Getting the Facts About Adolescent Substance Abuse and Treatment
Substance abuse is a major public health problem that puts millions of adolescents at increased risk for
alcohol-related and drug-related traffic accidents, risky sexual practices, poor academic
performance, juvenile delinquency, and developmental problems. Although several national
surveys indicate that teen use of most illicit drugs has held steady during the past few
years, adolescent drug abuse remains alarmingly high. Moreover, use of the dangerous club
drug MDMA (Ecstasy) appears to be increasing among older teens. Below are important facts
to know about substance abuse, addiction, treatment, and recovery among adolescents.
Substance Abuse and Adolescents
- Alcohol and Illicit Drug Use
Among youth age 12 to 17, an estimated 1.1 million meet the diagnostic criteria for
dependence on illicit drugs, and 915,000 are dependent on alcohol.1More than half (55 percent) of our nation’s 12th graders have tried an
illicit drug, and more than one-quarter (29 percent) have tried a drug other than
marijuana, such as cocaine, inhalants, and heroin.2
Youth age 16 to 17 have the second highest rate (16.4 percent) of current
illicit drug use in the country. The highest rate (19.9 percent) is found among young
people age 18 to 20.1
Although consumption of alcoholic beverages is illegal for people under 21
years of age, 10.4 million current drinkers are age 12 to 20. Of this group, nearly half
(5.1 million) engage in binge drinking, including 2.3 million who would also be classified
as heavy drinkers.1
About one-quarter of youth age 10 to 17 say their friends "huff"
(inhale the fumes of household products such as glue and paint), and more than one-third
(34 percent) of these youth are between age 13 and 15 when they are first exposed to peers
who use inhalants.3
In 1998, nearly 10 percent of adolescents (age 12 to 17) reported using an illicit drug
at least once during the past month. About 1 in 12 youth (8.3 percent) in this age group
are current (past month) users of marijuana, the most frequently used illicit drug, and
19.1 percent are current users of alcohol.1
- Attitudes Toward Alcohol and Illicit Drug Use
About half (54 percent) of youth age 12 to 17 perceive a great risk in smoking
marijuana once or twice a week or using cocaine once a month.1
Among 12th graders, less than two-thirds (62.5 percent) disapprove or strongly
disapprove of smoking marijuana occasionally.4
Among adolescents age 12 to 17, less than half (47 percent) perceive a great risk in
having five or more drinks once or twice a week; two-thirds (66.4) perceive such risk in
having four or five drinks nearly every day.1
About 40 percent of teens age 13 to 18 strongly agree that "really cool"
teens do not use drugs.5
Nearly one in four teens age 12 to 17 cite drugs as the most important problem facing
people their age.6
- Availability of Alcohol and Illicit Drugs
In 1998, 56 percent of youth age 12 to 17 reported that marijuana is easy or fairly easy
to obtain. Other illicit drugs that are perceived as easy or fairly easy to obtain include
cocaine (reported by 30 percent of these youth), crack (29 percent), and heroin (21
percent).1
In 1999, alcohol was reported fairly easy or very easy to get by 72.3 percent of 8th
graders and 88.2 percent of 10th graders.7
Nearly 14 percent of youth age 12 to 17 reported being approached by someone selling
illicit drugs during the 30 days prior to their interview for a 1998 survey.1
By the time they reach age 17, more than half (56 percent) of adolescents know a drug
dealer.6
Addiction as a Medical Disorder
- Addiction is a chronic disease involving a number of brain chemistry disorders.8
- Children of substance abusing parents are at increased risk for substance abuse and
related problems because of both genetic and environmental factors.9, 10
- Changes in brain chemistry over time make it difficult for persons with addictive
disorders to stop using drugs or alcohol despite their wish to do so.8 Lapses
in the prescribed treatment therapy also can interfere with a person’s ability to
stop using drugs or alcohol.
- Addiction treatment is as effective as treatments for other chronic medical conditions
such as diabetes and hypertension.11
- Recovery from addiction is dependent on the availability of treatment and may require
multiple courses of treatment as with other relapsing conditions.9
Consequences of Adolescent Substance Abuse
Adolescents face unique risks associated with substance abuse. The use of substances
may compromise an adolescent’s mental and emotional development by interfering with
how young people approach and experience interactions.12 In addition,
adolescents are at serious risk for a number of direct and indirect consequences,
including the following:
- Traffic Accidents—Nearly half (45 percent) of all deaths from
traffic accidents are related to the consumption of alcohol, and an estimated 18 percent
of drivers age 16 to 20 (or 2.5 million adolescents) drive under the influence of alcohol.12
- School-Related Problems—Adolescent substance abuse is associated
with declining grades, absenteeism from school, and dropping out of school. Cognitive and
behavioral problems experienced by teens abusing substances may interfere with their
academic performance.13
- Risky Sexual Practices—Adolescents who use drugs and alcohol are
more likely than nonusing teens to have sex, initiate sex at a younger age, and have
multiple sex partners, placing them at greater risk for unplanned pregnancies and HIV/
AIDS, hepatitis C, and other sexually transmitted diseases.14
- Delinquent Behavior—Adolescents who use marijuana weekly are six
times more likely than nonusers to report they run away from home, five times more likely
to say they steal from places other than home, and four times more likely to report they
physically attack people.15
- Juvenile Crime—Adolescents age 12 to 16 who have ever used
marijuana are more likely at some point to have sold marijuana (24 percent vs. less than 1
percent), carried a handgun (21 percent vs. 7 percent), or been in a gang (14 percent vs.
