Topic Overview

What is teen substance use?

Many teens try alcohol, tobacco, or drugs. Some teens try these substances only a few times and stop. Others can’t control their urges or cravings for them. This is substance use disorder. Moderate to severe substance use disorder is sometimes called addiction.

Teens may try a number of substances, including cigarettes, alcohol, household chemicals (inhalants), prescription and over-the-counter medicines, and illegal drugs. Teens use alcohol more than any other substance. Marijuana is the illegal drug that teens use most often.

Why do teens use drugs and alcohol?

Teens may use a substance for many reasons. They may do it because:

• They want to fit in with friends or certain groups.
• They like the way it makes them feel.
• They believe it makes them more grown up.

Teens tend to try new things and take risks, so they may take drugs or drink alcohol because it seems exciting.

Teens with family members who have problems with alcohol or other drugs are more likely to have serious substance use problems. Also, teens who feel that they are not connected to or valued by their parents are at greater risk. Teens with poor self-esteem or emotional or mental health problems, such as depression, also are at increased risk.

What problems can teen substance use cause?

Substance use can lead to serious problems such as poor schoolwork, loss of friends, problems at home, and lasting legal problems. Alcohol and drug use is a leading cause of teen death or injury related to car crashes, suicides, violence, and drowning. Substance use can increase the risk of pregnancy and sexually transmitted infections (STIs), including HIV, because of unprotected sex. Even occasional alcohol use by a teen increases the risk for future alcohol and drug problems.

Even casual use of certain drugs can cause severe health problems, such as an overdose or brain damage. Many illegal drugs today are made in home labs, so they can vary greatly in strength. These drugs also may contain bacteria, dangerous chemicals, and other unsafe substances.

What are the signs of substance use?

It’s important to be aware of the signs that your teen may be using alcohol, drugs, or other substances. Some of the signs include:

• Red eyes and health complaints, such as being overly tired. If your teen often uses over-the-counter eyedrops, he or she may be trying to cover up red eyes caused by smoking marijuana.
• Less interest in school, a drop in grades, and skipping classes or school.
• New friends who have little interest in their families or school activities.
• Chemical-soaked rags or papers, which may mean that your teen is inhaling vapors. Other signs of this are paint or other stains on your teen’s clothing, hands, or face.

What should you do if you find out that your teen is using alcohol, tobacco, or drugs?

If your teen is using alcohol, tobacco, or drugs, take it seriously. One of the most important things you can do is to talk openly with your teen about the problem. Urge him or her to do the same. Try not to use harsh, judging words. Be as supportive as you can during this time.

In most cases, a hostile, angry face-to-face meeting pushes your teen away from the family. If you don’t know what to do or if you feel uncomfortable, ask for help from a pediatrician, psychologist, or psychiatrist.

The type of treatment your teen needs depends on the level of substance use. For example, if your teen has tried drugs or alcohol only a few times, talking openly with him or her about the problem may be all that you need to do. But if your teen has substance use disorder, then he or she needs to be seen by a doctor, a counselor, or both. If your teen is physically dependent on a drug or alcohol, he or she may need to have detoxification treatment or a treatment that replaces the substance with medicine. Medicine works best if it is combined with one-on-one or family counseling, or both.

Returning to substance use, called relapse, is common after treatment. It is not a failure on the part of your teen or the treatment program. Recovery from substance use disorder is hard and takes time. Know that there may be setbacks that your teen will need to overcome one step at a time.

Can teen substance use be prevented?

To help prevent substance use:

• Talk to your child early about what you expect in his or her behavior toward alcohol, tobacco, and other drugs. If your teen thinks that you will allow substance use, he or she is more likely to try drugs or alcohol.
• Keep your teen busy with meaningful activities, such as sports, church programs, or other groups.
• Expect your teen to follow the household rules. Set reasonable consequences for behavior that needs to change, and consistently carry out the consequences.
• Keep talking with your teen. Praise your teen for even the little things he or she does well.
• Know your child’s friends. Having friends who avoid cigarettes, alcohol, and drugs may be your teen’s best protection from substance use.

