Peter R. Martin: Historical Vocabulary of Addiction, Vol. II
Adolescence
According to the electronic version of the Oxford English Dictionary (OED) the noun adolescence is of multiple origins, partly a borrowing from French (Old French adolescence from the late 13th century) and from Latin (adolēscentia). The origin of both is from the classical Latin adolēscentia (also adulēscentia) (“period of life between childhood and young adulthood, youth, youthfulness”), which is a combination of adolēscent-, adolēscēns with the suffix ‑ia (“A termination of Latin and Greek nouns… as the ending of abstract nouns from adjectives”).
There is but one meaning of the noun adolescence in English, defined in OED as: “The period following the onset of puberty during which a young person develops from a child into an adult; the condition or state of being adolescent.”
The noun puberty refers to the physiological events which signal commencement of sexual maturity and thus adolescence, defined in OED as: “The period of life during which a young person reaches sexual maturity and becomes capable of reproduction; the sequence of structural and functional changes that occur in the body during this period, including the appearance of secondary sexual characteristics (such as pubic, axillary, and [in the male] facial hair) and the onset of the secretion of sex hormones and the production of ova or sperm.”
These terms are highly relevant to the present discussion because the emerging drives that are initiated with puberty and mature during adolescence as the individual develops into adulthood (defined in OED as: “The condition or state of being adult, or an adult”), shape their unique behavioral repertoire and their involvement in the community of which they are a member and render them susceptible psychiatric disorders, including addiction.
The first use of the noun adolescence in the English language was in about 1425 in a Middle English translation of the influential Latin treatise Chirurgia Magna written by the French physician and surgeon Guy de Chauliac (c. 1300 – 1368), which was widely circulated in medieval Europe in its various translations (de Chauliac 1659): “In childre, when þai come to adolescence i. wexing age [?c1425 Paris MS. ȝong manis age].” This very early quotation of de Chauliac refers to adolescence as the stage of life after childhood characterized by growth and maturation. The great appetite and physical growth resulting in the well-recognized lanky frame of the adolescent was emphasized in a later quotation in the novel Melmoth the Wanderer by Charles Robert Maturin (1780 – 1824), an Irish Protestant clergyman and writer of Gothic plays and novels (Maturin 1823): “I had no food for many days requisite for the claims of adolescence, which were then rapidly manifesting themselves in my tall, but attenuated frame.”
Another early quotation from about 1439 by the English monk and poet John Lydgate in his Fall of Princes referred to the fact that adolescence provides a unique opportunity to teach youngsters because at this particular stage of life they possess a prodigious capacity to learn (Lydgate and Bergen 1923): “Afftirward in ther adolescence, Vertuousli to teche hem.” This notion is echoed by a quotation of Wilfrid Holme (d. 1538) from The fall and euill successe of rebellion from time to time wherein is contained matter, moste meete for all estates to vewe, a poem dated to about 1538 (Holme and Huth Library 1572): “We thinke in those things our wit should more excell, Than in our adolescence, or yet our beginning.”
Many other changes occur during adolescence, as indicated by a quotation from Lydgate’s poem Nightingale (dated to about 1450) which refers to the awakening of an uncanny interest in sexuality during this stage of life (Lydgate and Glauning 1900): “O lusty gaylauntes in youre adolescens.”
All in all, adolescence is not simply represented by increasing age beyond childhood but by monumental growth and changes in capacities and appetites which can result in healthy maturation or its derailment, especially within the perspective of the proclivity for or acquisition of addictive traits or disorders.
The noun puberty first appeared in the English language before adolescence did, in about 1384, in a quotation from the Vulgate Bible attributed to John Wycliffe (c. 1328 – 1384), a philosopher, translator, Catholic priest and Oxford theology professor (Wycliffe, Forshall and Madden 1850): “Weile thou, as a mayden gird with a sacche vpon the husbonde of hir puberte [Latin pubertatis], that is, tyme of weddynge.” This quotation makes the point that the start of puberty was originally considered the initiation of adulthood, an opportune moment for marriage leading to procreation.
Thomas Fuller (1654 – 1734), a British physician, preacher and intellectual wrote in his treatise Exanthematologia; or, An attempt to give a rational account of eruptive fevers, especially of the measles and small pox (Fuller, Austen and Rivington 1730): “Young People, before Puberty, for the most Part have a more kindly Sort than Adults.” This quote implies that substantial changes in temperament often accompany the onset of puberty and continue through adolescence. These emerging emotions can often overwhelm adolescents and all with whom they are connected and may result in impairment of coping with the stresses that characterize this stage of life.
