APA Format 6th Edition Template

ADOLESCENT SUBSTANCE ABUSE2ADOLESCENT SUBSTANCE ABUSE 23

Effects of Substance Abuse on AdolescentsCourtney Sack, Mackenzie Seyer, Maggie Shabel, Annika SainioGlobal Health PerspectivesMissouri State University & Satakunta University of Applied Sciences

Running head: ADOLESCENT SUBSTANCE ABUSE 1

Effects of Substance Abuse on AdolescentsThere are many different perspectives of health in the world today. The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (Harness & DeMarco, 2016, p. 63). Healthcare providers may define health in a different way such as being free of illness/disease, getting enough sleep each night, having adequate nutrition to sustain basic energy needs, and being physically active. Health also incorporates being mentally and socially stable. Overall, one must be content with his or her life. In contrast, adolescents that abuse substances view health in a different perspective. To these individuals, rather than just having the absence of an illness/disease, they see health as using substances such as drugs and alcohol to help their mental and social well-being. Many substance abusers use substances to mask the symptoms of underlying conditions such as depression and anxiety, so in order for them to feel healthy, they abuse the drug. If the abusers are unable to attain substances, they may go through withdrawal symptoms, which present as symptoms of illness. Having different views on health affects the way individuals live his or her life. Concerns for Health Promotion and Prevention of DiseaseThere are many different areas of concern for a nurse addressing health promotion and prevention of disease in adolescents with substance abuse issues. One concern that is constantly being brought up in this vulnerability group is mental health issues. Many adolescents that abuse drugs and substances also have mental health problems. According to an article Principles of adolescent substance use disorder treatment: A research based guide (2014), adolescents with substance abuse issues may suffer from depression, anxiety disorders, ADHD, oppositional defiant disorder, and conduct problems. Therefore it would be necessary for treatment of these issues to be included with treatment of substance abuse. Nurses need to be proactive about identifying mental health issues in this population so that the adolescents feel as though they have dignity and can live a healthy lifestyle without drugs. The same article states that stressplays a significant role in starting and continuing drug use as well as returning to drug use (relapsing) for those recovering from addiction. Nurses can promote health with this by helping the adolescent find ways to cope with stress differently than alcohol such as exercise, support groups, meditation, or activities in the community. Helping adolescents solve issues with mental health will give these individuals the strength to not rely on substances to feel better. The nurse needs to promote identification and treatment of mental health problems simultaneously with treatment for substance abuse. Safety is another area of concern for the nurse for those individuals abusing drugs. Safety concerns may include problems such as infection, organ damage, and/or safety on roads. According to the National Institute on Drug Abuse (2012), drug abuse not only weakens the immune system but is also linked to risky behaviors like needle sharing and unsafe sex. The combination greatly increases the likelihood of acquiring HIV-AIDS, hepatitis, and other infectious diseases. Cocaine, inhalants, nicotine, PCP, heroin, and marijuana may also cause respiratory effects on an individual such as difficulty breathing and lung cancer. The National Institute on Drug Abuse (2012) also includes that there are more deaths, illness, and disabilities from substance abuse than from any other preventable health condition. Today, one in four deaths is attributable to alcohol, tobacco, and illicit drug use. Nurses should educate adolescents on the short and long term effects of drug abuse and what can arise from substances. One safety concern is with drinking under the influence of drugs or alcohol. Drugs can impair an individuals ability to drive safely. Marijuana may decrease motor coordination, cocaine and meth may cause aggressive driving, and sedatives may cause drowsiness which can all lead to accidents. In 2011, the number of 12th grade students who drove after using marijuana was 12.4%, other illicit drugs was 2.4%, and alcohol was 8.7% (OMalley, 2013), demonstrating that unexperienced drivers were on the road under the influence of drugs. Safety is a major concern for the nurse with health promotion and disease prevention.Access to health services is another area of concern for the nurse. There are many reasons why an adolescent is not getting the care needed for the substance abuse. According to Principles of adolescent