior such as substance use.  As the brain is developing during this period there are biological and environmental factors that could increase the chances of adolescents developing substance abuse problems.  Substance abuse and addiction disorders have been linked to biological factors such as genetics.  Research is continuously being performed to determine if substance abuse and addiction disorders can be inherited though genetics and thus far it has been acknowledged that inherited factors do exist, however there has not been any concrete evidence to determine what is inherited.  For example, an adolescent with a family history of drug abuse can “have an increased susceptibility or sensitivity to the effects of drugs with reinforcing properties” (Biological Components of Substance Abuse and Addiction, 1993) and those reinforcing properties are environmental factors.

Factors that Influence Substance Abuse

Environmental factors that influence adolescent substance abuse problems include access to substances, exposure to substance abuse through observing others and socioeconomic status.  Socioeconomic status is an individual’s social status which represents their place in society and is “earned through actions or accomplishments” (Campbell, 2016).  Adolescents that live in an environment of a lower socioeconomic status, meaning that education levels and income are less than average, tend to have more access to illegal substances because there is a high level of the availability of drugs in those types of communities and are exposed to substance abuse though the observation of others.  Communities that are of a lower socioeconomic status often have a high presence of outlets that distribute alcoholic beverages and tobacco sales that increase the exposure to adolescents and “facilitate substance use and initiation and potential abuse” (Mennis, Stahler, & Mason, 2016).  Albert Bandura’s Social Learning Theory suggest that human behavior is learned through observing others and that is a contributing factor to how adolescents begin to abuse substances in environments that are of a lower socioeconomic status, by simply watching others such as older teenagers and/or adults partake in these behaviors without receiving any consequences. Biological and environmental factors increase risk factors associated with adolescents who develop addictive disorders.

  

Addiction

Addiction is a mental disorder associated with functions of the brain and is related to substance abuse because when an individual reaches a point in which they are doing something and not able to stop then they have developed an addiction (O'Driscoll, 2014).  Adolescents that continuously abuse drugs and alcohol impact their physical, psychological and cognitive development.  Substance abuse can impact physical development because adolescents are most likely not receiving the proper nutrition needed to ensure the proper development.  Psychological development is effected because cognitive functions are impaired because of the effects that alcohol and drugs have on the human brain.  Substance abuse alters human behavior which affects psychological development because adolescents are engaging in risky behavior that could be detrimental to the health of themselves and others. 

Developmental Theories

Erik Erickson developed a theory on eight stages of human development that can provide some insight on adolescent’s engaging in substance abuse.  The adolescent stage is identity vs. role confusion and is focused on fidelity.  (Gould, 2015) states that during this stage individuals are focused on what they do and often struggle with finding their own identity, peer relations and determining their place in society.  The identity vs. identity confusion stage can influence substance abuse because adolescents are trying to fit in societal norms that often involve drugs and alcohol.  Adolescents that partake in drug and alcohol abuse to fit in often can develop an addiction because of the feelings that are experienced when under the influence.

Intervention

Intervention can be identified as a method used to “produce an effect or to interrupt or stop the progression of a disease” (Frey, 2015) such as substance abuse and addiction.  In efforts community should join forces to develop intervention techniques.  Early detection of possible drug and alcohol abuse is the most effective because adolescents can be referred to treatment programs to help combat those issues.  A change of environment has always been the most recommended solution; however, it is not always the most feasible decision, therefore community efforts should be made to deter adolescents from partaking in the use of drugs and alcohol. Drug Abuse Resistance Education (DARE) is a proactive intervention technique that was designed to teach students about making decisions that will help them lead a safe and healthy life that is free from risky behaviors that involve substance abuse. 

Conclusion

Substance abuse is a serious problem in society and providing an explanation on how adolescents develop substance problems can help with developing intervention techniques that can assist with reducing the risk of the urge to experiment with alcohol and drugs.  There are several biological and environmental factors that contribute to adolescents developing addictive disorders and developmental theories have provided information on the different stages and how they relate to how substance abuse is dealt with.  Developing intervention techniques is the most appropriate and effective method that can be used to reduce the risk of adolescent experimenting with drug and alcohol abuse and it is important for everyone to be a part of the efforts.

