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Warning Signs of Substance Use in Teens: Tips for Parents

Updated: Sep 20, 2023

As a substance use counselor and recreational therapist, I find that I am often able to connect to my clients through music and lyrics. So let’s start with that. To exemplify the impact of substance use and abuse on one’s sense of control, judgment and decision making ability, let’s reflect on some powerful lyrics by the band Metallica that can be used to depict the consequences of substance use:

“Master of puppets, I'm pulling your strings

Twisting your mind and smashing your dreams Blinded by me, you can't see a thing…”

In therapy, I often use the reference of being “blinded” by the effects of a substance, while stressing the importance of taking off the “sunglasses” and allowing the reality to seep in so substance use does not take over. It’s hard to entertain that someone you love or care about could possibly be at risk. Let’s talk about what to look for and what you can do to prevent drugs or alcohol from becoming the “master of puppets” in your teen or family member.

First, for context, let’s review some alarming 2022 statistics from the National Center for Drug Abuse…

  • Among Americans aged 12 years and older, 31.9 million are current illegal drug users (used within the last 30 days).

  • 53 million or 19.4% of people aged 12 and over have used illegal drugs or misused prescription drugs within the last year.

  • If alcohol and tobacco are included, 165 million or 60.2% of Americans aged 12 years or older currently abuse drugs (i.e., used within the last 30 days).

  • 139.8 million Americans aged 12 and over drink alcohol.

  • Drug use is highest among persons between the ages of 18-25, at 39% compared to persons aged 26-29, at 34%.

  • 70% of users who try an illegal drug before age 13 develop a substance abuse disorder within the next 7 years compared to 27% of those who try an illegal drug after age 17.

  • 47% of young people use an illegal drug by the time they graduate from high school;

  • Users within the last 30 days include:

    • 5% of 8th graders

    • 20% of 10th graders

    • 24% of 12th graders - that’s an alarming 1 in 4 seniors!

These statistics are quite staggering, and as a parent, it's easy to feel overwhelmed by the numbers. Some parents may cope by denying that their child could possibly be among the statistics reported here. However, with the ever increasing stress among our nation’s youth, it is even more important to know the warning signs of substance use and how to effectively intervene so your child receives the help they need. The disease of addiction is progressive, and getting involved sooner than later is the key.

What are the risk factors that draw teens to the drug using crowd?

From my experience as a drug counselor, there are societal and cultural aspects that impact adolescents’ views of drugs. Society has a way of making alcohol and drug use appear acceptable, fun, and exciting. Take a look at TV commercials, portrayals of celebrities, and how famous people are often discussed in the media. In addition, while this may be hard for many parents, look at your family experiences and the traditions that often include alcohol. Some families do not have formal rules for alcohol and or drugs. In other families, alcohol and drugs can be a part of the family dynamics. Ask yourself, has my child seen a parent or family member under the influence of a substance? How often does this occur? What is the family’s reaction to this? Is it normalized? Family and social stressors can put teens at risk for drug use. Gender roles can also contribute to the social experience, as male and females can hold different views on what is acceptable when it comes to drugs and alcohol.

There are a number of environmental risk factors that increase a child’s risk for substance use. For example, factors that contribute may include a child’s relationship with their parents, conflict in the home, maltreatment, socioeconomic status, bullying, and familial modeling of substance use as an acceptable way to “have fun” or deal with stress. In addition, traumatic experiences, abuse (e.g., physical, sexual, emotional), and neglect can also contribute to risk towards substance use. Teens who have been physically and/or sexually abused are 2-4 times more likely to use substances. Witnessing violence within the home, at school, in the community, or within a peer group can lead to vicarious trauma, which is another risk factor. Children who do not have their basic needs, such as adequate shelter, clothing, food, healthcare, or safety, are at increased risk to use substances and are more likely to experience long term consequences due to substance use.

Those with limited “protective factors,” such as being isolated, struggling academically, lack of access to positive peers and extracurricular activities, and little to no parental monitoring, are at an even higher risk. Children who do not have adequate skills with which to cope with these life stressors may be drawn to a substance using peer group as a means to manage their distress.

