Introduction

Substance use, misuse, and abuse terminology can be complex, so can the idea of use limits, and even what constitutes a drink. This module introduces basic clinical terminology, drinking limits, and the standard drink.Substance-use-word-collage

Stages of Adolescent Substance Abuse

Potential for substance use and abuse

Several behavioral and environmental risk factors have been identified that increase the risk of substance abuse in the adolescent years. Individuals characteristics associated with childhood or adolescent substance use include decreased impulse control, the need for immediate gratification, and the need for peer acceptance. Parental use and/or abuse of alcohol, tobacco and other drugs is one environmental risk earlier in life. In the adolescent years, peer substance use and the availability of tobacco, drugs, alcohol, inhalants are additional risk factors for substance use and abuse.

Experimentation: learning the euphoria

Prevalence of Lifetime Alcohol Dependence by Age of Onset of DrinkingPeer influence plays a significant role in the decision if and when to experiment with tobacco, alcohol and other drugs including marijuana and inhalants. At this point in the adolescent substance use spectrum, few, if any, consequences of use exist. This, in addition to the “high” associated with the early stages of use may serve to reinforce the use behavior. Occasional, episodic use may increase to regular weekend use. There may be little apparent behavior change from the point of view of parents or other family members, teachers and health care providers.

Age at onset of use may play a role in future substance use disorders. For example, of those individuals who began drinking before age 14, 47% became dependent at some point, compared with 9% of those who began drinking at age 21 or older.

Regular substance use: seeking the euphoria

This stage may be marked by the use of other new drugs, eg, stimulants, lysergic acid diethylamide (LSD), or sedatives. At this stage, behavioral changes may be noted by parents and family or teachers and counselors, including:

  • Changes in friends
  • Negative changes in schoolwork, missing school, or declining grades
  • Increased secrecy about possessions or activities
  • Use of incense, room deodorant, or perfume to hide smoke or chemical odors
  • Subtle changes in conversations with friends, e.g. more secretive, using “coded” language
  • Change in clothing choices: new fascination with clothes that highlight drug use
  • Increase in borrowing money
  • Evidence of drug paraphernalia such as pipes, rolling papers, etc.
  • Evidence of use of inhalant products (such as hairspray, nail polish, correction fluid, common household products); Rags and paper bags are sometimes used as accessories
  • Bottles of eye drops, which may be used to mask bloodshot eyes or dilated pupils
  • New use of mouthwash or breath mints to cover up the smell of alcohol
  • Missing prescription drugs—especially narcotics and mood stabilizers

Some consequences may be incurred by the adolescent at this point including punitive consequences from family/legal or school system as a result of substance use or trauma as a result of intoxication. The adolescent may increase the frequency of use or use alone and engage in buying or stealing drugs.

Regular substance use: preoccupation with the “high”

At this stage, the adolescent engages in the daily use of drugs. He or she may perceive a loss of control over their substance use.  Multiple consequences of the substance use are occurring which may not deter use. An increase in risk-taking behavior may increase including risky sexual behavior and driving under the influence of substances. The adolescent often experiences estrangement from family and “straight” friends.

Burnout: use of drugs to feel normal

The adolescent may engage in the use of multiple substances and may be dependent or addicted to more than one substance. Feelings of guilt, alienation, shame, remorse, and depressed mood are common in the adolescent at this stage. Physical and mental deterioration are also often seen and can manifest as withdrawal from organized sports, exercise intolerance, insomnia, poor memory, poor concentration, apathy and/or mood lability. Continued risk-taking behavior, self-destructive behavior, and/or suicidal behavior may mark this stage of adolescent substance use.