Adolescent Substance Abuse: What Parents Need to Know


No matter what statistics you look at, it’s clear that substance abuse by adolescents is a major public health concern.  Although recent years have seen the percent of adolescents who are abusing substances level off, there are some disturbing trends in which teenagers are using and how early they are starting to use.  When you consider that 90% of adults with substance abuse problems started using before they turned 18 and 50% of those adults started before age 15, the trend towards younger and younger adolescents experimenting and becoming regular users becomes even more important.

To many adults, the experimentation with drugs and alcohol that occurs during the adolescent years seems like a normal part of growing up.  But using drugs and drinking alcohol aren’t just inappropriate because they are breaking the rules, they can result in very serious consequences to both their future and their health.

During this phase, teens can have a hard time forming cause and effect connections between choices they make today and the long term consequences of those choices.  Substance use can further lower inhibitions resulting in a string of bad choices.  From the increased risk of being involved in a motor vehicle accident to the increased likelihood of developing a lifelong addiction, substance abuse during adolescence is life threatening and needs to be treated accordingly.


According to the current Monitoring the Future Survey as reported by the National Institute on Drug Abuse:

  • The daily use of marijuana increased in 3 of the 4 high school grades year over year and was the highest it has been since the early 80’s amongst those in the senior class.
  • Marijuana use has surpassed cigarette smoking amongst the seniors.
  • Although cigarette smoking has been declining in recent years, those declines have stalled amongst high school students indicating that smoking may soon be on the rise again.
  • While marijuana is the drug of choice for high school students, prescription drugs and the abuse of over the counter medication are now number two in 12th graders.  Although non-medical use of drugs like Vicodin and Adderall has not increased in recent years, usage statistics remain high.
  • Ecstasy, which had seen years of decreasing use, increased last year in 8th graders.
  • Overall, alcohol use has continued to decline year over year.


Risk Factors

While there is no way to determine which adolescents will try drugs and alcohol or which will become addicted to one of these substances, there are some risk factors that increase the likelihood of developing a serious drug or alcohol problem.  These factors include:

  • Being part of a family with a history of substance abuse problems
  • Being depressed
  • Having low self esteem or feeling as though they do not fit in anywhere
  • Drug availability in the community
  • Learning disabilities and mental health conditions
  • Poor academic performance
  • Being part of an unhealthy social group


Warning Signs

There are several warning signs that parents can use to determine if their teenager is in danger.  As many of these signs can also point to problems other than alcohol or drug abuse, it is important to discuss any concerns with a medical practitioner to rule out physical causes.

There are several physical signs like unexplained fatigue, ongoing health complaints, bloodshot eyes, glazed over gaze, and a cough that lasts for weeks and won’t go away.   From an emotional standpoint, adolescents who exhibit sudden changes in personality, rapid mood swings,  increasingly irresponsible behavior, and general lack of interest, especially in things that they were previously interested in should be evaluated.  Other warning signs include starting fights with family members, breaking rules, dressing differently, withdrawing from friends and family, swapping current friends for a different group of friends, skipping school, and requiring significant disciplinary action on a regular basis.


How to Help

There is no question that one of the most effective tools parents have in preventing their teens from abusing drugs and alcohol is the relationship they have and are able to maintain with their teenager.  Parents should initiate discussions on the dangers of substance abuse, be honest, open, and invite their teen to participate.  Parents need to provide a good role model for teenagers to follow by exhibiting responsible behavior, communicating often, and raising issues as soon as they develop in a calm and supportive way.

Research has shown that parents are in fact the “Anti-Drug” and are the main deterrent against experimenting with drugs and alcohol during adolescence.    The key is building a solid relationship that encourages open communication.  Remain a visible presence in their daily lives by being involved, supporting them in their interests, and attending their activities like games, plays, and concerts.  Be clear, consistent, and fair in setting rules and expectations.  Overly harsh and restrictive rules often have the same result as no rules at all, an increased risk of substance abuse.  Overall, remain an active and interested participant in their lives and be available when they need advice, support, or help as they navigate the challenges of adolescence.

Substance Abuse in College Students


Statistics about college students and substance abuse are cause for alarm.  According to a report from The National Center on Addiction and Substance Abuse atColumbiaUniversitypublished in 2007, half of all college students binge drink and/or abuse both prescription and illicit drugs.  One out of every four college students meets the medical criteria for substance dependence which is two and a half times the national average.  When you factor in the long term consequences of these behaviors and the cost of college tuition, many college students are on a very expensive road to nowhere. 

There are severe short term consequences of these behaviors as well.  Researchers estimate that 1,700 college students die each year from unintentional alcohol related causes.  The incidence of acquaintance rape, drunk driving, assault, and other serious criminal acts has been shown to increase significantly when alcohol is present. As many as 80% of all campus arrests are alcohol related. 

