drug abuse in youth essay

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Teen drug abuse: Help your teen avoid drugs

Teen drug abuse can have a major impact on your child's life. Find out how to help your teen make healthy choices and avoid using drugs.

The teen brain is in the process of maturing. In general, it's more focused on rewards and taking risks than the adult brain. At the same time, teenagers push parents for greater freedom as teens begin to explore their personality.

That can be a challenging tightrope for parents.

Teens who experiment with drugs and other substances put their health and safety at risk. The teen brain is particularly vulnerable to being rewired by substances that overload the reward circuits in the brain.

Help prevent teen drug abuse by talking to your teen about the consequences of using drugs and the importance of making healthy choices.

Why teens use or misuse drugs

Many factors can feed into teen drug use and misuse. Your teen's personality, your family's interactions and your teen's comfort with peers are some factors linked to teen drug use.

Common risk factors for teen drug abuse include:

• A family history of substance abuse.
• A mental or behavioral health condition, such as depression, anxiety or attention-deficit/hyperactivity disorder (ADHD).
• Impulsive or risk-taking behavior.
• A history of traumatic events, such as seeing or being in a car accident or experiencing abuse.
• Low self-esteem or feelings of social rejection.

Teens may be more likely to try substances for the first time when hanging out in a social setting.

Alcohol and nicotine or tobacco may be some of the first, easier-to-get substances for teens. Because alcohol and nicotine or tobacco are legal for adults, these can seem safer to try even though they aren't safe for teens.

Teens generally want to fit in with peers. So if their friends use substances, your teen might feel like they need to as well. Teens also may also use substances to feel more confident with peers.

If those friends are older, teens can find themselves in situations that are riskier than they're used to. For example, they may not have adults present or younger teens may be relying on peers for transportation.

And if they are lonely or dealing with stress, teens may use substances to distract from these feelings.

Also, teens may try substances because they are curious. They may try a substance as a way to rebel or challenge family rules.

Some teens may feel like nothing bad could happen to them, and may not be able to understand the consequences of their actions.

Consequences of teen drug abuse

Negative consequences of teen drug abuse might include:

• Drug dependence. Some teens who misuse drugs are at increased risk of substance use disorder.
• Poor judgment. Teenage drug use is associated with poor judgment in social and personal interactions.
• Sexual activity. Drug use is associated with high-risk sexual activity, unsafe sex and unplanned pregnancy.
• Mental health disorders. Drug use can complicate or increase the risk of mental health disorders, such as depression and anxiety.
• Impaired driving. Driving under the influence of any drug affects driving skills. It puts the driver, passengers and others on the road at risk.
• Changes in school performance. Substance use can result in worse grades, attendance or experience in school.

Health effects of drugs

Substances that teens may use include those that are legal for adults, such as alcohol or tobacco. They may also use medicines prescribed to other people, such as opioids.

Or teens may order substances online that promise to help in sports competition, or promote weight loss.

In some cases products common in homes and that have certain chemicals are inhaled for intoxication. And teens may also use illicit drugs such as cocaine or methamphetamine.

Drug use can result in drug addiction, serious impairment, illness and death. Health risks of commonly used drugs include the following:

• Cocaine. Risk of heart attack, stroke and seizures.
• Ecstasy. Risk of liver failure and heart failure.
• Inhalants. Risk of damage to the heart, lungs, liver and kidneys from long-term use.
• Marijuana. Risk of impairment in memory, learning, problem-solving and concentration; risk of psychosis, such as schizophrenia, hallucination or paranoia, later in life associated with early and frequent use. For teens who use marijuana and have a psychiatric disorder, there is a risk of depression and a higher risk of suicide.
• Methamphetamine. Risk of psychotic behaviors from long-term use or high doses.
• Opioids. Risk of respiratory distress or death from overdose.
• Electronic cigarettes (vaping). Higher risk of smoking or marijuana use. Exposure to harmful substances similar to cigarette smoking; risk of nicotine dependence. Vaping may allow particles deep into the lungs, or flavorings may include damaging chemicals or heavy metals.

Talking about teen drug use

You'll likely have many talks with your teen about drug and alcohol use. If you are starting a conversation about substance use, choose a place where you and your teen are both comfortable. And choose a time when you're unlikely to be interrupted. That means you both will need to set aside phones.

It's also important to know when not to have a conversation.

When parents are angry or when teens are frustrated, it's best to delay the talk. If you aren't prepared to answer questions, parents might let teens know that you'll talk about the topic at a later time.

And if a teen is intoxicated, wait until the teen is sober.

To talk to your teen about drugs:

• Ask your teen's views. Avoid lectures. Instead, listen to your teen's opinions and questions about drugs. Parents can assure teens that they can be honest and have a discussion without getting in trouble.
• Discuss reasons not to use drugs. Avoid scare tactics. Emphasize how drug use can affect the things that are important to your teen. Some examples might be sports performance, driving, health or appearance.
• Consider media messages. Social media, television programs, movies and songs can make drug use seem normal or glamorous. Talk about what your teen sees and hears.
• Discuss ways to resist peer pressure. Brainstorm with your teen about how to turn down offers of drugs.
• Be ready to discuss your own drug use. Think about how you'll respond if your teen asks about your own drug use, including alcohol. If you chose not to use drugs, explain why. If you did use drugs, share what the experience taught you.

Other preventive strategies

Consider other strategies to prevent teen drug abuse:

• Know your teen's activities. Pay attention to your teen's whereabouts. Find out what adult-supervised activities your teen is interested in and encourage your teen to get involved.
• Establish rules and consequences. Explain your family rules, such as leaving a party where drug use occurs and not riding in a car with a driver who's been using drugs. Work with your teen to figure out a plan to get home safely if the person who drove is using substances. If your teen breaks the rules, consistently enforce consequences.
• Know your teen's friends. If your teen's friends use drugs, your teen might feel pressure to experiment, too.
• Keep track of prescription drugs. Take an inventory of all prescription and over-the-counter medications in your home.
• Provide support. Offer praise and encouragement when your teen succeeds. A strong bond between you and your teen might help prevent your teen from using drugs.
• Set a good example. If you drink, do so in moderation. Use prescription drugs as directed. Don't use illicit drugs.

Recognizing the warning signs of teen drug abuse

Be aware of possible red flags, such as:

• Sudden or extreme change in friends, eating habits, sleeping patterns, physical appearance, requests for money, coordination or school performance.
• Irresponsible behavior, poor judgment and general lack of interest.
• Breaking rules or withdrawing from the family.
• The presence of medicine containers, despite a lack of illness, or drug paraphernalia in your teen's room.

Seeking help for teen drug abuse

If you suspect or know that your teen is experimenting with or misusing drugs:

• Plan your action. Finding out your teen is using drugs or suspecting it can bring up strong emotions. Before talking to your teen, make sure you and anyone who shares caregiving responsibility for the teen is ready. It can help to have a goal for the conversation. It can also help to figure out how you'll respond to the different ways your teen might react.
• Talk to your teen. You can never step in too early. Casual drug use can turn into too much use or addiction. This can lead to accidents, legal trouble and health problems.
• Encourage honesty. Speak calmly and express that you are coming from a place of concern. Share specific details to back up your suspicion. Verify any claims your child makes.
• Focus on the behavior, not the person. Emphasize that drug use is dangerous but that doesn't mean your teen is a bad person.
• Check in regularly. Spend more time with your teen. Know your teen's whereabouts and ask questions about the outing when your teen returns home.
• Get professional help. If you think your teen is involved in drug use, contact a health care provider or counselor for help.

It's never too soon to start talking to your teen about drug abuse. The conversations you have today can help your teen make healthy choices in the future.

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• Dulcan MK, ed. Substance use disorders and addictions. In: Dulcan's Textbook of Child and Adolescent Psychiatry. 3rd ed. American Psychiatric Association Publishing; 2021. https://psychiatryonline.org. Accessed Jan. 24, 2023.
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• Why do teens drink and use substances and is it normal? Partnership to End Addiction. https://drugfree.org/article/why-do-teens-drink-and-use-substances/. Accessed Jan. 24, 2023.
• Teens: Alcohol and other drugs. American Academy of Child & Adolescent Psychiatry. https://www.aacap.org/aacap/families_and_youth/facts_for_families/fff-guide/Teens-Alcohol-And-Other-Drugs-003.aspx. Accessed Dec. 27, 2018.
• Drugged driving. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/drugged-driving. Accessed Jan. 24, 2023.
• Marijuana talk kit. Partnership for Drug-Free Kids. https://drugfree.org/drugs/marijuana-what-you-need-to-know/. Accessed Jan. 24, 2023.
• Drug guide for parents: Learn the facts to keep your teen safe. Partnership for Drug-Free Kids. https://www.drugfree.org/resources/. Accessed Dec. 12, 2018.
• Vaping: What you need to know and how to talk with your kids about vaping. Partnership to End Addiction. https://drugfree.org/addiction-education/. Accessed Jan. 24, 2023.
• How to listen. Partnership for Drug-Free Kids. https://www.drugfree.org/resources/. Accessed Dec. 12, 2018.
• Drug abuse prevention starts with parents. American Academy of Pediatrics. https://publications.aap.org/patiented/article/doi/10.1542/peo_document352/81984/Drug-Abuse-Prevention-Starts-With-Parents. Accessed Jan. 24, 2023.
• How to talk to your kids about drugs if you did drugs. Partnership for Drug-Free Kids. https://www.drugfree.org/resources/. Accessed Dec. 12, 2018.
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• Gage SH, et al. Association between cannabis and psychosis: Epidemiologic evidence. Biological Psychiatry. 2016;79:549.
• Quick facts on the risks of e-cigarettes for kids, teens and young adults. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html. Accessed Jan. 30, 2023.
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Teenage Drug Addiction: An Overview

• Substance Use Statistics
• Why Teens Use Drugs
• Drug Effects
• Specific Health Risks
• Symptoms and Warning Signs
• Four Stages of Addiction

Many teens experiment with substances but don’t continue to use them. For some adolescents, however, trying a substance like alcohol, marijuana, or illicit drugs leads to regular use. Once withdrawal and cravings set in, a teen dealing with addiction and dependence may not be able to stop using a substance, even if they want to.

Caregivers can prevent teen drug abuse by knowing the signs and talking to their children about the consequences of using substances. This article reviews statistics, risk factors, health effects, signs, and treatment for teenage  drug addiction .

Sturti / Getty Images

Teenage Substance Use Statistics

Public health experts track the rates of substance use in people of all ages. One group that they pay particular attention to is teens.

Basic Statistics

Here are some of the key statistics from the Monitoring the Future survey, which has been tracking youth substance use in the United States for over 40 years.

In 2023, here’s how many teens in the U.S. reported any illicit drug use in the last year:

• Eighth graders: 10.9%
• 10th graders: 19.2%
• 12th graders: 31.2%

In addition:

• By the time they reach 12th grade, 21.3% of teens have tried an illicit drug at least once.
• From 2016 to 2020, drug use among eighth graders increased by 61%.
• In a year, around 4,477 15-to-24-year-olds die of illicit drug overdoses (about 11.2% of all overdose deaths are in this age group).

Substances Used

Here is how many teens reported using a specific substance in the last year:

• Eighth graders: 15.1%
• 10th graders: 30.6%
• 12th graders: 45.7%
• Eighth graders: 8.3%
• 10th graders: 17.8%
• 12th graders: 29%
• Any illicit drugs:
• 10th graders: 19.8%
• 12th graders: 31.2 %
• Cigarettes:
• Eighth graders: 5.8%
• 10th graders: 9.4%
• 12 t thgraders: 15%
• Vaping nicotine (e-cigarettes):
• Eighth graders: 11.4%
• 10th graders: 17.6%
• 12th graders: 23.2%

Prescription Medications

Alcohol is the most commonly abused substance among teens, but rates of nicotine and prescription medication abuse are increasing. Examples of prescription drugs teens may misuse include stimulants like Adderall and benzodiazepines like Xanax .

What Causes Teens to Use Drugs?

The reasons why any person uses drugs are complex, and the same is true for teens. Wanting to fit in with peers, feeling overwhelmed by their changing brains and bodies, and pressure to perform in school or sports are just a few reasons why teens may start experimenting with drugs. Teens may not seek drugs out but are instead introduced to substances by someone they know, such as a friend, teammate, or even a family member.

In addition, teens often don’t know or understand the dangers of substance abuse. They may see occasional use as being safe and don’t believe they could become addicted to drugs or face consequences. They may also assume that they can stop using if they want to.

