Addiction among Youth: Issues and Challenges

YOUTH AND ADDICTION As per World Drug Report 2024, adolescence is a prime time for drug use since the brain is still developing throughout this time.[1] Although the percentage of 18–24-year-olds seeking drug-related treatment varies by location, it is generally lower than that of older age groups.[1] The proportion of people 18 and under who seek drug-related care is often extremely low, frequently <10% in the majority of locations. This is especially noticeable in Australia and New Zealand, North America, and Western and Central Europe, where treatment availability seems to be restricted for this age range. Substance use among youth in India is a growing public health concern. A multicentric study done by Venkatesh et al., across 15 states in India, involving 1630 young individuals (10–24 years) attending primary health centers, reported a 32.8% prevalence of substance use. The most commonly used substances were tobacco (26.4%), alcohol (26.1%), and cannabis (9.5%).[2] Adolescence, a critical period marked by significant brain development – particularly in areas related to decision-making and impulse control – heightens vulnerability to long-term consequences of substance use. Social influences, including peer pressure, further drive initiation, highlighting the need for targeted interventions.[3,4] Contributing factors include socioeconomic stress, family dynamics, peer pressure, and easy access to substances. The consequences extend beyond individual health, affecting academic performance, mental well-being, and social development. Addressing this issue requires a multi-faceted approach, incorporating education, community engagement, and policy measures. Urgent, coordinated efforts are essential to prevent and mitigate substance use among school-going youth, ensuring a healthier and more promising future.[5] Here, we will discuss the key issues in addiction among youth first, followed by the avenues of prevention and treatment. This is the viewpoint of the authors, and not a narrative or systematic review. Though some of these have been discussed elsewhere, the authors would like to bring to attention this viewpoint in a coherent manner. KEY ISSUES IN ADDICTION AMONG YOUTH Issue 1: Extent According to the National Family Health Survey (NFHS-5), conducted in India from 2019 to 21, about 0.3% of women aged 15–19 drink alcohol, with the frequency being marginally higher in rural regions (0.3%) than in urban areas (0.2%). About 2.2% of males in rural areas consume alcohol more than men in urban areas (1.4%). About 1.0% of women aged 15 to 19 report using tobacco. The frequency is higher in rural areas (1.2%) than in urban areas (0.5%). Around 6.5% of males in this age range smoke, with the frequency being higher among rural men (7.5%) than urban men (4.2%).[6] According to the European Monitoring Centre for Drugs and Drug Addiction (2024), cannabis remains the most frequently used illicit substance among European youth. In the past year, an estimated 15% (15.1 million) of individuals aged 15–34 in Europe reported cannabis use, with males being approximately twice as likely to use it as females. Cannabis use is still more prevalent than cocaine, amphetamines, or ecstasy.[7] According to the National Survey on Drug Use and Health by the Substance Abuse and Mental Health Services Administration, in 2019, around 4.9% of adolescents (ages 12–17) and 34.3% of young adults (ages 18–25) engaged in binge drinking within the past month. By 2022, nearly 48.8% (17.0 million) of young adults had experienced either a substance use disorder or any mental illness in the past year, a proportion higher than that of other adult age groups.[8] Drug experimenting is common among young individuals, and some of them will develop problematic drug usage, while others may use substances occasionally. With India’s enormous population, this means that substance use issues affect crores of people. Since these people are frequently in their prime, the economy and society may suffer significant indirect consequences as a result of their drug addiction.[2] Since the amount and prevalence of drug usage vary greatly depending on many criteria, several factors must be taken into account. Geographical location is important since drug use habits vary. Context is particularly important because, in contrast to ordinary days, consumption may increase during certain religious or cultural celebrations like Shivratri or Kawar. Issue 2: Typologies of addiction Addiction can take many different forms and be categorized according to several factors, such as its mode of action and legal status. According to pharmacology, drugs are divided into three groups: hallucinogens (like LSD and psilocybin), depressants (like alcohol and benzodiazepines), and stimulants (such as cocaine and amphetamines).[9] Another way to segregate substances is legal status.[10] In addition to substance use disorders, behavioral addictions, including compulsive gaming, gambling, and internet addiction, have neurological pathways that reinforce compulsive behaviors despite unfavorable outcomes.[11] Determining which types of addiction are the most common in people or groups, anticipating related consequences, and creating effective preventive and treatment plans all depend on an understanding of addiction typologies. Issue 3: Manifestation Since some of the features of dependence are hard to develop in younger individuals, we rarely see the core hallmarks of substance dependence in youth.[12] A major characteristic of dependence is impaired control, which typically shows itself as fluctuating control rather than a persistent incapacity to control substance use among the youth population. In a similar vein, tolerance may grow but is frequently less noticeable in adolescents and young adults than in adults because of shorter histories of substance use. In teens, withdrawal symptoms may also be less obvious or more inconsistent.