Are things getting better or worse? 

There are several studies that have been tracking college age substance use over the last 10-15 years and the findings are not encouraging.  The percentage of college students who drank in the fifteen year period from 1993 to 2005 was relatively stagnant at 70% and the percentage of binge drinkers remained constant at 40%.  And this is the good news.

The first area where a significant increase has been noted is in the number of students who binge drink frequently, rising 16% from 1993 to 2001. Increases were also noted in the number of students who drink more than 10 times a month (25%), those who get drunk three or more times a month (26%), and those who drink with the sole purpose of getting drunk (21%).  This means that although the number of college students who are drinking hasn’t increased, the ones who are drinking are drinking more and drinking more often.

The second area where a significant increase is emerging is in the use and abuse of prescription drugs.  The increases in the use of these substances are so high they almost seem outlandish with increases of 450% in the use of drugs like Xanax and 343% in the use of drugs like Vicodin and Percocet.    Adderall, which is the prescription drug that has gotten the most press for abuse by college students, actually has the lowest percentage increase from 1993 to 2001 at 93%.

The third area where increases tell a disturbing story is in the use of illicit drugs.  In the 15 year time span between 1993 and 2005 the percentage of college students using illicit drugs saw significant increases in all areas.  The use of marijuana on a daily basis more than doubled while the use of all other illicit drugs including cocaine, heroin, amphetamines, ecstasy, and hallucinogens increased by 52%.

It is clear to see that the programs and systems put in place over the last two decades to turn the tide of drug and alcohol abuse by American college students are failing.  This means more college students are suffering the consequences of these risky behaviors.

Who is at the highest risk?

Research from the Monitoring the Future organization indicates that there are some subgroups within the college environment which have a higher incidence of substance abuse and therefore are at a greater risk for developing substance abuse problems.  College students who participate in the Greek system and belong to fraternities or sororities are more likely to abuse substances and participate in risky behavior than their non-Greek peers.  Almost 90% of those students who participate in the Greek system drink alcohol compared to 67% of other students.  Students in the Greek system are also more likely to binge drink, 67% vs. 37%, drink and drive, 33% vs. 21%, and smoke marijuana, 21% vs. 16%.   Another subgroup at a higher risk is incoming freshman, 45% of whom were classified as heavy drinkers in 2001. 

Male college students are more likely than female students to have used any illicit drug in the previous 12 month period and for most of the individual illicit drugs, male students were twice as likely as their female counterparts to have used that drug in the last year.  Male students also use marijuana and alcohol on a daily basis at a rate twice that of female students.  All these statistics indicate that male students are at greater risk of substance abuse problems during their college career.

Other research indicates that there are regional differences in the use of alcohol and all drugs that may put some students at higher risk than others.  Students in the Northeast and West have a higher incidence of illicit drug use across the board.  The use of methamphetamines, crystal meth, and ecstasy is the highest in the Western states.  Alcohol use and abuse, including the highest prevalence of binge drinking, occurs more in the Northeast andMidwest.  

Consequences of Abuse

The consequences of substance abuse by college students can be both significant and severe.  Statistics show that the incidence of criminal activity like assault, vandalism, acquaintance rape, and driving under the influence increases with the use of alcohol or other substances.  In 2001 alone, more than 1700 students died as a result of alcohol related injuries.  The number of students who hurt themselves as a result of drinking went up by 38% between 1993 and 2001.  Arrests on college campuses that were alcohol related increased by more than 20% from 2001 to 2005 and accounted for more than 80% of all campus arrests in 2005.  Almost 100,000 students in 2001 alone were victims of an alcohol related rape or sexual assault and nearly 700,000 were assaulted by another student who was binge drinking.

The academic consequences of these behaviors cannot be understated.   According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA) Task Force on College Drinking, one of the main impacts of alcohol use on college campuses is failure to meet academic obligations.  As many as 25% of college students have experienced some academic problem because of their alcohol use including failing tests, skipping classes, falling behind on class work, missing deadlines for papers and projects, and getting lower grades than expected. 

The link between alcohol consumption and grades is so significant it can be used as an indicator.  The findings of a survey conducted over a 3 year period that included almost 100,000 students found that the number of drinks consumed per week directly correlated to the student’s grade point average as follows:

  • Students with A averages consumed 4 drinks per week
  • Students with B averages consumed 6 drinks per week
  • Students with C averages consumed 8 drinks per week
  • Students with D or F averages consumed as many as 10 drinks per week

These findings make it easy to see why there is also a direct relationship between alcohol consumption and college drop-out rates. 

