Drug Addiction and Abuse in Adolescents

Helping your child navigate the choppy waters of adolescence is probably one of the most difficult parenting tasks of all. Teens are hard-wired to stretch their wings, try new things, and take risks to learn about themselves and grow into young adults. Unfortunately, experimenting with mind-altering substances is a dangerous temptation many teens find irresistible and consider one of their rites of passage.

As a parent, the thought of your teenager using street drugs can be terrifying. It may be so terrifying you refuse to believe it can happen – but statistics show that it can and does happen. In addition, your personal experience as a teenager most likely confirms the possibility: almost everyone knows people from high school who either experimented with illicit drug occasionally or used them regularly. Therefore, you need to be open to the idea that your teen may decide to experiment with illicit drugs, too. Accepting the possibility and increasing your awareness are two of the most important things you can do to recognize drug use in your teen and intervene if they decide to venture down this precarious path.

This guide is designed to help you know what to look for and what to do if you suspect your child is abusing illicit drugs.

Adolescents: Drug Addiction and Abuse

First, we want to clarify the terminology around illicit drug abuse. The clinical term for illicit drug abuse – often called substance abuse or drug addiction – is substance use disorder, often written with the acronym SUD. This terminology reflects a change in the way we talk and think about illicit drug use in general. To reduce stigma and misunderstanding around the use, misuse and/or disordered use of illicit substances, we now refer to an individual diagnosed with SUD as a person with a substance use disorder rather than an addict, drug abuser, or junkie.

This change in terminology reflects the change in addiction treatment away from the old model that held that drug addiction is a character flaw or moral failing, toward the disease model of addiction, which asserts that substance use disorder is a chronic, relapsing disease that responds positively to evidence-based treatment, much the same way that chronic medical conditions like diabetes or hypertension are chronic relapsing diseases that respond positively to evidence-based treatment.

What is Substance Use Disorder?

The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a general definition of SUD that helps clarify the basics of this complex condition:

“Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.”

That definition is a good place to start. However, as the parent of an adolescent who may have a substance use disorder, it’s important to go deeper, and understand what a clinician – i.e. a mental health professional specializing in addiction – might look for when determining whether someone meets the clinical threshold for SUD.

The Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-V) is the go-to reference for mental health professionals. According to the DSM-V, SUD appears in three categories: mild, moderate, and severe. The presence of two or three of the following symptoms indicates a mild SUD, the presence of four or five indicates moderate SUD, and the presence of six or more of the following symptoms indicates a severe SUD.

Substance Use Disorder (SUD) Symptom Checklist

1. Taking an illicit substance in larger amounts or for longer than intended.
2. Inability to stop or limit using the substance despite wanting to stop or limit use.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Impaired ability to fulfill work, home, or school responsibilities because of substance use.
6. Continued substance use, even when it causes problems in relationships.
7. Withdrawing from social, occupational, or recreational activities because of substance use.
8. Continued substance use in dangerous or risky situations.
9. Continued substance use despite physical or psychological problems caused or exacerbated by substance use.
10. Requiring more of the substance to get the same effect.
11. Developing withdrawal symptoms, and/or taking the substance to avoid withdrawal symptoms.

Again, clinicians identify the presence of two or three symptoms as mild SUD, the presence of four or five symptoms as moderate SUD, and the presence of six or more symptoms as severe SUD.

Remember: only a mental health professional can diagnose SUD. We present the list above for your knowledge and understanding of the clinical criteria used to diagnose SUD. If you think your teen meets the criteria, then your first step should be to seek professional support – but we’ll discuss that in detail below.

Now we’ll define exactly what we mean by illicit drugs.

What Are Illicit Drugs?

Any drug used illegally is considered an illicit drug.

The term typically refers to illegal recreational drugs as well as legally prescribed medications used for recreational purposes. This guide, however, will focus on common recreational drugs of use, misuse, and disordered use, including:

• Hallucinogens such as LSD, PCP, psilocybin, and mescaline.
• Cannabinoids such as marijuana, hashish, or vaporized THC.
• Stimulants such as cocaine and methamphetamine.
• Opioids such as heroin and morphine.
• Club/Party Drugs such as ecstasy, Rohypnol, GHB, and ketamine.
• Anabolic steroids found in dietary supplements and/or procured illegally online.

