Early Warning Signs of Substance Use in Teens

How to Know and What to Do

Adults Who Care

At FCD Prevention Works, part of the Hazelden Betty Ford Foundation, we have worked with thousands of adults invested in keeping the children in their homes and communities healthy and safe. Many of these adults have watched bright students with vibrant futures threatened by alcohol and other drug use. These adults wonder, when a young person's use issue surfaces, what they could have done, if they should have seen it coming, and what signals they may have missed. In other words, how could this problem have been prevented?

One doesn't have to look far to find news and neighborhood stories about the devastating consequences of addiction among families and communities. The more time we spend working in the prevention field, the more convincing it is that preventing of the disease of addiction is far easier than waiting to treat it. As the old saying goes: An ounce of prevention is worth a pound of cure.

But to prevent illness and potential tragedy, we need to understand the origins of addiction first. To aid in our understanding as adults, we find ourselves asking the following questions about the kids for whom we care:

  • What puts a person at risk for addiction?
  • What behaviors and environments may come before substance use?
  • What are the warning signs of use?
  • When does use become a problem in the life of a young person?
  • When does problem use progress to become addiction?

These are complicated questions, with complicated answers. The good news is that research has defined tangible early warning signs that, if recognized and addressed, can help adults steer a child away from the risks that may trigger addiction.


Risk Factors

What puts a person at risk for addiction?

What behaviors and environments may come before substance use?


Family history, age of first use, craving, tolerance, and surroundings may all contribute to a heightened risk for addiction. They also happen to spell out a handy acronym, FACTS, that is commonly used to describe risk factors for addiction.

  • Family. When someone in a child's family - parents, siblings, or extended family members - has a history of substance use (including troubles with alcohol, tobacco/nicotine, marijuana, prescription drugs, or other drugs), that child may have a predisposition to addiction, and will therefore be at a greater risk of a substance problem than a child without a family history. Research from the Yale University School of Medicine tells us that first-degree relatives (children, siblings and parents) of alcoholics have approximately an eight-times greater chance of developing alcoholism than individuals without this family link.
  • Age. Age is another important risk factor for substance abuse issues. The younger a person is when they start using alcohol or other drugs, the more likely they are to develop an addiction. Current research by the National Institute of Mental Health suggests that the human brain does not complete its primary development until a person is in their 20s.
  • Cravings and Tolerance. Because they are still developing, younger brains are more sensitive to alcohol and other drugs, and more able to "learn" addiction, than fully developed adult brains. As a result, when a teen uses alcohol or other drugs early on, he or she can develop physical cravings and tolerance to the substances being used—a progressive cycle that may very rapidly lead to addiction.
  • Surroundings. Surroundings may be the most noticeable warning sign of substance use. Exposure to the use of alcohol and other drugs, whether it be within a family or a peer group, "normalizes" use so that it is perceived as "the thing to do." It also increases access to substances, making a person more vulnerable to first-time and ongoing use opportunities.

There are many circles of influence in a teen's life. Beginning in families, teens gain an understanding of both healthy and unhealthy behaviors. Parents and other caregivers who clearly communicate the risks of substance abuse with their children reduce the likelihood that their children will use substances by half. And, the behavior that parents and other family members model can have a huge impact on the beliefs that children will develop about alcohol and other drugs. An early interest in alcohol, other drugs or substance use behaviors by children may be a warning sign that caretakers can address.

A teen's circle of friends can also shape their beliefs and behavior regarding substance use. Teens are constantly trying to figure out how they fit into their world. As they work to find their place, teens can be strongly influenced by the behavior of those closest to them. If young people spend time with other teens who are engaged in risky, unhealthy behaviors, they are more likely to engage in those behaviors themselves.

As a caring adult, be aware of any shifts in friendships, associations and activities in which teens are engaged. Ask simple questions of the teens in your life (e.g., "How's so-and-so these days?") as a way to uncover any red flags in their peer relationships. If a teen is vague about who they hang out with or how they are spending their social time, take that opportunity to dig a little deeper into the specifics. In these conversations, it is important to remember to relate, rather than interrogate; being genuinely interested in teens' lives and their relationships is a powerful protective factor.

A teen's surroundings are also comprised of what they observe in the culture at large. Movies, television, the internet and music help shape perceptions about substance use. Media can portray substance use as cool, fun and entertaining. This same media can neglect to broadcast the negative consequences of teen alcohol and other drug use. These incomplete media messages can lead to dangerous misperceptions by teens about the realities of use. If a teen enjoys a movie or a song dealing with alcohol or other drug use, this may not be a warning sign in and of itself; however, these interests could lead to misperceptions about substance use in a teen's environment or culture. And, perceptions shape behavior.

