In this study, the frequency of substance use in children and adolescents diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and Impulsivity was investigated. It has been observed that the age rate of this disorder generally starts from birth in children and adolescents and increases during puberty when hormones and mood are taken into account. Considering the main themes of the studies, it is observed that most of the daily lives of impulsive children are affected, except for substance use, and this becomes even greater with substance use. In studies, there is a hypothesis between the frequency of substance use in children diagnosed with impulsivity and children who do not. In this formation of the hypotheses, problems occur in school and family life with the full expression of daily dysfunctions in adolescence children with and without substance use. Since it is a review article, the sources, journals, books and quotations mentioned in the bibliography were used.
Keywords:Attention Deficit, Hyperactivity, Child, Adolescent, Impulsivity, Substance Use
In this review study, the frequency of substance use in children and adolescents diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and Impulsivity was investigated. It has been observed that the age rate of this disorder generally starts from birth in children and adolescents and increases during puberty when hormones and mood are taken into accounts. Considering the main themes of the studies, it is observed that most of the daily lives of impulsive children are affected, except for substance use, and this increases with substance use. In studies, there is a hypothesis between the frequency of substance use in children diagnosed with impulsivity and children who do not. In this formation of the hypotheses, problems occur in school and family life in full expression of daily dysfunctions in adolescence children with and without substance use. Since it is a compilation article, sources, journals, books and quotations mentioned in the bibliography were used to collect the data.
Keywords:Attention Deficit, Hyperactivity, Child, Adolescent, Impulsivity, Substance Use
According to the researches carried out by the World Health Organization, impulsivity is defined as a disorder that responds to internal and external stimuli suddenly and impulsively, without thinking about the consequences of both self and others. This is especially common in adolescents. It has also been observed that the long-term consequences of the action given to the stimulants are not taken into account for the moment. However, there are some details that we should be aware of when explaining the concept in general. Impulsivity encompasses a variety of behaviors that are overly risky or inappropriate, unplanned, immature, and often lead to undesirable consequences. Impulsivity is manifested by features such as inattention, impatience, excitement seeking, pleasure seeking, risk taking, calculating less likely to be harmed, and extraversion. Impulsivity is also one of the core symptoms of many psychiatric disorders (Hollander and Evers, 2001:949-950). Impulsivity; It can be explained as a personality trait that provides integration with other external factors that have the potential to affect a person’s life in every aspect.
Although it is a necessary factor for the survival of human beings, the inability to prevent an impulse that may harm the individual and those around him is a clinical disorder frequently seen by specialists. (Yazıcı and Ertekin, 2010).
Freud, on the other hand, describes the drive as a constant flowing source of stimulus inside the body, unlike the stimulus that comes from external stimuli, which is at the point where the psyche coincides with the body. It is described as the expression of the inner and at the same time its external reflection (Freud, 1923).
We survive our impulses and learn to manage them. However, in individuals with this disorder, fear and doubt are replaced by adrenaline. They think about their own pleasure and ignore the dangers. With substance use, the person’s pleasure center is saturated and relaxation comes. Substance use affects self-control mechanisms in impulsive people and hinders the freedom of movement of the person. The substance use problem is biological, and it creates a personal, mental and hereditary structure. Impulsive behaviors are discussed in three dimensions. The first of these is not to use the available information without considering the consequences of the behaviors. Latter; It is not giving up the small reward that will give pleasure at the moment instead of the big reward to be obtained at the end. Finally, the third; It is the inability to suppress behaviors that are established and included in behavioral patterns. When these three dimensions are evaluated together, it can be said that impulsivity hinders the ability to evaluate the situation and respond flexibly to the pursuit of a certain goal in changing environmental conditions (Torregrossa et al., 2008:254). When we look at the literature, there are many studies between impulsivity and substance use. Most studies have found a relationship between impulsivity and substance use. The main causes may be childhood life histories or biological. In addition to being a multidimensional concept, impulsivity is the main component of many neurological and psychiatric diseases. (Horn et al., 2003).
