One Choice Featured On Prevention Podcast!

Caroline DuPont, MD, Vice President of the Institute for Behavior and Health, Inc. and Nancy Paquale, Director of the RyeACT Coalition were welcomed to the Prevention Leaders Podcast with Dave Clossom to share the One Choice prevention message and supporting data.

Listen in to Dr. DuPont and Ms. Pasquale as they chat with fellow prevention leader Dave Clossom about the way One Choice is helping community coalitions and prevention organizations reframe the way they approach youth substance use prevention.

 

Dr. Caroline DuPont, MD (left) and Nancy Pasquale (right) present the One Choice Prevention message with Catherine Caroll, a member of the One Choice Prevention National Student Advisory Board, at the 2022 Rx and Illicit Drug Summit in Atlanta.

 

One Choice for Health: A Data-Informed, Youth-Driven Prevention Message

**Click here to view or print a PDF copy of this commentary.***

The understanding of substance use disorder (SUD) or “addiction” as a chronic relapsing brain disease has improved over many decades and continues to evolve with science of evidence-based treatment and directly learning from individuals in long-term recovery. We know SUDs are most often pediatric-onset diseases: 9 in 10 adults with SUDs began drinking, smoking or using other substances before the age of 18.1 Thanks to advances in brain imaging, we also know that the human brain is not fully developed until about age 25,2 making adolescents uniquely vulnerable to substance use.3-4 As the nation looks to improve public health and reduce the astounding toll of overdose deaths and addiction, now is the time for a renewed focus on primary prevention – and when early substance use is initiated, provide effective intervention.

New Context to Youth Prevention Messaging

Youth substance use prevention efforts are often focused on individual substances, specific settings (e.g., impaired driving), and even specific amounts (e.g., binge drinking). While specific prevention messages are useful, they lack the context of the common patterns of substance use reported by youth. Nationally representative data from the National Survey on Drug Use and Health show that for young people, all substance use (and non-use) is closely related: among youth aged 12-17, the use of any one substance – alcohol, cigarettes, or marijuana – significantly increases the likelihood of using the other two substances and other illicit drugs.5 Similarly, not using any one substance significantly reduces the likelihood of using any other substances.

Figure 1 compares youth aged 12-17 who reported no use of alcohol in the past month (on the left) to those who reported various levels of past month alcohol use (on the right). Compared to their peers who did not use any alcohol in the past month, those who reported some alcohol use in the past month were 5.8 times more likely to have used marijuana, 3.8 times more likely to have used cigarettes and 4.8 times more likely to have used other illicit drugs. Youth who reported binge drinking (i.e., consuming 5+ drinks in one sitting) or heavy alcohol use (i.e., binge drinking 5+ times in the past month) were even more likely to have used marijuana, cigarettes, and other drugs.

Figure 1. Past Month Alcohol Use is Associated with Higher Use of Other Drugs Among Youth Aged 12-17

Source: National Survey on Drug Use and Health; DuPont, R. L., Han, B., Shea, C. L., & Madras, B. K. (2018). Drug use among youth: national survey data support a common liability of all drug use. Preventive Medicine, 113, 68-73.

The correlation of use holds true for other substances as shown in Figures 2 and 3. These data provide evidence for a generalized risk of substance use. Rooted in the science of the vulnerable developing brain, the goal of youth prevention can be reframed as, One Choice: no use of any alcohol, nicotine, marijuana. or other drugs by youth under age 21 for reasons of health.

 Figure 2. Past Month Marijuana Use is Associated with Higher Use of Other Drugs Among Youth Aged 12-17

Source: National Survey on Drug Use and Health; DuPont, R. L., Han, B., Shea, C. L., & Madras, B. K. (2018). Drug use among youth: national survey data support a common liability of all drug use. Preventive Medicine, 113, 68-73.

Figure 3. Past Month Cigarette Use is Associated with Higher Use of Other Drugs Among Youth Aged 12-17

Source: National Survey on Drug Use and Health; DuPont, R. L., Han, B., Shea, C. L., & Madras, B. K. (2018). Drug use among youth: national survey data support a common liability of all drug use. Preventive Medicine, 113, 68-73.

Is Making One Choice of No Use a Realistic Goal?

