Substance use amongst adolescents and teens has always been a reason for concern and is constantly evolving with new trends, data, substances, and challenges. Surveys show that as of 2022, the number of teens who had reported using an illicit substance in the last year was staggering: one in three 12th graders, one in five 10th graders, and one in ten 8th graders. Drug use is associated with harmful results, including violence, sexual risk behavior, mental health concerns, and suicide. What causes drug use? How do you identify it? What can be done?
Drug exposure falls into two categories: accidental and intentional drug use. Accidental accounts for therapeutic errors or naïve exploratory behaviors, whereas intentional drug use is due to risk-taking behaviors, personal experimentation, or self-harm. Substance misuse is impacted by curiosity, peer pressure, academic stress, emotional challenges, wanting to feel accepted, and enjoying the physical effects and high that drugs can provide.
High-risk substance misuse includes three major categories:
- Misuse of prescription drugs
- Using drugs that must be injected and have a high risk of blood-borne diseases such as hepatitis and HIV
- Illicit drugs, including cocaine, methamphetamines, heroin, inhalants, ecstasy, and hallucinogens
As is evident from the three major categories of high-risk alcohol and drug use, there is a wide variety of drugs that can be used with serious side effects. It is valuable for those who interact with adolescents and teens to be aware of the types of drugs that youth are accessing and their associated risks. Substances can include LSD, hallucinogens, tranquilizers, stimulants, marijuana (also through vaping), heroin, methamphetamine, cocaine, prescription pain relievers (OxyContin, Vicodin, Percocet, Hydrocodone), alcohol, and nicotine. The most commonly used substances amongst teens are marijuana, alcohol, and nicotine through vaping.
So, what are the facts telling us? What are the trends in substance misuse amongst adolescents and teens today?
- Drug use associated with self-harm or suicidal intent has increased by 311%
- 1.78 million teens aged 12-17 years old met the criteria for a diagnosis of Illicit Drug Use Disorder
- Amongst 1424-year-olds in the U.S., the second leading cause of death is drug overdose and poisoning
- 15% of high school students report illicit drug use-this includes using cocaine, inhalants, heroin, methamphetamines, hallucinogens, or ecstasy
- More than 90% of adults with a substance use disorder report beginning substance use during their adolescence.
With substance use amongst teens always changing in a landscape of new drugs, influences, and availability, it is important to follow current trends and understand the dynamics that contribute to pediatric substance use. For example, research shows that Gen Z has increased psychedelic and cannabis use, with decreased alcohol and cocaine use. Additionally, compared to the 1990s, cannabis and hallucinogens are more accessible.
According to the Partnership to End Addiction, there are seven teen substance use trends.
#1 Vaping: There is a current evolution of vaping, with it becoming more discreet, enjoyable, and dangerous. Vaping devices can look like USB drives, watches, or pens, and the flavored nicotine makes it more pleasurable. The concentration has increased as well. One pod can have the same amount of nicotine as an entire pack of cigarettes. Vaping amongst adolescents and teens has become popular and widely common in some social circles.
#2 Nicotine pouches: These substances are tobacco-free pouches that are placed between the lip and gum and deliver nicotine powder directly to the bloodstream through the mucous membranes of the mouth. Direct access to the bloodstream leads to the nicotine taking a quicker effect. They are one of the fastest-growing nicotine products in history.
#3 Cannabis: Youth may view cannabis as less dangerous than other substances because many states have legalized it for adults. Modern strains have 3-4 times the amount as compared to the 1990s, skewing many teens understanding of the dangers of cannabis. Marijuana impacts brain development, mental health, and is linked to depression, anxiety, suicidal thinking, psychosis, and can impair decision-making, especially quick decision-making.
#4 Alcohol: Alcohol is the most common substance used amongst teens, even with the decrease in usage. Popular alcohol products include hard seltzers, alcopops, coolers, and spirit-based ready-to-drink cocktails, which often feature a sweeter flavor profile. Drinking games and challenges can encourage alcohol use in social settings and can be popular on social media platforms and at social gatherings where peer pressure may be present. By 12th grade, 48.7% of teens have abused alcohol, and as of 2023, 757,000 teens ages 12-17 met the criteria for Alcohol Use Disorder.
#5 Prescription Drug Misuse: ADHD stimulants like Adderall are particularly popular to increase focus when studying or for weight loss. 14% of students report having misused prescription drugs, and opioid overdoses in individuals 15-24 years old increased 700.0% from 1999 to 2022.
#6 Fentanyl: This opioid is 50x stronger than heroin and can be found in counterfeit pills, as well as mixed with drugs like heroin and methamphetamines. Counterfeit pills are extremely dangerous and appear like regular prescription medications. In 2023, the percentage of overdose deaths involving fentanyl amongst those 15-24 years of age rose to 80.8%, compared to 2.7% as of 2018.
#7 Social Media: Social platforms make alcohol and drug use look fun, popular, and normal, and create misinformation. Drinking or substance use challenges circulate around social media, encouraging teens to participate to gain followers or acceptance from others. They see drug use shared on social media and even encouraged by influencers. Social media is all about connections, which in turn increases adolescents connections with others, leading to accessing drugs more readily.
