Substance Use Disorders

Substance use disorders (SUD) are chronic medical conditions that result from the complex interaction between psychoactive substances and brain circuitry. Genetics and environment play a big role in who will develop a substance use disorder.

Commonly used substances by children and teens include:

• Alcohol
• Cannabis (marijuana)
• Nicotine
• Opioids

Mental health disorders and substance use disorders often occur together. Teens with depression, anxiety, or attention deficit hyperactivity disorder (ADHD) are more likely to use substances and develop substance use disorders than their peers. Teens may use substances to manage their mood or anxiety, reduce stress, or increase concentration, however, substance use worsens underlying mental health disorders — and in some cases, can even trigger them.

• A substance use disorder refers to use that is causing physical, mental health, and/or functional problems.
• An addiction is a severe form of substance use disorder that refers to loss of control over use.

Teen substance use may come to a parent or another adult’s attention through signs of acute intoxication (drunk or high) or the smell of alcohol or smoke. Parents may find alcohol, drugs, or paraphernalia around the house or in their teen’s possession.

Many signs of a substance use disorder, such as irritability, moodiness, and social isolation, are non-specific, in other words, they could be signs of another issue. The following signs are indications that something is wrong, even if it’s not related to substance use.

• Alcohol, smoke, or other chemical odors on your teen’s breath or clothing
• Obvious intoxication or bizarre behavior
• Changes in dress and grooming
• Changes in choice of friends
• Frequent arguments, sudden mood changes, and unexplained violent actions
• Changes in eating and sleeping patterns
• Sudden weight gain or loss
• Loss of interest in hobbies
• Substantial drop in school performance
• Runaway and delinquent behavior
• Suicidal thoughts or behaviors
• Possession of drugs or paraphernalia (including cough medicine or any unusual collection of items that can be used as inhalants such as cleaning fluid, lighter fluid, or body spray)

Substance use disorders in adolescence are caused by multiple factors, including the following:

• Age: The earlier kids start using alcohol and drugs, the more likely they are to develop a substance use disorder.
• Genetics: Kids with family members who have substance use disorders are at a higher risk for developing problems themselves.
• Environment: Kids who live in environments where drugs are prevalent are more likely to try substances and develop substance use disorders.
• Abuse and trauma: Adolescents who have experienced trauma or who are victims of physical, sexual, or psychological abuse are more likely to develop substance-related disorders.
• Other health concerns: Adolescents with mental or physical health problems are more likely to develop substance-related disorders.

Substance use disorders are diagnosed through a comprehensive evaluation. This includes talking with the teen about their health and history of substance use, a physical examination, and if possible, talking with their parent or guardian about what they’ve observed.

Substance use disorders are treated with a three-pronged strategy:

1. Medical support, which could include medications to treat withdrawal symptoms and prevent cravings, medical counseling, and laboratory evaluation
2. Counseling support to help the adolescent identify their triggers and reasons for use and help them learn healthy alternatives
3. Behavioral support, which for teens is often provided by parents guided by professionals

Substance use disorders are chronic, relapsing conditions. However, with support, children and teens can recover and live healthy lives.

The Adolescent Substance Use and Addiction Program at Boston Children’s Hospital is committed to preventing and reducing substance use problems in children and adolescents. We take a distinctive approach to substance use disorders that recognizes the special vulnerabilities of each patient’s stage of physical, emotional, and social development while working with them and their families to create long-term, supportive solutions.