Other risk factors for drug use in teens include:

• Family history of substance use 
• Academic pressure
• Adverse childhood events ( ACES )
• Lack of supervision
• Mental health disorders
• Peer pressure
• Desire to escape (e.g., external situation like home life or internal situation like complex feelings)
• Social acceptance (e.g., fitting in with peers)
• Low  self-esteem
• Increased access to substances
• Transitional periods (e.g., starting puberty or attending a new school)

While drug use can lead to mental health disorders, sometimes it’s the other way around. Teens may use substances to self-medicate or numb emotional pain.

What Are the Effects of Using Drugs During Adolescence?

The body sends out a “feel good” chemical called  dopamine  when using a substance. This response tells the brain that it is worth using the substance again to get that feeling. As a result, a person starts having cravings for the substance. Addiction happens when cravings don’t stop,  withdrawal  occurs without the substance, and use continues even when there are negative consequences. Since the physical and mental urge to use is so strong, it becomes very hard to stop using a substance.

Teenagers who misuse substances can experience drug dependence ( substance use disorder ). Developmentally, adolescents are at the highest risk for drug dependence and severe addiction.  

Effects on Brain Development and Growth

The human brain continues to develop until about the age of 25. Using substances during adolescence can change brain structure and negatively affect brain functions like learning, processing emotions, and decision-making. It can also lead to the following:

• More risky behaviors : Substance abuse makes teens more likely to engage in risky behaviors like unprotected sex (or "condomless sex") or dangerous driving.
• Higher risk for adult health problems : Teenagers who abuse substances have a higher risk of heart disease, high blood pressure, and sleep disorders.
• Mental health disorders : It is common for teens with substance abuse disorders to have mental health conditions (and vice versa).
• Impaired academic performance : Substance use affects a teen’s concentration and memory, which may negatively affect their schoolwork.

Substance Misuse and Mental Health

A study showed that 60% of teens in a community-based substance use treatment program were also diagnosed with a mental health disorder.

What Are the Health Risks of Drug Abuse?

Drug and alcohol use can lead to substance use disorder as well as the specific health risks of the substance being abused.

Alcohol use can lead to an increased risk of:

• Liver disease, cirrhosis, and cancer
• Heart disease and stroke
• Depression 
• Lack of focus 
• Alcohol poisoning
• Increased risky behavior

Alcohol Statistics

In the United States, 29.5 million people ages 12 and older have an alcohol use disorder.

Marijuana can impair concentration, worsen mental health, interfere with prescription medications, lead to risky sexual behaviors, or contribute to dangerous driving. Smoking marijuana can also negatively affect lung health.

Marijuana is often thought of as not being "as bad" as other drugs and, in some cases, even good for you. However, marijuana can be harmful to teens because their brains are still developing. Marijuana use in teens is linked to difficulty with problem-solving, memory and learning issues, impaired coordination, and problems with maintaining attention.

Vaping and Edible Marijuana Use Is on the Rise

Recent data shows a shift from teens smoking marijuana to using vaping devices and edibles instead.

Opioids include legal prescription medications such as hydrocodone, oxycontin, and fentanyl, as well as illegal drugs such as heroin. These drugs carry a high risk of overdose and death. The annual rate of opioid overdose deaths for those aged 15 to 24 years is 12.6 per 100,000 people.

Over-the-Counter and Prescription Medications

Over-the-counter (OTC) and prescription medications can be misused more easily than others because they’re often easy for teens to obtain. Diet pills, caffeine pills, and cold and flu products with dextromethorphan are just a few examples of OTC substances teens may use. They may also have access to family member’s prescriptions for drugs like opiate painkillers and stimulants or get them from friends who do.

There are serious health risks to misusing OTC cold and cough products, including increased blood pressure, loss of consciousness, and overdose. There can also be legal issues if a teen is using someone else’s prescriptions.

Tobacco can lead to multiple chronic illnesses, including:

• Lung disease 
• Heart disease
• Vision loss
• Decreased fertility

E-Cigarettes (Vaping)

Vaping  is attractive to teens because e-cigarettes are often flavored like fruit, candy, or mint. These products may contain nicotine or other synthetic substances that damage the brain and lungs. The teenage brain is vulnerable to the harmful effects of nicotine, including anxiety and addiction.

E-cigarettes come in a variety of shapes and sizes and might be disguised as everyday items, such as:

• USB Flash Drives
• Hoodie (sweatshirt) strings
• Smartwatches
• Toys (e.g., fidget spinners)
• Phone cases

Cocaine  carries a risk of overdose and withdrawal. It causes decreased impulse control and poor decision-making. Withdrawal symptoms from cocaine include restlessness, paranoia, and irritability. Snorting cocaine can cause nosebleeds and a loss of smell. Using cocaine can lead to heart attacks, lung problems, strokes, seizures, and coma.

Cocaine Can Be Fatal With First Use

There have been reports of people dying the first time they use cocaine, often from sudden cardiac arrest, respiratory arrest, or seizures.

Ecstasy (MDMA)

Ecstasy is a stimulant that causes an increased heart rate, blurred vision, and nausea. It can also lead to brain swelling, seizures, and organ damage.

Ecstasy is also known as:

Inhalants are fumes from gases, glue, aerosols, or solvents that can damage the brain, heart, lungs, kidneys, and liver. Using inhalants even once can lead to overdose, suffocation, seizures, and death.

Methamphetamine

Methamphetamine (crystal meth) is a highly addictive stimulant that has multiple health consequences, including:

• Severe weight loss
• Lack of sleep
• Dental problems
• Change in brain structure
• Paranoia and hallucinations

Disease Transmission Risk

Injecting drugs with shared needles increases the risk of contracting HIV, hepatitis B, and hepatitis C.

What Are the Signs a Teen Is Using Drugs?

Being on the lookout for drug paraphernalia and signs and symptoms of drug abuse can help adults recognize at-risk teens. 

Behavioral warning signs of drug use in teens include:

• Personality changes 
• Irritability 
• Difficulty sleeping
• Inappropriate or odd behavior (e.g., laughing randomly)
• Loss of interest in hobbies or extracurricular activities
• Avoiding eye contact
• Acting secretive or like they’re hiding something
• Staying out late
• Social withdrawal (e.g., from family, friends)
• Poor academic performance
• Hanging out with new friends or no longer hanging out with their usual friend group
• Poor hygiene
• Skipping school
• Isolation (e.g., staying in their room, refusing family meals)

Not All Warning Signs Indicate Drug Use

These warning signs do not necessarily mean a teen is using drugs. Other health problems like allergies, sinus infections, hormone imbalances, or mental disorders can also cause these symptoms in teens.

Physical signs  of drug use in teens may include:

• Persistent cough
• Dilated pupils
• Increased or decreased energy
• Sleeping all the time or not at all
• Mood swings
• Memory problems
• Talking very fast or slowly
• Runny nose or nosebleeds
• Increased/decreased appetite
• Weight loss
• Smells like smoke or alcohol (e.g., on clothes, skin, or breath)

Other than behavior and physical signs in a teen, you should also be aware of objects that can be used to do drugs. Examples of drug paraphernalia include:

• Mirrors with white powder
• Razorblades
• Rolled dollar bills
• Crack pipes and spoons
• Needles and syringes
• Rolling paper

Substance Abuse Screening

The American Academy of Pediatrics (AAP) recommends that teens be screened at each annual medical exam appointment with questionnaires that ask them about substance use and their knowledge of the risks.

What Are the Four Stages of Drug Addiction?

You should also be aware of the four stages of addiction. The earlier teen drug use is recognized, the sooner they can get help.

• Experimentation: A teen tries one or more substances. Some teens will only try a substance once. Others will continue to experiment and increase their use.
• Regular or “social” use: A teen begins to use one or more substances regularly. At this stage, they may limit their use to just when they’re with friends or only in situations where they feel it’s needed—e.g., before a test.
• Risky use: A teen continues to use a substance that they have regularly been using, even if it’s caused problems for them at school, at home, and in their relationships. They crave the substance, both physically and mentally. At this stage, the substance has become central to a teen’s life, and they’ll take risks to get and use it.
• Dependence and Addiction: A teen is addicted to a substance, and most of their time and energy is devoted to getting and using it. At this stage, they would need intervention and treatment to quit, as they may not be able to stop on their own, even if they wanted to. 

How Can Parents Prevent Teenage Drug Use?

While they may not express it, teens do value bonds with the adults in their lives. Nurturing that connection with them includes being involved in their lives and having open, honest communication. 

How to Talk to Your Teen About Drug Use

Open communication starts by showing an interest in and talking to your teen about everything. This dialogue builds trust and respect, making it easier for you to talk about difficult topics.

Giving teens your undivided attention, without distractions, helps them feel special and heard. This quality time could be during chores, dinner, walks, car rides, or a fun family game night.

Here are some general tips to keep in mind when you’re talking about drugs with your teen:

• Stay curious and show interest.
• Ask open-ended questions.
• Actively listen.
• Don’t interrupt.
• Give compliments.
• Stay up late to talk.
• Chat over their favorite food. 

If you’re trying to start a conversation with your teen because you think they may be using drugs, their response to being confronted will determine how you’ll need to approach the conversation.

If your teen admits to using drugs, stay calm. Be supportive and willing to listen. Find out as much as you can about their drug use—what substances they’re using, how often they’re using them, and how they’re getting them. Be clear that the risks of drugs are serious and that drug use will not be tolerated. At the same time, make sure that you reassure your teen that you love them and that you want to help.

If your teen denies using drugs and you think they are lying , communicate the negative consequences of drug and alcohol use. Be clear that you want them to be safe and that experimenting with substances is dangerous—even if it’s just one time. If you are not able to keep the line of communication open with your teen, talk to their healthcare provider. They can help connect you to resources and support you in taking more decisive action, like drug testing.

Other Strategies

Talking to your teen openly and often is key, but there are also other steps you can take:

• Model responsible behavior for them.
• Stay involved with their activities but let them express their boundaries.
• Meet their friends and their parents.
• Teach them how to make good decisions when under pressure.

Protect Teens From Prescription Medications

Prescription drugs are generally safe when they're taken as prescribed. However, any time a person takes medication for reasons other than what they were prescribed for, it is considered medication abuse. Strategies to protect teens from prescription medication misuse include:

• Storing prescription medications in a safe place
• Locking up controlled substances 
• Getting rid of old medications

Safe Medication Disposal

Do not dispose of medications by flushing them down the toilet or pouring them down the sink. Medications can be crushed and mixed into the trash (to keep them away from children and pets) or returned to your local pharmacy or community drug take-back program.

Drug Addiction Treatment for Teens

Even if the adults in their lives try to prevent it, some teens will develop substance use disorders. Support for teens with drug addiction includes treating withdrawal or underlying mental health conditions, and addressing emotional needs, usually with a qualified mental health professional such as a psychiatrist or psychologist.

Treatment for teens experiencing substance use disorder includes a combination of the following:

• Outpatient clinics
• 12-step programs
• Inpatient mental health or substance use units 
• Medications
• Therapy (individual, group, or family)

Substance Use Helpline

If your teen is struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

If you are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger, call 911 .

Talk to your teen’s healthcare provider about what treatment would be best for them. Here are a few topics to discuss:

• Underlying health problems
• Benefits of treatment
• Credentials of team members
• Side effects 
• Family involvement
• Schoolwork during treatment
• Length of treatment
• Follow-up care

Experimenting with drugs or alcohol is tempting for teenagers because they may not know or understand the dangers of using substances—even just once. Academic pressure, low self-esteem, and peer pressure are just a few factors that increase their risk of substance use.

Caregivers need to have an open line of communication with their teens and teach them about the risks of using drugs. It’s also important to know the signs of drug use and intervene early to help teens who are at risk for or have already developed substance use disorders.

While drug use may increase the risk of mental health disorders, it’s also important to note that these disorders can lead to substance abuse to self-medicate or numb the emotional pain. If you suspect that a teenager is experiencing either, consult a pediatrician or mental health professional as soon as possible. 

Frequently Asked Questions

Depending on the substance and severity, a tube may be placed through the nose to suction drugs from the stomach. Activated charcoal is given through the tube to bind with the drug to release it from the body, decreasing the amount released into the bloodstream. If an antidote (reversal agent) such as Narcan is available for that substance, it may be given. 

National surveys from the National Institute on Drug Abuse show adolescent drug use rates have remained steady. However, the survey’s detected a shift in the types of drugs used by teens. Alcohol is still the most often abused substance, but the rates are decreasing. Instead, nicotine use and misuse of prescription medications are on the rise.  

University of Michigan. Teen drug use remains below pre-pandemic levels .

National Center for Drug Abuse Statistics. Drug use among youth: facts & statistics .

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NCDAS. Drug use among youth: facts & statistics .

