Addiction in the US: Teen substance abuse

What does adolescent drug use look like in the U.S. today?  According to the 2019 Monitoring the Future Survey conducted by the National Institutes of Health, approximately 38% of 12th graders surveyed reported using an illicit drug during the past year, a large portion of that going to marijuana.  In fact, while the use of some substances such as prescription drugs has decreased in recent years, daily marijuana use has continued to increase among 8th graders, 10th graders and 12th graders since 2017.

A 2009 research review found that substance use in adolescence, even as little as 1-2 years of heavy drinking, can have lasting effects on your child’s brain development. Similar results were found for heavy marijuana use as well. The research suggests that substance use during this period may lead to abnormalities in brain functioning, which over time, are linked to changes in neuro-cognition.

 During teenage years, the prefrontal cortex region–the area of the brain responsible for making decisions and comparative and value judgements–is still developing. This means, teens and adolescents may be more likely to engage in risky and impulsive behaviors that provide immediate rewards rather than considering the long-term consequences. According to Dr. Nora Volkow, the not yet matured prefrontal cortex plays a major role in young people being more susceptible to abusing drugs and alcohol, as they may lack the impulse control to fully weigh the long term impacts on their lives and their brain’s development.

7 warning signs of teen substance abuse

Moving from adolescence to teenage years can be an especially trying time for families. Becoming a young adult means attempting to find oneself while also asserting a new level of personal independence. However, as the parent of a teen, this time can be especially scary. As your teenager begins to exercise new freedoms, you might also worry whether this includes using drugs and/or alcohol.

The following 7 warning signs may indicate that it is time to check in with your teen or adolescent child about drug or alcohol abuse:

Teen substance abuse can be especially challenging to identify. This is because certain behaviors generally associated with drug and alcohol abuse can also be typical behaviors of an “angsty” teen and adolescent. Moreover, signs of drug or alcohol use may be  confused symptoms of co-occurring or separate mental health issues that can appear during this time such as depression, anxiety or eating disorders, which should also be addressed. 

Remember, while some of these behaviors may be dismissed as those of a “typical teenager”, it is important to trust your gut. If you are worried that your teenager is using drugs or alcohol, it is best to address the issue through direct and open communication. And if you don’t find that your child is actually using drugs or alcohol, discussing it may allow you to detect  and address other issues or problems occurring in your teen’s life.


Do you suspect your teenager is using drugs or alcohol?

Preparing for a difficult conversation

Before running to confront your child about your suspicions, it is best to take some time and consider how you will approach the issue. This will not be an easy discussion, and it will likely be the first of many, so planning ahead will help you stay in control of the conversation and achieve a better outcome. Below are 4 steps to take to prepare for the conversation with your child

1. Talk to your spouse or significant other

If your child is being raised in a two parent home, it is important for you and your significant other to be on the same page. If one parent is preaching abstinence from drugs and alcohol while the other is unintentionally encouraging or permitting these behaviors, your future efforts to curtail your teen’s substance use will be greatly undermined. This does not mean it is time for the blame game. Understand that neither one of you is at fault and that pointing fingers will do little to effectively resolve the problem at hand. Instead, come to an agreement on how you will both approach the topic with your teenager, and prepare for a difficult conversation. Supporting each other and presenting a united front will be critical.

2. Define new rules and what you hope to achieve from the conversation,

Setting a realistic goal for what you hope to get out of the conversation will not only help to guide the discussion, but also to achieve a more productive result. Remember, this goal does not have to be a big one such as getting them to admit their drug and alcohol abuse and promising to never use again. In fact, It is best to set a small and realistic intention for the conversation, like simply expressing to your child that you don’t want them to use drugs or alcohol. 

Additionally, it is important to reevaluate the current boundaries you have set with your teen. This may mean creating an entirely new set of rules and consequences or adjusting what already exists. Either way, prior to approaching your teen, you should be able to clearly articulate your rules around things like drugs, alcohol, curfew, friends, and parties, as well as the consequences for breaking them. Make sure that you and your significant other are in agreement when it comes to these rules prior to the conversation with your teen or adolescent.

