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New Trends in Wellness Practices Among Youth

Steve

Chassman, LCSW, CASAC

VP of Organizational Development

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Healthy Coping Strategies

Self-Expression

Painting
Journaling
Listening to or playing music
Creating art

Mindfulness

Meditation
Breathing exercise
Digital Downtime (no phone!)
Reading

Confiding in Others

Talking to friends and/or loved ones
Going to guidance
Therapy
Support groups

Physical Wellness

Playing sports
Going to the gym
Walking
Drinking water
Eating a variety of foods

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Rates of mental health conditions among youth have increase 2-3x in the past decade.

Most common conditions:

Anxiety disorders
Depressive disorders

Early intervention=better outcomes.

Most youth, however, currently do not receive the help they need.

Overview: Mental Health Conditions Among Youth

(American Psychiatric Association, 2022; Bitsko et al., 2022; Walter et al., 2020; Gleason & Thompson, 2022; Kowalchuck, et al., 2022)

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Common Co-Morbid Disorders Among Youth

Common Co-Morbid SUD & Mental Health Conditions:

A co-morbid disorder is when 2 or more disorders are occurring at the same time in the same person.

Examples:

A 15-year-old who experiences overwhelming anxiety in social situations might use marijuana before socializing to self-medicate & feel less worried.
A 16-year-old who is depressed might use alcohol daily to feel happier when in reality they’re not happier but are temporarily blunting the irritability they feel.

~60-70% of adolescents who meet diagnostic criteria for a substance use disorder (SUD) also meet criteria for one or more psychiatric disorder(s).

Anxiety disorders
Depressive disorders
ADHD
Bipolar disorder
Eating disorders
Post-traumatic stress disorder (PTSD)

(Hammond, 2017; Partnership to End Addiction, 2019; Walter et al., 2020)

Talking Points:

Given the increase in mental health concerns, it's no surprise we're seeing a rise in substance use among youth as well as more comorbid disorders, where a person has 2 or more mental conditions at the same time.

70% of adolescents who meet diagnostic criteria for a substance use disorder (SUD) also meet criteria for one or more psychiatric disorders.

Youth with an untreated mental health disorder may use substances to temporarily alleviate symptoms (self-medicate). It's also possible that using substances may be the primary cause of behavioral/mental health symptoms (e.g. nicotine may mimic feelings of anxiety; alcohol can cause significant changes in mood; marijuana can cause severe anxiety and paranoia).

-As we get into the risk factors and impact we'll explore more on how use of substances (including to self-medicate) may impact youth in the short and long term.

https://www.ncbi.nlm.nih.gov/books/NBK571451/

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Anxiety-Related Disorders

Social anxiety
General anxiety disorder
Obsessive-compulsive disorder

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Depression

Symptoms

Feelings of sadness
Angry outbursts
Loss of interest or pleasure
Sleep disturbances; lack of energy
Changes in appetite
Anxiety
Trouble thinking, concentrating, or making decisions

Risk Factors

Low self – esteem
Childhood Trauma
Genetic predisposition (relative with a history of depression).
History of Mental health disorders
Certain medications
Abuse of Alcohol or illegal drugs

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Mood-Related Disorders

Major depression
Dysthymia
Bipolar disorder

About 20 percent of Americans with an anxiety or mood disorder such as depression have an alcohol or other substance use disorder, and about 20 percent of those with an alcohol or substance use disorder also have an anxiety or mood disorder.

ADAA.org

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Health issues.

Cardiovascular
Neurological
Gastrointestinal

Significant sleep and/or appetite changes.
Overdose/Death.

Biological

Impact of Mental Health & SUDs

Interpersonal issues (family, friends).
Academic issues.
Legal problems.

Social

Behavioral changes.
Difficulty regulating emotions.
Poor judgment & decision making.
Lose of interest in activities once enjoyed.
Co-occurring mental health conditions.

Psychological

Loss of purpose in life.
Not living in alignment with personal values.

Spiritual

Signs can be both obvious and subtle.

Consequences of Underage Drinking:

As a substance, alcohol damages almost every system in your body.

The heart, brain, & liver are especially affected.

Impairs brain development.

Memory

Learning

Impulsivity

Increase in risky decisions.

Sexual activity

Impaired driving

Suicide

Motor vehicle crashes continue to be the leading cause of death among youth who drink.

