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Drug use among teens is a common problem.

One drug use survey of high school students found:

72% stated that they had ever drank alcohol

42% had drank alcohol in the previous month

24% were binge drinkers, having 5 or more drinks in a row at least once in the past month

37% had ever smoked marijuana and 20% smoked marijuana in the past month

20% had taken prescription drugs without a prescription

11% had used inhalants

6% had used cocaine, 4% had used methamphetamines, and over 2% had used heroin

These high rates of alcohol and drug use makes universal screening important. In fact, the American Academy of Pediatrics recommends that all teenagers be screened for tobacco, alcohol, and other drug use at all well-child checkups.​

Drug Screening

It is important to understand that when we talk about universal screening for alcohol and drug use, we are not actually talking about universal drug testing, in which all kids actually have a drug test.

Universal drug screening simply helps you figure out who is at risk for drug abuse by asking them -- but not with an actual blood or urine test.

Many pediatricians use the quick and easy two-part CRAFFT Screening Tool from the Center for Adolescent Substance Abuse Research (CeASAR) at Children's Hospital Boston to screen teens for high-risk drug and alcohol use. It starts by asking three questions about whether a teen drinks alcohol, smokes marijuana, or uses anything else to get high.

If the teen answers yes to any of those questions, they are then asked six other CRAFFT questions, a mnemonic using the keywords in the questions:

C - Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs?

R - Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?

A - Do you ever use alcohol/drugs while you are by yourself, ALONE?

F - Do you ever FORGET things you did while using alcohol or drugs?

F - Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?

T - Have you gotten into TROUBLE while you were using alcohol or drugs?

One point is given for each yes response to the CRAFFT questions. Those teens with a total score of two or more are thought to have a positive screen, and according to the AAP, "are at high risk of having a substance use disorder." Even a CRAFFT score of one could indicate a moderate risk of having substance use problems, though, and might indicate the need for intervention.

Also, keep in mind that even those teens who deny using any drugs or alcohol should still be asked the CRAFFT 'Car' question.

In addition to being able to provide brief advice to encourage teens to stop drinking alcohol or using other drugs, and referring them to treatment when necessary, universal screening also allows pediatricians to provide teens who report no drug or alcohol use with "brief positive feedback about their ability to make healthy choices."

Drug Testing

Do they have new friends, a drop in grades, or are they getting in trouble a lot more? Many parents quickly look to drug testing when they become worried or think that their kids might be using drugs.

It is important to keep in mind that drug testing teens is much more complicated than simply buying a home drug test, getting your teen drug tested at school, or even taking your teen to his pediatrician for a drug test.

Things to consider include that:

the AAP is against involuntary drug testing of teens

a drug test may be negative even if a teen is using drugs if the test was done more than two to three days after the last time drugs were used (window of detection)

standard drug tests often don't include frequently abused drugs, such as alcohol, ecstasy, and inhalants

drug tests can be defeated by teens if the urine sample is overly diluted, substituted with someone else's sample, or if the sample is adulterated, especially if the teen isn't directly observed giving the urine sample

drug testing can be seen as an unwarranted invasion of privacy and could create "an environment of resentment, distrust, and suspicion" among teens and their parents

Also, drug tests can sometimes be hard to interpret, especially when faced with a possible false-positive test -- a drug test that is positive because of an over-the-counter medication or food, such as poppy seeds.

The AAP does state that drug testing can be done as a diagnostic test for teens in drug abuse treatment. Voluntary drug testing may also be used, according to the AAP, "when it is necessary to determine the cause of dysfunctional behavior and other changes in mental status or suspicious physical behavior."

However, instead of a drug test, teens suspected of drug abuse, but who deny drug and alcohol use on drug screening, should likely be referred to a "qualified health care professional for evaluation, counseling, and treatment as needed." Remember, a negative drug test isn't necessarily going to mean that your teen isn't using drugs or alcohol, and a positive drug test will likely prompt a referral anyway.

In addition to home drug tests and school-based drug testing, which the AAP are against, drug tests that can be done when appropriate include drug abuse panels that can test for five to 10 drugs, including:

Amphetamines (amphetamine and methamphetamine)

Barbiturates

Benzodiazepines (Valium and Xanax)

Cocaine metabolites

Marijuana metabolites (at 20, 50, or 100 ng/mL screens)

Methadone

Methaqualone

Opiates (morphine, codeine, hydrocodone)

Phencyclidine

Propoxyphene

Ethyl alcohol can usually be added to most drug abuse panels, too.

Remember to consider the pros and cons before doing a drug test on your teen.

Thanks for your feedback!

What are your concerns?

Other Inaccurate Hard to Understand

Article Sources

American Academy of Pediatrics Policy Statement. Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians. Pediatrics 2011; 128:5 e1330-e1340.

American Academy of Pediatrics Policy Statement. Alcohol Use by Youth and Adolescents: A Pediatric Concern. Pediatrics 2010 125: 1078-1087.

American Academy of Pediatrics Policy Statement. Testing for Drugs of Abuse in Children and Adolescents: Addendum - Testing in Schools and at Home. Pediatrics Vol. 119 No. 3 March 2007, pp. 627-630.

American Academy of Pediatrics Clinical Report. Tobacco, Alcohol, and Other Drugs: The Role of the Pediatrician in Prevention, Identification, and Management of Substance Abuse. Pediatrics 2005 115: 816-821.

CDC. Youth Risk Behavior Surveillance - United States, 2009. MMWR. Vol. 59. No. SS-5. June 4, 2010.

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All Teens Should Be Screened for Drug Abuse

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Drug use among teens is a common problem.

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Video on how to talk to kids of all ages about drugs. 

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Video on how to talk to kids of all ages about drugs. 

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How to Talk to Kids About Drugs | Parents

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Monitoring Your Teen’s Activities: What Parents and Families Should Know | Adolescent and School Health | CDC

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By making a habit of knowing about their teens and setting clear expectations for behavior, parents can reduce their teens’ risks for negative health outcomes. This fact sheet provides actions parents can take to monitor their teen’s activities and help them stay safe and healthy.

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Mental Health Resource for parents of teens. 

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Mental Health Resource for parents of teens. 

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The Mental Health Resources for Parents are online resources aimed specifically at parents of adolescents and young adults. Health care providers and youth serving professionals can offer these additional resources or print the PDF one-page reference sheet to parents looking for additional information, including online resources, support groups, peer networks, helplines, treatment locators, and advocacy opportunities.

Mental Health Online Resources for Parents
Mental Health Networks
Mental Health Treatment Guides
Treatment Services Locator

MENTAL HEALTH ONLINE RESOURCES FOR PARENTS

Center for Young Women's Health and Young Men's Health: These websites provide information targeted at parents of adolescents, including guides on how to support children suffering from depression and eating disorders. http://youngwomenshealth.org/parents/ and http://youngmenshealthsite.org/parents/

Jed Foundation: Promoting emotional health and prevent suicide among college students, this website provides resources, including Transition Year, that are designed to help parents recognize the signs of a mental health problems and help their child's transition to college. http://www.jedfoundation.org/parents

Kelty Mental Health Resource Center: Numerous resources for parents and caregivers can be found at this website including a resource library and family toolkit. http://keltymentalhealth.ca/family

Teen Mental Health: Geared towards teenagers, this website provides learning tools on a variety of mental illnesses, videos, and resources for parents and caregivers. http://teenmentalhealth.org/care/parents/

MENTAL HEALTH NETWORKS

Balanced Mind Parent Network: This network guides families raising children and teens with mood disorders to the answers, support, and stability they seek. http://www.thebalancedmind.org/
TREATMENT SERVICES LOCATOR

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Mental Health Resources For Parents of Adolescents and Young Adults

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The Mental Health Resources for Parents are online resources aimed specifically at parents of adolescents and young adults. Health care providers and youth serving professionals can offer these additional resources or print the PDF one-page reference sheet to parents looking for additional information, including online resources, support groups, peer networks, helplines, treatment locators, and advocacy opportunities.