Parents and other adults may view adolescent substance use as inevitable or a rite of passage – but many American teens are already making One Choice today, and that number is growing.6 As shown in Figure 4, for decades, the percentage of American high school seniors who have not used any alcohol, cigarettes, marijuana, or other drugs in their lifetime has increased dramatically. The most recent Monitoring the Future data shows that in 2019, over 31% of high school seniors did not use any substances in their lifetime, and nearly 59% did not use any substances in the past month. These trends are also seen among 10th and 8th grade students.7

Figure 4. No Use of Alcohol, Cigarettes, Marijuana and Other Illicit Drugs by US High School Seniors, 1976-2019

Source: Monitoring the Future, 2019; Levy, S., Campbell, M. C., Shea, C. L., DuPont, C. M., & DuPont, R. L. (2020). Trends in substance nonuse by high school seniors: 1975–2018. Pediatrics, 146(6), e2020007187.

A New Health Standard for Youth

Just as the nation has embraced other health standards to support teen health – use a seat belt, wear a bicycle helmet, eat a healthy diet, avoid sugary drinks, and exercise regularly – together we can make no use of alcohol, nicotine, marijuana, or other drugs a new health standard for young people under age 21. This is not a reincarnation of the famous “Just Say No” campaign which focused on marijuana use. These data shows that alcohol, nicotine, and marijuana all dominate youth substance use and that the use of any of these three drugs is closely related to the use of all others.

Youth substance use is a health issue, not a moral issue. The One Choice goal is based on the science of the developing brain; highlights the long and strong youth-led trend in more young people refraining from substance use; follows legal age limits; and supports all other drug prevention efforts, including those that focus on single drugs and use in specific settings and specific amounts.

Teens are biologically driven to seek new and exciting behaviors which can put them at increased risk for substance use. Although use of alcohol, nicotine, marijuana, and other drugs is illegal for anyone under age 21 in the US, there are several factors that can make these substances more attractive to this age group including increased availability, normalization of use, and a decrease in perceived harm from use. As such, it is important to recognize the impact of Commercialized Recreational Pharmacology, defined as the super-stimulation of brain reward for profit.8 It is driven by the exploitation of people who use both legal and illegal substances and profits most off heaviest users. The US has a long and troubled history with the legal alcohol and tobacco industries related to youth, and now faces powerful, growing legal vaping and recreational cannabis (marijuana) industries that promote and profit from addiction to their products.

Take Action to Promote Adolescent Health and to Reduce the Toll of Future Addiction

Addiction is a preventable pediatric-onset disease; reducing the future prevalence of substance use disorders can begin with improving youth prevention. In this effort there are essential roles for parents, families, school and community leaders, health care providers and addiction professionals. What can caring adults do?

  • Articulate the One Choice goal as a health standard for young people. Talk early and often about expectations of no use before the age of 21 of any substances including alcohol, nicotine, and marijuana and its foundation of the science of the developing brain. Fit the One Choice goal into your family’s and community’s vision for youth health and wellness.
  • Identify substance use and intervene early. The American Academy of Pediatrics (AAP) provides guidelines for screening young patients for substance use, noting the importance of normalizing no use and of offering strong, supportive comments when no use is reported.9 When substance use is reported, brief interventions and, when needed, referral to treatment can make a positive difference in the health and wellness trajectory of a young person.
  • Amplify youth voices. Each year, more young Americans are making the decision to not use any alcohol, nicotine, marijuana, or other drugs. Give this growing group opportunities to share the reasons why they make One Choice and how that decision is working out for them.
  • Join the One Choice Community. The nation is searching for policies to reduce the burden of addiction on our nation’s families, communities, and health care, as well as how to save lives from opioid and other drug overdoses. We must begin this important work by promoting strong, clear public health prevention efforts based on the steady, sound, and clear support for no use of any alcohol, nicotine, marijuana, or other drugs for youth under age 21 for reasons of health.

We invite you to learn more about the Institute for Behavior and Health’s One Choice initiative and how prevention groups are integrating the message and supporting data into prevention initiatives at www.OneChoicePrevention.org.