Illicit drugs come in many forms, such as pills, powder, liquids, and oils. Marijuana, one of the most commonly used illicit drugs, is a dried plant/flower. Illicit drugs are consumed in a variety of ways, such as smoking, injecting, drinking, or inhaling. Parents should know that every drug listed above has multiple street names. Many of these names sound completely innocent, such as brown sugar for heroin, chalk for methamphetamine, and soap for GHB.

Drug Use Among Adolescents: The Statistics

The following facts and figures show important information for parents regarding substance use among adolescents. The complete data sets are published by the Centers for Disease Control (CDC) as part of the annual Youth Risk Behavior Survey (YRBS). Parents can find these general facts statistics online in the 2019 YRBS and on resources pages published by The National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Adminitration (SAMHSA).

Substance Use and Teens: Key Facts

• 23.9% of adolescents age 12-17 reported using illicit drugs at least once
  • 17.2% used illicit drugs in the past year
  • 8.7% used illicit drugs in the past month
• 7.5% of adolescents age 12-17 reported using an illicit drug other than marijuana in the past year
• 35.7% of 12^th graders reported using marijuana in the past year
• 28.8% of 10th graders reported marijuana in the past year
• 11.8% of 8th graders reported marijuana in the past year
• Vaping marijuana is the most common way teens use illicit drugs
  • 20.8% of 12^th graders reported vaping marijuana in the past year
    • 14% reported vaping marijuana in the past month
    • 3.5% reported vaping marijuana daily
  • 19.4% of 10^th graders reported vaping marijuana in the past year
    • 14% reported vaping marijuana in the past month
    • 3.5% reported vaping marijuana daily
  • 7.0% of 8^th graders reported vaping marijuana in the past year
    • 3.9% reported vaping marijuana in the past month
    • 0.8% reported vaping marijuana daily
• Long term use of illicit drugs damages vital organs, particularly the heart, liver, and brain.
• Smoking or vaping marijuana damages the lungs.

The Importance of Parental Involvement

A report from Partnership for a Drug-Free America published in 2013 showed that, statistically speaking, parental involvement is the best way to prevent substance use and misuse in teens. The data in the report demonstrate that teens are less likely to initiate drug use when their parents clearly communicate their disapproval of drug use, and that teens are less likely to initiate drug use when parents clearly communicate the risks associated with drug use.

However, the same data show that 34 percent of parents feel powerless in preventing their teen from using drugs, and that if a teen learns about the risks associated with drugs from peers rather than parents, they’re more likely to initiate drug use. In light of this information, it’s clear that parents – whether they think it will have an effect or not – should both express their disapproval of illicit drug use to their teens, and educate them about the risks of illicit drug use.

Looking for and Recognizing the Signs of Illicit Drug Abuse

No responsible parent wants their teen using illicit substances, developing a substance use problem, or developing and substance use disorder. The temptation for teens, however, is great. Drugs are not as easily accessible as alcohol, but they are fairly easily accessible – and that increases both temptation and risk for teenagers. If you accept the possibility that your teen may experiment with drugs and runs the risk of developing a substance use disorder, you’re more likely to notice the warning signs.

One of the most important things to remember when looking for signs of drug use and misuse is to watch for and pay close attention to any changes in your teen’s typical behavior, mood, or personality.