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Truth Initiative has expanded its quit-smoking resources to include the first-of-its kind e-cigarette quit program.

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Positive parenting tips from the Centers for Disease Control outline developmental considerations for each age group and share tips for parents.

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Centers for Disease Control and Prevention

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As a parent you give your children a good start in life-you nurture, protect and guide them. Parenting is a process that prepares your child for independence. As your child grows and develops, there are many things you can do to help your child. These links will help you learn more about your child's development, positive parenting, safety, and health at each stage of your child's life.

Page last reviewed:

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Child Development Positive Parenting Tips | CDC

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Learn more about your child's development, positive parenting, safety, and health at each stage of your child's life.

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Teen drug abuse: Help your teen avoid drugs

Teen drug abuse can have a major impact on your child's life. Find out how to help your teen make healthy choices and avoid using drugs.
By Mayo Clinic Staff
The teen brain is in the process of maturing. In general, it's more focused on rewards and taking risks than the adult brain. At the same time, teenagers push parents for greater freedom as teens begin to explore their personality.

That can be a challenging tightrope for parents.

Teens who experiment with drugs and other substances put their health and safety at risk. The teen brain is particularly vulnerable to being rewired by substances that overload the reward circuits in the brain.

Help prevent teen drug abuse by talking to your teen about the consequences of using drugs and the importance of making healthy choices.

Why teens use or misuse drugs

Many factors can feed into teen drug use and misuse. Your teen's personality, your family's interactions and your teen's comfort with peers are some factors linked to teen drug use.

Common risk factors for teen drug abuse include:

A family history of substance abuse.

A mental or behavioral health condition, such as depression, anxiety or attention-deficit/hyperactivity disorder (ADHD).

Impulsive or risk-taking behavior.

A history of traumatic events, such as seeing or being in a car accident or experiencing abuse.

Low self-esteem or feelings of social rejection.

Teens may be more likely to try substances for the first time when hanging out in a social setting.

Alcohol and nicotine or tobacco may be some of the first, easier-to-get substances for teens. Because alcohol and nicotine or tobacco are legal for adults, these can seem safer to try even though they aren't safe for teens.

Teens generally want to fit in with peers. So if their friends use substances, your teen might feel like they need to as well. Teens also may also use substances to feel more confident with peers.

If those friends are older, teens can find themselves in situations that are riskier than they're used to. For example, they may not have adults present or younger teens may be relying on peers for transportation.

And if they are lonely or dealing with stress, teens may use substances to distract from these feelings.

Also, teens may try substances because they are curious. They may try a substance as a way to rebel or challenge family rules.

Some teens may feel like nothing bad could happen to them, and may not be able to understand the consequences of their actions.

Consequences of teen drug abuse

Negative consequences of teen drug abuse might include:

Drug dependence. Some teens who misuse drugs are at increased risk of substance use disorder.

Poor judgment. Teenage drug use is associated with poor judgment in social and personal interactions.

Sexual activity. Drug use is associated with high-risk sexual activity, unsafe sex and unplanned pregnancy.

Mental health disorders. Drug use can complicate or increase the risk of mental health disorders, such as depression and anxiety.

Impaired driving. Driving under the influence of any drug affects driving skills. It puts the driver, passengers and others on the road at risk.

Changes in school performance. Substance use can result in worse grades, attendance or experience in school.

Health effects of drugs

Substances that teens may use include those that are legal for adults, such as alcohol or tobacco. They may also use medicines prescribed to other people, such as opioids.

Or teens may order substances online that promise to help in sports competition, or promote weight loss.

In some cases products common in homes and that have certain chemicals are inhaled for intoxication. And teens may also use illicit drugs such as cocaine or methamphetamine.

Drug use can result in drug addiction, serious impairment, illness and death. Health risks of commonly used drugs include the following:

Cocaine. Risk of heart attack, stroke and seizures.

Ecstasy. Risk of liver failure and heart failure.

Inhalants. Risk of damage to the heart, lungs, liver and kidneys from long-term use.

Marijuana. Risk of impairment in memory, learning, problem-solving and concentration; risk of psychosis, such as schizophrenia, hallucination or paranoia, later in life associated with early and frequent use. For teens who use marijuana and have a psychiatric disorder, there is a risk of depression and a higher risk of suicide.

Methamphetamine. Risk of psychotic behaviors from long-term use or high doses.

Opioids. Risk of respiratory distress or death from overdose.

Electronic cigarettes (vaping). Higher risk of smoking or marijuana use. Exposure to harmful substances similar to cigarette smoking; risk of nicotine dependence. Vaping may allow particles deep into the lungs, or flavorings may include damaging chemicals or heavy metals.

Talking about teen drug use

You'll likely have many talks with your teen about drug and alcohol use. If you are starting a conversation about substance use, choose a place where you and your teen are both comfortable. And choose a time when you're unlikely to be interrupted. That means you both will need to set aside phones.

It's also important to know when not to have a conversation.

When parents are angry or when teens are frustrated, it's best to delay the talk. If you aren't prepared to answer questions, parents might let teens know that you'll talk about the topic at a later time.

And if a teen is intoxicated, wait until the teen is sober.

To talk to your teen about drugs:

Ask your teen's views. Avoid lectures. Instead, listen to your teen's opinions and questions about drugs. Parents can assure teens that they can be honest and have a discussion without getting in trouble.

Discuss reasons not to use drugs. Avoid scare tactics. Emphasize how drug use can affect the things that are important to your teen. Some examples might be sports performance, driving, health or appearance.

Consider media messages. Social media, television programs, movies and songs can make drug use seem normal or glamorous. Talk about what your teen sees and hears.

Discuss ways to resist peer pressure. Brainstorm with your teen about how to turn down offers of drugs.

Be ready to discuss your own drug use. Think about how you'll respond if your teen asks about your own drug use, including alcohol. If you chose not to use drugs, explain why. If you did use drugs, share what the experience taught you.

Other preventive strategies

Consider other strategies to prevent teen drug abuse:

Know your teen's activities. Pay attention to your teen's whereabouts. Find out what adult-supervised activities your teen is interested in and encourage your teen to get involved.

Establish rules and consequences. Explain your family rules, such as leaving a party where drug use occurs and not riding in a car with a driver who's been using drugs. Work with your teen to figure out a plan to get home safely if the person who drove is using substances. If your teen breaks the rules, consistently enforce consequences.

Know your teen's friends. If your teen's friends use drugs, your teen might feel pressure to experiment, too.

Keep track of prescription drugs. Take an inventory of all prescription and over-the-counter medications in your home.

Provide support. Offer praise and encouragement when your teen succeeds. A strong bond between you and your teen might help prevent your teen from using drugs.

Set a good example. If you drink, do so in moderation. Use prescription drugs as directed. Don't use illicit drugs.

Recognizing the warning signs of teen drug abuse

Be aware of possible red flags, such as:

Sudden or extreme change in friends, eating habits, sleeping patterns, physical appearance, requests for money, coordination or school performance.

Irresponsible behavior, poor judgment and general lack of interest.

Breaking rules or withdrawing from the family.

The presence of medicine containers, despite a lack of illness, or drug paraphernalia in your teen's room.

Seeking help for teen drug abuse

If you suspect or know that your teen is experimenting with or misusing drugs:

Plan your action. Finding out your teen is using drugs or suspecting it can bring up strong emotions. Before talking to your teen, make sure you and anyone who shares caregiving responsibility for the teen is ready. It can help to have a goal for the conversation. It can also help to figure out how you'll respond to the different ways your teen might react.