Between 2018 and 2023, studies showed an increase in youth emergency department visits due to substance use, including a rise in younger adolescents. Alcohol and drug use have actually decreased in recent years, but why are healthcare professionals seeing a rise in emergency department visits regarding substance use and overdose? The answer lies in the lethality of the drugs that are more readily available and easier to obtain. Rising overdose deaths are largely due to lethal drugs such as fentanyl and other synthetic opioids. Overdoses have also increased amongst teens despite the decrease in usage as a result of combinations of drugs that are deadly. New products, the influence of social media, and shifting laws impact substance use in teens and are making dangerous drugs more acceptable amongst the pediatric population.
With data showing the reality of substance misuse in youth, what factors place specific individuals at higher risk?
Risk factors
Many risk factors place adolescents and teens at higher risk for alcohol and drug use. These risk factors can be social, physical, emotional, mental, and environmental.
High-risk substance risk factors include:
- Family history of substance misuse
- Poor parental monitoring
- Parental approval regarding drug use
- Parental or familial substance use
- Family rejection of sexual orientation
- Associating with friends or peers who use substances
- Lack of interest in school
- Low academic achievement
- Negative childhood experiences, including sexual abuse
- Trauma
- Mental health issues
- Personalities that tend to have increased impulsivity or sensation-seeking
It is also critical to acknowledge and take into consideration that youth and teens may also metabolize substances differently depending on their age and size, as compared to adults. They may use them as a means for coping with mental health challenges such as anxiety or depression, or when facing relationship issues with friends or family. Genetics and addiction can also be intertwined, further proving that every individual has unique risk factors based on their physical, social, environmental, mental, and emotional circumstances. Youth who are uneducated about the dangers of substance misuse may also be more likely to participate in drug use. So, what makes substance abuse so dangerous?
Short- and Long-Term Complications
Alcohol and drug use have many negative impacts physically, mentally/emotionally, and behaviorally, both in short-term and long-term contexts. Rates of physical and mental illness are higher amongst those with substance use disorders.
Physical: Substances can have a profound impact on the body, given the nature of the drug and the effects it has. It also increases the risks for developing hepatitis, HIV/AIDS, and other blood-borne illnesses that come from intravenous drug use. There is a tremendous risk of overdose. Opioids decrease the bodys respiratory drive, resulting in decreased breathing and oxygenation. Additionally, a developing brain makes adolescents and youth especially vulnerable to the negative impacts of substance use.
Mental/Emotional: Substance use can affect memory, learning, and attention, as well as lead to addiction and dependence, which can also pertain to the physical consequences of drug use. Psychoactive substances such as cannabis, nicotine, and alcohol can impact healthy brain development and thinking.
Behavioral: Substance use has been associated with problematic behavior, experience with the juvenile justice system, and difficulties in school. These complications can have a lasting lifelong impact on adolescents and teens. Adverse outcomes associated with drug use include criminal justice involvement, injury, school dropout, and death.
Alcohol and drug use have serious consequences, so what signs point to potential drug use that are important to be aware of?
Signs of Drug Use and How to Spot Them
Identifying substance misuse can be less difficult if there is a proper understanding of what signs and symptoms point to drug use. There are behavioral, emotional, and physical indicators, all of which are evidence of the dangerous results that alcohol and drug use can produce. Recognizing these signs or symptoms can lead to establishing and participating in interventions to help adolescents and teens recover and create healthier living habits and lifestyle choices. The Substance Abuse Hotline shares indicators of substance use in teens.
Behavioral/Emotional Indicators:
- Declining academic performance or doing poorly in school
- Sudden changes in friends, social circles, or those they associate with
- Loss of interest in hobbies or activities they once enjoyed
- Lying about whereabouts or secretive behavior
- Anxiety
- Mood swings
- Increased irritability
- Paranoia
- Increased aggression
Physical Indicators:
- Unexplained weight gain or loss
- Bloodshot eyes or dilated pupils
- Persistent cough
- Frequent nosebleeds
- Difficulty sleeping or different sleep patterns
- Sudden fatigue
- Increased thirst (related to vaping)
Evidence:
- Money, alcohol, or prescription medications that disappear
- Strange smells in the bedroom or on clothes (including sweet ones due to vaping)
- New or excessive use of scent-blocking products, such as incense, cologne/perfume, or even air fresheners
- Unusual wrappers, packaging, small devices, or paraphernalia
- Prescription medication bottles that are not prescribed to the individual, or unfamiliar pills
The signs of drug use can aid parents, families, educators, and healthcare professionals in deciphering substance use. What interventions and treatments are available if drug use is occurring?
Intervention and Prevention Opportunities
Research has shown that a lack of early intervention related to drug use can lead to drug dependency. Prevention and intervention methods can have a profound impact on adolescents and teenagers. Prevention is the first step in addressing substance use. If it is happening, interventions can be put in place to reduce usage and avoid additional harm.