Neurological development also plays an important role in substance use among teens. Within the brain, the prefrontal cortex, which is the area of the brain that is responsible for critical thinking and executive functions such as planning, problem solving, decision making, and impulse control, is in the developmental stage until around the age of 25. In other words, the brain region that is responsible for logical reasoning is still developing during a vulnerable period where stress and risk seeking behaviors are at their peak. Teens who are drawn to immediate gratification or who have limited impulse control (e.g., those with comorbid factors that further impact the executive functioning system, such as ADHD) are at even higher risk for substance use.

It is also important to understand what is occurring in the brain at the neurobiological level when an individual uses a substance of abuse. There are chemical compounds in illicit drugs and alcohol (including nicotine) that result in a calming effect on the brain, and these effects can be relatively immediate. Those with undiagnosed or untreated ADHD, mood disorders, or anxiety disorders have a tendency to “self-medicate” with substances in order to obtain short-term symptom relief. In addition, substances of abuse quickly target the pleasure center of the brain (immediate gratification) while hijacking the underdeveloped executive system (reasoning center). For teens who are struggling with anxiety, trauma, and/or acute or long term stressors, the immediate gratification of substances in reducing their symptoms can be alluring, particularly among those with limited protective factors to offset their stress.

What are the Warning Signs?

There are a number of common warning signs that your teen may be using a substance. These include problems with work or school, changes in appearance, changes in behavior, and financial problems ( While several of these factors could signal the onset of a mood or anxiety disorder, a combination of these factors is also a sign of possible substance use. These issues may emerge gradually over a period of time, but sudden changes typically signify that there is a problem that needs your attention. Some of the signs to be aware of include:

Personal Neglect

  • Poor hygiene

  • Disheveled appearance

  • Wearing the same clothes

  • Changes in appetite

  • Changes in sleep patterns

  • Body odor

Sudden Changes in behaviors

  • Decreased interest in activities

  • Sudden shift in peer group

  • Lack of motivation

  • Increased irritability or hostility

  • Secretive, hiding phone, bars family members from entering their room

  • Staying out late, missing curfew

  • Decline in grades, missing school, quitting activities

  • Lying, stealing

  • Getting into trouble at school

  • Sleeping in later than typical, sleeping during the day

Financial Issues

  • Requests for money without explanation

  • Money is missing

  • Personal items have disappeared, selling personal items

  • Expensive items have surfaced without explanation

Physical changes

  • Glassy or red eyes

  • Seemingly disoriented

  • Stumbling or staggering

  • Slurred speech

  • Dilated pupils

  • Unusually hyperactive, pressured speech or conversely atypically lethargic and sleepy

  • Smell of “skunk” on body or clothing

Do’s and Don’ts for How to Respond

When you suspect or discover that your child is using substances, it is very easy to feel overwhelmed and powerless. It can make you feel defeated. The anxiety that underlies these emotions can result in confronting, arguing and reacting in a punitive manner with your teen. Attempts to exert authority over the situation without a clear plan can backfire. Therefore, it is important that parents are able to manage their own feelings and thoughts before approaching your teen on the topic of substance use. If possible, when two parents are involved in the child’s life, it is beneficial that they are both on the same page before approaching their teen. Ideally, parents who are positioned as a “united front” and address the matter from a place of concern rather than immediate confrontation are likely to yield a more desirable outcome. If that is not the case, you can still take steps to address the matter with your teen in an effective manner. Following are some “do’s” and “don’ts” for managing the process.

Here are some things to avoid, as it may further the divide between you and your loved one or it may further their resistance for help:

  • Don’t yell, demean, demoralize, “guilt trip,” criticize, or act like you know it all.

  • Don’t bring up death or overdose as a scare tactic. Teens are at a developmental stage of egocentrism, where it is difficult to make the connection that their behavior could result in a fatal outcome (e.g., “that won’t happen to me”).

  • Don’t expect to sway them by discussing long term health consequences of substance use. Teens have underdeveloped executive functioning systems (poor long term planning) and tend to seek immediate gratification.

  • Don’t over-share your personal experiences with substances. It has the potential to be used against you.

