Signs of Teen Substance Abuse: What Medical Professionals Look For

Joleen Sams, MSN, APRN, FNP-C

Updated

Reviewed by NursingEducation Staff

Most teens who try or use alcohol, marijuana, and other substances during the teen and young adult years never develop substance use disorders. Substance use during the teen years is often dismissed as experimentation. However, over 90% of adults who do develop substance use disorders began their use during adolescence. Parents, caregivers, and other adults who work with teens should know and recognize signs that may indicate a teen is abusing drugs and alcohol to be proactive in identifying these signs to intervene early and prevent potential harm.

Common Signs of Substance Use

There are several signs of substance use you should be aware of, including behavioral changes, personality shifts, psychological, emotional, and health issues, and changes in hygiene and appearance.

Behavioral Changes

Several behavioral changes may indicate your teen is struggling, including:

Shifts in Mood and Personality

Mood and personality changes are common when teens and young adults start using drugs and alcohol. You may notice mood and personality changes, such as:

Emotional and Psychological Symptoms

Psychological upheaval is a significant aspect of substance use. Some changes you might see include:

Physical Health

Physical health changes with substance abuse include:

Signs of current intoxication differ based on the substance used but may include:

Hygiene and Appearance

Teens are typically hyper-aware of how they look. Sudden changes in personal grooming could be a cause for concern, including:

You may also notice the smell of substances like marijuana, cigarettes, or alcohol on your teen, in their car, or on their belongings.

How Medical Professionals Can Help In Identifying Teen Substance Abuse

Healthcare providers at all levels of the medical system play a significant role in identifying and addressing teen substance abuse. Healthcare providers, nurses, and support staff may conduct screenings, initiate conversations, and provide support for teenagers and their families.

Regular Check-Ups and Conversations

Annual check-ups are essential at every age and stage in life. Parents should allow teens time alone with their healthcare provider to discuss sensitive topics. Teens are much more likely to open up about mental and sexual health and substance use with a healthcare provider they trust. Teens are taking responsibility in other areas of their lives; it’s important for parents to foster this independence as well.

Many healthcare providers start the practice of ‘time alone‘ with a patient as early as age 11. This allows both the parent and child to get used to the idea, so it feels like a routine part of healthcare. Often, the parent will attend a portion of the appointment and then step out of the room. This allows the patient and healthcare provider time to discuss more sensitive topics such as mental health concerns, substance use, and sexual activity.

Physical Examination and Testing

Physical exams during adolescence ensure appropriate overall health development, including mental health concerns. Routine drug testing is not typical but can be ordered if there are concerns.

Most Commonly Abused Substances Among Teens

Alcohol, tobacco, and marijuana are the most commonly used substances among teens. Parents and caregivers should understand the signs of acute intoxication, abuse potential, and how to intervene to decrease the possibility of developing a substance use disorder.

Alcohol

Alcohol is one of the most commonly used substances, with about 46% of 12th graders reporting use during the last year. Signs of intoxication may include dizziness, slurred speech, nausea, vomiting, and impaired movement and learning. Long-term consequences include decreased cognitive function and organ damage.

Nicotine

Tobacco contains nicotine, a highly addictive substance that young people commonly use. Vaping is the most common way for teens to smoke tobacco, with about a quarter of 12th graders reporting use in 2023. The dangers of smoking include addiction, heart disease, cancer, and chronic lung problems. Teens who use tobacco products are more likely to use other substances at younger ages.

Marijuana

Marijuana use is prevalent among teens due to its psychoactive effects and relatively easy access, with 29% of 12th graders reporting cannabis product use in the last year. This is stable compared to previous survey results. Teens perceive marijuana as a ‘safe’ drug for a variety of reasons, including its legalization throughout many areas and regions.

This drug elicits hallucinations, sedation, loss of inhibition, and increased appetite. Marijuana decreases memory processing, the ability to learn, problem-solving ability, coordination, and can impair judgment. It can also cause anxiety and paranoia.

Prescription and Over-the-Counter Medications

Several prescription drugs or over-the-counter (OTC) medications are misused every year. OTC cough syrups that contain dextromethorphan (DXM) can cause hallucinations, and very high doses can lead to death. Prescription drugs often abused include opioids (hydrocodone, oxycodone, and fentanyl), stimulants (Adderall and Ritalin), and central nervous system depressants (Valium, Xanax, and Klonopin). Ensure all prescription and OTC medications are kept in a safe, locked area. Teens who are legally prescribed medications should only have access to their daily dose.

Illicit Drugs

Teens use illicit drugs at lower rates than those discussed above; about 7% of 12th graders reported any drug use other than marijuana. However, once a teen engages in any substance use, they are at higher risk for trying other substances.

Illicit drugs are typically stimulants or depressants and are illegal at any age. Examples of stimulants include methamphetamine, cocaine, ecstasy (MDMA), and bath salts. Depressants include the opioids heroin, fentanyl, methadone, and morphine. Short- and long-term health consequences depend on the substance used.

Reasons Behind Teen Substance Abuse

A complex interplay between personality, peer pressure, stress, familial influences, and environmental factors can lead to substance use and abuse. Teenagers are susceptible to substance use and abuse for a variety of reasons.

Research over the last 50 years has identified factors that are protective against substance use and risk factors that make substance use more likely. In straightforward terms, strong social connections protect against substance use disorder (SUD), while those with adverse experiences and social isolation are more likely to become substance users.

Peer Pressure and the Desire to Fit In

Adolescents are susceptible to peer pressure and crave social acceptance. Teens with friends who use alcohol, nicotine, and other drugs are more likely to try them. Many teens may simply try a substance out of boredom or curiosity.