Impulse Control Disorder In DSM5-TR, many different episodes have been mentioned, such as harming property or life because of the inability to resist serious aggressive impulses. The aggression expressed in these behaviors is disproportionate to the psychosocial effects. These mood episodes cannot be explained by another personality disorder illness or are not due to the physiological influence of a general medical condition.
Impulse Control Disorders Not Elsewhere Classified
They are grouped under the heading “impulse control disorders not elsewhere classified” in DSM-IV-TR. According to DSM-IV-TR, the disorders listed here are; intermittent explosive disorder, kleptomania, pyromania, pathological gambling and trichotillomania. Disorders other than these disorders showing impulsivity were combined under the heading of “impulse control disorders not otherwise specified”. Characteristics of people with these disorders include:
1. They fail to resist the urge or urge to perform certain actions that are harmful to themselves or others. Action can be planned or unplanned.
2. They experience an increasing sense of tension, distress and anxiety before the action.
3. A sense of satisfaction and relief comes from doing the action. They may or may not feel guilt or remorse after the act.
It occurs as a result of intense increase in impulsive behaviors, concussion, deterioration of mental structure and damage to inhibitory control functionality. This situation is similar to the term disinhibition, which is also used in neuropsychology and cognitive neuroscience. Although some positive aspects of impulsivity are emphasized, there is a tendency towards violence and crime, etc., especially for the individual in adolescence. It constitutes a dysfunctional basis for behaviors that are deemed inappropriate by various societies, such as Verdejo et al., 2008.
impulsive aggressions; Verbal or physical aggression to oneself or another person, intentionally or unplanned. Impulsivity is a predisposition. So being impulsive is called a behavior pattern rather than a single act. They are quick and unplanned movements that are consciously made without the opportunity to weigh the consequences of the action. Considering this feature, it distinguishes impulsivity from compulsive behaviors and impaired judgment, which are the behaviors that occur by planning. Despite these cognitions, there is still no clear and comprehensive explanation of impulsivity, and the boundaries between the ‘normal and disease’ dimension are not clear-cut. Being impulsive or exhibiting these behaviors can first be noticed in childhood. Being impulsive or impulsive is organic. The prefrontal cortex and orbitofrontal cortex are involved in the control of suppression, decision making and response selection processes. The orbitofrontal cortex plays a major role in guiding behavior based on available knowledge about the consequences of one’s actions. Therefore, impulsivity is frequently observed in people with frontal lobe damage. The main neurotransmitters involved in impulsivity are serotonin, dopamine, noradrenaline, glutamate and GABA. In particular, it has been stated that the decrease in brain serotonin levels reduces the suppression of behavior. (Özdemir et al., 2012: 293-314) It is emphasized that certain innate characteristics interact with serotonin and dopamine and are important factors in determining the level of impulsivity (Robins, 2005). This is reinforced in the face of some behaviors learned in the family with congenital control disorder. Attitudes of parents play an important role in impulsive children and adolescents. Although the concept of friends first comes to mind when we say environment for children, the people who make up the closest environment are family members. The parent is the first person with whom the child interacts and socializes during the developmental period. When we look at the personality structure of the child, the attitudes and value judgments of the parents are seen. It is clearly demonstrated that parents have an undeniable importance in the development and change of children and adolescents (Fisher & Rush, 2008).
Moeller et al. (2001) used three methods for assessing impulsivity:
1. Behavioral Laboratory Measurements
2. Self-Report Tests
3. Event-related Potentials
A Study on Impulsive Control Disorder and Adolescents
Öner et al. (2012) studied among high school students studying in Turkey and with young people between the ages of 13-18. In this research, 6,294 schools and 3,028,092 students affiliated to the Ministry of National Education (MEB) were selected by the Turkish Statistical Institute. A special questionnaire was developed for the data collection tool. The symptoms of impulsivity and mental problems of adolescents were aimed to be revealed with this study. In the study, parents’ education level, job and economic status, age, anti-social behavior, physical violence and substance use were controlled. Then, the presence of a single impulsivity symptom significantly increased the risk of physical violence, frequent smoking, frequent alcohol use, substance use, self-harming behavior, carrying a gun, gang membership, relationship problems, academic failure, and the young person’s own mental state negatively. has been observed. As a result of the research, by looking at the answers given by the adolescents, it was seen that the risk increased as the number of impulsivity symptoms increased. Finally, many common relationships have been identified between behavioral problems, relationship, academic problems, substance use, and impulsivity.
