Substance Use in Adolescents: A Guide for Parents

One of a parent's greatest fears is learning that their child is using a substance. That fear usually swings to one of two extremes: either it is assumed it will never happen, or the smallest sign triggers panic.

Neither extreme helps. What is realistic is knowing that experimentation is possible during adolescence, recognising the factors that raise and lower risk, and being able to respond appropriately when something is noticed.

This article does not describe substances or their effects. Its purpose is to show what families need to notice, how to handle the first conversation, when specialist support is needed, and what the protective factors are.

Key Points

• Experimenting in adolescence and dependence are different things; not every instance of experimentation leads to dependence, but neither is any instance unimportant.
• Impulse control systems in the adolescent brain have not yet matured; this makes risky decisions more likely.
• Early age of onset is among the strongest factors markedly increasing the risk of developing dependence.
• Substance use is often not isolated; depression, anxiety disorder, ADHD or a history of trauma may underlie it.
• Responses based on punishment and threat do not stop use; they lead to concealment and to the family losing visibility.

Why Adolescence?

Adolescence is the riskiest period for substance use to begin, and there is a neurodevelopmental explanation.

The brain's reward system matures rapidly in adolescence, while the prefrontal systems that control impulses and anticipate consequences develop later. That mismatch creates the situation of "I knew I shouldn't, but I did."

Peer influence, identity formation, the need to test limits and aspiration to adulthood are added to this. None of these excuses use, but they explain why punishment-based approaches fall short.

Experimentation, Use, Dependence

These three are not the same, and confusing them leads both to unnecessary panic and to unwarranted reassurance.

• Experimentation: Use on one or a few occasions out of curiosity or because of the peer setting. In most adolescents it does not progress.
• Regular use: Repeated use. Impairment of functioning has begun: school, friendships and family relationships are affected.
• Dependence: Loss of control over use, failed attempts to stop, withdrawal symptoms, life organising itself around use.

Treating the experimentation stage as "unimportant" is a common error. The reason it is not unimportant is not that every instance leads to dependence, but that starting young permanently raises the risk.

Risk Factors

Individual Factors

• Early age of onset
• Attention deficit hyperactivity disorder, particularly if untreated
• Depression, anxiety disorders
• History of trauma, abuse or neglect
• Conduct disorder, impulsivity
• Low self-esteem, a need for acceptance within a peer group

Family Factors

• A family history of substance or alcohol use
• Supervision that is either too loose or too rigid
• Breakdown of family communication, persistent conflict
• Parents normalising their own use
• Experiences such as bereavement, divorce or violence in the family

Environmental Factors

• Belonging to a peer group that uses
• Ease of access
• Difficulties at school, absenteeism, academic failure
• Unstructured, unsupervised free time

Protective Factors

As important as risk factors, and the area a family can directly influence:

• Open, non-judgemental communication with the family
• Clear, consistent rules known in advance
• Parents knowing where and with whom the young person is
• Attachment to school and academic support
• Structured activities such as sport or the arts
• A friendship circle that does not use
• The presence of at least one adult the young person trusts

Warning Signs

No single sign is proof on its own; several occurring together, as a change, is what carries meaning.

Behavioural Changes

• A sudden and complete change of friendship circle
• Deterioration in coming-home times, not saying where they are
• Shutting themselves in their room, marked distancing from family
• Increased requests for money, or money and possessions going missing
• Losing interest in activities previously enjoyed
• Excessive secrecy: hiding the phone, changing passwords

School-Related Changes

• Increasing absenteeism
• Marked decline in grades
• Behavioural complaints from teachers
• Withdrawal from school activities

Physical and Psychological Signs

• Marked change in sleep patterns
• Change in appetite and weight
• Reddened eyes, frequent runny nose, unexplained smells
• Sudden mood changes, irritability
• Impaired memory and attention
• Loss of motivation

Many of these signs also occur in adolescence itself or in other conditions such as depression. They are therefore not proof but a reason to open a conversation. The same symptoms may indicate depression or bullying at school; one should proceed by asking rather than assuming.

Prevention: When Should the Conversation Begin?