substance abuse use disorder treatment: A research based guide (2014), only 10% of 12-17 year olds needing substance abuse treatment actually receive any servicesBy far the largest proportion of adolescents who receive treatment are referred by the juvenile justice system. Adolescents are not receiving the treatment they need for their substance abuse and instead are only getting the services they need if they get in trouble with the law first. This is not acceptable and nurses need to promote easier ways for adolescents to access treatment centers and health services. In a study consisting of nineteen adolescents who abused substances, the researcher concludes that Adolescents are using drugs because they are manifesting depressive traits or symptoms but cannot be fully diagnosed with a clinical depression. This researcher has found that these adolescents go on to use illicit substances in an attempt to self-medicate their symptoms (Taylor, 2011). These adolescents are not receiving the appropriate care for their depression and therefore feel the need to abuse drugs to treat the illness. Nurses need to find resources for adolescents to access that will help them get the treatment they need for health conditions which will then help them with substance abuse. This vulnerability group may also not have the money to seek treatment, not feel the need to seek treatment, be scared of being judged for their substance abuse problem and withdrawal symptoms, or may not have access to transportation to health services. Nurses should be an advocate for these adolescents and help them seek community resources to help with treatment and health services. RehabilitationIn laymans terms, rehabilitation means to restore to good health. Depending on the reason for the rehabilitation, the way to restore health can vary; however, education and therapy are primary factors that promote the restoration of health. Rehabilitation is a major component of nursing when it comes to treating substance abusers. Numerous approaches are used to rehabilitate adolescent substance abusers throughout the United States. Included in these approaches are behavioral approaches, family-based approaches, addiction medications, recovery support services, and treatment referral sources.Behavioral approaches use therapists or trained clinicians to promote a change in the negative behavior (substance abuse). They often use incentives to encourage the adolescent to remain abstinent, such as setting goals for them to reach, and by doing so strengthen their motivation to change. The therapist works closely with the adolescent to help them modify their behavior related to drug abuse. The therapist may also incorporate the family by helping them to improve their communication and interactions so the adolescent can enhance their ability to handle stressful situations that may lead them back to abusing. Methods are also taught on how to replace the substance abuse with constructive and rewarding activities. Behavioral methods that have shown promise in helping with the rehabilitation process include group therapy, adolescent community reinforcement approach, cognitive-behavioral therapy, contingency management, motivational enhancement therapy, and the twelve step facilitation method. A common finding in all of these methods is that active participation is needed from the adolescent on their road to recovery (NIH, 2014).Another way to work toward rehabilitation in the adolescent is through a family-based approach. Family-based methods include Brief Strategic Family Therapy, Family Behavior Therapy, Functional Family Therapy, Multidimensional Family Therapy, and Multisystemic Therapy. Family therapy highlights the importance of engaging the family (which can include parents, siblings, grandparents, and peers) in the treatment process. Problems other than the substance abuse are addressed, such as communication, school, and peer networks. Inclusion of the family is crucial, especially since the adolescent is most likely to be living with the parents or other family member. Outpatient settings are the most common way family therapy is offered. It is believed that family-based approaches are the best and most effective methods for treating adolescent substance abuse (NIH, 2014). Although there are several medications that can treat addiction to numerous substances, none of them have officially been approved for use in teenagers by the FDA. The neurobiological impact of these medications has not been studied thoroughly enough to accurately say they are safe for use in people under the age of eighteen whose brains are still developing. However, some doctors may still choose to prescribe medications to the adolescent (especially the older teen) addicted to nicotine, alcohol, or opioids. Cannabis, methamphetamine, and cocaine have no FDA-approved medications that treat addiction to them (NIH, 2014). After