Life-threatening behavior, like smoking, drugs, violence and suicide attempts, are used by the adolescent to cope with a feeling of not being appreciated, boredom, isolation, and a lack of goals and future plans. This is the age of self-directed violence, exteriorized by aggression or risk-taking behavior.
In this age group, road accidents constitute the primary cause of death (40%), far in front of suicide (19%) and disease. Another risk is the consumption of toxic substances (alcohol, medications, hard drugs) so as to be ‘out of it’, but also to lower, more or less consciously, a state of internal tension.
The parents should side with health professionals at the center of this battle of risk prevention.
From the data published in 1994 by Choquet and Ledoux based on an inquiry on French teenagers 11–19 years old, the following characteristics concerning addictive behavior were identified. Concerning tobacco use, 14.5% smoke daily and 8.4% smoke at least 10 cigarettes/day. Advertising of tobacco products can be a factor inciting their use and its prohibition should be continued.
Rates of tobacco use were the same for both sexes. The first cigarette was often smoked in junior high school, and girls were more frequently regular smokers. Concerning alcohol consumption, 12.4% drank regularly, several times a week. Drugs were used, defined as more than 10 times, by 5.4% of the adolescents, with hashish leading the list and heroin pulling up the rear; this behavior was predominantly masculine. Drug use was not associated with ethnic origin or French nationality. Still more disquieting was the finding that 3.7% of the teenagers had run away from home and 5–7% had attempted suicide.
The relationships between alcohol and/or drug use and sexual behavior have been extensively analyzed. Both substances can interfere with sexual pleasure and orgasm, in particular when condoms are used. In this study, 64% of the adolescents who had sexual intercourse did so after having consumed alcohol, as compared to 15% who had taken drugs. According to some studies, drug use is responsible for one-third to one-half of homicides committed by teenagers.
Drug use during pregnancy strongly affects fetal and maternal behaviors.
All toxic substances can lead to premature delivery and intrauterine growth retardation. All substances other than hallucinogenic drugs can provoke withdrawal syndromes in the mother and the newborn. Alcohol and cocaine are considered to be teratogenic (craniofacial dysmorphism syndrome of newborn alcoholism, and specific cerebral, cardiac or renal malformations) and syndromes associated with weaning justify specifically adapted management of these patients.
Nutritional deficits (caloric, iron and folate intake) associated with dietary habits totally incompatible with pregnancy and episodes of bulimia and/or anorexia probably favor the higher risk of malformations observed in this population.
Bulimic episodes correspond to a rather urban syndrome and are more specifically associated with females.
Finally, 17% of teenagers took medications to combat nervousness or anxiety, or to sleep better; these agents are more frequently consumed by girls and their use increases with age.
Suicidal thoughts and acts are more commonly associated with girls: 6.5% had previously attempted suicide, with 1 out of 4 having undertaken more than one attempt; 1.3% had been hospitalized for attempted suicide.
Revision date: June 14, 2011
Last revised: by Janet A. Staessen, MD, PhD