Diseases

Clear communication by parents about the negative physical, emotional, and functional effects of drugs, as well as about their expectations regarding drug use have been found to significantly decrease substance abuse in teens. Adequate parental supervision has also been found to be a deterrent to drug use in youth. Specifically, parents knowing how, where, and with whom adolescents socialize, as well as limiting their children's access to substances that can be abused have been associated with less teenage drug use. Limiting the amount of alcohol, cleaning solutions (inhalants), prescription, and over-the-counter medications that are kept in the home to amounts that can be closely monitored and accounted for has also been found to decrease substance abuse by teens. Family focused abuse-prevention programs have produced reductions in adolescent drug abuse. Among ethnic minorities in the United States (for example African Americans, Hispanic, Native and Asian Americans), those who strongly identify with their communities and cultures have been found to be less likely to experience risk factors for using drugs compared to their peers who are less connected to their communities and cultures. Therefore, incorporation of a cultural component to drug-abuse prevention programs may enhance the effectiveness of those programs. Moreover, teens 15 to 16 years old who use religion to cope with stress tend to use drugs significantly less often than their peers who do not use religion to cope. Alcohol and other drug use has been found to occur most often between the hours of 3 p.m. and 6 p.m., immediately after school and prior to parents coming home from work. Teen participation in extracurricular activities has therefore been revealed as an important measure in preventing substance abuse in this age group.

Tobacco

• Tobacco Smoking among teens in grades 8, 10 and 12 continued to decline in 2014 - a positive trend since most smokers begin their habit in adolescence—according to the latest survey results from the nationwide Monitoring the Future study.
• Based on annual surveys of 40,000 to 50,000 students in about 400 secondary schools, the researchers found that the percentage of students saying that they smoked at all in the prior 30 days fell for the three grades combined.

Alcohol

• The use of alcohol by teens has dropped dramatically over roughly the past two decades—particularly among the youngest teens—and continues to drop in 2014. The 30-day prevalence of alcohol use declined significantly in all three grades in 2014.
• The 12th-grade decline is statistically significant as is the decline for the three grades combined.
• All three grades are now at the lowest point that they have been at least since the mid-1990s, and likely longer. Among 8th graders, most of whom are 13 or 14 years old, the proportion who have ever taken "more than just a few sips" of alcohol by 8th grade has fallen by half since the 1990s.
• Prevalence of recent binge drinking (having five or more drinks in a row at least once in the past two weeks) dropped significantly in 2014 to under 20 percent of high school seniors. As with 30-day prevalence, all grades are at their lowest points since at least the mid-1990s.
• The two-week prevalence rates for binge drinking are now at 12 percent in the three grades combined - down from a peak level of 22 percent.
• Disapproval of binge drinking continues a gradual increase in the upper grades. Perceived availability for alcohol continues longer-term declines, which are sharpest in the lower grades.

Illicit Drugs

• The index of any illicit drug use tends to be driven by marijuana, which is by far the most prevalent of the many illicitly used drugs.
• In 2014, the proportions of students indicating any use of an illicit drug in the prior 12 months declined slightly in the 12th grade, but remained unchanged from the prior year in the eighth and tenth grades.
• The percentages indicating any use in their lifetime are 20.3 percent, 37.4 percent and 49.1 percent. In other words, half of America's high school seniors have tried an illicit drug by the time they graduate and four in 10 have used it in just the past year.
• "But it should also be noted that fully half of today's seniors have not tried an illicit drug by the end of high school," said Lloyd Johnston, the principal investigator of the study.

Marijuana

• In general, the use of marijuana among teens has been drifting higher in recent years following a decade or more of fairly steady decline.
• In 2014, use among the three grades declined slightly.
• Annual prevalence (the percent using once or more in the prior 12 months) declined from 12.7 percent to 11.7 percent among 8th graders 29.8 percent to 27.3 percent among 10th graders and from 36.4 percent to 35.1 percent among 12th graders.
• "The belief that regular marijuana use harms the user, however, continues to fall among youth, so changes in this belief do not seem to explain the change in use this year, as it has done over most of the life of the study," Johnston said.
• From 2013 to 2014, the percent of students seeing great risk from being a regular marijuana user has fallen among 8th graders from 61 percent to 58.9 percent, among 10th graders from 46.5 percent to 45.4 percent, and among 12th graders from 39.5 percent to 36.1 percent.

