Teens and young adults are increasingly self-medicating with a combination of caffeine, stimulant medications and alcohol, and it seems that energy drinks -- at times mixed with other substances -- have become the performance-enhancing drugs (PEDs) of choice. Two recent Drug Abuse Warning Network (DAWN) reports from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) are deeply disturbing.
"Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern" -- The number of emergency department (ED) visits related to energy drink use doubled from 2007 (10,068) to 2011 (20,783). About 42 percent of the visits involved alcohol and/or drug use, with nearly 10 percent involving CNS stimulants medications like Adderall and Ritalin.
"Emergency Department Visits Involving Attention Deficit/Hyperactivity Disorder Stimulant Medications" -- ED visits involving attention deficit/hyperactivity disorder (ADHD) stimulant medications between 2005 and 2010 jumped from 13,379 to 31,244, with 50 percent of the visits in 2010 related to non-medical use.
The energy drink abuse issue is so pervasive and concerning that the American Academy of Pediatrics (AAP) issued a landmark statement in 2011, noting:
... energy drinks are consumed by 30 percent to 50 percent of adolescents and young adults. Frequently containing high and unregulated amounts of caffeine, these drinks have been reported in association with serious adverse effects, especially in children, adolescents, and young adults with seizures, diabetes, cardiac abnormalities, or mood and behavioral disorders or those who take certain medications ... Energy drinks have no therapeutic benefit, and many ingredients are understudied and not regulated.
Additionally, while there are certainly legitimate reasons for stimulant prescriptions, the number of ED visits related to adverse effects, particularly for non-medical use, calls into question the risk-benefit rubric for these powerful medications.
Why are so many teens and young adults turning to stimulant drinks and drugs? Given that I run a busy pediatric practice and take care of patients up to age 21 (or so), I went straight to the source. I heard the same things repeatedly: "We are too busy, too stressed, overworked, and over-scheduled. We don't have time to eat well, exercise or get enough sleep. We are exhausted and stressed out beyond belief."
It's no wonder rates of mental illness in young people are skyrocketing. ADHD diagnoses were recently reported at an all time high in one California study, rising 25 percent in 10 years. ADHD, anxiety and depression have all been linked to lack of sleep, poor nutrition, lack of exercise, and stress. I do believe that medications are sometimes necessary and lifesaving. But with poor access to quality mental health treatment, more and more kids are prescribed psychiatric medications -- in many cases, simply just to keep up with life. As Georgia pediatrician Dr. Michael Anderson lamented in the New York Times, "I don't have a whole lot of choice ... We've decided as a society that it's too expensive to modify the kid's environment. So we have to modify the kid."
Too expensive? When the real costs are these kids' lives? When the long-term costs are our future? Of course it's quicker to write medication prescriptions than to coach lifestyle changes. But it certainly isn't better -- or cost-effective in the long-term. What are our options? We must invest in mind-body skills programs for young children so that by the time they are teens and young adults, they will have stocked their mental health toolboxes with effective and safer stress-coping options. Whether it's yoga, music, exercise, meditation or free play in natural settings -- or all of the above -- we must, as a society, make a commitment to develop community-wide strategies that are built in to the educational and health care systems to teach parents and young kids how to slow down and make sustainable, health-promoting lifestyle changes. We have to change the environment to fit our children, not vice versa. That must be the promise we make to our young ones, so that they do not continue to self-medicate simply in order to cope with life. Their future, and ours, depends on it.
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