rehabilitation treatment has been done, the teens may benefit from recovery support services. Services focus on reinforcing the gains the adolescent made throughout treatment. Often, the support service is a weekly group for them to attend and receive encouragement from others struggling with similar problems. The community setting enables the adolescents to provide mutual support and share experiences, ensuring that they are not alone in their struggle. Recovery support services include Assertive Continuing Care, Mutual Help Groups, Peer Recovery Support Groups, and Recovery High Schools. These services are not substitutes for treatment and should only be used as add-ons after initiation of a treatment regimen has begun (NIH, 2014).Rehabilitation for substance abuse must be tailored to the specific teen. Each person has their own unique traits. In order to ensure successful change, the adolescents treatment plan must be built around the specific person, considering their strengths and weaknesses. The age, level of physical and psychological development, sex, relationships, community, culture, and family and peer relationships must all be taken into consideration during the initial assessment. In other words, the treatment plan must address the needs of the whole person, rather than just focusing on his or her drug use (NIH, 2014).In contrast to the United States, the rehabilitation system in Finland consists of a number of separate and relatively independent subsystems. Substance abuse treatment and rehabilitation is available in A-clinics and youth stations. There are specific substance abuse units, as well as mental health services on psychiatric units for people struggling with substance abuse. Treatment can be implemented in emergency departments in addition to detoxification units. Kela, a provider of social security benefits in Finland, helps to both fund rehabilitation services and provide income security, called Rehabilitation Allowance, during participation in rehabilitation. To qualify for rehabilitation, you must have a medical certificate with information about your illness and your need for rehabilitation. Most of the rehabilitation services available from Kela are provided free of charge. Otherwise, drug treatment is the responsibility of the municipalities which is regulated by the Act on Welfare for Substance Abusers, the Social Welfare Act, the Mental Health Act, and a decree governing detoxification and substitution treatment for opioid addicts. Specifically, social welfare provides specialized services needed to rehabilitate substance abusers. However, drug treatment services are now becoming more prominent in primary health care. Drug treatment is divided into five main categories: outpatient clinics, short term inpatient care, long-term rehabilitation units, support services, and peer support activities.There are specific outpatient services aimed at youths with drug abuse problems. These services include an assessment, counseling (both individually and family), group therapy, and referrals. Short-term inpatient care focuses on detoxification. It is provided in special rehab units and the length of stay varies from one day to four weeks. Long-term rehabilitation incorporates residential psychosocial treatment for drug users, residential services, and psychiatric services. Support services include day-care centers and housing services. They help place the adolescents in better living conditions and help them find employment to facilitate treatment and recovery. Emergency clinics are able to provide immediate medical care for addicts requiring it. At a global level, access to proper rehabilitation services is severely lacking in low and middle-income countries (WHO, 2014). According to WHO, 15.3 million people have some sort of drug use disorder in the world (2015). The world drug problem is threatening public health in all the countries burdened by it. Alcohol, tobacco, and illegal drug use cause considerable morbidity and mortality throughout the world (Wu, p. 5, 2010). Even when access to treatment options is available, many people do not choose to be treated. Regrettably, while adolescents and young adults are particularly likely to be active substance abusersthey are much less likely to receive substance abuse treatment or to perceive a need for it (Wu, p. 8, 2010). Lack of information on where to go to seek help, especially in low-income countries, is a major barrier that is keeping abusers from seeking help. Due to the global substance abuse issue, there is a need for research and policies from each nation in order to create a practical knowledge base for the populations at risk. These policies need to incorporate preventative measures, screening, risk-reduction, and rehabilitation for long-term recovery (Wu, p. 9, 2010).Health ServicesThere are many health services in the community in the United States for adolescents that