2 percent) than youth who have never used marijuana.16
- Developmental Problems—Substance abuse can compromise an
adolescent’s psychological and social development in areas such as the formation of a
strong self-identity, emotional and intellectual growth, establishment of a career, and
the development of rewarding personal relationships.12
- Physical and Mental Consequences—Smoking marijuana can have
negative effects on the user’s mind and body. It can impair short-term memory and
comprehension, alter one’s sense of time, and reduce the ability to perform tasks
that require concentration and coordination, such as driving a car. Evidence also suggests
that the long-term effects of using marijuana may include increased risk of lung cancer
and other chronic lung disorders, head and neck cancer, sterility in men, and infertility
in women.17, 18
- Future Use Disorders—The earlier the age at which a person first
drinks alcohol, the more likely that person is to develop an alcohol use disorder. A
person who starts drinking alcohol at age 13 is four times more likely to develop alcohol
dependence at some time in his or her life than someone who starts drinking at age 20.19
Signs and Symptoms of Substance Abuse
People who interact with adolescents in the home or community need to be alert to
changes in an adolescent’s behavior and appearance that may signal substance abuse.
By recognizing the potential warning signs and symptoms of substance use, you may be able
to get help for a teenager in need of treatment. The following behavior changes, when
extreme or lasting for more than a few days, may indicate alcohol-related or drug-related
problems and the need for further screening by a professional.
- Sudden changes in personality without another known cause
- Loss of interest in once favorite hobbies, sports, or other activities
- Sudden decline in performance or attendance at school or work
- Changes in friends and reluctance to talk about new friends
- Deterioration of personal grooming habits
- Difficulty in paying attention, forgetfulness
- Sudden aggressive behavior, irritability, nervousness, or giddiness
- Increased secretiveness, heightened sensitivity to inquiry
Screening and Assessment of Adolescent Substance Abuse
- Screening for adolescent substance abuse should be conducted by health care delivery
systems, juvenile justice and family court systems, and community organizations such as
schools, vocational rehabilitation, and religious organizations.20
- Adolescents who should be screened for substance abuse include all teens who receive
mental health assessments, enter the child welfare system, drop out of school, or stay at
homeless shelters. Adolescents arrested or detained within the juvenile justice and family
court systems also should be screened.20
- Screening for substance abuse should focus on the adolescent’s severity of use and
core associated factors such as mental health status, family history of parental
addiction, functioning in school, and any legal problems.20
- Referral to a comprehensive assessment should be made for all adolescents whose
screening reveals indicators (e.g., daily use of one or more substances) of serious
substance abuse problems.20
Treatment of Adolescent Substance Abuse
- Admissions to substance abuse treatment programs for persons age 17 or younger increased
to 8.9 percent of all admissions in 1997. Persons age 19 and younger accounted for more
than 49 percent of all admissions for marijuana use and dependence.21
- Among youth age 12 to 17, an estimated 175,000 have received treatment or counseling for
their drug use, and 148,000 have received treatment or counseling for alcohol use.1
- A significant gap exists between the number of adolescents who need substance abuse
treatment and those who receive it. According to a study in Minnesota, only one-fourth of
youth age 14 to 17 who need substance abuse treatment received it.22
- Substance abuse treatment is effective for adolescents. A national study of
community-based treatment programs for adolescents found that reported weekly marijuana
use dropped by more than half in the year following treatment. Clients also reported less
heavy drinking, less use of hard drugs, and less criminal involvement. Other benefits
included better psychological adjustment and improved school performance after treatment.23
Special Considerations for Adolescent Treatment
Treating adolescents for substance abuse requires special consideration of the
adolescent’s individual experience and how it affects the nature and severity of his
or her alcohol or drug use. Understanding the adolescent’s situation will help
explain why alcohol or drugs are used and how they became an integral part of his or her
identity.
Factors that need to be considered when tailoring treatment for adolescents include the
following:
- Developmental Stages—Treatment for adolescents must address their
unique developmental needs, which vary with the age of the client. Developmental features
of younger adolescents are different from those of older adolescents. For example, older
adolescents are more capable of abstract thinking and are more likely to openly rebel than
younger adolescents.12
- Ethnicity and Culture—Norms, values, and health beliefs differ
across cultures and can affect substance abuse treatment. For example, some cultural
groups may consider treatment invasive; others may wish to involve the extended family.