In 2022, 956 drivers in the U.S. under age 21 were impaired by alcohol when involved in fatal motor vehicle crashes.

People who drink alcohol before age 15 are more likely to develop an alcohol use disorder compared to those who wait until turning 21.

For example, adults ages 26 and older who began drinking before age 15 are 3.5 times more likely to report having AUD in the past year than those who waited until age 21 or later to begin drinking.

https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/underage-drinking-united-states-ages-12-20

Effects of marijuana:

Impairs youth brain development, as well as memory, learning, focus, motor control, impulse control, & decision making.

Can cause or exacerbate anxiety, depression, & psychotic symptoms.

Recent study found this is 2-4.5x higher than teens who do not use marijuana.

Use before age 18 is 4 to 7x more likely to result in problem use – which 30% of users develop.

Vaping/nicotine impact

Physical Impact

Nicotine poisoning & addiction.

Harm from chemicals.

Risk of fire from defective vapes.

Damage to: brain, liver, kidneys, heart, lungs.

Mental Impact

Impairs cognitive functioning in youth (e.g. memory, ability to focus, organization of information, etc).

Increased impulsivity & hyperactivity.

Other Impacts

Increased risk of using marijuana.

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Defining

Addiction

Addiction is a process & progression.

The earlier in life a person starts drinking, smoking, or using other substances, the worse their addiction is likely to become.

Use: Use of a substance to enhance a normally positive experience.

Misuse: Use of a substance for the above reason, & at times to cope with negative experiences, feelings, & situations.

Leads to unhealthy outcomes that are usually not repeated, like lying, vomiting, blackouts, argument, or injury.

Disordered use: Use of a substance where negative outcomes are repeated.

Ranges from mild (arguments and injuries that are managed) to severe.

Dependence: Use of a substance where use continues despite more serious negative consequences. May attempt to quit use without success or may not believe a problem exists.

May include increase in tolerance & withdrawal effects.

Students are most likely to start using illicit drugs between grades 7th-10th.

In 2023, students in 8th grade reported they mostly first used a substance in 7th grade.

Specifically:

Alcohol

Marijuana

Vaping (nicotine)

Cigarettes

This is especially important for a few reasons- tells us when to focus prevention efforts AND is impactful b/c we know the earlier someone starts using, typically the worse their addiction may become

https://monitoringthefuture.org/wp-content/uploads/2024/01/mtfoverview2024.pdf

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Marijuana Legalization in NYS

Legalization in New York State:

Recreational dispensaries (as of September 10, 2024):

35 in Manhattan.
3 in Farmingdale (only ones in Suffolk County).
There are and will be no recreational dispensaries in Nassau County.

Must be 21+ to purchase.

Many offer options for purchases to be delivered directly to them.

Products sold as weed in smoke shops or stores not registered via state of NY Office of Cannabis Management are not regulated (could be laced with heart & anxiety medication).

(New York State Office of Cannabis Management, 2024)

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What is Marijuana?

Marijuana is the most commonly abused illicit drug in the United States.
It is a dry, shredded green, brown or gray mix of flowers, stems, seeds and leaves from the hemp plant, Cannabis sativa.
The main active chemical in marijuana is delta-9-tetrahydrocannabinol, or THC for short.
It contains more than 800 other chemicals

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Harmless?????

Marijuana is the number one substance reported in emergency room admissions and autopsy reports

Reported to be involved in as many as 30% of adolescent motor vehicle accidents, 20% of adolescent homicides, 13% of adolescent suicides

About 9% of people who try marijuana will become addicted to it. The number goes up to about 1 in 6 among people who start using marijuana as teenagers, and to 25-50% among daily users.

A meta-analysis of 60 studies concluded that cannabis causes impairment in almost every performance area connected with safe driving: - Tracking

- Motor coordination

- Visual functions

- Complicated tasks that require attention

Now if we consider that most young people are not only smoking but drinking and mixing a whole host of medications with marijuana, the dangers increase significantly.

Kickback from this comes from young people who say “yes but I know someone who drives BETTER (or does any task better) when they smoke. Let them know about habituation, and that constantly doing tasks under the same condition make it easier for you to complete those tasks while under that condition. There is a bell curve to this with substances. At a certain point, that skill or ability will decline while under the influence, and may (depending on the task) deplete their ability to ever again be able to do that task sober – since a lot of young people say “they’ll quit once they’re in college, or they’ll quit when they get a job… etc.) They may be permanently damaging their skills.