have issues with substance abuse. Services may include alcoholism treatment programs, centers for behavioral change, drug rehabilitation centers. For adolescents that have problems with substance abuse, it is important for them to have easy access since the adolescent may not have transportation, free services for those that do not have health insurance or are homeless due to drug use, and for the health service to be nonjudgmental of the problems that the individual is experiencing. In Springfield, MO one very important health service is Burrell Behavioral Health institution that has a Youth Substance Abuse treatment program for those ages twelve to seventeen that are having issues with substance abuse. The program has individual counseling, family counseling, group education, therapeutic social interactions, and may include residential treatments, day treatments, or outpatient services. The program accepts most insurances and also Medicaid to help with the costs of the program. Heartland Center is another health service in Springfield, MO as well as in Kansas City, and Southwest Missouri for the vulnerability group that has services for outpatient substance abuse treatment, a medically monitored inpatient detoxification program, and medication assisted treatment. At Heartland, they treat the whole person, tailor treatment to each individual in the program, build positive relationships, and empower individuals. Missouri has many Medicaid-funded and State-funded services including Burrell Behavioral Health Care Center, Pathways Community Behavioral Healthcare, Family Counseling Center, Community Treatment, Tri-County Mental Health Services, Preferred Family Healthcare, and Comprehensive Mental Health Services (Missouri Department of Mental Health, 2013). These health services are all over Missouri and are affordable for those with issues of substance use. Finland also has many resources for health services such as Eastern and Western Substance Abuse Services/ Outpatient Clinic that treat harmful addictions, Hangonkatu 24- hour withdrawal therapy and Toolo withdrawal therapy ward, and Aurinkoinen hymy which helps mental health and substance abuse customers to cope in their daily lives, offers peer group support and organizes interesting everyday activities (City of Helsinki, 2015). Health services that are accessible and affordable are extremely important for adolescents with substance abuse since so many adolescents are less likely to seek treatment by themselves.Adolescents that are suffering from substance abuse may find support groups to be very beneficial. Support groups may help specifically for substance use or for other issues such as mental health issues of depression, anxiety, or PTSD. Alcoholic Anonymous groups are found all over the world in both the United States and Finland. NAMI of Southwest MO has support groups such as Five Stages of Recovery, Overcoming Depression, Wellness for Recovery, Managing Panic, Anxiety, and OCD, Diagnosing and Awareness, and Body and Mind Wellness (NAMI Southwest Missouri, 2015). These support groups are free and help with the mental illnesses that may be involved with substance abuse. Finland also has many health care services for adolescents struggling with substance abuse. School health care is a popular service that is intended to ensure that all students grow, develop, and live a healthy lifestyle. Mental health disorders and substance abuse may begin in childhood and adolescence. Preventing substance abuse is a very important task for school health services. A school nurses job is to promote both the individual and schools community health. Health education in the schools help the students develop the skills to promote health and wellbeing (Tervekoululaninen). Identification of drug problems in adolescents is important because these individuals are more influenced by treatment. Substance abuse treatment requires the identification of predisposing and protective factors. Treatment should aim to take in account the social environment and individual development of the adolescent. Means for the treatment of substance abuse problems include speech input, identification of resources, monitoring use of substances, motivational interviewing, outpatient treatment, inpatient treatment, and medications. Outpatient treatment is the primary form of treatment for younger adolescents. Inpatient services and medications are mainly used in those with severe substance abuse disorders. A significant role is played by voluntary organizations for treatment of substance abuse (Ks. ToimintaSuomi 5). Other services such as A-Clinics, detoxification units, youth centers, rehabilitation centers, Jrvenp Social Hospital provide detoxification and psycho-social services for substance abusers. Different municipalities in Finland vary in the quantity and quality of their substance abuse services. Treatment should be started in the