Some teens try substances such as alcohol or drugs only a few times and stop. Teens who keep using substances may form a strong need, or craving, for them. This can lead to a substance use disorder. Personal, family, and community factors increase a teen's risk for using substances and maybe developing a disorder.

Personal risk factors

These include:

• Temperament and personality.

  Teens who have certain traits may be more likely to use substances. These include being rebellious, being impulsive, resisting authority, feeling like a failure, and not having close relationships.

• Genetics.

  Genes play an important role in personality. As a result, substance use disorder often runs in families.

• Certain health conditions.

  Teens are more likely to use alcohol or drugs if they have untreated attention deficit hyperactivity disorder (ADHD), conduct disorder, depression, post-traumatic stress disorder, or an anxiety disorder. Alcohol and drugs may make these conditions worse.

• Wrong ideas about substance use.

  Teens often have the wrong ideas about the harmful effects of substances. And they often think that "everybody does it" and so should they.

• Starting at an early age.

  Using alcohol or other drugs at a young age greatly increases a teen's risk for having a substance use disorder.

Family risk factors

Teens are more likely to use alcohol or drugs if:

• A parent uses alcohol or other substances.
• A parent or teen has depression, anxiety, or ADHD.
• They think their parents believe that it's normal for teens to experiment with alcohol and drugs.
• Their family has frequent stress or conflict or emotional, physical, or sexual abuse.
• Their parents aren't involved enough with them and don't supervise them. Harsh or inconsistent punishment or being too lax also can increase the risk of substance use.

Community risk factors

These include:

• Access to substances in the home and community.
• Peer influence. A teen may want to fit in with a group of peers who use substances.
• Promotion of alcohol, tobacco, and drugs by the media. Many types of popular media show alcohol and tobacco use as "cool" and as a way to gain popularity, success, and sex appeal.

Positive self-esteem, a supportive family, and positive role models help teens gain confidence to make good choices. Even young children have opinions about substance use. So start early to help your child learn the skills needed to avoid substance use.

• Be a good role model.

  As a parent, your attitude toward tobacco, alcohol, and drugs is one of the greatest influences on whether your child will use substances. If you have a substance use disorder, get help. If you quit, your teen is more likely to get help early if your teen starts using a substance.

• Share your beliefs.

  They may not act like it, but most children listen to what their parents tell them. Talk with your teen about the effects of substances on emotions, schoolwork, and health. If you have a family history of substance use, talk with your teen about their increased risk for the same problems.

• Get informed.

  Learn about the substances commonly used by teens. Find out how the drugs work, what their street names are, and what the signs of being under the influence are.

• Stay connected.

  Know your teen's friends. Know where your teen is at all times. Set times when your family is expected to be together, such as at mealtimes. Plan outings or other fun activities.

• Be fair and consistent.

  Extreme discipline can increase the risk of substance use.

  • Expect your teen to follow the household rules. Set reasonable consequences for unacceptable behaviour. Then consistently carry them out.
  • Make a contract with your teen. Write down what you expect from your teen and what the consequences will be if the plan isn't followed.
  • Praise your teen for successes.
• Encourage activities.

  Keep your teen busy with meaningful activities. These may include sports, faith group programs, or other group involvement. Teens who feel good about themselves are less likely to use alcohol and drugs.

• Talk about the personal and legal consequences.
  • Talk about how the use of substances while trying to develop adult skills—like going to school or getting a job—can affect your teen's future.
  • Explain that substance use can lead to behaviours such as unsafe sex, sexually transmitted infections, and pregnancy.
  • Remind your teen that it's illegal for teens to use any substances.
  • Talk about the increased risk of car crashes, violence, and arrests because of substance use.

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Sometimes it's hard to tell if a teen is using alcohol or drugs. Parents may worry that their teens are involved with drugs or alcohol if they become withdrawn or negative. But these behaviours are common for teens going through challenging times. These behaviours may also be signs of a mental health condition, such as depression.

It's important not to accuse your teen unfairly. Try to find out why their behaviour has changed. Tell your teen that you're concerned.

Signs of teen substance use

Experts recommend that parents look for a pattern or a number of changes in appearance, behaviour, and attitude, and not just one or two of the changes listed here.

Signs that a teen may be using substances include a:

• Change in appearance. Examples include:
  • Red and glassy eyes, and frequent use of eyedrops and breath mints.
  • "Track marks" where drugs have been injected into veins.
  • Less attention paid to dressing and grooming.
  • Loss of appetite or unexplained weight loss.
• Change in behaviour. Examples include:
  • Decreased attendance and performance at school.
  • Loss of interest in school, sports, or other activities.
  • Repeated health complaints, such as being overly tired.
  • Newly developed secrecy, or deceptive or sneaky behaviour.
  • Withdrawing from family and friends.
  • Having new friends and being reluctant to introduce them.
  • Lying or stealing.
• Change in attitude. Examples include:
  • Disrespectful behaviour.
  • A mood or attitude that is getting worse.
  • Lack of concern about the future.

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If you think that your teen is using alcohol or drugs, gather all the information you can before you take your teen to a doctor. This will help ensure an accurate diagnosis.

If the doctor believes that your teen may have a substance use disorder, the doctor will:

• Ask about your teen's past health and do a physical exam.
• Want to talk with your teen in private. The doctor will ask questions about your teen's attitude toward substance use, the history of use, and any effects of drug use.

The doctor may try to find out if your teen has certain conditions, such as:

These health conditions are common in teens who use substances. Your child's doctor will want to treat these conditions as well as the substance use.

The doctor may refer your teen to a professional who is experienced in teen substance use disorders.

