Latest Studies Focus on Adolescents and Substance Abuse

adolescents and substance abuse - Girl drinking alcohol

Dr. Mark Gold’s Research You Can Use

Alcohol-related cirrhosis increase due to adolescents and substance abuse

Deaths in the United States, as a consequence of cirrhosis, have risen by 65 percent and fatalities owing to liver cancer have doubled from 1999 to 2016. This increase in deaths has been noted in both the genders and in almost every ethnic group. White Americans, Native Americans, and Hispanic Americans have experienced the greatest surges in death from cirrhosis due to adolescents and substance abuse increases.

Dr. Elliot Tapper, an assistant professor at the University of Michigan and first author on the paper, highlights alcohol-related liver disease, especially due to the rising trends of binge-drinking, as the primary cause for cirrhosis-related deaths in young Americans.

While people aged 25-34 years experienced the highest average annual increase in cirrhosis-related mortality, this is still a relatively small number in comparison to the overall number of patients dying of cirrhosis.

The study further continues to highlight other crucial environmental factors that can lead to cirrhosis and liver cancer. Yet, these exposures remain widely underreported and unappreciated. Deaths, as a result of cirrhosis, are expected to rise three-fold by 2030.

Many of the states with the largest relative mortality increases are also where obesity has rapidly increased. Many of the states that reported rising rates of alcohol-related cirrhosis deaths also had increased rates of alcohol use disorder and vice versa. Increase in cirrhosis mortality was highest in Kentucky, New Mexico, and Arkansas, according to the study.

Man sitting on a curb with a beer in his handDue to the study being observational, a direct relationship between the two trends could not be confirmed.

Additionally, Tapper said a potential limitation of the study came from its use of death records, which have been found to be inaccurate around 10 percent of the time.

Why does this matter?

While the focus has remained on the deaths due to opioids, this study uncovers the critical role played by alcohol. Alcohol use also has spiked in recent years, simultaneously raising the risk of liver disease.

A National Epidemiologic Survey on Alcohol and Related Conditions reported an 11.2 percent increase in monthly alcohol use, a 29.9 percent rise in high-risk drinking, and a 49.4 percent increase in alcohol-use disorders between 2001 and 2013. An earlier diagnosis would help prevent and timely treat liver diseases. It is just as important to screen for and treat alcohol use disorders.

Preventable measures such as raising the price of alcohol and diagnosing cirrhosis using existing blood tests need to be a focus. The studies highlight the needs of the current cirrhosis patient: both screening for liver cancer and intensive treatment to prevent the other morbidities associated with cirrhosis.

1. Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: observational study. BMJ. 2018 Jul 18;362:k2817. doi: 10.1136/bmj.k2817. PMID: 30021785

Gambling and Stimulant Use Among Adolescents

Adolescence is typically characterized by many fundamental psychological, mental and physical changes in a person’s life. During this time, experimentation and risk-taking tendencies are common occurrences, often exerting negative social, academic and psychological repercussions. Gambling is one such popular and prevalent behavior among adolescents, posing greater chances of addictive potential and associated risks.

Questionnaire responses of 6542 high-school students, aged 12-19 years, were assessed for this study in order to explore the relationships between various types and patterns of gambling, and stimulant drugs. These included cocaine, methamphetamine, non-medical use of stimulants, and 3,4-methylenedioxymethamphetamine (MDMA).

Poker chips and stack of cash on gaming table

Results showed that the consumption of any stimulant drug was directly associated with greater gambling frequency and problem gambling in both the genders.

High-school students who had used any stimulant in the past year were 2.7 times more likely to exhibit at-risk/problem gambling compared to those who had not used stimulants. Individuals using stimulants six or more times in the past year had greater likelihoods of frequent and at-risk/problem gambling behaviors.

Similar results have emerged from other studies of college students who recently used amphetamine-type stimulants. Notably higher odds of problem gambling emerged for these students in comparison to those who had not used stimulants. This represented a 74 percent greater likelihood of problem gambling in the past six months among those using stimulants.

Why does this matter?

The impact of the presently expanding gambling environment on the youth is largely ignored and even less understood. This study, however, is the first of its kind to directly examine the association between stimulant use and gambling among high-school students.

The results contribute to our limited understanding of the associations between stimulant drug use and gambling behaviors among high-school students. Increasing use of stimulants and availability of gambling opportunities, like on sports, government lotteries, internet gambling and broadcasting of poker tournaments, we can expect gambling and problem gambling to be a more significant problem in the future than it is today.

Within the current gambling climate, it is essential to understand the degree to which youth gamble, gambling’s influence on development, and how prevention and intervention strategies should be designed to target gambling in adolescents with maximum efficacy.


1. Richard J, Potenza MN, Ivoska W, Derevensky J. The Stimulating Nature of Gambling Behaviors: Relationships Between Stimulant Use and Gambling Among Adolescents. J Gambl Stud. 2018 Jun 2. doi: 10.1007/s10899-018-9778-7.