Treatment services need to be culturally competent and use the preferred language of
adolescent clients and their families.12
- Gender and Sexual Orientation—Factors that influence adolescent
substance abuse and involvement in treatment differ by gender. For example, whereas
adolescent girls more often have internalizing coexisting disorders such as depression,
boys are more likely to have externalizing disorders such as conduct disorders. Effective
treatment for gay, bisexual, and transgendered youth includes helping them to acknowledge
and accept their sexual identity.12
- Coexisting Mental Disorders—Adolescents with substance abuse
disorders are more likely than their abstinent peers to have coexisting mental health
problems such as anxiety disorders, attention deficit-hyperactivity disorder, and
depression. In these teens, substance abuse may disguise, exacerbate, or be used to
"self medicate" psychiatric symptoms. Without tailored treatment, coexisting
mental disorders could interfere with the adolescent’s ability and motivation to
participate in addiction treatment and could increase the potential for relapse.12,
24, 25
- Family Factors—An adolescent’s family has a potential role
both in the origin of his or her substance abuse problem and as an agent of change in the
adolescent’s environment. Treatment should take into account family factors that
increase risk for substance abuse problems in youth, such as any history of parental or
sibling substance abuse problems or addiction; domestic violence; physical, sexual, or
emotional abuse, and neglect. Whenever possible, parents should be involved in all phases
of their adolescent’s treatment.12
Identification of Community Resources
There are a number of ways to find out about substance abuse treatment programs in your
area. Contact these sources of referral information.
- Your school district’s nursing staff, psychologist, social worker, or substance
abuse coordinator or counselor may be able to identify local treatment programs. Other
possible sources of referral information include your doctor, local hospital, pastor or
clergy, and county mental health society.
- Public and private agencies, such as local health departments, state alcohol and drug
authorities, and state and local professional societies may compile directories that can
help you locate treatment programs. These directories may offer information on the types
of facility settings and care provided as well as special services for adolescents.
Ways to Support Adolescents in Treatment and Recovery
Adolescents who are in treatment or recovery need all the support they can get from
their families and communities. Consider taking one or more of the following actions to
support youth undergoing treatment for and recovery from substance abuse.
- Encourage schools to offer student assistance programs, counseling on substance abuse,
and confidential referral to treatment and recovery resources in the community.
- Encourage purchasers of health insurance to obtain comprehensive coverage for substance
abuse and mental health services.
- Encourage treatment centers, schools, and community-based youth organizations to conduct
support groups for children of parents who are addicted to alcohol and drugs.
- Encourage adolescents who have recovered successfully from addictive disorders to
participate in community events that target their peers.
- Because alcohol and drug use among youth often occurs in groups, be aware that
encouraging one young person to seek help may lead others in his or her social group to
seek treatment.
- Encourage environmental changes in your community that promote recovery such as reducing
the number of billboards advertising alcoholic beverages and holding alcohol-free
recreational events.
- Encourage the participation of family members in all aspects of the treatment and
recovery process for adolescents, and foster the availability of family-centered support
groups and other services that address the needs of the entire family.
- Be a positive role model for young people in treatment and recovery by not engaging in
any illegal or unhealthy substance use.
- Get involved in organizations that advocate public policies and funding to support
substance abuse treatment and recovery programs for adolescents.
- Stay informed about available local resources for treatment and recovery and use this
knowledge to help others.
Sources
1 Summary of Findings from the 1998 National Household Survey on Drug
Abuse. DHHS Publication No. (SMA) 99-3328. Rockville, MD: Office of Applied Studies,
Substance Abuse and Mental Health Services Administration, 1999.
2 Monitoring the Future. 1999 Data from In-School Surveys of 8th, 10th, and
12th Graders. Table 1a: Trends in Lifetime Prevalence of Use of Various Drugs for 8th,
10th, and 12th Graders, 1991-1999. Ann Arbor, MI: Survey Research Center, Institute for
Social Research, University of Michigan, 1999.
(Accessed December 20, 1999.)
3 American Academy of Pediatrics (AAP). Releases New Findings on Inhalant
Abuse (Press Release), September 30, 1999.
4 Monitoring the Future. 1999 Data from In-School Surveys of 8th, 10th, and
12th Graders. Table 8: Trends in Disapproval of Drug Use by 8th, 10th, and 12th Graders,
1991-1999. Ann Arbor, MI: Survey Research Center, Institute for Social Research,
University of Michigan, 1999.
5 Partnership for a Drug-Free America (PDFA). 1999 Partnership Attitude
Tracking Study. New York, NY: PDFA, 1999.
