Substance Abuse and Psychosis in Adolescents Over the past several decades, the U.S. population has grown significantly and continues to do so at a rapid pace. The most recent U.S. Census Bureau figures estimate that the population in the United States is currently nearing 304,800,000. Of this tremendous number, approximately one quarter are children under that age of eighteen years and over 40 million are adolescents (U.S. Census Bureau, 2001a). For the purpose of this examination, we will define adolescents as individuals between the ages of ten and eighteen years, although it is important to keep in mind that there are many different definitions and understandings of adolescents, most of which are not as directly related to chronological age (Santrock, 2001). Adolescents are a very special population because these are often the years in which childhood and adulthood become blurred, roles, expectations and needs change, as well as significant physical and psychological growth. As we also know, experimentation is often characteristic of adolescence and this experimentation can be physical, sexual or philosophical; all of which may possibly lead to drug use. This paper seeks to examine the question of whether or not drug abuse is related to psychosis in adolescents.
Literature Review
Adolescent Drug Use According to a national study in 2006, over 60 percent of reported that drugs were used, kept and sold on their school campuses on a regular basis. These drugs included popular illicit drugs such as marijuana and Ecstasy as well cocaine and prescription drugs (Eaton, 2006). While many people appear hopeful at the minor decrease in use of illicit drugs by adolescents in recent years, many fail to recognize the corresponding increase in teens using and abusing prescription drugs. Prescription drugs have become increasingly popular with todayâ 셲 adolescents for a number of reasons including their ease of administration, accessibility (many teens access the drugs in their own homes of those of their relatives, and the reported high and â 쐍umbingâ �effect of common narcotics. According to the National Institute on Drug Abuse, one of the most commonly abused drugs by older adolescents and high school seniors is the prescription narcotic pain killer Hydroco done, which is known by its brand name Vicodin. In 2004, almost one out of ten high school seniors reported â 쐒ecreationalâ �or non-medical use of Vicodin, while one out of every twenty high school seniors reported the same use of the drug brand name Oxycontin, which has an even higher narcotic concentration than Vicodin, and is known in the medical community and abroad for its highly addictive properties. Experts believe that in addition to increased prescription drug abuse, attitudes toward the decriminalization of marijuana have led to the underreporting of its use. That is, there are large subcultures of teens and even adults that believe that marijuana is not a â 쐂rugâ �and do not consider their use of it detrimental or reportable (Eaton, 2005). Contrary to these beliefs that marijuana is harmless to adolescents, are the numerous studies investigating the psychoactive properties of Cannabis and the fact that the immediately observable cognitive deficits do not dissipate as quickly as one believed and in fact can continue to wreak havoc on a young personâ 셲 body for up to 24 hours after smoking marijuana. The chemical THC has been linked to decreased capacity of short term memory and there is evidence of increased anxiety, depression, and suicidal ideation in adolescents who are chronic users of marijuana. This information is crucial for those inv estigating any possible connection between adolescent cannabis abuse and mental health because it is a classic â 쐁hicken and egg scenario,â �that it, we ask whether or not the marijuana is being used as a coping skill to deal with these psychological issues, or if these issues are secondary to its use (Crowley, Macdonald, Whitmore & Mikulich, 1998).
Drug-Induced Psychosis
In addition to the previous two sections on adolescent abuse of prescription medication and marijuana use, it is important to note that adolescents are also abusing other drugs at significantly high rates including alcohol, cocaine and methamphetamines. All of the above-mentioned drugs alter brain chemicals, which can trigger psychoactive effects. Depending on a number of confounding variables, these altered brain chemicals can lead to a drug-induced psychosis. The Diagnostic and Statistical Manual Fourth Edition Text Revision (DSM-IV TR) explains that substance-induced psychosis is mental condition which involves significant disturbances in oneâ 셲 ability to think, communicate and behave in appropriate ways. It is characterized by symptoms including delusions, hallucinations and disordered thinking and is directly attributable to the consumption of a drug. This psychosis often occurs in the context of substance abuse or dependence and is different to other causes of psychosis in that symptoms appear quickly and last a relatively short time (until drug wears off). Drug-induced psychotic symptoms are more common than a true drug-induced psychosis (Crome, 2007). Alcohol is a central nervous system depressant that is known for its psychoactive effects. Because the effect of alcohol is dose dependent, adolescents who begin consuming alcohol are at increased risk for alcohol related accidents, alcohol poisoning and substance-induced psychotic episodes. Although alcohol-induced psychosis is uncommon and generally takes place either during intoxication or as symptoms of withdrawal, there are a small percentage of individuals with vulnerability to psychosis who experience their first psychotic break during an episode of abusing alcohol (Shedler & Block, 1990).

