Substance Abuse and The Adolescent with Diabetes Mellitus

Karen Leslie, MD, FRCPC, Division of Adolescent Medicine, The Hospital for Sick Children, Assistant Professor in Paediatrics, The University of Toronto

Adolescent substance use is common. Provincial surveys of high school students reveal that about two-thirds of adolescents have used alcohol at least once in the past year, about one-third have used tobacco, and almost one third have used cannabis. In addition, the use of hallucinogenic substances (eg. LSD, ecstasy) have increased over the past decade.

‘Substance Abuse’ can be defined in many different ways. One of the most broad definitions in that of the American Medical Association Council on Scientific Affairs “Any use of drugs (including alcohol) that causes physiological, psychological, economic, legal or social harms to the individual user or others affected by the drug user’s behaviour”.

The risks to an adolescent with a chronic illness who chooses to use tobacco, alcohol or other drugs (which will be referred to as ‘substance use’ for the rest of this article) are greater than for an adolescent without a chronic illness. Young people with Diabetes Mellitus (DM) have their own specific health risks related to substance use.

The following are identified in the literature as being ‘markers’ for increased risk of developing substance abuse problems:

There is a paucity of literature looking at adolescents with chronic illness (including diabetes) and substance abuse. Cadman et al. (Pediatrics 1987) reported from the Ontario Child Health Study, which looked at chronic illness, disability and mental and social well being. Their study found that children and adolescents with chronic medical illness ‘with disability’ had the greatest risk for psychiatric disorders and social adjustment problems. Those ‘without disability’ had risk for psychiatric problems but not social adjustment problems. Extrapolating this information to adolescents with DM, one could surmise that adolescents with DM might be at increased risk for psychiatric problems, which include substance abuse.

Looking specifically at the issue of DM and substance use, Gold et al (J. Adol Health 1994) used an anonymous questionnaire and urine screening with a group of adolescents with DM, and found that the overall incidence of substance use was not more than the general population, however 40-60% of the subjects had elevated scores on a drinking scale, and, even more concerning was that few perceived that alcohol or drug use affected their diabetic control.

Glasgow and colleagues (J. Adol Health 1991) looked at the correlation between drug and alcohol use and poor diabetic control in a sample of 100 adolescents. Of the 100, 7 had weekly use of alcohol, and although this study found no statistical significance between substance use and control, there was a trend toward patient use of alcohol or drugs with poorer control.

What are the potential risks for an adolescent with DM who uses a substance? There are 3 main areas of risk directly relating to DM:

In addition, these adolescents are also at risk for the other risks from substance use including:

There are a large number of substances an adolescent may choose to use or abuse. The only substances that have been studied specifically in the diabetic population are tobacco and alcohol. The health care practitioner therefore needs to have an understanding of the different substances adolescents use, and should be able to provide information to their patients about the potential risks involved in their use.

In summary, adolescents with DM have the potential to develop significant health risks as a result of substance use and abuse. It is recommended those health care practitioners working with this population: