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By Jeffrey T. Day, RN, ARNP, PMHNP, FNP, AGPCNP 
Introduction
Adolescents these days are faced with many challenges. These include transitioning to puberty, entering into high school, forming new relationships, experiencing love for the first time, making new friends, and establishing an identity. One might not expect that with all these new challenges an adolescent would also have to face an addiction to a chemical substance. However in America today many adolescents are doing just that especially in low income neighborhoods where African American adolescents live and go to school. An addiction to drugs crosses all age groups and all cultural identities. Adolescents are not immune to this ever increasing problem in our world today. Adolescent drug use is vastly becoming the number one public health concern.
Many adolescents do not consider the long term consequences of using illegal substances. Many of our young high school students in America today have used substances or at least know someone close to them who does. An alarming concept is that many are starting to use at a very early age prior to adolescence. There are many risk factors to consider when studying this vulnerable population. The home environment and parenting are two major risk factors that can contribute to the adolescent using substances. The American culture is also worthy of examination, Adolescents tend to mock the behavior of those they look up to. These people could be peers who also have a problem with substances. In this case, the adolescent might feel that it is socially appropriate to use chemicals.
Description: Resource Availability
At least three quarters of high school students have used addictive substances. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), black or African American individuals age 12-17 have the highest percentage for receiving mental health services from an in-patient or residential treatment setting for drug and alcohol rehabilitation. Cigarette use is very high among black adolescents living in poverty. The rate of marijuana use among black adolescents has almost doubled in the last 10 years. A national trend report issued by the National Survey on Drug Use and Health in 2011 notes that alcohol use among young African American adolescents remained steady at 10.8%-10.9% from 2002 to 2010. Marijuana use among adolescent African American adolescents actually rose from 6.9% to 7.5% during the same time frame. Use of non-medical prescription drugs actually dropped from 3.0% to 2.6% in the same time frame.
The trends capture a picture of our African American youth and their trends to use illegal substances. Age and gender distributions were generally not accounted for. Instead the data takes into account all individuals in an age group of 12-17 year old males and females. It is also important to look at the context of environment, behavior, and personal development when analyzing such data. Many things should be taken into consideration such as socioeconomic factors, family dynamics, and education level. Life trauma also plays a part in the development of addictive behaviors among black adolescents. Abuse, neglect, criminalization, homelessness, and abandonment are among the many reasons why black adolescents pick up substances. According to Szalavita (2011) at TIME magazine, black youth tend to be arrested for illegal substance possession and use at a rate of 10 times that of their white counterparts. Peer pressure among young black youth is also a critical component to assess when looking at why youth use and how their use plays a role in their life. Many black youth are involved in gangs and this can be a setting that promotes illicit drug use. The NIH (2014) reports that alcohol use was the number one reason for drug rehabilitation in the past few years. Second to that was alcohol addiction plus use of another drug. Third was marijuana and fourth being heroin.
Drug dealing is also very rampant among African American youth. Many have to sell in order to support their own habits. Others sell as a middle man in order to make money and sustain their basic human needs such as shelter and clothing. Developing social networks that allow and promote the use and sale of drugs is also common among black youth. Elkington et al. (2011) say "Parent and peer risk factors were strongly associated with increasing substance use as youth age” (p. 1035). Many young black youth, especially in urban areas of the United States, have parents who also engage in the use or selling of illicit drugs. Many urban black families live in poverty and have no means of sustainment without the sale or use of illicit drugs. This instills a certain value in the use of drugs in the youth from an early age. Some related trends associated with this vulnerable population include under utilization of medical services, neglect of mental health and hygiene, risk of homelessness, suicidal thoughts and attempts, and self neglect. Many do not finish high school as their grades typically suffer when the addiction takes over or becomes worse. Many of these black youth are faced with dealing with the criminal justice system as well with limited or no resources to help them fight for their justice.
Risks
There are many risks inherent to African American adolescents who use and abuse drugs or alcohol. Dying at an early age from overdose, suicide, or even homicide is all too familiar with this vulnerable population. Premature deaths are quite common among young addicts. A decreased functional status is also a fact that many face. Quality of life goes down as does hope and dreams for the future. Marshall (2014) says "Alcohol and drug consumption in adolescence appears to persist into adulthood and is associated with dependence, premature death and diminished work capacity” (p. 180). Morbidity and mortality is high among black youth who use during adolescent years as many develop severe medical problems such as chronic limitations of airways (CAL) and emphysema from smoking such drugs as marijuana or crack cocaine. Chronic use of alcohol affects the liver and can create such disorders as cirrhosis or fatty liver.
Other risks associated with young black adolescent addicts include the potential to join violent gangs, become involved in serious criminal activity, and alienation from family and friends. When addressing a decreased functional status among these youth, it would be prudent to think about such things as malnutrition, anemia, insomnia, severe psychosis, depression, and lack of physical activity. Niciu et al. (2014) say "several studies have shown that long-term drug and alcohol abstinence is associated with at least partial normalization of many abnormalities” (p. 45). The morbidity rate among black adolescent youths can be closely linked to rate of alcohol and drug use over the span of their teenage years. The diminished quality of life that many of these youths suffer from can and will improve with rehabilitation and subsequent abstinence. Appetite can improve, depressive thoughts gets better, and even weight normalizes.
