Module 2: Screening and Assessment

Types of Substance Use Disorders

There are two types of substance use disorders, namely substance abuse and substance dependence. It is important to note that not all youth who use drugs have a disorder. Adolescents generally progress through stages of drug use.

• Substance Abuse Many youth in the juvenile justice system meet DSM-IV criteria for substance abuse. They continue their use of alcohol and/or other drugs despite problems at home with family members and/or with school or work. They have driven a car or engaged in other dangerous behavior (including criminal behavior) while intoxicated that could have resulted in injury to themselves or others.
  
  
• Substance Dependence Although some youth involved with juvenile justice may not have used a substance long enough to develop symptoms of tolerance or withdrawal, they can still meet DSM-IV criteria for substance dependence. These youth use substances (e.g., alcohol, cannabis, amphetamines) in a compulsive manner. Once they start using the drug, they find it difficult to stop, even when they have made up their mind to cut down on their substance use. Almost all of their daily activities revolve around the substance, interfering with their ability to go to school or have meaningful relationships with people other than their substance-using friends. These youth also continue using the substance despite knowing it is causing physical or psychological problems for them.

Stages of Drug Use

The majority of teenagers will experiment with alcohol, and many will try marijuana. However, not all adolescents who use alcohol and other drugs have a substance use disorder. It is helpful to look at adolescent drug use as progressing through various "stages" (Crowe & Schaefer, 1992). Only a small subset of youth will progress to the third and fourth stage of substance use. The stages are:

1. Experimental and Social
2. Purposeful Misuse
3. Habitual Use or Daily Preoccupation
4. Dependency or Addiction

Stage 1: Experimental and Social Use of Drugs or Alcohol
The following are characteristics of Stage 1:

Behavioral

• Use drugs/alcohol occasionally (weekends, parties)
• Get drugs/alcohol from friends; sometimes obtain parent's alcohol
• Have no major changes in behavior (although they may lie about use, experience moderate hangovers, or adults may find evidence)

Emotional or Mental

• Use drugs/alcohol because of curiosity, peer pressure, rebellion, boredom, or as a social lubricant or as a way to experience pleasurable feelings
• Experience euphoria/intoxication and then return to a normal state