unit where the matter will be raised, and the entire case network should be used appropriately. Treatment systems should be so clear that even professional helpers are able to use different treatments for substance abuse flexibly. There are many services for substance abuse in Finland that are accessible to adolescents. Government and Nongovernment Organizations There are several governmental and nongovernmental organizations in the United States as well as national organizations whose main focus is providing prevention, treatment, and recovery resources for adolescents who abuse substances. These organizations are helping address the community health concerns regarding substance abuse within the adolescent population. With their help, awareness is being raised and facts are being given on adolescent substance abuse. One of these organizations is the Substance Abuse and Mental Health Services Administration (SAMHSA) which is an organization that actively engages in the prevention of drug and alcohol abuse by incorporating the cooperation of schools, families, faith-based organizations and workplaces. Their initiative focuses on helping at-risk youth, youths in tribal communities and children of military families to lead healthy lives by avoiding the traps of substance abuse and untreated mental illness. They offer different resources and information on prevention, treatment, and recovery programs to help adolescents and other age groups who are either at risk or are already struggling with substance abuse (SAMHSA, 2014). This organization found that in 2012, there were about 23.1 million Americans aged 12 and older who required treatment for substance use, resulting in significant costs to families, employers, and publicly funded health systems. Because substance abuse issues are some of the most difficult problems to prevent or reduce, a mixture of prevention interventions is required to address substance use issues in communities. Some of their prevention strategies include creating environments that make it easier to act in healthy ways. For example, offering fewer places for young people to purchase alcohol, so consuming alcohol becomes less convenient is one way to help prevent alcohol/drug abuse. With these prevention strategies in place SAMHSA found that the prevalence of past 30-day use of alcohol, tobacco, and marijuana declined significantly among both middle school and high school students (SAMHSA, 2014).Another organization is the National Institute on Alcoholism and Alcohol Abuse and the National Institute on Drug Abuse (NIDA) which are both part of the National Institute of Health. There are specific adolescent organizations that offer educational videos and drug facts. Information and assistance are also available for and about youth who live in a family where alcoholism is present called PEERx (NIDA, 2015). The NIDA uses the Monitoring the Future (MTF) survey to keep track of trends regarding adolescent drug use. It measures drug use and attitudes among eighth, 10th, and 12th graders. In the 2014 survey it was shown that the use of cigarettes, alcohol, and prescription medications among adolescents has decreased since 2013 and marijuana use has plateaued. The results are part of a two-decade trend among the nations youth. What this means is that the prevention efforts of the NIDA are proving to be effective and it is now more important than ever to continue educating adolescents as well as parents, teachers, the community, and health care providers about the harms of drug use among adolescents whose brains are still developing (NIH, 2014).The Drug Free America Foundation Inc. (DFAF) is a drug prevention and policy organization committed to developing, promoting and sustaining national and international policies and laws that will reduce illegal drug use and drug addiction. They work to reduce adolescent substance abuse and support families impacted by addiction. It features a referral hotline (1-855-DRUGFREE) and a substance abuse treatment facility locator for young people who need help or know someone who needs help (Drug Free, 2015). A well-known campaign that this organization uses is the Above the Influence campaign. It seeks to equip young people with the self-confidence, strength and knowledge to rise above the negative peer pressure associated with drugs and alcohol. The campaign has Facebook and YouTube pages for adolescents that provide tips and advice on how to walk away from substance abuse and other bad decisions and how to talk to friends who have chosen the wrong path. From their website, adolescents can receive answers from medical doctors and learn about several different drug facts (ATI, 2015). DFAFs efforts have helped parents, who have children that are abusing substances, find ways to educate their children and get them the help they need. It also offers ways for these parents to cope with and handle the stresses they