Talk to your teen. You can never step in too early. Casual drug use can turn into too much use or addiction. This can lead to accidents, legal trouble and health problems.

Encourage honesty. Speak calmly and express that you are coming from a place of concern. Share specific details to back up your suspicion. Verify any claims your child makes.

Focus on the behavior, not the person. Emphasize that drug use is dangerous but that doesn't mean your teen is a bad person.

Check in regularly. Spend more time with your teen. Know your teen's whereabouts and ask questions about the outing when your teen returns home.

Get professional help. If you think your teen is involved in drug use, contact a health care provider or counselor for help.

It's never too soon to start talking to your teen about drug abuse. The conversations you have today can help your teen make healthy choices in the future.

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Show references

1. Dulcan MK, ed. Substance use disorders and addictions. In: Dulcan's Textbook of Child and Adolescent Psychiatry. 3rd ed. American Psychiatric Association Publishing; 2021. https://psychiatryonline.org. Accessed Jan. 24, 2023.

2. 6 parenting practices: Help reduce the chances your child will develop a drug or alcohol problem. Partnership to End Addiction. https://drugfree.org/addiction-education/. Accessed Jan. 24, 2023.

3. Why do teens drink and use substances and is it normal? Partnership to End Addiction. https://drugfree.org/article/why-do-teens-drink-and-use-substances/. Accessed Jan. 24, 2023.

4. Teens: Alcohol and other drugs. American Academy of Child & Adolescent Psychiatry. https://www.aacap.org/aacap/families_and_youth/facts_for_families/fff-guide/Teens-Alcohol-And-Other-Drugs-003.aspx. Accessed Dec. 27, 2018.

5. Drugged driving. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/drugged-driving. Accessed Jan. 24, 2023.

6. Marijuana talk kit. Partnership for Drug-Free Kids. https://drugfree.org/drugs/marijuana-what-you-need-to-know/. Accessed Jan. 24, 2023.

7. Drug guide for parents: Learn the facts to keep your teen safe. Partnership for Drug-Free Kids. https://www.drugfree.org/resources/. Accessed Dec. 12, 2018.

8. Vaping: What you need to know and how to talk with your kids about vaping. Partnership to End Addiction. https://drugfree.org/addiction-education/. Accessed Jan. 24, 2023.

9. How to listen. Partnership for Drug-Free Kids. https://www.drugfree.org/resources/. Accessed Dec. 12, 2018.

10. Drug abuse prevention starts with parents. American Academy of Pediatrics. https://publications.aap.org/patiented/article/doi/10.1542/peo_document352/81984/Drug-Abuse-Prevention-Starts-With-Parents. Accessed Jan. 24, 2023.

11. How to talk to your kids about drugs if you did drugs. Partnership for Drug-Free Kids. https://www.drugfree.org/resources/. Accessed Dec. 12, 2018.

12. My child tried drugs, what should I do? Partnership to End Addiction. https://drugfree.org/article/my-child-tried-drugs-what-should-i-do/. Accessed Jan. 24, 2023.

13. Gage SH, et al. Association between cannabis and psychosis: Epidemiologic evidence. Biological Psychiatry. 2016;79:549.

14. Quick facts on the risks of e-cigarettes for kids, teens and young adults. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html. Accessed Jan. 30, 2023.

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Publicaciones Destacadas

Entre el 2003 y el 2016, las conversaciones entre padres e hijos han aumentado en un 73%, mientras el consumo de alcohol entre menores ha disminuido en un 50%. Padres en todo el país han seguido teniendo conversaciones importantes con sus hijos. Esto ha tenido un rol vital en la reducción del consumo de alcohol
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Stay up to date with Responsibility.org Entre el 2003 y el 2016, las conversaciones entre padres e hijos han aumentado en un 73%, mientras el consumo de alcohol entre menores ha disminuido en un 50%. Padres en todo el país han seguido teniendo conversaciones importantes con sus hijos.

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Para padres y cuidadores

Desde consejos para prevenir el consumo de sustancias hasta orientación para gestionar la recuperación de la adicción, tenemos la información y los recursos que necesitas en cada paso del camino.

¿Cómo podemos ayudar?

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Para padres y cuidadores Desde consejos para prevenir el consumo de sustancias hasta orientación para gestionar la recuperación de la adicción, tenemos la información y los recursos que necesitas en cada paso del camino. ¿Cómo podemos ayudar?

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Help for Talking About Alcohol and Drugs

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Help for Talking About Alcohol and Drugs

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Learn why you should talk with your child about alcohol and other drugs.
Download Why You Should Talk With Your Child About Alcohol and Other Drugs in English (PDF | 558 KB)
Parents Have a Significant Influence in Their Children's Decisions to Experiment With Alcohol and Other Drugs

One of the most influential factors during a child's adolescence is maintaining a strong, open relationship with a parent. When parents create supportive and nurturing environments, children make better decisions. Though it may not always seem like it, children really hear their parents' concerns, which is why it's important that parents discuss the risks of using alcohol and other drugs.

It's Better to Talk Before Children Are Exposed to Alcohol and Other Drugs

If you talk to your kids directly and honestly, they are more likely to respect your rules and advice about alcohol and drug use. When parents talk with their children early and often about alcohol and other drugs, they can protect their children from many of the high-risk behaviors associated with using these drugs.

Some Children May Try Alcohol or Other Drugs at a Very Young Age

It is never too early to talk to your children about alcohol and other drugs. Children as young as nine years old already start viewing alcohol in a more positive way, and approximately 3,300 kids as young as 12 try marijuana each day. Additionally, about five in 10 kids as young as 12 obtain prescription pain relievers for nonmedical purposes. The earlier you start talking, the better.

The Older Kids Get, the More Likely They'll Try Alcohol or Other Drugs

About 10 percent of 12-year-olds say they have tried alcohol, but by age 15, that number jumps to 50 percent. Additionally, by the time they are seniors, almost 70 percent of high school students will have tried alcohol, half will have taken an illegal drug, and more than 20 percent will have used a prescription drug for a nonmedical purpose. The sooner you talk to your children about alcohol and other drugs, the greater chance you have of influencing their decisions about drinking and substance use.

Not Talking About Alcohol and Other Drugs Still Sends Kids a Message

Kids don't always have all the facts when it comes to alcohol and other drugs. If parents don't talk about the risks of underage drinking and substance use, their kids might not see any harm in trying alcohol and other substances. Having a conversation allows parents to set clear rules about what they expect from their kids when it comes to alcohol and other drugs.

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Why You Should Talk With Your Child About Alcohol and Other Drugs

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Learn why you should talk with your child about alcohol and other drugs.

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TEENSAFE.ORG: In this course, you will learn how to protect your teenager’s health, life and future through a series of brief videos that demonstrate the effects of adolescent substance use on the developing brain. You also will learn practical tips on how to keep your teen safe.

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TEENSAFE.ORG: In this course, you will learn how to protect your teenager’s health, life and future through a series of brief videos that demonstrate the effects of adolescent substance use on the developing brain. You also will learn practical tips on how to keep your teen safe.

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INSURANCE INFORMATION: Parents and families can find information on health insurance coverage of substance abuse treatment through the Federal Insurance Marketplace and Affordable Care Act coverage requirements.

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INSURANCE INFORMATION: Parents and families can find information on health insurance coverage of substance abuse treatment through the Federal Insurance Marketplace and Affordable Care Act coverage requirements.

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All Marketplace plans cover mental health and substance abuse services as essential health benefits.

Mental and behavioral health services are essential health benefits

All plans must cover:

Behavioral health treatment, such as psychotherapy and counseling

Mental and behavioral health inpatient services

Substance use disorder (commonly known as substance abuse) treatment

Your specific behavioral health benefits will depend on your state and the health plan you choose. You'll see a full list of what each plan covers, including behavioral health benefits, when you compare plans in the Marketplace.