3. Be ready to discuss your own experience with drugs and alcohol

When confronted, your teen may become angry and bring up your own drug and alcohol use as an example of your hypocrisy. Don’t be rattled. It is important to be honest and address the issue with your child. Before speaking with them, take some time to think about how you will respond carefully and thoughtfully. If you did not use drugs or alcohol as a teen, explain your decision and the reasoning behind it to them. If you did in fact use substances during your teen or adolescent years, discuss what you have learned and the challenges you experienced as a result of your use.

4. Prepare yourself for a negative reaction and learn de-escalation techniques 

Confronting your teen about drug and alcohol use will not be easy. Your child may deny that any drugs, alcohol, or paraphernalia you have found belong to him or her; become angry; or call you a hypocrite for your current or past use. Be prepared to deal with an emotional or even angry response by thinking about the ways in which you can respond. Come prepared with any concrete evidence you have found of substance use, as well as specific examples of behaviors that concern you. Additionally, remember that yelling and arguing will not help you better achieve your objective. Know how to check in with yourself ahead of time. If you are concerned that you will be unable to keep your cool, research de-escalation techniques to help the tense conversation remain calm and productive. 

How to approach the conversation with your teen

Once you feel prepared to address the issue of drugs and alcohol with your teen, find a time to sit down and talk to your child. Some helpful tips for during conversation include:

  • Choose the correct time for the conversation. Avoid attempting this conversation if you believe that your child is under the influence or if tensions are already high at the moment. Also, be sure that there is sufficient time to fully discuss the issue in a relaxed and thoughtful manner. 
  • Explain your concerns, but avoid making outright accusations.The goal is to create a dialogue with your child. By expressing your concerns and suspicions rather than directly accusing your teen, you won’t prompt as much of a defensive or combative response.
  • Be specific and clear. Explain to your child why exactly you are concerned. Enumerate your specific concerns. Has your teen’s behavior changed? Do they regularly have red eyes or a strange odor on them? Have you found evidence of drug or alcohol use? If so, explain this to your child. They may respond with anger or a denial, but that is okay. 
  • Listen and foster a conversation. Take the time to talk to your teen about their thoughts and experiences around drugs, alcohol and peer pressure. Also, although you want to be sure to effectively communicate the boundaries, rules and their consequences, don’t forget to allow your child the opportunity to respond. Listen to their feedback and allow them space to negotiate the rules. While your child’s safety is a foremost concern, you also want to create rules that work for both parties and that can be effectively implemented. However, once the rules are set, they should be honored and enforced. 
  • Keep calm and remind your child how much you care about them.  If you feel you are getting too angry or the conversation is getting too heated, stop the discussion and pick it up at another time when you are both in a calmer state.  Also, don’t forget to remind your child, you are talking to them now because you love them and care about their wellbeing.
  • Ask for help from experts. If you are finding it challenging to effectively have this conversation with your child, look to outside help. Is there a school counselor, therapist or family doctor that might be able to help?


My teen has a drug or alcohol problem. What should I do?

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When to consult a professional about your teen’s drug abuse

Have you approached your teen about their drug or alcohol use and seen little change, or worse, are you concerned their drug or alcohol use has escalated into a larger problem? You may consider consulting a professional, such your family doctor, to provide a screening for signs of drug use and other related conditions. According to the Academy of Pediatrics such drug abuse screenings are recommended as a part of universal adolescent health care and can also be done during general checkups.

If you are planning on getting a screening for your teen, it may be helpful to call ahead and ask if your doctor is comfortable using a standard assessment tool or follows the Screening, Brief Intervention, and Referral to Treatment (SBIRT) guidelines for early intervention.  These evidence-based guidelines will allow your medical professional to diagnose if your teen has a substance use disorder; provide a brief intervention where her or she engages in a conversation about substance abuse; and refer your teenage child to treatment, if needed

If your teenage or adolescent child has been diagnosed with a substance use disorder, it is time to seek treatment. There are many kinds of treatment programs and rehab facilities out there, and this may feel overwhelming at first. 