Facts About Teen Drug and Alcohol Use

How substance use affects teens’ health

Substance use can lead to long-term social and health problems, injury, and even death. Growth and development can be affected by tobacco, alcohol, and drugs. Teens who use these substances may have trouble finding their identity, building relationship skills, and becoming emotionally stable. They also may have trouble preparing for their future. Substance use can affect memory and learning, which can harm a teen’s schoolwork.

And substance use can grow very quickly from experimenting or occasional use to frequent use and substance use disorder in teens at risk.

Tobacco

Nicotine is only one of the thousands of chemicals in tobacco, but it is the major component that acts on the brain. The lungs readily absorb nicotine from the smoke of cigarettes, cigars, or pipes. The tissues of the mouth can also absorb nicotine when a person smokes cigars or pipes or chews tobacco.

Nicotine is one of the most addictive substances. Some teens show early signs of tobacco use disorder within days to weeks after starting to smoke. Repeated tobacco use causes a need for increasingly larger amounts of nicotine to feel the same effect (tolerance). And repeated use causes withdrawal symptoms if the person tries to quit.

Alcohol

Alcohol affects all organs of the body but has its most serious effects on the liver. Alcohol decreases the quality of sleep, especially if a person is using it often to help him or her fall asleep. It can cause problems with brain development in teens. Some teens who drink alcohol regularly may not learn how to handle stressful situations without drinking alcohol.

Alcohol is a sedative. So drinking alcohol makes it harder for a person to think and act quickly. It slows down thinking and moving, and it makes a person less alert. A car crash is more likely when a person drives after drinking alcohol.

Drinking can lead teens to have unprotected sex. This raises the chance of pregnancy and sexually transmitted infections (STIs).

Marijuana

Marijuana can hinder memory, problem-solving, and learning. It can also cause mood swings, anxiety, and depression.

Cocaine

Cocaine can cause abnormal heartbeats, sometimes causing a deadly heart attack, seizure, or stroke.

Other substances

Other substances teens use include:

• Inhalants (glues, aerosol sprays, gasoline, paints, and paint thinners). These are some of the substances most frequently misused by junior high students, because they don’t cost much and are easy to get. They contain poisons that can cause brain damage or, in rare cases, even death with the first use.
• Club drugs like ecstasy (MDMA) and date rape drugs, such as flunitrazepam (Rohypnol) and gamma-hydroxybutyrate (GHB). The number of teens using these drugs is small compared with those using cigarettes, alcohol, and marijuana. But these club drugs can be dangerous, especially in overdose or when combined with alcohol or other drugs.
• Methamphetamine (commonly called meth, crank, or speed). Methamphetamine can cause seizures; stroke; serious mental problems, including paranoia, hallucinations, and delusions; and long-term health problems.
• Hallucinogens, including ketamine, LSD, and PCP (phencyclidine). Serious and lasting problems such as psychosis or hallucinogenic flashbacks can occur after a teen uses LSD.
• Opioids, such as codeine, heroin, and morphine. Teens who use these drugs may steal, prostitute themselves, or resort to other dangerous or illegal behavior to buy drugs.
• Prescription drugs, such as diazepam (for example, Valium), hydrocodone and acetaminophen (Norco), and oxycodone (OxyContin). Teens also use nonprescription medicines, such as cough syrups and cold pills.
• Anabolic steroids, which teens use to build muscle tissue and decrease body fat. Steroids can cause liver cancer and increase the risk of heart attack and stroke.

Why Some Teens Use Alcohol and Drugs

Personal, family, and community factors increase a teen’s risk for using substances and possibly developing a problem.