  References

Berk, L. E. (2014). Development Through the Lifespan (Vol. Sixth Edition). Upper Saddle River, New Jersey: Pearson.

Biological Components of Substance Abuse and Addiction. (1993). Retrieved from Princeton.edu: www.princeton.edu/~ota/disk1/1993/9311/931103.PDF

Campbell, J. (2016). Social status. Salem Press Encyclopedia.

Frey, R. P. (2015). Intervention. Salem Press Encyclopedia of Health.

Gould, M. A. (2015). Erikson's Eight Stages of Development. Research Starters: Sociology (Online Edition).

Mennis, J., Stahler, G. J., & Mason, M. J. (2016). Risky Substance Use Environments and Addiction: A New Frontier for Environmental Justice Research. International Journal of Environmental Research and Public Health, 13(6). doi:10.3390/ijerph13060607

NIDA. (2014). Retrieved from Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide

O'Driscoll, C. (2014). Addiction: A Guide to Understanding Its Nature and Essence. Hauppauge, New York: Nova Science Publishers, Inc.

Wulffson, R. M. (2015). Substance abuse. Salem Press Encyclopedia of Health.

The Strange Situation Review

The Strange Situation

The attachment theory provides an explanation on the importance of how bonding and attachment is to personal development in infancy and childhood. The emotional tie between a mother and infant is known as bonding and often occurs shortly after birth. Attachment is a relationship that develops during infancy and John Bowlby a British psychiatrist believes that there are four phases in the development of attachment.  In phase 1, newborns are still in the bonding face, therefore attachment has not begun.  In phase 2, which occurs around two months, infants demonstrate the ability to recognize the difference between caregivers, however attachment has not yet developed.  In phase 3 is when attachment begins around seven months and “infants clearly discriminate the caregiver from other people and begin to show preferential treatment toward the caregiver” (Rieser-Danner & Slaughter, 2016).  Phase 4 is when infants secure the bond with caregivers and attachment becomes relevant to their relationship. This paper will provide a review of a study conducted by psychologist Mary Ainsworth in which she explored different aspects of mother and infant attachments.

Experiment Details

The Strange Situation was an assessment that was conducted by Psychologist Mary Ainsworth as a method to investigate “how attachment might vary between children” (McLeod, 2008).  There were 56 infants that were participants from middle class white families and they were divided into subsamples, one included 23 infants, “who had been observed longitudinally from birth onward, were observed in the strange situation when 51 weeks old” (Ainsworth & Bell, 1970) and the other included 33 infants who were observed at 49 weeks of age.  The observation was conducted in a room that was intended to “be novel enough to elicit exploratory behavior, and yet not so strange that it would evoke fear and heighten attachment behavior at the outset” (Ainsworth & Bell, 1970).  The room was furnished but it was arranged in a way that a significant amount of empty space was left open.  There was a chair for the child and toys were present on one side and a chair for the mother and opposite that chair was a chair for a stranger on the other side.  The experiment begun with the infant being placed in the area that was purposely left empty and was “left free to move where he wished” (Ainsworth & Bell, 1970).  There was a total of eight different scenarios used to initiate, measure and record behaviors that occurred.  The scenarios involved mother-infant and the observer; mother-infant; mother-infant and stranger; mother departs leaving infant alone with stranger; mother departs leaving infant alone; stranger comes back while infant is alone; mother comes back while infant was with stranger and stranger leaves.  The results of those scenarios were recorded to demonstrate the difference in the behavior of the infants as it relates to attachment.

The behaviors that were described during the research were categorized in four different ways, proximity and contact-seeking behaviors; contact-maintaining behaviors; proximity and interaction-avoiding behaviors; contact and interaction-resisting behaviors.  Proximity and contact-seeking behaviors involved the infant actively attempting to make contact gestures such as reaching, approaching or crying.  Contact-maintaining behaviors occurred once the infant made contact, they made every effort to maintain that contact through “resisting release by intensified clinging on” (Ainsworth & Bell, 1970).  Proximity and interaction behaviors occurred when someone other than the caretaker attempted to interact with the infant and the infant purposely ignored that adult by looking away and then moving away. Contact and interaction-resisting behavior occurred with the infant resisting contact from someone other than the caregiver and throws temper tantrums trying to get away from the unfamiliar person. 