are experiencing. Although there is not much statistical information to prove that this organization is helping to reduce the incidence of adolescent substance abuse, the organization is still a valuable resource for individuals who are dealing with these issues to utilize. Lastly, the Foundation for a Drug-Free World is a nonprofit organization that provides information about drugs to adolescents in order for them to make educated decisions to choose a drug-free life. Their Truth About Drugs campaign provides activities that promote a drug-free life in which adolescents can become involved. Their website includes documentaries of real life events and stories from individuals who used to abuse drugs. This information can empower youth to make a decision from the beginning to live a life free of drugs (Drug Free World, 2015). The effects of this program have been very influential. There has been increasing number of young people who use these materials and in turn share the truth about drugs with their friends and families. More than 10,000 schools use the Truth About Drugs material and curriculum, and about 1,200 organizations, law enforcement and government agencies in 180 countries have joined with Scientologists to combat drug abuse through this program. With its use, the global Truth About Drugs program will continue taking steps toward achieving a generation that will remain free from the devastations of drug abuse.Several other organizations exist that are helping to improve the adolescent substance abuse issue. These programs are very useful resources to use as preventative measures and to provide treatment options to those who are already struggling. Furthermore, substance abuse among adolescents has statistically been reduced with the use of these organizations. In comparison, Finlands social and health care systems foundation has been implemented with the support of the state on social welfare and health care on the municipal level. Finland also has an extensive health and social welfare field that produces both commercial and free services works. Public health services are distributed to primary health care and specialized medical care. Primary health care is universally available to all, forming the basis for the health system. One is entitled to public health care or primary health care by the municipal which includes medical treatment and the necessary specialized medical care which is organized in central hospitals. Municipalities are responsible for providing social welfare and health care. They can generate social and primary care services alone or form municipal boards with each other. The municipality can also buy services from another municipality or a private service provider (Sosiaali-ja terveysministeri; Jrjestelm vastuut) (MOL; Terveydenhuoltoalat).Basic healthcare in Finland includes the following: health counseling, medical care, rehabilitation, mental health services, dental care, school health services, and occupational health care. For students, municipality organizes school health care in primary schools, secondary schools and occupational schools, as well as health care services in health care centers. School health care includes health checks carried out by a doctor or nurse, health education, dental care, as well as a psychologist and speech therapist services (Kansanelkelaitos. 2012) (MOL; Terveydenhuoltoalat)In addition to the public sector, services are produced by private companies. Private health care compliments the public health services. Private health cares share of the production in health services is constantly growing when municipalities organize social health services by purchasing them from private service providers. Health services provided by companies can offer alternatives to public services and increase customer choice. Private health care services are provided by private hospitals, clinics and doctors, private receptions, private retirement homes, facilities for mentally handicapped, rehabilitation centers and day-care centers, physical therapy institutes, laboratories, radiology institutes, private receptions for dentists, dental clinics and ambulance companies as well as health spas (MOL: Terveydenhuoltoalat) (AVI. 2015). Municipalities pay for nearly all of the private services including mental institutions and family therapy for adolescents (Vyrynen, R. 2010). The most common private health services in Finland include physical therapy services, medical and dental practice activities, and occupational health care (AVI. 2015).The third sector, the non-profit associations, is private meaning it remains between the public sector and families. It is a social sector whose characteristics are a non-profit economy, organizations or social groups goals. Non-profit organizations are different from the private (corporate) economy in the fact that it does not seek a profit (JK Humalajoki). The third sector's