Family risk factors for teenagers engaging in drug abuse include low parent supervision or communication, family conflicts, inconsistent or severe parental discipline, and family history of alcohol or drug abuse. Individual risk factors include any history of physical or sexual victimization, learning or emotional problems, difficulty managing impulses, emotional instability, thrill-seeking behaviors, and perceiving the risk of using drugs to be low.

Here are just a few of the many dangerous effects of drug use in adolescents:

• Drugs of any kind decreases teens' ability to pay attention.
• The younger a person is when they begin using drugs the more likely they are to develop a substance-abuse problem and the more likely they are to relapse into drug abuse when trying to quit.
• Juveniles who use drugs are more likely to have unprotected sex, sex with a stranger, as well as to engage in sexual activity at all. This, in turn, puts them at risk for pregnancy, rape commission or victimization, and for sexually transmitted diseases.
• Substance use can cause or mask other emotional problems, like anxiety, depression, mood swings, or hallucinations (for example, hearing or seeing things). Either of those illnesses can result in death by suicide or homicide.
• Anabolic steroids have been associated with impotence in boys and men, clitoral enlargement in girls and women, as well as baldness, stunted growth, heart attacks, strokes, liver disease, cancer, acne and infections, including HIV/AIDS in both sexes.
• Depending on how the body takes in and processes each kind of drug, substances of abuse can affect virtually every one of the body's systems. Examples of this include permanent brain damage associated with inhalants, heart attack or stroke from stimulants, halted breathing from sedatives. Any of these problems can result in death.

Ways to recognize that a person is intoxicated or "high" on a drug depends on the substance with which he or she is intoxicated and include the following:

• Tobacco products: frequent smell of tobacco, irritability, discolored fingertips, lips or teeth, cigarette butts at curbside
• Cannabinoids: reddened whites of eyes, sleepiness, excessive hunger, lack of motivation, excessive happiness, paranoia
• Cold medications: sleepiness, rapid or slowed heart rate
• Inhalants: runny nose, smell of gasoline or other solvent, confusion or irritability
• Depressants: sleepiness, lowered inhibitions, poor coordination, slowed heart rate or blood pressure, dizziness, coma, death in overdose
• Stimulants: rapid heart rate or blood pressure, irritability, excessive happiness, less need for sleep, paranoia, seizures
• Narcotics: less experiencing of pain, excessive happiness, sleepiness, slowed or stopped breathing, coma, death in overdose
• Hallucinogens: trouble sleeping, blurred perceptions, paranoia
• Dissociative anesthetics: higher blood pressure and heart rate, memory loss, nausea and vomiting, irritability, aggressiveness
• Club drugs (for example, Ecstasy): feverish teen that does not sweat, finding multiple lollipops or other hard candies, the teen seeming to love everyone and/or have an excessively happy mood (euphoria)
• Others (for example, anabolic steroids): increased irritability or aggressiveness, rapid increase in muscle definition, thinning or loss of head hair, marked increase in acne over a short period of time, finding needles

The physical symptoms of withdrawal from these drugs are often nearly the opposite of the effects of intoxication.

Some of the most common symptoms of drug abuse in teenagers include lying, making excuses, breaking curfew, staying in their room, becoming verbally or physically abusive toward others, having items in their possession that are connected to drug use (paraphernalia), the smell of drugs (for example, solvent smell of inhalants, marijuana smell) on them, mood swings, sleepless nights, stealing, and changes in friends. Examples of paraphernalia include matches, rolling papers, and pipes for drugs that are smoked, multiple pill bottles for substances that are in pill form, mirrors for drugs that are snorted, and needles, syringes, and items that can be used as tourniquets for drugs that are injected. In addition to those more behavioral symptoms, loved ones can look for the physical symptoms of drug intoxication and withdrawal. Given the complexity of those symptoms and how much they depend upon the specific drug being abused, loves ones are advised to have their family member evaluated medically and/or psychiatrically if substance abuse is suspected for any reason.