6 National Center on Addiction and Substance Abuse at Columbia University.
Back to School—National Survey of American Attitudes on Substance Abuse V: Teens
and Their Parents. New York, NY: National Center on Addiction and Substance Abuse at
Columbia University, 1999.
7 Monitoring the Future. 1999 Data from In-School Surveys of 8th, 10th, and
12th Graders. Table 10: Trends in Perceived Availability of Drugs for 8th, 10th, and 12th
Graders, 1991-1999. Ann Arbor, MI: Survey Research Center, Institute for Social Research,
University of Michigan, 1999.
8 Center for Substance Abuse Treatment. "The Science of Addiction:
Simplified," Substance Abuse in Brief. Rockville, MD: Substance Abuse and
Mental Health Services Administration, July 1999.
9 Anthenelli, R.M., Schuckit, M.A. Genetic Studies of Alcoholism. International
Journal of Addiction, 25:81-94, 1990.
10 Merkiangas, K.R., Stolar, M., Stevens, D.E., et al. Familial Transmission
of Substance Use Disorders. Archives of General Psychiatry, 55:973-979, 1998.
11 National Institute on Drug Abuse (NIDA). Principles of Drug Addiction
Treatment: A Research-Based Guide. NIH Publication No. 99-4180. Rockville, MD: NIDA,
National Institutes of Health, October 1999.
12 Center for Substance Abuse Treatment. Treatment of Adolescents With
Substance Abuse Problems. Treatment Improvement Protocol (TIP) Series, No. 32. DHHS
Publication No. (SMA) 99-3283. Rockville, MD: Substance Abuse and Mental Health Services
Administration, 1999.
13 Crowe, A.H. Drug Identification and Testing in the Juvenile Justice
System: Summary. Washington, DC: Office of Juvenile Justice and Delinquency
Prevention, Office of Justice Programs, U.S. Department of Justice, 1998.
14 National Center on Addiction and Substance Abuse at Columbia University. Dangerous
Liaisons: Substance Abuse and Sex. New York, NY: National Center on Addiction and
Substance Abuse at Columbia University, 1999.
15 Greenblatt, J.C. Adolescent Self-Reported Behaviors and Their Association
with Marijuana Use. In: Analyses of Substance Abuse and Treatment Need Issues.
Rockville, MD: Office of Applied Studies, Substance Abuse and Mental Health Services
Administration.
16 Synder, H.N., Sickmund, M. Juvenile Offenders and Victims: 1999
National Report. Washington, DC: National Center for Juvenile Justice, 1999.
17 Zhang, Z.F., Morgenstern, H., Spitz, M.R., et al. Marijuana Use and
Increased Risk of Squamous Cell Carcinoma of the Head and Neck. Cancer Epidemiology,
Biomarkers, and Prevention 8(12):1071-1078, December 1999.
18 Center for Substance Abuse Prevention. Tips for Teens About
Marijuana. Rockville, MD: Substance Abuse and Mental Health Services Administration,
1998.
19 Grant, B.F., Dawson, D.A. Age at Onset of Alcohol Use and its Association
with DSM-IV Alcohol Abuse and Dependence. Journal of Substance Abuse 9:103-110,
1997.
20 Center for Substance Abuse Treatment. Screening and Assessing
Adolescents for Substance Use Disorders. Treatment Improvement Protocol (TIP) Series,
No. 31. DHHS Publication No. (SMA) 99-3282. Rockville, MD: Substance Abuse and Mental
Health Services Administration, 1999.
21 Office of Applied Studies. National Admissions to Substance Abuse
Treatment Services: The Treatment Episode Data Set (TEDS) 1992-1997. Rockville, MD:
Substance Abuse and Mental Health Services Administration, 1999.
22 Minnesota Department of Human Services. Estimate of the Need for
Alcohol/Drug-Related Services for Adolescents in Minnesota: Implications for Managed Care
Organizations and Health Care Providers. St. Paul, MN: Minnesota Department of Human
Services, Performance Measurement and Quality Improvement Division, 1997.
23 Hser, Y-I., Grella, C., Hsieh, S-C., Anglin, M.D. National Evaluation of
Drug Treatment for Adolescents. Presented at the College on Problems of Drug Dependence
Annual Meeting, June 1999.
24 Center for Substance Abuse Treatment. Assessment and Treatment of
Patients With Coexisting Mental Illness and Alcohol and Other Drug Use. Treatment
Improvement Protocol (TIP) Series, No. 9. DHHS Publication No. (SMA) 95-3061. Rockville,
MD: Substance Abuse and Mental Health Services Administration, 1995.
25 Winters, K.C. Treating Adolescents with Substance Use Disorders: An
Overview of Practice Issues and Treatment Outcome. Substance Abuse 20(4):203-225,
1999.
Source: Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment
Page last reviewed by At Health on January 15, 2007
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