Finding the right type treatment program for your child

The first step in seeking treatment for your teen or adolescent is figuring out what level of care he or she requires. The American Society of Addiction Medicine has developed a set of criteria to standardize and simplify the process. Answering the following 6 questions will help define the level of care that is appropriate for your teenage or adolescent child:

  1. What is his or her level of intoxication and potential for withdrawal?
  2. Are there other medical conditions present?
  3. What emotional, behavioral or cognitive conditions are present?
  4. How ready or motivated to change is your teen or adolescent?
  5. How likely is your child to relapse or to continue using?
  6. What does the recovery environment look like (peers, family, school, interactions with the legal system, etc.)?

Depending on your responses, there are 3 types of rehabilitation treatment settings that may be appropriate. Remember, you should also always look for a fully accredited facility.

Outpatient / intensive outpatient treatment programs

Outpatient and intensive outpatient programs are generally recommended for teens and adolescents with less severe addictions and fewer existing mental disorders. Programs offered may work with peer groups and/or individually and can vary in intensity, ranging anywhere from once or twice a week to 3 hours a day. Liberty ranch offers an intensive outpatient program to teenagers aged 18 and older and adults based on the 12 steps of recovery. The program includes individual and group counseling with an emphasis on cognitive-behavioral, psychotherapy and family counseling. 

Partial hospitalization 

Partial hospitalization programs provide treatment in cases that require a higher level of care than inpatient settings, but do not require round-the-clock care. Treatment is delivered 4-6 hours a day 5 days a week or more.  However, your teen or child is still able to live at home and maintain some of their regular activities

Residential / Inpatient treatment programs

Do you feel that your child’s addiction is too severe to live at home? Does he or she require constant supervision? In this case, residential and inpatient drug and alcohol addiction treatment programs provide 24 hour-a-day supervision and may be appropriate in such extreme situations. Such programs are especially apt in situations involving complex psychiatric conditions, family issues, and any other issues that can severely inhibit your teen or adolescent’s ability to remain sober without constant supervision.

If you are unsure which program is most appropriate for your child’s situation, consider asking a consulting a medical professional or addiction specialist. 

Considerations when choosing a treatment program for teens or adolescents

If your teenage child is in fact referred to treatment, it is important to seek a rehab facility or treatment program that offers a comprehensive care plan addressing the numerous factors and contexts that may have precipitated or impacted your teenager’s substance use disorder.  

The National Institute on Drug Abuse recommends a number of evidence-based principles be incorporated into the treatment process when dealing with teens and adolescents. First and foremost, your teen’s treatment should be tailored to their unique issues, needs and circumstances. Treatment is not just a one-size-fits-all remedy. Rather, the specific experiences, level of psychological development, gender, cultural and community context of the individual should be incorporated into a comprehensive treatment plan. 

Additionally, treatment should address the whole of the issue, not just the drug problem. In other words, there may be many circumstances that are propelling your teenage child’s drug and alcohol use. Not addressing these issues as well as the substance use disorder could sabotage your teen’s success in the treatment process. Rather, treatment should consider your teen or adolescent’s overall situation. This may include their psychological well-being, financial, medical and housing issues, as well as their social situation. 

To this end, a solid treatment plan should specifically take the mental health of your teen into account. Identifying and treating co-existing mental conditions is critical to an effective treatment plan. According to a 2008 study on comorbidity in adolescents and adults, authors Chan, Dennis and Funk found co-occurring that mental health issues appeared in two thirds of participants the year prior to beginning treatment. Moreover, adolescents who abused drugs regularly were found to suffer from disorders such as depression, anxiety, oppositional defiant disorder, among others.  

As a part of the treatment plan, behavioral therapies can be especially helpful in teaching your teen new ways to respond to their context, helping replacing negative behaviors associated with drug and alcohol abuse with more positive and constructive actions. These therapies, which should be conducted by a trained clinician, may be especially useful to your adolescent or teenage child post-treatment, when they don’t have the same structured system of support they experienced during rehab.

Finally, a strong treatment plan will incorporate the family and close community into the rehabilitation process. Family plays an important role in the day-to-day of your teen. Strengthening these bonds and improving communication patterns will allow you to listen and interact with your teen more effectively and become a pillar of support during and following treatment. Participating actively in their treatment process will positively affect their experience as well as educate you and your family about substance abuse and addiction. Moreover, you and your family will learn how to support his or abstinence from drugs and alcohol as well as detect a relapse. 

