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 abuse.
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 abuse 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.
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 abuse 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 abuse cause?
Substance abuse can lead to serious problems such as poor schoolwork,
loss of friends, problems at home, and lasting legal problems. Alcohol and drug
abuse is a leading cause of teen death or injury related to car crashes,
suicides, violence, and drowning. Substance abuse can increase the risk of
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.
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 abuse?
important to be aware of the signs that your teen may be abusing 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.
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
psychologist, or psychiatrist.
The type of treatment your
teen needs depends on the level of substance abuse. 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 a
substance abuse problem, then he or she needs to be
seen by a doctor, a counselor, or both. If your teen is addicted to 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.
to substance abuse, called relapse, is common after treatment. It is not a
failure on the part of your teen or the treatment program. Recovery from
addiction 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 and abuse be prevented?
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.
your child's friends. Having friends who avoid cigarettes, alcohol, and drugs
may be your teen's best protection from substance abuse.
Health Tools help you make wise health decisions or take action to improve your health.
Actionsets are designed to help people take an active role in managing a health condition.
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 abuse 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 abuse can affect memory and learning, which can
harm a teen's schoolwork.
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 addiction 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.
Inhalants (glues, aerosol sprays,
gasoline, paints, and paint thinners). These are some of the substances most
frequently abused 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 abusing these drugs is small compared with
those abusing 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
Hallucinogens, including ketamine, LSD, and PCP
(phencyclidine). Serious and lasting problems such
as psychosis or hallucinogenic flashbacks can occur after a teen uses
Opiates, 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 (Vicodin), and oxycodone (OxyContin). Teens also abuse 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 Abuse Alcohol and Drugs
family, and community factors increase a teen's risk for using substances and
possibly developing a problem.
Personal risk factors
Genetics. People with alcohol and drug abuse
problems often have a family history of substance abuse.
Temperament and personality. Rebelliousness, resisting
authority, feelings of failure, and not having close relationships may lead a teen to use substances.
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 an abuse problem.
Family risk factors
Teens are more likely to use alcohol or drugs if:
A parent uses or abuses alcohol or other substances.
A parent or teen has
attention deficit hyperactivity disorder
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 abuse.
Community risk factors
Access to substances in the home and community.
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.
Teens who don't use alcohol,
cigarettes, and other drugs are less likely to use them as adults. Efforts to
prevent teen substance abuse should begin early in life with education, encouragement of healthy behaviors, and good
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 abuse problem, a community program can help your teen learn
skills to avoid substance abuse.
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 abuse problem, get
help. If you quit, your teen is more likely to get help early if he
or she starts abusing 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 abuse 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 abuse. 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 abused 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?
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
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
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
Loss of appetite or unexplained weight
Red and glassy eyes and frequent use of eyedrops and breath
Change in behavior
Decreased attendance and performance at
Loss of interest in school, sports, or other
Newly developed secrecy, or deceptive or sneaky
Withdrawal from family and friends
friends and reluctance to introduce them
Change in attitude
A mood or attitude
that is getting worse
Lack of concern about the future
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
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.
health professional believes that your teen may have a substance abuse 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
abuse 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.
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 abuse problem will discuss treatment.
Getting treatment early for yourself (or another family member) decreases your
child's risk of having a substance abuse problem. Also, your child
will be more likely to get treatment early if he or she does develop a
substance abuse 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 abuse, 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 abusing 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.
Dependence on alcohol or drugs. Your teen will need treatment in a structured
program and may need medical help for withdrawal symptoms. If
your teen is addicted to heroin or another opiate, he or she may be referred
to a methadone treatment program. These programs use the medicines
buprenorphine, or antidepressants such as bupropion
(Wellbutrin) to help people cope with the withdrawal symptoms caused by opiate
Dependence on tobacco. Your teen can get help to quit and prevent serious health problems. For more
information, see the topic
Types of programs
There are several types of teen
substance abuse 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.
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 range from very structured programs with psychotherapy and family therapy to
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
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
Your teen is involved in an aftercare program or case
Other Places To Get Help
National Institute on Drug Abuse (NIDA) (U.S.)
National Institute on Alcohol Abuse and Alcoholism: The Cool Spot (U.S.)
National Institute on Drug Abuse: NIDA for Teens
Alcoholics Anonymous (AA) World
Partnership for a Drug-Free America
Nemours: KidsHealth for Parents/for Kids/for Teens/for Educators (U.S.)
Nemours: KidsHealth for Parents/for Kids/for Teens/for Educators (U.S.)
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 (2010). 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.
Moeller FG (2011). Drug abuse and dependence. In EG Nabel, ed., ACP Medicine, section 3, chap. 6. Hamilton, ON: BC Decker.
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.
ByHealthwise Staff Primary Medical ReviewerPatrice Burgess, MD - Family Medicine Specialist Medical ReviewerPeter Monti, PhD - Alcohol and Addiction
How this information was developed to help you make better health decisions.