General signs of illicit drug abuse:

• Secretive behavior such as sneaking around, hiding, or attempting to hide things
• Spending increasing amounts of time alone in their room
• Increased need or demand for privacy
• Persistent lying
• Borrowing, stealing, or selling valuables
• Mood swings
• Erratic behavior
• Irritability, anger, or agitation
• Sudden drop in grades
• Skipping school or work
• Decreased interest in activities they once enjoyed, such as sports, clubs, and/or extracurricular activities
• Drastic changes in sleep or appetite
• Decrease interest in personal hygiene and basic grooming
• Withdrawal from friends and family 

Signs of use by type of illicit drug:

Hallucinogens:

• Perceptual distortions involving space and time
• Visual hallucinations
• Euphoria
• Paranoia
• A sense things aren’t real
• Disorientation
• Disturbing flashbacks
• Anxiety
• Dizziness
• Depression

Cannabinoids:

• Frequent use of air fresheners, incense, perfume, or cologne
• Rolling papers, pipes, bongs (water pipes), small baggies
• Lack of motivation, lethargy
• Paranoia
• Poor coordination
• Bloodshot eyes
• Dry mouth
• Increased appetite/cravings for junk food and/or sweets
• Slowed reaction time
• Laughing for no reason; acting silly
• Odor of marijuana in room or on hair, clothing, and belonging
• Anxiety or feelings of panic

Stimulants:

• Exhilaration
• Increased energy
• Low appetite/rapid weight loss
• Staying awake for lengthy periods of time
• Insomnia
• Restlessness
• Anxiety
• Violent behavior
• Paranoia
• Psychosis
• Skin sores
• Decaying teeth
• Dizziness
• Frequent sniffing or nose bleeds

Opioids:

• Euphoria
• Sleepiness
• Confusion
• Fatigue
• Slurred speech
• Slowed breathing
• Flu-like symptoms
• Injection marks

Club Drugs:

• Excitement
• Euphoria
• Memory loss
• Slurred speech
• Lowered inhibition
• Anxiety
• Depression
• Confusion
• Memory problems
• Paranoia
• Aggressive or violent behavior
• Sweating/chills
• Drinking large amounts of water
• Dilated pupils
• Hallucinations
• Clenched teeth or jaw
• Sleepiness

Anabolic Steroids:

• Paranoia
• Aggressive or violent behavior
• Hostility or rage
• Irritability
• Physical changes such as breast development or hair loss in males/development of facial hair or a deeper voice in females

The list above is far from complete, but it should give you a good idea of what to look for. It’s important to remember that these are all potential warning signs of illicit drug use, misuse, or abuse, and not unequivocal proof. Many of these signs or symptoms could be caused by an undiagnosed mental health disorder or a medical condition, and many of the behaviors listed above could be typical adolescent differentiation.

If you suspect your teen uses, misuses, or abuses illicit drugs – after recognizing the signs – then it’s important to arrange a full assessment and evaluation with a healthcare professional. This is more than important: it’s essential. If you see the signs, don’t ignore them or assume your child is just going through a phase.

Knowing the First Steps to Take

If you know for a fact your teen uses, misuses, or abuses illicit drugs, it’s time to be proactive. Don’t hope or assume the drug use will go away by itself over time. If they begin experimenting with drugs as an early adolescent, they have an increased risk of developing substance use disorder (SUD) later in adolescence or as an adult. That’s why ignoring drug use or thinking of it as typical teenage behavior is a mistake.

Here are three initial steps you can take to address the problem of illicit drug use:

1. Talk to your teen.

An open, honest, and calm conversation with your teen is the best place to start. Strive to keep any negative emotions, such as disappointment, anger, or fear at bay as you express your concerns. Avoid lecturing, scolding, or confronting your teen. Those behaviors almost always backfire, and rather than facilitating communication, they increase the chance your teen will shut down and tune you out completely. Instead of being angry or confrontational, let your teen know you genuinely want to understand and listen to whatever they have to say. Understand that your teen may not be willing to talk, especially if the lines of communication have been damaged or strained for some time. That’s okay: this conversation won’t instantly restore those lines of communication, but it is the first step.

2. Set up an appointment for an evaluation.

One option for an evaluation is with your family doctor or your child’s pediatrician. Their doctor can do a physical examination including lab tests to check for drugs in their system unless too much time has passed. A physical exam can also rule out any underlying medical issues that could be causing some of the signs you’ve noticed. Also, your doctor can give you a referral or recommendation for treatment.

