Drug and alcohol abuse is a major problem among all age groups in the United States. However, young adults are especially at risk. They tend to abuse alcohol and prescription and illicit substances at higher rates than older adults or adolescents. Many young adults begin abusing drugs when they are adolescents, and they continue that problem into adulthood. Others do not begin drinking or taking drugs until they are over 18 years old.
Drug addiction is a chronic disease that changes the brain by triggering the reward center, which, in turn, releases neurotransmitters like dopamine and serotonin that flood the person with good feelings like relaxation and high energy. Young adults drink and use drugs for a variety of reasons – to feel relaxed in new social situations, as a way to make friends, to help them study for college tests, or to relax after a stressful work week or semester. Unfortunately, all of these minor upsides come with many consequences.
By the time a high school student turns 17 or 18 years old, in their senior year, they have likely been exposed to drugs or alcohol through their peers. About 70 percent of high school students have tried alcohol, 50 percent have tried an illicit drug, 40 percent have smoked a cigarette, and over 20 percent have abused a prescription drug without a prescription. Adolescents report abusing drugs or alcohol as a way to deal with problems in school by lowering stress or increasing performance, out of a desire for a new experience, or because of peer pressure, believing all their friends or the popular students are doing drugs.
Genetic factors and a family history of mental illness or substance abuse are also risk factors for young adults developing an addiction to drugs or alcohol. Teenagers who abuse drugs or alcohol are more likely to continue these behaviors into young adulthood.
The Monitoring the Future Survey (MTF) for 2016 followed trends for a few decades to understand how young adults’ drug and alcohol abuse patterns are changing. For example, among those 19 to 22 years old in 1996, four percent abused marijuana overall; among those enrolled in college, 2.8 percent abused marijuana, and among those not enrolled in college, 5.3 percent abused marijuana. By 2016, 7.8 percent of that age group abused marijuana, with an average of 4.9 percent of college students and 12.8 percent of non-college young adults abusing the drug. The MTF survey found that daily marijuana use was at its highest level in this age group since the early 1980s.
Problem drinking is higher among college students than their non-college peers.
Amphetamine misuse appears to be higher among college students, per the MTF survey, than among their peers not attending college.
In contrast, nicotine abuse and illicit drug abuse tend to be higher among young adults who have not attended college. An earlier MTF survey from 2014 reported that, annually, the prevalence of illicit drug abuse was 39 percent among college students compared to 44 percent among their non-college peers. Most of this illicit drug abuse involved marijuana. There was some amphetamine abuse and about 6.6 percent of young adults who were not in college abused prescription sedatives or tranquilizers. About five percent of non-college-attending young adults abused ecstasy or related amphetamines, and abuse of prescription opioids, cocaine, and hallucinogens was slightly below five percent.
Young adults often have demanding jobs or internships, conflicting school and work schedules, and a lot of peer pressure to drink or abuse drugs socially that they have to manage. This confluence of unique struggles means people between the ages of 18 and 26 need specific approaches to treatment that take into account their age and associated stresses.
The foundation of addiction treatment, regardless of age, is medically supervised detox followed by behavioral counseling through a rehabilitation program. This basic outline allows for several approaches to manage the process, which can be tailored to each individual’s needs. For example, detox may or may not involve prescription medication and a tapering schedule. Rehabilitation may involve group counseling once per week through an outpatient program, or it could involve six months of ongoing individual and group counseling through residential treatment.
Each person has different needs to safely overcome addiction and reduce their risk of relapse. Young adults need tailored approaches to treatment, such as group therapy geared toward their demographic, to help them overcome substance abuse problems.
During young adulthood, the brain continues to develop, grow, and change. Abusing drugs or alcohol during this time can cause lasting harm to the brain by changing certain structures as they develop. This can mean a young adult who struggles with addiction will have impulse control, mood, and learning problems for years even after they have received effective treatment. Evidence-based detox and rehabilitation programs will take these potential brain development issues into account when creating treatment plans to help young adults.
As with treatment approaches used for older adults, addiction to opioids, nicotine, or alcohol can be managed with medication-assisted treatment (MAT). In young adults, a clinician may be less likely to prescribe some of these medications because of brain changes that are ongoing in this age group; however, for people struggling with severe addiction to these drugs, MAT with a tapering schedule is still the best approach to safe withdrawal. Other substances of abuse, like marijuana and amphetamines, are widely abused among young adults but do not have associated MAT to help individuals taper off the substances. However, medical supervision during the detox process will still help to manage some withdrawal symptoms and reduce the risk of relapse.
Finding the best rehabilitation program for a young adult may be a challenge. Group therapy has long been the basis of both outpatient and inpatient treatment, but for adolescents and young adults, peer-based group therapy can sometimes be detrimental, as peers in their teens or early 20s may negatively influence each other in this format. For this age group, individual therapy often serves as the backbone of treatment, and support groups are recommended. Family-based therapy also appears to work well for young adults.
There are other therapeutic approaches that are effective for young adults.
Adolescent community reinforcement approach (A-CRA): This program addresses problem-solving, coping, and communication skills in adolescents and young adults while encouraging active, sober participation in positive social and recreational activities. A therapist will intervene with the adolescent or young adult and, through brief intervention techniques, encourage their client to find healthier ways to be social and reduce stress.
Brief strategic family therapy (BSFT): A therapist works with each family member individually over 12 to 16 sessions. The therapist observes how family members work together, and identifies and addresses negative patterns of interaction to begin fixing these issues.
Family behavioral therapy (FBT): This approach to treatment combines contingency management and cognitive-behavioral therapies. The young adult and at least one parent or guardian plan out interventions for specific issues, set behavioral goals, and work on new skills to make home life more supportive.
Multidimensional family therapy (MDFT): This comprehensive family and community-based treatment focus on adolescents and young adults at risk of behavior problems like delinquency and conduct disorders. This can be especially effective at preventing incarceration for drug abuse and reducing the risk of recidivism by bringing in the family and community to support the young adult.
Outpatient treatment typically allows flexibility to remain in school, go to work, and live at home in a supportive family environment. Some young adults with a diagnosis of a moderate addiction will benefit from partial hospitalization while living at home. Inpatient programs may provide education options, but young adults who need inpatient treatment should consider taking a leave of absence from school to focus on recovery. Many colleges now offer sober dorms and sober fraternal organizations, along with campus counselors and peer support groups, so young adults can have ongoing support after completing rehabilitation.
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