Monitoring the Future. Alcohol: Trends in last 12 months prevalence of use in 8 th , 10 th , and 12 th grade .

Monitoring the Future. Marijuana: Trends in last 12 months prevalence of use in 8 th , 10 th , and 12 th grade .

Monitoring the Future. Any illicit drug: Trends in last 12 months prevalence of use in 8 th , 10 th , and 12 th grade .

Monitoring the Future. Cigarettes: Trends in last 12 months prevalence of use in 8 th , 10 th , and 12 th grade .

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Essay on Drug Addiction Among Youth

Students are often asked to write an essay on Drug Addiction Among Youth in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

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100 Words Essay on Drug Addiction Among Youth

Understanding drug addiction.

Drug addiction is a serious issue among youth. It refers to the compulsive use of drugs, leading to harmful consequences.

Causes of Drug Addiction

Several factors contribute to drug addiction in youth. Peer pressure, stress, and curiosity are some common reasons.

Effects of Drug Addiction

Drug addiction can lead to physical and mental health problems. It also affects academic performance and social relationships.

Preventing Drug Addiction

Awareness and education are key to preventing drug addiction. Schools should provide information about the dangers of drug use.

250 Words Essay on Drug Addiction Among Youth

The escalating issue of drug addiction among youth.

Drug addiction among youth is an alarming issue that has been escalating globally. The vulnerability of the younger demographic to substance abuse is a result of various factors, including peer pressure, stress, and the quest for self-discovery.

Factors Fueling Drug Addiction

Peer pressure is a significant contributor to drug abuse among youth. Young individuals, in their quest to fit in, often succumb to the pressure of trying drugs. Moreover, stress, whether academic or personal, pushes some into the abyss of drug addiction as a coping mechanism.

The Detrimental Effects of Drug Addiction

The consequences of drug addiction are far-reaching. Physically, it can lead to severe health issues such as heart diseases, liver damage, and even death. Psychologically, it can cause mental disorders like depression and anxiety. Socially, it can lead to isolation, negatively affecting academic performance and future career prospects.

Prevention and Treatment

Preventing drug addiction among youth requires a multifaceted approach. Schools and colleges need to incorporate drug education in their curriculum to raise awareness about the dangers of drug use. Parents and caregivers should maintain open lines of communication with their children about the risks involved with drug abuse.

For those already in the grip of addiction, treatment options include therapy, counseling, and rehabilitation programs. These treatments aim to help individuals overcome their addiction and reintegrate into society as productive members.

500 Words Essay on Drug Addiction Among Youth

Introduction.

Drug addiction among youth is a pressing issue that has been plaguing societies around the globe. It is an intricate problem that stems from a myriad of causes and has severe consequences, not only for the individual but also for the society at large.

Causes of Drug Addiction Among Youth

Several factors contribute to drug addiction among youth. Peer pressure is a significant contributor, as young people often succumb to the urge of fitting in, even if it means experimenting with drugs. The transition phase from adolescence to adulthood is fraught with challenges and insecurities, making youth vulnerable to drug use as a form of escapism.

The effects of drug addiction are multifaceted and devastating. Physically, it can lead to a weakened immune system, organ damage, and in some cases, fatal overdose. Psychologically, it can result in impaired judgment, memory loss, and mental health disorders.

The repercussions extend beyond the individual to affect their families and communities. It can lead to strained relationships, financial difficulties, and even crime. On a societal level, addiction can burden healthcare systems and increase crime rates, thereby affecting overall social stability and progress.

Prevention and Intervention Strategies

Secondly, mental health support should be more accessible to youth. By addressing the root causes of drug use, like mental health disorders, we can significantly reduce the likelihood of addiction.

Lastly, communities and families need to foster an environment where youth feel safe to discuss their struggles. Open dialogue can help identify early signs of drug use and provide necessary support to those in need.

Drug addiction among youth is a complex issue that requires collective effort and understanding. By addressing the root causes and implementing effective prevention strategies, we can hope to curb this growing problem. It is crucial for society to remember that addiction is not a moral failing but a health issue that requires compassion, support, and appropriate intervention.

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Essay on Drug Abuse

Here we have shared the Essay on Drug Abuse in detail so you can use it in your exam or assignment of 150, 250, 400, 500, or 1000 words.

You can use this Essay on Drug Abuse in any assignment or project whether you are in school (class 10th or 12th), college, or preparing for answer writing in competitive exams. 

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Essay on Drug Abuse in 150 words

Essay on drug abuse in 250-300 words, essay on drug abuse in 500-1000 words.

Drug abuse is a global issue that poses serious risks to individuals and society. It involves the harmful and excessive use of drugs, leading to physical and mental health problems. Drug abuse can result in addiction, organ damage, cognitive impairment, and social and economic difficulties. Prevention efforts should focus on education, raising awareness about the dangers of drug abuse, and promoting healthy lifestyles. Access to quality healthcare and addiction treatment services is crucial for recovery. Strengthening law enforcement measures against drug trafficking is necessary to address the supply side of the problem. Creating supportive environments and opportunities for positive engagement can help prevent drug abuse. By taking collective action, we can combat drug abuse and build healthier communities.

Drug abuse is a growing global concern that poses significant risks to individuals, families, and communities. It refers to the excessive and harmful use of drugs, both legal and illegal, that have negative effects on physical and mental health.

Drug abuse has severe consequences for individuals and society. Physically, drug abuse can lead to addiction, damage vital organs, and increase the risk of overdose. Mentally, it can cause cognitive impairment, and psychological disorders, and deteriorate overall well-being. Additionally, drug abuse often leads to social and economic problems, such as strained relationships, loss of employment, and criminal activities.

Preventing drug abuse requires a multi-faceted approach. Education and awareness programs play a crucial role in informing individuals about the dangers of drug abuse and promoting healthy lifestyle choices. Access to quality healthcare and addiction treatment services is vital to help individuals recover from substance abuse. Strengthening law enforcement efforts to curb drug trafficking and promoting international cooperation is also essential to address the supply side of the issue.

Community support and a nurturing environment are critical in preventing drug abuse. Creating opportunities for individuals, especially young people, to engage in positive activities and providing social support systems can serve as protective factors against drug abuse.

In conclusion, drug abuse is a significant societal problem with detrimental effects on individuals and communities. It requires a comprehensive approach involving education, prevention, treatment, and enforcement. By addressing the root causes, raising awareness, and providing support to those affected, we can combat drug abuse and create a healthier and safer society for all.

Title: Drug Abuse – A Global Crisis Demanding Urgent Action

Introduction :

Drug abuse is a pressing global issue that poses significant risks to individuals, families, and communities. It refers to the excessive and harmful use of drugs, both legal and illegal, that have detrimental effects on physical and mental health. This essay explores the causes and consequences of drug abuse, the social and economic impact, prevention and treatment strategies, and the importance of raising awareness and fostering supportive communities in addressing this crisis.

Causes and Factors Contributing to Drug Abuse

Several factors contribute to drug abuse. Genetic predisposition, peer pressure, stress, trauma, and environmental influences play a role in initiating substance use. The availability and accessibility of drugs, as well as societal norms and cultural acceptance, also influence drug abuse patterns. Additionally, underlying mental health issues and co-occurring disorders can drive individuals to self-medicate with drugs.

Consequences of Drug Abuse

Drug abuse has devastating consequences on individuals and society. Physically, drug abuse can lead to addiction, tolerance, and withdrawal symptoms. Substance abuse affects vital organs, impairs cognitive function, and increases the risk of accidents and injuries. Mental health disorders, such as depression, anxiety, and psychosis, are often associated with drug abuse. Substance abuse also takes a toll on relationships, leading to strained family dynamics, social isolation, and financial instability. The social and economic costs of drug abuse include increased healthcare expenses, decreased productivity, and the burden on criminal justice systems.

Prevention and Education

Preventing drug abuse requires a comprehensive and multi-faceted approach. Education and awareness programs are essential in schools, communities, and the media to inform individuals about the risks and consequences of drug abuse. Promoting healthy coping mechanisms, stress management skills, and decision-making abilities can empower individuals to resist peer pressure and make informed choices. Early intervention programs that identify at-risk individuals and provide support and resources are crucial in preventing substance abuse.

Treatment and Recovery

Access to quality healthcare and evidence-based addiction treatment is vital in addressing drug abuse. Treatment options include detoxification, counseling, behavioral therapies, and medication-assisted treatments. Rehabilitation centers, support groups, and outpatient programs provide a continuum of care for individuals seeking recovery. Holistic approaches, such as addressing co-occurring mental health disorders and promoting healthy lifestyles, contribute to successful long-term recovery. Support from family, friends, and communities plays a significant role in sustaining recovery and preventing relapse.

Law Enforcement and Drug Policies

Effective law enforcement efforts are necessary to disrupt drug trafficking and dismantle illicit drug networks. International cooperation and collaboration are crucial in combating the global drug trade. Additionally, drug policies should focus on a balanced approach that combines law enforcement with prevention, treatment, and harm reduction strategies. Shifting the emphasis from punitive measures toward prevention and rehabilitation can lead to more effective outcomes.

Creating Supportive Communities:

Fostering supportive communities is vital in addressing drug abuse. Communities should provide resources, social support networks, and opportunities for positive engagement. This includes promoting healthy recreational activities, providing vocational training, and creating safe spaces for individuals in recovery. Reducing the stigma associated with drug abuse and encouraging empathy and understanding are crucial to building a compassionate and supportive environment.

Conclusion :

Drug abuse remains a complex and multifaceted issue with far-reaching consequences. By addressing the causes, raising awareness, implementing preventive measures, providing quality treatment and support services, and fostering supportive communities, we can combat drug abuse and alleviate its impact. It requires collaboration and a collective effort from individuals, communities, governments, and organizations to build a society that is resilient against the scourge of drug abuse. Through education, prevention, treatment, and compassion, we can pave the way toward a healthier and drug-free future.

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Drugs, Brains, and Behavior: The Science of Addiction Preventing Drug Misuse and Addiction: The Best Strategy

Why is adolescence a critical time for preventing drug addiction.

As noted previously, early use of drugs increases a person's chances of becoming addicted. Remember, drugs change the brain—and this can lead to addiction and other serious problems. So, preventing early use of drugs or alcohol may go a long way in reducing these risks.

Risk of drug use increases greatly during times of transition. For an adult, a divorce or loss of a job may increase the risk of drug use. For a teenager, risky times include moving, family divorce, or changing schools. 35  When children advance from elementary through middle school, they face new and challenging social, family, and academic situations. Often during this period, children are exposed to substances such as cigarettes and alcohol for the first time. When they enter high school, teens may encounter greater availability of drugs, drug use by older teens, and social activities where drugs are used. When individuals leave high school and live more independently, either in college or as an employed adult, they may find themselves exposed to drug use while separated from the protective structure provided by family and school.

A certain amount of risk-taking is a normal part of adolescent development. The desire to try new things and become more independent is healthy, but it may also increase teens’ tendencies to experiment with drugs. The parts of the brain that control judgment and decision-making do not fully develop until people are in their early or mid-20s. This limits a teen’s ability to accurately assess the risks of drug experimentation and makes young people more vulnerable to peer pressure. 36

Because the brain is still developing, using drugs at this age has more potential to disrupt brain function in areas critical to motivation, memory, learning, judgment, and behavior control. 12  

Can research-based programs prevent drug addiction in youth?

Yes.  The term research-based or evidence-based means that these programs have been designed based on current scientific evidence, thoroughly tested, and shown to produce positive results. Scientists have developed a broad range of programs that positively alter the balance between risk and protective factors for drug use in families, schools, and communities. Studies have shown that research-based programs, such as described in NIDA’s  Principles of Substance Abuse Prevention for Early Childhood: A Research-Based Guide   and  Preventing Drug Use among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders , can significantly reduce early use of tobacco, alcohol, and other drugs. 37  Also, while many social and cultural factors affect drug use trends, when young people perceive drug use as harmful, they often reduce their level of use. 38

How do research-based prevention programs work?

These prevention programs work to boost protective factors and eliminate or reduce risk factors for drug use. The programs are designed for various ages and can be used in individual or group settings, such as the school and home. There are three types of programs:

• Universal programs address risk and protective factors common to all children in a given setting, such as a school or community.
• Selective programs are for groups of children and teens who have specific factors that put them at increased risk of drug use.
• Indicated programs are designed for youth who have already started using drugs.

Young Brains Under Study

Using cutting-edge imaging technology, scientists from the NIDA’s Adolescent Brain Cognitive Development (ABCD) Study will look at how childhood experiences, including use of any drugs, interact with each other and with a child’s changing biology to affect brain development and social, behavioral, academic, health, and other outcomes. As the only study of its kind, the ABCD study will yield critical insights into the foundational aspects of adolescence that shape a person’s future.