The Scottish psychiatrist Thomas Smith Clouston (1840 – 1915), wrote of adolescence as the stage of life in which mental diseases tended to first develop (Clouston 1880):
“Then what a change in the mental activity of the brain does the period of puberty cause! Looking at the matter from the combined point of view of physiologists and psychologists, we must connect the new development of the affective faculties, the new ideas, the new interests in life, the new desires and organic cravings, the new delight in a certain sort of poetry and romance, with a new evolution of function in certain parts of the brain that had lain dormant before. This awakening into intense activity of such vast tracts of encephalic tissue, though provided for in the evolution of the organ, does not take place without much risk of disturbance to its mental functions, especially where there is an inherited predisposition in that direction. And if this predisposition is thus developed into actual derangement of function, it happens, as might have been surely predicated a priori, that the type of derangement is much influenced by the great function of the reproduction of the species then arising de novo. To form a right conception of the kinds of mental disease that occur at the various important periods of life it is essential that we consider them in connexion with the normal changes that take place in the organism at these periods, with the normal modifications in the mental energy at those periods, and with the changes that take place in the brain texture and mode of action, so far as we know them. In short, we must take a physiological view of mental disease.”
The age by which children may be considered to have reached adulthood has varied considerably throughout history determined by ever-changing mores and accompanying biological, socioeconomic and psychological issues (Herman-Giddens 2006; Lewis, Shapland and Watts 2016; Feixa 2020). Similarly, the age of puberty has also changed over time — it has been reported that the biological onset of puberty during the past century has been occurring at progressively earlier ages, especially in females (Karapanou and Papadimitriou 2010; Dorn and Biro 2011; Biro, Greenspan and Galvez 2012; Lewis, Shapland and Watts 2016; Wang, Asokan, Onnela et al. 2024).
The historical notion that childhood blends seamlessly into early adulthood with no, or a much-truncated adolescence following puberty, namely duration of this stage of life, has evolved substantially over the centuries (Worthman and Trang 2018). All the same, as recently as at the start of the 20th century, even in the “developed world,” most youngsters, except the well-to-do, left school after only a few years and were deemed ready for full employment in their early teens with the likelihood of marriage for many soon thereafter.
The contemporary view of adolescence in the United States originated from the ideas of G. Stanley Hall (1844 – 1924), who was known for his work in child development and educational psychology, establishing psychology in the U.S. as a legitimate scientific discipline and founding the American Journal of Psychology (Hall 1905; Kett 2003). The following quote encapsulated Hall’s overarching perspective of adolescence (Hall 1905):
“Life is... a stream flowing from high mountain ranges which wring it from the clouds, coursing down through all the manifold ways in which the water comes down at Lodore to the sea of eternity. Adolescence is the chief rapids in this river of life which may cut a deep canyon and leave its shores a desert.”
In the early 20th century, adolescence began to be referred to as “a period of stress and strain, of Sturm und Drang, which marks the transition from the boy to the man” (Hall 1905; Holmes 1910) — clearly, this quote would need to be restated today to indicate that it applies equally to the transition from the girl to the woman and to those in whom gender identity is more fluid. The tumult of adolescence is again captured by Hall (1905):
“The teens are emotionally unstable and pathic. It is a natural impulse to experience hot and perfervid psychic states, and it is characterized by emotionalism. We see here the instability and fluctuations now so characteristic. The emotions develop by contrast and reaction into the opposite.”
It was advanced by Hall and contemporaries that in light of the characteristic “stress and strain” of adolescence, there was a need for an “extended moratorium on assumption of the responsibilities of adulthood” in order that a youngster may master the developmental tasks of adolescence (Erikson and Erikson 1997; Worthman and Trang 2018). These tasks — if anything, have been greatly augmented and complicated by the plethora of technological and other “advances” of the past century — must be successfully accomplished before a young person is ready for the challenges of adulthood, namely further education, vocation, mature relationships, marriage and parenting.
The striking transformations during adolescence are likely initiated by biological signals from the developing nervous system that cause a surge of sex hormones that seem to drive behavior during this stage of life as well as promote maturational growth of all organs of the body. Developmental changes in the structure and function of the brain are associated with these hormonal changes beginning in puberty, resulting in the emergence of the often-disruptive psychological features of adolescence.
