Freedman, Ethan
Colgate University
Psychology 363A: Developmental Psychopathology
Prof. Rebecca Shiner
November 17, 2023
Acknowledgements:
In introducing the following work, I would like to acknowledge all those who played a role in the development of this essay – primarily, the class of Psyc: 363A facilitated and taught by Prof. Rebecca Shiner. With the help of my peers from this course as well as my professor, I was able to gather research and information related to the subject of substance use disorder and adverse childhood experiences. Also with the help of my peers and Prof., I was given tangible guidance towards how to introduce technology’s role in administering adverse experiences.
Moreover, I would like to acknowledge that a majority of the resources provided to me hinged on using Colgate University’s facilities. Colgate University is situated on the Oneida Nation’s land, one of the nations of the Haudenosaunee people.
Abstract
Substance Use Disorders (SUD) are highly prevalent among adult and adolescent populations as there are numerous factors that contribute to the development of disorder usage. With this, adverse childhood experiences (ACEs) have commonly been cited as an influence for the development of substance use. While there are many adverse experiences that are directly correlated with substance usage, technology as a distributor of maladaptive childhood experiences has seldom been addressed due to research on the impact of tech being as old as modern machinery itself. With research commonly pointing to factors like screen time and cyberbullying as reasons for the onset of substance usage, the following work pushes for consideration of technology in conversations about purveyors of adverse childhood experiences. With little research pertaining explicitly to the subject of technology, ACEs, and SUD, literature posits tangible and abstract understandings for how technology may be pervasive in creating maladaptive experiences relating to the etiology of substance usage in adolescents.
Key Words: Adolescents, Substance Use Disorder, Adverse Childhood Experiences, Technology, Peer Victimization, Cyberbullying
Substance Use Disorder:
Technology as a Purveyor of Adverse Childhood Experiences and Disordered Usage
The Diagnostic and Statistical Manual for Mental Disorders (DSM) has undergone many revisions in an attempt to incorporate, consolidate, and reorganize many of the diagnostic criterias for specific disorders – one of which is Substance Use Disorder (SUD). When the DSM IV was in primary use in the nineties, SUD was consistently inaccurately measured in adolescents because research was exclusively done on drug usage in adult populations (Fulkerson et al., 1999). Having performed the first large scale epidemiological study of adolescents to investigate the dimensions of substance use disorder criteria for the DSM IV, Fulkerson et al. (1999) yearned for an adoption of a unidimensional diagnostic criteria that incorporate adolescents, while simultaneously demanding a distinction between substance usage and dependency.
Restructured for the DSM V, the American Psychiatric Association defines substance use disorder as a “cluster of cognitive, behavioral, and psychological symptoms indicating that the individual continues using the substance despite significant substance related problems” (Christensen et al, 2021; American Psychiatric Association, 2013, p. 483). Spanning a list of ten different substance classes (alcohol, cannabis, opioids, psychedelics, prescription medications, and more), SUD has a general domain of symptoms related to impaired control. Christensen et al. (2021) position impaired control as taking a substance in larger amounts over longer periods of time, failing to fulfill societal roles due to substance use, and risky usage in general have an impact on the severity of an agent's SUD. While Substance use dependence might include a persistent desire and failure to control use as well as spending a great deal of time trying to inquire about substances, distinctions within symptom categories are important for understanding severity and prevalence of SUD – especially for adolescent populations .
Highly prevalent among adolescents, drug use disorder often takes the form of consumption of alcohol and marijuana, and was found to increase with age as adolescents transition into adulthood (Christensen et al., 2021; Johnston et al., 2019). Lifetime prevalence in adolescence of alcohol is 23.5% in eighth graders and 58.5% in twelfth graders, and marijuana usage is at 13.9% in eighth grade and 43.6% in twelfth graders – illustrating that disorder usage begins very early on in adolescents (Christensen et al., 2021). In general, Christensen et al. (2021) highlights that adolescent drug use disorder is prevalent with 11.4% of adolescents 13-18 meeting diagnostic criteria for SUD. In tandem, the comorbidity of SUD with other mental health diagnoses is 4.4% in adolescence, and very common among agents with anxiety disorders as drug usage and alcohol abuse in this population is at 17.3% and 18%.
From a meta-analysis on risk and protective factors of drug abuse among adolescents, Nawi et al. (2021) posit how there are many individual, familial, and communal risk and protective factors constantly interacting with each other to evoke substance use. In conjunction with Christensen et al. (2021) which highlights genetic and neurobiological factors that play a role in the onset of SUD, pathways of etiology for disordered usage might be external, internal, repeated usage, or contextual. Nawi et al. (2021) positions how contextual factors relating to the broader environment of an adolescent agent intersect with individual factors in many ways – one of which is screen time and technology usage.