Personal risk factors

These include:

• Genetics. People with substance use disorder often have a family history of substance use.
• Temperament and personality. Rebelliousness, resisting authority, feelings of failure, and not having close relationships may lead a teen to use substances.
• Certain health problems. Teens who have untreated attention deficit hyperactivity disorder (ADHD), conduct disorder, depression or long-term depressed feelings (dysthymia), post-traumatic stress disorder, or an anxiety disorder are more likely to use alcohol or drugs. Alcohol and drugs may make these conditions worse.
• Drug expectations. Teens often have the wrong ideas about the harmful effects of substances. And they often think that “everybody does it” and so should they.
• Early age at first use.Using alcohol or other drugs at a young age greatly increases a teen’s risk for having substance use disorder.

Family risk factors

Teens are more likely to use alcohol or drugs if:

• A parent uses or overuses alcohol or other substances.
• A parent or teen has depression, anxiety or attention deficit hyperactivity disorder (ADHD).
• They think their parents believe that teens experimenting with alcohol and drugs is expected and normal.
• Their family has frequent conflict, physical or sexual abuse, or stress.
• Parents aren’t involved enough with their teens and don’t supervise them. Harsh or inconsistent punishment or being too lax also can increase the risk of alcohol and drug use.

Community risk factors

These include:

• Access to substances in the home and community.
• Peer influence. A teen may want to fit in with a group of peers, and those peers use substances.
• Promotion of alcohol, cigarettes, and drugs by the media. The entertainment and other media show alcohol and cigarette use as “cool” and as a way to gain popularity, success, and sex appeal.

Prevention Strategies

Teens who don’t use alcohol, cigarettes, and other drugs are less likely to use them as adults. Efforts to prevent teen substance use should begin early in life with education, encouragement of healthy behaviors, and good family bonds.

Positive self-esteem, a supportive family, and positive role models help teens gain confidence to make good choices.

If you live in a high-risk neighborhood or your teen is at high risk for an substance use problem, a community program can help your teen learn skills to avoid substance use.

Even young school children have opinions about substance use. So start early to help your child learn the skills needed to avoid substance use.

Be a role model, and stay connected

• Be a role model. As a parent, your attitude toward alcohol, cigarettes, and drugs is one of the greatest influences on whether your child will use substances. If you have a substance use problem, get help. If you quit, your teen is more likely to get help early if he or she starts using a substance.
• Share your beliefs. Even though they may not act like it, most children listen to what their parents tell them. Talk with your teen about the effects of substances on emotions, schoolwork, and health. If you have a family history of substance use problems, talk with your teen about his or her increased risk for the same problems.
• Stay connected. Know your teen’s friends. Know where your teen is at all times. Set times when the family is expected to be together, such as at mealtimes. Plan family outings or other family fun activities.
• Be fair and consistent. Extremes of discipline can increase the risk of substance use. Set reasonable consequences for unacceptable behavior, and consistently carry them out. Praise your teen for his or her successes. Expect your teen to follow the household rules. Use a parent-teen contract to write down expected behaviors and consequences if the plan is not followed.
• Encourage activities. Keep your teen busy with meaningful activities, such as sports, church programs, or other group involvement. Teens who feel good about themselves are less likely to use alcohol and drugs.
• Get informed. Learn about the substances commonly used by teens. Talk with a doctor. Find out how the drugs work, what their street names are, and what the signs of being under the influence are.

Talk about personal and legal consequences

• Personal consequences. Explain that some behaviors, such as unsafe sex, can lead to consequences that last a lifetime. Talk about how the use of substances while trying to develop adult skills—graduating from high school, going to college, getting a job—can affect your teen’s future.
• Legal consequences. Remind your teen that it is illegal for teens to use any substances. Talk about the increased risk of car crashes, violence, and arrests because of substance use.

Is Your Teen Using Alcohol or Drugs?

Sometimes it’s hard to tell if your teen is using alcohol or drugs. Parents may worry that their teens are involved with drugs or alcohol if they become withdrawn or negative. But these behaviors are common for teens going through challenging times.

It’s important not to accuse your teen unfairly. Try to find out why your teen’s behavior has changed. Tell him or her that you are concerned.

