This is a copy of the original blog post on 10/21/2011 from our website (www.aboundhealth.com). We moved it here to make it easier for people to share their comments.
“Isn’t it normal for teenagers to experiment with alcohol/other drugs?” “We should still use the term experimentation because that is the word people are familiar with”. These are just a couple of the frequent questions and statements I hear. But is it in fact normal for teenagers to experiment with substances? I would suggest that experimenting with alcohol and other drugs is neither normal nor normative.
If we want to talk straight statistics, data do not support experimentation as normal, or typical of adolescents. Looking at portions of the National Survey on Drug Use and Health (NSDUH) alone , one can see that the majority of teens do not endorse past month alcohol use. While the 3-4% for 12-13 year-olds and the 12-13 % for 14 to 15 year-olds is of course concerning, it actually reveals that substance use is not typical. Even among the early college age (18-20 years), fewer than half report past month use. While it is a significant minority, it is not most or typical. One could say it is just as typical for an 18-20 year-old to not drink as to drink:
Further, also among the early college age (18-20), of those who report past month alcohol use, only 45% of those report binge use. That translates into less than one-quarter of 18-20 year-olds endorsing binge drinking. Neither current drinking nor binge alcohol use are actually typical of college aged young people. Finally, notice that even among the group newly of legal drinking age (21-25 years) , overall use increases but the proportion of binge drinking does not:
The incidence data are even lower for each age group for illicit drug use:
Again, the numbers for the younger age ranges are alarming, and an area for intervention and prevention. However, neither alcohol nor other drug use are representative of young people at any age, not even in college where many have purported that binge alcohol use is “the norm”.
Now normative is a little different, determined in part by family and societal expectations or values. (Here I am excluding use in religious or cultural rites.) It is typical for teens to test boundaries, assert their autonomy, and even be a bit more risk-taking. But is it normative, and acceptable that they try substances? On the whole we saw from the data standpoint it is not. The NSDUH data further reveal that kids report around 90% parental disapproval of cannabis use; and this disapproval correlates with abstinence. This not only suggests that cannabis use generally does not fit with individual family values, but that when parents express this disapproval, kids tend to follow it. For some families this is different, especially in those impacted by parental substance abuse. In that setting, kids may try substances either at home or outside and have it be seen by parents as normal. On the other hand, parents with addictive illness may disapprove of children’s use, but some kids may still view substance use as normative/acceptable because their parent is using. On the societal level, not to mention legal, we disapprove of underage alcohol and illicit drug use. Similar to other disapproved behaviors, our overall expectation is that kids will not use alcohol (underage) or illicit drugs. Interesting then that we should invent “drug experimentation” but not “shoplifting experimentation” or “vandalism experimentation”.
Finally, I’m not sure how we define experimentation clinically. If we define an experiment as hypothesis testing, then I doubt that is what any teen is setting out to do with drug use. If we define it more loosely, for instance taking it to see what happens, then really every episode of drug use could be considered experimental. There is no operational definition of adolescent experimental drug use. It is variably equated with first use, initiation, and others. All have subtly different meanings. Regardless of definition, experimentation means the brain is exposed to alcohol and/or other drugs with each use. Where research is concerned, experimentation is treated as a risk factor: “adolescent development [is a] biologically critical period of greater vulnerability for experimentation with substances and acquisition of substance use disorders” (Chambers, 2003, Am J Psych 160:1041). Further, the younger kids are when they are first exposed, the greater risk for developing substance abuse/addiction.
So who cares if they experiment? Granted, there are thousands of people who tried substances (especially alcohol, cannabis, and hallucinogens like LSD) in their adolescence and came through without addiction or injury. But as a parent or provider, can you definitively predict whose experimentation will be harmless versus that which will end in addiction, injury and/or death? Whether we keep the word experimentation or not, I suggest we remind ourselves that experiment = exposure. For yourself, your child or your patient, is it worth the risk? Share what you think.