Early Warning Signs of Teen Substance Use

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When you know your teen's passions, interests and habits, the early warning signs of trouble will be more apparent.

Chances are your teen's mood swings can be attributed to the racing and changing hormones that come with adolescence. In other words, teen mood swings are normal. You'll want to pay attention, though, if your teenage son or daughter is experiencing mood swings along with changes in behavior or appearance, such as:

  • Losing interest in activities they once enjoyed
  • Dropping old friends for a new group
  • Acting despondent, aggressive or angry
  • Sleeping more than usual
  • Breaking rules
  • Exhibiting physical changes like sudden weight loss, frequent nosebleeds, bloody or watery eyes, or shakes and tremors

These are behavioral and physical signs that your child could be misusing medications, or using drugs or drinking alcohol. Knowing the signs and symptoms of teen drug use can help you better understand if or when you should consider a teen drug intervention program. 

What are some early signs of teen drug abuse and addiction?

One of the most challenging aspects of addiction is that it is a progressive disease. Early warning signs can be hard to spot, and unhealthy patterns can develop into a full-blown substance use disorder (often referred to as substance abuse) if not addressed.

When you know your teenage son or daughter's passions, interests and habits, the early warning signs of trouble will be more apparent because you will sense when something seems off or amiss. Casual drug use can quickly spiral out of control if you ignore problems, rationalize underage drinking or smoking marijuana as "experimentation" or "just a phase," or avoid having open and honest discussions with your child. It's much easier to turn problematic behavior around when warning signs first surface, rather than when the situation escalates or an emergency occurs. Especially for kids who are at higher risk of alcohol or other drug addiction, paying attention to early signs of trouble can reduce the likelihood of a future problem. As a parent or concerned adult, you can never intervene too soon.

Friends in a teen's social circle may be aware of drug use before adults are, either by directly observing the risky behavior or hearing stories from others in their friend group. Don't expect adolescent friends to convince their peers to stop drinking or using drugs, though. Adolescents will typically avoid having such a potentially awkward conversation or otherwise intervening. Unfortunately, this has the effect of passively enabling the unhealthy behaviors. If your child is surrounded by friends who avoid saying anything negative about smoking marijuana, drinking alcohol, using prescription drugs such as opioids, or other stimulants in a non-medical way, or doing cocaine or heroin, the unspoken message is that those dangerous behaviors are acceptable. At this age, a friend's opinion has power, so it's more important than ever to keep the lines of communication open with your son or daughter, rather than relying on their friends to intervene.

What kinds of behaviors or symptoms could indicate teen drug abuse or substance abuse?

Behavioral signs of drug use or substance abuse include:

  • Avoiding eye contact
  • Ignoring or breaking curfew
  • Acting irresponsibly
  • Frequently asking for money
  • Stealing
  • Locking bedroom doors
  • Making secretive calls
  • Isolating from others/damaging relationships with family or friends
  • Making excuses (or outright lying)
  • Withdrawing from classroom participation/slipping in grades
  • Resisting discipline or feedback
  • Missing school or work
  • Losing interest in hobbies or activities
  • Abandoning long-time friends

Physical indicators of possible substance use or abuse include:

  • Poor hygiene/change in appearance
  • Glazed or bloodshot eyes
  • Frequent runny nose or nosebleeds
  • Paranoia, irritability, anxiety, fidgeting
  • Changes in mood or attitude
  • Difficulty staying on task/staying focused
  • Small track marks on arms or legs (wears long sleeves even in warm weather)
  • Pupils larger or smaller than usual
  • Cold, sweaty palms or shaking hands
  • Sores on mouth
  • Headaches
  • Puffy, swollen face
  • Extremely tired or extremely hyperactive
  • Rapid weight gain or loss

What are the risk factors for teen drug abuse?

At the Hazelden Betty Ford Foundation, we have worked with thousands of adults invested in keeping the young people healthy and safe in their homes and communities. If you discover that your child has a drug or alcohol problem, it's normal to wonder what you could have done differently, if you should have seen it coming and what signals you may have missed. In other words, how could you have prevented this problem? And, perhaps more urgently, when does drug use or abuse progress to addiction?

These are complicated questions with complicated answers. The good news is that science has defined tangible early warning signs and symptoms that, if recognized and addressed, can help adults steer kids away from risks that could make them more vulnerable to addiction.

There are five main factors that contribute to a heightened risk for addiction, spelling out the acronym FACTS.