Robert L. DuPont, MD, IBH President

Caroline DuPont, MD, IBH Vice President

Corinne Shea, MA, IBH Director of Programs and Communications

 

References:

1 The National Center on Addiction and Substance Abuse at Columbia University. (2011). Adolescent Substance Use: America’s #1 Public Health Problem. New York, NY: Author. Available: https://drugfree.org/reports/adolescent-substance-use-americas-1-public-health-problem/

2 Gogtay, N., Giedd, J. N., Lusk, L., Hayashi, K. M., Greenstein, K., Vaituzis, A. C., Nugent III, T. F., Herman, D. H., Clasen, L. S., Toga, A. W., Rapoport, J. L., & Thompson, P. M. (2014). Dynamic mapping of human cortical development during childhood through early adulthood. PNAS, 101(21), 8174-8179. https://www.pnas.org/content/101/21/8174.full

3 DuPont, R. L. & Lieberman, J. A. (2014, May 9). Young brains on drugs [Editorial]. Science, 344(6184), 557. https://doi.org/10.1126/science.1254989

4 Volkow, N. D., Han, B., Einstein, E. B., & Compton, W. M. (2021). Prevalence of substance use disorders by time since first substance use among young people in the US. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2020.6981

5 DuPont, R. L., Han, B., Shea, C. L., & Madras, B. K. (2018). Drug use among youth: national survey data support a common liability of all drug use. Preventive Medicine, 113, 68-73. https://doi.org/10.1016/j.ypmed.2018.05.015

6 Levy, S., Campbell, M. C., Shea, C. L., DuPont, C. M., & DuPont, R. L. (2020). Trends in substance nonuse by high school seniors: 1975–2018. Pediatrics, 146(6), e2020007187. https://doi.org/10.1542/peds.2020-007187

7 Levy, S., Campbell, M. C., Shea, C. L., & DuPont, R. L. (2018). Trends in abstaining from substance use in adolescents: 1975-2014. Pediatrics, 142(2), e20173498. https://doi.org/10.1542/peds.2017-3498

8 DuPont, R. L., & Levy, S. (2020). The nation’s drug problem is commercial recreational pharmacology [From the Field]. Alcoholism & Drug Abuse Weekly, 32(35), 3-7. https://doi.org/10.1002/adaw.32827

9 Levy, S. J., Williams, J. F., & Committee on Substance Use and Prevention. (2016). Substance Use Screening, Brief Intervention, and Referral to Treatment. Pediatrics, 138(1), e20161211. https://doi.org/10.1542/peds.2016-1211

California should ban marijuana advertising to protect children and teens

A guest op-ed in The Sacrament Bee by Marvin Seppala, MD, Chief Medical Officer of Hazelden Betty Ford Foundation, describes the need for preventing youth marijuana use, beginning with banning advertising:

It’s one thing to decriminalize cannabis, but it’s another to encourage use with marketing and advertising that reaches kids.

And that’s the problem: Almost all commercial advertising makes its way to the eyes and ears of children. If we care about public health, we should ban all cannabis ads.

Dr. Seppala continues:

The entire point of advertising is to motivate people to want, and then purchase, a product, and to shape public perceptions about the product. We also know companies that market addictive substances benefit from reaching young people. The younger that people begin using, the more they purchase over a lifetime, the more profits they generate, and — unfortunately — the greater their risk for developing addiction.

Read more at The Sacramento Bee.

Teens are Encouraged to Join the One Choice Movement

For today’s teens, many uncertainties can feel very overwhelming. But one thing remains certain – avoiding alcohol, tobacco, marijuana and other drugs is the best choice to promote healthy physical and mental development. Preventing or delaying all substance use by teens reduces the risk of later addiction as adults.

The good news is that most teens are making that choice. Members of the North Coastal Prevention Coalition (NCPC) are encouraging others to join them.

“Life is the most precious gift, and the teenage years are a deciding factor of how that life will be made,” notes Madison Matella, Vice-President of NCPC’s Youth Coalition. “I like the One Choice message because it’s positive and will help me encourage my peers to make healthy choices.”

Teen Binge Drinking, Misuse of Opioid Medications Linked to Other Risky Behaviors

An article published by Reuters highlights two new studies from Pediatrics, the journal of the American Academy of Pediatrics, that report a close association between adolescent substance use and other risky behaviors.