There are few medications that are considered effective in treating drug addiction. Those are currently limited to the treatment of alcoholism, as well as opioid, and nicotine addiction. Please read the Alcohol and Teens article for information about the medications that manage alcohol addiction. Effective medication treatment for other addictions is primarily limited to address addiction to opiates and nicotine. Methadone, levo-alpha acetyl methadol (LAAM), and buprenorphine hydrochloride are non-sedating, non-intoxicating opiates that treat opiate addiction by preventing symptoms of withdrawal from heroin and other opiates. Naltrexone blocks the effects of opiates and is therefore useful in both treatment of overdose of opiates and in longer-term treatment. Nicotine addiction is often medically addressed by medications that replace nicotine in the form of patches, gum, or nasal spray. Buproprion, which was originally found to be an effective antidepressant, has been found to decrease patients' cravings for nicotine. The National Institute of Drug Abuse (NIDA) recommends that treatment of substance abuse: be readily available when the addicted person is ready to enroll; be tailored to the complex, multiple and changing needs (for example medical, mental health, social, legal, and family) of each individual; and consider the use of medication treatment when appropriate and include random drug testing. There are numerous individual treatments for chemical dependency in teens. Relapse prevention uses methods for recognizing and amending problem behaviors, as well as providing support to the adolescent in his or her community. Individualized drug counseling specifically emphasizes short-term behavioral goals in an attempt to help the individual reduce or stop the use of drugs altogether, as well as maintaining their safety. Some such programs include drug testing. Twelve-step programs like Narcotics Anonymous are individualized drug-counseling methods. Motivational enhancement therapy encourages the teen to increase their desire to participate in therapy. Stimulus control refers to a treatment method that teaches the person to stay away from situations that are associated with substance abuse and to replace those situations with activities that are contrary to using drugs. Urge control is an approach to changing patterns that lead to drug use. Social control involves family members and other significant others of the addict in treatment. Family interventions for drug addiction that tend to be effective for teens include multidimensional family therapy (MDFT), group therapy, and multifamily educational intervention (MFE). MDFT has been found to be quite effective. Longer-term residential treatment of three to five months that addresses peer relationships, educational problems, and family issues is often used in treating substance abuse in teens. For youths in the first stage of drug use, where they have not yet used drugs, preventative measures are used. Therefore, limiting access to drugs, addressing any risk factors of the youth or family, as well as optimal parental supervision and expression regarding expectations is often recommended. The approach to those who have experimented with drugs is not minimized by drug treatment counselors, social workers, psychologists, psychiatrists, and other mental-health professionals, since infrequent use can progress to the more serious stages of use if not addressed. Therefore, professionals recommend that the youth be thoroughly educated about the effects and risks of drugs, receive fair but firm limits on the use of substances, and that the user be referred for brief counseling, a self-help group, and/or family support group. Teens that have progressed to the more advanced stages of drug addiction are typically treated intensively, often including inpatient drug treatment (drug rehab) and involves a combination of the medication, individual, and familial interventions already described above.

Virtually every drug that is abused by adults is also abused by adolescents. In addition to alcohol, common categories of drugs of abuse include the following:

• Tobacco products (for example, cigarettes, cigars, chewing tobacco)
• Cannabinoids (for example, marijuana, hashish), sometimes called "pot, weed, Mary Jane, or herb" and is smoked in a "joint," "blunt," "bong," "backwood," or pipe
• Cold medications (for example, chlorpheniramine and pseudoephedrine [Sudafed], diphenhydramine [Benadryl]
• Inhalants (for example, gasoline, ammonia), the use of which is often referred to as "huffing"
• Depressants (for example, barbiturates, benzodiazepines), sometimes called "reds, yellows, yellow jackets, downers or roofies"
• Stimulants (for example, amphetamines, cocaine, methamphetamine), sometimes called "bennies, black beauties, speed, uppers, blow, crack, rock, toot, crank, crystal, or skippy"
• Narcotics (for example, morphine, heroin, codeine, oxycodone [Oxycontin], hydrocodone/acetaminophen [Vicodin], sometimes called cody, schoolboy, dope, Tango and Cash, or monkey"
• Hallucinogens (for example LSD, "mushrooms"), sometimes called "acid, yellow sunshines, buttons, or shrooms"
• Dissociative anesthetics (for example, phencyclidine/PCP, ketamine), sometimes called "lovely, boat, Love Boat, angel dust, K, vitamin K, or cat" and whose use is often referred to as "getting wet"
• Club drugs (for example, Ecstasy), sometimes called "X"
• Others (for example, anabolic steroids), sometimes called "juice or roids"