Experts recommend that parents look for a pattern or a number of changes in appearance, behavior, and attitude, not just one or two of the changes listed here.

Change in appearance

• Less attention paid to dressing and grooming
• Loss of appetite or unexplained weight loss
• Red and glassy eyes and frequent use of eyedrops and breath mints

Change in behavior

• Decreased attendance and performance at school
• Loss of interest in school, sports, or other activities
• Newly developed secrecy, or deceptive or sneaky behavior
• Withdrawal from family and friends
• New friends and reluctance to introduce them
• Lying or stealing

Change in attitude

• Disrespectful behavior
• A mood or attitude that is getting worse
• Lack of concern about the future

Taking action

Any use of alcohol, cigarettes, or drugs in childhood or the teen years is a problem, unless it turns out to be a one-time event. If you suspect or see signs that your teen is using substances, check it out. Don’t wait for it to become a big problem.

A home drug screening test provides immediate, early information about whether a urine sample contains drugs such as amphetamine, cocaine, and marijuana. But it does not show which drug has been used, and some tests are inaccurate.

• Substance Use Problems: Dealing With Teen Substance Use

When to See a Health Professional

If you think that your teen is using alcohol or drugs, gather all the information you can before taking your teen to a health professional. This will help ensure an accurate diagnosis.

Health professionals who can diagnose and treat substance use problems include:

• Medical doctors (such as a family physician, general practitioner, pediatrician or psychiatrist).
• A physician assistant.
• A nurse practitioner.

Professional counseling for substance use problems, either individually or in a group setting, can be done by a:

• Psychiatrist.
• Psychologist.
• Social worker.
• Licensed mental health counselor.

Tests

If the health professional believes that your teen may have a substance use problem, he or she will ask about your child’s medical history and will do a physical exam. He or she will ask questions about your teen’s attitude toward substance use, the history of use, and any effects of drug use. The health professional will want to talk with your teen in private.

Urine, blood, or hair drug analysis (toxicology testing) or a blood alcohol test is not usually done to diagnose substance use problems. Health professionals typically will not do these tests without the teen’s consent. Parental consent is not enough unless there is a medical or legal reason for testing.

The health professional may try to find out if your teen has attention deficit hyperactivity disorder (ADHD), conduct disorder, depression, long-term depressed mood (dysthymic disorder), anxiety disorders, or post-traumatic stress disorder. These health problems are common in teens who use substances. Your child’s doctor will want to treat these problems and the substance use.

Referral

Your doctor may refer you to a professional who is experienced in teen alcohol and drug problems.

Early detection

Ideally, when your child is in grade school, your doctor will begin asking about your child’s attitudes toward alcohol, cigarettes, and drugs. As your child grows, the doctor will continue to discuss this issue during medical visits. Getting help at an early age is very important. That’s because early substance use increases the chance that your child will become dependent on alcohol or have other risky behaviors.

A health professional who suspects that you or another family member has a substance use problem will discuss treatment. Getting treatment early for yourself (or another family member) decreases your child’s risk of having a substance use problem. Also, your child will be more likely to get treatment early if he or she does develop a substance use problem.

Finding the Right Treatment for Your Teen

You can help find the right treatment for your teen and help him or her succeed during and after treatment.

• Get the right treatment. Talk with a health professional about treatment options in your area. Adult programs don’t meet the needs of teens. They usually stress long-term health and relationship effects of substance use disorder, which is not a concern for teens. If your teen needs to be placed in an inpatient or outpatient program, look for a program with the features he or she needs. These may include a school program or opportunities for parental involvement.
• Be involved in the treatment and aftercare program. Let your teen know that you support him or her. It may take a long time for your teen to reestablish trust, to be forgiven by you, and to forgive himself or herself.
• Get help for your family. Talk with a health professional about help for you and your family. Your family members need to know that they did not cause the disease, but that their behavior can affect the disease. Support groups such as Al-Anon and Alateen may be very helpful for family members.
• Help establish a direction. Having a sense of direction in life is important for your teen to remain drug-free. Treatment usually includes help to identify talents and strengths. These can be used to find healthy interests, hobbies, and jobs.