Compared to their non-using peers, high school students who reported lifetime misuse of prescription opioids were significantly more likely to have engaged in all 22 risky behaviors examined by researchers:

Pediatrics+-+Risky+Behaviors+Assessed.jpg
A screenshot from the Pediatrics video abstract showing lifetime misuse of opioids was strongly associated with lifetime use of other substances.

A screenshot from the Pediatrics video abstract showing lifetime misuse of opioids was strongly associated with lifetime use of other substances.

In the second study, researchers showed that binge drinking in 12th grade is a robust predictor of early adulthood driving while impaired (DWI), riding with an impaired driver (RWI), blackout, extreme binge drinking, and risky driving. Authors conclude, “Our study suggests that ongoing parental practices could be protective against DWI, RWI, and blackouts once adolescents transition from high school into early adulthood. Prevention programs that incorporate binge drinking-focused screening and bolster parental practices may reduce the likelihood of later major alcohol-related health-risk behaviors and consequences in emerging adults.”

Health Care Professionals and Families Must Focus on Youth Substance Use Prevention

The peer-reviewed journal JAMA Network Open asked Robert L. DuPont, MD and Caroline DuPont, MD, President and Vice President, respectively, of IBH, to respond to a new research study by Bertha K. Madras, et al., "Associations of parental marijuana use with offspring marijuana, tobacco, and alcohol use and opioid misuse."

In their commentary, Drs. DuPont note that this study showed that when parents used marijuana, their children had increased risk of using marijuana too. "This underscores the need for engagement by both parents and health care professionals in youth substance use prevention and parental substance use disorder treatment." Drs. DuPont then connect the findings to IBH's own youth prevention work:

The association of parent use of marijuana with offspring use of marijuana and tobacco complements a recent finding suggesting that there is a common liability for substance use among adolescents. Among young people aged 12 to 17 years, the use of one substance is positively associated with the use of others, and nonuse of any one substance is positively associated with non-use of others. There is also evidence that there is a large and steadily increasing number of American youth who do not use any substances, including alcohol, tobacco, or marijuana. More than half (52%) of high school seniors have not used any substance in the past month and more than one-quarter (26%) have not used any substance in their lifetime, up from lows in 1982 of 16% and 3%, respectively. Together, these facts can empower parents when they are educated about their own substance use choices affecting the risks of their children using substances. They can also inform health care professionals that no use of alcohol, nicotine, marijuana, or other drugs is not only the health standard for youth but that nonuse by young patients is common and achievable.

This commentary extends the work of IBH to set a new health standard for youth prevention of One Choice: no use of any alcohol, nicotine, marijuana or other drugs by youth under age 21.

MORE EVIDENCE ON LINK BETWEEN DAILY HIGH-POTENCY MARIJUANA USE AND PSYCHOSIS

Although there is ample evidence linking marijuana and psychosis, a new study in The Lancet Psychiatry is the first to show the impact on population rates of psychosis. Reuters reports “one in five new cases of psychosis across the sites studied could be linked to daily cannabis use, and more than one in 10 linked to use of high-potency cannabis. This would mean that if high potency cannabis were no longer available, the incidence of psychosis in Amsterdam, for example, would be expected to drop to 18.8 from 37.9 per 100,000 people a year, and in London to 31.9 from 45.7 per 100,000 people a year.”

Read the Reuters story here. Access the full study here.

WE CANNOT LET E-CIGARETTES BECOME AN ON-RAMP FOR TEENAGE ADDICTION - OP-ED

An op-ed in The Washington Post from Alex M. Azar, Secretary of Health and Human Services (HHS) and Scott Gottlieb, Commissioner of the Food and Drug Administration (FDA), brings much-needed attention to the growing problem of youth use of nicotine through e-cigarettes: In one year fom 2017 to 2018, “the number of high-school-age children reporting use of e-cigarettes rose by more than 75 percent. Use among middle-schoolers also increased nearly 50 percent. That is an epidemic… The surge in e-cigarette use by teenagers is alarming because nicotine is highly addictive and can harm brain development, which continues into young adulthood [emphasis added]. Worse, kids who start on e-cigarettes are actually more likely than non-user peers to migrate to smoking tobacco…”

This is a valuable national-level wake-up call on the part of two key federal leaders, and it focuses exactly on a central theme of the ONE CHOICE prevention message: zero use of alcohol, nicotine, cannabis, and any other substance that can skew teen brain development toward addiction as an adult.