Pre-existing mental and behavioral health conditions are covered, and spending limits aren't allowed

Marketplace plans can't deny you coverage or charge you more just because you have any pre-existing condition, including mental health and substance use disorder conditions.

Coverage for treatment of all pre-existing conditions begins the day your coverage starts.

Marketplace plans can't put yearly or lifetime dollar limits on coverage of any essential health benefit, including mental health and substance use disorder services.

Parity protections for mental health services

Marketplace plans must provide certain "parity" protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.

This generally means limits applied to mental health and substance abuse services can't be more restrictive than limits applied to medical and surgical services. The limits covered by parity protections include:

Financial - like deductibles, copayments, coinsurance, and out-of-pocket limits

Treatment - like limits to the number of days or visits covered

Care management - like being required to get authorization of treatment before getting it

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Mental health and substance abuse health coverage options

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All Marketplace plans cover mental health and substance abuse services as essential health benefits. All plans must cover: Behavioral health treatment, such as psychotherapy and counseling Mental and behavioral health inpatient services Substance use disorder (commonly known as substance abuse) treatment Your specific behavioral health benefits will depend on your state and the health plan you choose.

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Facts About Teen Drug Use (Spanish included)

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Facts About Teen Drug Use (Spanish included)

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Parents: Facts and Resources to Talk With Teens About Drugs

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Parents: Learn the facts about drugs and how their use can affect your teen. Find resources that offer tips for talkign with your teen about drug use and where to go to find help.

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Early Detection of Illicit Drug Use in Teens 

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Early Detection of Illicit Drug Use in Teens 

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Shahid Ali, MD, Charles P. Mouton, MD, Shagufta Jabeen, MD, Ejike Kingsley Ofoemezie, MD, Rhan K. Bailey, MD, Madiha Shahid, MS, and Qiang Zeng, MD

Abstract

The illicit use of drugs, including alcohol, by teenagers has been extensively studied and documented. It is not uncommon for teenagers to be involved in illicit drug use before exhibiting signs and symptoms of drug use. Unsuspecting parents may be unaware of drug use in their children. The authors' objective in this article is to review the literature on illicit drug use in teenagers and highlight the risk factors for teen involvement. The authors also review the warning signs that a teen is using illicit drugs. The aim of this article is to assist parents and healthcare workers involved in substance use intervention programs to be more aware of these risk factors and warning signs in order to adopt early screening and intervention measures.

Keywords: Drug abuse, teenager, risk factors, early detection, drug screening, symptoms of drug use, illicit drugs, detoxification

Introduction

Illicit drug use among teenagers has been well documented, and it appears to be more widespread than parents and guardians may suspect., There is statistical evidence that teens are getting involved in drug use as early as the 6th to 8th grade (12-14 years old). ⁻ In a study of drug use among racial and ethnic minorities, the National House-hold Survey on Drug Abuse (NHSDA) concluded that the risks of starting illegal drug use, alcohol use, and tobacco cigarette smoking are largely found during the adolescent and young adult years. The study provided new information about the risk stratifications of starting to use each drug of interest during adolescence. They pointed out that drug-taking behavior represents a shifting and dynamic phenomenon. The study observed that there were increasing numbers of new initiates for various different drugs occurring during the last years of the twentieth century.

The data and statistics on illicit drug and alcohol use and the consequences of such activities among teenagers are very frightening. Several authors have reported the association between alcoholism and illicit drug use among teenagers and motor vehicle accidents, ⁻ risky sexual behaviors,, increase suicidality,,, homicides, mental health problems, and high rate of school dropout.,

There are also legal and social consequences associated with illicit drug use. Youth violence and other criminal activities attributable to illicit drug use exert its toll in many communities., Illicit drug consumption has been identified as a major factor in the spread of communicable and sexually transmitted diseases, including human immunodeficiency virus (HIV) infection.,

When pregnant teenage girls get involved in illicit drug use, the pregnancy outcomes have been shown to adversely affect both mother and fetus in many ways, which includes poor maternal health, inadequate nutrition and prenatal care, assisted or instrumental deliveries, premature deliveries, and low birth weight infants., Teenage drug use also increases the risk for child abuse from neglect, infanticide, and family violence. There is also documented evidence that children of parents who use drugs are more likely to use illicit drugs later in life. ⁻

One of the most powerful tools at our disposal in reducing the prevalence of teen drug use is communication. For inexplicable reasons, communication is dreaded and seldom used by parents or if used at all, not on a continuing basis. Some of the proposed reasons for this lapse are that parents are busy with other personal interests, working, or they do not want to invade the privacy of their teenage sons and daughters who are suspected of using drugs.,,⁻

More cost-effective measures need to be adopted with less emphasis on punishment and incarceration and more emphasis on preventive strategies. By exploring the risk factors that predispose teens to illicit substance use, we may be able to intervene and prevent use in high-risk teens. Hopefully, this knowledge will contribute toward instituting appropriate intervention programs to address the issue.

We believe there is a need in our society to adapt or seek new methods of fighting the problem of illicit drug use in teens. This article will review risk factors for illicit drug use in teenagers and propose methods of curbing this behavior.

Risk factors

There are various risk factors that can predispose a teenager to drug use.,,,, The age at which these risk factors are encountered by susceptible teens may dictate what influences they have on them and the progression of the illicit behavior., These risk factors can be broadly classified under family risk factors, individual risk factors, and miscellaneous risk factors.,,,,, Family risk factors include inadequate parental supervision, poor communication, family tension and conflicts, inconsistent or unduly severe parental discipline, broken homes, and family history of parental alcohol or drug abuse.,, Examples of the individual risk factors include history of early childhood negative and aggressive behavior; history of physical or sexual abuse; being male, Caucasian, and an older adolescent; emotional, social, or academic difficulties; poor impulse control; unstable emotions; thrill-seeking behaviors; and very low perception of the dangers inherent in drug use.,,, The miscellaneous factors include low socioeconomic status, level of education, living in a high crime and drug-use neighborhood; ease of drug availability; peer-group pressure; and history of mental illness.,,⁻

Warning Signs

One of the earliest warning signs that predicts teenage drug use is changes in behavior and mannerism.,,, The first change that is usually observed is frequent change of friends.,, The teen may either have a gradual or sudden frequent change of friends with whom parents or guardians are not familiar or do not approve. The teen may make up unsatisfactory excuses for the observed behavior or might get angry unnecessarily when confronted. Substance-using teenagers may exhibit withdrawal from usual family bonding, routines, and activities. They may prefer to be left alone in their rooms, skip family dinner, or remain uncommunicative with parents and siblings. Some may choose to stay home rather than participate in regular family routines like family outings, holiday trips, movies, and completing house chores.

In addition, the drug-seeking habits of teenagers who are using drugs may become apparent when they suddenly begin to violate agreed upon hours of curfew restrictions.,, This behavior may be confused with normal teen truancy, such as hanging out with his or her usual buddies or a girlfriend or boyfriend, but a teen who is seeking drugs or alcohol will often invent stories or behaviors to cover his or her tracks.

Many of the drugs of abuse, most especially marijuana and alcohol, can impair the sense of judgment or produce disinhibition.,, This may cause apparent slurring of speech and other difficulties in verbal expression. When under the influence, a teen may limit his or her communication or become unusually talkative with incoherent words and sentences or use drug jargon. A red flag that may alert a parent or healthcare professional to teenage drug use is the deterioration of school grades and skipping of classes.,, However, some teens are savvy enough to invent situations to effectively mask this problem. Parents should receive notifications from school teachers or other school officials if their child is skipping classes or is exhibiting poor grades.

