Substance Use and Abuse in Adolescence

Why do youth use drugs? At what point does drug use become truly problematic? How can we help young people avoid drug abuse and disorders? We touch on these questions on this page, with links to more detailed resources below.

Vulnerabilities and Risk Factors

Normal adolescent brain development may make youth more susceptible to problematic substance use. During adolescence, incentive and reward pathways in the brain are active, while capacity for judgment (prefrontal cortex) is still immature. In other words, in adolescence we are especially sensitive to rewards like pleasure, and we are more willing to take risks in order to get those rewards, even if we understand the harm that could come from our actions. According to the National Institute on Drug Abuse, "addiction occurs when repeated use of drugs changes how a person's brain functions over time."

Some youth have additional vulnerabilities:

• Youth who have a family history of substance disorders are at higher risk. It is important for youth to understand their family history and know that they could have greater vulnerability to addiction.
   
• Untreated mood disorders such as anxiety and depression are linked to substance use. Youth may begin to seek relief from mental health conditions through alcohol and other drugs. The relationship can also go in the other direction: frequent drug use can lead to certain mental health disorders.
   
• If the adults and peers in their environment are using drugs or alcohol, this normalizes use for young people.
   
• Greater tendencies toward sensation-seeking and impulsivity make certain youth more susceptible to using drugs and becoming addicted.
   
• Trauma and adverse experiences in childhood can make drug use more likely.

Stages of Drug Use

One theoretical model posits a continuum of drug and alcohol use from abstinence to dependency. An adolescent's experience with one or more substances might move through some or all of the stages in this order:

1. Abstinence.
    
2. Experimental use: the first one or two times used, often to satisfy curiosity about what intoxication feels like.
    
3. Social use: regular use with peers in low-risk recreational settings, such as weekend use with friends.
    
4. Problem use: use that leads to harmful consequences, such as driving while drunk. In this stage, disinhibition can cause us to do things that we would avoid if sober.
    
5. Abuse: continued use despite negative consequences.
    
6. Dependency/disorders: tolerance is developed to the drug, and withdrawal symptoms are experienced when the drug is not taken.

Adolescents who begin drug or alcohol use early in life are more likely to progress to problematic use and addiction.

How can we help?

There are many ways to help youth avoid problematic use of drugs and alcohol. We can strengthen young people's capacity and motivation to resist drugs by focusing on protective factors: the characteristics, relationships, and supportive environments that buffer against the risk factors described above.

• Individual qualities that protect against drug abuse include positive future orientation, sense of responsibility and purpose, caring for others, and self-esteem. We can foster these qualities in youth by providing meaningful opportunities for contribution.
   
• Parents can make a difference by setting a positive example, fostering open communication, and reinforcing clear expectations.
   
• Positive relationships that lead to a sense of belonging and connectedness at school and in the community mitigate risk.
   
• When their friends and peers are involved in pro-social activities, youth are likely to join in.
   
• Programs can promote the social and emotional competencies that enable us to thrive in all aspects of life.
   
• Adults can teach and model healthy ways to manage stress so that youth are less likely to turn to drugs and alcohol as a form of self-treatment.

Positive youth development is an approach that can help communities create healthy environments for their youth.

Resources

For Health Educators

Substance Use in Adolescents: Basics for Health Educators
ACT for Youth: In this 2019 webinar, Dr. Taylor Starr discusses trends, risk and protective factors, stages of substance use, facts about commonly used substances, and a framework for talking to teens.

HealthTalk.org: Advice to young people about drugs and alcohol
University of Oxford: In these video clips, youth in the UK call on their own experiences to offer advice about alcohol and drugs.

Trends and Prevalence

Monitoring the Future
University of Michigan: Monitoring the Future is a large, annual survey that focuses primarily on drug and alcohol use among 8th, 10th, and 12th grade students.

High School YRBS
CDC: The Youth Risk Behavior Survey (YRBS), conducted every two years with high school students, includes questions on alcohol and other drug use. National and state level data are available.

National Survey on Drug Use and Health
Substance Abuse and Mental Health Services Administration (SAMHSA): This survey provides data on the use of tobacco, alcohol, illicit drugs, and mental health in the United States and at the state level.

Common Drugs

Commonly Abused Drugs Charts
National Institute on Drug Abuse (NIDA): NIDA provides brief descriptions of common drugs, including street names, possible health effects, and treatment options. More detailed information and reports on certain drug categories are also available on this site.

Screening

The CRAFFT Screening Tool
Center for Adolescent Substance Abuse Research: This validated screening tool consists of six questions developed to screen adolescents for high risk alcohol and other drug use disorders.

Addiction and Disorders

DrugFacts - Understanding Drug Use and Addiction
NIDA: This page covers the basics of addiction clearly and succinctly, and links to further resources.

Parent Guides

Talking to Your Child about Drugs
KidsHealth (Nemours): This article includes suggestions for talking to children and adolescents from an early age.

Preventing Teen or Young Adult Drug Use: How to Talk with Your Child
Partnership for Drug-Free Kids: This brief guide for parents emphasizes open-ended questions to engage youth in conversations about drugs.

Talk2Prevent
New York State Office of Alcoholism and Substance Abuse Services: This site provides information on underage drinking and a toolkit for parents.

Information for Teens

TeensHealth: Drugs and Alcohol
TeensHealth (Nemours): In this section of a comprehensive health site for teens, articles on drugs, alcohol, and tobacco include tips on how to quit.

Prevention

Evidence-Based Practices Resource Center
SAMHSA: This Center aims to provide communities, clinicians, policy-makers, and others in the field with the tools they need to incorporate evidence-based practices into their communities or clinical settings.

A Guide to Evidence-Based Practices
SAMHSA: This guide features research findings and details about EBPs used to prevent and treat mental and substance use disorders.

Communities That Care PLUS
University of Washington: Communities That Care is an evidence-based approach that uses positive youth development strategies to decrease alcohol use, tobacco use, violence, and crime.

Treatment

DrugFacts - Treatment Approaches for Drug Addiction
NIDA: This page presents Principles of Effective Treatment, then briefly describes treatment steps and approaches, including medications.

Behavioral Health Treatment Services Locator
SAMHSA: Enter a starting location to find nearby treatment facilities in the U.S. for substance abuse and/or mental health problems.

New York State Links

Office of Alcoholism and Substance Abuse Services (OASAS)
OASAS: This site covers treatment, prevention, recovery, services, training, and regulations applicable in New York State.

Treatment Availability Dashboard
OASAS: On this page, search for state certified outpatient or inpatient programs in New York State.