As defined by the Diagnostic and Statistical Manual of Mental Disorders, drug dependence is a negative pattern of using a substance that leads to a number of problems, which may include needing more of a drug to get intoxicated (tolerance), difficulties that occur when the effects of the drug wear off (withdrawal), using more of a substance or for longer time than intended, and other life problems because of their use of a drug or drugs. Five stages of drug use have been identified. The first stage is described as access to drugs but no use thereof. In that stage, minimizing the risk factors that make a teenager more vulnerable to using drugs are an issue. The second stage of drug use ranges from experimentation or occasional use to regular weekly use of substances. The third stage is characterized by youth progressing to further increasing the frequency of using one or more drugs on a regular basis. This stage may also include the teenager either buying, stealing, or drug dealing to get drugs. In the fourth stage, adolescents have established regular usage, have become preoccupied with getting intoxicated ("high"), and have developed problems in their social, educational, vocational, or family life as a result of using the substance. The final and most serious fifth stage of drug use is defined by the youth only feeling "normal" when they are using. During this stage, risk-taking behaviors like stealing, drug dealing, engaging in physical fights, unprotected sex, or driving while intoxicated increase and they become most vulnerable to having suicidal or homicidal thoughts.

Supporting the substance-abuse sufferer medically is the approach to managing most drug intoxications, since many substances of abuse can affect bodily functions (for example, heart rate, blood pressure, breathing rate). In addition to close medical monitoring, doctors usually have the individual assessed psychiatrically, since drugs are associated with everything from impaired judgment to severe aggression, assaultive behavior, and even suicidal and homicidal behaviors. Some medications are available to specifically counteract the effects of drugs. For example, naltrexone is used to counteract the effects of opioid intoxication. Blood pressure medications may be administered to patients who are suffering from high blood pressure associated with stimulant intoxication and with withdrawal from depressants. Fluids are often administered to those who have become dehydrated, and cooling blankets are given to those whose temperatures have become dangerously high, as may occur with Ecstasy.

• Al-Anon-Alateen: 888-4AL-ANON
• Alcoholics Anonymous World Services: 212-870-3400
• American Council on Alcoholism treatment referral line: 800-527-5344
• Codependents Anonymous: http://www.coda.org
• Kids Against Drugs: http://www.kidsagainstdrugs.com
• Marijuana Anonymous World Services: 800-766-6779; [email protected]
• Mothers Against Drunk Driving: 800-GET-MADD
• Narcotics Anonymous World Services: 818-773-9999
• National Alcohol and Substance Abuse Information Center: 800-784-6776. http://www.addictioncareoptions.com
• National Council on Alcoholism and Drug Dependence: 800-NCA-CALL or 800-475-HOPE
• National Clearinghouse for Alcoholism and Drug Information: 800-729-6686
• National Resource Center: 866-870-4979
• Recovery Resource Online: http://www.soberrecovery.com
• Orchard Recovery Center: http://www.treatmentcenter.com
• U.S. Department of Health and Human Services' Substance Abuse Mental Health Services Administration (SAMSHA): 800-662-HELP (4357)
• Johnston, L. D.,O'Malley, P. M., Miech, R.A., Bachman, J. G., & Schulenberg, J. E. (2014). Monitoring theFuture national results on adolescent drug use: Overview of key findings, 2013. Ann Arbor,Mich.: Institute for Social Research, the University of Michigan.