Read the full op-ed here.

NEW STUDY SHOWS MORE YOUTH THAN EVER BEFORE ARE MAKING THE ONE CHOICE

According to a new study, over the last 40 years there has gradually been an enormous increase in the number of teens who are making just One Choice: zero use of alcohol, tobacco, cannabis, or any other substance that can skew their brain development towards adult addiction.

In the video below, Robert L. DuPont, MD, President of the Institute for Behavior and Health, and Sharon Levy, MD, Director of the Adolescent Substance Use and Addiction Program at Boston Children's Hospital, discuss their study showing this positive long-term trend.

REDUCING FUTURE RATES OF ADULT ADDICTION MUST BEGIN WITH YOUTH PREVENTION

Click here to download or print a PDF copy of this commentary

Reducing Future Rates of Adult Addiction Must Begin with Youth Prevention

February 16, 2018, Revised 2019

The United States is confronting a public health crisis of rising adult drug addiction, most visibly documented by an unprecedented number of opioid overdose deaths.1 Most of these overdose deaths are not from the use of a single substance – opioids – but rather are underreported polysubstance deaths.2 This is happening in the context of a swelling national interest in legalizing marijuana use for recreational and/or medical use. As these two epic drug policy developments roil the nation, there is an opportunity to embrace a powerful initiative. Ninety percent of all adult substance use disorders trace back to origins in adolescence.3,a New prevention efforts are needed that inform young people, the age group most at-risk for the onset of substance use problems, of the dangerous minefield of substance use that could have a profound negative impact on their future plans and dreams.

Moving Beyond a Substance-Specific Approach to Youth Prevention

The adolescent brain is uniquely vulnerable to developing substance use disorders because it is actively and rapidly developing until about age 25. This biological fact means that the earlier substance use is initiated the more likely an individual is to develop addiction. Preventing or delaying all adolescent substance use reduces the risk of developing later addiction.

Nationally representative data from the National Survey on Drug Use and Health shows that alcohol, tobacco and marijuana are by far the most widely used drugs among teens. This is no surprise because of the legal status of these entry level, or gateway, drugs for adultsb and because of their wide availability. Importantly, among American teens age 12 to 17, the use of any one of these three substances is highly correlated with the use of the other two and with the use of other illegal drugs. 4 Similarly for youth, not using any one substance is highly correlated with not using the other two or other illegal drugs.

For example, as shown in Figure 1, teen marijuana users compared to their non-marijuana using peers, are 8.9 times more likely to report smoking cigarettes, 5.6, 7.9 and 15.8 times more likely to report using alcohol, binge drink, and drink heavily, respectively, and 9.9 times more likely to report using other illicit drugs, including opioids. There are similar data for youth who use any alcohol or any cigarettes showing that youth who do not use those drugs are unlikely to use the other two drugs. Together, these data show how closely linked is the use by youth of all three of these commonly used drugs.

aAmong Americans age 12 and older who meet criteria for substance use disorders specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). bMarijuana remains illegal under federal law but is legal in some states for recreational use the legal age is 21, and in some states for medical use, the legal age is 18. Nationally the legal age for tobacco products is 18 and for alcohol it is 21.

Figure 1. Past Month Use of Other Drugs, if Marijuana is Used, Ages 12-17

Figure 1. Past Month Use of Other Drugs, if Marijuana is Used, Ages 12-17

These findings show that prevention messaging targeting youth must address all of these three substances specifically. Most current prevention efforts are specific to individual substances or kinds and amounts of use of individual drugs (e.g., cigarette smoking, binge drinking, drunk driving, etc.), all of which have value, but miss a vital broader prevention message. What is needed, based on these new data showing the linkage of all drug use by youth, is a comprehensive drug prevention message: One Choice: no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health. 5,6,7 This no use prevention message provides clarity for young people, parents, physicians, educators, communities and for policymakers. It is not intended to replace public health prevention messages on specific substances, but enhances them with a clear focus on youth.

