Substance use is a broad term that includes the use of alcohol, tobacco, e-cigarettes/vaping, inhalants, and a variety of drugs/substances, such as cocaine, hallucinogens, methamphetamines, marijuana, ecstasy, opioids, “magic mushrooms,” “bath salts,” as well as the nonmedical use of various prescription drugs.
- Substance use is correlated with:
- risky behaviors in adolescents, such as unprotected sex, poor decision-making, the possibility of overdosing, impaired driving or boating, and various other risk-taking behaviors.
- the development of a variety of later health problems in adulthood.
- the possibility of violence, including fighting, homicides, and relationship victimization.
- difficulties with family and peer relationships, as well as with academics and school functioning.
- Sustained substance use can:
- affect both growth and development of adolescents, including brain development.
- cause attention/concentration deficits, memory difficulties, and problems with cognitive flexibility.
- carry the risk of increased use of substances with decreased interest in other healthier activities.
- The earlier the onset of substance use, the greater the likelihood that the individual will continue to use substances and/or develop a substance use disorder later in life.
The specific effects and consequences of substance use in adolescence depends on a complex array of factors, including the specific substances used, the adolescent’s general physical and mental health, the amount of substances used, whether the substances are combined with other substances, the setting and circumstances of the substance use, family and environmental factors, and peer influences.
The current statistics on adolescent substance use vary because of the particular study and substance being studied, but as a general benchmark the CDC reports that tobacco, marijuana, and alcohol are the substances most commonly used by adolescents. The CDC reports that, by 12th grade, approximately 2/3 of students studied reported having tried alcohol; about 1/2 of 9th through 12th grade students studied reported having used marijuana; and about 4/10 of 9th through 12th grade students studied reported having tried cigarettes. You can locate additional statistics regarding adolescent use of these and other substances in the Resources/References list, below.
The concern for the reports of increased use of substances by adolescents has prompted the American Academy of Pediatrics (AAP) to recommend starting substance use screening at nine years. The AAP has many useful screening recommendations and a list of specific screening instruments that mental health practitioners can use, as well as some general recommendations for intervention.
What can mental health clinicians do to help?
The first step is to develop an awareness of the substances being used, the issues and signs/symptoms of adolescent drug use, and the possible consequences associated with adolescent substance use. Another step is to familiarize ourselves with the screening tools and assessment instruments available, and to incorporate ways to screen and evaluate for substance use as part of intake and ongoing check-in procedures. Because of the issues of client confidentiality when dealing with adolescents, clinicians need to be prepared in advance on how to handle adolescent substance use disclosures. Clinicians also always need to be aware of scope of practice and be able to find out when a referral to another treatment provider and/or to a specific treatment program is indicated.
Regarding treatment, adolescent drug abuse treatment is most commonly offered in outpatient settings. There is no universal treatment approach, and treatment planning should consider the needs of the whole person. Any mental health issues should be addressed as part of treatment planning. Research shows that treatment outcomes are better when the client stays in treatment for 3 months or more. More than one episode of treatment might be necessary due to relapse; and continuing care following treatment, such as home visits, case management, and referrals to other services can be beneficial.
Evidence-based therapeutic approaches recommended by the National Institute on Drug Abuse:
Behavioral Approaches: researchers have found specific behavioral approaches to be effective in the treatment of adolescent substance use. The National Institute on Drug Abuse recommends the following evidence-based behavioral treatment approaches: Cognitive-Behavioral Therapy (CBT), Adolescent Community Reinforcement Approach (A-CRA), Contingency Management (CM), Motivational Enhancement Therapy (MET), and Twelve-Step Facilitation Therapy.
Family Approaches: Involving the family in the adolescent’s treatment process is very effective in addressing adolescent substance use. Specific evidence-based family therapy approaches recommended by the National Institute on Drug Abuse include Brief Strategic Family Therapy (BSFT), Family Behavior Therapy (FBT), Functional Family Therapy (FFT), Multidimensional Family Therapy (MDFT), and Multisystemic Therapy (MST).
Recovery Support Services: Recovery support services are used in conjunction with active treatment, rather than being a stand-alone treatment. While several types of recovery support services have promising preliminary evidence, according to the National Institute on Drug Abuse, the only current evidence-based recovery support services approach is Assertive Continuing Care (ACC), a home-based approach delivered by trained clinicians with the goal of preventing relapse.
Medications: While mental health therapists cannot prescribe medications, an awareness of the medications used to treat substance use is helpful. According to the National Institute on Drug Abuse, none of the medications used to treat adult addictions have been approved by the FDA to treat adolescents. Also, it should be noted that there are currently no FDA-approved medications to treat addiction to cannabis, cocaine, or methamphetamine in any age group. However, physicians may prescribe medications “off-label.” This link discusses the use of medications with substance use disorders: Addiction Medications.
In summary, adolescent substance use is an increasingly prevalent, complex, and ever-changing concern that therapists are likely to encounter in mental health practice. Mental health practitioners can refer to the resources listed below to help adolescent clients and their families.
References & Resources:
American Academy of Family Physicians: American Family Physician Journal: Adolescent Substance Use and Misuse: Recognition and Management: https://www.aafp.org/afp/2019/0601/p689.html
American Academy of Pediatrics: Substance Use Screening, Brief Intervention, and Referral to Treatment:
CDC: Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html
CDC: Teen Substance Use & Risks: https://www.cdc.gov/ncbddd/fasd/features/teen-substance-use.html
DEA: Psilocybin (Magic Mushrooms): https://www.dea.gov/factsheets/psilocybin
National Institute on Drug Abuse: Children & Teens: https://www.drugabuse.gov/children-and-teens
National Institute on Drug Abuse: Synthetic Cathinones ("Bath Salts") Drug Facts: https://nida.nih.gov/publications/drugfacts/synthetic-cathinones-bath-salts
National Institute on Drug Abuse: Evidence-Based Approaches to Treating Adolescent Substance Use Disorders: https://nida.nih.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/evidence-based-approaches-to-treating-adolescent-substance-use-disorders
National Institute on Drug Abuse: Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: https://nida.nih.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/introduction
SAMHSA’s Helpline: Visit www.samhsa.gov/find-help/national-helpline or call 1-800-662-HELP (4357)
SAMHSA: Understanding Inhalant Use: https://www.samhsa.gov/data/sites/default/files/report_3095/ShortReport-3095.html
Society for Adolescent Health and Medicine: Substance Use Resources For Adolescents and Young Adults: https://www.adolescenthealth.org/Resources/Clinical-Care-Resources/Substance-Use/Substance-Use-Resources-For-Adolesc.aspx