Although this tumult calms eventually after the “storm” in most youngsters, in some adolescents it represents the beginnings of serious psychopathology and the eventual diagnosis of potentially disabling psychiatric disorders (Andriezen 1903; Quevedo, Benning , Gunnar et al. 2009; Kretzer, Lawrence, Pollard et al. 2024; Mitchell and Nugiel 2024) — the focus of the present discussion is the relatively common emergence of addictive disorders during this period of life.
The rapidity and breadth of biological changes in the mind and body are likely the essential determinants of this disequilibrium in emotional state manifested during the period beginning with puberty. The earliest brain changes in adolescence involve enhancement of the complexity of neural connections in and between brain regions of the brain by selective formation and pruning of neural synapses — one consequence particularly relevant to addiction is the increase in brain dopaminergic neurotransmission, particularly in the prefrontal cortex, striatum, and limbic system (Colver and Longwell 2013). These changes account for the development of emotional regulation, decision-making and reward processing which contribute to the valued traits of flexibility, creativity and novelty-seeking of the adolescent brain as well as the impulsiveness, reward-seeking and risk-taking also associated with this period of life.
The limbic system, associated with pleasure and reward, matures much earlier than the prefrontal cortex that is ultimately responsible for judgment, decision-making and impulse control, and therefore the balance early in adolescence is to increased reward and sensation-seeking behaviors (Martin 2020, 2023). Enhanced dopamine neurotransmission in the brain reward system is the basis for a heightened response to substance use and other rewarding behaviors, potentially making adolescents much more susceptible to addiction (Volkow, Michaelides and Baler 2019). Therefore, young people are very likely to engage in risk-taking behaviors and may have greater exposure to and also seek out substances like alcohol, tobacco and drugs or various forms of thrilling/harmful behaviors like sexuality, aggression and gaming, etc. The younger age at which substance use begins, the more harmful it can potentially be to the developing brain that has been shown to be particularly susceptible to neurotoxic effects of addictive substances early in adolescence (Tapert, Caldwell and Burke 2004; Jacobus and Tapert 2013; Teague and Nestler 2022).
Significant maturation of the prefrontal cortex and pruning of the brain neural circuits required for executive functioning and decision-making in response to the salience/reward associated with environmental stimuli have been found to continue well into the third decade of life (Casey, Jones and Hare 2008; Benningfield, Blackford, Ellsworth et al. 2014; Sawyer, Azzopardi, Wickremarathne et al. 2018; van Blooijs, van den Boom, van der Aar et al. 2023).
Therefore, the notable brain development that characterizes the period after onset of puberty can last much beyond what has been designated as the legal age of maturity and when independence from the family of origin has typically occurred. Otherwise stated, the age designated by society/legal system for completion of secondary education, buying and drinking alcohol, enlistment in the military, voting in elections, driving automobiles and marriage all occur significantly before youngsters actually reach their maximal capacity for sound judgment — there is thus a significant mismatch in the modern world between the expectations of society and the actual pace of human development.
Importantly, Twenge and Park (2019) have reported that since the 1970s “fewer adolescents… engaged in adult activities such as having sex, dating, drinking alcohol, working for pay, going out without their parents, and driving.” This observation suggests that despite the longer time taken during adolescence for the transition to adulthood the available time is less effectively utilized and adolescence may be less preparatory for the next stage of life than it used to be. The fact that in recent times interest in and availability of social media and digital forms of experience have increased to unprecedented levels may in part explain this — indeed, for many young people electronic sources of data may displace the actual experience of, and involvement with other human beings, essential for achievement of a healthy passage to adulthood (Holman, Garfin and Silver 2014; Liu, Kamper-DeMarco, Zhang et al. 2022; Dun-Campbell, Hartwell, Maani et al. 2024; Nagata, Otmar, Shim et al. 2025).
Therefore, opportunities for healthy maturation may be compromised and risks for misadventure during adolescence enhanced, especially if one factors in the striking societal burdens adolescents now face, including intense peer pressure, undue societal expectations and demands related to overinvolvement in social media, all of which may adversely influence brain development and set the stage for early emergence of psychopathology (Asch 1956; London and Lim 1964; Botvin 1983; Liu, Peng, Wu et al. 2025; Nagata, Otmar, Shim et al. 2025).
It is not surprising that addictive disorders usually begin during adolescence or young adulthood (Kandel 1978). Additionally, the age group between 18-25 has the highest prevalence of alcohol and drug use disorders across all age categories (Vasilenko, Evans-Polce and Lanza 2017). Various factors contribute to the fact that addictive disorders tend to commence early in life. The challenges and responsibilities inherent in transitioning to adulthood, including evolving relationships within and outside the family, education, work and emerging intimacy can all lead to dysfunctional behaviors and use of drugs of abuse as a means of coping with these many stressful experiences (Martin 2019). However, addiction is not exclusively a disease of the young, but later onset addictive disorders may well be different from the early-onset form — much as is the case in other illnesses like diabetes mellitus — with respect to genetic risk, pathogenesis, diagnosis and treatment (Cloninger 1987).