Methamphetamine is a highly addictive central nervous system stimulant that produces effects similar to those of cocaine. Because methamphetamine is synthetic and less expensive, it is often times more accessible to adolescents than cocaine. Over six percent of all high school students report having used methamphetamine and between 2002 and 2006, admissions to teen treatment programs of teens abusing methamphetamine increased by 25 percent (Crome, 2007). Methamphetamine is known to commonly cause drug-induced psychosis as those using the drug often have auditory and/or visual hallucinations and paranoia. This substance is also known to cause brain damage and even death in adults and young people alike from heart failure and stroke. Chronic methamphetamine use has been shown to cause prolonged paranoia and hallucinations, and other psychological conditions. In this case, drug-induced psychosis can continue beyond the period during which the drug was being abused and pres ent as true psychosis (McKetin, McLaren & Kelly, 2005).
As previously mentioned the abuse of prescription drugs by adolescents has increased in prevalence in recent years and appears to continue on an upward trend. In examining the effects that prescription drug abuse has on adolescents it is important to look at the most commonly abused class of prescription drugs by teens, opiates. These drugs, as all of the others mentioned, work on the central nervous system by creating a sedating and euphoric effect for most users. Adolescents report using the drugs both recreationally and as coping mechanisms and attempts to self-medicate when there are other emotional issues present (Lessenger & Feinberg, 2008). While these drugs do not generally produce the same psychosis-related symptoms as many stimulants, their use does alter brain chemicals and can lead to dependence, addiction, psychological problems and psychotic breaks in previously vulnerable individuals.
Marijuana is the last substance we will review and is the one that has been examined most closely when considering causes of psychosis, especially in young people. A 25-year longitudinal study demonstrated that long-term marijuana use beginning in adolescence was associated with increased incidence of mental illness (Arseneault & Poulton, 2002). This study examined adolescents who reported as chronic marijuana users during adolescents over the 25 year period and found that cannabis use was likely to play some sort of a causal role in psychosis, more specifically in schizophrenia. While this study failed to make an argument for direct causal correlations between schizophrenia and marijuana use, it did show that those chronic users were more likely to develop schizophrenia and three times as likely to develop depression. In this study, researchers attempted to control for as many confounding variables as possible during the onset such as: disturbed behavior, low IQ, pla ce of upbringing, cigarette smoking, poor social integration, gender, age, ethnic group, level of education, and previous psychotic symptoms. While the causal argument could not be made, it clearly indicated areas for future research to investigate what kind of role marijuana use does in fact play, in the development of psychosis (Arseneault & Poulton, 2002).
Conclusion
In seeking to answer the question of whether or not drug abuse causes psychosis in adolescents and reviewing available literature, it became clear that not only is adolescent drug abuse very prevalent, but also the mental health of our youth in general is a concern. Regardless of whether psychosis was directly or indirectly caused by substance abuse, or if the abuse was a catalyst the push a predisposed individual into a psychotic break, or if the condition was pre-existing, we know that these issues need to be dealt with and treated. Because the cause and effects are so closely related, it creates a cycle that render our youth stuck. These young people eventually become adults and many enter into the drug abusing adult population, which laymen and researchers alike agree is an enormous problem in American society. Drug abuse during adolescence may not directly cause psychosis, but it increases the risk for psychosis and a malady of other psychological problems in additi on to the plethora of physiological and social concerns. Given the number of young people in the United States, the fact that the population is increasing rapidly and the obvious drug related social issues facing America, it seems that further research in this area is warranted. Based on the findings in this work, implications for future research point to investigating the adolescent onset of psychosis more closely and specifically, rather than longitudinally. Because of the vast number of confounding variables in a longitudinal study, and the fact there are already established associations between drug abuse and psychological problems, it appears that the research process needs to be narrowed down significantly in order to more fully investigate how drug abuse in adolescence affects the likelihood of developing psychosis.

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