Kids and teens use substances for a variety of reasons. They may begin because of curiosity and peer pressure. Often, those who become habitual users are trying to “solve a problem.” Substances can help them relax, alleviate boredom, fit in socially, escape emotional or physical pain, deal with traumatic memories, relieve anxiety, go to sleep, get up in the morning, lose weight, etc. Substance use is “reinforcing,” which means that a child is more likely to keep taking them when they seem to help with a given problem or need. Caregivers need to understand what it is specifically that makes substances appealing to their child to address his or her use. And when substance use is severe, it can be difficult for any caregiver to address these issues and keep a child safe without professional help.

What are the symptoms of Substance Use Disorders?

The term “substance use” exists along a spectrum from initial use to greater frequency (and usually more consequences) and eventually to addiction. There are numerous Substance Use Disorders, which range from the type of substance being used or abused (e.g., alcohol, marijuana, prescription medicine, etc.) to the impact that the substance is having on the individual. At the center of each disorder is that there is problematic, recurrent use of drugs or alcohol that leads to significant distress or impairment in the individual’s life.

Even if a child’s or teen’s use of alcohol and/or other drugs does not rise to the level of a Substance Use Disorder, their use can interfere with their daily functioning. A young person does not need to be dependent on drugs or go through withdrawal symptoms for the substance to have a huge impact on academic and/or social functioning.

Core Symptoms

Associated Symptoms

  • The alcohol or substance is taken in larger amounts and over a longer period than intended
  • There is a “craving” or strong desire to use the substance or alcohol
  • There is a great deal of time spent in activities necessary to obtain, use, or recover from the substance or alcohol
  • There is a recurrent failure to fulfill obligations at home, school, or work
  • Continued substance or alcohol use results in interpersonal problems
  • The individual experiences tolerance to the substance or alcohol, and more is needed to achieve desired effect
  • The individual experiences withdrawal from the substance or alcohol, or uses again in order to avoid the effects of withdrawal
  • The individual’s use and symptoms occur within a 12-month period
  • Loss of interest in hobbies or extracurricular activities
  • Comments from teachers, classmates, or friends
  • Changes in friendships
  • Mood swings
  • Irritability or argumentativeness
  • Unusual agitation, restlessness, or hyperactivity
  • Lethargy or lack of motivation
  • Locking doors, demanding more privacy, isolating, or missing family events
  • Declining grades, skipping school or poor work performance
  • Becoming more accident-prone
  • Engaging in risky behaviors (e.g., sexual activity or driving under the influence)
  • Borrowing or taking money or valuables
  • Missing prescription drugs or missing alcohol

How is a Substance Use Disorder diagnosed?

Substance Use Disorders can take many forms. To be diagnosed, a child’s or teenager’s alcohol or substance use must cause issues in school, social problems, and/or dangerous behavior. Developing tolerance to the substance (needing more to feel drunk or high) and or showing symptoms of withdrawal are also signs that professional help may be necessary.

A mental health or medical professional will diagnose a child or teen with a Substance Use Disorder after determining whether their behavior and the symptoms they are experiencing meet the diagnostic criteria. This may be accomplished through caregiver and child/teen interviews.

Substance Use Disorder Facts

Worldwide frequency of the condition

Prevalence rates for Substance Use Disorders vary widely based on the region, specific substance being used, and the severity of the disorder. For instance, frequency estimates for 12-17-year-olds vary from 4.6% for Alcohol Use Disorder, to 2.7-3.1% for Cannabis Use Disorder, to 2.8-3.9% for non-prescription opioid use. There is no recent, specific epidemiological data for Greece.

Burden of the condition in Greece

Substance Use Disorders account for less than 0.03% for all disability adjusted life years (DALYs) lost to health conditions in Greece for 5- to 14-year-old children and adolescents. However, in the age 14-49 year category, alcohol accounts for 1.45% and substances account for 1.93%.

Gender ratio

Gender comparative data for Substance Use Disorders suggests that males are more likely to be diagnosed than females, although rates vary based on the specific substance being used.