  • Don’t put on TV shows like “Intervention” or “Scared Straight” in an effort to educate them. While education is important, people who use substances have a pattern with risk and these shows can heighten their situation to continue using.

What to do instead:

  • DO express how you have personally observed risk behaviors and consequences of use in others (you don’t need to be overly specific with who) and make the connection to what you are now observing in your teen. (Ex: “I am concerned about how distant you have been. I am asking out of concern because you were really working hard and accomplishing a lot of great things.”)

  • DO go through their room; monitor their phone, computer, and social media accounts. As the parent, you are responsible for ensuring their safety. You do not need your child’s permission to keep them safe. Privacy is a privilege, and if they are using substances, they are not behaving in a safe and responsible manner. Trust is something to be earned and can be a goal to work towards together.

  • DO become aware of their friends, talk to the parents of their friends to confirm their whereabouts.

  • DO show up at social places where your loved one goes, display your presence in their life. (Ex. “I’d like to watch you and your friends at the skatepark. I know you’ve been working on some new tricks.”)

  • DO invite their friends over to your house.

  • DO express your love, convey concern.

  • DO encourage them to connect to a trusted adult or therapist to talk to and be able to ask questions.

  • DO establish clear expectations and follow through with consequences. Inconsistency in parenting and “rescuing” can lead to “enabling” behaviors.

  • DO have your child assessed for underlying mental health conditions that may be undiagnosed, such as learning disabilities, ADHD, depression, mood or anxiety disorders.

  • DO consult with a medical prescriber (physician, nurse practitioner) to explore the benefits of psychotropic medications to manage your teens mental health symptoms. Prescription medications can provide relief without negative consequences. Contrary to what some may believe, the prescription medications that are used to manage common adolescent mental health conditions are not addictive, nor do they have adverse long term effects, particularly when compared to risks of substances of abuse.

  • DO prioritize your own self care in this process.

Model Positive Coping Skills & Seek Help

Recovery teaches people how to be responsible for themselves. Just like when you fly on an airplane, safety procedures tell you to put your mask on first and then assist the other person. That’s why self care is important. You may say to yourself, “I don’t have the time.” Remember, you are modeling effective coping strategies and demonstrating the importance of self care and boundaries to your child. Here are some calming strategies to consider for yourself and your teen:

  • Mindfulness

  • Deep breathing

  • Reframing negative thoughts

  • Validating yourself for what you are experiencing

  • Seek ways to decompress: Listen to positive music, exercise, engage in physical activity

  • Have a personal mantra or affirmation

  • Practice self compassion

And, if you are willing to take a step further:

  • Seek out a counselor

  • Attend a community support meeting online or in person (e.g., AA, Al-Anon)

  • Talk to a friend

  • Journal

  • Engage in hobbies

How NOT to cope:

  • Don’t compare yourself or your family to other people (every situation is unique)

  • Remain in Denial

Now that you have some tools in your pocket on how to manage yourself while in this situation, let’s take a look at communication. In many cases, communication does not occur due to denial, fear, and stigma. There is no shame in not having the answers and asking for help. The disease of addiction is a complex set of symptoms and behaviors. It often requires external factors to assist the individual and the significant people in their lives. Working with a therapist who specializes in adolescent development and substance use disorders can assist you to communicate more effectively with your child, address underlying stressors, and identify and practice adaptive strategies for your teen to cope with stress. A therapist can also help you to set up a behavioral plan in the home that outlines clear expectations, consequences, and privileges/rewards for improvements when your teen displays responsibility, accountability and trustworthiness.

Right now it may feel daunting, but when conflict is managed and handled with care, it can turn into real growth. Some of the most wonderful, intelligent and creative people we may know have struggled through a period of substance use or abuse. Recovery is a gift. Every moment is an opportunity to shift so that the “master of puppets” can be put in its place.

For more in-depth information on Substance Abuse in Teens, check out our 3-part Facebook Live Series: Recognizing the Warning Signs of Risk in Teens:


Konick and Associates has clinicians who specialize in substance use and co-occurring problems, anxiety, depression, challenging behaviors, and treatment resistant issues in adolescents and adults. If you or your loved one is seeking assistance, contact our office today to schedule an appointment.

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