Lack of motivation is another sign of drug use.,, A red flag for illicit drug use is when the teenager suddenly begins to show apathy, poor morale, low productivity, lack of self-control, aggressive behavior, difficult temperament, and poor interactions with family members at school and within the community. The teen may start pilfering money or stealing things to pawn in order to pay for their drugs. Coworkers or classmates may report multiple thefts or missing personal items. Neglect of personal hygiene and appearance and adoption of unusual dress habits may signal involvement in drug use. This may include wearing wrinkled or dirty clothes and paying little or no attention to hair grooming and cleanliness, which are a reflection of low self image. Some teens may dress inappropriately, wear inappropriate make up, and get body piercing or tattoos.

Changes in personality may be exhibited as deception and disrespect to authority figures. A teen involved with drugs may suddenly begin to tell lies to cover the acts, including their movements and associations. More often than not, attempts to caution or correct this behavior are vehemently resisted as an unwanted intrusion and a violation of their privacy. Manipulative and secretive traits are another tell-tale behavior of teens on drugs. They may start making and receiving frequent phone calls, mostly in hushed or whispered tones, and act sneaky and suspicious. Their email or cell phone records may leave a trail of evidence.

Some teens who use drugs display irrational behaviors or many become dramatic in their actions. In order to maintain their drug habits, often with limited resources, the teen may become irritable, verbally abusive, and even violent with siblings and parents. They may threaten to quit school, run away from home, drop out of school, or destroy family property. Others may threaten to cause bodily harm to them or even threaten suicide.,,,

Depression, mood instability, and apathy are also warning signs of potential teen drug and substance abuse.,,,, Teens using drugs may become alienated and disinterested in things they were passionate about in the immediate past or become introverted and holed up in their room. Other symptoms include crying spells and mood swings.

Changes in appearance and the exhibition of some symptoms are some of the most definitive ways of identifying teens that are using illicit drugs. The appearance of bloodshot eyes, widely dilated pupils, or pin-point pupils are very indicative of drug use. Bloodshot eyes may signify that the teen is on marijuana.,,, Pupillary dilatation can indicate the teen is using drugs such as cocaine, amphetamines, or hallucinagenics. Pin-point pupils are associated with the use of barbiturates and heroin.,

There may be noticeable changes in body habitus, such as unexplained and sudden weight loss, weight gain, or poor oral hygiene.,, The observation of skin changes, such as needle tracks in the antecubital region, are an indication that the teen may be using injectible substances like heroin. The teen may start wearing long-sleeved garments even in very warm weather to cover up these marks. Cocaine use may be associated with raw, dripping nostrils from snorting, and opiates may cause sensation of crawling insects all over the body.,,, The withdrawal symptoms of cocaine or amphetamines may be evident as the teen constantly scratches or picks at his or her skin and hair. It is important to rule out other organic causes (e.g., diabetic neuropathy, syphilis) or prescription drugs side effects (e.g., methylphenidate).

Conclusion

There is an urgent need for parents, school teachers, and healthcare providers to be familiar with the early signs and symptoms of drug and substance abuse to be able to implement preventive measures. A comprehensive health approach that takes into consideration the involvement of primary care practitioners needs to be adopted. Other equally important considerations should include the special characteristics and vulnerabilities of special populations at risk, family structures, social and demographic characteristics, poverty, and housing and living conditions. Multiple avenues, including the internet, should be included in the larger prevention and intervention protocols.

To improve outcomes in identifying teens at risk of using illicit drugs, we recommend that strategies be adopted and incorporated at the primary care level for identifying and screening at-risk teenagers. Healthcare providers need to be routinely updated in their knowledge and skills to identify the early warning signs of illicit drug use, especially within this population. Parents and guardians of teens with risk factors for drug use need to be provided with the information and tools to identify these signs and seek help promptly. Where the parent is the drug user, every effort should be made to reduce the exposure and the impact of this behavior on their teenager. The agencies saddled with the responsibility of addressing the issues of drug use need to direct their energy and resources to measures and strategies that will curb exposure and access to illicit drugs instead of focusing more on punishment and incarceration which have failed to reduce the use of illicit drugs.

Footnotes

FUNDING: No funding was received for the development of this article.

FINANCIAL DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article.

References

1. National Institute of Drug Abuse Preventing Drug Use Among Children and Adolescents: A Research-based Guide for Parents, Educators, and Community Leaders, 2nd Edition NIH Publication No. 04-4212(A). October 2003.

8. National Institute on Drug Abuse Drug Use Among Racial/Ethnic Minorities. NIH Publication No. 03- 3888. Printed 1995. Last revised September 2003.

10. Substance Abuse and Mental Health Services Administration Results from the 2006 National Survey on Drug Use and Health: National Findings Office of Applied Studies. NSDUH Series H-32, DHHS Publication No. SMA 07-4293.

11. Substance Abuse and Mental Health Services Administration Misuse of Over-The-Counter Cough and Cold Medications Among Persons Aged 12 to 25 Rockville, MD: Substance Abuse and Mental Health Services Administration, 2008.

14. Rebecca Voelker. Stress, sleep loss, and substance abuse create potent recipe for college depression. JAMA. 2004;291(18):2177-2179. 14. Grunbaum JA, Kann L, Kinchen SA, et al. Youth Risk Behavior Surveillance-National Alternative High School Youth Risk Behavior Survey, United States, 1998. MMWRCDC Surveill Summ. 1999;48(7):1-44.

15. Rooney M, Chronis-Tuscano A, Yoon Y. Substance use in college students with ADHD. J Atten Disord. 2011 Feb 2; [Epub ahead of print]

37. Baingana FK, Alem A, Jenkins R. Mental health and the abuse of alcohol and controlled substances In: Jamison DT, Feachem RG, Makgoba MW, et al., editors. Disease and Mortality in Sub-Saharan Africa, Second Edition Washington, DC: World Bank; 2006.

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Early Detection of Illicit Drug Use in Teenagers

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The illicit use of drugs, including alcohol, by teenagers has been extensively studied and documented. It is not uncommon for teenagers to be involved in illicit drug use before exhibiting signs and symptoms of drug use. Unsuspecting parents may be unaware ...

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How to recognize if you have a substance use disorder (for teens)

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How to recognize if you have a substance use disorder (for teens)

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How do I know if I have a drug use problem?

Addiction can happen at any age, but it usually starts when a person is young. If you continue to use drugs despite harmful consequences, you could be addicted. It is important to talk to a medical professional about it-your health and future could be at stake.

Have friends or family told you that you are behaving differently for no apparent reason-such as acting withdrawn, frequently tired or depressed, or hostile? You should listen and ask yourself if they are right-and be honest with yourself. These changes could be a sign you are developing a drug-related problem. Parents sometimes overlook such signs, believing them to be a normal part of the teen years. Only you know for sure if you are developing a problem because of your drug use. Here are some other signs:

hanging out with different friends

not caring about your appearance

getting worse grades in school

missing classes or skipping school

losing interest in your favorite activities

getting in trouble in school or with the law

having different eating or sleeping habits

having more problems with family members and friends

There is no special type of person who becomes addicted. It can happen to anyone.

See NIDA's video: Anyone Can Become Addicted to Drugs

Thanks to science, we know more than ever before about how drugs work in the brain, and we also know that addiction can be successfully treated to help young people stop using drugs and lead productive lives. Asking for help early, when you first suspect you have a problem, is important; don't wait to become addicted before you seek help. If you think you are addicted, there is treatment that can work. Don't wait another minute to ask for help.

Why can't I stop using drugs on my own?