With extensive research surrounding many causal factors for substance use disorder, adverse childhood experiences (ACE’s) have been cited as a dominating variable related to the etiology of SUDs (Broekhof et al., 2023; Meadows et al., 2023). While the context of disadvantageous experiences in life and substance usage might span an extensive domain, technology as a space capable of administering adverse experiences has seldom been addressed. While discourse might leave room for technological experiences to remain implicitly addressed in broader categories of experiences, peer victimization is consistently related to substance usage among adolescents – and often experienced in cyberspace (Afifi et al., 2020; Boccio et al., 2022; Brochado et al., 2017). With systematic and peer reviewed research on the extent that adverse experiences spill into the domain of the internet being as old as the internet itself, quantitatively little research addresses maladaptive and adverse experiences with technology as a reason for the onset of SUD in adolescents (Tao & fisher., 2023; Ng Fat et al., 2021). While hardly addressed, adverse childhood experiences increasing the likelihood of substance use disorder stretches into the realm of adverse experiences via technology as the internet spaces in which one operates, the time spent on social media, and the extent that an agent witnesses community violence are all tied to increased levels of substance usage in adolescents (Tao & fisher., 2023; Ng Fat et al., 2021; Harper et al., 2021). In the end, technology usage and experiences attached to SUD is discussed in tandem with some of the more effective treatments for disordered drug usage as society is forever progressing towards a world where tech plays a more pivotal role in the lives of adolescents and adults.
Adverse Childhood Experiences (ACEs) and Substance Usage
With drug abuse being a detrimental problem worldwide, and often beginning in adolescence, Nawi et al. (2021) provide insight into risk and protective factors for substance usage. Highlighting that the adolescent period is critical for the initiation of drug usage, with maximum usage occurring between the ages of 18-25 years, individual factors were the most commonly cited reasons for substance usage occurring. With agents suffering the ability to regulate emotions, substance usage could be a way of externalizing their behaviors to avoid or suppress negative feelings (Nawi et al., 2021). While we know a community is capable of contributing to drug abuse among adolescents via peer socialization processes like peer pressure, the individual factors must be given more attention in research.
Broekhof et al. (2021) delve into individual factors for agents' onset of substance use disorder – specifying the theme of adverse childhood experiences (ACEs) as a primary perpetrator. Adverse childhood experiences refer to potential traumatic events that have an effect on the development of children all the way through to the end of adolescence and into adulthood. Eager to distinguish how maladaptive childhood experiences might differ by gender, Broekhof et al. (2021) set out to study adolescents who were first assessed for adverse childhood experiences, and later diagnosed with substance use disorder in adulthood. Results were relatively clear as ACE’s increased the likelihood that an agent would develop substance usage, but more can be uncovered about ACE’s as part of the etiology for SUDs. Hypothesizing that specific ACEs correlated with substance usage would differ between genders, Broekhof et al. (2021) confirms females are more likely to have alcohol use disorder and males illicit drug use. With adverse childhood experiences being potentially traumatic and capable of disrupting a child’s development, substance usage can play a role in emotional regulation systems of an adolescent agent. Negative experiences with sexual and physical abuse, as well as neglect, were the most common ACE predictors for females developing substance usage (Broekhof et al., 2023). Moreover, physical abuse, parental divorce, and witnessing violence added to the prevalence of substance usage in male populations (Broekhof et al., 2023).
While Broekhof et al. (2023) reinforces the association between specific adverse childhood experiences and the onset of substance use disorder by gender, findings yield that parental substance use and mental health are predictors of SUD regardless of gender – wonderfully positioning the research of Meadows et al. (2023). Meadows et al. sought to reinforce the significant association between ACES and initiations of substance usage reporting that the more adverse childhood experiences an agent undergoes, the more likely they are to develop disordered substance usage. With the individual, familial, and communal contexts providing risk and protective factors for substance use disorder, the notion that the higher quantity of ACE’s correlates to higher likelihood of drug usage is comprehensible as there are many realms in which adverse experiences can come to fruition.