Main Points

The research determined that “patterns of attachment is believed to be the result of the history of interaction between the caregiver and infant” (Rieser-Danner & Slaughter, 2016), therefore it does not occur by chance but rather it is based on the circumstances.  If the infant is exposed to an unfamiliar environment they may experience fear and that will result in attachment intensifying and those feelings can only be resolved with reuniting the infant with their caretaker. The findings from the research suggest that levels of attachment are based on individual differences that is dependent upon the relationship developed between a mother and her child.  If a mother is consistently responsive to the needs of their child in a sensitive manner a secure attachment will develop and mothers that are less sensitive when responding to the needs of their child are more than likely to develop an insecure attachment.

Examining the main points that were presented in the research study and reflecting on my own personal experience, I would have to say that I agree with the conclusion to the experiment.  I believe that children whom are accustomed to always being with their mother will experience heightened levels of anxiety if someone must care for them not in the presence of their mother and/or father.  I can support this claim through personal experience with my now 11-year-old daughter who was cared for by her father for the first six months of her life and when it was time for her to go to daycare, she demonstrated contact and interaction behaviors for the first week of being in the care of someone else.  When an infant or young child’s normal routine is altered and they are exposed to a different environment and unfamiliar people are present I believe they develop a sense of fear and may struggle to adapt to that environment. 

 Intervention

German psychoanalyst Erik Erikson developed a psychosocial theory that focused on infant/toddler development in relation to the parent-infant relationship.  Erikson’s theory state that “a healthy outcome during infancy depends on the quality of care giving; relieving discomfort promptly and sensitively and holding the infant gently” (Berk, 2014, p. 184), therefore developing a level of trust can ensure a healthy attachment.  Many parents have reservations about having others care for their children at such a young age and opt out of childcare arrangements, however I personally believe that the best way for infants and toddlers to develop levels of trust outside of their parents is to be in different environments.  When infants and toddlers are exposed to environments that promote healthy interactions amongst each other healthy attachments can develop making it easier on the parents to separate from their children for short periods of time.  Having a complete understanding of developmental milestones is also important to intervention because that allows caretakers to make informed decisions regarding the level of care the child should be receiving.  Understanding child development ensures that caretakers are implementing age-appropriate interactions and activities with children that will not increase levels of anxiety due to frustration and fear of the unknown.

Conclusion

Several experiments have been conducted to measure mother-infant attachments and The Strange Situation was a specific experiment that caught a lot of attention.  The experiment was conducted in a laboratory setting instead of the home environment because researchers believed that was the only way to produce valid results.  The goal was to identify different levels of attachment by exposing the infant to different conditions involving the caretaker and strangers. The results concluded that there were high levels of attachment in the infants when left in the presence of strangers without the mother being present, therefore supporting the attachment theory claim on the importance of bonding and attachment is to personal development.  The review of the strange situation was designed to summarize the experiment, discuss the main points that were made by the researchers and provide an opinion on whether I agreed or disagreed with the viewpoints.  Finally, the review discussed specific techniques that are applicable to ensuring infants and toddlers develop healthy attachments with caregivers.

References

Ainsworth, M. S., & Bell, S. M. (1970). Attachment, exploration, and separation: Illustrated by the behavior of one-year-old in a strange situation. Child Development, 41(1), 49-67.

Berk, L. E. (2014). Development Through the Lifespan (Vol. Sixth Edition). Upper Saddle River, New Jersey: Pearson.

McLeod, S. (2008). Strange Situation. Simply Psychology. Retrieved from www.simplypsychology.org/mary-ainsworth.html

Rieser-Danner, L. A., & Slaughter, V. (2016). Attachment and bonding in infancy and childhood. Salem Press Encyclopedia Of Health.

