In the past few years, there has been an alarming rise in substance use amongst youth in the U.S. The National Center for Drug Abuse Statistics reports that 2.08 million, or 8.33%, of 12- to 17-year-olds report using drugs in the last month. They deemed this issue a public health crisis.
These statistics can be frightening for parents as they try to protect their teens. But with an understanding of why so many youths are resorting to substance use, parents can feel empowered to utilize preventative measures and quickly get help for their teens if needed.
Here, Gabriela Hernandez, a licensed clinical social worker at Cherese Mari Laulhere Mental Health Inpatient Center at CHOC, addresses parents’ common questions about substance use and abuse amongst teens, and what they can do to help.
Why are teens exploring substance use?
Substance use is usually a symptom of a greater problem like a mental health issue, trauma, stress or pressure. There may be a variety of reasons that kids and teens are exploring substance use, like:
- Peer pressure. Adolescents are often motivated to seek new experiences, particularly those they perceive as thrilling or daring. If they are a part of a group of friends or peers where substance use is accepted or encouraged, there is a greater chance that they will participate or experiment in order to fit in.
- Conflict at home. In homes with intense conflict (more than just a disagreement), youth may use substances as an escape from their pain.
- Rebelling against parents. If a teen isn’t getting along with their parents or family, they may turn to substances to lash out.
- Trauma. Many young people begin taking drugs to numb the physical or emotional pain associated with trauma. Gabriela says that a large portion of the patients that CHOC sees for substance abuse have an underlying trauma or an adverse childhood experience (ACE) that they are trying to sort through.
- Poor performance at school. Some adolescents may turn to certain drugs like prescription stimulants because they think those substances will enhance their ability to do homework and improve their grades.
- Genetics. Teenagers with parents, grandparents or other relatives who had or have substance-use issues are more likely to develop an addiction.
- Self-image issues. Young people may begin taking stimulants to lose weight or seek an unrealistic body type. In these cases, it’s common for eating disorder behaviors to be mixed with substance use.
Understanding the teen brain
It’s important that parents understand teen development and why teens may be so susceptible to using substances based on the reasons mentioned above, says Gabriela. During this age, teens’ brains are still developing, and they may be easily influenced by their surrounding peers and environments.
Some typical behaviors of teens during this developmental period may include:
- Decision-making is influenced by emotions rather than consequences.
- Emotional regulation is difficult. Teens may be driven by their strong emotions rather than reason.
- Peer approval is rewarding to the brain. They want to be accepted and safe in a social group and they may be influenced to better maintain that connection.
- Teens need larger doses of risky behavior than adults to feel a rush.
- They think they are the center of the universe. Teens often think that they are having a unique experience like they are the only one who feels a certain way and no one else may understand.
For teens at this stage, using substances may feel rewarding to them and they may not recognize the consequences. And because their brain is still developing, they are at the highest risk for addiction during this period.
What are the types of substances that teens may be using and how do they get them?
Gabriela explains the different classes of substances and the common drug names that may be commonly accessed by teens. These include illicit (or illegal) drugs, prescription medications and other substances like:
- Cannabis, such as tetrahydrocannabinol (THC) and marijuana.
- Cocaine and methamphetamines.
- Prescription stimulants, such as ADHD medications.
- Inhalants, such as gas and solvents.
- Synthetic substances, like synthetic cannabinoids (also known as synthetic marijuana, K2 or spice) or synthetic cathinone (known as bath salts).
- Hallucinogens like lysergic acid diethylamide (LSD), acid or mushrooms.
- Methylenedioxymethamphetamine (MDMA) like ecstasy or molly.
- Prescription pain relievers, like opioids or sedatives.
In the U.S., there has been an increasing trend of teens using new substances such as synthetic drugs and prescription pills.
Part of that increase is due to the prevalence and access to these substances on social media. A teen can find someone with the substance online, request it online, pay online and then set up a time to meet – all without a parent or guardian noticing. And, once the teen does have the physical substance, it may be a small pill that doesn’t smell and can’t be easily detected. Many substances may also be easily concealed in vape pens.
A teen may also try to get prescription medications or other illicit substances from an adult family member or friend. Gabriela suggests that parents always keep track of what medications they have at home and make sure to lock them in a medicine cabinet or medicine lockbox (which can be easily purchased online).