Economics of Prevention

Evidence-based interventions for substance use can save society money in medical costs and help individuals remain productive members of society. Such programs can return anywhere from very little to $65 per every dollar invested in prevention. 39

Reasons Behind Youth’s Engagement to Drug Abuse in the 21st Century Essay

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Question at Issue

• Unemployment and Drug Abuse among Youths in the 21st Century

Peer Pressure and Drug Abuse among Youths

Family lifestyle and drug abuse among youths, works cited.

What are the reasons behind youths’ engagement in drug abuse in the 21st century?

Although youths in the 21 st century engage in drug abuse due to several factors, it suffices to declare factors such as the rising unemployment status, peer pressure, and their hiked tendency to copy their parents’ behaviors as the principal drivers of drug abuse. However, one would wish to know why.

Unemployment and Drug Abuse among Youths in the 21 st Century

Eighner’s words of people being satisfied with what they have and or letting go of what their financial ability cannot afford do not seem to apply in the life of youths in the 21 st century.

Youth joblessness has become a key issue in the 21 st century. It has continued to have serious effects on development potential of young people. The increased rate of unemployment among young people encourages them to use drugs to change the way they feel or they way they perceive their incapacitated situation rather than accepting the situation and or using the right means of overcoming it.

They have to carry on with offensive acts and prostitution to sustain themselves. Drug abuse has physical, mental, and social effects. Physical injury also results from accidents that youths encounter while they are drunk. Joblessness and poverty also make the youths resort to self-treatment following the evident absence of funds for appropriate therapeutic treatment.

Morrel et al. confirm the existence of a “link between unemployment and increased drug, tobacco, and alcohol use” (237). Unemployment leads to stress, which makes youths use drugs hoping to feel better. However, on the contrary, they end up being drug addicts. Unemployment makes youths become vulnerable to drug abuse because they have a lot of free and idle time on their hands, which gives them the chances to involve themselves in socially deviant behaviors with drug abuse being one of those behaviors.

Lack of employment is among the factors that influence their feeding habits and hence their health. In fact, Eighner has come in handy to address the issue of healthy eating habits that even the jobless youth should use (6). However, he also points out financial issues that arise because of lack of jobs that determine what people or rather youth will choose to consume (drugs) based on their little or no cash at all (7).

Many youths who have no employment end up abusing drugs because they need to survive and or keep on pressing in this life. When youths are growing from being children to adults, they have a lot of hopes and aspirations, which fade off as time goes by as they involve in drug abuse as a way of forgetting their unemployment status.

Moreover, congruent with Eighner’s words, a decent job can help add to habitable earnings, civilized shelter, and high-quality social sustenance, which can help promote health and wellbeing of the youths, help them recover from mental health problems, and avoid substance abuse-related harms (6).

However, youths still abuse drugs despite some having good employment. In fact, Wells and Stacy say, “Finding meaningful employment will not solve all problems, but it’s a very important part of the bigger picture for many people” (164). Congruent with Curry’s Why We Work, it is possible for youths to experience stress to the extent of demanding ‘time offs’ (23) in their jobs. As a result, majority will use this opportunity to use stimulants as a way of relieving themselves from stress. Stimulants will make a youth forget his or her situation.

On the other hand, depressants like prescription of sleeping pills can give the youth a good and extended night’s sleep, which is especially common to unemployed young people for they want to remain sleepy so that they do not think much of their situation. They prefer taking depressants to escape their problems. As they repeatedly take the pills, they end up being drug addicts. Research done by Florida found out, “states with higher unemployment rates do tend to have higher rates of drug use” (Wells and Stacy 163).

Peer pressure is among the strongest predictors of drug use during adolescence. Peers initiate youths into drugs, provide drugs, model drug- using behaviors, and shape attitude about drugs. Currently, youths are adopting a common lifestyle.

Most adolescents are drained by this lifestyle not because they lack something essential in their lives like a job or because they have a genuine reason as to why they have adopted to that very lifestyle but because they want to fit into their peer group for acceptance. Peer pressure leads to the abuse of drugs by teenagers. Teens engage in drugs in order to rhyme with their peers. The extensive and continuous use of these drugs lands them to drug addiction.

A drastic rise in drug abuse among teens in the 21 st century has been noted following their parting with their parents to join their peers at school. On the contrary, Cisneros’ The Storyteller is an article that features the life of a young tutor who has been far from her parents for a while. Although Cisneros has peers in her workplace, she is an epitome of young people who choose to go against the norms to do what is right no matter the pressure (Cisneros 153) of experimenting things along with her peers.

According to Morrel et al., “teenagers seem to have more problems with peer pressure because they are just beginning to learn about whom they are and what their belief systems are” (240).

Peer pressure stands out as among the principal causes that can drive the present-day knowledgeable youths towards drugs dependence. When educated youths are through with their studies, they start hunting jobs. Sometimes, the jobless time can extend due to rapid changes in the job market thus leading them to start experiencing headaches, depressions, and confusion.

At this stage, the peers who seem to be helping them to overcome the situation lead the educated youths into the act of abusing drugs. By the time they realize they are abusing drugs, they already have reached the addiction stage. Peer pressure qualifies as one of the central roots of drug abuse among youths because many teenagers try drugs because they were given by their friends. Unfortunately, what people believe their peers want them to do is often the cause of what they actually do.

The way family functions can have a strong impact on a teenager. Teenagers coming from families where there is minute parental management and attention have high chances of misusing drugs in relation to teens from homes with more parental participation. Teens who spent the better part of the day without their parents have high chances of participating in hazardous behaviors. Tough folk relations can help prevent drug abuse.

Coming from a home that stresses on using of harmful substances has a tendency to make a young person perceive it as up to standard. Detrimental family pressure may be an aspect in a teen’s early drug testing. In fact, “Exposure to family members who reach for a substance to cure every pain of ailment can cause a teen to do the same” (239). Young people acquire many of their principles from parents and other mature influences.

They often mimic what they see. In addition, adolescents who have the perception that they are not close to or treasured by their parents are at a larger hazard because they have low self-esteem, which leads to depression and hence drug addiction. A teen may also engage in a drug abuse act when he or she comes from a family with poor familial factors like poor communication strategies between youths and their parents.

In conclusion, youths lie within a delicate age set, which is prone to many dangers especially drug abuse. The paper has discussed drug abuse as the main challenge facing youths in the 21 st century. It has clearly described how youths engage in drug abusing activities. Three reasons behind this engagement have been addressed.

Unemployment is one of the issues discussed in this paper whereby many unemployed persons engage in abusing drugs as a way of getting consolation. Peer pressure also plays a big role in the act of drug abuse among the youths. Lastly, family lifestyle has a major influence on teens and their likelihood of abusing drugs.

Curry, Andrew. Why We Work. London: Routledge, 2010. Print.

Cisneros, Sandra. “The Storyteller.” The Oprah Magazine 10.3(2009): 153. Print.

Eighner, Lars. “On Dumpster Diving.” The Threepenny Review 1.47(1991): 6-8. Print.

Morrel, Stanley, Jack Taylor, and Kerr Bill. “Jobless. Unemployment and Young People’s Health.” Medical Journal of Australia 168.5(1998): 236-40. Print.

Wells, Brian, and Barrie Stacy. “A Further Comparison of Cannabis (marijuana) Users and Non users.” British Journal of Addiction to Alcohol and Other Drugs 71.2(1976): 161-165. Print.

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• Published: 13 November 2021

Risk and protective factors of drug abuse among adolescents: a systematic review

• Azmawati Mohammed Nawi 1 ,
• Rozmi Ismail 2 ,
• Fauziah Ibrahim 2 ,
• Mohd Rohaizat Hassan 1 ,
• Mohd Rizal Abdul Manaf 1 ,
• Noh Amit 3 ,
• Norhayati Ibrahim 3 &
• Nurul Shafini Shafurdin 2  

BMC Public Health volume  21 , Article number:  2088 ( 2021 ) Cite this article

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Drug abuse is detrimental, and excessive drug usage is a worldwide problem. Drug usage typically begins during adolescence. Factors for drug abuse include a variety of protective and risk factors. Hence, this systematic review aimed to determine the risk and protective factors of drug abuse among adolescents worldwide.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was adopted for the review which utilized three main journal databases, namely PubMed, EBSCOhost, and Web of Science. Tobacco addiction and alcohol abuse were excluded in this review. Retrieved citations were screened, and the data were extracted based on strict inclusion and exclusion criteria. Inclusion criteria include the article being full text, published from the year 2016 until 2020 and provided via open access resource or subscribed to by the institution. Quality assessment was done using Mixed Methods Appraisal Tools (MMAT) version 2018 to assess the methodological quality of the included studies. Given the heterogeneity of the included studies, a descriptive synthesis of the included studies was undertaken.

Out of 425 articles identified, 22 quantitative articles and one qualitative article were included in the final review. Both the risk and protective factors obtained were categorized into three main domains: individual, family, and community factors. The individual risk factors identified were traits of high impulsivity; rebelliousness; emotional regulation impairment, low religious, pain catastrophic, homework completeness, total screen time and alexithymia; the experience of maltreatment or a negative upbringing; having psychiatric disorders such as conduct problems and major depressive disorder; previous e-cigarette exposure; behavioral addiction; low-perceived risk; high-perceived drug accessibility; and high-attitude to use synthetic drugs. The familial risk factors were prenatal maternal smoking; poor maternal psychological control; low parental education; negligence; poor supervision; uncontrolled pocket money; and the presence of substance-using family members. One community risk factor reported was having peers who abuse drugs. The protective factors determined were individual traits of optimism; a high level of mindfulness; having social phobia; having strong beliefs against substance abuse; the desire to maintain one’s health; high paternal awareness of drug abuse; school connectedness; structured activity and having strong religious beliefs.

The outcomes of this review suggest a complex interaction between a multitude of factors influencing adolescent drug abuse. Therefore, successful adolescent drug abuse prevention programs will require extensive work at all levels of domains.

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Introduction

Drug abuse is a global problem; 5.6% of the global population aged 15–64 years used drugs at least once during 2016 [ 1 ]. The usage of drugs among younger people has been shown to be higher than that among older people for most drugs. Drug abuse is also on the rise in many ASEAN (Association of Southeast Asian Nations) countries, especially among young males between 15 and 30 years of age. The increased burden due to drug abuse among adolescents and young adults was shown by the Global Burden of Disease (GBD) study in 2013 [ 2 ]. About 14% of the total health burden in young men is caused by alcohol and drug abuse. Younger people are also more likely to die from substance use disorders [ 3 ], and cannabis is the drug of choice among such users [ 4 ].

Adolescents are the group of people most prone to addiction [ 5 ]. The critical age of initiation of drug use begins during the adolescent period, and the maximum usage of drugs occurs among young people aged 18–25 years old [ 1 ]. During this period, adolescents have a strong inclination toward experimentation, curiosity, susceptibility to peer pressure, rebellion against authority, and poor self-worth, which makes such individuals vulnerable to drug abuse [ 2 ]. During adolescence, the basic development process generally involves changing relations between the individual and the multiple levels of the context within which the young person is accustomed. Variation in the substance and timing of these relations promotes diversity in adolescence and represents sources of risk or protective factors across this life period [ 6 ]. All these factors are crucial to helping young people develop their full potential and attain the best health in the transition to adulthood. Abusing drugs impairs the successful transition to adulthood by impairing the development of critical thinking and the learning of crucial cognitive skills [ 7 ]. Adolescents who abuse drugs are also reported to have higher rates of physical and mental illness and reduced overall health and well-being [ 8 ].

The absence of protective factors and the presence of risk factors predispose adolescents to drug abuse. Some of the risk factors are the presence of early mental and behavioral health problems, peer pressure, poorly equipped schools, poverty, poor parental supervision and relationships, a poor family structure, a lack of opportunities, isolation, gender, and accessibility to drugs [ 9 ]. The protective factors include high self-esteem, religiosity, grit, peer factors, self-control, parental monitoring, academic competence, anti-drug use policies, and strong neighborhood attachment [ 10 , 11 , 12 , 13 , 14 , 15 ].