According to many studies, the effect of family and then environmental factors on children and adolescents has been examined. Addressing the concept of parent is seen as the first unchanging rule in understanding the adolescent. How the adolescent in the process of change perceives the mother and father is of great importance. Beginning from the first years of life, the young individual’s parental behaviors, which he sees as role models, have similar characteristics. However, this situation may change for young people in the following periods (Parman, 2006). The socioeconomic, cultural, literacy level of the family and the susceptibility to hereditary disease are among the factors that are of great importance. In children and adolescents who have no impulse control, the pleasure principle is indispensable and irresistible to them, and they go after the excitement that will satisfy the body and the self. This drive, the desire to satisfy pleasures, leads to dangerous life patterns. This is especially common in adolescent age groups. In addition to the transition period from childhood to adulthood, adolescence includes a noticeable change in personality and social behavior, starting from physical, sexual and cognitive changes, and being influenced by parents, other family members, social environments and school (Gander & Gardiner, 2007). Young people show a tendency to violence and impulsive behaviors especially during adolescence. Adolescents with impulse control disorder may exhibit behaviors that they do not think about with their peers while searching for belonging within their youth group. In particular, the need for children and adolescents to be included in the peer group shows that they resort to ways such as theft, harassment, peer bullying and substance abuse that will affect their lives. Today, it is observed that substance abuse is increasing especially in impulsive adolescents.
Substance Abuse and Addiction
Substance abuse, continuous alcohol/substance use, and some deficiencies arise in the person’s full fulfillment of his/her work, home and school responsibilities. The substance is used repeatedly, leading to dangerous situations and various problems. Legal problems may occur. Despite causing problems in social and interpersonal relations, the person continues to use alcohol/substance. Addiction is a disease as well as substance use. Addiction has biological, social and behavioral dimensions. Each dimension is equally important in understanding addiction. Addiction is a disease that can improve but relapses when alcohol or substance is used again. If the addict starts to use alcohol/substance again after he stops using alcohol/substance, he will reach the dose of the substance he used in a very short time and will return to the point where he left off in a short time. For this reason, it would be inconvenient for the addicted person to start using alcohol/substance again, albeit a little. However, many addicts are not aware of this and it has been determined that they use substances again for the purpose of self-testing, thinking that they can use it less. The development of addiction varies according to the duration of alcohol/substance use, the personality characteristics of the person using it, the type of substance and its purity. Each substance has a different addictive potential. It has also been observed that some children, adolescents or adults who use alcohol or drugs use more than one substance. However, one of the substances they usually use is the “preferred substance”.
Tobacco is the most widely used addictive substance in the world. 70% of those who quit using tobacco start to use it again within a month. This ratio shows how addictive tobacco is.
Burning tobacco creates three important elements apart from ash; these are tar, nicotine and carbon monoxide. Tobacco use can cause severe damage to the heart and respiratory system, as well as increase the risk of cancer. Tobacco use is the most common type of substance use in children and adolescents.
Alcohol substance use does not show the effect of alcohol by binding to a receptor. Therefore, it is still a matter of debate on what its effects on the CNS depend on. According to the fluxus hypothesis proposed to explain the effects of alcohol, alcohol binds to gangliosides in the cell membrane. It is also said that alcohol weakens the effect of stimulating NMDA receptors, while increasing the effect of suppressive GABA receptors. Another view is that alcohol acts on dopamine-serotonin systems. It is also known that alcohol increases the production of endorphins, which are natural opioids in the body. All these mechanisms have a role in the development of different types of alcohol dependence.