[12] Substance use disorder in youth differs from that in adults due to various factors. Since substance use often begins recently, dependence patterns may not be deeply established. Neurobiological changes during this stage also influence symptom presentation. Fear of rejection, admonition, or financial dependence often leads young individuals to hide their use, making detection difficult sometimes. If unaddressed, substance use can escalate, increasing the risk of long-term dependence. Issue 4: Vulnerability The adolescent brain is still growing, especially in the brain regions that deal with decision-making and impulse control. Because their inhibitory mechanisms are still developing and immature, adolescents are more likely to engage in risky behavior.[13] Additionally, they are experimenting throughout this time, and peer pressure and curiosity may push them to try new things, including using drugs. Substance abuse during this crucial stage, however, might change brain chemistry and make a person more prone to addiction. Reward circuits in the brain might be “hijacked,” which would encourage substance-seeking behaviors and make it more difficult to avoid using them in the future.[13] The risk variables of initiating substance use identified in the study by Nawi et al. were divided into three primary categories: community, family, and individual factors.[14] The following individual risk factors were found: high levels of impulsivity, rebelliousness, emotional regulation impairment, pain catastrophizing, incomplete homework, higher screen time, and alexithymia; experiencing maltreatment or negative upbringing; having psychiatric disorders, such as major depressive disorder and conduct problems; having previously used e-cigarettes; behavioral addiction; low perceived risk; high perceived drug accessibility; and high attitude to use synthetic drugs. Negligence, inadequate supervision, uncontrolled pocket money, low parental education, poor maternal psychological control, smoking during pregnancy, and family history of substance use were the familial risk factors. Peers who consume drugs were mentioned as one community risk factor.[14] Issue 5: Life trajectories Youth is a crucial stage of life that is characterized by important changes, such as completing higher education, building a personal identity, forming relationships, entering the workforce, and beginning a family. It is a period of discovery, development, and exploring the various facets of life. Addiction, on the other hand, has the potential to seriously alter these paths by compromising social and familial ties, limiting professional options, and affecting cognitive and emotional development.[15] Substance abuse during this stage can result in health issues, trouble sustaining stable relationships, academic or professional failure, and other issues that eventually impact long-term well-being.[16] Issue 6: Peer influence An adverse trajectory of substance use disorder is frequently set in motion by early-onset substance use influenced by peers, followed by a quickly growing pattern of use that is supported by peer pressure. Social dynamics play a critical role in the onset of addiction since peer approval, and the need to fit in can be strong motivators for beginning substance use. People start forming their identities outside their families during adolescence, and the friendships frequently reflect larger cultural influences, such as the accessibility and acceptance of substance use. Belonging to specific peer groups can occasionally represent defiance of authoritative figures or accepted standards. Personality characteristics of the individual and the manner of how well a person “fits” in with their peer group can also influence how youth use drugs.[17,18] Issue 7: Marketing and availability Marketing tactics that sell addictive items (like cigarettes and alcohol) to build a devoted and lasting consumer base frequently target youth. Young consumers find substances like alcohol and cannabis more alluring when clever marketing strategies are used, such as creating buzz about products, supporting events and festivals, and providing enticing flavors.[19-21] Due to its glamorization in party culture, mainstream entertainment, and online media, alcohol is becoming more and more accepted in society. Teetotalers are frequently marginalized as a result of this normalization, which has the potential to further ingrain substance usage into social norms. A slow change in society, sometimes presented as “progress,” has also affected how people view cannabis products. Higher usage may result from greater accessibility and marketing exposure, but addiction is not always the result.[19-21] Issue 8: Comorbidities Substance use disorders and other adolescent psychiatric disorders are significantly overlapping.[22] Psychiatric comorbidity among patients with substance use disorders is significantly more prevalent in children and adolescents (76%) compared to older patients (>18 years: 23.4%).[23] Conduct disorders (28%–62%, depending on the study) with and without hyperkinetic disorders are the most prevalent psychiatric comorbidities. Depressive, anxiety, and impulse control disorders (16%–61%) are next in line. Additional comorbidities include schizophrenia, substance-induced psychoses (caused by cocaine, amphetamines, ecstasy, cannabis, and LSD), eating disorders, borderline personality disorders, and social phobia. Attention deficit disorder with or without hyperactivity, personality disorders (antisocial and narcissistic personality disorders), conduct disorders, and mixed conduct and emotional disorders are common comorbidities among boys. Depressive disorders, post-traumatic illnesses, emotional development problems, and borderline personality disorders are the most prevalent comorbidities among females. On the one hand, research indicates that substance use disorders significantly exacerbate the development of mental illnesses in children and adolescents.