Use of methamphetamine by young people: is there reason for concern?
The problem of methamphetamine (MA) use among adult populations world-wide persists and must be addressed [1], but there also is a need to examine MA use among young people [2]. Although epidemiological data from around the world present a mixed picture, in many regions of the world MA use by adolescents appears to be a significant public health problem.
In the United States, federal government statistics minimize the problem of MA use by adolescents. For example, a national survey of 12th graders indicates a downward trend of life-time MA use from 1999 to 2005 (4.7% to 2.5%, respectively) [3]. However, state- and local-level data from treatment programs in some parts of the United States reveal that rates of treatment admissions of adolescents with diagnoses of MA abuse and dependence are more than 20% of all admissions and are increasing [4]. Although there is tremendous variability in youth MA rates across Europe, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) survey shows that the prevalence of methamphetamine/amphetamine use in youth aged 15–24 years has been rising since 1990 [5]. Findings from a Czech Republic survey [European School Survey Project on Alcohol and Other Drugs (ESPAD)] on 17–18-year-old students in 2003 indicate that nearly 8.4% had used MA (Pervitin) in their life-time and 5.4% had used in the previous year [6]. Data from Taiwan and northern Thailand also suggest that MA use is highly problematic among adolescents [7,8].
According to the 2004 Australian National Drug Strategy Household Survey, the life-time MA use prevalence rate for youth aged 14–19 years is 6.6% [9]. Use in the previous 12 months was reported to be 4.4%, with female teenagers (4.9%) slightly more likely to be recent users than male teenagers (4.0%) [9]. Data from the Canadian Addiction Survey (2004) show that life-time MA use among older youth (15–19-year-olds and 20–24-year-olds) is high—8.3% and 11.2%, respectively [10]. In Cape Town, South Africa, treatment centres, 42% of admissions for 15–19-year-olds were for treatment of MA dependence in the second half of 2006 [11].
SPECIAL CONCERNS ABOUT MA USE BY ADOLESCENTS
Effects on the developing brain
There is extensive evidence demonstrating MA's toxicity on the adult human brain when used at high doses over extended periods of time [12]. There is concern that MA abuse by young people, whose brains are still maturing and developing [13], could result in different types of neurological and psychiatric consequences. Although, to date, no published brain imaging studies have reported on young MA users, a growing body of animal studies is emerging [14], indicating that MA exposure causes different alterations in central nervous system serotonin and dopamine functions in adolescent animals than those produced in adults. Brain imaging studies with youth are needed to understand the long-term impact of MA use by young people.
Clinical attributes of young MA users
The limited clinical data which exist on MA-abusing adolescents suggest that these youth have a significant amount of psychiatric symptomatology. Several studies have reported that adolescents in treatment for MA abuse have higher levels of depressive symptoms and suicidal ideation than do adolescents in treatment for other substances (primarily marijuana and alcohol) [15]. Furthermore, MA abuse has been implicated in risky sexual behaviors (i.e. multiple sex partners and unprotected sexual intercourse) among youth in the United States [16].
MA use is especially problematic among girls, as evidenced by their much higher rates of admission into treatment programs compared to boys [3,15]. Yen & Chong [17] report MA-using Taiwanese girls display higher rates of mood and eating disorders than do boys. Rawson & colleagues [15] found that MA-abusing girls reported higher levels of depression and suicidal tendencies than did MA-abusing boys.
Prevention and treatment implications
At present, only one study has reported data on preventive interventions aimed at reducing adolescents' MA use [18]. Results from this study suggest that effective prevention methods should focus on brief universal interventions, including reducing early initiation of substance use (i.e. alcohol, marijuana and tobacco), incorporating skills-building opportunities and alternative activities, and incorporating family and peer/social support [18]. The following strategies for preventing the use of MA by youths were suggested by experts on MA use and treatment providers from numerous countries at a United Nations Office on Drugs and Crime (UNODC) meeting in 2006 [1]: school-based activities (e.g. life skills training,training of teachers, use of positive reinforcement techniques), careful targeting of high-risk families for preschool interventions, using peer-based techniques to impart information and skills and empowering communities in order to reduce drug-related harm.
There is limited understanding of effective treatment models for youth in the resolution of MA problems. While there are unique clinical issues associated with MA use, best practices for treating youth substance abuse, including integrative methods of treatment using cognitive behavioral techniques, motivational interviewing, family therapy and contingency management, should be incorporated into treatment models for MA-based intervention strategies. Gender and cultural differences also need to be considered when preventing and treating MA abuse.
CONCLUSIONS
In some parts of the world, MA use by adolescents is a significant public health concern. Young women appear to be at special risk for developing MA-related problems and their use is associated with elevated levels of depression and suicidal thinking. High-risk sexual behaviors are associated with MA use, creating increased risk for sexually transmitted diseases, including HIV and hepatitis. There is a paucity of data on specific prevention and treatment approaches for reducing MA use among youth; however, general best practice principles are recommended.