Some claim adolescent use of alcohol, cigarettes and marijuana is inevitable, a goal of no use of any drug as unrealistic and that the appropriate goal of youth prevention is to prevent the progression of experimentation to later heavy use or problem-generating use. These opinions are misleading and reflect a poor understanding of neurodevelopment that underpins drug use. Teens are driven to seek new and exciting behaviors which can include substance use if the culture makes them available and promotes them. This need not be the case. New data in Figure 2 show over the last four decades, the percentage of American high school seniors who do not use any alcohol, cigarettes, marijuana or other drugs has increased steadily. In 2014, 52% of high school seniors had not used any alcohol, cigarettes, marijuana or other drugs in the past month and 26% had not used any alcohol, cigarettes, marijuana or other drugs in their lifetimes.8 Clearly making the choice of no use of any substances is indeed possible – and growing.

Figure 2. Past Month and Lifetime Trends among High School Seniors in Abstaining from Alcohol, Cigarettes, Marijuana and Other Illicit Drugs

Figure 2. Past Month and Lifetime Trends among High School Seniors in Abstaining from Alcohol, Cigarettes, Marijuana and Other Illicit Drugs

Key lessons for the future of youth prevention can be learned from the past. Substance use peaked among high school seniors in 1978 when 72% used alcohol, 37% used cigarettes, and 37% used marijuana in the past month.9 These figures have since dropped significantly (see Figure 3). In 2016, 33% of high school seniors used alcohol, 10% used cigarettes and 22% used marijuana in the past month. This impressive public health achievement is largely unrecognized.

Figure 3. Percentage of US High School Seniors Reporting Past Month Substance Use, 1975-2016

Figure 3. Percentage of US High School Seniors Reporting Past Month Substance Use, 1975-2016

Although the use of all substances has declined over the last four decades, their use has not fallen uniformly. The prevalence of alcohol use, illicit drug use and marijuana use took similar trajectories, declining from 1978 to 1992. During this time a grassroots effort known as the Parents’ Movement changed the nation’s thinking about youth marijuana use10 with the result that youth drug use declined a remarkable 63%. Rates of adolescent alcohol use have continued to decline dramatically as have rates of adolescent cigarette use. Campaigns and corresponding policies focused on reducing alcohol use by teens seem to have made an impact on adolescent drinking behavior. The impressive decline in youth tobacco use has largely been influenced by the Tobacco Master Settlement Agreement which provided funding to anti-smoking advocacy groups and the highly-respected Truth media campaign. The good news from these long-term trends is that alcohol and tobacco use by adolescents now are at historic lows.

It is regrettable but understandable that youth marijuana use, as well as use of the other drugs, has risen since 1991 and now has plateaued. The divergence of marijuana trends from those for alcohol and cigarettes began around the time of the collapse of the Parents’ Movement and the birth of a massive, increasingly well-funded marijuana industry promoting marijuana use. Shifting national attitudes to favor legalizing marijuana sale and use for adults both for medical and for recreational use now are at their highest level11 and contribute to the use by adolescents. Although overall the national rate of marijuana use for Americans age 12 and older has declined since the late seventies, a greater segment of marijuana users are heavy users (see Figure 4). Notably, from 1992 to 2014, the number of daily or near-daily marijuana uses increased 772%.12 This trend is particularly ominous considering the breathtaking increase in the potency of today’s marijuana compared to the product consumed in earlier decades. 13,14,15 These two factors – higher potency products and more daily use – plus the greater social tolerance of marijuana use make the current marijuana scene far more threatening than was the case four decades ago.

Figure 4. Millions of Americans Reporting Marijuana Use, by Number of Days of Use Reported in the Past Month

Figure 4. Millions of Americans Reporting Marijuana Use, by Number of Days of Use Reported in the Past Month

Through the Parents’ Movement, the nation united in its opposition to adolescent marijuana use, driving down the use of all youth drug use. Now is the time for a new movement backed by all concerned citizens to call for One Choice: no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health. This campaign would not be a second iteration of the earlier “Just Say No” campaign. This new no-use message focuses on all of the big three drugs together, not singly and only in certain circumstances such as driving.