A study came out that says stoned drivers tend to think they are more stoned than they really are, and therefore do their best to compensate for it. In contrast, drunk drivers typically think they are less drunk than they are. (i.e. stoned drivers rate themselves as impaired even though their driving performance is not, and drunk drivers rate themselves as fine but their driving is impaired). Cannabis users are more likely to crash if something interrupts their driving and need more time to change lanes and slow down.

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Short-term Effects

Marijuana intoxication can cause:

Reduced inhibition
Distorted perceptions- sight, sound, time, touch
Impaired coordination
Difficulty with thinking and problem solving
Interferes with learning and memory
Can make driving dangerous
Causes increased heart rate
Anxiety
Paranoia

http://www.nida.nih.gov/infofacts/marijuana.html

People smoke marijuana to get high, but it affects different people in different ways.

So, what are the short-term effects of marijuana?

Marijuana can reduce inhibition, which can lead to risky behaviors, can cause distorted perceptions, impair coordination, create difficulty with thinking and problem solving and cause problems with learning and memory.

The cerebellum is the section of our brain that controls balance and coordination. THC affects the cerebellum’s function, and also affects the basal ganglia, another part of the brain that’s involved in movement control.

These THC effects can cause disaster on the road. Research shows that drivers, who have been using marijuana have slower reaction times, impaired judgment, and problems responding to signals and sounds.

Studies conducted in a number of localities have found that approximately four to 14 percent of drivers who sustained injury or death in traffic accidents tested positive for THC. (http://www.drugabuse.gov/publications/infofacts/drugged-driving)

Within a few minutes after inhaling marijuana smoke, an individual's heart begins beating more rapidly, the bronchial passages relax and become enlarged and blood vessels in the eyes expand, making the eyes look red.

The normal heart rate of a teen usually between 70 to 80 beats per minute. Marijuana can cause the heart rate to increase by 20 to 50 beats per minute or, in some cases, even double. This effect can be greater if other drugs are taken with marijuana.

Lead-in for next slide: Ask “How many of you think that marijuana can cause long-term effects of can be addictive?“

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Long Term Effects and Addiction

Addiction

Ability to do complex tasks

Difficulty with memory and learning

Lung damage

Decreased reaction time

Decreased muscle growth

Amotivational Syndrome

http://www.nida.nih.gov/infofacts/marijuana.html

When people smoke marijuana for years, they can suffer some pretty negative consequences.

Ability to do complex tasks could be compromised
Negative impact on pursuit of life goals
Inability to be 100 percent focused on succeeding

Long-term marijuana users have self-reported less life satisfaction, poorer education and job achievement and more interpersonal and mental health problems compared to people who do not use marijuana.

The smoke from marijuana contains some of the same chemicals found in tobacco smoke; plus, marijuana users tend to inhale more deeply and hold their breath longer, so more smoke enters the lungs. Not surprisingly, people who smoke marijuana have some of the same breathing problems as those who smoke tobacco—they are more susceptible to chest colds, coughs, and bronchitis than people who do not smoke.

Research suggests that about nine percent of users become addicted to marijuana. That number is higher for those who start in their teens (17 percent) and among daily users (25-50 percent).

Studies suggest it may take 6 to 12 weeks for even partial recovery of cognitive functioning to occur.

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Marijuana

(CDC, 2023; SAMHSA, 2022)

According to the CDC, in 2023:

In the U.S. an estimated 29% of high school seniors used marijuana in the past year. 6.5% reported daily use within the past month.

An estimated 17.8% of 10th graders used marijuana at some point in the past year compared to 19.5% in 2022, and 8.3% of 8th graders which was unchanged from 2022.

Marijuana is the second most commonly used substance among youth.

Commonly known as: cannabis, weed, pot, bud

Talking points:

Rates of past month use:

12th graders= 18.4% (nearly 1 in 6 students)

10th graders= 10.3% (1 in 10 students)

8th graders= 4.7% (nearly 1 in 20 students)

According to the CDC, Among NYS High School Students in 2021:

~14.2% of high school students in NY reported using marijuana one or more times in the 30 days prior to this survey.

20.6% were seniors

16.8% were juniors

12.5% were sophomores

7.3% were freshman

Students identities:

More likely to be American Indian or Alaska Native.

More likely to be bisexual, gay, or lesbian.

