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.
Teens may use a substance for many reasons. They may do it because:
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.
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.
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:
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.
To help prevent substance use:
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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.
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 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.
Marijuana can hinder memory, problem-solving, and learning. It can also cause mood swings, anxiety, and depression.
Other substances teens use include:
Personal, family, and community factors increase a teen's risk for using substances and possibly developing a problem.
Teens are more likely to use alcohol or drugs if:
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.
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.
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.
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:
Professional counseling for substance use problems, either individually or in a group setting, can be done by a:
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.
Your doctor may refer you to a professional who is experienced in teen alcohol and drug problems.
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.
You can help find the right treatment for your teen and help him or her succeed during and after treatment.
The type of treatment your teen gets will depend on how bad his or her substance problem is.
There are several types of teen substance use treatment 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.
Outpatient programs range from very structured programs with psychotherapy and family therapy to drop-in centers.
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.
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:
Other Works Consulted
- American Academy of Child and Adolescent Psychiatry (2005). Practice parameter for the assessment and treatment of children and adolescents with substance use disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 44(6): 609–621.
- American Cancer Society (2012). Child and teen tobacco use. Available online: http://www.cancer.org/cancer/cancercauses/tobaccocancer/childandteentobaccouse/index.
- Bukstein OG (2009). Adolescent substance abuse. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3818–3834. Philadelphia: Lippincott Williams and Wilkins.
- Centers for Disease Control and Prevention (2010). Youth risk behavior surveillance—United States, 2009. MMWR, 59(SS-5): 1–142.
- Johnston LD, et al. (2012). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2011. Ann Arbor: Institute for Social Research, The University of Michigan. Available online: http://monitoringthefuture.org/pubs/monographs/mtf-overview2011.pdf.
- Shonkoff JP, et al. (2012). The lifelong effects of early childhood adversity and toxic stress. American Academy of Pediatrics, 129(1): e232–e246. Available online: http://pediatrics.aappublications.org/content/129/1/e232.full.html.
- Stager MM (2011). Substance abuse. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 671–685. Philadelphia: Saunders.
- Substance Abuse and Mental Health Services Administration (2012). Results From the 2010 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-42, DHHS Publication No. SMA 11-4667). Available online: http://www.samhsa.gov/data/NSDUH/2k10MH_Findings/2k10MHResults.htm.
Current as of: February 11, 2021
Author: Healthwise Staff
Medical Review:Patrice Burgess MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & Martin J. Gabica MD - Family Medicine & Kathleen Romito MD - Family Medicine & Peter Monti PhD - Alcohol and Addiction & Christine R. Maldonado PhD - Behavioral Health
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