Marijuana is a narcotic substance derived from cannabis. It contains 421 kinds of chemicals. Its active ingredient is tetrahydrocannabiol. Sarıkız is also called as dry, grass, joint, derman. It differs according to the way it is processed and takes different names accordingly. The way it is used is usually wrapped in a cigarette and the smoke is inhaled, or it is eaten by adding it to a cake or Turkish delight. It takes effect within half an hour of taking it and disappears within three hours. Since it passes into the adipose tissue, the duration of action may take 8-12 hours. Physically, tachycardia, dry mouth, increased appetite are observed. The psychological effect varies according to the mood of the person, the amount of the substance, the environment and past experiences. These effects include changes in color, sound and time perception, euphoria, and relaxation. Removal of inhibition, decreased concentration and coordination disorder can be seen. Reasoning is impaired, talkativeness is observed.
It has been found to cause lung cancer and bronchitis. Compared to cigarettes, it is five times higher. A state of panic, fear, and doubt arises. It causes memory impairment and loss of concentration. It has been found to reduce testosterone levels in men. In chronic users, a picture with a lack of motivation has been described. Apathy, loss of goal-directed effectiveness, and loss of ability to solve new problems are observed. A psychotic picture characterized by paranoid delusions can be seen in high-dose cannabis use. When taken in very high doses, toxic delirium with confusion and loss of consciousness may develop. If the psychotic course is evident, low-level antipsychotic medication can be started. Marijuana has no physical withdrawal. However, when it is not taken, restlessness, nervousness, restlessness, tension, insomnia and loss of appetite are observed. The dependency level is low.
LSD is the best researched member of this group, but whose efficacy level is not fully known. LSD acts on both dopaminergic and serotonergic systems. This substance is used orally. It has also been observed that it is sometimes crushed and sucked into the nose. Vitality and well-being, visual hallucinations and sedation are a few of the effects. This substance is seen with complaints of dryness in the mouth, feeling of thirst, inability to relax, dry hot skin, pupillary dilation and restlessness. His tolerance level is low to medium and his immunity was found to be low. A full understanding of LSD pharmacodynamics will perhaps lead to an understanding of the biochemistry of schizophrenia.
It is thought that there are at least six types of receptors in the human body to which opioids bind. The distinctions used to classify opiates according to their clinical effects, such as agonist, partial and milk agonist-antagonist, seem to depend on the different effects of different substances on these receptors.
The receptors that feed the addictive behavior are agonist receptors. There are two subtypes of this receptor: they are called receptors to which enkephalins, which are opioids produced by the human body, also bind, do not have a very tight binding, and many abused opiates are tightly bound. The diversity of the receptors is also used in the treatment of addiction.
Heroin: Morphine is a naturally derived opioid. It is in the form of light brown powder. Heroin is obtained by treating the opium poppy plant with acid anhydride. It is also known as white, powder, cheese. It is used by wrapping in cigarettes, snorting, heating on aluminum foil, inhaling steam and intravenously. It starts to take effect shortly after taking it. Its effect lasts for 4-6 hours. Therefore, it should be used at least twice a day. Euphoria, loss of pain sensation, slowing of heart and respiratory rate, facial flushing, increase in blood pressure are observed. Pupils narrow. Vomiting and constipation occur. Speech slows down, body temperature drops, and orgasm-like cramps are seen in the abdomen.
Pneumonia is common in tuberculosis heroin users. Heroin can cause perforations in the nasal septum. Serious problems develop with intravenous use. Infections such as hepatitis and HIV can be transmitted in particular. Septicemia and septic embolism occur. Hyperpigmentation is observed at the injection site. Abscess, gangrene, vasculitis, infective endocarditis may develop. When a high dose is taken, respiration slows down and a comedy develops. Pulmonary edema may develop. Withdrawal occurs within 6-8 hours following the last dose. Tolerance develops very quickly. The level of addiction is quite high.
