An Overview of Substance Use

What’s the Attraction?

Teens and young adults use substances for a variety of reasons. They may begin because of curiosity and peer pressure. Often, those who become habitual users are trying to “solve a problem.” Substances can help them relax, alleviate boredom, fit in socially, escape emotional or physical pain, deal with traumatic memories, relieve anxiety, go to sleep, get up in the morning, lose weight, etc. Substance use is “reinforcing,” which means that a child is more likely to keep taking them when they seem to help with a given problem or need. It’s important for parents to understand what it is specifically that makes substances appealing to their child in order to address his or her use. And when substance use is severe, it can be difficult for any parent to address these causes and keep a child safe without professional help.

Substance Use Basics

It’s helpful to have a basic understanding of the different kinds of substances, their effects and how to recognize signs of use. Common substances used by adolescents and young adults include alcohol, tobacco (JUUL, cigarettes), marijuana (leaf, THC oils, dabs and vape pens), hallucinogens (LSD and PCP), sedatives (Xanax, Ambien), stimulants (Adderall, cocaine) and opioids (Vicodin, heroin, Percocet).

How do you know if a child is using alcohol and/or drugs? Aside from direct evidence (such as bottles, bags or other paraphernalia), parents often see physical, emotional and behavioral changes. Of course, the specifics of these changes depend directly upon the substance being used. For example, stimulants can cause an irregular heartbeat, insomnia, irritability and unexplained weight loss. Opioids, like Vicodin, Percocet and heroin, can cause a lack of enthusiasm and energy, constipation, slowed breathing, pinpoint pupils and nausea.

Some behavioral changes that may occur with substance use:

  • Loss of interest in hobbies or extracurricular activities
  • Comments from teachers, classmates or friends
  • Changes in friendships
  • Mood swings
  • Irritability or argumentativeness
  • Unusual agitation, restlessness or hyperactivity
  • Lethargy or lack of motivation
  • Locking doors, demanding more privacy, isolating or missing family events
  • Declining grades, skipping school or poor work performance
  • Becoming more accident-prone
  • Engaging in risky behaviors (such as sex or driving under the influence)
  • Borrowing or taking money or valuables
  • Missing prescription drugs or missing alcohol

Many of these symptoms overlap with mental health disorders. For example, it can be hard to tell if a child who becomes withdrawn and isolated is depressed, using alcohol, or both. You can learn more about differentiating between substance and mental health disorders in Section 3.

What Is a Substance Use Disorder?

The term “substance use” exists along a spectrum from initial use to greater frequency (and usually more consequences) and eventually to addiction.

Regardless of the substance, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (known as the DSM-5) defines a substance use disorder as a problematic, recurrent use of drugs or alcohol that causes significant distress or impairment in a person’s life. There are four categories of behaviors that are used to determine the severity of the problem: impaired control, social impairment, risky use, and tolerance and withdrawal.

A person needs to meet two or three of these criteria to be diagnosed with a mild substance use disorder. Meeting four or five of the criteria is considered a moderate substance use disorder, and six or more is deemed a severe substance use disorder.

Even if a child’s use of alcohol and/or other drugs doesn’t rise to the level of an “official” substance use disorder, it can interfere with functioning. There is a trend in the field moving away from categorizing severity by dependence or withdrawal criteria and looking instead at the impact on one’s life. A young person does not need to be dependent on drugs or go through withdrawal symptoms for the substance to have a huge impact on academic and/or social functioning.