We are at a bitterly contentious time in US drug policy, with front page headlines and back page articles about the impact of the rising death rate from opioids, the human impact of these deaths and the addiction itself.16 At the same time there are frequent heated debates about legalizing adult marijuana and other drug use. Opposing youth substance use as a separate issue is supported by new scientific evidence about the vulnerability of the adolescent brain and is noncontroversial. Even the Drug Policy Alliance, a leading pro-marijuana legalization organization, states “the safest path for teens is to avoid drugs, including alcohol, cigarettes, and prescription drugs outside of a doctor’s recommendations.” 17

This rare commonality of opinion in an otherwise perfect storm of disagreement provides an opportunity to protect adolescent health and thereby reduce future adult addiction. Young people who do not use substances in their teens are much less likely to use them or other drugs in later decades. The nation is searching for policies to reduce the burden of addiction on our nation’s families, communities and health systems, as well as how to save lives from opioid and other drug overdoses.18 Now is precisely the time to unite in developing strong, clear public health prevention efforts based on the steady, sound message of no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health.

Robert L. DuPont, M.D.

President, Institute for Behavior and Health, Inc.

Former Director, National Institute on Drug Abuse (1973-1978)
Former White House Drug Chief (1973-1977)

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[1] Hedegaard, M., Warner, M., & Minino, A. M. (2017, December). Overdose deaths in the United States, 1999-2016. NCHS Data Brief, 294. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Available: https://www.cdc.gov/nchs/data/databriefs/db294.pdf

[2] Florida Drug-Related Outcomes Surveillance and Tracking System (FROST), University of Florida College of Medicine. http://frost.med.ufl.edu/frost/

[3] The National Center on Addiction and Substance Abuse at Columbia University. (2011). Adolescent Substance Use: America’s #1 Public Health Problem. New York, NY: Author. Available: https://www.centeronaddiction.org/addiction-research/reports/adolescent-substance-use-america%E2%80%99s-1-public-health-problem

[4] DuPont, R. L., Han, B., Shea, C. L., & Madras, B. K. (2018). Drug use among youth: national survey data support a common liability of all drug use. Preventive Medicine, 113, 68-73.

[5] DuPont, R. L. (2015). It’s time to re-think prevention: increasing percentages of adolescents understand they should not use any addicting substances. Rockville, MD: Institute for Behavior and Health, Inc.

[6] DuPont, R. L. (2017, October 23). For a healthy brain teens make “One Choice”. Rockville, MD: Institute for Behavior and Health, Inc. Available: https://www.preventteendruguse.org/s/IBH_Commentary_One_Choice_10-23-17.pdf

[7] Chadi, N., & Levy, S. (2017). Understanding the highs and lows of adolescent marijuana use. Pediatrics, 140(6). Available: http://pediatrics.aappublications.org/content/pediatrics/early/2017/11/02/peds.2017-3164.full.pdf

[8] Levy, S., Campbell, M. C., Shea, C. L., & DuPont, R. L. (2018). Trends in abstaining from substance use in adolescents: 1975-2014. Pediatrics, doi: 10.1542/peds.2017-3498.

[9] Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2017). Monitoring the Future national survey results on drug use, 1975–2016: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan. Available at http://monitoringthefuture.org/pubs.html#monographs

[10] Dufton, E. (2017). Grass Roots: The Rise and Fall of Marijuana. New York, NY: Basic Books.

[11] Geiger, A. (2018, January 5). About six-in-ten Americans support marijuana legalization. Washington, DC: Pew Research Center. Available: http://www.pewresearch.org/fact-tank/2018/01/05/americans-support-marijuana-legalization/

[12] Caulkins, J. (2017, November 7). Psychoactive drugs in light of libertarian principles. Law and Liberty. Available: http://www.libertylawsite.org/liberty-forum/psychoactive-drugs-in-light-of-libertarian-principles/

[13] ElSohly, M. A., Mehmedic, Z., Foster, S., Gon, C., Chandra, S., & Church, J. C. (2016). Changes in cannabis potency over the last 2 decades (1995-2014): Analysis of current data in the United States. Biological Psychiatry, 79(7), 613-619.

