Adolescent Neurological Development and its Implications for Adolescent Substance Use Prevention

Barbara Lopez; Seth J. Schwartz; Guillermo Prado; Ana E. Campo; Hilda Pantin


J Prim Prev. 2008;29(1):5-35. 

In This Article

Abstract & Introduction

Recent technological advancements have facilitated the study of adolescent neurological development and its implications for adolescent decision-making and behavior. This article reviews findings from the adolescent neurodevelopment and substance use prevention literatures. It also discusses how findings from these two distinct areas of adolescent development can complement each other and be used to build more developmentally appropriate interventions for preventing adolescent substance use. Specifically, a combination of child-centered and family-based strategies is advocated based on extant neurological and prevention literature. Editors' strategic implications: Researchers are encouraged to take up the authors' challenge and study the links between adolescent neurological development/decision making ability and the long term efficacy of comprehensive interventions for preventing adolescent substance use.

Despite recent reductions in the prevalence of adolescent substance use (Johnston et al. 2006a), substance use, including cigarette, alcohol, and drug use, in adolescents remains an important public health concern. Adolescents continue to display higher rates of experimental substance use than those found in adults (Chambers et al. 2003). Community based studies have found that substance initiation and use peak in late adolescence and young adulthood (Johnston et al. 2006a, b; Kandel and Yamaguchi 1999). Lifetime substance use nearly doubles between 8th grade and 12th grade (Johnston et al. 2006a), indicating that a large portion of adolescents initiate substance use in high school.

These high rates of substance use initiation in adolescence (12-18 years old) and emerging adulthood (18-25 years old: Arnett 2000) may be associated with an increased orientation toward risk taking in adolescence. For example, Gullone and Moore (2000) found that older adolescents (15-18 years old) engaged in more risk taking behavior, including substance use, than do younger adolescents (11-14 years old). Substance use in adolescence is associated with a number of problematic concomitants and sequelae, such as repeated arrests (e.g., Flory et al. 2004), substance use disorders (e.g., DeWit et al. 2000; Sung et al. 2004), comorbid psychopathology (e.g., Bucholz et al. 2000; Chung and Martin 2001; Cornelius et al. 2004; Schuckit and Hesselbrock 1994), lowered educational attainment (Ellickson et al. 2004), sexually transmitted diseases (e.g., Cook et al. 2000), teen pregnancy (e.g., Clark et al. 1997), and physical health problems in adulthood (Clark et al. 2001; Hansell and White 1991; Newcomb and Bentler 1987). Moreover, the earlier substance use begins, the more severe it and its consequences will be, and the more likely it is to be associated with negative consequences in adulthood (Grant and Dawson 1997; Hawkins et al. 1992; Flory et al. 2004). For example, Flory et al. (2004) found that youth who began to use alcohol by 12 years old evidenced more arrests and greater likelihood of substance use disorders at ages 20-22 than did youth who did not drink or who postponed drinking until after 14 years old.

In terms of consequences, adolescent substance use may influence adult outcomes by way of affecting the adolescent's functioning across several areas, including psychological (lower autonomy and perceived competence: Chassin et al. 1999) and social (e.g., relationship; King et al. 2006; Newcomb and Bentler 1988) problems. These wide-ranging impairments in adolescent functioning can, in turn, interfere with successful acquisition of adult roles such as marriage (Baumrind and Moselle 1985; Friedman et al. 2004), parenting (e.g., irresponsible parenting; King et al. 2006; Newcomb and Bentler 1988), and gainful employment (e.g., greater unemployment, job instability, lower income; Baumrind and Moselle 1985; Friedman et al. 2004).

The higher rates of substance use in adolescence than in adulthood may have biological as well as social underpinnings. Accordingly, the purpose of this article is to review findings from the adolescent neurodevelopment and substance use prevention literatures and to discuss ways in which findings from these two distinct areas of adolescent development can complement each other and can be used to build more developmentally appropriate interventions for preventing adolescent substance use. Specifically, we review findings from (a) prevention studies aimed at reducing adolescent substance use and (b) neurological development studies focusing on decision-making and emotion regulation. Findings from these two areas are then used to inform research directions for adolescent substance use prevention. More specifically, findings from studies on neurological development suggest that adolescent decision making ability and emotion regulations skills are not fully developed. As a result, we argue that prevention programs that rely solely on decision-making abilities to reduce risk for substance use may not be developmentally appropriate.

In this article, we have chosen to focus on universal and selected (e.g., girls, Hispanics, African Americans) primary prevention studies (Mrazek and Haggerty 1994), which generally focus on delaying initiation of substance use. We do so for four reasons. First, the age range targeted by primary prevention (middle school and high school) represents the time when considerable changes in neurological development can be observed and when risk for substance use initiation increases sharply (Johnston et al. 2006a, b; Kandel and Yamaguchi 1999). Second, initiation of substance use in adolescence is often associated with other aspects of the problem behavior syndrome (e.g., school failure, unsafe sexual behavior, and deviant behavior; Jessor et al. 2003). Third, initiation of substance use in adolescence has also been shown to lead to neurological changes (e.g., increased risk taking; Fishbein et al. 2005; Verdejo-Garcia et al. 2006) that may result in greater susceptibility to addiction (Volkow and Li 2006). These patterns may create different pathways to substance use for initiators and non-initiators. Finally, the theory, goals, and structure of universal and selective interventions are different from those of indicated interventions, which target specific subgroups of adolescents who have already begun engaging in high risk behaviors such as conduct problems and substance use, and therefore results from indicated interventions may not generalize to universal and selective interventions (Nation et al. 2003).

A search of the PsycInfo psychological literature database was used to obtain relevant interventions aimed at preventing substance use initiation (primary prevention) that were published between January 1996 and February 2007. We focused on the past 10 years to provide a more recent review of the literature. We targeted primary prevention interventions for adolescents in general, using the search terms "prevention," or "initiation"; and "adolescent"; and "cigarette" or "tobacco" or "smoking" or "drug" or "alcohol" or "substance". We limited the preventive interventions included in the review to those that used randomized trial designs (see Carroll and Rounsaville 2003, for a complete description of stages of behavioral clinical trials). Pilot, uncontrolled, or non-randomized studies were not included in this review. This search yielded 40 prevention intervention trials. Specific information on these trials is presented in Table 1 .


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