The majority of previous systematic reviews done worldwide on drug usage focused on the mental, psychological, or social consequences of substance abuse [ 16 , 17 , 18 ], while some focused only on risk and protective factors for the non-medical use of prescription drugs among youths [ 19 ]. A few studies focused only on the risk factors of single drug usage among adolescents [ 20 ]. Therefore, the development of the current systematic review is based on the main research question: What is the current risk and protective factors among adolescent on the involvement with drug abuse? To the best of our knowledge, there is limited evidence from systematic reviews that explores the risk and protective factors among the adolescent population involved in drug abuse. Especially among developing countries, such as those in South East Asia, such research on the risk and protective factors for drug abuse is scarce. Furthermore, this review will shed light on the recent trends of risk and protective factors and provide insight into the main focus factors for prevention and control activities program. Additionally, this review will provide information on how these risk and protective factors change throughout various developmental stages. Therefore, the objective of this systematic review was to determine the risk and protective factors of drug abuse among adolescents worldwide. This paper thus fills in the gaps of previous studies and adds to the existing body of knowledge. In addition, this review may benefit certain parties in developing countries like Malaysia, where the national response to drugs is developing in terms of harm reduction, prison sentences, drug treatments, law enforcement responses, and civil society participation.

This systematic review was conducted using three databases, PubMed, EBSCOhost, and Web of Science, considering the easy access and wide coverage of reliable journals, focusing on the risk and protective factors of drug abuse among adolescents from 2016 until December 2020. The search was limited to the last 5 years to focus only on the most recent findings related to risk and protective factors. The search strategy employed was performed in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) checklist.

A preliminary search was conducted to identify appropriate keywords and determine whether this review was feasible. Subsequently, the related keywords were searched using online thesauruses, online dictionaries, and online encyclopedias. These keywords were verified and validated by an academic professor at the National University of Malaysia. The keywords used as shown in Table  1 .

Selection criteria

The systematic review process for searching the articles was carried out via the steps shown in Fig.  1 . Firstly, screening was done to remove duplicate articles from the selected search engines. A total of 240 articles were removed in this stage. Titles and abstracts were screened based on the relevancy of the titles to the inclusion and exclusion criteria and the objectives. The inclusion criteria were full text original articles, open access articles or articles subscribed to by the institution, observation and intervention study design and English language articles. The exclusion criteria in this search were (a) case study articles, (b) systematic and narrative review paper articles, (c) non-adolescent-based analyses, (d) non-English articles, and (e) articles focusing on smoking (nicotine) and alcohol-related issues only. A total of 130 articles were excluded after title and abstract screening, leaving 55 articles to be assessed for eligibility. The full text of each article was obtained, and each full article was checked thoroughly to determine if it would fulfil the inclusion criteria and objectives of this study. Each of the authors compared their list of potentially relevant articles and discussed their selections until a final agreement was obtained. A total of 22 articles were accepted to be included in this review. Most of the excluded articles were excluded because the population was not of the target age range—i.e., featuring subjects with an age > 18 years, a cohort born in 1965–1975, or undergraduate college students; the subject matter was not related to the study objective—i.e., assessing the effects on premature mortality, violent behavior, psychiatric illness, individual traits, and personality; type of article such as narrative review and neuropsychiatry review; and because of our inability to obtain the full article—e.g., forthcoming work in 2021. One qualitative article was added to explain the domain related to risk and the protective factors among the adolescents.

PRISMA flow diagram showing the selection of studies on risk and protective factors for drug abuse among adolescents.2.2. Operational Definition

Drug-related substances in this context refer to narcotics, opioids, psychoactive substances, amphetamines, cannabis, ecstasy, heroin, cocaine, hallucinogens, depressants, and stimulants. Drugs of abuse can be either off-label drugs or drugs that are medically prescribed. The two most commonly abused substances not included in this review are nicotine (tobacco) and alcohol. Accordingly, e-cigarettes and nicotine vape were also not included. Further, “adolescence” in this study refers to members of the population aged between 10 to 18 years [ 21 ].

Data extraction tool

All researchers independently extracted information for each article into an Excel spreadsheet. The data were then customized based on their (a) number; (b) year; (c) author and country; (d) titles; (e) study design; (f) type of substance abuse; (g) results—risks and protective factors; and (h) conclusions. A second reviewer crossed-checked the articles assigned to them and provided comments in the table.

Quality assessment tool

By using the Mixed Method Assessment Tool (MMAT version 2018), all articles were critically appraised for their quality by two independent reviewers. This tool has been shown to be useful in systematic reviews encompassing different study designs [ 22 ]. Articles were only selected if both reviewers agreed upon the articles’ quality. Any disagreement between the assigned reviewers was managed by employing a third independent reviewer. All included studies received a rating of “yes” for the questions in the respective domains of the MMAT checklists. Therefore, none of the articles were removed from this review due to poor quality. The Cohen’s kappa (agreement) between the two reviewers was 0.77, indicating moderate agreement [ 23 ].

The initial search found 425 studies for review, but after removing duplicates and applying the criteria listed above, we narrowed the pool to 22 articles, all of which are quantitative in their study design. The studies include three prospective cohort studies [ 24 , 25 , 26 ], one community trial [ 27 ], one case-control study [ 28 ], and nine cross-sectional studies [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. After careful discussion, all reviewer panels agreed to add one qualitative study [ 46 ] to help provide reasoning for the quantitative results. The selected qualitative paper was chosen because it discussed almost all domains on the risk and protective factors found in this review.

A summary of all 23 articles is listed in Table  2 . A majority of the studies (13 articles) were from the United States of America (USA) [ 25 , 26 , 27 , 29 , 30 , 31 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ], three studies were from the Asia region [ 32 , 33 , 38 ], four studies were from Europe [ 24 , 28 , 40 , 44 ], and one study was from Latin America [ 35 ], Africa [ 43 ] and Mediterranean [ 45 ]. The number of sample participants varied widely between the studies, ranging from 70 samples (minimum) to 700,178 samples (maximum), while the qualitative paper utilized a total of 100 interviewees. There were a wide range of drugs assessed in the quantitative articles, with marijuana being mentioned in 11 studies, cannabis in five studies, and opioid (six studies). There was also large heterogeneity in terms of the study design, type of drug abused, measurements of outcomes, and analysis techniques used. Therefore, the data were presented descriptively.

After thorough discussion and evaluation, all the findings (both risk and protective factors) from the review were categorized into three main domains: individual factors, family factors, and community factors. The conceptual framework is summarized in Fig.  2 .

Conceptual framework of risk and protective factors related to adolescent drug abuse

DOMAIN: individual factor

Risk factors.

Almost all the articles highlighted significant findings of individual risk factors for adolescent drug abuse. Therefore, our findings for this domain were further broken down into five more sub-domains consisting of personal/individual traits, significant negative growth exposure, personal psychiatric diagnosis, previous substance history, comorbidity and an individual’s attitude and perception.

Personal/individual traits

Chuang et al. [ 29 ] found that adolescents with high impulsivity traits had a significant positive association with drug addiction. This study also showed that the impulsivity trait alone was an independent risk factor that increased the odds between two to four times for using any drug compared to the non-impulsive group. Another longitudinal study by Guttmannova et al. showed that rebellious traits are positively associated with marijuana drug abuse [ 27 ]. The authors argued that measures of rebelliousness are a good proxy for a youth’s propensity to engage in risky behavior. Nevertheless, Wilson et al. [ 37 ], in a study involving 112 youths undergoing detoxification treatment for opioid abuse, found that a majority of the affected respondents had difficulty in regulating their emotions. The authors found that those with emotional regulation impairment traits became opioid dependent at an earlier age. Apart from that, a case-control study among outpatient youths found that adolescents involved in cannabis abuse had significant alexithymia traits compared to the control population [ 28 ]. Those adolescents scored high in the dimension of Difficulty in Identifying Emotion (DIF), which is one of the key definitions of diagnosing alexithymia. Overall, the adjusted Odds Ratio for DIF in cannabis abuse was 1.11 (95% CI, 1.03–1.20).

Significant negative growth exposure

A history of maltreatment in the past was also shown to have a positive association with adolescent drug abuse. A study found that a history of physical abuse in the past is associated with adolescent drug abuse through a Path Analysis, despite evidence being limited to the female gender [ 25 ]. However, evidence from another study focusing at foster care concluded that any type of maltreatment might result in a prevalence as high as 85.7% for the lifetime use of cannabis and as high as 31.7% for the prevalence of cannabis use within the last 3-months [ 30 ]. The study also found significant latent variables that accounted for drug abuse outcomes, which were chronic physical maltreatment (factor loading of 0.858) and chronic psychological maltreatment (factor loading of 0.825), with an r 2 of 73.6 and 68.1%, respectively. Another study shed light on those living in child welfare service (CWS) [ 35 ]. It was observed through longitudinal measurements that proportions of marijuana usage increased from 9 to 18% after 36 months in CWS. Hence, there is evidence of the possibility of a negative upbringing at such shelters.

Personal psychiatric diagnosis

The robust studies conducted in the USA have deduced that adolescents diagnosed with a conduct problem (CP) have a positive association with marijuana abuse (OR = 1.75 [1.56, 1.96], p  < 0.0001). Furthermore, those with a diagnosis of Major Depressive Disorder (MDD) showed a significant positive association with marijuana abuse.

Previous substance and addiction history

Another study found that exposure to e-cigarettes within the past 30 days is related to an increase in the prevalence of marijuana use and prescription drug use by at least four times in the 8th and 10th grades and by at least three times in the 12th grade [ 34 ]. An association between other behavioral addictions and the development of drug abuse was also studied [ 29 ]. Using a 12-item index to assess potential addictive behaviors [ 39 ], significant associations between drug abuse and the groups with two behavioral addictions (OR = 3.19, 95% CI 1.25,9.77) and three behavioral addictions (OR = 3.46, 95% CI 1.25,9.58) were reported.

Comorbidity

The paper by Dash et al. (2020) highlight adolescent with a disease who needs routine medical pain treatment have higher risk of opioid misuse [ 38 ]. The adolescents who have disorder symptoms may have a risk for opioid misuse despite for the pain intensity.

Individual’s attitudes and perceptions

In a study conducted in three Latin America countries (Argentina, Chile, and Uruguay), it was shown that adolescents with low or no perceived risk of taking marijuana had a higher risk of abuse (OR = 8.22 times, 95% CI 7.56, 10.30) [ 35 ]. This finding is in line with another study that investigated 2002 adolescents and concluded that perceiving the drug as harmless was an independent risk factor that could prospectively predict future marijuana abuse [ 27 ]. Moreover, some youth interviewed perceived that they gained benefits from substance use [ 38 ]. The focus group discussion summarized that the youth felt positive personal motivation and could escape from a negative state by taking drugs. Apart from that, adolescents who had high-perceived availability of drugs in their neighborhoods were more likely to increase their usage of marijuana over time (OR = 11.00, 95% CI 9.11, 13.27) [ 35 ]. A cheap price of the substance and the availability of drug dealers around schools were factors for youth accessibility [ 38 ]. Perceived drug accessibility has also been linked with the authorities’ enforcement programs. The youth perception of a lax community enforcement of laws regarding drug use at all-time points predicted an increase in marijuana use in the subsequent assessment period [ 27 ]. Besides perception, a study examining the attitudes towards synthetic drugs based on 8076 probabilistic samples of Macau students found that the odds of the lifetime use of marijuana was almost three times higher among those with a strong attitude towards the use of synthetic drugs [ 32 ]. In addition, total screen time among the adolescent increase the likelihood of frequent cannabis use. Those who reported daily cannabis use have a mean of 12.56 h of total screen time, compared to a mean of 6.93 h among those who reported no cannabis use. Adolescent with more time on internet use, messaging, playing video games and watching TV/movies were significantly associated with more frequent cannabis use [ 44 ].

Protective factors

Individual traits.

Some individual traits have been determined to protect adolescents from developing drug abuse habits. A study by Marin et al. found that youth with an optimistic trait were less likely to become drug dependent [ 33 ]. In this study involving 1104 Iranian students, it was concluded that a higher optimism score (measured using the Children Attributional Style Questionnaire, CASQ) was a protective factor against illicit drug use (OR = 0.90, 95% CI: 0.85–0.95). Another study found that high levels of mindfulness, measured using the 25-item Child Acceptance and Mindfulness Measure, CAMM, lead to a slower progression toward injectable drug abuse among youth with opioid addiction (1.67 years, p  = .041) [ 37 ]. In addition, the social phobia trait was found to have a negative association with marijuana use (OR = 0.87, 95% CI 0.77–0.97), as suggested [ 31 ].

According to El Kazdouh et al., individuals with a strong belief against substance use and those with a strong desire to maintain their health were more likely to be protected from involvement in drug abuse [ 46 ].