Critical Thinking in Psychology

Autism can be defined as “a neurodevelopmental disorder characterized by impairment in emotional expression and recognition, difficulty with social relationships, delayed and/or abnormal language and communication, and preoccupation with repetitive, stereotyped behaviors or interests” (Slaughter, 2016).  The exact cause of autism is not known; however extensive research has determined that it is “caused by an abnormality in the development of the brain” (Autism, 2016) and has nothing to do with parental and/or environmental influences which is why early intervention is necessary.  Early detection of autism allows medical providers to establish intervention techniques to improve communication abilities and social skills which is why research was conducted to study the age of recognition of symptoms and their correlates in children that were diagnosed.  My current position as a Behavior Technician working with young children diagnosed with autism prompted the selection of this topic so a better understanding can be established on the importance of early intervention.

Summary of the Article

Literature Review

            The peer-reviewed article that I selected was featured in The Journal of Indian Association for Child & Adolescent Mental Health in which a study was conducted using records retrieved from a health care center located in India “to find the age of recognition (AOR) of symptoms by parent and delay in diagnosis and seeking professional help in children with autism” (Bagal, Kadam, & Parkar, 2016, p. 1).  The purpose of the study was to provide evidence that supports the belief that early detection and intervention of autism “can significantly improve the social and communication abilities in children” (Bagal, Kadam, & Parkar, 2016, p. 1).  The focus of the research was to demonstrate the need for “more awareness about ASD to be spread among general population; the need for proper training amongst health care professionals for diagnosis ASD and adequate referral mechanism; and, monitoring the development of child should be mainstreamed into primary health care services for early diagnosis and intervention” (Bagal, Kadam, & Parkar, 2016).

Methods Section

            The first step to conducting the study was submitting a proposal to the Investigation Review Board detailing the purpose of the research.  Once the proposal was approved researchers collected data from case records located in several different locations in India, one being the Child Guidance Clinic of Department of Psychiatry.  Researchers selected case records from fifty children diagnosed with autism between 2007-2013 and excluded the case records of “children with intellectual disability with autistic features as primary diagnosis” (Bagal, Kadam, & Parkar, 2016, p. 1).  The study was conducted over a three-month period in which information was retrieved from case records pertaining to the age autism was detected, symptoms, pregnancy complications, birth and developmental history.  After the information from the case records was compiled together it had to be measured and researchers used “non-parametric test such as Kruskal-Wallis test, and multiple regression analysis was applied using SPSS 16.0” (Bagal, Kadam, & Parkar, 2016, p. 296).

Results Section

            The data collected during the study identified fifty patients that were diagnosed with Autism in which “82% were male and 18% were female which corresponds to the male: female ratio of nearly 4:1 as stated by study done by Indring et al which was a record-linkage study done in Sweden” (Bagal, Kadam, & Parkar, 2016, p. 296).  Early detection was a key factor to the study which is why age of recognition was taken from each record and that information determined that parents normally recognize symptoms of autism around three years and six months and the average age of diagnosis was six years and six months. Researchers examined each record for pregnancy related complications to determine if there was a relation between those complications and autism and of those records only 36% identified pregnancy related complications such as “hypoxia, meconium stained liquor, torsion of the neck and delayed labor” (Bagal, Kadam, & Parkar, 2016, p. 298).  Prior abortions, intellectual disability, family history of mental illness and medical complications were other categories that data was collected.  A decrease in social interactions was the most common symptom that was noticed by parents first and the study retrieved that information from 32% of the cases.  Delayed speech was the most common symptom noticed by parents in a previous study, however only 26% of the cases noted that as the first noticeable symptom.  The information retrieved was categorized by symptoms that were present in women that displayed pregnancy related complications and concluded that there is no solid evidence that “pregnancy related complications, medical complications, intellectual disability and behavioral problems during childhood are independent risk factors for autism” (Bagal, Kadam, & Parkar, 2016, p. 303) and that further research is needed to make a final determination.