Seeking an Escape From Stress and Anxiety

Today’s teens are experiencing stress and anxiety at alarming rates. Some teens seek to escape by turning to substances that offer immediate relief with little thought regarding long-term consequences.

Influence of Family

Family dynamics play a crucial role in the development of SUD. Teens who experience family strife and volatility, including but not limited to violence or substance use, are more likely to struggle with substance abuse. Children with strong family ties are less likely to engage in risky behaviors.

How to Address Teen Substance Abuse

Parents, caregivers, educators, and communities all have a vested interest in preventing teen substance abuse. Over 90% of adults with substance use disorder can trace their first use back to adolescence. SUD is costly for individuals and society as a whole.

Steps for Parents and Caregivers

Parents should focus on fostering strong connections with their children. Check-in with your teen, get to know their friends, and have conversations about what they are doing on a regular basis. Parents and caregivers should also learn to recognize signs of substance use and know how to get professional help.

Role of Teachers and Schools

Educators and schools also play a role in substance use prevention, as these professionals are trained to identify at-risk students. Prevention programs focus on fostering strong social connections and decreasing known risk factors.

How Medical Professionals Approach Teen Substance Abuse

Monitoring the Future (MTF) is an annual survey of 8th, 10th, and 12th graders in the United States. With almost fifty years of data, the results from this survey give medical professionals, educators, and community leaders excellent data about drug and alcohol use. This survey, along with hundreds of other types of research, has helped medical professionals identify the best ways to approach substance use screening and interventions.

The American Academy of Pediatrics recommends screening for substance use; the annual physical appointment provides an excellent opportunity for this.

Confidentiality and Ethical Considerations

Teens have a right to expect confidentiality, which can significantly foster and create positive relationships with their healthcare providers. Teens who are guaranteed the right to confidentiality may be more willing to disclose risky behaviors and seek help.

Medical professionals who work with teens face several legal and ethical considerations. Parents generally have legal access to their children’s medical records until age 18, except in certain circumstances.

Healthcare providers must balance a teen’s right to confidentiality and ability to make healthcare decisions with the legal statutes in place, which vary at the local and state levels.

Intervention Strategies

Several interventions are available for teens who struggle with substance abuse. Some of the most effective interventions include:

Other interventions may include exercise, yoga, and mindfulness practices. The entire family should engage in therapy to support a teen’s recovery.

Referral to a Specialist for Support and Treatment

When healthcare providers, educators, social workers, or other trained professionals identify a teen struggling with substance abuse, referral to a specialist is critical. Many professionals know the resources available in the local area and can make recommendations. Some national resources to help you find specialized care include:

The Importance of Early Detection and Intervention

Early identification and detection of teen substance use can help mitigate potential life-long consequences. Interventions can prevent physical and mental health complications, legal consequences, and improve social and educational engagement.

Potential Long-Term Consequences of Teen Substance Abuse

The developmental stage of teens and young adults is unique in that they make decisions and engage in behaviors that have long-lasting consequences and implications. Decision-making is often short-sighted and impulsive.

Physical Effects

Substance use can cause significant physical health effects. Long-term damage varies by substance used but may include:

Emotional and Psychological Effects

Substance abuse can also cause or exacerbate long-lasting mental health disruptions, such as mood disorders and cognitive impairment. Substance use disorder affects every aspect of a person’s life.

Social and Educational Impact

Substance use disrupts positive social and family relationships, and declines in academic performance can limit a teen’s future opportunities.

Potential Legal Consequences

Possession and use of alcohol, nicotine, and marijuana are illegal for teens; other illicit drugs are illegal for all. Teens who use and abuse substances are more likely to enter the justice system. Criminal charges are a real possibility, which can ultimately limit future employment or education opportunities.

Importance of Early Intervention on Recovery

Early detection and intervention for teens with substance abuse can have a significant impact on their recovery. Teens who engage in therapy and other intervention methods are more likely to move forward and live healthy, productive adult lives.

Preventing Teen Substance Abuse

There are several ways parents, caregivers, and other adults who work with teens can prevent teen substance abuse.

Importance of Open Communication

Talk to your children about drugs and alcohol in age-appropriate terms from the time they are little. Let them know how you feel about underage substance use. Then, be willing to listen more than you speak as your child enters middle and high school years. Allow them time and space to discuss matters that are important to them.

Education on the Dangers of Substance Abuse

Discuss the potential dangers and outcomes associated with substance use in terms your child will understand. Substance use can lead to lifelong health, social, and legal consequences and limit opportunities.

Positive Reinforcement and Building Self-Esteem

Make sure your child knows you love, respect, and care for them with your words and actions. Provide opportunities for them to shine and praise their achievements. Positive reinforcement is much more effective over the long term than punishing behaviors. It builds self-esteem, which is protective against substance use disorder.

FAQs

Here are some frequently asked questions regarding teen substance abuse.

What are common signs a teen is using drugs or alcohol?

Sudden changes in behavior and hygiene, eating and sleeping patterns, declines in school performance, and changes in friends may be signs of substance use.

What’s the best way to prevent teen substance use?

The best way to prevent teen substance use is to prioritize strong social connections. Teens with positive family and friend relationships, good role models, and involvement in extracurricular activities are less likely to develop substance abuse disorders. Start conversations early in life regarding your thoughts and beliefs regarding substance use, and foster open, honest communication with your teen.

What are the risk factors for teen substance use?

Several risk factors are associated with teen substance abuse. Some include a family history of substance abuse, mental health conditions including depression, anxiety, and ADHD, trauma history, and low self-esteem.

Where can I find local help and resources for teen substance abuse?

You can ask your primary healthcare provider or school counselors about local resources that can help with teen substance use. Some websites and helplines that provide assistance include FindTreatment.gov, 988 Suicide & Crisis Lifeline, and the SAMHSA National Helpline, which are all available 24/7.

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