DOMAIN: family factors

The biological factors underlying drug abuse in adolescents have been reported in several studies. Epigenetic studies are considered important, as they can provide a good outline of the potential pre-natal factors that can be targeted at an earlier stage. Expecting mothers who smoke tobacco and alcohol have an indirect link with adolescent substance abuse in later life [ 24 , 39 ]. Moreover, the dynamic relationship between parents and their children may have some profound effects on the child’s growth. Luk et al. examined the mediator effects between parenting style and substance abuse and found the maternal psychological control dimension to be a significant variable [ 26 ]. The mother’s psychological control was two times higher in influencing her children to be involved in substance abuse compared to the other dimension. Conversely, an indirect risk factor towards youth drug abuse was elaborated in a study in which low parental educational level predicted a greater risk of future drug abuse by reducing the youth’s perception of harm [ 27 , 43 ]. Negligence from a parental perspective could also contribute to this problem. According to El Kazdouh et al. [ 46 ], a lack of parental supervision, uncontrolled pocket money spending among children, and the presence of substance-using family members were the most common negligence factors.

While the maternal factors above were shown to be risk factors, the opposite effect was seen when the paternal figure equipped himself with sufficient knowledge. A study found that fathers with good information and awareness were more likely to protect their adolescent children from drug abuse [ 26 ]. El Kazdouh et al. noted that support and advice could be some of the protective factors in this area [ 46 ].

DOMAIN: community factors

• Risk factor

A study in 2017 showed a positive association between adolescent drug abuse and peers who abuse drugs [ 32 , 39 ]. It was estimated that the odds of becoming a lifetime marijuana user was significantly increased by a factor of 2.5 ( p  < 0.001) among peer groups who were taking synthetic drugs. This factor served as peer pressure for youth, who subconsciously had desire to be like the others [ 38 ]. The impact of availability and engagement in structured and unstructured activities also play a role in marijuana use. The findings from Spillane (2000) found that the availability of unstructured activities was associated with increased likelihood of marijuana use [ 42 ].

• Protective factor

Strong religious beliefs integrated into society serve as a crucial protective factor that can prevent adolescents from engaging in drug abuse [ 38 , 45 ]. In addition, the school connectedness and adult support also play a major contribution in the drug use [ 40 ].

The goal of this review was to identify and classify the risks and protective factors that lead adolescents to drug abuse across the three important domains of the individual, family, and community. No findings conflicted with each other, as each of them had their own arguments and justifications. The findings from our review showed that individual factors were the most commonly highlighted. These factors include individual traits, significant negative growth exposure, personal psychiatric diagnosis, previous substance and addiction history, and an individual’s attitude and perception as risk factors.

Within the individual factor domain, nine articles were found to contribute to the subdomain of personal/ individual traits [ 27 , 28 , 29 , 37 , 38 , 39 , 40 , 43 , 44 ]. Despite the heterogeneity of the study designs and the substances under investigation, all of the papers found statistically significant results for the possible risk factors of adolescent drug abuse. The traits of high impulsivity, rebelliousness, difficulty in regulating emotions, and alexithymia can be considered negative characteristic traits. These adolescents suffer from the inability to self-regulate their emotions, so they tend to externalize their behaviors as a way to avoid or suppress the negative feelings that they are experiencing [ 41 , 47 , 48 ]. On the other hand, engaging in such behaviors could plausibly provide a greater sense of positive emotions and make them feel good [ 49 ]. Apart from that, evidence from a neurophysiological point of view also suggests that the compulsive drive toward drug use is complemented by deficits in impulse control and decision making (impulsive trait) [ 50 ]. A person’s ability in self-control will seriously impaired with continuous drug use and will lead to the hallmark of addiction [ 51 ].

On the other hand, there are articles that reported some individual traits to be protective for adolescents from engaging in drug abuse. Youth with the optimistic trait, a high level of mindfulness, and social phobia were less likely to become drug dependent [ 31 , 33 , 37 ]. All of these articles used different psychometric instruments to classify each individual trait and were mutually exclusive. Therefore, each trait measured the chance of engaging in drug abuse on its own and did not reflect the chance at the end of the spectrum. These findings show that individual traits can be either protective or risk factors for the drugs used among adolescents. Therefore, any adolescent with negative personality traits should be monitored closely by providing health education, motivation, counselling, and emotional support since it can be concluded that negative personality traits are correlated with high risk behaviours such as drug abuse [ 52 ].

Our study also found that a history of maltreatment has a positive association with adolescent drug abuse. Those adolescents with episodes of maltreatment were considered to have negative growth exposure, as their childhoods were negatively affected by traumatic events. Some significant associations were found between maltreatment and adolescent drug abuse, although the former factor was limited to the female gender [ 25 , 30 , 36 ]. One possible reason for the contrasting results between genders is the different sample populations, which only covered child welfare centers [ 36 ] and foster care [ 30 ]. Regardless of the place, maltreatment can happen anywhere depending on the presence of the perpetrators. To date, evidence that concretely links maltreatment and substance abuse remains limited. However, a plausible explanation for this link could be the indirect effects of posttraumatic stress (i.e., a history of maltreatment) leading to substance use [ 53 , 54 ]. These findings highlight the importance of continuous monitoring and follow-ups with adolescents who have a history of maltreatment and who have ever attended a welfare center.

Addiction sometimes leads to another addiction, as described by the findings of several studies [ 29 , 34 ]. An initial study focused on the effects of e-cigarettes in the development of other substance abuse disorders, particularly those related to marijuana, alcohol, and commonly prescribed medications [ 34 ]. The authors found that the use of e-cigarettes can lead to more severe substance addiction [ 55 ], possibly through normalization of the behavior. On the other hand, Chuang et al.’s extensive study in 2017 analyzed the combined effects of either multiple addictions alone or a combination of multiple addictions together with the impulsivity trait [ 29 ]. The outcomes reported were intriguing and provide the opportunity for targeted intervention. The synergistic effects of impulsiveness and three other substance addictions (marijuana, tobacco, and alcohol) substantially increased the likelihood for drug abuse from 3.46 (95%CI 1.25, 9.58) to 10.13 (95% CI 3.95, 25.95). Therefore, proper rehabilitation is an important strategy to ensure that one addiction will not lead to another addiction.

The likelihood for drug abuse increases as the population perceives little or no harmful risks associated with the drugs. On the opposite side of the coin, a greater perceived risk remains a protective factor for marijuana abuse [ 56 ]. However, another study noted that a stronger determinant for adolescent drug abuse was the perceived availability of the drug [ 35 , 57 ]. Looking at the bigger picture, both perceptions corroborate each other and may inform drug use. Another study, on the other hand, reported that there was a decreasing trend of perceived drug risk in conjunction with the increasing usage of drugs [ 58 ]. As more people do drugs, youth may inevitably perceive those drugs as an acceptable norm without any harmful consequences [ 59 ].

In addition, the total spent for screen time also contribute to drug abuse among adolescent [ 43 ]. This scenario has been proven by many researchers on the effect of screen time on the mental health [ 60 ] that leads to the substance use among the adolescent due to the ubiquity of pro-substance use content on the internet. Adolescent with comorbidity who needs medical pain management by opioids also tend to misuse in future. A qualitative exploration on the perspectives among general practitioners concerning the risk of opioid misuse in people with pain, showed pain management by opioids is a default treatment and misuse is not a main problem for the them [ 61 ]. A careful decision on the use of opioids as a pain management should be consider among the adolescents and their understanding is needed.

Within the family factor domain, family structures were found to have both positive and negative associations with drug abuse among adolescents. As described in one study, paternal knowledge was consistently found to be a protective factor against substance abuse [ 26 ]. With sufficient knowledge, the father can serve as the guardian of his family to monitor and protect his children from negative influences [ 62 ]. The work by Luk et al. also reported a positive association of maternal psychological association towards drug abuse (IRR 2.41, p  < 0.05) [ 26 ]. The authors also observed the same effect of paternal psychological control, although it was statistically insignificant. This construct relates to parenting style, and the authors argued that parenting style might have a profound effect on the outcomes under study. While an earlier literature review [ 63 ] also reported such a relationship, a recent study showed a lesser impact [ 64 ] with regards to neglectful parenting styles leading to poorer substance abuse outcomes. Nevertheless, it was highlighted in another study that the adolescents’ perception of a neglectful parenting style increased their odds (OR 2.14, p  = 0.012) of developing alcohol abuse, not the parenting style itself [ 65 ]. Altogether, families play vital roles in adolescents’ risk for engaging in substance abuse [ 66 ]. Therefore, any intervention to impede the initiation of substance use or curb existing substance use among adolescents needs to include parents—especially improving parent–child communication and ensuring that parents monitor their children’s activities.

Finally, the community also contributes to drug abuse among adolescents. As shown by Li et al. [ 32 ] and El Kazdouh et al. [ 46 ], peers exert a certain influence on other teenagers by making them subconsciously want to fit into the group. Peer selection and peer socialization processes might explain why peer pressure serves as a risk factor for drug-abuse among adolescents [ 67 ]. Another study reported that strong religious beliefs integrated into society play a crucial role in preventing adolescents from engaging in drug abuse [ 46 ]. Most religions devalue any actions that can cause harmful health effects, such as substance abuse [ 68 ]. Hence, spiritual beliefs may help protect adolescents. This theme has been well established in many studies [ 60 , 69 , 70 , 71 , 72 ] and, therefore, could be implemented by religious societies as part of interventions to curb the issue of adolescent drug abuse. The connection with school and structured activity did reduce the risk as a study in USA found exposure to media anti-drug messages had an indirect negative effect on substances abuse through school-related activity and social activity [ 73 ]. The school activity should highlight on the importance of developmental perspective when designing and offering school-based prevention programs [75].

Limitations

We adopted a review approach that synthesized existing evidence on the risk and protective factors of adolescents engaging in drug abuse. Although this systematic review builds on the conclusion of a rigorous review of studies in different settings, there are some potential limitations to this work. We may have missed some other important factors, as we only included English articles, and article extraction was only done from the three search engines mentioned. Nonetheless, this review focused on worldwide drug abuse studies, rather than the broader context of substance abuse including alcohol and cigarettes, thereby making this paper more focused.

Conclusions

This review has addressed some recent knowledge related to the individual, familial, and community risk and preventive factors for adolescent drug use. We suggest that more attention should be given to individual factors since most findings were discussed in relation to such factors. With the increasing trend of drug abuse, it will be critical to focus research specifically on this area. Localized studies, especially those related to demographic factors, may be more effective in generating results that are specific to particular areas and thus may be more useful in generating and assessing local control and prevention efforts. Interventions using different theory-based psychotherapies and a recognition of the unique developmental milestones specific to adolescents are among examples that can be used. Relevant holistic approaches should be strengthened not only by relevant government agencies but also by the private sector and non-governmental organizations by promoting protective factors while reducing risk factors in programs involving adolescents from primary school up to adulthood to prevent and control drug abuse. Finally, legal legislation and enforcement against drug abuse should be engaged with regularly as part of our commitment to combat this public health burden.

Data availability and materials

All data generated or analysed during this study are included in this published article.

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The authors acknowledge The Ministry of Higher Education Malaysia and The Universiti Kebangsaan Malaysia, (UKM) for funding this study under the Long-Term Research Grant Scheme-(LGRS/1/2019/UKM-UKM/2/1). We also thank the team for their commitment and tireless efforts in ensuring that manuscript was well executed.

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Nawi, A.M., Ismail, R., Ibrahim, F. et al. Risk and protective factors of drug abuse among adolescents: a systematic review. BMC Public Health 21 , 2088 (2021). https://doi.org/10.1186/s12889-021-11906-2

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The Impact of Substance Use Disorders on Families and Children: From Theory to Practice

The effects of a substance use disorder (SUD) are felt by the whole family. The family context holds information about how SUDs develop, are maintained, and what can positively or negatively influence the treatment of the disorder. Family systems theory and attachment theory are theoretical models that provide a framework for understanding how SUDs affect the family. In addition, understanding the current developmental stage a family is in helps inform assessment of impairment and determination of appropriate interventions. SUDs negatively affect emotional and behavioral patterns from the inception of the family, resulting in poor outcomes for the children and adults with SUDs. Social workers can help address SUDs in multiple ways, which are summarized in this article.