Prevention measures include:
- Positive family or parent relationships
- Parental disapproval of substance use
- Involvement with school
- Relationships with peers who do not abuse substances
- Parental presence and monitoring
Educational Programs: Education about the dangers of drug use has been shown to have positive results when started earlier in life, rather than waiting until middle school. This includes conversations at home and education programs at schools. As part of these educational opportunities, it is essential to address dangerous trends and emerging substances. It is valuable to tailor educational programs to the specific drugs being seen within a community or school district. Studies have also shown that peer teaching opportunities and programs led by students are effective and resonate with students. Other valuable education programs can help students develop proper stress management and coping skills so that substance use can be avoided. These programs can be implemented in schools and help teens develop skills to manage stress, handle peer pressure, and make positive decisions.
Establishing Trust and Initiating Conversations: It is estimated that more than of teens dont ask for help when experiencing distress related to substance abuse disorder. Fostering an environment of trust and inviting open conversations can help reduce drug use and help those who are already involved in substance use. If it is suspected, the following tips can be beneficial for having difficult conversations.
- Create or initiate a conversation in a calm environment
- Ask open-ended questions
- Do not use accusations
- Show empathy
- Do not incorporate anger or frustration
- Refrain from judgment or punishment
Establishing an honest, transparent dialogue is key when discussing substance misuse and navigating how to help those involved in it. Be aware of signs of drug use and have open conversations with youth about drug use and the associated dangers. In such conversations, it is beneficial to help youth understand how to fight peer pressure, how to handle being offered drugs, and learn how to make good decisions on their own.
Addressing Mental Health: Depression, anxiety, and overall decreased mental health can lead to alcohol and drug use as a form of coping, relief, or self-harm. Focusing on mental health can decrease substance use rates without even explicitly discussing substance use. It is important to acknowledge that mental health difficulties and substance misuse increase amongst those with high impulsivity, thrill-seeking, feelings of hopelessness or despair, or anxiety. Substance abuse counselors can help teens recognize why they may be using substances and find alternatives, whether it be stress relief or coping mechanisms. Mental health challenges can be both a cause and a result of alcohol and drug use.
Substance Abuse Treatment Interventions
Teen and adolescent substance abuse can be an overwhelming and daunting topic, leaving healthcare providers, parents, and educators feeling unsure as to how to protect youth. Many options for treatment and interventions can be implemented to break the cycle of substance abuse and help the individual learn how to navigate life without drugs, and decrease addiction, dependency, and risk for substance abuse disorders. Interventions can be outpatient, short-term inpatient, or, for more severe cases, residential treatment. Treatment can include cognitive behavioral therapy (CBT), family-based interventions such as multisystemic therapy (MST) and functional family therapy (FFT), or motivational enhancement therapy (MET). Always consult a medical or mental health professional about substance misuse issues.
How to Find Help
For those who have a child with substance use concerns, help is available. Knowing where to find such help can be overwhelming for parents. Options for help can include:
- Contact a school counselor or pediatrician who can provide resources and assistance for the adolescent/teen and their families
- Reach out to local behavioral health centers that treat adolescents
- Emergency department visits can be appropriate for life-threatening situations and concerns. Always seek emergency assistance for any signs of suicidal ideation or intent, drug overdose, or dangerous behaviors.
- SAMHSAs National Helpline is available 24/7 for free at 1-800-662-HELP (4357)
What Can Healthcare Providers Do?
Healthcare providers play a unique role in addressing pediatric substance use, whether they are school medical professionals, pediatricians, or emergency department staff. As healthcare professionals, it is important to acknowledge why the drugs are being used, whether its for social or emotional reasons, or enjoying the high that drugs offer, while helping teens be educated about the dangerous results of drug use. Healthcare providers serve as important points of contact for many youth. 5% of adolescents in the United States use the emergency department as their means of healthcare.
Some adolescents and teens may also be more comfortable discussing alcohol and drug use with a healthcare provider compared to a parent or other adult figure. When associating with youth, ask screening questions or administer questionnaires about drug use or symptoms, as well as complete suicide risk screenings. Screenings can be conducted in various health settings, including outpatient office visits, inpatient settings, and emergency departments. If signs of drug use are apparent, initiate conversations about drug use using empathetic language and provide resources for treatment programs or other forms of assistance.
In Summary
Substance use is dangerous and is a problem among the pediatric population. Even with the overall decline in substance use amongst teens, there has been a rise in lethal drug use, resulting in more severe complications and overdoses. It is important to acknowledge the constantly changing substance misuse trends, the influence of social media, and the drugs that are circulating amongst teens. Understanding the signs and symptoms of drug use, as well as prevention and intervention methods, can help decrease pediatric drug use and help youth find a life trajectory that is free of substance use.
About the Author:
Rachel Pugmire is a registered nurse and freelance writer. She received her Bachelor of Science in Nursing in 2018, with a minor in gerontology. Her areas of expertise include emergency medicine, pediatrics, and pharmaceutical clinical trials. Medical writing has given her a platform to do what she is passionate about, which is educating patients, their families, and other healthcare professionals.
Rachel is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely those of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
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