It is called psychotic drug addiction. These; Diazepam, Clonazepam, Lorezapam, Flunitrazepam, Barbiturate, Meprobamate, Fenprobamates.
The best known hallucinogen is LSD. It is sold in the form of tablets or impregnated flakes. They are in the same group as phencyclidine and dimethoxymethamphetamine. Some cacti and mushrooms are also used for the same effects. Although it is used orally, it can also be absorbed through the skin.
Visual hallucination, sharpening of colors, depersonalization, derealization, disorientation, doubt, euphoria, anxiety, panic, increase in blood pressure have been observed in its visible effects. Synesthesia and paresthesias occur. While they create positive effects when they are taken in a safe and comfortable environment, they also create very negative pictures in the opposite situation.
Panic attacks, depression, paranoid delusions, confusion, suicide attempts, pupillary dilation have occurred. When delusions and hallucinations are accompanied by derealization, psychosis is encountered. Its tolerance develops slowly, and its addiction potential has been found to be low.
They are substances or drugs that increase attention, awareness and alertness by acting on the central nervous system. As the effectiveness of the substance increases, the side effects also increase. The most common caffeine in the world and the nicotine in cigarettes is a type of stimulant. The most well-known stimulants are cocaine, amphetamine, ectasy and ephedrine.
Cocaine: It is obtained from the coca tree, which grows mostly in South America. It is a white colored powder. It is called coke or ice. Crack is a ready-to-use high-potency form of cocaine. Cocaine is often used by snorting. It is used by wrapping it like a cigarette or by inhaling its vapor. It is also used intravenously alone or together with heroin or by putting it into the vagina, penis, rectum.
It shows a stimulating effect. Its effect begins immediately after taking it, but the effect ends within half to an hour. Euphoria, feeling good, vitality, increased sense of pleasure, disappearance of anxiety, increase in self-confidence, increase in sexual activity are observed. Pupillary dilation and intense sweating. Body temperature and blood pressure increase.
In its side effects, paranoid pictures may occur or psychosis may be observed. Aggressive behavior is common. A person who feels that insects are crawling under the skin may damage their skin. Myocardial infarction, sudden death, and pulmonary edema have been observed in young people. Rarely, if it is used orally, it forms gangrene in the intestine. Infections due to impaired immune system are common. If cocaine is inhaled for a long time, it can cause deformation of the mucous and cartilage tissue in the nose. When high doses are taken, epileptic seizures, hyperthermia, cardiac arrhythmia, respiratory paralysis and death are seen. Hypertension, agitation, diaphoresis, tachycardia and delirium are observed. Cocaine-induced psychosis can be seen. When the effect of cocaine wears off, a severe depression, anxiety, irritability and stagnation are experienced. Its tolerance develops very rapidly and its addiction potential is high.
Amphetamine (Ephedrine, Captagon):
Amphetamines are usually in capsule or tablet form and are taken orally. Intravenous use of amphetamines is also seen. The use of amphetamine and its derivatives is illegal in Turkey. However, it is brought illegally. It is called ‘Speed’. Its stimulant, mind-opening, performance-enhancing and debilitating effects have been identified. Hypertension, vascular fibroid necrosis and paranoia are seen with chronic use. Aggression, delusions, violent behavior, disorientation, delirium, cardiac arrhythmia, headache, convulsions, cerebrovascular diseases, subarachnoid hemorrhage, coma and death are likely. Its effects last much longer than cocaine. Distress, unhappiness, depression, inactivity, nightmares, excessive sleep, headache, sweating, and suicide attempts have been observed in the use of this substance. Symptoms reach their highest level in 2-4 days. The tolerance range is medium, and the risk of addiction is medium.