Treatment for level of use

The type of treatment your teen gets will depend on how bad his or her substance problem is.

• Experimenting.If your teen has started experimenting with substances, education through a school or community program may be all he or she needs. Some schools have programs for students with alcohol and drug use problems that provide support and drug education.
• Weekly use. If your teen is using a substance at least weekly, some form of treatment is usually needed. It’s important to pay close attention to your teen’s concerns, which may be related to emotional or self-esteem problems. Find activities that your teen can substitute for substance use. Treatment helps motivate the teen to stop using substances and to learn skills to refuse drugs in the future. Family counseling should also be a part of treatment.
• Substance use disorder. Your teen will need treatment in a structured program and may need medical help for withdrawal symptoms. If your teen is physically dependent on heroin or another opioid, he or she may be referred to a methadone treatment program. These programs use the medicines methadone, buprenorphine, or antidepressants such as bupropion (Wellbutrin) to help people cope with the withdrawal symptoms caused by opioid use.
• Tobacco use. Your teen can get help to quit and prevent serious health problems. For more information, see the topic Quitting Smoking.

Types of programs

There are several types of teen substance use treatment programs.

Inpatient programs

Inpatient programs are highly structured and closely supervised in a hospital or treatment center. The teen stays day and night during treatment, which normally lasts about 4 weeks. These programs usually have an aftercare program that provides support and encouragement.

• The programs provide education and individual, family, and group counseling. They are often based on the principles of Alcoholics Anonymous and Narcotics Anonymous.
• Another type of inpatient program is the therapeutic community, which is not based in a hospital. Teens do a series of tasks with constant feedback from peers. These programs may last up to 2 years. Some teens choose to stay and work in the program after treatment.
• Wilderness challenge programs combine a wilderness experience and some form of treatment. The goal is to help troubled teens communicate better with their families, control their anger, and build healthy relationships. A variety of programs are available. Their quality varies greatly. They are expensive and tend to limit contact with parents. Talk with a health professional if you are considering sending your teen to one of these programs.

Outpatient programs

Outpatient programs range from very structured programs with psychotherapy and family therapy to drop-in centers.

• These programs require that the teen spend 8 hours or more during the day at the facility, but the teen is home at night. Day treatment programs usually have the same features (individual, group, and family counseling) as inpatient programs. But day treatment normally costs less.
• Less intensive outpatient programs are designed for young people who do not need as much time in day treatment or to be in an around-the-clock treatment center. Treatment includes one-on-one or group counseling and family therapy. Treatment in the teen’s own community makes it easier for the family to be involved.

Whatever type of program you choose, it should consider teen developmental issues, such as peer pressure and the need to test limits. The treatment also needs to provide a way for your teen to continue his or her education. It may boost your teen’s self-confidence and self-esteem if he or she can do even small academic tasks during treatment.

What to do if your teen relapses

Getting a teen to stop using alcohol, cigarettes, or other drugs is only the first step. Substance use fills an emotional need. That need has to be found and satisfied in a healthy way for your teen to be able to stay off the substance.

Returning to substance use (having a relapse) after treatment is common. It’s not considered a treatment failure. Most relapses occur within the first 3 months after treatment. Most often, teens need to go through treatment more than once and follow a long recovery process.

Your teen is less likely to relapse if:

• The treatment program motivates him or her to stop using and to learn the skills to deal with drug cravings, high-risk situations, and relapse.
• Your teen can commit to being substance-free for 12 to 24 months.
• Your teen has or finds a healthy hobby or interest.
• Your teen gets treatment for other health problems he or she may have, such as attention deficit hyperactivity disorder (ADHD), depression or long-term depressed mood (dysthymia), post-traumatic stress disorder, or an anxiety disorder.
• Your teen is involved in an aftercare program or case management.