Discussion Section

            The data collected examined children that were diagnosed with autism and the information in each case was separated into categories to generate statistical information that was used to determine the relation between the age of recognition and symptoms as they relate to pregnancy complications. Information pertaining to pregnancy complications, medical complications and family history of mental illness was retrieved from the records to establish risk factors, however the data collected did not establish if those risk factors were independent variables or not.  The data collected also included symptoms and when they were first noticed by parents to support the main reason for the study which was the importance of early detection in relation to intervention.

Conclusion Section

            The age of recognition in symptoms in children diagnosed with autism was studied in detailed to provide information that can support claims on the importance of spreading awareness.  The exact cause of autism has yet to be determined, however many studies have been conducted to determine possible risk factors to increase awareness in pregnant women that may be subjected to these factors such as pregnancy related complications.  Pregnancy related complications resulted in early detection of autism which made early intervention possible, however in cases where pregnancy related complications were not a factor, detection of autism was detected a later age.

Analysis of the Article

Strengths

            The purpose of the study was to demonstrate the need to increase awareness on autism in communities in India so parents, particularly women of child bearing age would understand the risk factors and receive adequate care during pregnancy and follow-up care and evaluations after the child is born and the article detailed supporting facts of this claim.  Age of recognition was the main supporting fact in which the article showed the importance of prenatal care as it relates to pregnancy related complications and symptoms of autism.  Researchers used information from the records obtained from the clinic as supporting evidence by creating groups based on symptoms and when they were noticed in which pregnancy related complications were present and not present. This information allowed the researchers to further their discussion on why increased awareness and education on autism is important.

Weaknesses

            The study was conducted using only fifty records of individuals diagnosed with autism and although the article demonstrated the necessity of increased awareness, fifty cases only laid the groundwork and established evidence that supports the claim. 

Reflections

Supported Opinions

            Pregnancy related complications have been directly related to many birth defects, however autism is partially excluded from that claim and I personally believe that because autism is a neurodevelopmental disorder it is possible that pregnancy related complications can be a contributing factor.  Prenatal care is extremely important during pregnancy because it allows health care providers to monitor the pregnancy for any problems that may arise.  Health-related problems during pregnancy can affect the fetus which can result in birth defects.  Pregnancy related complications often results in the birth of a child through C-section instead of vaginally and several studies have been conducted to determine the relation between the two.  There was a study conducted in which research demonstrated that “neonates delivered by C-section with general anesthesia were associated with a higher incidence of autism than neonates delivered vaginally or those delivered by C-section with regional anesthesia” (Chien, Lin, Shao, Chiou, & Chiou, 2015).

 Standards Check

The information provided in the article was retrieved from case records of children diagnosed with autism therefore accuracy was determined.  The information was relevant to the study because the research was to determine the importance of early recognition and the age of recognition and age of diagnosis was retrieved from the case records.  There was great depth in the information provided because the study not only focused on the age of recognition and diagnosis, but also symptoms related to autism and how they correlate with pregnancy related complications.

Conclusion

When I first began my position as a Behavior Technician I was paired with young children diagnosed with autism in a pre-school setting and it was unclear to me as to why behavior modification was so important at this early stage, however current studies are providing me with the opportunity to enhance my knowledge on the disorder as I gain clarity on the importance of early intervention.  The article demonstrated the importance of early detection, recording background information, symptoms and family history as key factors to the claim of the importance of increased awareness in the communities. Research studies are continuously being conducted on autism and the information obtained from this article is the beginning of research efforts that will better assist the development of behavior modification skills for children with autism.

References

Autism. (2016). Funk & Wagnalls New World Encyclopedia, 1p. 1.

Bagal, R., Kadam, K., & Parkar, S. (2016). To study the age of recognition of symptoms and their correlates in children diagnosed with autism spectrum disorders: A retrospective study. Journal Of indian Association For Child & Adolescent Mental health, 12(4), 291-308.

Chien, L., Lin, H., Shao, Y., Chiou, S., & Chiou, H. (2015). Risk of Autism Associated with General Anesthesia During Cesarean Delivery: A Population-Based Birth-Cohort Analysis. Journal Of Autism & Developmental Disorders, 45(4), 932-942. doi:10.1007/s10803-014-2247-y

Slaughter, V. P. (2016). Autism. Magill's Medical Guide (Online Edition).