Ecstasy: It is a type of amphetamine called methylene dioxy methamphetamine. The active ingredients are similar to both amphetamines and hallucinogenic substances. They are sold in the form of tablets with pictures such as birds, elephants, rabbits and ghosts. They are called ‘White Doves’. It is taken orally and its pediment is foreseen in night casinos for entertainment purposes. This substance takes effect within 20 to 60 minutes and its effect lasts between 4 and 6 hours. Changes in mobility, vitality, increase in energy, closeness to the opposite sex, sense of trust and perception are also observed. Side effects of substance use include increase in body temperature, blood pressure and pulse rate, loss of fluid, narrowing of the pups, sweating, lack of pleasure without using ectasy, and coordination disorder. It can cause liver failure. It has been determined that dehydration, increase in body temperature and sudden death due to the additive in it are seen in ectasy users. Deprivations such as feeling of emptiness, fatigue, dizziness and headache can be seen. Its immunity level is low, but it has been proven to develop moderate tolerance.
Volatile substances under this heading are considered as solvents and adhesives. Among these substances are bale or glue, thinner, oil stain removers, clothes and glass cleaning liquids, acetone content cosmetic products, fabric dye, lighter fluid and gasoline. These substances are used by inhalation. Often the substances are inhaled by putting them in a plastic bag, or the head is inserted into a plastic bag in order to be able to smell more substances. It starts to take effect in a short time and it is seen that it appears as euphoria, the removal of inhibition, relaxation, coordination disorder, stupor, confusion, dizziness and drunkenness. Vivid visual, auditory and tactile hallucinations are seen. Diagnoses of tachycardia, syncope, ataxia, decrease in blood pressure, generalized muscle weakness, increase in creatine phosphokinase level, ST segment depression in EKG, reversed T wave and permanent brain damage are defined. Confusion, disorientation, cardiac arrhythmia, coma, and death occur when exposed to high doses. Suffocation due to bag snagging is common. Supportive treatment approaches are sufficient. Symptoms improve in a short time with discontinuation of use. Tolerance of this addiction develops rapidly and the risk of being addicted is found to be medium-high.
Item types are listed above. These substances, which are mentioned in the substance addiction literature of the World Health Organization, cause addiction in children, adolescents and adults, and their effects are felt throughout life.
In today’s conditions, it is easier to reach, enjoy and try some substances. Especially the decrease in the rate of substance abuse age is highly affected by these factors.
Impulsivity and Substance Use
Substance use includes elements that are too complex to be called an impulsive behavior. For substance abuse, it is necessary to be planned and to go towards the goal. However, in response to anxiety, family and environmental factors, the person immediately takes the substance without thinking about the consequences. Once a person uses the substance, addiction starts to develop and there will be a desire to use the substance again. Considering that impulsivity is associated with substance use in at least some individuals, substance use should be quite high in individuals with impulsive behavior. In the study of Braddy et al., it was determined that substance use and addiction were higher in impulsive violent criminals, arsonists, and people with intermittent explosive disorder compared to the general population. (Özdemir et al., 20212: 293-314)
The rate of impulsivity was found to be high in people with substance addiction. In particular, impulsivity using multiple items rather than a single item is more common. Studies using behavioral measures have shown that substance users are more likely to prefer instant rewards, even if they are smaller. There is a clear relationship between behavioral disorders and impulsivity and substance abuse, but much less between attention deficit hyperactivity disorder (ADHD). In some studies, substance abuse is more common in children with attention deficit and hyperactivity disorder. In other studies, it has been claimed that attention deficit and hyperactivity disorder alone does not increase the risk of substance use, but this risk increases when seen together with impulsivity. It has not yet been proven whether the impulsivity factor is a cause or a consequence in substance use.