Families often ask when the subject of substances should be raised. The answer is earlier than expected: the conversation should begin before a problem arises.

From the later primary school years onwards, the subject can be raised within everyday life rather than as a lecture: a scene in a series, an item in the news, or something heard at school provides a natural entry point.

The aim of these early conversations is not to frighten but to establish two things. First, to show that this is a family in which the subject can be discussed. Second, to ensure the young person knows whom to go to if they encounter a problem.

Short conversations spread over time are more effective than a single big talk.

Parents' Own Use

How alcohol or tobacco use is presented at home directly affects a young person's attitude. Use to relieve stress — "it was an exhausting day, a drink will help" — teaches a young person that substances are a coping tool.

A rule also loses its force when it carries a double standard. A limit set by a family that does not regulate its own use is not taken seriously.

How Should the First Conversation Go?

The family's first response is the most important factor determining whether the young person accepts help.

Timing and Setting

The conversation is not held while the young person is under the influence; it should take place when they are calm, when you are alone and when there is no time pressure. Conversations held in front of others, or with the young person caught at the door, push them into defensiveness.

What to Do

• Stay calm. Shouting and threats are the first thing that ends the conversation.
• Ask directly. Rather than indirect hints: "I've noticed some things and I'm worried. I want to talk with you."
• State your observation, not an accusation. "Over the past two months your friendship circle has changed completely, your grades have dropped and you come home late" — these are observations.
• Listen. The young person's own account is more valuable than your assumptions.
• Ask why. Use has a function: reducing anxiety, fitting in, escaping boredom. No solution can be built without understanding that function.
• Say clearly that you will seek help. This is a decision about support, not a punishment.

What to Avoid

• Moral lectures and threats: "You've destroyed us", "I'll throw you out" sever the relationship.
• Punishing in the moment and never discussing it afterwards: Punishment alone does not change behaviour.
• Removing all autonomy at once: Increases concealment and ends the family's visibility entirely.
• Glorifying your own past: "We did it too and nothing happened" legitimises use.
• Discussing only the outcome: A response given without understanding the cause remains superficial.
• Promising secrecy: Where there is a safety risk, it is a promise that cannot be kept.

Assessment and Treatment

Comprehensive Assessment

Assessment is not only about use. In the consultation conducted at Assoc. Prof. Mehtap Eroglu's practice in Ankara, the type and frequency of use, age of onset and effect on functioning are established.

Co-occurring conditions are then screened: depression, anxiety disorders, attention deficit hyperactivity disorder, post-traumatic stress disorder. Missing these is the most common reason treatment fails.

Seeing the young person alone for part of the consultation is particularly important here; accurate information about use is rarely shared in front of the family.

Should I Arrange a Test?

Another frequent question is testing without the young person's knowledge. This approach is generally not recommended.

Covert testing seriously damages trust when it comes to light and achieves nothing beyond improving the young person's ability to conceal. A negative result can also create false reassurance.

Testing is meaningful when used as part of treatment, with the young person's knowledge and consent, for monitoring purposes. The decision should be made with the clinician.

Psychotherapy

Approaches with demonstrated effectiveness in adolescent substance use include motivational interviewing, cognitive behavioural therapy and family-based therapies.

Motivational interviewing focuses on the young person finding their own reasons for change; it is markedly more effective than a goal imposed from outside.

Family-based approaches are among the best-evidenced methods in adolescent substance use. The subject of change is not only the young person but the pattern of communication and supervision within the family.

Treating Co-occurring Conditions

Without treating underlying depression, anxiety or attention deficit, lasting reduction in substance use is difficult. The young person is often using to soothe those conditions; use functions for them not as a problem but as a solution.

Treated ADHD has been shown to reduce the later risk of substance use; this is important information in the treatment decision.

How Are Family Rules Set?

Rules to be applied at home during treatment need to be clear and agreed in advance. Vague rules are both unenforceable and generate fresh conflict each time.

A workable framework has three components:

• Non-negotiables: Matters of safety — where and with whom they are, how they will get home, no substances in the house.
• Graduated autonomy: Supervision is relaxed in line with progress. This gives the young person a concrete goal.
• Known consequences: What happens if a rule is broken should be agreed at the outset, not decided in the moment.