Repeated drug use changes the brain. Brain imaging studies of drug-addicted people show changes in areas of the brain that are needed to learn and remember, make good decisions, and control yourself. Quitting is difficult, even for those who feel ready. NIDA has an excellent video (below) that explains why drugs are so hard to quit (hint: it's all about the brain). If you aren't sure you are addicted, it would be helpful for you to look at this brief video. It helps explains why your inability to stop using drugs does not mean you're a bad person, just that you have an illness that needs to be treated.

See NIDA's video: Why Are Drugs So Hard to Quit?

Treatment is always based on the person's needs. However, if you are still using a drug when you are admitted to a treatment program, one of the first things addiction specialists need to do is help you safely remove drugs from your system (called "detox"). This is important because drugs impair the mental abilities you need to make treatment work for you.

When people first stop using drugs, they can experience different physical and emotional withdrawal symptoms, including depression, anxiety, and other mood disorders, as well as restlessness and sleeplessness. Remember that treatment centers are very experienced in helping you get through this process and keeping you safe and comfortable during it. Depending on your situation, you might also be given medications to reduce your withdrawal symptoms, making it easier to stop using.

I tried rehab once and it didn't work-why should I try it again?

If you have already been in rehab, it means you have already learned many of the skills needed to recover from addiction, and you should try it again. Relapsing (going back to using drugs after getting off them temporarily) does not mean the first treatment failed. People with all kinds of diseases relapse; people with other chronic diseases such as high blood pressure and asthma-which have both physical and behavioral components-relapse about as much as people who have addictions.

Treatment of all chronic diseases, including addiction, involves making tough changes in how you live and act, so setbacks are to be expected along the way. A return to drug use means treatment needs to be started again or adjusted, or that you might need a different treatment this time.

I don't like lying to my parents but, they don't understand me and my problems. If we talk about drugs, they will just yell at me. How can I avoid a fight?

First of all, remember that they were teens once, and they understand teen life more than you think. Secondly, when you first tell them about your problem, they might get angry out of fear and worry. They might raise their voices because they are very, very worried about you and your future. Try to stay calm and simply ask for help. Repeat over and over again that you need their help.

Parents do get angry when they find out their kids have been lying to them. You'd do the same! Be honest with them. Let them know you want to change and need their help.

I am also afraid my parents will take away the car keys-what can I do about that?

The single most responsible thing you can do is stop driving until you get help for your drug use. This might be inconvenient, but if you do drugs and drive, you could end up not only killing yourself but killing others as well. That could lead to a lifetime in prison. This is no different than drinking and driving. For more see our DrugFacts on drugged driving.

If you tell your parents that you are willing to give up your driving privileges, they will know you are serious about getting help.

Taking drugs helps me feel less depressed-what's wrong with that?

The relief you feel is only temporary and can cause more problems down the road, as your brain and body start to crave more and more drugs just to feel normal. It is very possible you need to find treatment for your depression as well as for your drug use. This is very common. It is called "comorbidity" or "co-occurrence" when you have more than one health problem at the same time. For more information, see Drug Facts for Teens Co-Occurring Substance Use and Other Mental Health Issues.

Be certain to tell your doctor about your drug use, as well as any depression or anxiety you feel, or any other mental health issues you are experiencing. There are many nonaddictive medicines that can help with depression or other mental health issues. Sometimes doctors do not talk to each other as much as they should. For example, a therapist you might be seeing for depression does not always consult with your pediatrician. So you need to be your own best friend and advocate-and make sure all of your health care providers know about all of the health issues that concern you. You should be treated for all of them at the same time.

Note: If you ever feel so depressed that you think about hurting yourself, there is a hotline you can call: 1-800-273-TALK (8255). This is called the National Suicide Prevention Lifeline, and you can share all of your problems with them. A caring, nonjudgmental voice will be on the other end, listening.

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How To Recognize a Substance Use Disorder

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Addiction can happen at any age, but it usually starts when a person is young. If you continue to use drugs despite harmful consequences, you could be addicted. It is important to talk to a medical professional about it--your health and future could be at stake.

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Helpful Links for Parents | NIDA for Teens

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Find other resources that can help you understand teen drug use.

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What do I do if my child is using drugs? 

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What do I do if my child is using drugs? 

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It can be a jarring and frightening time if you suspect or find out your child is using drugs or alcohol. The most important thing you can do is to confront it. But how, exactly, is the best way to do this?

As with every important conversation, it's best to take some time to prepare. Before you decide to confront your loved one and have the conversation, take a deep breath and plan out your discussion points, and think a bit about the "why" behind their use. We're here to give you tips and strategies on how to do it.

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What Do I Do if My Child Is Using Drugs? | Partnership to End Addiction

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It can be a jarring and frightening time if you suspect or find out your child is using drugs or alcohol. The most important thing you can do is to confront it. But how, exactly, is the best way to do this? As with every important conversation, it's best to take some time to prepare.

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If you suspect your teen is using drugs. 

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If you suspect your teen is using drugs. 

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Prepare to Take Action if You Suspect Teen or Young Adult Drug Use

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Is your child using drugs? Take time to prepare for the important conversation ahead, and lay the foundation for more positive outcomes.

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Treatment Referral Resources | National Institute on Drug Abuse

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Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Locator: 1-800-662-HELP or search - findtreatment.gov The "Find A Physician" feature on the American Society of Addiction Medicine (ASAM) Web site: https://www.asam.org/publications-resources/patient-resources The Patient Referral Program on the American Academy of Addiction Psychiatry Web site: http://www.aaa

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Al-Anon: Supporting an Alcoholic Child. 

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Al-Anon: Supporting an Alcoholic Child. 

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Coping With an Alcoholic Child | Meetings: 888-425-2666 | Al-Anon Family Groups

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Dealing with a child’s alcoholism is heartbreaking and confusing. Al-Anon can help make sense of a son or daughter’s alcohol addiction. Call 888-425-2666.

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Addiction treatment is a multifaceted process that requires intervention from psychiatrists, doctors, therapists, and certified addiction counselors. Fortunately, New Bridge Foundation® in Berkeley, California has a respected 50+-year history of providing exceptional drug rehab services to adult individuals. Our clients can take advantage of diverse programs and methods that are geared to help them achieve lasting recovery. They may decide to admit to one of our residential programs, at our treatment center located in the beautiful San Francisco Bay Area, or elect to participate in one of our outpatient treatment programs offered via telehealth.

Why Our Drug Rehab Center, Located in Berkeley CA Is Necessary

Substance use disorder is a serious condition. Despite popular belief, it is not something an individual can control or stop simply because they want to. Once a dependence forms, the help of drug rehab programs such as the ones we offer in Berkeley, CA becomes necessary.

At New Bridge Foundation®, our substance abuse treatments focus on alcohol rehab and drug rehab services. In our drug treatment center in Berkeley, CA, we help our clients identify the origins and triggers of their addiction. Through our programs, clients learn how to understand these triggers and develop relapse prevention tools. A comprehensive and professional treatment regimen is necessary to maintain long-term healing.

Detoxification

Detoxification can be the first phase of addiction treatment at our drug rehab center Berkeley, CA offers. For individuals who are addicted to drugs, use often leads to physical and psychological symptoms. This is referred to as withdrawal, and without professional intervention, the process can be medically dangerous-or even fatal.

At New Bridge Foundation®, we offer detox services in a safe, supportive, non-hospital setting. Residents are provided with around-the-clock care as they go through withdrawal. Our Medical Director oversees all detox services to ensure individuals receive the best treatment during this process.

Short-Term Residential Rehab (Helios)

Many individuals need to enter a program in order to have time away from the environments that trigger substance abuse. Our residential rehab treatment facility in Berkeley, CA is ideal for those looking to detach from day-to-day stressors.