Another option is to have your child evaluated by a psychologist, psychiatrist, or another mental health professional – preferably one who specializes in or has experience with treating substance use disorder (SUD) in the adolescent population. A mental health evaluation can help determine if your teen has any emotional issues or an undiagnosed mental health disorder, such as anxiety or bipolar disorder, that may the root cause of drug use, misuse, or abuse. Many teens use drugs to cope with stress, alleviate troubling mental health symptoms, or numb negative emotions.

A third option for an evaluation is an adolescent drug and alcohol treatment center: they’re the most likely place to find psychiatrists, therapists, or counselors with experience treating adolescent SUD.

3. Seek appropriate treatment and support.

 Once your child receives a professional evaluation and assessment, the assessing provider will offer treatment recommendations. These recommendations will be determined by your teen’s specific needs, the severity of the drug abuse, and the length of the drug abuse.

Recommended treatment may include:

• Individual or group therapy or alcohol and drug counseling. This level of treatment usually involves weekly sessions lasting one to two hours. These sessions may be incorporated into a more intensive level of treatment – discussed below – as needed.
• Dual-diagnosis treatment. This treatment is recommended if your teen has a co-occurring mental health disorder in addition to their alcohol use disorder. Treatment focuses on treating both rather than focusing on only one or the other.
• Substance use disorder rehabilitation. Rehab is offered at various levels of intensity depending on your child’s needs and the severity of the problem. We offer details about the levels of care below.
• Medication. Medication may be prescribed for teens to help alleviate serious drug withdrawal symptoms, reduce agitation or psychotic symptoms, or to help treat a co-occurring mental health disorder.
• Family therapy. Drug abuse impacts the entire family. Also, many teens use illicit drugs to cope with family conflict, abuse in the home, or other problems going on at home. Family therapy can help address these issues.

Supporting and Encouraging Your Child

The world of illicit drugs can be dark and scary for any parent. The path to recovery can be rocky, especially for the first few weeks or months. Your involvement, support, and encouragement are three of the most valuable things you can give your teen during this challenging time – even if your relationship has been damaged or strained by the substance use or other factors in your lives.

Here are several ways you can support and encourage your teen:

• Be present in your teen’s life, physically and emotionally.
• Be available and willing to listen to what your teen has to say.
• Show genuine compassion and empathy for what your teen is going through.
• Don’t pressure your teen to talk or open up.
• Be respectful in your actions and words.
• Avoid criticizing, talking over, or talking down to them.
• Educate yourself about substance use disorder.
• Educate yourself about treatment for substance use disorder.
• Actively participate in their treatment and recovery.
• Spend quality time with your teen and show a genuine interest in their life
• Keep your negative emotions in check and try to see things from their perspective
• Create a home environment that will support your teen’s recovery. Keep any prescription medication locked in a cabinet or drawer. If you have a liquor cabinet or bar, keep it locked. Making alcohol in the home readily accessible sets them up for potential relapse, even if alcohol was not the drug they misused most often.
• If your teen relapses, be patient and understanding. Avoid judging, ridiculing, or over-reacting.
• Understand that drug addiction can be very difficult to overcome. If your teen struggles, it doesn’t mean there’s something wrong with them: it means they’re having a challenge overcoming a chronic, relapsing medical condition.
• Stay calm even when you’re anxious or scared.
• Be willing to address your own issues that may create conflict or stress in your relationship with your teen or negatively impact your overall family dynamic.

What to Do When Things Escalate

Substance use disorder can cause erratic behavior, mood swings, and even suicidal thoughts and behavior in teens. The unpredictability of addiction can cause circumstances to escalate quickly, leading to a precarious or outright dangerous situation. As a parent, you need to have a plan in place and take quick action to ensure the safety of your entire family.

If things do escalate there are several things you can do:

• Contact your child’s primary care provider
• If they have a mental health provider, such as a therapist or counselor, contact them
• Enlist the help of a close family member or friend for support or assistance
• In case of accidental overdose – also known as alcohol poisoning – take your teen to the nearest hospital emergency room. Signs of drug overdose include:
  • Vomiting
  • Seizures
  • Conscious but unresponsive to stimuli
  • Limp body
  • Slow breathing (less than eight breaths per minute)
  • Erratic breathing (gaps of more than ten seconds between breaths)
  • Unusual snoring, choking, or gurgling noises
  • Abnormally pale skin
  • Blue tinged skin
  • Low body temperature
  • Unconsciousness/unresponsiveness

If your teen is unconscious or unresponsive, call 911 immediately.