Products sold as weed in smoke shops or stores not registered via state of NY Office of Cannabis Management are not regulated (could be laced with heart & anxiety medication).

-delta-8- tetrahydrocannabinol:

Delta-8 derived from hemp, part of the cannabis sativa plant.

Synthetic cannabinoids that are unregulated & untested; not FDA approved.

Because the amount of delta-8 THC in hemp is very low, other chemicals (e.g. household products) are used to make it.

Often marketed as “synthetic marijuana” with claims of being a legal & safer alternative; can be more potent with unpredictable effects (e.g. seizures).

In 2023, approximately 1 in 9 (11.4%) high school seniors reported using Delta-8 during the past year.

Some manufacturers may use potentially unsafe household chemicals to make delta-8 THC through this chemical synthesis process. Additional chemicals may be used to change the color of the final product. The final delta-8 THC product may have potentially harmful by-products (contaminants) due to the chemicals used in the process, and there is uncertainty with respect to other potential contaminants that may be present or produced depending on the composition of the starting raw material. If consumed or inhaled, these chemicals, including some used to make (synthesize) delta-8 THC and the by-products created during synthesis, can be harmful. FDA, 2022.

Delta-8 is federally legal as a result of the 2018

Agriculture Improvement Act, although some states ban or heavily regulate its use.

Majority of youth using Delta-8 also reported using marijuana in 2023.

Most youth who reported using Delta-8 in 2023 lived in Midwest & Southern parts of the US.

More use in states without marijuana legalization.

-The Monitoring the Future Study included a question about delta-8 use in the survey completed by students during 2022-2023. Was the first time any questions were asked to gauge prevalence of use nationally. The researchers reported plans to expand questions about such use in the 2024 report.

https://monitoringthefuture.org/data/bx-by/drug-prevalence/#drug=%22Delta-8%22

https://nida.nih.gov/news-events/news-releases/2024/03/delta-8-thc-use-reported-by-11-of-12th-graders-in-2023

https://jamanetwork.com/journals/jama/article-abstract/2816083

https://www.npr.org/sections/health-shots/2024/03/14/1238450380/delta-8-thc-products-high-teens-risks

https://www.fda.gov/consumers/consumer-updates/5-things-know-about-delta-8-tetrahydrocannabinol-delta-8-thc

https://monitoringthefuture.org/data/bx-by/drug-prevalence/#drug=%22Marijuana+%28Cannabis%29%22

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DIAGNOSTICAL AND STATISTICAL MANUAL OF MENTAL DISORDERS

Cannabis-Related Disorders

Cannabis Use Disorder
Cannabis Intoxication
Cannabis Withdrawal
Other Cannabis-Induced Disorders
Unspecified Cannabis-Related Disorders

To be coded as:

305.20 Mild:

2-3 symptoms.

304.30 Moderate:

4-5 symptoms.

304.30 Severe:

6 or more symptoms.

Cannabis Use Disorder

A problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at least 2 of the following, occurring within a 12-month period:

Cannabis is often taken in larger amounts or over a longer period than was intended.
Unsuccessful efforts to cut down or control cannabis use.
A great deal of time is spent in activities to obtain cannabis, use cannabis, or recover from its effects.
Craving, or a strong desire or urge to use cannabis.
Cannabis use resulting in a failure to fulfill major role obligations at work, school, or home.
Continued use despite having recurrent interpersonal problems.
Important social, occupational, or recreational activities are reduced because of use.
Recurrent cannabis use in situations in which it is physically hazardous.
Cannabis use is continued despite knowledge of having a recurrent physical or psychological problem.
Tolerance, as defined as either:

1. need for markedly increased cannabis to achieve intoxication

2. markedly diminished effect with continued use of the same amount of the substance.

Withdrawal, as manifested by either:

withdrawal symptoms or
cannabis use to avoid withdrawal symptoms

DSM-5

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Marijuana Treatment Admissions

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Alcohol

According to the CDC, in 2024:

Alcohol continues to be the most commonly used substance among youth.

Almost half of high school seniors reported drinking alcohol at some point during the past year.

This rate was nearly 1 in 3 (30.6%) among 10th graders.
Almost 1 in 6 (15.1%) among 8th graders.

(Miech et al., 2024; National Institute on Alcohol Abuse and Alcoholism, 2023)

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Consequences of Underage Drinking:

As a substance, alcohol damages almost every system in your body.