Family history
Age of first use

  • Family
    When someone in a child's biological family—parents, siblings, or extended family members—has a history of substance use (alcohol, tobacco/nicotine, marijuana, prescription drugs or other drugs), that child may have a predisposition to addiction and will be at a greater risk of developing the disorder than a young person without a family history. Research from the Yale University School of Medicine indicates that first-degree relatives (children, siblings and parents) of alcoholics have eight times the risk of developing alcoholism than individuals without a family link.
  • Age
    Age is another important risk factor for substance use disorder. 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 a person's brain isn't fully developed until they're in their twenties—alcohol and drugs can damage the "wiring" in a teenager's brain, leading to issues in the future.
  • Cravings and Tolerance
    Because younger brains are still developing, they are more sensitive to alcohol and other drugs than fully developed adult brains. As a result, when a teen uses alcohol or other drugs early on, they can develop physical cravings and tolerance to the substances being used—a progressive cycle that may very rapidly lead to active addiction.
  • Surroundings
    Surroundings may be the most noticeable warning sign of substance use. Exposure to the use of alcohol and other drugs, whether within a family or a peer group, "normalizes" use so that it's perceived as what everyone is doing. In this regard, parents have a critical opportunity to act as positive role models. Such environment also increases access to substances, making a person more vulnerable to first-time use and opportunities to keep using.

There are many circles of influence in a teenager's life. Beginning with families, teens gain an understanding of both healthy and unhealthy behaviors. When parents and other caregivers clearly discuss the risks of drug abuse with their children, the likelihood that they will misuse substances is reduced by 50 percent. Set a good example. The positive behavior that you and other family members model can have a dramatic impact on how your teenager perceives alcohol and other drugs.

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, they can be strongly influenced by peer pressure. 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. Ask simple questions of the teens in your life (e.g., "How's so-and-so doing these days?") as a way to uncover any red flags in peer relationships. If a teen is vague about who they hang out with—or how they're spending their time away from home—take that opportunity to dig a little deeper. In these conversations, relate, don't interrogate. Don't lecture. Listen and show that you're genuinely interested. Try to establish a strong bond of trust.

What's portrayed in movies, on TV, online and in music can also help shape perceptions about alcohol and drug addiction. Whether it's Ewan McGregor shooting heroin in Trainspotting, Tony Montana snorting cocaine in Scarface, or glamorizing underage drinking and smoking marijuana in Superbad, the media can portray drug use as cool, fun and entertaining—while neglecting to broadcast the negative consequences of addiction and drug abuse, serious health consequences, relationship troubles, financial issues, incarceration, overdose and even death. Incomplete media messages can lead to dangerous misperceptions. If your teenager likes a movie or a song referencing alcohol or other drug use, this might not be a warning sign in and of itself; however, these interests can lead to misperceptions about substance use. Perceptions shape behavior. 

Being aware of your teenager's 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 your teenager about the realities of substance use can powerfully impact their perceptions; don't be afraid to finish a conversation that society has started.

Ten facts about teen alcohol and drug abuse

  1. Some teens are at higher risk due to genetics, the age when they start using, and socioeconomic circumstances (and other factors).
  2. Casual drug use can lead to abuse and addiction, causing health issues, financial problems and legal trouble.
  3. Today's marijuana is much stronger than it was in the past, making it more dangerous. And yes, marijuana is addictive.
  4. Many teens with addiction also have a co-occurring mental health disorder.
  5. A teenager's brain is much more susceptible to addiction because it is still developing.
  6. Addiction, whether in a teenager or adult, is a disease. It is not a moral failing. Focus on the behavior, not the person.
  7. As a caregiver or parent, remind yourself: you did not cause it, you cannot control it and it cannot be cured. Addiction can, however, be managed over the course of a lifetime just like any other chronic disease, like diabetes or hypertension.
  8. The best prevention is to talk with your kids. Spend time with them, and let them know what your expectations are, what the rules are and what the consequences are if they break the rules. Check in regularly.
  9. Vaping rates, whether nicotine or THC, have increased tremendously in the last few years among teens. Vaping is not harmless.
  10. Addiction treatment works; lives can be restored.

How effective are residential treatment centers for teens suffering from anxiety and mild substance abuse?

Many teens who struggle with addiction also have a co-occurring mental health disorder, such as anxiety or depression. The most effective treatment integrates care for both issues, so look for outpatient or residential/inpatient treatment centers with licensed professionals who are trained to address co-occurring substance use and mental health treatment at the same time. It's important to recognize that one disorder does not cause the other; they occur at the same time.

Where can my teen and I find help for substance abuse?

While resources vary from community to community, be assured that help is within reach. Local resources include schools, medical professionals, mental health specialists and treatment providers. If you are searching for an addiction treatment provider specializing in teen rehabilitation, start with your insurance company. They can provide you with a list of in-network treatment providers. Regardless of the program you choose, treatment should always start with a physical, as well as mental health assessments and chemical use history, to determine the appropriate level of care. Given the right treatment and support, adolescents struggling with a substance use disorder can move into happy, healthy, productive lives.

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