Students who abuse alcohol or other substances are not the only ones impacted by their behavior.  Other students on campus are consistently subjected to circumstances that impact their college experience because of substance abuse by others.  Almost 60% of college students have had to miss sleep or found themselves unable to study because of another student’s drinking or drug use. The safety of students is also compromised by the use of alcohol or drugs by other students.  Almost 30% of students report being insulted or humiliated by another student and 15% have had personal property damaged by someone else’s intoxicated negligence.  These students also find themselves as the victim in many of the crimes mentioned above.

What Makes College Students So Susceptible?

When students make the transition from high school to college, it can be the most challenging experience of their young lives.  The volatility of this time period puts students at risk as they search for new social connections and try to find their place in their new environment.  Additionally, there is this mainstream idea that part of the college experience is drinking, experimenting, and behaving with reckless abandon which leads many students to seek out these experiences as soon as they arrive on campus.  College students are also in the highest risk age group for heavy alcohol consumption and experimentation with the use of multiple substances. 

College students also find themselves dealing with new kinds of stress and pressures that they may be unprepared to handle including financial obligations and responsibility, making major life altering decisions, and separating from parents and other support systems.  Students also look to alcohol and drugs as the means to ensure social acceptance and as tools to create confidence when they are feeling unsure and insecure in their new environment. 

Living arrangements do seem to play a part in determining whether or not a student will use alcohol or other substances.  Students who live at home and commute to college are less likely than those who live in residence halls to abuse alcohol.  However, hovering parents who continually insert themselves into their child’s life can keep college students from achieving the appropriate level of maturity they need in order for them to transition into responsible adults.  Parents who make major decisions for their college age child and regularly rescue them from the consequences of their actions don’t allow them space and opportunity to learn how to make the right decision in difficult situations.

College students are also less likely to seek help, even when they are in very real trouble, because of the social stigma associated with alcohol dependence and drug addiction.


The abundance of research on substance abuse by college students shows that the situation is not improving.  Despite efforts to curb alcohol use and access to illicit drugs on college campuses, the prevailing public attitude that drinking and experimenting with drugs are part of the college experience continues to undermine the ability to make real, lasting changes.  Students are engaging in risky behavior like unprotected sex, driving under the influence, and experimentation with all types of drugs in alarming numbers and many students are paying a steep price for this self-discovery.  As long as it remains socially acceptable and even socially commendable to participate in binge drinking and swap study time for sorority parties, it will be difficult to make the high in higher education mean what it used to mean. 



How Do You Know Your Teenager is on Drugs?

As a counselor who works with teens and parents, this is one of the most common questions I am asked. Parents often struggle with this issue because the natural mood swings and personality changes that are a part of the teen years can make it difficult to determine if their child is acting normal or needs help. They are also hesitant to ask difficult questions because they don’t want to damage their relationship with their teen by accusing them of taking drugs.  Maintaining a relationship built on trust can be an important part of successfully navigating the teenage years and it only takes one misstep to demolish the foundation of that trust. Parents may be hesitant to approach their teens when they are concerned because they don’t want to alienate them or push them further away.

In order to know when to be concerned, when to ask questions, and when to intervene, you need to know the facts. Here are the common signs of teenage drug use.

1. Changes in Social Circles
One sign that parents should be watching for is a significant change in their child’s friends or social circles. If your teenager has been friends with the same kids since elementary school and suddenly shifts to an entirely different set of friends, this may be cause for concern. First, look for other factors like joining a new club, or playing on a sports team that may explain an influx of new friends. Changes in social circles or standing by themselves are not always indicative of drug use, but parents should pay attention to these types of changes as they can point toward several teenage problems.

2. Changes in School Participation
Another thing to watch for is the development of a negative attitude about school in general. This includes spending less time and effort on school work and home work, skipping classes, and grades that are going down.

3. Changes in Personality
When teenagers begin using drugs, they often become more secretive and are touchier about privacy and having their own space. Signs of these behavior changes include getting angry if you are in their room, unwillingness to let you borrow their cell phone, refusing to leave their backpacks or school bags where others could access them, or offering vague answers about where they are going and who they are spending their time with.

4. Changes in Aromatic Usage
If your teen suddenly develops the need to burn incense or use room deodorizer on a regular basis, but doesn’t seem more concerned with cleaning their room, they may be trying to hide the smell of smoke or other odors. Intensified use of body spray or perfume is also a sign that something may be amiss.

5. Changes in Financial Needs
One indication that your teen may be using drugs is an increased need for money. This may be evident because of an increase in their requests to borrow money, offers to work around the house for cash, or money disappearing from purses and wallets. Teens that become suddenly invested in selling or pawning things like video games and other electronics may also have a problem that needs parental attention.

Parents and their involvement in their teenager’s lives are still the best deterrent to drug use. Providing a supportive environment with clear expectations helps set the stage for drug-free teen years. But it is equally important to know the signs that your teen is in trouble and how to help them through whatever problems they are facing.


by Jan Hamilton, MS, PMHNP-BC
Psychiatric Nurse Practitioner