With the right combination of positivity, support, and medical intervention, achieving recovery is possible. During our Short-Term Residential Rehab (Helios) program, all residents have access to around-the-clock care from our friendly, multi-disciplinary staff. Each day is structured and productive with access to addiction education, specialized programs, evidence-based therapeutic methods, and peer support.

Short-Term Outpatient Program (Helios)

Depending on individual circumstances, there are some individuals who can't commit to residential rehab. Many people have outside obligations that require their attention such as school, family, and career responsibilities.

However, for individuals who can remain abstinent while continuing to live at home, New Bridge Foundation®'s Short-Term Outpatient Rehab is ideal. We offer two types of outpatient services. You can participate either in our Day Treatment or our Intensive Outpatient Program. Both programs are currently being provided via Telehealth and are highly educational and engaging. Our outpatient services can also be a step down from our residential programs in Berkeley CA. Experience has shown us that transitioning from residential treatment to an Outpatient Program is a nice way of solidifying the gains made in the residential program.

Long-term Residential Treatment (START)

Addiction severity varies dramatically from person to person. Some individuals attend rehab numerous times, only to continue relapsing. For those with chronic drug and alcohol problems, long-term residential treatment is an ideal option.

Using a holistic approach, our START program uses traditional and alternative methods. Lasting from three to six months, extended care allows individuals to strengthen their recovery. With time on their side, residents learn how to lead fulfilling, productive lives and overcome addictive behaviors which may have led to serious consequences.

Specialized Programs

Along with our drug rehab programs, we also offer specialized programs to help specific populations. This includes our co-occurring disorders program. Individuals who struggle with both a mental health disorder and a substance use disorder require dual diagnosis treatment. This program addresses both the substance use disorder as well as any other mental health disorders simultaneously. This strategy is seen as an important component in preventing individuals struggling with co-occurring disorders from relapse down the road.

We also offer specialized drug rehab programs for the LGBTQ+ community as well as the Operation Success program for active-duty military, their dependents, and veterans. These populations face unique circumstances that may make the road to recovery more difficult. We tailor our drug rehab programs to address the specific needs and challenges of these different groups of people thus ensuring that they receive the holistic and comprehensive care they need for long-term recovery.

New Bridge Foundation®: A Comprehensive Drug Rehab Center in Berkeley, CA

New Bridge Foundation® in Berkeley, California works with clients as individuals. Depending on client needs, individuals are able to participate in any of the above-noted drug rehab services. Additionally, program participants will have access to a variety of treatment methods including, but not limited to:

Individual counseling

Group therapy and education

Family education and support group

Individualized treatment planning

Relapse prevention

Discharge planning

Free aftercare for life

Our drug rehab center in Berkeley, CA can provide the environment and care necessary to achieve lasting sobriety. New Bridge Foundation® can offer a space for healing and recovery. Our staff of qualified, multi-disciplinary professionals provides comfort and care during all comprehensive treatment programs. Call us today at 866-772-8491 to begin your life-changing journey.

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Drug Rehab Center Berkeley CA | New Bridge Foundation®

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Addiction treatment is a multifaceted process that requires intervention from psychiatrists, doctors, therapists, and certified addiction counselors. Fortunately, New Bridge Foundation® in Berkeley, California has a respected 50+-year history of providing exceptional drug rehab services to adult individuals. Our clients can take advantage of diverse programs and methods that are geared to help them achieve lasting recovery.

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Drug Policy Alliance page on Substance Use Treatment

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Drug Policy Alliance page on Substance Use Treatment

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While many Americans have used alcohol or an illicit drug in their lifetime, most will never develop a substance use disorder. Substance use occurs along a continuum from abstinence to addiction, and some people may find themselves moving along this continuum at various points in their lives.

The majority of people will manage their substance use without seeking professional help. Many alter their patterns of use according to their health, and others simply need harm reduction support and materials to stay safe. Others who develop issues with their use will choose to pursue professional substance use disorder treatment.

What is Substance Use Disorder Treatment?

Substance use disorder (SUD) treatment involves professionally delivered psychosocial treatment and/or medications to reduce harmful substance use and improve health and quality of life. These services are provided in a variety of settings, including specialized treatment facilities like outpatient, inpatient, or residential centers, and in medical settings such as hospitals and clinics.

Unfortunately, there are currently no standard federal licensing or credentialing requirements for substance use treatment facilities, and there are varying levels of accountability for facilities in individual states. As a result, treatment quality in the U.S. varies widely.

Psychosocial Treatment (also known as behavioral treatment)
This is the primary form of treatment available in most substance use treatment facilities in the U.S. It can involve any combination of individual, couples, family, or group therapy. The most commonly available types of psychosocial treatments include Cognitive Behavioral Therapy, Motivational Interviewing, Contingency Management, Relapse Prevention, and Twelve-Step Facilitation.

Each of these forms of psychosocial treatment have varying degrees of efficacy and evidence supporting their use. Unfortunately, the consistent use of evidence-based treatments remains a challenge in the U.S., and few facilities provide multiple therapy options for clients to choose from.

Medication-Assisted Treatment (MAT)
There are currently three FDA-approved medications for opioid use disorder: methadone, buprenorphine, and naltrexone. Methadone is known as the gold-standard treatment for opioid use disorders because it has the most research supporting its efficacy, and it has proven to cut overdose risk by 50% among patients who take the medication. Buprenorphine shares many of these same benefits, whereas the evidence on naltrexone and reduced overdose risk is still mixed. Drug Policy Alliance (DPA) is committed to allowing client choice for any of the three forms of MAT for opioid use disorder in all treatment settings. Research suggests that these medications remain underutilized in the U.S.

Self-help Groups
These groups are free, available in the community or online, and are facilitated by fellow peers and people in recovery instead of trained or credentialed professionals. The oldest and most well-known self-help groups are Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), with chapters across the U.S. and around the world.

Research suggests that self-help groups can be helpful for some individuals with substance use disorder, but more research is needed to understand what aspects of self-help are most beneficial and for whom. Self-help groups should not be mistaken for treatment.

DPA believes that people should be able to choose the self-help groups that align with their own personal recovery goals and personal preferences. We do not endorse any single self-help group over others, and we do not believe that attendance at any self-help group should be mandated or coerced by a treatment facility, the justice system, employers, or other entities.

Substance Use Disorder Treatment and COVID-19

States have instituted a number of policy changes in response to the COVID-19 pandemic that have proven to reduce exposure to the virus in many parts of the country. But they have also had the unintended consequence of restricting access to substance use disorder treatment. Stay-at-home orders and social distancing requirements have reduced in-person outpatient, inpatient, and residential treatment availability, including access to Medication-Assisted Treatment (MAT) for opioid use disorder. While many programs have embraced telehealth services and have loosened restrictions for MAT treatment, far too many still struggle to get the services they need.

DPA is fighting to expand and make permanent some loosened restrictions for MAT in light of COVID-19 and to continue to remove barriers that were hindering treatment access prior to the pandemic.

See our COVID-19 policy recommendations.

Why Don't Most People Receive Treatment for Substance Use Disorders?

The majority of people with substance use disorders do not seek treatment and many can overcome their problems without treatment. However, far too many people who desire treatment often face challenges that stop them from accessing the services they want. The more barriers people face, the less likely they are to access services.

Some of the most common obstacles are:

Cost: Treatment is not affordable or fully covered by health insurance, or what is covered is inaccessible due to insurance requirements and limitations.

Few providers: In many parts of the country, especially rural communities, there are too few providers nearby and long waitlists at existing providers. This can also include long distances to travel for treatment, which can be challenging for those without reliable transportation and busy schedules.

Programmatic issues: Many treatment providers have strict attendance requirements or limited treatment hours, which may be challenging for people who work or have family/caretaking responsibilities. Treatment may not be attractive to potential clients due to imposing restrictions on drug use like abstinence-only programs, visitation, and limited access to other services or MAT.