What is the difference between substance use and substance abuse or addiction?
Substance use and substance abuse or addiction often get used in the same terminology, says Gabriela, but they are different.
Substance use is usually recreational or experimental. Typically, those who are using substances:
- Have only used the substance once or twice.
- Participate in using substances only on the weekend and not to the point of intoxication.
- Are social when using substances; they use them around others.
- Can stop at any time.
- Usually use marijuana or alcohol rather than stronger drugs like opioids.
- Can stop the behavior with a simple reprimand like getting caught by parents or their school. In these cases, the teens can recognize the consequences and are willing to stop the behavior.
On the contrary, those who may be addicted or abusing substances typically:
- Feel like they must use the substance regularly or daily.
- Have intense urges to use the substance that block out any other thoughts.
- Need higher doses of the substance over time to get the same effect.
- Take larger amounts of the substance over a longer period of time than intended.
- Go to great effort to maintain a supply of the drug.
- Continue to spend money on the drug even if they can’t afford it.
- Fail to meet obligations and school responsibilities or begin cutting back on social or recreational activities because of drug use.
- Continue to use the drug, even though they know it’s causing them physical or psychological harm.
- Do things to get the drug that they normally wouldn’t do, such as stealing from family members or friends.
- Participate in risky activities when they’re under the influence of the drug.
- Are stuck in a cycle of getting the drug, using the drug or recovering from the effects of the drug.
- Fail in their attempts to stop using the drug. They may not want to stop or think the consequences are severe enough to stop using.
- Experience withdrawal symptoms when they attempt to stop using the substance.
How can substance use lead to substance abuse or addiction?
Occasional, recreational or explorational substance use easily leads to substance abuse and addiction if not stopped by parents, educators or law enforcement. Teens who are using substances may continue to do so because:
- It feels good. With the substance, the brain produces feelings of pleasure and euphoria. It may be thrilling for the teen to use the substance, and they may start to crave that thrill.
- Substances may help them feel better by being avoidant or numb. With substances, teens may not have to deal with even temporary stressors. Over time, whenever they feel an emotion, they may want to relieve it through substances.
- Parents or peers may be giving them attention.
- They are fitting in with peers that are also using substances. Teens may feel a part of a group that is risky, thrilling and fun.
How do I know if my teen is abusing substances/drugs?
Parents can keep an eye out for behaviors that may indicate that their teen is using or abusing substances. These behaviors include:
- Problems at school. Your teen may be frequently missing school or work, show a sudden disinterest in school activities or have a significant drop in their grades.
- Physical health issues. Your teen may have a lack of energy and motivation; experience weight loss or gain; have red eyes; or have an excess of energy.
- Neglected appearance. Your teen may show a lack of interest in clothing, grooming or looks. They may also have a hard time getting through the day and completing daily tasks like brushing their teeth or taking a shower.
- Changes in behavior. Your teen may start to show exaggerated efforts to bar family members from entering their room or may start to be secretive about where they are going and who they are seeing. There might be sudden, drastic changes in relationships with family and friends
- Money issues. Your teen may make sudden requests for money without a reasonable explanation, or you may notice that money is missing or has been stolen.
What kinds of substance use treatments for available for teens?
Parents should look to resources to help their teens overcome substance use or abuse. Depending on the severity of their using habits, different treatment options may be better suited for different teens. Of course, parents are the experts on their teens and should consult their teen’s doctor to pick the treatment plan that’s best for their family.
Many schools and community centers will offer educational programs that warn teens about the consequences of substance use and inform parents about access. There are also mentoring programs that can help teens connect and get help with issues, so they don’t turn to substance use in the first place.
If intervention is needed, there are several different kinds of treatment programs available to families. Parents will want to consult their primary care physician for referrals and check to see what their health insurance may cover.
Substance use treatment options include:
- Residential treatment centers (RTC). Typically, a patient will go to a treatment facility and stay there for about 30 days. Treatment often includes individual and group therapy to treat their most urgent need of substance abuse and then mental health in general. There are usually specific treatment centers for specific substances.
- Partial hospitalization programs (PHP). PHPs are intense therapeutic programs that last several hours a day for multiple days a week. A patient will spend most of the day at the facility receiving treatment and then return home at night. The PHP may last around 10 to 12 weeks and may replace school.