Connecting the potential for ACE’s via Technology and Substance Usage
With total screen time being a predictor of substance usage in adolescents, as higher screen time for an individual was correlated with higher likelihood of usage, Nawi et al. (2021), Broekhof et al. (2023), and Meadows et al. (2023) position technology as a space in which adverse experiences can exist. However, the extent that technology has been explicitly cited as a factor related to increased substance usage in adolescents has not been addressed thoroughly. While negative experiences for adolescents with technology are most commonly brought up in conversations about social media and cyberbullying, the reality of the internet is that any facet of content is at an agent’s fingertips (Boccio et al., 2022; Brochado et al., 2017). To sufficiently explore how technology may be increasing SUD by adding to the capacity of adversity experienced during adolescents, one must address the various experiences technology allows to materialize.
With explicit tangible research on the effects of adverse experiences with technology in relation to increased substance usage being seldom addressed, understanding how technology can generate adverse effects primarily necessitates a lightly abstract argument. From a cross sectional survey of adolescents ages 14-17 in Canada, greater risks of substance usage was correlated with ACE’s – but more specifically peer victimization (Afifi et al., 2020). Afifi et al. (2020) divulge on the common adverse experiences and their relationship to mental health, physical health, and substance use; however, substance usage was operationalized as nicotine, alcohol, and cannabis use. While most studies like to ignore the prevalence of nicotine usage due to the normalization of cigarette and e-cigarette products in western society, adolescents who experienced ACEs in tandem with peer victimization had significantly higher chances of smoking, alcohol use, binge drinking, and cannabis use (Afifi et al., 2020). With peer victimization being measured as bullying among adolescents, Afifi et al. (2020) refrain from distinguishing whether technology is an arena for mistreatment – but emphasize that peer victimization is linked to increased substance usage in adolescents.
Moreover, Boccio et al., (2022) argue in unity with Afifi et al. (2020) as they postulate further on the relationship between nicotine usage and bullying – emphasizing the role technology can play. With one in five adolescents experiencing victimization and one in six dealing with cyberbullying, substance usage has been increasing next to experiences of peer victimization (Boccio et al., 2022). Detailing the relationship of peer victimization to substance usage might be viscerally related to experiences with technology as cyberbullying becomes more pervasive next to social media platforms (Brochado et al., 2017). While Brochado et al., (2017) found that the prevalence of cyber-victimization varies by culture and might depend on the extent that ‘cyberbullying’ is a recognized phenomenon within literature, they orient how prevalence of cyberbullying among adolescents struggles to be defined next to the various measures for cyber victimization in existing research. That being said, with bullies no longer having to face their subjects in person, but capable of hiding behind a screen, the extent that an adolescent might feel subject by their peers is increasing. With Afifi et al. (2020) uncovering the relationship between peer victimization and drug usage and Boccio et al., (2022) exposing how physical, verbal, and cyber victimization are associated with increased prevalence of nicotine usage among adolescent samples, adverse experiences with technology that center around peer victimization might lead to an increased substance usage among adolescents. However, a deeper understanding of the relationship between substance use and adverse experiences on the internet is required to understand the extent that technology purveys disordered usage.
Expanding on Technology as a realm for ACEs and its relationship to SUD.
With research on adolescent adverse experiences administered via technology revolving around cyberbullying and peer victimization, the capacity for tech to administer antagonistic effects that correlate to substance use necessitates expansion. While Nawi et al. (2021) only briefly mentioned the correlation time spent on technology has with substance usage, Ng Fat et al. (2021) further unpack this notion. From a self reported survey of adolescent social media usage and drinking frequency, social media usage was compared to substance usage longitudinally in a population of adolescents ten to fifteen years old (Ng Fat et al., 2021). For those who used social media less than one hour a day, there was a lower risk of drinking monthly compared to those who spend one to three hours a day on media platforms. Spending more than an hour and less than four hours was associated with a lower risk of binge drinking, but connected to indulgence of this behavior at least three or more times a month (Ng Fat et al., 2021). While this information is pivotal for understanding the extent technology feeds into substance use, the most telling finding by Ng Fat et al. (2017) came from controlling for some social media usage as a baseline of longitudinal manipulation. In other words, instead of comparing adolescents in their sample to children who had no media usage, the control condition of some social media usage was predictive of increased consumption over time among youths and young adults. With social media use becoming a staple in rising generations of adolescents, the extent that substance usage is being normalized within content depicted on platforms might play a role in substance usage increasing. What is more telling is that there is no evidence for the ascent of social media platforms contributing to non substance use behaviors – except in sub-facets of the internet designed specifically for sobriety.