The heart, brain, & liver are especially affected.

Impairs brain development.

Memory
Learning
Impulsivity

Increase in risky decisions.

Sexual activity
Impaired driving
Suicide

(National Institute on Alcohol Abuse and Alcoholism, 2024)

Alcohol

Motor vehicle crashes continue to be the leading cause of death among youth who drink.

In 2022, 956 drivers in the U.S. under age 21 were impaired by alcohol when involved in fatal motor vehicle crashes.

People who drink alcohol before age 15 are more likely to develop an alcohol use disorder compared to those who wait until turning 21.

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E-cigarettes/Vaping

According to the CDC in 2024:

(New York State Department of Health, 2024; CDC, 2023)

An estimated 1 in 10 high school students reported using an electronic cigarette (vape) during the past month.

An estimated more than 1 in 4 middle & high school students who reported current use, use e-cigarettes daily.

Commonly known as: nic, rig, cart

According to the NYS Dept. of Health:

An estimated 1 in 5 high school students reported using an electronic cigarette (vape) in 2024.

In 2023: 2.1 million (7.7%) middle & high school students currently used e-cigarettes. This includes:

550,000 (4.6%) middle school students.

1.56 million (10.0%) high school students.

Among HS students currently using e-cigarettes, nearly 1 in 3 used daily in 2023; and over 1 in 3 (40%) reported frequent use.

Almost 21% of MS students reported frequent use in 2023.

**In the past year (from 2022 to 2023) we saw a decrease in prevalence of HS students current use of e-cigarettes (from 14% to 10%); slight increase however in MS student current use from 3.3% to 4.6% (from about 1 in 30 to nearly about 1 in 20 students).

Current Use

10.0% of students (2.80 million) reported current use of any tobacco product

12.6% (1.97 million) high school students and 6.6% (800,000) middle school students reported current use of any tobacco product.

*CDCs monitoring the future study reported this rate was ~16% among HS students use in past 30 days which is about 1 in 6. Likely higher than these figures.

3.4% of students (920,000) reported current use of any combustible tobacco product

3.4% of students (940,000) reported current use of multiple (≥2) tobacco products

Most Commonly Used Types of Devices:

E-cigarettes (7.7%)

Cigars (1.6%)

Cigarettes (1.6%)

Nicotine Pouches (1.5%)

Smokeless (chewing tobacco, snuff, dip, or snus) (1.2%)

Other oral nicotine products (lozenges, discs, tablets, gums, dissolvable tobacco products, and other products) (1.2%)

Hookahs (1.1%)

Heated Tobacco Products (1.0%)

Pipe Tobacco (0.5%)

9 out of 10 students reported using a flavored vape. fruit flavors being the most popular, followed by candy, desserts, or other sweets; mint; and menthol.

Disposable vapes more commonly used than refillable ones.

Most common brands: Elf Bar (56.7%), Esco Bars (21.6%), Vuse (20.7%), JUUL (16.5%), and Mr. Fog (13.6%)

]

*NYS Data:*

-No data available for middle school students.

-In 2020, New York State ended the sale of tobacco products in pharmacies and implemented bans on the sale of flavored vapor products, the redemption of

coupons and multi-pack discounts on tobacco and vapor products, and the exterior display of tobacco product ads near

schools.

*Between 2020-2022, rate of HS students in NYS who vape decreased from 22.5% to 18.7%.

*What is vaping?*

Vaping involves the super-heating of liquid vape juice or oils into a vapor for inhalation.

NOT the same as inhaling water vapor.

Vapes are most often used to consume:

Nicotine

Marijuana

A single nicotine vape is usually equal to a pack of cigarettes.

Most common form of nicotine used among youth as of 2023.

Around two-thirds of youth who vape want to quit & made at least 1 attempt to quit in 2021.

