Understanding how social change and technological development have shifted the way substance use disorders (SUD) affect individuals and families
[This is part two of a two-part blog on the topic of the changing culture of drug use in the United States and beyond. If you haven’t read part one, I recommend doing so first.]
In last week’s blog, I introduced the notion of a changing drug landscape in the United States and elsewhere: illegal drug use is no longer the occasional recreational experimentation with hallucinogenics that it was for many parents and adults today. Instead, an increase in the medications prescribed for pain management, depression, anxiety, and focus conditions such as ADD and ADHD have made prescription drug use the primary form of drug use in this country and around the world.
But how has this changed the way in which young people acquire and use these substances? Here, I’ll take a closer look at the reasons behind drug use by children and teenagers as well as the changing systems used by drug dealers to acquire, market, and sell these illegal products to young people.
Taking a Chill Pill: A Different Kind of Drug Use
At one time, it was commonplace for young people to seek out hallucinogenics such as mushrooms or marijuana or perhaps some illegally acquired alcohol to use at a party. Many adults even nostalgically recall this practice in their own adolescence. And while young people do still take these types of drugs and consume alcohol underage illegally, parties and social events are no longer the only reason behind their interest in finding and using illegal drugs.
Among the list of reasons young people and adults alike use prescription drugs, the Mayo Clinic now includes both increasing alertness and improving concentration and academic/work performance.  This inclusion represents the intensifying pressures young people face to perform academically – many children and teens feel as though they must achieve certain grades in order to impress their families, live up to expectations, and obtain admission to elite university programs or be considered for prestigious career options. One study on stimulant abuse in college students estimated that up to 20% of young people attending a university or college routinely use illegally obtained prescription stimulants (such as Ritalin, Adderall, or Vyvanse) for academic purposes. 
Other young people are misusing prescription drugs to self-medicate against feelings of depression or anxiety. Both Xanax and Valium have experienced a sharp rise in popularity over the past ten years as young people use them to boost their feelings of self-confidence and reduce negative thoughts or stress. 
Unlike prescription drugs, which are used to focus or study and which are often shared between friend groups, these stronger antidepressants and anti-anxiety medications are more often acquired through the Internet: reports of teenagers using the “dark web” to buy large amounts of what they assume to be anti-depressants are increasingly common. There are entire websites and online communities devoted to Xanax and Valium, and young people are often more adept at accessing them than the adults in their lives. These have been named “online drug cultures” by researchers, and they are one of the ways in which illegal drug use is being changed by the emergence of digital technologies. 
Drugs over Text: A Different Kind of Drug Dealing
Perhaps the most significant factor in the changing drug landscape in America and globally is the introduction of the Internet. Where a person seeking illegal drugs would historically have to simply “know a guy” (that is, have a social connection to a known drug dealer), the advent of the Internet makes it possible for anyone with a laptop or smartphone to connect to total strangers immediately. This obviously has serious implications for the illegal use of drugs by young people.
There is not yet a huge amount of research on how the development of digital connective technologies like the Internet and smartphones is affecting drug use in the United States and globally, but a 2020 study that was published in Australia attempted to track the relationship between mobile phone use and drug buying and selling. This research found that fifty-nine percent of individuals who had been detained by police for charges relating to drug use had used mobile phones either to buy, sell, deliver or supply drugs. What’s more, those individuals using their phones to obtain drugs were, on average, younger than those who weren’t.
The report also indicates that messaging apps such as WhatsApp, iMessenger, and Facebook Messenger were often used on smartphones to solicit drugs.  This aligns with recent publications by anti-drug advocacy groups and drug administration departments around the world that suggest that there are specific text codes young people use to buy and sell illegal drugs via their phones and which are commonly found on messaging apps. 
This year, in fact, the Drug Enforcement Administration released an infographic showing some of the emoji codes that are routinely used to refer to drugs on smartphones. Emojis are an extremely popular way of showing emotion or referring to specific things in text, but they are also frequently used by young people to obtain illegal drugs without having to refer to them by name and risk getting caught. Some of the more commonly used codes include:
· the red X emoji or the heart emoji to refer to MDMA and ecstasy
· the snowflake emoji to refer to cocaine
· the tree emojis or the puff of smoke emoji to refer to marijuana
· the parking sign emoji to refer to Percocet
· the chocolate bar emoji to refer to Xanax. 
As the world changes, so do patterns of illegal drug use. As therapists, coaches, and healthcare professionals – or simply as concerned adults – we owe it to young people to understand how different social and cultural factors affect the way they understand drugs, their access to drugs, and how drugs are being offered to them in the modern world. More prescription drugs are available than ever before as doctors increasingly prescribe potent painkillers, antidepressants, and stimulants for a variety of health and mental health conditions. Knowing how these prescription medications are more likely to wind up being misused is critical to understanding how and why young people develop substance use disorders when taking them.
Illegal drug use is no longer mere recreational experimentation; for many young people, there is a real danger in seeking out prescription drugs in order to relieve anxiety, improve school performance, or “escape” a troubling reality. What’s more, the development of digital technologies has made it increasingly easy for anyone with access to a phone or the Internet to access illegal drugs of all sorts.
Being aware of this changing reality for young people is the first step to helping them avoid substance use disorders. Having open conversations on these topics with the young people in your life is a great way to introduce the issue and to develop the kind of honest discourse that will help support them as they navigate this challenging and ever-changing drug landscape.
 Mayo Clinic. (2022) Prescription Drug Abuse. Patient Care & Health Information. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/symptoms-causes/syc-20376813
 Kennedy, S. (2018) Raising Awareness
Aabout Prescription and Stimulant Abuse in College Students Tthrough On-Campus Community Involvement Projects. Journal of Undergraduate Neuroscience Education. Fall; 17(1): A50-A53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312145/
 Lee, D. (2018) Anxious teenagers ‘by Xanax on the dark web.’ The Guardian. Jan 14. https://www.theguardian.com/society/2018/jan/14/xanax-anxious-teenagers-buy-dark-web-tranquillisers
 Center for Substance Abuse Treatment (US). Improving Cultural Competence. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 59.) 6, Drug Cultures and the Culture of Recovery. Available from: https://www.ncbi.nlm.nih.gov/books/NBK248421/
 Sullivan, R. and Voce, A. (2020) Use of mobile phones to buy and sell illicit drugs. Australian Institute of Criminology, Statistical Bulletin 22. April. https://nla.gov.au/nla.obj-2592078597/view
 Zapal, H. (2021) Drug Slang Emojis: Here’s What Every Parent Needs to Know. Bark. May 26, https://www.bark.us/blog/drug-slang-emojis/ Drug Enforcement Administration. (2022) Emoji Drug Code, Decoded. One Pill Can Kill. https://www.dea.gov/sites/default/files/2021-12/Emoji%20Decoded.pdf