What are the signs of substance abuse?

Parents should consider substance use or abuse when they notice changes in their adolescent's behavior. Changes that might be a sign of substance abuse include increased moodiness or sudden changes in mood, getting into fights, secretiveness, and associating with friends who are getting into trouble. Signs of substance use can also include doing worse in school, cutting classes, dropping out of activities or getting into more arguments. Parents can be alert to noticing more direct signs such as missing pills, unexplained over-the-counter medications in the house, cigarettes or rolling paper in the laundry, or smells of alcohol or smoke.
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How can parents tell the difference between experimentation and a "real problem" with substance abuse?

The best way to tell is to look for impairment. How is your teen doing? Is he doing worse at school? Is she moody? How is he interacting with friends and family? Has she had a driving accident?
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What should parents do first if they think their adolescent has a substance abuse problem?

Parents can contact a trusted professional, for example, a school counselor, a pediatrician or a family doctor. If they have access, they can seek advice from a specialist such as a child psychiatrist, psychologist, or substance abuse counselor.
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How is adolescent substance abuse treated?

Treatment can occur in different settings, depending on the severity of the problem and the availability of treatment options. Milder cases can occur in weekly outpatient counseling. Intensive outpatient treatment involves more time in treatment, ranging from a few hours to a full day, all or most days of the week. Residential treatment involves admission to a 24 hours/day, 7 days/week program and typically would last for at least a week, and sometimes much longer.

Several types of treatment have been shown to be effective. Motivational Interviewing is one type that can help the adolescent engage in treatment. Cognitive Behavioral Therapy is another type of treatment that can help the adolescent gain skills to help them avoid substance use when they experience emotional or environmental triggers (like peer use). Several models of family therapy have been tested and found effective. These include Multi-Systemic Therapy and Multidimensional Family Therapy.

An adolescent who also has a psychiatric disorder will need coordinated treatment for the psychiatric disorder, such as therapy and/or medication.
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Is there anything that parents can do to prevent substance abuse?

Yes. Parents can help in many ways. They can communicate their concerns about substance use and can set clear expectations for behavior. Supervision and monitoring is important, including meeting friends, knowing where their children are, and having developmentally appropriate rules, for example curfews. Parents can be alert to early signs of substance use, such as smelling alcohol or cigarette smoke, changes in mood or odd behavior when the adolescent returns home. Parents concerned about their children's mental health should seek treatment, since untreated psychiatric disorders can increase the risk of substance abuse. Parents who have mental health or substance abuse problems should seek treatment for themselves, and also to help prevent their children from having a substance abuse problem.
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What is the connection between psychiatric disorders and substance abuse?

Adolescents with substance use disorders are more likely to have a psychiatric disorder, including depression, anxiety, attention deficit hyperactivity disorder and conduct disorder. In some cases, the psychiatric disorder starts before the substance use, but in other cases, it starts after substance abuse has become a problem. Additionally, substance abuse is more likely to continue in adolescents who also have a psychiatric disorder. Treatment is more difficult for adolescents who have both problems. Both conditions should be treated at the same time, with an integrated care plan.
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Do drug tests have a role in adolescent substance use treatment?

Drug tests may have an important role in assisting treatment provided by a professional. Drug test results can be affected by many factors, including how they are collected, the type of drug being tested, and the way that the test is run. Because of this, the use of drug tests is best guided by a professional who is familiar with the tests.
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