Primary vape brands used by youth:

Elf Bar (56.7%)

Esco Bars (21.6%)

Vuse (20.7%)

JUUL (16.5%)

Mr. Fog (13.6%)

References:

https://www.cdc.gov/mmwr/volumes/72/wr/mm7244a1.htm?s_cid=mm7244a1_w

https://www.fda.gov/tobacco-products/youth-and-tobacco/results-annual-national-youth-tobacco-survey

https://www.health.ny.gov/press/releases/2024/2024-01-11_vaping.htm

https://www.health.ny.gov/prevention/tobacco_control/reports/statshots/volume15/n1_youth_tobacco_use.pdf

https://www.lung.org/research/sotc/state-grades/highlights/new-york

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm

https://www.fda.gov/tobacco-products/youth-and-tobacco/results-annual-national-youth-tobacco-survey

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10995917/

https://truthinitiative.org/research-resources/quitting-smoking-vaping/quitting-tobacco-facts-and-stats

https://truthinitiative.org/research-resources/tobacco-industry-marketing/spinning-new-tobacco-industry-how-big-tobacco-trying

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Stress

Financial
Academic/school

Mass shootings
Competitive academic arena

Family
Social/friendships
Social media/technology
Cultural/identity discord

Low self-esteem

Untreated mental health conditions:

Depression
Anxiety
Trauma

Physical pain

Curiosity/Experimentation

To feel good or to avoid feeling altogether

RISK FACTORS: WHY SOME YOUTH USE SUBSTANCES

Use of Substances Ranges From:

Recreational Use
Coping Skills
Self-medication

(National Institute on Alcohol Abuse and Alcoholism, 2023; American Psychiatric Association, 2022; Kowalchuk et al., 2022; Narmandakh et al., 2021; Walter et al., 2020)

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(CDC, 2023)

Rates of Substance Use Disorders (SUDs)

Among People in the U.S. 12+

Drug Use Disorder

Includes data from all past year users of marijuana, cocaine, heroin, hallucinogens, inhalants, methamphetamine, & rx. psychotherapeutic drugs (i.e., pain relievers, tranquilizers, stimulants, or sedatives).

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Perceived Harmfulness of Substance Use Among 12th Graders in 2023

(Miech et al., 2024)

Smoke one or more packs of cigarettes per day.

Have 5 or more drinks once or twice each weekend.

Have 1-2 alcoholic drinks nearly daily.

52.4%- perceived harm having 5 or more alcoholic drinks once or twice each weekend.

Rates of perceived parent disapproval of drug use by 8th graders was mostly in the upper 80s-90%

Rates of perceived friends drug use among 8th graders was well under 10% for most hard drugs; was 36.9% for how many estimated any of their friends drank alcohol, 6% reported most or all their friends drank alcohol ever.

Rates of how many friends 8th graders perceived get drunk at least once a week: 19.4% reported having any friends; 2% reported most or all of their friends get drunk at least once a week.

Rates of how many friends they estimated use nicotine vapes= 41.4% reported any friends vape; 8.9% reported most or all of their friends vape.

https://monitoringthefuture.org/wp-content/uploads/2024/01/mtfoverview2024.pdf

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Adolescent SUDs in NYS

(CDC, 2023)

Past Year Rates from 2023

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Scope of Youth Problem Gambling

• Prevalence: An estimated 4-6% of underage youth experience severe gambling problems, while 10-15% are at risk of developing one.

• Early Onset: Adolescent problem gamblers report beginning to gamble at early ages, often around 10 years old.

• Rapid Progression: Youth move rapidly from social or recreational gambling to problem gambling behavior.

80%

of underage youth report gambling at least once during the past year, often starting in the home environment with family.

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The Modern Gambling Landscape

SHIFT IN YOUTH EXPOSURE

Traditional Gambling

• Geographically restricted to physical casinos or tracks

• Strict, enforceable legal age barriers at the door

• Highly visible financial transactions using physical cash

• Separated entirely from youth-centric entertainment

The Digital Reality

• Available 24/7 on smartphones right in the bedroom

• Bypassed age verification using basic digital workarounds

• Frictionless digital payments (Apple Pay, Crypto, Skins)

• Embedded directly inside mainstream video games and social video streams

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The Severe Consequences of Addiction

IMPACT BREAKDOWN

Mental Health & Crisis

• Strong correlations to severe clinical anxiety, deep depression, and chronic sleep deprivation.

• Carries the highest suicide attempt rate among all major behavioral addictions.

Financial & Legal Devastation

• Rapid depletion of personal savings, allowances, and college funds.

• Turning to illegal avenues like theft, fraud, or selling personal belongings to fund compounding losses.

Social & Academic Decay

• Sudden drop-offs in grades, chronic school truancy, and loss of future educational opportunities.

• Severe strain or complete fracturing of core relationships with family members and close peers.