Health Status
In discussing the health status of young black addicts, it is important to refine the discussion to morbidity and morality in this population. Votruba et al. (2009) say "disadvantaged neighborhoods can raise the mortality risk with young black adolescents and homicide by gunshots are the highest causes of death” (p. 814). Generally speaking, the mortality rate can even be higher when you throw in the concept of drug use or drug sales when a firearm is involved. Sometimes education can play a positive factor in reducing mortality for black youth addicts, but the quality of the neighborhood and environment the youth is subjected to might have the most impact on whether the young one stays clean or stays alive.
In our modern times, it is crucial to also consider the rate of infectious diseases among young black addicts. Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) are rampant among addicts. Many youth will go for years without knowing whether or not he or she has HIV/AIDS. Needle sharing and unprotected sex are the leading causes of the viral transmissions. Many areas across the country have implemented needle exchange programs in an effort to stop the spread of the disease. DiClemente et al. (2001) say "STD/HIV interventions should consider psychological distress as one potential risk factor impacting young blacks and any program efficacy” (p. 85). Psychological distress is a health concern for many black addicts. Any point of entry into psychological care for these youth should first aim at reducing the stress associated with the factors that lead to an addiction. Subsequent treatment modalities will be far more productive once the stress is identified and alleviated. This will also help ensure a smoother detoxification and rehabilitation.
Summary
Many young adolescents today are facing new crises and new dilemmas that many of their parents did not face. Of particular interest are young African American adolescents. Many of these youth live in America’s urban poverty stricken areas. Many are drug addicted in addition to being homeless, medically ill, or psychiatrically impaired. Current trends demonstrate that the numbers of these individuals are rising and not declining. There is certainly not enough treatment facilities dedicated to helping the addicted youth in our country. Among the vast variety of substances young black youth are getting addicted to, alcohol seems to be at the top of the list. Many black youth are void of support networks that can help them instill self esteem and overcome the addiction. Some do not have families backing them in the fight to overcome an addiction.
As providers in our modern world, we have an obligation to these youth. Our obligation is embedded in our compassion and care for another human being. We hold the responsibility for identifying, assessing, diagnosing, and ultimately treating the young black youth of America so that he or she can live up to their potential and become a productive member of society. It is not our place to judge or ascertain the why’s of a youth’s addiction, but rather to meet the young person where they are in life and help them progress forward. Winston Churchill once said "continuous effort-not strength or intelligence-is the key to unlocking our potential.” If Mr. Churchill was right, then it is the effort of the provider, the community, and the social networks to help unlock the potential within the adolescent. The young black youth has potential, it is our job to help him or her see that potential. Once the adolescent understands the uniqueness of their mind and the ability of their body, an addiction will be easier to overcome. Any long journey begins with the first step. Guiding the young black adolescent to take the first step toward a clean and healthy life will help empower that person to stay clean for the rest of his or her life. That first step begins with taking an avid interest in the life of an adolescent.
References
Behavioral Health and Black/African Americans. (2014). From the Substance Abuse and Mental Health Service Administration (SAMHSA) website: http://www.samhsa.gov/obhe/african-american.aspx. Retrieved April 13, 2014.
DiClemente, R., Wingood, G., Crosby, R., Sionean, C., Brown, L., Rothbaum, B., Zimand, E., Cobb, B., Harrington, K., & Davies, S. (2001). A prospective study of psychological distress and sexual risk behavior among black adolescent females. Pediatrics, 108(5): 85-95.
Drug Facts: Treatment Statistics. From the National Institutes of Health website: http://www.drugabuse.gov/publications/drugfacts/treatment-statistics. Retriened April 13, 2014.
Elkington, K., Bauermeister, J., & Zimmerman, M, (2011). Do parents and peers matter? A prospective socio-ecological examination of substance use and sexual risk among African American youth. Journal of Adolescence, 34(5): 1035-1047.
Marshall, E. (2014). Adolescent alcohol use: risks and consequences. Alcohol and Alcoholism, 10(1): 180-200.
Niciu, M., & Mason, G. (2014). Neuroimaging in alcohol and drug dependence. Current Behavioral Neuroscience Reports, 1(1): 45-54.
Substance Use Among Black Adolescents, (2014). From the National Survey on Drug Use and Health Report (NSDUH) website: http://www.samhsa.gov/data/2k11/WEB_SR_004/WEB_S R_004.htm. Retrieved April 13, 2014.
Szalavitz, Maia. (2011). Study: Whites More Likely to Abuse Drugs Than Blacks. Taken from TIME magazine website: http://healthland.time.com/2011/11/07/study-whites-more-likely-to-abuse-drugs-than-blacks. Retrieved April 13, 2014.
Votruba, M., & King, J. (2009). Effects of neighborhood characteristics on the mortality of black male youth: Evidence from Gautreaux, Chicago. Social Science & Medicine, 68(5): 814-823.
About the Author...
Jeffrey T. Day is a Psychiatric Nurse Practitioner at Queens Consultation Center in Rego Park, NY. Last Update: 5/18/2014
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