[14] World Health Organization. (2016). The Health and Social Effects of Nonmedical Cannabis Use. Geneva, Switzerland: Author. Available: http://www.who.int/substance_abuse/publications/cannabis/en/

[15] Rocky Mountain High Intensity Drug Trafficking Area. (2017, October). The Legalization of Marijuana in Colorado: The Impact, Volume 5. Denver, CO: Author. Available: https://rmhidta.org/files/D2DF/2017%20Legalization%20of%20Marijuana%20in%20Colorado%20The%20Impact2.pdf

[16] E.g., Sanger-Katz, M. (2018, August 16). Bleak new estimates in drug epidemic: a record 72,000 overdose deaths in 2017. The New York Times, p. A1. Available: https://www.nytimes.com/2018/08/15/upshot/opioids-overdose-deaths-rising-fentanyl.html; Seelve, K. Q. (2018, January 21). One son. Four overdoses. Six hours. A family’s anguish. New York Times, p. A1. Available: https://www.nytimes.com/2018/01/21/us/opioid-addiction-treatment-families.html

[17] Drug Policy Alliance. (2018). Real drug education. New York, NY: Author. Available: http://www.drugpolicy.org/issues/real-drug-education

[18] The President’s Commission on Combatting Drug Addiction and the Opioid Crisis. (2017). Final Draft Report. Available: https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-15-2017.pdf

NEW STUDY ON NEGATIVE LONG-TERM EFFECTS OF HEAVY MARIJUANA USE ON BRAIN FUNCTION AND BEHAVIOR

A study published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging looked at the effects of heavy marijuana use on brain function and behavior. The accompanying press release summarizes, "Young people with cannabis dependence have altered brain function that may be the source of emotional disturbances and increased psychosis risk that are associated with cannabis abuse. The alterations were most pronounced in people who started using cannabis at a young age [emphasis added]. The findings reveal potential negative long-term effects of heavy cannabis use on brain function and behavior, which remain largely unknown despite the drug’s wide use and efforts to legalize the substance."

Read the press release here.

Access the full study here.

TEENS CAN MAKE ONE CHOICE FOR A BETTER FUTURE - IBH COMMENTARY

Click here to download or print a PDF copy of this commentary.

 
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For a Healthy Brain Teens Make “One Choice”

One Choice is a consistent, clear social messaging concept designed to encourage young people under 21 not to use any alcohol, tobacco, marijuana or other drugs to protect their health, especially the health of their brains. At present, prevention efforts tend to focus on a single substance or circumstance, e.g., only marijuana, only alcohol or binge drinking, or not drinking and driving. One Choice cuts through these details and centers in on the single decision that teens face every day: whether or not to use any substance at all. Rather than a series of substance-specific decisions, teens make one overarching, day-by-day decision on whether or not to use any substance, including alcohol, tobacco, marijuana and other drugs. Data from the National Survey on Drug Use and Health (NSDUH) from the Substance Abuse and Mental Health Services Administration (SAMHSA) show that the use by teens age 12 to 17 of any one of the three gateway drugs – alcohol, cigarettes or marijuana – dramatically increases the likelihood of use of the other two substances and other illicit drugs. Similarly, non-use of any one of these substances significantly reduces the likelihood of using the other two or other illicit drugs. This is the basis for One Choice. Adolescents, regardless of past substance use, have the choice today and the choice every day to not use any substance to maintain a healthy brain.

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Addiction is rooted in adolescence: 90 percent of adults with substance use disorders begin using in the teenage years. The good news is that a growing percentage of teens in the US are making the choice not to use any substance. Nationally representative data from the National Institute on Drug Abuse (NIDA)-funded Monitoring the Future (MTF) survey show that over the course of the last four decades a steadily increasing percentage of high school seniors report having never used any alcohol, cigarettes, marijuana or other illicit drugs.

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In 2014, over one quarter (25.5%) of high school seniors had never used any alcohol, cigarettes, marijuana or other drugs in their lifetimes.  Half (50%) of high school seniors had not used any substance in the past 30 days.  It is possible for every teen to make the choice not to use any substances.  More and more teens are making that One Choice.

 To learn more about One Choice to maintain a healthy brain, visit the IBH website, www.PreventTeenDrugUse.org.  

 Robert L. DuPont, MD, President, Institute for Behavior and Health, Inc.

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