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Clinical Warning Signs & Presentation

• Behavioral Changes: Decreased academic performance, sudden drops in school attendance, increased delinquency, and replacing old friends with gambling associates.

• Psychological Indicators: Lower self-esteem, higher self-reported anxiety, heightened impulsivity, emotional excitability, and frequent dissociation during gambling activities.

• Severe Impacts: Significant disruption of familial relationships, accumulated debts, hidden financial crime or theft, and high correlation with major depressive episodes.

• The Brain Deficit: Neurologically, the adolescent brain develops the behavioral 'gas pedal' faster than the 'braking system,' severely restricting the ability to control time or money spent.

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The Convergence of Gaming and Gambling

• The New Gambling Vector: Modern youth often do not recognize online activities as 'gambling.' Microtransactions, loot boxes, and randomized card packs normalize the psychological rush of wagering.

• Esports & Sports Betting: The widespread availability of digital platforms allows underaged teens to easily engage in mobile sports betting and fantasy sports for real money.

• Illusions of Control: Video gaming mechanics create strong illusions of skill and control, masking purely randomized mechanics and fostering a sense of community identity around risk-taking.

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Co-occurring Disorders & Crisis Risks

• Dual Diagnoses: Adolescents presenting with gambling disorders exhibit highly elevated rates of Substance Use Disorders (SUD), alcohol abuse, nicotine dependency, and cross-addictions.

• Psychiatric Comorbidities: ADHD, PTSD, major depression, general anxiety, and bipolar disorder are unusually common among the problem gambling population.

• Suicide Crisis Danger: Adolescents with gambling problems (ages 14-17) are at drastically heightened risk for suicidal ideation and actions. Suicide attempt rates reach up to 15-20% among those presenting for clinical care.

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Did You Know?

(Centers for Disease Control and Prevention, 2024; World Health Organization, 2021)

Suicide was the 2nd leading cause of death

among people ages 10-14 in the U.S.

in 2023.

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Pathways to Prevention & Support

ACTIONABLE NEXT STEPS

Proactive Strategies

• Open, judgment-free family dialogues explicitly addressing gambling risk

• Mandatory integration of digital literacy and gaming mechanics in school health curricula

• Utilization of device-level parental controls to completely block betting apps and lock microtransactions

Crisis Resources

• National Problem Gambling Helpline: Call or Text 1-800-GAMBLER (Confidential 24/7 Support)

• National Council on Problem Gambling (NCPG): Access youth-tailored screening tools and resource finders

• Gamblers Anonymous (GA): Localized peer-led recovery networks and dedicated family support systems

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Coping Skills

Unhealthy Coping Skills

Substance Use / Self-Medication
Emotional Eating
Gambling
Over spending
Sexual Obsessions
Feelings of Inadequacies / Low Self-Worth
Anger Management Issues / Rage

Healthy Coping Skills

Exercise
Communication (peers, professionals, family, supports)
Relaxation techniques (meditation, quiet time, spiritual practice, activities of enjoyment)
Acceptance (does not mean likability)
Mindfulness
Self-expression/Creative expression

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Developing through age ~26.

More motivated to explore & take risks.

Very good at focusing on what feels good (dopamine pathways), not as good at considering consequences of their actions.

Brain Development & Youth

Substance Use

(Jones & Salzman, 2020; Partnership to End Addiction, 2019; Walter et al., 2020; American Lung Association, 2022; CDC, 2022)

Talking points

-Briefly I want to talk about the dangers of youth using drugs.

-It's important to understand that while youth may use substances to self-medicate a mental health condition, it's possible that for some youth their mental health concerns are caused by their substance use.

-There are a lot of concerns when it comes to youth using substances like nicotine; first and foremost, nicotine can mimic feelings of anxiety, which can cause youth to vape or smoke more in an effort to combat that anxiety while unknowingly increasing such feelings.

-while e-cigarettes were originally marketed as a “safer” alternative to regular cigarettes, we’re finding that’s not leading to better outcomes. Among youth we’re finding that vaping increases youths likelihood of using regular cigarettes by 4x that of youth who have never vaped. Also increases likelihood of youth using marijuana by same amount (i.e. 4x greater chance than youth who never vaped).

Youth who use drugs like nicotine, marijuana, and/or alcohol are more likely to have mood, behavioral, addiction, and impulsivity issues, in addition to slower brain development which may create irreversible changes to their brain functioning since their brains aren’t typically fully developed until their mid to late 20s. Specifically substance use among youth can impair ability to learn new information, focus, recall information, assess risks/manage impulses, and even have fun.

