Substance use disorder

Given the reality that the majority of teenagers experiment with illegal substances—most frequently marijuana and alcohol—it’s important to be able to distinguish between use that may be undesirable or unhealthy, but is normal adolescent behavior, and use that constitutes a psychiatric disorder.

Substance-use disorder comprises a wide variety of behaviors that include, but are not limited to, addiction, excessive usage, and dangerous substance-induced behavior. Children can have alcohol and substance abuse problems even if they aren’t addicted—that is they haven’t developed a tolerance for the substance and don’t show signs of withdrawal if they stop using it. And regardless of the level of usage, substance abuse is considered a serious problem when it interferes with a child’s day-to-day functioning.

You might worry about a substance abuse problem if you know your child is frequently intoxicated, uses substances before or during school, sells drugs, or conceals alcohol or drugs in his room. But since many teenagers effectively hide their drug or alcohol consumption from their parents, other behaviors that result from substance abuse might be your first clue. These behaviors may include skipping school frequently, performing poorly in school, changing friends, and dropping activities or former interests. You might also notice dangerous behavior like getting in fights or driving while impaired. Your child does not need to be addicted to have a substance problem.

Parents of children with psychiatric disorders should know that their kids are particularly vulnerable to substance problems. Even normal teenage experimentation can become risky for someone with an anxiety or mood disorder. Use of alcohol or drugs, even when it’s limited, can worsen symptoms of panic attacks, trigger a manic or depressive episode in children with bipolar disorder, and induce psychosis. It is important to know that using substances will also interfere with the efficacy of prescribed medications: The most common reason for anti-depressant medication not working is excessive drinking.

There are a variety of genetic and environmental factors that might make a child more susceptible to substance abuse, including a family history of addiction or another psychiatric disorder. Seeing parents consume alcohol or other substances may initiate usage in children. Kids without strong family support are also more vulnerable to substance use. Parental supervision helps prevent kids who use substances from transitioning into chronic abusers. Boys are more likely than girls to be diagnosed with alcohol or drug-related problems.

Substance use disorder takes many forms, depending on the substance and the intensity or frequency of use. Substance use merits intervention when use of the substance (or substances) results in poor academic performance or school attendance, dangerous behaviors, or social problems. Other criteria include physical or psychological tolerance such that increased consumption is required to attain the desired effect; withdrawal symptoms; taking a substance in larger amounts or for longer than intended; unsuccessful attempts to cut down or control substance use; abandoning or ignoring formerly significant after-school, recreational and social activities and/or friends; and a strong craving for a specific substance.

The first step of treatment is to stop using the substance. In severe cases of physical addiction, detoxification is necessary to help with symptoms of withdrawal. Creating a supportive environment and eliminating your child’s triggers for substance abuse is essential. Treatment may occur on an outpatient or inpatient basis depending on the severity of the problem. Your child’s doctor might recommend individual counseling with a psychologist, psychiatrist, or addiction counselor. Family counseling is often necessary. Your doctor might also recommend special rehabilitation treatment programs or self-help groups for kids and families with substance problems. Children with co-existing psychiatric disorders should be given a treatment plan that addresses those conditions as well.

Six out of ten people who have been diagnosed with substance problems also have a psychiatric disorder. Children are more likely to abuse drugs if they have anxiety disorders, bipolar disorder, depression, or schizophrenia. Kids who experience environmental stressors like moving or divorce may also begin abusing substances.

How can I tell if my child has a problem with substances?
While it’s not unusual for teenagers to take a drink or try marijuana, you should be concerned about substance abuse if your child is skipping school, abandoning former interests, using substances before or during school, or concealing alcohol or drugs in his room. Other signs include uncharacteristically poor academic performance and dangerous behaviors such as getting in fights and driving while impaired. You should also be concerned if your child is using drugs that are more physically addictive than alcohol or marijuana, including cocaine, amphetamines, and various other prescription medications.
Is my child okay if he’s not addicted?
Not all children who abuse substances will experience addiction. If substance use seriously disrupts a child’s life and development, it may constitute a substance use disorder.
Will taking prescribed psychotropic medicine make my child more likely to abuse drugs?
No. In fact children with psychiatric conditions who are not receiving medication are more inclined to abuse alcohol and drugs. One study indicates that children medicated for ADHD have their risk for using substances lowered to 50%, which is within the normal population risk.
What causes substance abuse?
Substance abuse can be caused by a variety of environmental and genetic factors. Kids with a family history of addiction are more likely to abuse substances. Children who lack strong family support are also more susceptible, as are children with other psychiatric disorders.
How can I stop my kid from developing a substance problem?
Parental supervision greatly decreases substance use problems. If you are unable to directly supervise your child, consider monitoring his behavior with phone calls at prescribed times. Also be aware that some substances that, unfortunately, are available to teenagers are more likely to become physically addictive than alcohol or marijuana; these include cocaine, amphetamines, and various other prescription medications.
Is substance abuse dangerous?
Substance abuse can be very dangerous because it may lead to hazardous behaviors such as unsafe sex and impaired driving, along with potential addiction. Kids who abuse substances are also more susceptible to developing other psychiatric disorders. Many substances are also considered toxic and should be considered dangerous regardless of usage patterns or behaviors.