INTRODUCTION AND THEORETICAL FRAMEWORK

The family remains the primary source of attachment, nurturing, and socialization for humans in our current society. Therefore, the impact of substance use disorders (SUDs) on the family and individual family members merits attention. Each family and each family member is uniquely affected by the individual using substances including but not limited to having unmet developmental needs, impaired attachment, economic hardship, legal problems, emotional distress, and sometimes violence being perpetrated against him or her. For children there is also an increased risk of developing an SUD themselves ( Zimic & Jakic, 2012 ). Thus, treating only the individual with the active disease of addiction is limited in effectiveness. The social work profession more than any other health care profession has historically recognized the importance of assessing the individual in the context of his or her family environment. Social work education and training emphasizes the significant impact the environment has on the individual and vice versa. This topic was chosen to illustrate how involving the family in the treatment of an SUD in an individual is an effective way to help the family and the individual. The utilization of evidence-based family approaches has demonstrated superiority over individual or group-based treatments ( Baldwin, Christian, Berkeljon, & Shandish, 2012 ). Treating the individual without family involvement may limit the effectiveness of treatment for two main reasons: it ignores the devastating impact of SUDs on the family system leaving family members untreated, and it does not recognize the family as a potential system of support for change. Two theories important to understanding how and why SUDs impact the family are attachment theory and systems theory.

Attachment Theory

It is estimated that more than eight million children younger than age 18 live with at least one adult who has a SUD that is a rate of more than one in 10 children. The majority of these children are younger than age 5 (U.S. Department of Health and Human Services [USDHHS], 2010). The studies of families with SUDs reveal patterns that significantly influence child development and the likelihood that a child will struggle with emotional, behavioral, or substance use problems ( Substance Abuse and Mental Health Services Administration [SAMHSA], 2003 ). The negative impacts of parental SUDs on the family include disruption of attachment, rituals, roles, routines, communication, social life, and finances. Families in which there is a parental SUD are characterized by an environment of secrecy, loss, conflict, violence or abuse, emotional chaos, role reversal, and fear.

Relationships serve as the communication conduits that connect family members to each other. Attachment theory provides a way of understanding the development and quality of relationships between family members. John Bowlby (1988) developed attachment theory through the clinical study of mammalian species and humans. He postulated that at the time of an infant's birth, the primary relationship, usually with the mother but not always, serves as the template for all subsequent relationships throughout the life cycle. This relationship forms a subsystem within the larger family system. It is through this relationship, at a prelanguage level, that infants learn to communicate and relate to their environment. They do this through crying, cooing, rooting, and clinging. The way in which the primary caretaker responds to these cues will establish the quality of the attachment. Generally, if the child experiences the primary caretaker as responsive and nurturing, a secure attachment will form. If the child experiences the primary caretaker as unresponsive or inconsistently responsive, an insecure attachment may form that can result in a variety of problems including anxiety, depression, and failure to thrive.

A parent with a SUD, who is mood altered, preoccupied with getting high or spending significant amounts of time recovering from the effects of substances, may miss the opportunities to foster healthy attachment. Consequently, the intricate attachment system that is built on hundreds of thousands of reciprocal and implicit interactions between infant and attachment figure will be affected. Eye contact, tone, volume and rhythm of voice, soothing touch, and the ability to read the needs of the infant are all intricate building blocks of attachment. Healthy attachment is a psychological immune system of sorts. Just as humans need a physiological immune system to fight off disease and illness, likewise, the relational attachment system provides protection against psychological problems and illness. Without a healthy attachment system, a child is much more vulnerable to stress and therefore more susceptible to having problems with trauma, anxiety, depression, and other mental illness. Attachment theory posits that the quality of the parents' attachment system that developed in infancy will affect their ability to form healthy attachments to their own children and with other adults.

Family Systems Theory

Family systems theory grew out of the biologically based general systems theory. General systems theory focuses on how the parts of a system interact with one another. In general systems theory an individual cell is one example of a system, and in family systems theory the family is essentially its own system. Key concepts in both theories are feedback, homeostasis and boundaries that are defined and operationalized in this section. Family systems theory was developed in the late 1960s and early 1970s. Nathan Ackerman, Jay Haley, Murray Bowen, Salvadore Minuchin, Virginia Satir, and Carl Witaker, among others were highly influential figures in this movement and developed its applications to psychiatric treatment. Out of this theory multiple models of family therapy developed including but not limited to strategic, structural, experiential, and more recently the multisystemic family systems therapy (MFT) model. All the family therapy models share the basic principal of family systems theory that is that the individual cannot be fully understood or successfully treated without first understanding how that individual functions in his or her family system. Individuals who present in our clinical settings can be seen as “symptomatic,” and their pathology can be viewed as an attempt adapt to their family system so as to maintain homeostasis.

Homeostasis refers to the idea that it is the tendency of a system to seek stability and equilibrium ( Brown & Christensen, 1986 ). The idea of homeostasis is key to understanding the effect of SUDs on the family in that each family member tends to function in such a way that keeps the whole system in balance even if it is not healthy for specific individuals. For example, a latency-age child may cover up her father's drinking by cleaning up after him if he is sick, getting him into bed after he passes out, and minimizing his drinking to her mother. Her efforts allow his SUD to continue with limited consequence and keep the family system at relative equilibrium by reducing fighting between the mother and father. Although that adaptation may keep the family system in a state of equilibrium, it also serves to maintain the problem. Feedback refers to the circular way in which parts of a system communicate with each other. The process of feedback is how the parent–child attachment relationship is formed. In a family system, a wife may identify that she abuses pain pills because her husband ignores her and she is depressed. The husband may in turn state that he avoids his wife because she is always morose and high on pain pills. Each person's behavior becomes reinforcing feedback for the other. Boundaries define internal and external limits of a system and are established to conserve energy by creating a protective barrier around a system. In a family they regulate interpersonal contact. In a healthy family, boundaries surround the parental subsystem and the child subsystem by keeping them separate. In a family with a parent who has a SUD, boundaries around the parental and child subsystems are typically permeable as the parental subsystem does not function well as a cohesive unit. Boundaries around the family itself are rigid to maintain the family secret of substance abuse. Healthy boundaries are important in the normal development of a family and children.

FAMILY IMPACT

Genetic and environmental factors contribute to the development of SUDs. Given that the family in which one is raised influences both of these, it is important to explore the impact of SUDs on the family. Studies looking at the relative weight of these influences show that both add contribution and impact ( Haber et al., 2010 ). The impact will vary depending on the role and gender that the individual with the SUD has in the family. For example, if an adolescent child is identified as having a SUD, this will affect the family differently than if a parent has an SUD. The attitudes and beliefs that family members have about SUDs are also of importance as these will influence the individuals as they try to get sober and will influence the efficacy of treatment interventions. For example, if a parent sees a SUD as a moral failing and thinks his or her adolescent child should just use “will power” to quit, this will be important to know if the treating therapist is working from a disease model of addiction. Education with the family about SUDs, their development, progression, and treatment will be needed. When family members have appropriate education and treatment for themselves they can play a significant role in the abusers' recognition of the problem and acceptance of treatment. The evidence-based family treatment Community Reinforcement And Family Training (CRAFT) has demonstrated its effectiveness in increasing the rate at which abusers enter treatment ( Roozen, de Waart, & van der Kroft, 2010 ).

When one person in a family begins to change his or her behavior, the change will affect the entire family system. It is helpful to think of the family system as a mobile: when one part in a hanging mobile moves, this affects all parts of the mobile but in different ways, and each part adjusts to maintain a balance in the system. One consequence of this accommodation can be that various family members may inadvertently sabotage treatment with their own behaviors as they respond to the change in the individual using substances. For example, if an adult son tries to get sober and his retired father feels as if he has lost his “drinking buddy,” he might express to his son that he can have “just a couple beers at the game.” This will put pressure on the son to continue his use so as not to disappoint his father. These behaviors can be seen as an attempt to maintain the comfortable equilibrium of the system because as one person changes it upsets the equilibrium of the whole family system including extended family relationships. Family therapy can be a useful intervention where the therapist can assist and support the son in setting limits with the father saying he does not want to drink at all and suggesting alternative non-drinking-related activities. Individual therapy can be used with the son to affirm his decision to remain sober and reinforce the importance of his establishing his own identity as a nondrinking person.

We know that individuals who grow up in a family where there is an SUD are at significantly higher risk to develop SUDs due to genetic and environmental factors ( Hawkins, Catalano, & Miller, 1992 ). It is essential to assess for active substance abuse in the immediate and extended family. Knowing that an individual with an SUD grew up in a family with an SUD has significant implications in treatment. Active substance abuse in the family of a client who is trying to get clean will also put that client at risk for relapse.

Developmental Stages of the Family

Understanding the family's specific developmental stage can help with assessing the interventional needs of a family. Carter and McGoldrick (1989) identify eight stages of the family life cycle and corresponding developmental tasks. SUDs can disrupt these developmental tasks depending on who has the SUD and at what developmental stage the family is in when the SUD develops. Table 1 is an adaptation of Carter and McGoldrick's family life cycle stages as applied to families with SUDs. When families do not move through the life cycle and get stuck, individual members can exhibit clinical symptoms. It should be noted that blended families with stepparents and stepchildren have their own developmental needs that are impaired by SUDs as well, but those are not detailed in this table.

Impact of SUD on Family Life Cycle Stages

Note . This table has been adapted from Carter and McGoldrick's (1989) model of the stages of the family life cycle. Modifications have been made to Column 2 to identify concepts relevant to the family with a SUD, and Columns 3 and 4 are contributions of the authors of this article.

SUD = substance use disorder; AA = Alcoholics Anonymous; NA = Narcotics Anonymous.

Impact of Parental Substance Abuse on Children

Clinicians have speculated that what are called “attachment disorders” may occur at elevated rates among children affected by alcohol, in part due to abuse and neglect (when these have happened), and in part because of alcohol-related deficits in cognitive and social-emotional functioning that lead to less resilience ( Coles et al., 1997 ). Studies indicate that between one third and two thirds of child maltreatment cases involve some degree of substance use ( U.S. Department of Health and Human Services [USDHHS], 1996 ). The negative consequences of having one or both parents with a SUD ranges from covert damage that is mild and may play out when a child or adolescent is having difficulty establishing trusting relationships with people, to being overly emotionally responsible in relationships and taking on adult roles much younger than developmentally appropriate. An even more severe impact can begin in utero with maternal substance abuse that causes damage to the growing fetus resulting in birth defects, fetal alcohol syndrome, and/or fetal alcohol effects. These difficulties may cause disabilities that require early intervention and often ongoing and social and mental health services. Social workers can help by encouraging their clients who abuse substances to use precautions to prevent pregnancy and providing education about the risks of maternal drug use on the developing fetus. If a social worker is working with a pregnant client with an SUD, referral to a Perinatal Addiction Clinic and/or high-risk pregnancy OB/GYN clinic is indicated.

As previously mentioned, all primates learn how to regulate their affect from their primary attachment figures through the attachment system and modeling. Parents who have substance use problems will likely have their own affect dysregulation that may have preceded or resulted from their substance use. Consequently, development of healthy affect regulation will be difficult for children and adolescents to achieve. This can result in children and adolescents having an increased risk for internalizing problems such as depression, anxiety, substance abuse, and so on or externalizing problems such as opposition, conduct problems (stealing, lying, and truancy), anger outbursts, aggressivity, impulsivity, and again substance abuse. Children may present to a social worker in direct practice at community mental health center or a school setting. Social workers can assist these clients by looking for signs and symptoms of parental substance use while observing the child's behavior in social settings and in play behavior. Social workers should look for how the child's presenting symptoms serve a function in the family system to maintain homeostasis. Providing family therapy, parent training and education, play therapy, social skills training, and coping skills training either in individual or group therapy in an outpatient, school or in-home therapy setting are ways that social workers can be helpful. Sometimes a referral to Child Protective Services will be indicated.

Parental Substance Abuse and Child Abuse and Neglect

A parent with a SUD is 3 times more likely to physically or sexually abuse their child. The sequalae of this is that these children are more than 50% more likely to be arrested as juveniles, and 40% more likely to commit a violent crime ( USDHHS, 1996 ). Children who have experienced abuse are more likely to have the externalizing disorders such as anger, aggression, conduct, and behavioral problems whereas children who experience neglect are more likely to have internalizing disorders (depression, anxiety, social withdrawal, poor peer relations). Incest has a very high association with parental substance abuse as do all types of sexual abuse. About two thirds of incest perpetrators report using alcohol directly before the offending incident ( USDHHS, 1996 ).

Although active substance abuse can impair attachment and healthy modeling for affect regulation, sometimes the consequences of severe and ongoing substance abuse on the part of a parent can result in parent and child separation. This separation could be because of parental incarceration, long-term treatment or an intervention on the part of child protective services that removes the child from an unsafe or high-risk home environment and places him or her in an out-of-home placement such as foster care, relative placement, or a group or residential home. In extreme cases, the separation may be due to the substance-related death of the parent from overdose, motor vehicle accident, or medical complications due to substance abuse. The significant increase in out-of-home child placements in the 1980s and 1990s closely paralleled the pandemic drug addiction in the United States during those decades ( Jaudes & Edwo, 1997 ). Any long-term separation will have a negative impact on the child's ability to attach, regulate affect, and can lead to a trauma response of numbing or hyperarousal (inability to discriminate and respond appropriately to stimulus). These impairments in the psychological emergency response system are directly related to, and substantially increase, subsequent traumatic victimization. Maltreated children of parents with a SUD are more likely to have poorer physical, intellectual, social, and emotional outcomes and are at greater risk of developing substance abuse problems themselves ( USDHHS, 2003 ).