One-Size-Fits-All Approach: Treatment may not be tailored to the specific needs or preferences of individuals, including their personal treatment and recovery goals, as well as the needs of special populations including those with co-occurring mental health diagnoses, racial or ethnic minorities, or gender or sexual minorities.

Stigma: The taboo associated with substance use often makes it difficult for people to seek help.

Even when treatment is accessible, it is often not evidence-based, provided by highly-trained professionals, or subject to adequate oversight. Client engagement is correspondingly low and drop-out rates are high.

Key SUD Treatment Issues

Principles of Treatment
DPA has established seven principles to ensure substance use treatment is provided at and held to the highest quality standards. We're working to instill these principles into policies, providers, and payers across the country.

Medication-Assisted Treatment
Medication-Assisted Treatment (MAT) is the use of FDA-approved medications for the treatment of substance use disorders. DPA works to ensure all forms of MAT are available and accessible for all who could benefit.

Heroin-Assisted Treatment
Heroin-Assisted Treatment (HAT) refers to the medically supervised administration of pharmaceutical-grade heroin to people with heroin use disorders who have not responded well to more traditional forms of treatment. We advocate for the adoption of HAT models in the U.S.

Contingency Management
Contingency management is a behavioral therapy that uses tangible (usually monetary) rewards to reinforce positive behavior change. DPA is pushing for the widespread dissemination of contingency management into mainstream substance use treatment.

Involuntary Treatment
Every person has the right of bodily autonomy, which includes the right to refuse unwanted treatment. Unfortunately, policymakers and providers often ignore this right and force people into services they do not want. DPA challenges mandated treatment and coercion in treatment settings and advocates for more attractive treatment designed to increase voluntary access, as well as lower threshold and harm reduction options along the continuum of care.

Treatment in the Criminal Justice System
People involved in the criminal legal system should be able to determine the goals and strategies for substance use treatment with the consultation of their chosen treatment provider. They should have access to the full range of treatment services available in the community, including MAT and harm reduction services. DPA fights for improved access, quality, and choice of substance use treatment in criminal legal settings.

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While many Americans have used alcohol or an illicit drug in their lifetime, most will never develop a substance use disorder. Substance use occurs along a continuum from abstinence to addiction, and some people may find themselves moving along this continuum at various points in their lives.

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1. Adolescent substance use needs to be identified and addressed as soon as possible. Drugs can have long-lasting effects on the developing brain and may interfere with family, positive peer relationships, and school performance. Most adults who develop a substance use disorder report having started drug use in adolescence or young adulthood, so it is important to identify and intervene in drug use early.

2. Adolescents can benefit from a drug abuse intervention even if they are not addicted to a drug. Substance use disorders range from problematic use to addiction and can be treated successfully at any stage, and at any age. For young people, any drug use (even if it seems like only "experimentation"), is cause for concern, as it exposes them to dangers from the drug and associated risky behaviors and may lead to more drug use in the future. Parents and other adults should monitor young people and not underestimate the significance of what may appear as isolated instances of drug taking.
A relapse signals the need for more treatment or a need to adjust the individual's current treatment plan.

3. Routine annual medical visits are an opportunity to ask adolescents about drug use. Standardized screening tools are available to help pediatricians, dentists, emergency room doctors, psychiatrists, and other clinicians determine an adolescent's level of involvement (if any) in tobacco, alcohol, and illicit and nonmedical prescription drug use. When an adolescent reports substance use, the health care provider can assess its severity and either provide an onsite brief intervention or refer the teen to a substance abuse treatment program.

4. Legal interventions and sanctions or family pressure may play an important role in getting adolescents to enter, stay in, and complete treatment. Adolescents with substance use disorders rarely feel they need treatment and almost never seek it on their own. Research shows that treatment can work even if it is mandated or entered into unwillingly.

5. Substance use disorder treatment should be tailored to the unique needs of the adolescent. Treatment planning begins with a comprehensive assessment to identify the person's strengths and weaknesses to be addressed. Appropriate treatment considers an adolescent's level of psychological development, gender, relations with family and peers, how well he or she is doing in school, the larger community, cultural and ethnic factors, and any special physical or behavioral issues.

6. Treatment should address the needs of the whole person, rather than just focusing on his or her drug use. The best approach to treatment includes supporting the adolescent's larger life needs, such as those related to medical, psychological, and social well-being, as well as housing, school, transportation, and legal services. Failing to address such needs simultaneously could sabotage the adolescent's treatment success.

7. Behavioral therapies are effective in addressing adolescent drug use. Behavioral therapies, delivered by trained clinicians, help an adolescent stay off drugs by strengthening his or her motivation to change. This can be done by providing incentives for abstinence, building skills to resist and refuse substances and deal with triggers or craving, replacing drug use with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships.

8. Families and the community are important aspects of treatment. The support of family members is important for an adolescent's recovery. Several evidence-based interventions for adolescent drug abuse seek to strengthen family relationships by improving communication and improving family members' ability to support abstinence from drugs. In addition, members of the community (such as school counselors, parents, peers, and mentors) can encourage young people who need help to get into treatment-and support them along the way.

9. Effectively treating substance use disorders in adolescents requires also identifying and treating any other mental health conditions they may have. Adolescents who abuse drugs frequently also suffer from other conditions including depression, anxiety disorders, attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct problems. Adolescents who abuse drugs, particularly those involved in the juvenile justice system, should be screened for other psychiatric disorders. Treatment for these problems should be integrated with the treatment for a substance use disorder.

10. Sensitive issues such as violence and child abuse or risk of suicide should be identified and addressed. Many adolescents who abuse drugs have a history of physical, emotional, and/or sexual abuse or other trauma. If abuse is suspected, referrals should be made to social and protective services, following local regulations and reporting requirements.

11. It is important to monitor drug use during treatment. Adolescents recovering from substance use disorders may experience relapse, or a return to drug use. Triggers associated with relapse vary and can include mental stress and social situations linked with prior drug use. It is important to identify a return to drug use early before an undetected relapse progresses to more serious consequences. A relapse signals the need for more treatment or a need to adjust the individual's current treatment plan to better meet his or her needs.

12. Staying in treatment for an adequate period of time and continuity of care afterward are important. The minimal length of drug treatment depends on the type and extent of the adolescent's problems, but studies show outcomes are better when a person stays in treatment for 3 months or more. Because relapses often occur, more than one episode of treatment may be necessary. Many adolescents also benefit from continuing care following treatment, including drug use monitoring, follow-up visits at home, and linking the family to other needed services.

13. Testing adolescents for sexually transmitted diseases like HIV, as well as hepatitis B and C, is an important part of drug treatment. Adolescents who use drugs-whether injecting or non-injecting-are at an increased risk for diseases that are transmitted sexually as well as through the blood, including HIV and hepatitis B and C. All drugs of abuse alter judgment and decision making, increasing the likelihood that an adolescent will engage in unprotected sex and other high-risk behaviors including sharing contaminated drug injection equipment and unsafe tattooing and body piercing practices-potential routes of virus transmission. Substance use treatment can reduce this risk both by reducing adolescents' drug use (and thus keeping them out of situations in which they are not thinking clearly) and by providing risk-reduction counseling to help them modify or change their high-risk behaviors.

Components of Comprehensive Drug Abuse Treatment The best treatment programs provide a combination of therapies and other services to meet the needs of the individual patient.

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Principles of Adolescent Substance Use Disorder Treatment | National Institute on Drug Abuse

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Many adolescents who abuse drugs have a history of physical, emotional, and/or sexual abuse or other trauma. Adolescent substance use needs to be identified and addressed as soon as possible. Drugs can have long-lasting effects on the developing brain and may interfere with family, positive peer relationships, and school performance.