[22] However, it has been demonstrated that mental illnesses frequently occur before substance use, which can either negatively impact the course of substance use disorder, such as when treatment programs are stopped, or raise the risk for substance use disorder, such as through self-medication.[10,22] As a coping mechanism for challenging circumstances, people may start or continue abusing substances or engage in addictive behaviors. Because addiction may first conceal underlying emotional, psychological, or social problems, this might make treatment more difficult. These underlying issues frequently reappear after substance use is controlled or decreased, necessitating additional intervention. Since unresolved problems may raise the chance of relapse, addressing these concerns is crucial for long-term rehabilitation. Issue 9: Legal issues When under the influence of drugs or alcohol, poor decision-making can result in impulsive and irresponsible behaviors, which raises the risk of criminal offenses. Violence, like assaults and domestic abuse, has been closely associated with alcohol intoxication in particular.[24] Furthermore, to get money for their next “hit” (or dose of substance), people with addiction may turn to theft or other criminal activity, such as chain-snatching.[25] Simple possession can also result in legal issues because many nations like India have laws that make it illegal to consume drugs like heroin for personal use, which leads to jail time rather than treatment.[1] PREVENTING ADDICTION AMONG YOUTH Preventing addiction among youth demands navigating through a maze of social, systemic, and ethical hurdles. At the community level, bringing together diverse voices of different stakeholders like adolescents, parents, educators, and policymakers is easier said than done. Even when adolescents are included in designing prevention strategies, conflicting priorities and cultural gaps often stall progress.[26] Authorities struggle to balance strict rules with respecting youth’s independence. While overly rigid programs push adolescents away, lenient approaches fail to curb risky behaviors.[27] It becomes even more challenging when healthcare, education, and law enforcement rarely work in synchronization, leaving prevention efforts fragmented and under-resourced.[28] Inconsistent funding and shifting of policy priorities undermine long-term prevention efforts, particularly in regions with volatile governance. Moreover, the rise of new substances such as vaping and synthetic drugs worldwide, makes it challenging for communities to implement culturally appropriate prevention strategies.[28] In clinical settings, building trust with adolescents is a delicate process, often hindered by stigma or past negative experiences that make them guarded from seeking help. Studies show that overworked clinicians frequently lack the time or specialized training needed to bridge this trust gap effectively.[29] Family dynamics add another layer of complexity. Well-intentioned parents may unintentionally clash with their teenagers over privacy concerns, placing clinicians in ethically challenging positions regarding confidentiality.[30] These situations require a nuanced approach to balance the needs of the young individuals with the concerns of their family members. Even if the initial treatment works well, relapse is common rather than rare. Many factors in a person’s surroundings can make a recovery difficult, such as peer pressure, an unstable home environment, or a lack of proper support after treatment.[30] Families are often the first line of defense and can unintentionally worsen addiction through strained relationships and poor communication among family members.[31] Instead of placing the entire burden of recovery on family members, a structured, family-driven, yet professionally guided approach may be helpful. As shown in Table 1, workshops for parents can help primary caregivers understand addiction as a mental health condition rather than as a moral sin, can build empathy, and can promote communication.[31] Digital platforms supported by government and NGO partnerships can make affordable family therapy more accessible in smaller cities. Beyond individual and family interventions, community engagement plays a crucial role in addiction prevention. Through peer-led support groups in schools and colleges, we can create safe spaces for open dialogue, while partnerships involving regional influencers like sports stars and local artists can help de-stigmatize seeking help. Furthermore, investment in community resources such as libraries, sports complexes, and art and music centers can provide healthier options for socialization, reducing the need for escapism-driven addiction.[32]Table 1: Preventing addiction among youthTo conclude, youth addiction in India is a pressing public health challenge shaped by unique sociocultural, economic, and systemic factors. Some of the key take-home points on this aspect are presented in Table 2. Neurodevelopmental changes during adolescence, stigma around mental health, and fragmented healthcare systems that lack rural access to evidence-based therapies amplify vulnerabilities. Most prevention efforts are further complicated by legal ambiguities, comorbid psychiatric disorders, and the normalization of addictive behaviors in digital and social spaces. A holistic, culturally adapted, and multi-stakeholder approach is essential for effectively tackling addiction among youth. Prioritizing emotional well-being over punitive measures, expanding access to evidence-based therapy through community-based interventions, strengthening family support with professional guidance, and addressing socioeconomic determinants are critical steps in building long-term resilience and recovery.Table 2: Key take-home points pertaining to addiction among youthFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.