Peak age of onset

The peak age of onset for Substance Use Disorders is 19.5 years, which is consistent for both cannabis use and alcohol use, both of which have a peak age of onset at 19.5 years.

Proportion of the condition that emerges before age 18

According to recent data, the proportion of Substance Use Disorders, in general, that emerge before age 18 years is 15.2%. This means that 15.2% of individuals with Substance Use Disorders will have been diagnosed by the time they are 18 years old. This is lower than for disordered use of cannabis, which is 17.5%, and disordered use of alcohol, which is 18.3%.

What are the associated factors for Substance Use Disorders?

Some common factors associated with Substance Use Disorder are:

  • Familial factors. Although the generic risk for developing a disorder varies depending on the substance (i.e., alcohol, cannabis, opioids, etc.), research suggests that the risk increases when struggles with alcohol and/or substances exist in a child’s or teen’s family history.
  • Environmental factors. These include poverty, low familial educational level, cultural attitudes toward intoxication, availability of alcohol and/or substances, use or abuse among immediate family members, and abuse.

What other disorders co-occur with Substance Use Disorders?

Substance Use Disorders might commonly co-occur with other mental health problems, including anxiety, depression, and bipolar disorders, as well as other substance problems.

How are Substance Use Disorders treated?

There are several steps to treating a Substance Use Disorder. The specifics depend on how serious the young person’s disorder is and how long they have had it.

The very first step in treatment is to help the child or teenager stop using the substance. In severe cases of addiction, a medical doctor might prescribe a supervised detoxification to help with symptoms of withdrawal. That means that the individual gets support while they stop using the substance. That treatment might be able to happen at home with a lot of structured therapy during the day. If the addiction has been going on for a long time, the individual might need to go to an inpatient substance abuse program.

After the child or teenager stops using alcohol or drugs, several different kinds of therapy are often used at the same time. This can include:

  • Psychotherapy where the child or teen meets one-on-one with a therapist who specializes in substance abuse
  • Family counseling where the whole family meets with a therapist
  • Self-help groups for the child or teen and/or the family

Finally, many kids with Substance Use disorder also have other disorders like anxiety or depression. They may even have started using drugs or alcohol to avoid the symptoms of those disorders by getting intoxicated or high. Those other disorders need to be treated at the same time the substance use disorder is being treated.

Where to find more information

If you need more information on substance use and reasons for concerns, you can also go to "Alcohol and substance use " on our website.

To learn more about the technical work conducted to develop this guide, please consult our reference list:

References

Clinical description, symptoms, and diagnostic information

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Child Mind Institute. (2023, January 12). Complete guide to substance use + mental health. https://childmind.org/guide/parents-guide-to-substance-use-mental-health/
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6C40 Disorders Due to Use of Alcohol. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1676588433
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6C41 Disorders Due to Use of Cannabis. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1913137404
  • ICD-11 for mortality and morbidity statistics. (2022, February). Disorders Due to Substance Use. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/590211325

Facts

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from http:// vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)
  • Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7

Associated factors

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Arango, C., Dragioti, E., Solmi, M., Cortese, S., Domschke, K., Murray, R. M., Jones, P. B., Uher, R., Carvalho, A. F., Reichenberg, A., Shin, J. I., Andreassen, O. A., Correll, C. U., & Fusar‐Poli, P. (2021). Risk and protective factors for mental disorders beyond genetics: An evidence‐based atlas. World Psychiatry, 20(3), 417–436. https://doi.org/10.1002/wps.20894
  • Cragg, A., Hau, J. P., Woo, S. A., Kitchen, S. A., Liu, C., Doyle-Waters, M. M., & Hohl, C. M. (2019). Risk Factors for Misuse of Prescribed Opioids: A Systematic Review and Meta-Analysis. Annals of Emergency Medicine, 74(5), 634–646. https://doi.org/10.1016/j.annemergmed.2019.04.019
  • Degenhardt, L., Charlson, F., Ferrari, A., Santomauro, D., Erskine, H., Mantilla-Herrara, A., Whiteford, H., Leung, J., Naghavi, M., Griswold, M., Rehm, J., Hall, W., Sartorius, B., Scott, J., Vollset, S. E., Knudsen, A. K., Haro, J. M., Patton, G., Kopec, J., … Vos, T. (2018). The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet Psychiatry, 5(12), 987–1012. https://doi.org/10.1016/S2215-0366(18)30337-7
  • Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50
  • Nawi, A. M., Ismail, R., Ibrahim, F., Hassan, M. R., Manaf, M. R. A., Amit, N., Ibrahim, N., & Shafurdin, N. S. (2021). Risk and protective factors of drug abuse among adolescents: A systematic review. BMC Public Health, 21(1), 2088. https://doi.org/10.1186/s12889-021-11906-2