Any rehabilitation or treatment plan should consider the following factors:

  • Environmental factors (neighborhood, transportation, school, living situation)
  • Family and community
  • Mental health problems and comorbidity
  • Cultural factors
  • Sexuality and gender
  • Sensitive issues, traumatic life experiences, situations of abuse or risk of self harm or suiccide 
  • Economic issues
  • Health problems and sexually transmitted diseases
  • Personal issues (psychological development, relationships)

How to support your child following treatment

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Following the completion of a treatment program of discharge from a rehab facility, it may be challenging for your teen or adolescent to cope with the outside world without the support of a structured program. The Partnership for Drug-Free Kids highlights several ways you can help make this transition easier in its Continuing Care E-book.

1. Work with professionals to create and implement an post-treatment plan

Having a post-treatment plan can help your child remain sober by offering structure and support. An aftercare plan may be provided by your child’s rehab facility. Otherwise, you can work with professionals to develop a plan that works for your teen or adolscent’s specific situation. A plan may include specific activities such as attending peer support meetings regularly, continued checkups and monitoring to detect drug or alcohol use, and sessions with a counselor.

2. Find a peer support group for yourself and your child

Narcotics Anonymous and Alcoholics Anonymous can both be helpful in providing a confidential place for your teen or adolescent. Based on the 12 steps of recovery, these groups offer a safe and confidential space for your child to share their challenges and success of sobriety with others going dealing with addiction. Look for meetings geared towards teens and adolescents specifically or contact AA and NA central offices to find a meeting nearby.  

3. Involve your child’s primary care physician

Part of your teen or adolescent’s aftercare plan may involve random and regular drug testing performed by his or her clinician. Involving a health care provider is important because it allows your child to receive messages of abstinence from a qualified medical source and lets you know if your teen has been using again. Look for a clinician who is well-informed on the topic of addiction.

4. Make sure your child goes to their appointments during and following treatment

Attending regular appointments–whether they are for counseling, drug testing, or peer group– is important to your teen’s recovery. One of the biggest challenges when it comes to appointments can be transportation. Your teen or adolescent may not have a driver’s license or it may be suspended. If you can not provide transportation, help your child find ways to make it to their appointments through public transportation, relatives or friends. 

5. Create clear consequences for rule-breaking and follow through

As previously mentioned, it is important to create and clearly communicate a list of rules so your child knows what is permitted and what is not in order to reinforce abstinence from drugs and alcohol. The consequences for breaking these rules, however, should not be too severe or long-lasting. For instance, take away your child’s cell phone for a week, but also allow them the opportunity to earn it back. You don’t want your child to feel hopeless and like they are constantly being punished whether they use or not. Instead, you want them to understand and respect boundaries, as well as learn from their mistakes.

6. Provide positive reinforcement 

While it is important to help your child follow through with post-treatment plans as well as enforce consequences when rules are broken, it is equally necessary to provide your child with positive reinforcement. This means providing recognition for accomplishments, no matter how small.  Reward good behavior, no matter how small, with positive verbal reinforcement or other prizes rather than just focusing on punishment and negative behaviors. Remember, it can be overwhelming for your child to only hear about substance abuse all the time. So make sure to tell your child that you love them and take interest in other parts of their lives outside of substance abuse. Sometimes not talking about drugs and alcohol for the day can make all the difference.


If your child is in a dangerous or emergency situation, please call 911 or contact your local emergency services. Otherwise, the following resources may be helpful to you and your family. 

Peer Support Networks

If you are looking for a peer support network to provide guidance and support for your teenage child, use the meeting locators to find an  Alcoholic Anonymous or Narcotics Anonymous meeting near you. Be sure to look for meetings specifically geared towards youth.

For spouses and family members with a loved one dealing with addiction, use the Nar-Anon, Al-Anon, and Families Anonymous locators to find a nearby peer support meeting. 

Treatment Resources

Si desea obtener más información sobre las opciones de tratamiento para usted o su ser querido, comuníquese con Liberty Ranch para una consulta gratuita