Lightly tangential, yet attached to findings from Ng fat et al. (2017), Harper et al (2021) bring to light the role that witnessing community violence can play in increasing substance usage among adolescents. Pointedly addressing how witnessing community violence and firearm carrying relates to substance usage and suicide risk among youths, Harper et al. (2021) sought to analyze data from a 2021 youth risk behavior survey. While witnessing community violence and gun carrying was associated with an increase of substance use and suicide risk in adolescents, adverse childhood experiences already discursively make room for witnessing community violence. In other words, research on ACEs and substance usage already encapsulates findings on the role that witnessing community violence can play (Harper et al., 2023; Nawi et al, 2017). Youth who witnessed community violence were more likely to report carrying weapons and a lifetime of substance use behavior – especially when in conjunction with other ACEs. (Harper et al. 2023; Meadows et al., 2023). With the understanding that witnessing community violence correlates to maladaptive behaviors like substance usage in adolescent populations, more attention should be given to the kinds of content one can consume via technology as well as the communal spaces one can create. With cyberbullying increasing on social media platforms (Boccio et al., 2022; Brochado et al., 2017) bystanders who are witnessing community violence where their peers are bullying each other is an abstract example of what might be causing substance usage in adolescents attached to technology. More broadly, witnessing community violence via media platforms and technology expands far beyond adolescents being bystanders to peer victimization, but delves into the kinds of content one is viewing. While technology might render an agent capable of finding cute and silly videos that generate positive affect, the extent that someone is witnessing community violence via their media platforms depends on the domains they enter. Whether it is a news cycle, social media accounts for specific content, or simply the front page of the internet, community is formed within cyber-subspaces and witnessing community violence via technology is often out of our control.
While it is known that witnessing community violence correlates to increased substance usage, the extent that the internet fosters spaces for surveying violence needs more attention. That being said, Tao and Fisher’s (2023) research on discrimination as a motivator for web based activism engagement revealed the risk of a niche internet space related to LGBTQ+ youth and substance usage. Eager to look at the omnipresent relationship for the LGBTQ+ community with web based safe havens for peer social support and general exposure to discrimination, Tao and Fisher (2023) found a direct correlation with social media civic engagement and substance abuse. While there was no relationship between LGBTQ+ agents seeking internet safe havens for the tangible reason of being exposed to social discrimination, activist spaces for LGBTQ+ adolescents were associated with the highest amounts of substance usage. In tandem with Harper et al. (2021), activist spaces on the internet might be more pervasive in sharing content related to community violence. This could be due to content depicting community violence against LGBTQ+ individuals reinforcing the reason for activism being necessary in the first place. In these spaces, time spent on social media is associated with higher substance use risks – possibly due to increased consumption of content relating to community based violence (Tao and Fisher, 2023).
Conclusions and Future Directions:
The etiology for substance use disorder within the context of a developmental psychopathology framework cites many pathways as responsible for the onset of disordered consumption – one of which is adverse experiences in childhood. (Christensen et al., 2021; Broekhof et al., 2023; Meadows et al., 2023). ACEs can encompass a wide variety of moments in an adolescent’s life, but with the increase in technology it is incredibly important to address the extent adverse experiences result from technology usage. While it is known that time spent on technology, social media, and within activist spaces correlates to substance use in adolescents , the extent that substance usage is attached to experiences of peer victimization or witnessing community violence has the most research – yet not nearly enough (Afifi et al., 2020; Boccio et al., 2022; Brochado et al., 2017, Tao & fisher., 2023; Ng Fat et al., 2021).
To expand on how substance usage is tied to adverse experiences with the internet, future research must look to treatments and diagnosis criteria that center adolescents' voices as primary sources for understanding the onset of their own substance use disorder. Understanding how agents with SUD conceptualize their recovery and priorities is pivotal to treating disordered usage (Schoenberger et al., 2022). This can be expanded into leaving room for individuals with SUD to define the reason they feel substance usage has become a problematic behavior in their life. When we leave room for agency among people with SUD in treatments and diagnosing, we leave more room for technology to be brought up as a reason for the onset of substance usage. In a world ever progressing towards automation, the extent that adverse experiences can result from technology usage is only increasing with time. While there are a few tech specific testaments for the onset of substance use that are defined within the criterion of adverse childhood experiences, expanding discourse on how technology becomes an instrument in administering maladaptive moments in agent’s lives is beyond necessary. Whether it's witnessing community violence, living through peer victimization, or something else entirely – negative experiences with technology span as infinite of a domain as the internet itself. To expand on adverse experiences from technology might provide more insight into how tech purveys disorder substance usage.
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