basic tasks include representation of different population groups, influence and expertise, volunteering and other assistance work, organization and implementation, providing social and health services, as well as experimental and development activities associated with the above-mentioned. Although the health care system works in Finland fairly equally, the third sectors are still needed; it has a very significant contribution specifically to complement the activities organized by the society.Comparatively, Finland and the United States have similar health care systems when it comes to overall healthcare. For example, the two countries both have publicly funded, privately funded, and non-profit organizations in which adolescent substance abusers can find refuge. These organizations allow for various opportunities for prevention of substance abuse and for adolescents who do abuse substances to receive help and become healthier individuals. TheoryA helpful nursing tool that can be used to improve the issue of substance abuse in adolescents is Dorothea Orems Self-Care Deficit Theory. Within Orems theory are three smaller, interwoven sub-theories. The first of these sub-theories is the Theory of Self-Care, which incorporates ten basic conditioning factors. These include age, gender, developmental state, health state, pattern of living, healthcare system factors, family system factors, sociocultural factors, availability of resources, and external environmental factors. Having or not having these factors all influence the chances of an adolescent becoming involved with substance abuse. Primary prevention focuses on the education regarding a topic. If education can be provided to adolescents regarding the harmful effects and consequences of substance use, then those factors that may increase their chances of substance abuse will be of less significance. Through education, the proper promotion of human functioning and development within social groups can be taught, including the importance of saying no to substance use. Ultimately, the teenager will have a higher chance of preventing hazards to human life, human functioning, and human well-being and will be able to care for himself or herself more efficiently. Educating adolescents is the first step in reducing and preventing substance abuse (Masters, 2012). The second sub-theory is the Theory of Self-Care Deficit. This part of the theory explains how individuals can be helped when they are no longer capable of completely caring for themselves. From a nursing perspective, to help determine those individuals that require our care, screening measures can be done to identify those at a higher risk for substance abuse, as well as screening for current or past use of substances, thus providing secondary prevention. After identifying these individuals, the third sub-theory, the Theory of Nursing Systems, comes into play. This involves the supportive-educative system where both the nurse and the individual participate in self-care activities and the responsibility of care gradually shifts from the nurse to the individual. The primary purpose of the nurse is to promote independence in the patients self-care abilities, which will encourage the adolescent to complete treatment and help them abstain from abusing. In this section of the theory, tertiary preventative measures are involved when treatment options for the effected individuals, such as rehabilitation and recovery programs, are initiated (Masters, 2012). Orems theory can play a major role in providing primary, secondary, and tertiary prevention measures to adolescent substance abusers.ConclusionAdolescent substance abusers view health as not merely the absence of illness but as using substances to help their mental and social well-being. The drugs may help mask the symptoms of any underlying conditions. Concerns for health promotion and prevention of disease include mental health issues, safety, and access to health services. There are numerous options for rehabilitation in both the United States and Finland. It is of the utmost importance to tailor the rehab choice to the specific individual to ensure the best results. There are many affordable and accessible health services for adolescents that are going through treatment for substance abuse in both the United States and Finland. These health services include group education, counseling, and outpatient services.Although substance abuse among adolescents is an issue in several countries, including the United States and Finland, there are several programs in each country that are used as prevention strategies and help in treating individuals who are already struggling with substance abuse. These programs have helped significantly in the reduction of substance abuse among adolescents to help them become healthier individuals. Despite all of these measures taken to prevent and promote recovery in adolescent substance abusers, it is still a prominent issue in the United States, Finland and throughout the world.