Being aware of teens' views regarding alcohol and other drug use can be a valuable tool in identifying risk and taking a preventative stance in their lives. Talking with teens about the realities of substance use can powerfully impact their perceptions; don't be afraid to finish a conversation that society has started.


Warning Signs

What are the warning signs of use?

When does use become a problem in the life of a young person?

When does problem use progress to become addiction?


The teen years are a time of great change. Body and brain changes occur at a quick pace. A healthy, growing teen's behavior can include sometimes worrisome mood swings, emotional outbursts and demands for privacy. But the more familiar you are with a child, the more you will be able to discern whether what you are observing is typical adolescent growth or the warning signs of an alcohol or other drug problem. Be alert if you notice any of the following changes:
  • heightened secrecy
  • fishy-sounding excuses or outright lying
  • difficulty thinking or keeping focus
  • withdrawing from classroom participation
  • resistance to discipline or feedback
  • increased tardiness or absence
  • paranoia, irritability, anxiety, fidgeting
  • changes in mood or attitude
  • significant weight loss or gain
  • loss of interest in hobbies or activities
  • decline in school performance
  • abandonment of long-time peer group.

One of the most challenging aspects of addiction is that it is a progressive disease. Early warning signs can go unnoticed until well into unhealthy patterns of use and even addiction. By being involved in a child's daily life, an adult can become familiar with what a teen is impassioned by, where the teen derives joy, and what gives the teen confidence. This awareness can provide endless opportunities to validate a child's interests and achievements. Cultivating a relationship with a child that allows the recognition of the early warning signs of use is one of the strongest protective factors there is.

Usually, warning signs of substance use are most apparent to those closest to the person of concern. That said, sometimes substance use goes unnoticed or, more commonly, unaddressed. Denial of use and rationalization of risky behaviors can be an unconscious defense against the upsetting reality of substance abuse.

Friends in a teen's social circle are often aware of substance use behaviors long before adults are, either by directly observing the behavior or hearing about use from others in their network of friends. Some students will address their concerns in a healthy way, by speaking with their friend or getting an adult involved. Many, though, will avoid a potentially awkward intervention by passively enabling the unhealthy behaviors and not expressing concern. Some may even justify the dangerous behaviors of their peers by thinking that a peer's use is "not that bad" or "under control". When a substance-using teen is surrounded by friends who are not saying anything negative about their use, it becomes very easy to think that dangerous behaviors are acceptable.

When asked why students don't intervene when they have a concern about a friend, we often hear, "I didn't want to make them feel uncomfortable," or "I felt something was wrong but I was afraid if I said something I would get laughed at," or "There's no point in saying something because I can't make them change." Supporting healthy teens by encouraging them to identify and address problems with substance use helps create a culture of prevention within a community. Through education and encouragement, students can develop the skills necessary to intervene with a friend and play an important role in the prevention of substance abuse.

In your neighborhood, community or local school, teens may have access to a variety of substances. However, whether it's alcohol, marijuana, pain medication or something else, there are common behaviors that may indicate substance use. One of the earliest signs may be an increased need for money, or not being able to account for money spent. Another may be an abrupt change of friends or a reluctance to introduce new friends to parents. As use progresses into abuse and addiction, warning signs usually become more obvious, and it is increasingly difficult for a person abusing alcohol or other drugs to function in their daily life. Increasing interpersonal conflict, accidents, injuries and stealing can be indications of a serious problem.

In the life of a young person progressing into an alcohol or other drug addiction, negative consequences build up over time. The teen may have had numerous conversations of concern with worried peers and adults. The compulsion and craving for the alcohol or other drug in the young person increases until he or she has little or no capacity to manage use.

At this point professional help is likely the most effective course of action. While resources may vary from community to community, people rarely are unable to find quality professional help. Certainly within a school community or health department local to you, you will find someone who can direct families to professionals specializing in addiction. Given the right treatment and support, adolescents struggling with substance abuse can move into happy, healthy, productive lives.


FCD Prevention Works™ is the leading international nonprofit provider of school-based substance abuse prevention services. For 40 years, FCD has worked worldwide to provide students and the adults who care for them with the knowledge, understanding and skills they need to make intelligent, healthy choices about alcohol, tobacco and other drug use. FCD is part of the Hazelden Betty Ford Foundation.
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