Substance use among adolescents ranges from experimentation to dependence (see see Overview of Drug Abuse). The consequences range from none to minor to life threatening, depending on the substance, the circumstances, and the frequency of use. However, even occasional use can put adolescents at risk of significant harm, including overdose, motor vehicle collisions, violent behaviors, and consequences of sexual contact (such as pregnancy and sexually transmitted diseases). Although experimentation with alcohol and, to a lesser extent, marijuana is common, experimentation with other illicit drugs and misuse of prescription or over-the-counter drugs is uncommon. Adolescents who engage in these behaviors are at higher risk of harm. Parental attitudes and the examples that parents set regarding their own use of alcohol, tobacco, prescription drugs, and other substances are a powerful influence.
Alcohol is the substance most often used by adolescents. About 72% of high school seniors report having tried alcohol, although only 55% say they have ever been drunk. Society and the media portray drinking as acceptable or even fashionable. Despite these influences, parents can make a difference by conveying clear expectations to their adolescent regarding drinking, setting limits consistently, and monitoring. On the other hand, adolescents whose family members drink excessively may think this behavior is acceptable. Some adolescents who try alcohol go on to develop an alcohol use disorder, such as abuse or dependence. Risk factors for developing a disorder include starting drinking at a young age and genetics. Adolescents who have a family member with an alcohol use disorder should be made aware of their increased risk.
The majority of adults who smoke cigarettes begin smoking during adolescence. Children as young as age 10 experiment with cigarettes. Nearly one fifth of 9th graders report smoking regularly. In the United States, more than 2,000 people begin smoking every day. Of these new smokers, 31% are under age 16 and more than 50% are under age 18. If adolescents do not try cigarettes before age 19, they are very unlikely to become smokers as adults. Factors that increase the likelihood of an adolescent smoking are having parents who smoke (the single most predictive factor) or peers and role models (such as celebrities) who smoke. Risk factors often associated with smoking include
Parents can help prevent their adolescent from smoking by being positive role models (that is, by not smoking), openly discussing the hazards of tobacco, and encouraging adolescents who already smoke to quit, including supporting them in seeking medical assistance if necessary.
Use of illicit substances other than tobacco and alcohol in adolescents, although decreasing overall in the last few years, remains high. In 2007, about 47% of 12th graders had used illicit drugs at some time in their life. Only about 25% had ever used an illicit drug other than marijuana.
About 2% of high school seniors have used anabolic steroids (see see Other Drugs of Abuse) in their lifetime. Although steroid use is more common among athletes, non-athletes are not immune. Use of anabolic steroids is associated with a number of side effects, including premature closure of the growth plates at the ends of bones, resulting in permanent short stature. Other side effects are common to both adolescents and adults.
Although use of most drugs is declining, there has been a notable increase in the misuse of prescription drugs, most notably narcotic pain drugs, anti-anxiety drugs, and stimulants. Over-the-counter (OTC) cough and cold drugs are also used by adolescents to get high. These drugs are widely available and are considered safe by many adolescents and now serve as gateway drugs. Even young adolescents may try drugs, with some reporting drug use as early as age 12. Many adolescents who experiment with OTC, prescription, and illicit substances go on to develop substance use disorders.
Behaviors that should prompt parents to discuss their concerns with their child and doctor include
Parents who find drugs or drug paraphernalia should discuss their concerns with their child.
During routine health care visits, parents should expect their child's doctor to give their child a questionnaire to screen for drug and alcohol use. Doctors can help assess whether an adolescent has a substance use disorder and implement an appropriate intervention. A drug test may be a useful part of an assessment, but this procedure has significant limitations. Results of a urine test may be negative in adolescents who use drugs if the drug is cleared from the body before the test is done, a drug not included on a standard testing panel has been used, or the specimen is adulterated. Given these limitations, a doctor with expertise in this area should determine whether a drug test is warranted in a given situation, and parents should respect their doctor's advice. When parents demand a drug test or demand information that would break their child's confidentiality, they may create an atmosphere of confrontation and inadvertently make it difficult for a doctor to obtain an accurate substance use history and form a therapeutic alliance with their child.
If the doctor thinks the adolescent has a substance use disorder, a referral for further assessment and treatment may be warranted. In general, the same behavioral therapies used for adults with substance use disorders (see see Overview of Drug Abuse) can also be used with adolescents. However, these therapies should be adapted. Adolescents should receive services from adolescent programs and therapists with expertise in treating adolescents with substance use disorders. In general, adolescents should not be treated in the same programs as adults.
Last full review/revision January 2009 by Sharon Levy, MD, MPH