Co-occurring disorders

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Campêlo, S. R., Barbosa, M. A., Porto, C. C., & Dias, D. R. (2021). Prevalence of comorbid substance use disorders with anxiety disorders or post-traumatic stress disorder in people seeking treatment for substance abuse: A systematic review protocol. JBI Evidence Synthesis, 19(8), 1924–1933. https://doi.org/10.11124/JBIES-20-00267
  • Hunt, G. E., Malhi, G. S., Lai, H. M. X., & Cleary, M. (2020). Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990–2019: Systematic review and meta-analysis. Journal of Affective Disorders, 266, 288–304. https://doi.org/10.1016/j.jad.2020.01.141
  • Hunt, G. E., Malhi, G. S., Cleary, M., Lai, H. M. X., & Sitharthan, T. (2016). Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990–2015: Systematic review and meta-analysis. Journal of Affective Disorders, 206, 331–349. https://doi.org/10.1016/j.jad.2016.07.011
  • Lai, H. M. X., Cleary, M., Sitharthan, T., & Hunt, G. E. (2015). Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990–2014: A systematic review and meta-analysis. Drug and Alcohol Dependence, 154, 1–13. https://doi.org/10.1016/j.drugalcdep.2015.05.031
  • Tiyatiye, B., & Akosile, W. (2022). A systematic review of prevalence of comorbid obsessive-compulsive disorders and substance use disorders in clinical settings, 1990-2021. Journal of Substance Use, 1–6. https://doi.org/10.1080/14659891.2022.2148579

Interventions

  • Austin, A. M., Macgowan, M. J., & Wagner, E. F. (2005). Effective Family-Based Interventions for Adolescents With Substance Use Problems: A Systematic Review. Research on Social Work Practice, 15(2), 67–83. https://doi.org/10.1177/1049731504271606
  • Crowe, M., Eggleston, K., Douglas, K., & Porter, R. J. (2021). Effects of psychotherapy on comorbid bipolar disorder and substance use disorder: A systematic review. Bipolar Disorders, 23(2), 141–151. https://doi.org/10.1111/bdi.12971
  • Das, J. K., Salam, R. A., Arshad, A., Finkelstein, Y., & Bhutta, Z. A. (2016). Interventions for Adolescent Substance Abuse: An Overview of Systematic Reviews. Journal of Adolescent Health, 59(4), S61–S75. https://doi.org/10.1016/j.jadohealth.2016.06.021
  • Pistone, I., Blomberg, A., & Sager, M. (2020). A systematic mapping of substance use, misuse, abuse and addiction prevention research: Current status and implications for future research. Journal of Substance Use, 25(3), 231–237. https://doi.org/10.1080/14659891.2019.1684583
  • Steele, D. W., Becker, S. J., Danko, K. J., Balk, E. M., Adam, G. P., Saldanha, I. J., & Trikalinos, T. A. (2020). Brief behavioral interventions for substance use in adolescents: A meta-analysis. Pediatrics, 146(4), e20200351. https://doi.org/10.1542/peds.2020-0351
  • Steele, D. W., Becker, S. J., Danko, K. J., Balk, E. M., Saldanha, I. J., Adam, G. P., Bagley, S. M., Friedman, C., Spirito, A., Scott, K., Ntzani, E. E., Saeed, I., Smith, B., Popp, J., & Trikalinos, T. A. (2020). Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ). https://doi.org/10.23970/AHRQEPCCER225

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