Social workers can help by using trauma-informed, attachment-informed, and systems-based approaches to direct practice in individual therapy and family therapy with special attention to multigenerational trauma and substance abuse. The role of the social worker may include providing in-home therapy supporting parents in being more effective with parental supervision, providing structure, and facilitating healthy caring communication. Social workers may serve on multidisciplinary teams to advocate for a child who is adjudicated, abused, and/or neglected. In addition, social workers may provide expert testimony in courts and participate in permanency planning for children in out-of-home placements. Lastly, social workers play an essential role in specialized courts (family courts, mental health courts, adult drug courts, and juvenile drug courts), providing a unique person in environment and multisystems lens to helping children and families. Specialized drug courts have been shown to produce favorable outcomes for the whole family ( Burns, Pullman, Weathers, Wirschem, & Murphy, 2012 ).

Parental Substance Abuse and Child Social and Emotional Functioning

Many children living in a home where there is an addiction develop into “parentified children.” This occurs when the caretaker is unable to meet the developmental needs of the child, and the child begins to parent themselves and perhaps younger siblings earlier than developmentally appropriate. In a phenomenon called “reversal of dependence needs” the child actually begins to parent the parent.

Case Example

Ashley was a 15-year-old female who was referred to treatment by her school counselor for self-injury. She is a classic “hero” child who has excellent grades and is well liked by her peers. Her parents separated when she was age 5, and she lived with her biological mother until she was 12. Her father obtained full custody of her after being contacted by the domestic violence shelter where she was living with her mother and younger brother. They had moved to the shelter after a domestic violence incident involving her mother's boyfriend. Her biological mother was alcohol dependent; she had difficulty keeping a job and moved frequently. In fifth grade, Ashley changed schools 7 times in a single academic year. Her mother worked as a waitress and a bartender and would often go out drinking after her evening shifts. Ashley then became the caregiver to her younger brother. From age 9 she remembers her mother coming home, being intoxicated sometimes in a black-out, and Ashley helping her into bed. She remembers caring for her mother at night, cleaning up her vomit, wiping her face, and tending to her younger brother in the mornings by getting his breakfast and helping him get ready for school. She stated to her therapist that she remembers thinking, “If only I take really good care of her, maybe she'll be able to take care of me someday.”

In reversal of dependence needs, the parent's needs are placed before the child's. This sets the child up for a potential lifetime of inability to set healthy boundaries in relationships and make the important triad connections between thoughts, feelings, and behaviors. It creates a lack of self-awareness and sometimes an over awareness of others' needs. In the literature one can find these difficulties well-documented under children of alcoholics and adult children of alcoholics research ( Berkowitz & Perkins, 1988 ; Cork, 1969 ; Hecht, 1973 ; Morehouse & Richards, 1982 ; Stroufe, Egeland, Carlson, & Collins, 2005 ; Tarter, 2002 ; Zucker, Donovan, Masten, Mattson, & Moss, 2009 ).

Communication is a significant social skill for interpersonal effectiveness. Parents with a SUD may have difficulty with assertiveness and direct communication. Many subjects are covertly “off-limits” to discuss. Children in these families also often witness the convergence of poor communication and affect dysregulation with their caregivers that frequently results in domestic violence. Although these difficulties may not be overtly diagnosable with a physical or psychological disorder, the patterns have significant developmental, social, and interpersonal consequences. Common emotions these children experience are anxiety, fear, depression guilt, shame, loneliness, confusion, and anger. They may believe that they caused their parent's SUD, or perhaps they are expected to keep the drug use a secret from others in the family or in the community. Perhaps they recognize their parent is mood altered or in withdrawal but are told that, “Your dad is just sick; he needs his medicine.” A parent's moodiness, forgetfulness, and preoccupation can create a chaotic and unstructured, unpredictable environment that leaves the child guessing and asking the questions, “What is going to happen next?” and “What is normal?” Children may present in community mental health settings with a variety of presentations. In terms of diagnosable mental and emotional disorders, children affected by parental substance abuse are virtually at higher risk for nearly every childhood disorder in the Diagnostic Statistical Manual of Mental Disorders ( DSM-IV-TR ; American Psychiatric Association, 2000 ). Of most significant correlation are the following: eating disorders, behavior disorders, anxiety disorders, depression, post-traumatic stress disorder, and SUDs. Social workers can help by evaluating the function of the presenting symptoms through a family systems perspective. Social workers can help children and families have more direct and honest, yet developmentally appropriate communications; and helping youth to deal with covert and overt emotions that are related to their parent's substance use. Social workers can achieve this through the provision of play therapy, individual therapy, family therapy, and group therapy in a variety inpatient, outpatient, in-home, and community based settings.

Parental Substance Abuse and Educational Functioning

Educational problems are also characteristic of some children affected by parental substance use. Problems with unexcused absences in childhood can turn into more serious truancy problems in adolescence and culminate in school dropout. In early childhood, parents read less and provide less learning-based stimulation to their infants and toddlers. In school-age years, parents are less available to provide assistance with homework, monitor school performance, and track assignments. These children may have difficulty with attention and concentration due to increased anxiety levels related to a chaotic home environment. Unstructured bedtimes and mealtimes as well as witnessing domestic violence and safety issues all contribute to an increase in learning problems and behavioral problems for these children at school. It is difficult for children to focus on higher order thinking and learning when basic survival needs are not met. Similar to the home environment, communication between substance abusing parents and teachers and the larger school system is poor. Many parents struggling with an SUD had difficulty with the school system in their own school-age years and avoid interacting with it due to their own anxiety or shame.

The role of the social worker may include providing school-based supportive services to the youth as well as connecting clients with afterschool care, tutoring services, or mentoring agencies such as Big Brothers Big Sisters. In-home and outpatient family therapy and education, supporting parents in being more effective with parental supervision and discipline, providing structure, rewards, and consequences for school attendance and performance and supporting parents in communicating with the school systems can help as well. Social workers can also help by participating in Individualized Education Plan (IEP) meetings, making school referrals for special education, and requesting psychoeducational and neuropsychological testing. Referral to a child and adolescent psychiatrist for a medication evaluation may also be helpful as well as assisting teachers with behavioral interventions in the classroom.

The Impact of Substance Abuse on Parents of Adult Children

As children transition into adulthood they are still strongly affected by their parents as their parents are by them. One of the factors that can perpetuate SUDs is the enabling that family members frequently engage in. Enabling is a form of accommodation that protects the individual with the SUD from fully experiencing the consequences of his or her substance use. An example of enabling is when the parents of a 25-year-old man repeatedly bail him out of jail and pay for lawyer and court fees generated as a result of drug-related arrests. The parents are attempting to help their son and maintain homeostasis in the system by preventing him from going to jail, however the secondary effect is that the son experiences no consequence to his use. As a result, his SUD is more likely to continue. Parents and grandparents do not always agree on how to “help” an adult child with an SUD. Social workers can encourage parents of adult children to seek their own help in Al-Anon and Nar-Anon. These are 12-Step programs for family members that will help them disengage with love, so that they stop enabling and begin to care for themselves. Often parents blame themselves for their children's substance use and feel responsible for fixing the problem. In Al-Anon and Nar-Anon they receive support from other family members and learn they did not cause the SUD, nor can they control it or cure it.

How Social Workers in Nonaddiction Settings Can Help

It is beyond the scope of this article to present in detail how to assess for an SUD, and social workers inexperienced in this area should refer patients to those who specialize in the treatment of SUDs. However with the prevalence of SUDs in the general population being at least 10%, and higher for those presenting with mental health problems, social workers in all settings will find themselves working with individuals with SUDs. All clients, and especially those with known or suspected SUDs, should be reassured of confidentiality. Due to the shame and stigma associated with having an SUD, this is of utmost importance to obtain accurate information. Clients should be asked if they believe they have an SUD and can be informed of how the social worker typically helps those with SUDs. Social workers need to educate themselves about the clinical and community resources in their area available for the treatment of SUD and refer to these resources when indicated. This includes outpatient substance abuse programs, methadone clinics, intensive outpatient programs, detoxification, and residential settings as well as self-help meetings.

Most social workers are mandated reporters so this can present an ethical issue for those who work with individuals with SUDs, especially those with dependent children. Many patients know this and may withhold information about their substance use out of fear of being reported to Child Protective Services. Mandated reporters should disclose this role to their clients and be specific about what circumstances require reporting, while also emphasizing they will do everything they can to assist clients in obtaining the help they need. Being honest in this way helps establish rapport. Social workers should be aware of their own biases, if any, regarding substance abuse. Only if clients feel a positive therapeutic rapport and trust the social worker will they disclose substance use.

SUDs affect families and children in every area of their development. Social workers have opportunities to intervene and change the trajectory of these potential problems at many junctions. When assessing any client is it essential to inquire about substance use history in the family, in the individual, and current use. There is a way to do this that is sensitive and does not put the person on the defensive. Motivational interviewing strategies can be employed to build rapport, increase motivation for change, and decrease resistance ( Miller & Rollnick, 2002 ; W. R. Miller & Rose, 2010). In addition a variety of objective measures can be presented as part of your normal evaluation (Michigan Alcohol Screening Test [MAST; Selzer, 1971 ], Drug Abuse Screening Test [DAST; Skinner, 1982 ], and Substance Abuse Subtle Screening Inventory for Adolescents [SASSI-A2; Miller, 1999 ]). Assessment not only of the individual in front of you but of their family members as well such as parents, siblings, and extended family members may be needed. One way to approach this is with a genogram ( McGoldrick & Gerson, 1985 ). Genograms can reveal SUD patterns in a visual way and help to obtain family details of substance use without directly asking about the problem thereby decreasing defensiveness.

Once a substance use problem has been identified, educating the client about what it means to have a SUD, the treatments available, and the stages of recovery can be useful. Clients can be encouraged to share the impact of the substance use on themselves and on their family system. Encouraging clients to share their feelings related to their experiences in the family is important as it helps them to break the silence so often associated with living with an SUD, and it can also increase their awareness about cognitive and behavioral patterns that contribute to the SUD. If through the assessment it becomes clear that your client or someone in the family would benefit from treatment specifically for his or her SUD, facilitating a formal evaluation or referral to treatment will be helpful. An undetected SUD can cause treatment of any type of problem to be ineffective.

Following are some specific steps that social workers can take to be helpful when a SUD is suspected or identified:

• Routinely assess for SUD problem and refer the individual to a specialty clinic for further assessment or treatment when indicated.
• Assess for past/present SUD in family or origin
• Explore feelings
• Explore impact on children and extended family
• Know the structure of the family that the individual you are working with comes from (i.e., blended family, single-parent family).
• Know the developmental stage of the family that the individual you are working with comes from (family with teenagers, aging family).
• Family therapy, couples therapy
• Play therapy, social skills training
• Parent training
• Psychiatric services
• Coordinate with school systems to help clients access school-based services, after-school care, and tutoring. Help parents with advocating in the school system for their children if psychoeducational/neuropsychological testing is needed or the development of an Individualized Education Plan.
• Facilitate referrals to specialized courts is indicated: adult drug court, teen drug court, family court.
• Educate clients with SUDs about pregnancy prevention and provide education about risks of drug exposure on fetus.
• Inform about AA, NA for the patient with a SUD and Al-Anon, Nar-Anon, Alateen for family members. Provide location and times of meetings in their area.
• If there are safety issues with regard to children or the elderly, Child Protective Services or Elder Protective Services referral may be needed.
• Ask questions about if the current living situation is physically safe or if there have been past or present incidences of domestic violence.

Individuals with SUDs cannot be understood and treated effectively without considering the impact on the whole family. Addictions researchers have confirmed the reciprocal relationship between the disease of addiction and the environment. All persons influence their social environment and in turn are influenced by it. The family system must be factored into the understanding of the disease development and maintenance as well as be included in the efforts necessary for successful ongoing treatment. The earlier we can intervene in the progression of an SUD, the better the outcomes for all family members. For further readings on this topic SAMHSA TIP #39 ( Center for Substance Abuse Treatment, 2004 ) provides an overview of substance abuse treatment and how to incorporate the family, and TIP #24 ( Center for Substance Abuse Treatment, 2004 ) is a guide to substance abuse services for primary care clinicians.

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