Is Digital Media Use Among Adolescents Linked to Attention Deficit/Hyperactivity Disorder?

Attention Deficit/hyperactivity disorder (ADHD) is essentially a psychiatric condition characterized by the persistent difficulty to maintain attention and manage impulsivity, alongside restlessness and hyperactivity. Almost 7 percent of adolescents are estimated to have ADHD symptoms, and this rate is only expected to rise.

Video game controllerSince ADHD in adolescents is associated with many non-genetic and environmental factors, it is only natural to explore further its association with the current trends of excessive digital media engagement.

For the study, 2587 adolescents, aged between 15 and 16 years of age, with no significant baseline ADHD symptoms were assessed over a follow-up period of almost 23 months. The most common digital media activity was reported to be frequently checking social media.

It was noted that high-frequency engagement in each additional digital media activity was associated with much higher chances of subsequent ADHD symptoms throughout the follow-ups.

The students who reported no high-frequency media engagement were at a much lower mean rate of acquiring ADHD symptoms than those who reported a high frequency of engaging in multiple digital media activities. Even though this association was statistically relevant, further research is necessary to determine if this limited association is causal.

Why does this matter?

Even though previous research has looked into violent and fast-paced video games, this study is the first to explore a long-term relationship between modern digital media and attention disorders. Modern digital platforms are specifically designed to be easily accessible and extremely stimulating.

If a causal relationship can be established between frequent use of digital media and ADHD symptoms, intervention strategies could be effectively designed to minimize the risks posed. Doctors do recommend restrictions of screen time for growing kids and young adolescents.


1. Ra CK1, Cho J, Stone MD, De La Cerda J, Goldenson NI, Moroney E, Tung I, Lee SS, Leventhal AM..Association of Digital Media Use With Subsequent Symptoms of Attention-Deficit/Hyperactivity Disorder Among Adolescents. JAMA. 2018 Jul 17;320(3):255-263. doi: 10.1001/jama.2018.8931.

Suicide and Opioid Overdose Deaths

In 2016, the Centers for Disease Control and Prevention (CDC) reported 42,000 opioid-overdose fatalities, including an unknown number of suicides. As the United States witnessed a surge of opioid-overdose deaths of epidemic proportions over the past years, a need for better understanding of the dynamics and the course leading to these deaths has emerged. This study especially highlights the importance of distinguishing accidental overdoses from intentional suicides in order to make prevention strategies more effective.

Man struggling with Opioid AddictionPatients with chronic pain and those struggling with mood disorders are more vulnerable to addiction and to commit suicide. Patients with addiction are at an even higher risk.

Addicted patients’ will to live becomes clouded by addiction as they indulge more freely in risky behaviors or may even have suicidal thoughts and intent.

Around 50 percent of the estimated 44,965 suicides in the United States in 2016, were carried out by firearm and 15 percent by drug overdose, as per the CDC. Suicide rate involving opioid overdose doubled from 2.2 percent to 4.3 percent between 1999 and 2014.

Most significant increases were noted in population age of 45 to 64 years. Meanwhile, 17 percent of drug-related deaths in 2010 were classified as suicides.

Statistical uncertainty remains as a coroner cannot confidently ascertain intent, especially in the absence of a suicide note. As a result, undetermined opioid deaths vary significantly across states based upon numerous individual, system and state-level elements.

A study based upon the National Death Index data found substance use disorders to be associated with a greater suicide risk in a sample of nearly 5 million veterans. For the population with OUD, suicide risk was 87 in 100,000.

This was alarmingly six time the general population rate of 14 in 100,000. Despite controlling for other risk factors, suicide risk was more than double among women with OUD and higher by 30 percent among men with OUD.

The 2014 National Survey of Drug Use and Health depicted an increased suicidal risk of 40 to 60 percent when associated with an OUD involving prescription opioids. Regular opioid users were prone to depression, 75 percent more likely to make suicide plans and twice as likely to attempt suicide.

250,000 emergency department visit by adults for opiate overdose were reported in the 2006–2011 data from the Nationwide Emergency Department Sample. Only 54 percent of these overdoses were categorized as “unintentional”; 26.5 percent were intentional, and 20 percent were deemed “undetermined.”

Reports have also shown a steady annual increase in opiate-overdose visits to emergency departments. As per this data, the rate of suicides among opioid-overdose deaths can be estimated around 20 to 30 percent. Yet, this rate could be higher.

Why does this matter?

Opioid overdose deaths and suicide rates have continuously reduced life expectancy for Americans. It’s imperative to recognize that these two epidemics are closely associated and need to be dealt with simultaneously.

Woman struggling with Sexual AddictionEven though preventive strategies have been initiated to curb opioid addiction and expand treatment, more attention also needs to be paid to reduce opioid overdose deaths.