In those with substance use disorders, diagnoses such as ASPD and BPD and impulsivity-related conditions such as suicide risk are more common in adolescents. Impulsivity is the area of human development with the highest behavioral disorder when looking at the hormonal structure of adolescence. Studies have shown that adolescents are prone to substance use. Individuals who cannot achieve changing mood and stability develop a life in which they resort to substance use in mental conditions and continue with alienation from the family, alienation from the environment, peace of mind and behavioral disorders. When substance abuse and lack of attention are added to this variable mood picture of impulsive individuals, daily dysfunction, school and work problems, problems with family and environment can be seen. In adolescence, this situation shows an increase in interest in friends, which is an environmental factor. This is common in adolescence with a broken or fragmented family structure. Studies show that impulsive individuals have a higher risk of substance use habits in adolescence. This rate is more common in boys and moderate in girls. It is seen more frequently in boys as adrenaline, excessive speeding with motor vehicles and excessive substance use, while in girls this rate increases as suicide, aggression and anger.
Attention Deficit: It is a mental disorder in children, adolescents or adults with distraction, lack of focus and sustainability in attention.
Hyperactivity: His hands and feet fidget or fidget in his seat. May get up from seat in classroom or other situations where sitting is expected, or run around or climb in situations where it is inappropriate. (may be limited to subjective feelings of restlessness in adolescents or adults)
Impulsivity: Impulsivity is the children who paste the answer before the question is completed. He often has trouble waiting his turn. Interrupts or intrudes on others (for example, meddling in other people’s conversations or games).
Child: A child, a person between infancy and adolescence. Generally, childhood begins after the ability to speak and walk; It is accepted that the childhood period ends with the adolescence period, when sexual development begins.
Adolescent: Adolescent or adolescent is a person in the physical, sexual, social and psychosocial transition period between childhood and adulthood. The physical and sexual development seen in this period is called adolescence.
Substance Use: It is the use of substances that adversely affect the functions of the body, and therefore, the use of these substances cannot be stopped even though it is damaged. The addict experiences withdrawal symptoms when he takes a break from substance use. Increases the frequency and dose of substance use over time.
The purpose of this research; This study investigates hormonal fluctuations, behavioral disorders, social relationships, and the decrease or effect of standard of living in children and adolescents with impulsivity along with substance use disorder. It was investigated to observe whether the rate of substance use increases after this diagnosis compared to children and adolescents who do not show or have not been diagnosed with impulsive symptoms, and to indicate the levels of difference between them in line with this study. Considering these hypotheses, answers to the following questions will be sought.
Is there a difference in the level of susceptibility of children and adolescents diagnosed with impulsivity to substance use disorder in children and adolescents who have not?
Did individuals with substance use disorder have substance use disorder due to impulse control disorder in their past life childhood and adolescence patterns?
The method of this article is that it is a compilation study by using thirteen articles, eight theses and two books. Sample groups were frequently used in this article review, which covers many children and adolescents diagnosed as impulsive.
Biological and psychological research recommends the dimensional approach, as impulsivity plays a key role in many disorders and is important in the treatment approach. (Özdemir et al., 2012: 293-314) The level of impulsivity and risky behaviors among children and adolescents lead to significant problems in individuals and societies, and the level of substance addiction. Research shows that impulsivity and risky behaviors are more common in substance use. There is a difference between boys and girls who engage in impulsive behavior. It has been determined that it is more common in adolescents diagnosed with Impulse Control Disorder, and in terms of gender discrimination, more frequent and dangerous behaviors are exhibited in males. Assuming that in addition to substance addiction, gender is taken into account in impulsive male behaviors, a tendency to sexual abuse and violation of authority and rules are observed especially in schools. Substance use tendencies, childhood traumatic experiences, and severity of psychiatric illness in children and adolescents may differ between genders. It will be useful to consider these differences in the treatment process. (Yıldız et al., 2020: 190-202). Studies present that individuals with childhood and adolescence Impulse Control Disorder have a high tendency and risk for substance abuse. One of them is smoking and the other is alcohol substance use. In this review study, the risk and relationship between childhood and adolescence individuals and substance use were investigated. In our country, the use of substances has increased in children and adolescents in recent years, and cigarette is the easiest tobacco product in terms of accessibility. Studies