- Intensive outpatient programs (IOP). IOP programs typically occur two to five days per week and involve therapy and treatment appointments. CHOC’s intensive outpatient program typically involves three-hour appointments, four days a week, involves parents and focuses on overall mental health.
- Outpatient therapy. This consists of seeing a specialist once a week. It’s important to make sure that the therapist has experience with substance use. They should be able to address why the teen needs to turn to substances, and how to replace substances with something healthy.
- Self-help groups. Programs like Alcoholics Anonymous/Narcotics Anonymous or Al-Anon/Alateen take place in a group setting and can help teens connect to others that have had similar experiences.
Attachment-based Family Therapy
Attachment-based family therapy can be an effective treatment strategy for teens who may be turning to substances as a coping mechanism for previous traumatic experiences with family. It uses an evidence-based approach for treating depression and anxiety in adolescents by repairing damage in the family system and rebuilding trust within the parent-child relationship.
This type of therapy is based on attachment theory (the psychological theory concerning relationships between humans) and explores how one’s childhood experiences might impact their ability to form meaningful bonds. Because substance use takes a toll on the entire family, families must work together in treatment.
How can I help my teen who is using substances/drugs?
Parents can help their teens struggling with substance use and abuse by playing an active role in preventing substance use, helping them quit, getting the necessary treatment and recovering. Parents should keep the following strategies in mind when navigating substance use with their teens:
- Don’t minimize experimentation. Don’t normalize your teen occasionally using substances. Instead, set the expectation that you don’t want that for them, and promote other activities for them to have fun and be social.
- Don’t ignore mental health issues or risk factors. If a teen is using substances, the cause may have started two to three years earlier. Keep an eye on your teen’s behavior. Have they experienced anxiety or depression for months?
- Consider your family history. If a parent or family member has a substance use issue, sometimes families don’t consider or address it.
- Be honest about your own substance use. It’s important to set a good example for your teen. Have you developed a habit of drinking alcohol to unwind after work? Be transparent with your teens.
- Respond promptly to changes in behavior. Respond to mental health red flags swiftly and appropriately. Have direct conversations and address behaviors with a counselor, doctor or mental health professional if needed.
- Don’t blame yourself. Don’t let past issues in your relationship with your teen get in the way of intervening. It’s important to set aside guilt and keep your teen accountable for their actions; you can always repair past experiences and ruptures.
- Be flexible. To quit using a substance is a process, and relapse and setbacks may be part of it. There are no mistakes in substance use recovery so be patient with your teen.
- Don’t confuse intelligence with maturity. Even if your teen is excelling academically, it doesn’t mean they will make the best decisions around their peers.
- Lock up your alcohol or medications. Reduce access to your substances even if you don’t detect that your teen may be looking for them.
- Get help. If you sense that your teen is struggling with mental health issues or substance use, intervene as soon as possible.
The elements of changing a behavior
When trying to change a behavior — such as a teen quitting their use of substances — it’s important to keep the following in mind, says Gabriela. These stages of change are not linear and may shift back and forth. The elements of changing a behavior include:
- Readiness to change. As the parent, do you have the resources and knowledge to make a lasting change successful? Make sure to access resources and support from treatment programs and your teen’s doctor or mental health professional.
- Barriers to change. Determine if there may be anything preventing your teen from changing. Are they still in the same friend circle that is using substances? Is it hard for them to develop friendships or are they struggling with another mental health issue?
- Likelihood of relapse: What might trigger a return to a former behavior? It’s important for parents to be open, assess a successful change and persevere through setbacks.
If you can sense that your child may be struggling and using substances as a means to escape, access resources like a school counselor, your pediatrician and CHOC’s mental health toolkit for support.
Additional support is available through Substance Abuse and Mental Health Services (SAMHSA). Call 1-800-662-HELP (4357) for treatment referral. SAMHSA’s National Helpline is free and confidential, with a year-round treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
Watch Gabriela’s full webinar on this topic as part of CHOC’s Mental Health Education Program (MHEP), which offers free webinars to parents on a variety of relevant mental health subjects. To view upcoming webinars, view the MHEP events calendar.
For more health and wellness resources from the pediatric experts at CHOC, sign up for the Kids Health newsletter.
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