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Substance Use and Abuse in Adolescents


The Manual's Editorial Staff

Last full review/revision May 2020| Content last modified May 2020
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Substance use in adolescents is a teen's use of alcohol, tobacco, and drugs (including prescription medicines without a prescription). Such use could be occasional experimenting or regular and ongoing.

Any substance use raises the risk of other problems. For example, adolescents who use substances are more likely to have car crashes, fights, unwise or unwanted sex, overdose, or other behavior problems. Substance use is considered substance abuse when adolescents continue to use substances even after these behavior problems happen.

Adolescents who abuse substances are at a higher risk of having long-term problems. These problems include mental health problems, poor grades in school, and substance use disorders such as addiction and overdose.

  • It’s common for adolescents to try alcohol or other substances, but regular use is rarer

  • Alcohol is the most common substance used by adolescents—they often drink heavily and binge drink, which raises the chance of fights, car crashes, and other causes of injury

  • Parents, peers, and the media influence an adolescent's attitude toward substance use

What types of substances do adolescents use and abuse?

Adolescents use and abuse many substances, including over-the-counter medicines. The most common substances are:

Adolescents also abuse:


  • Alcohol is the substance most often used by teens

  • Adolescents have a higher chance of a drinking problem if they start young or have family members with drinking problems

  • To prevent alcohol use, discourage your teen from drinking and set a good example yourself


  • Tobacco use includes smoking cigarettes, pipes, or cigars, chewing tobacco, putting tobacco between the lower lip and gum, and inhaling it into the nose

  • Most adults who smoke started smoking as adolescents

  • Adolescents are more likely to smoke if they have parents who smoke

  • To prevent tobacco use, don’t use tobacco in front of your children and talk to them about the effects of tobacco

  • If your child already smokes or uses tobacco, encourage quitting and help him or her find support

Electronic cigarettes (e-cigarettes, vapes) don't burn tobacco. They heat up a liquid that contains nicotine, which is the active ingredient in tobacco. The "smoke" that comes off e-cigarettes is just water vapor that contains nicotine. Because it's the smoke from burning tobacco that causes lung cancer and chronic lung disease (COPD), e-cigarettes have been promoted as a safer alternative to cigarettes. However, they aren't necessarily safe:

  • E-cigarettes contain nicotine, which is very addictive

  • Doctors don't know whether other substances mixed with the liquid nicotine may be dangerous

  • Most adolescents who use e-cigarettes also use tobacco products

What should I do if my adolescent is using or abusing substances?

Talk to your child and your child's doctor about substance abuse if you notice:

  • Unusual behavior

  • Depression or mood swings

  • A change in friends

  • Worse grades

  • Loss of interest in activities

  • Drugs or drug items, such as pipes, syringes, and scales

Your child's doctor will:

  • Ask your child in private about substance use

  • Help figure out if a substance use problem is likely

  • Refer your child for testing, if needed

  • Refer your child to treatment, if needed

Treatment for substance use disorders in adolescents is like treatment in adults. But adolescents should be treated by those who specialize in that age group and their needs.

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