show that the rate of smoking has reached the highest level among adolescents in the last 10 years due to the effect of the pandemic. Adolescence has the most important age range for substance use. Considering being included in the peer group and the sense of belonging among these age groups, the rate of substance use or experimentation is more common. The family pattern and structure of adolescents who have not gained a sense of belonging and have just stepped into the individuation phase are also very important. The feelings of family neglect and irresponsibility lead adolescents to their peers more, and the first substance use or habit is gained through bad friends. The role of the family at this stage is very important. In this context, the parent’s use of alcohol and drugs, neglect of their child, broken family, and intra-familial conflict are among the factors found to increase the risk of substance use. (Yıldız et al., 2020: 190-202). There are positive developments in the fight against substance addiction in our country, but along with these developments, it also lacks a scientific basis. It would be appropriate to inform the family in terms of risk factors and if necessary, go through the education process. Impulsive children whose families have a fundamental lack of knowledge are more prone to substance addiction and have a higher trial rate. Studies show that children and adolescents who do not have a family and stay in shelters or child welfare institutions are prone to substance use and crime. Children and adolescents living on the street are the biggest risk factor. Especially adolescents are at risk of using harmful substances due to the ease of access to the substance and the lack of family structure. Suicide rates have increased with substance use and the tendency to crime has increased. Within the scope of school and work life, productivity decreases. Impulsive individuals who use drugs and have difficulty adapting to daily life have more aggressive and explosive movements with substance use. Substance withdrawal may sound like another impulsive attack for them. In most of the studies, it has been proven that individuals with substance use impulsivity have a higher risk of substance use than other healthy groups. Based on such results, it has been observed that impulsivity predisposes to substance use or that substance use increases impulsive behaviors. While some findings indicate that impulsivity will be an effective factor in substance use, it is also known that no definite answer can be obtained.
In our country, outpatient and inpatient treatment needs are not sufficient for children and adolescents in the context of substance addiction. Within the scope of treatment, the substance addiction treatment center ÇEMATEM (Child and Adolescent Substance Addiction Treatment Center) is a rehabilitative medical and psychosocial support institution in order to prevent substance use in children and adolescents. ÇEMATEM provides many substance abuse prevention services for children and adolescents, including psychotherapies, counseling services, sports and cultural activities. However, it is clear that the number of these institutions is insufficient for children and adolescents with substance use. The number of these institutions should be increased, and protective programs for impulsivity and risky behaviors, which are serious risk factors among children and adolescents, should be increased.
This review study consisted of children aged 7 years and adolescents aged 18 years between the years 2021-2022. Since it is a compilation study, literature articles, journals and books were used. The study is limited to the review of children and adolescents aged 7-18 who were diagnosed with Impulse Control Disorder and were using substances. It is assumed that better results and findings will be obtained if the framework of these limitations is expanded.
With the technology of today’s life, a noticeable difference has been observed in the behavior of children and adolescents. These behaviors include game addiction, technology addiction and substance abuse. One of the biggest factors affecting quality of life is a history of substance abuse. Family neglect and abuse of adolescents with impulsivity and substance use should also be considered. In such cases, adolescents attach more importance to their social (friend) environment and may take part in such substance use to gain acceptance. Behaviors up to peer bullying are observed in adolescents who cannot control their impulsivity and substance use as well as their behaviors. Psychological support is of great importance in children and adolescents who have such behavioral disorders and use medication. In such cases, it is recommended that families have a more understanding, compassionate, embracing and supportive structure and language. Substance use is seen as an escape route in adolescents who suffer from a warm family environment of impulsive individuals. In such cases, social health organizations or shelters should be given great importance. There are services on addiction for children in our country, but they are not enough. The importance of youth years should be emphasized in the phase of substance use and addiction, and efforts should be made to make such organizations more common. The benefits of raising awareness, giving seminars on substance abuse and receiving psychoeducation from educators are emphasized more frequently. Children and adolescents play an important role in the development and growth of a society. Parents should follow the mental health pattern of children and adolescents and take precautions accordingly.