ReferencesAdolescent health topics: Substance abuse. (2015). retrieved from http://www.hhs.gov/ash/oah/adolescent-health-topics/physical-health-and-nutrition/home.htmlAdolescent substance abuse. (2015). Retrieved from http://www.burrellcenter.com/services-2/child-and-adolescent-services/adolescent-substance-abuse/.AVI. (2015). Yksityiset terveyspalvelut. Viitattu 02.10.2015 https://www.avi.fi/web/avi/yksityiset-terveyspalvelut#.Vg55PkYx2I1 Becker, S. J. (2013).Adolescent substance abuse: National trends, consequences, and promising treatments.Brown University Child & Adolescent Behavior Letter, 29(5), 1-7.Directory of adolescent substance use treatment programs. (2013) Retrieved from http://dmh.mo.gov/ada/docs/adolescenttreatmentdirectory.pdfGopiram, P., & Thomas Kishore, M. (2014). Psychosocial Attributes of Substance Abuse Among Adolescents and Young Adults: A Comparative Study of Users and Non-users.Indian Journal of Psychological Medicine,36(1), 58-61. doi:10.4103/0253-7176.127252Halonen, T. (2014). Seikkailu jatkukoon nkymttmn nuoren tarina. Viitattu 01.10.2015 http://alusta.uta.fi/artikkelit/2014/09/09/seikkailu-jatkukoon---naekymaettoemaen-nuoren-tarina.html Helsingin Kaupunki. (2015). Tukiasuminen. Viitattu 29.09.2015 http://www.hel.fi/www/Helsinki/fi/sosiaali-ja-terveyspalvelut/sosiaalinen-tuki-ja-toimeentulo/asunnottomien-tuet-ja-palvelut/tukiasuminen/ JK Humalajoki. Kolmassektori. Viitattu 02.10.2015 http://www.humalajoki.fi/index.php/kolmassektori Johns Hopkins Medicine. (2015).Substance abuse/chemical dependence in adolescents. Retrieved from :http://www.hopkinsmedicine.org/healthlibrary/conditions/ pediatrics/substance_abusechemical_dependence_in_adolescents_90,P01643/Kansanelkelaitos. (2012). Mit kela korvaa. Viitattu 02.10.2015 http://www.kela.fi/mita-kela-korvaa_julkiset-ja-yksityiset-terveyspalvelut Kansanelkelaitos. (2015). Rehabilitation. Viitattu 02.10.2015 http://www.kela.fi/web/en/rehabilitation Kuntoutusportti. (2015). Kuntoutusjrjestelm. Viitattu 02.10.2015 http://www.kuntoutusportti.fi/portal/fi/kuntoutus/kuntoutusjarjestelma/Mannerheimin Lastensuojeluliitto. (2009). Terveyden edistmisen ohjelma. Viitattu 29.09.2015 http://www.mll.fi/mll/toiminta/terveyden_edistamisen_ohjelmaMannerheimin lastensuojeluliitto. Historia. Viitattu 02.10.2015 http://www.mll.fi/mll/historia/Masters, K. (2012). Nursing theories: A framework for professional practice. Sudbury, MA: Jones & Bartlett Learning, LLC.Medical consequences of drug abuse. (2012) Retrieved from http://www.drugabuse.gov/related-topics/medical-consequences-drug-abuseMental health and substance abuse. (2015). Retrieved from http://www.hel.fi/www/Helsinki/en/socia-health/mental/day/smile/.MOL. Terveydenhuoltoalat. Viitattu 02.10.2015 http://www.mol.fi/avo/alat/10.htmNational Institutes of Health, National Institute on Drug Abuse. (2014). Principles of adolescent substance use disorder treatment: A research-based guide. Retrieved from http://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder treatment-research-based-guide/references

OMalley, P.M., Johnston, L.D. (2013). Driving after drug or alcohol use by US high school seniors, 2001-2011.Am J Public Health, 103(11); 2027-2034. Principles of adolescent substance use disorder treatment: A research based guide. (2014). Retrieved from http://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/introductionRimpel, A. 2005. Nuorten terveys. Terveyskirjasto 18.7.2005. Viitattu 29.9.2015 http://www.terveyskirjasto.fi/terveyskirjasto/tk.koti?p_artikkeli=suo00046Salmi, T. 2014. Kolmannen sektorin toiminta-alue laajenee. Viitattu 02.10.2015 http://www.potilaanlaakarilehti.fi/kommentit/kolmannen-sektorin-toiminta-alue-laajenee/#.Vg5eakYx2I0Sosiaali- ja terveysministeri. Jrjestelm vastuut. Viitattu 02.10.2015 http://stm.fi/sotepalvelut/jarjestelma-vastuut Sosiaali- ja terveysministeri. Sosiaalipalvelut. Viitattu 02.10.2015 http://stm.fi/sosiaalipalvelut Support. (2015). Retrieved from http://www.namiswmo.com/services/support/. Taylor, O. D. (2011). Adolescent depression as a contributing factor to the development of substance use disorders.Journal of Human Behavior in the Social Environment, 21(6), 696-710. doi:10.1080/10911359.2011.583519Vyrynen, R. 2010. Yksityiset sosiaalipalvelut. Viitattu 02.10.2015 https://www.thl.fi/fi/tilastot/tilastot-aiheittain/yksityiset-sosiaali-ja-terveyspalvelut/yksityiset-sosiaalipalvelutWorld Health Organization. (2014). Disabilities and rehabilitation. Retrieved from http://www.who.int/disabilities/en/World Health Organization. (2015). Management of substance abuse. Retrieved from http://www.who.int/substance_abuse/facts/en/ Wu, L.T. (2010). Substance abuse and rehabilitation: Responding to the global burden of diseases attributable to substance abuse. Substance Abuse and Rehabilitation, 1, 5-11.