DO NOT WAIT.

When Individual Therapy Isn’t Enough

When a teenager has a substance use disorder, weekly individual therapy or drug and alcohol counseling may not be sufficient to get and keep them sober and on a stable road to recovery.

A more intensive level of treatment may be necessary if your teenager:

• Continues to use illicit drugs
• Lacks a stable support system
• Has a co-occurring mental health disorder
• Actively contemplates suicide or attempts suicide
• Is psychotic or manic
• Is unable to function or carry out the typical responsibilities and activities of day-to-day life, such as getting out of bed, eating, dressing themselves, and going to school

More intensive levels of treatment may include:

• Intensive Outpatient Programs (IOP)
• Partial Hospitalization Programs (PHP)
• Residential Treatment Centers (RTC)
• Inpatient Hospitalization

Here’s a description of these levels of care:

Intensive Outpatient Programs (IOP)

This level of treatment is a step above weekly therapy or weekly drug counseling. The amount and timing of treatment depend on the program. Teens typically participate in treatment 3 times a week for 3 hours per session, live at home, and attend school during an intensive outpatient program.

Partial Hospitalization Programs (PHP)

This level of treatment is a step up from intensive outpatient treatment. As with IOP treatment, the amount and timing of treatment depend on the specific program. Adolescents go to treatment daily, usually for 4 hours per day, and attend school at least part-time. They live at home or, if additional support is needed, in a sober living facility.

Residential Treatment Centers (RTC)

Residential drug treatment, also often referred to as inpatient drug treatment, involves having your son or daughter live full-time at a non-hospital treatment facility. This intensive level of treatment may last anywhere from 28 to 120 days, depending on your child’s treatment needs and progress. In addition to receiving full-time treatment for substance use disorder, one of the greatest advantages of residential drug rehab is being in a drug-free environment. This enables your child to focus on recovery without having to deal with the temptation to use drugs

IOP, PHP, and RTC programs can be beneficial for adolescents who have a mental health disorder in addition to a substance use disorder.

Inpatient Psychiatric Hospitalization

Hospitalization may be necessary if your teen is a danger to themself or others (suicidal or psychotic), or in need of 24/7 medical monitoring due to excessive alcohol use. Medical monitoring may be recommended in association with heavy binge drinking, which is an increasing and dangerous trend amongst adolescents and young adults. Abrupt cessation of alcohol use (going cold turkey) can cause dangerous and potentially life-threatening withdrawal symptoms, which is why medical monitoring may be necessary.

These levels of care – excluding psychiatric hospitalization, during which immediate safety and psychiatric stability are the primary goals – typically involve some combination of the following therapeutic approaches:

• Individual therapy and counseling
• Group therapy and counseling
• Family therapy and counseling
• Experiential activities such as exercise and mindfulness
• Community support (Narcotics Anonymous or SMART Recovery)

The exact combination of treatment depends on the treatment center and the level of care your teen needs.

Take Care of Yourself

This process will probably be challenging. Helping your child is your highest priority, but do not neglect your own self-care along the way. You’ll be more available and effective if you bolster your own emotional, physical, and mental well-being while your teenager is in treatment.

Here are some steps you can take:

• Surround yourself with support by joining a support group (local or online), seeing with a therapist, and reaching out to family and friends – there’s no reason to go through this alone.
• Make sure you get eat three healthy meals a day and get plenty of sleep and rest
• Find healthy ways to manage your stress, such as yoga, meditation, and exercise
• Make time for yourself so you can relax, recharge, and restore life balance.

The road to recovery is rarely linear. There will be successes and setbacks. There will be tough days and wonderful days – but whatever you do, don’t lose hope and never give up on your teenager. Thousands of teens recover from substance use disorder, even when things look bleak at first.

There is a light at the end of this tunnel, as countless teens and their parents have found:

Your teen can recover!