A good step would be to implement CDC’s recommendations to determine the manner and intent of death, educate medical professionals to actively screen patients for suicide risks and opioid addiction, and treatment referrals for emergency department patient who have overdosed.

Campaigns to create awareness of suicide risk need to engage family and friends, alongside reducing the stigma associated with addiction and suicide.

This study also helps direct research to successfully assess suicidal tendencies in patients with chronic pain, formulating accurate treatments, prevention and therapeutic strategies simultaneously. It is essential to identify important co-morbidities like depression, anhedonia, and suicidal ideation.

Recognizing the fact that many opioid overdose patients may be trying to attempt or contemplate suicide would alter the course of their treatment in order to include mandatory psychiatric and addiction evaluation and treatment.


Oquendo MA, Volkow ND.Suicide: A Silent Contributor to Opioid-Overdose Deaths. N Engl J Med. 2018 Apr 26;378(17):1567-1569. doi: 10.1056/NEJMp1801417.

Marijuana and Opioid Use Disorders

The relationships between cannabis and the development of an opioid use disorder remain ambiguous. Past epidemiological studies have shown positive correlations between cannabis use and odds of potential non-medical use of opioids and other drugs.

Teenage Girl with a marijuana problemThis study focuses on the dimensional facets of drug self-exposure and their association with a future opioid use disorder.

The volunteers’ ages of initiation of excessive use of different drugs were assessed, specifically individuals with an opioid dependence diagnosis.

It was discovered that both cannabis and alcohol use occurred before the onset of heaviest use of heroin, in volunteers with OD diagnosis. These ages of cannabis and alcohol use onset did not vary from each other, occurring particularly in the transitionary period from adolescence to adulthood.

In the same group of volunteers, the age of onset of heaviest use of cocaine occurred at roughly the same age. The study is retrospective and limited by recall bias of volunteers.

Recent state-wide studies have reported a reduction in opioid overdoses in mostly anecdotal studies of opioid-related morbidities, following the legalization of medical cannabis.

Other studies have reported the opposite. Varying findings on the influence of cannabis use on opioid use, death and treatment outcomes in opioid-dependent individuals make it difficult for scientists and those in public policy to formulate effective policies and interventions. It is logical to take the least risk position: drugs of abuse are dangerous until proven safe and effective for a specific condition or disease.

The FDA has helped us use these criteria to decide that cocaine is safe and effective for laryngeal surgery. The same criteria have been used to evaluate Ketamine for depression. Non-medical cannabis use has also been associated with a greater likelihood of irregular opioid-taking behaviors in patients with chronic pain.

Cannabis is being used as a temporary substitute for other substances, including the non-medical use of prescription opioids, has also been suggested. However, at the same time, opioid overdose death autopsies point to considerable co-occurring cannabis and opioid use and abuse.

Why does this matter?

Man lighting his smokeThis study is one of the few individual-level examinations in which self-exposure to cannabis and alcohol are both examined, as predictors of a diagnosed opioid use disorder.

This sets the pace for future studies to focus on whether increasing non-medical cannabis exposure, especially in adolescence and young adulthood, can result in neuro-behavioral changes that may expose them to greater vulnerability to opioid use disorders.

The findings of this study have support from identical results reported by other researchers using different methods in recent studies, where cannabis use was found positively related to an increase, rather than a decrease, in the likelihood of developing non-medical opioid use and
opioid use disorder.


Butelman ER, Maremmani AGI, Bacciardi S, Chen CY, Correa da Rosa J, Kreek MJ. Non-medical Cannabis Self-Exposure as a Dimensional Predictor of Opioid Dependence Diagnosis: A Propensity Score Matched Analysis. Front Psychiatry. 2018 Jun 27;9:283. doi: 10.3389/fpsyt.2018.00283. eCollection 2018

About the Author:

Mark GoldMark S. Gold, M.D.  served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2014. Dr Gold was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor.
Learn more about Mark S. Gold, MD

About the Transcript Editor:

Sana Ahmed photoA journalist and social media savvy content writer with extensive research, print and on-air interview skills, Sana Ahmed has previously worked as staff writer for a renowned rehabilitation institute, a content writer for a marketing agency, an editor for a business magazine and been an on-air news broadcaster.

Sana graduated with a Bachelors in Economics and Management from London School of Economics and began a career of research and writing right after. Her recent work has largely been focused upon mental health and addiction recovery.

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2. Gold MS, Kobeissy FH, Wang KK, Merlo LJ, Bruijnzeel AW, Krasnova IN, Cadet JL.Methamphetamine- and trauma-induced brain injuries: comparative cellular and molecular neurobiological substrates.
5. Mark Gold, 800 Cocaine, Bantam Books, 1984.

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Published on September 14, 2018
Reviewed by Jacquelyn Ekern, MS, LPC on September 14, 2018
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