Marijuana can also cause or exacerbate mental health issues including anxiety, depression, and psychosis (which involves a disconnection to reality).

It’s also important to mention that many youth who are vaping are using unregulated products which may contain a variety of chemicals that are harmful (e.g. formaldehyde [used in hair products & to preserve deceased bodies], benzene [found in car exhaust], & diethylene glycol [used in antifreeze, causes lung disease]).

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Health issues.

Cardiovascular
Neurological
Gastrointestinal

Significant sleep and/or appetite changes.
Overdose/Death.

Biological

Impact of Mental Health & SUDs

Interpersonal issues (family, friends).
Academic issues.
Legal problems.

Social

Behavioral changes.
Difficulty regulating emotions.
Poor judgment & decision making.
Lose of interest in activities once enjoyed.
Co-occurring mental health conditions.

Psychological

Loss of purpose in life.
Not living in alignment with personal values.

Spiritual

Signs can be both obvious and subtle.

Consequences of Underage Drinking:

As a substance, alcohol damages almost every system in your body.

The heart, brain, & liver are especially affected.

Impairs brain development.

Memory

Learning

Impulsivity

Increase in risky decisions.

Sexual activity

Impaired driving

Suicide

Motor vehicle crashes continue to be the leading cause of death among youth who drink.

In 2022, 956 drivers in the U.S. under age 21 were impaired by alcohol when involved in fatal motor vehicle crashes.

People who drink alcohol before age 15 are more likely to develop an alcohol use disorder compared to those who wait until turning 21.

For example, adults ages 26 and older who began drinking before age 15 are 3.5 times more likely to report having AUD in the past year than those who waited until age 21 or later to begin drinking.

https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/underage-drinking-united-states-ages-12-20

Effects of marijuana:

Impairs youth brain development, as well as memory, learning, focus, motor control, impulse control, & decision making.

Can cause or exacerbate anxiety, depression, & psychotic symptoms.

Recent study found this is 2-4.5x higher than teens who do not use marijuana.

Use before age 18 is 4 to 7x more likely to result in problem use – which 30% of users develop.

Vaping/nicotine impact

Physical Impact

Nicotine poisoning & addiction.

Harm from chemicals.

Risk of fire from defective vapes.

Damage to: brain, liver, kidneys, heart, lungs.

Mental Impact

Impairs cognitive functioning in youth (e.g. memory, ability to focus, organization of information, etc).

Increased impulsivity & hyperactivity.

Other Impacts

Increased risk of using marijuana.

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What Makes it Hard to Get Help?

Untreated mental health condition(s).

Family challenges.

Examples: cultural differences in views of mental health, relative with mental health challenges, difficult home circumstances like a single-caregiver household, etc.

Lack of resources (money/cost of care, travel, provider availability, etc).

Fear.

Feelings of shame and/or denial.

Talking points:

There are many barriers that can prevent people from accessing the care they need.

For youth those barriers can include untreated mental health conditions that prevent them from perceiving they have a problem including using substances to self-medicate which may temporarily mask symptoms; challenges in their family such as having cultural differences in how they view health and mental health where getting help from therapists or anyone outside the family is considered “wrong” or having a caregiver or sibling with their own mental health challenges that takes away the attention from the youth who may be struggling; not having the resources needed such as money, transportation, providers with availability; and also feelings of shame and/or denial (such as the idea that my child could never be depressed) can be barriers to care for youth.

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Possible Warning Signs: When to Seek Help for Youth?

(National Institute on Alcohol Abuse and Alcoholism, 2023; Elia, 2022; Kowalchuk et al., 2022)

Significant & unexpected changes in mood.

Used to be energetic, now frequently sleeping/tired.
Explosive/disruptive outbursts.
Persistent irritability.

Academic and/or behavioral problems/changes.

Rebelliousness.
Skipping school/avoiding situations.
Frequently lying and/or asking for (or stealing) money.
Difficulty concentrating or remembering.
Abrupt change in grades.
Loss of interest and/or isolation.

Changes in group(s) of friends.

Coordination issues; slurred speech.

Health issues:

Increase in lung infections.
Complaints of frequent stomach aches/headaches.
Spots or sores around mouth.

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An Important Final Reminder

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