Urine, blood, or hair drug analysis (toxicology testing) or a blood alcohol test isn't usually done to diagnose a substance use disorder.

Screening test for substance use

Teens often experiment with lots of things, including alcohol, drugs, and tobacco. The doctor will ask your teen questions to get a better idea of any substances your teen may have tried. This is called screening. The answers help the doctor know if there are signs of a substance use disorder.

If you don't think that your teen has been screened for substance use, you can ask the doctor to do a screening test.

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Treatment for level of use

The type of treatment your teen needs will depend on how severe your teen's substance use is. Keep in mind that most young people who use alcohol or drugs don't develop a substance use problem. Most who want to cut back on or stop using alcohol or drugs are able to do so on their own. But others may need help.

• Experimenting.

  If your teen has started experimenting with substances, then education through a school or community program may be all your teen needs. Some schools have programs that provide support and substance use education.

• Weekly use.

  If your teen is using a substance at least weekly, then some form of treatment is usually needed. Treatment helps motivate the teen to stop using substances and to learn skills to refuse alcohol or other substances in the future. Family counselling may also be a part of treatment.

  It's important to listen to your teen and pay close attention to their concerns. They may be dealing with emotional or self-esteem problems. Help your teen find activities that can take the place of substance use.

• Substance use disorder.

  Teens who have substance use disorder use alcohol, drugs, or both even though it causes harm to themselves or others. It can range from mild to severe. The more signs of this disorder a teen has, the more severe it may be. People who have it may find it hard to control their use. Your teen may need treatment in a structured program.

  • If your teen is physically dependent on a substance, your teen may need medical help for withdrawal symptoms.
  • Teens who use heroin or misuse other opioids (opioid use disorder) may be referred to an opioid agonist treatment program. It is sometimes called a medication-assisted treatment program. These programs use medicines such as methadone. Medicines may help control cravings, ease withdrawal symptoms, and prevent relapse.

Types of programs

There are several types of substance use treatment programs for teens. But the two basic categories are inpatient programs and outpatient programs.

Whatever type of program you choose, it should:

• Consider teen developmental issues, such as peer pressure and the need to test limits.
• Provide a way for your teen to continue their education. Doing even a small amount of schoolwork during treatment may help boost your teen's self-confidence and self-esteem.

Inpatient programs

Inpatient programs are very structured and closely supervised in a hospital or treatment centre. The teen stays day and night during treatment.

• These programs provide education as well as individual, family, and group counselling.
• The programs usually have an aftercare program that provides ongoing support and encouragement.

Other types of inpatient programs are:

• Therapeutic communities. They aren't based in a hospital. Teens do a series of tasks with constant feedback from peers. These programs may last up to 2 years. Some teens choose to stay and work in the program after treatment.
• Wilderness challenge programs. These combine a wilderness experience and some form of treatment. The goal is to help teens communicate better with their families, control their anger, and build healthy relationships. A variety of programs are available. Their quality varies greatly. They are expensive and tend to limit contact with parents. Talk with a health professional if you are thinking about sending your teen to one of these programs.

Outpatient programs

Outpatient programs range from very structured programs with counselling and family therapy to drop-in centres.

• Day treatment programs require that the teen spend 8 hours or more during the day at the facility. But the teen comes home at night. Like inpatient programs, day programs usually offer one-on-one, group, and family counselling. But day treatment normally costs less.
• Less intensive outpatient programs are designed for young people who don't need as much time in day treatment or to be in an around-the-clock treatment centre. Treatment includes one-on-one or group counselling and family therapy. Treatment in the teen's own community makes it easier for the family to be involved.

Here are some ideas for how you can help your teen succeed during and after treatment.

• Find the right treatment.

  Talk with a health professional about treatment options in your area.

  • Ask about programs for teens. Adult programs don't meet the needs of teens. The adult programs usually stress long-term health and relationship effects of a substance use disorder. These effects aren't as great of a concern for teens.
  • Consider whether your teen needs to be in an inpatient or outpatient program. Look for a program with the features your teen needs. These may include a school program or opportunities for parental involvement.
• Be involved in the treatment and aftercare program.

  Let your teen know that you support them. It may take a long time for your teen to rebuild trust and to forgive themself. And it may take time for you to forgive them.

• Get help for your family.

  Talk with a health professional about help for you and your family. Your family members need to know that they didn't cause the condition but that their behaviour can affect the condition. Support groups such as Al-Anon and Alateen may be very helpful for family members.

• Help your teen find a positive direction.

  Having a sense of purpose in life is important for your teen to stay substance-free. Treatment usually includes help for teens to identify their talents and strengths. Teens can use this knowledge to find healthy interests, hobbies, and jobs.

What to do if your teen relapses

Returning to substance use is common after treatment. This is called relapse.

Getting a teen to stop using alcohol or other substances is only the first step. Substance use fills an emotional need. That need has to be satisfied in a healthy way for your teen to be able to stay off the substance.

Relapse is less likely if your teen:

• Is motivated by the treatment program to stop using and to learn the skills to deal with drug cravings, high-risk situations, and relapse.
• Can commit to being substance-free.
• Has or finds a healthy hobby or interest.
• Gets treatment for other conditions they may have. Examples may include ADHD, depression, post-traumatic stress disorder, or an anxiety disorder.
• Is involved in an aftercare program or case management.

It's important to know that:

• Relapse isn't a failure on the part of your teen or the treatment program. Recovery from a substance use disorder is hard, and it takes time.
• There may be setbacks that your teen will need to overcome one step at a time. Most teens need to go through treatment more than once and follow a long recovery process.

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