There have generally been two experimental approaches to investigating the interplay of heightened reward sensitivity, immature decision-making abilities, social pressures, experimentation, risk-taking and underlying vulnerabilities to mental health conditions in the development in adolescence of pathological use of substances and engagement in other dysfunctional addictive behaviors. First, the cross-sectional study of young individuals with addiction intended to identify the characteristics they manifest (Massengale, Glaser, LeLievre et al. 1963; Gilbert and Lombardi 1967). The informativeness of this type of study can be greatly enhanced when the group with drug use disorders are compared with a control group of subjects who do not have the disorder (Zimmering, Toolan, Safrin et al. 1952). These observational studies can determine via a historical perspective the characteristics of those with these disorders and therefore can lead to hypotheses about when and how the disorder first began, namely mechanisms of pathogenesis.
A second approach is the longitudinal study which is considerably more powerful from a scientific perspective. These are initiated before or early in the clinical course of when a cohort of individuals develop the disorder. These subjects can subsequently be followed over time to determine characteristics that predispose to the development of addiction and lead to disease progression (Vaillant 1966, 2003; Kandel 1978). This form of investigation can be particularly useful for mechanistic understanding of the risk of developing addictive disorders and prognostic factors that determine clinical course.
Addictive disorders beginning during adolescence do not always continue into adulthood. Although addictive disorders, once started, have been thought to be characterized by an irrevocably deteriorating life-long progression, there is strong evidence to the contrary. According to a scholarly review of the early literature on spontaneous recovery in alcoholism, Smart (1976) reported that the first study of spontaneous recovery was by Miller (1942) and in subsequent studies spontaneous recovery rates varied from 10% to 42% “for alcoholics not seeking treatment.”
Smart (1976) suggested that: “Investigations of spontaneous recovery should focus on concomitant changes in social stability but also informal “treatment” by friends, relatives and Alcoholics Anonymous.” As Hall intimated, the turbulence of adolescence (“the chief rapids in this river of life”) may diminish once adulthood is reached due to ongoing education, beginning employment and gaining the responsibilities associated with a family.
Adolescence is a critical period for development of the emotional brain and the individual’s self-image. These important developmental processes are built upon individual temperament and previous healthy or abusive/traumatic childhood experiences occurring within or outside the home (Kellam, Ensminger Simon 1980; Felitti, Anda, Nordenberg et al. 1998). Behavioral maturation in adolescence is fueled by exploration and experimentation which may result in engagement in high-risk behaviors and traumatic experiences that challenge existing ways of adaptation and, for some, may cause expression of psychopathological traits or psychiatric disorders. Peers significantly influence adolescent behavior, and if substance use is prevalent within a peer group, it can increase the likelihood of initiation of such behaviors (Kandel 1973).
In addition, access to alcohol and other drugs in the home or community, lack of adult supervision, role models starting substance use can increase the likelihood of adolescent initiation early in life that is associated with increased risk of subsequently developing a use disorder (Richmond-Rakerd, Slutske, Lynskey et al. 2016). Mental health disorders, such as anxiety, depression, ADHD or psychotic disorders can also emerge during adolescence and this enhances the risk of substance use as teens attempt to self-medicate their disturbing emotions — of course, those at genetic risk for addictive disorders per se are most vulnerable (Zimmering, Toolan, Safrin et al. 1952; Richmond-Rakerd, Slutske, Lynskey et al. 2016).
In summary, addiction usually starts in adolescence due to profound growth and maturational changes in the mind and body that are initiated with puberty. Adolescence is thus characterized by the emergence of powerful and hard-to-control emotions. The tumultuous emotions of this stage of life are combined with a remarkable interplay of heightened reward sensitivity, immature decision-making abilities, social pressures, experimentation and underlying vulnerabilities to primary other psychiatric disorders or exposure to substances.
While adolescence is a period of heightened risk for substance use initiation and potential addictive behaviors due to brain development and environmental factors, early onset addictive disorders can also resolve once the responsibilities of adulthood begin and the prefrontal cortex reaches maturity. The development of addiction later in life due to a combination of factors including life stressors and other contributing elements are likely pathophysiologically different disorders that may need their own approach to management.
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June 5, 2025