In the family sessions Assoc. Prof. Mehtap Eroglu conducts, this framework is turned into a written document the family sets and the young person knows.

When Is Higher-Level Support Needed?

Where there are withdrawal symptoms, daily use, intravenous use, repeated failed attempts to stop, or a severe accompanying mental health condition, outpatient monitoring may be insufficient and referral to an inpatient programme may be required.

Emergencies

Emergency services should be contacted without delay in the following situations:

• Confusion, unresponsiveness, being unable to be roused
• Difficulty or irregularity of breathing
• Seizure
• Chest pain, palpitations, very high temperature
• Severe agitation, aggression, detachment from reality
• A wish to die or an act of self-harm

In these situations discussion is deferred; safety comes first. In Ankara the nearest hospital emergency department or the 112 emergency line can be reached, and the young person should not be left alone.

The School's Role

Young people spend most of their time at school, and changes are often noticed there first. With the family's consent, contact with the counselling service is an important component of monitoring.

The information shared should be limited and the young person's privacy protected. What the school needs is not diagnostic detail but monitoring of absence and identifying someone the young person can approach when struggling.

Discussing the young person's situation in front of peers leads to stigma and weakens attachment to school — one of the strongest protective factors.

Siblings and Family Balance

In a family with an adolescent using substances, all attention and resources turn towards that young person. Siblings often withdraw quietly and stop voicing their own needs.

Two patterns are common in these children. The first is trying to protect the family by causing no trouble; the second is turning to similar behaviour in order to be noticed.

An age-appropriate, honest and limited explanation to siblings is recommended. They need to know what is happening, not to feel guilty, and to have space to ask questions. Complete secrecy leads a sibling to construct worse scenarios.

It is decisive that the family continues to give one-to-one time to its other children throughout the process.

Expert Opinion

According to Assoc. Prof. Mehtap Eroglu, the situation encountered most often in referrals for adolescent substance use is that the family's only goal is to stop the use. Yet use is an outcome; it does not stop lastingly unless its cause is addressed.

Clinical experience from consultations in Ankara shows that a considerable proportion of these young people have an untreated anxiety disorder, depression or attention deficit underneath. The young person has found the fastest way to soothe something distressing.

Assoc. Prof. Mehtap Eroglu also emphasises that tightening supervision suddenly and completely is the most common mistake. That response does not reduce use; it only ends the family's visibility. Supervision should be confined to the safety boundary while the channel of relationship stays open.

A further important point is that recovery is not linear. Relapses may occur throughout, and they are not failures but points at which the plan needs review. What should be assessed is not a single event but the overall trend in frequency of use and in functioning.

Assessment and Appointment Process in Ankara

Referrals for substance use in Ankara mostly occur after a family has noticed something by chance; some arrive through school counselling services.

In the assessment conducted by Assoc. Prof. Mehtap Eroglu in Ankara, the process begins with a review of the young person's safety. The type, frequency and age of onset of use are addressed directly and without judgement. Asking these questions openly does not increase use; it opens a space in which the young person can speak.

Co-occurring conditions are then screened and the family's pattern of communication and supervision assessed. Where possible both parents are invited; in referrals in Ankara, differences in approach between parents emerge as one of the most frequent factors enabling a young person to evade supervision.

What families in Ankara find useful to bring to the first appointment: any previous assessment reports, a list of current medications, the school attendance record, and concrete observations from recent months.

If you would like to arrange an assessment for your young person in Ankara, you can review our adolescent psychiatry service and request an appointment.

In Summary

Experimentation and dependence are different things in adolescence; but an early age of onset permanently raises the risk of developing dependence later.

Warning signs are not proof on their own; several occurring together as a marked change is a reason to open a conversation.

A calm, non-judgemental response oriented towards seeking help is the most important factor determining a young person's engagement with treatment. Punishment and sudden tightening of supervision do not stop use; they only lead to concealment.

Substance use is often not isolated; without addressing underlying depression, anxiety or attention deficit, lasting improvement is difficult.

For information about the general challenges of adolescence and adolescent mental health, see our adolescent psychiatrist guide.