Substance Use

Adolescent Patients 

What does it look like?

A substance use disorder (SUD) is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. The regular use of alcohol and/or other drugs produces changes in the brain which strongly reinforce the behavior of drug use, teaching the person to repeat it. These behavioral changes are also accompanied by changes in brain function, especially in the brain’s natural inhibition and reward centers.

SUDs are a medical problem, and are often tied in to mental health and co-occurring conditions such as anxiety, depression, and PTSD. In most cases, the initial decision to drink or use substances is a choice. However, after continued use, changes in the brain can seriously impair one’s ability to control their use.

For adolescents, SUD can look different than they do in adults. Symptoms of substance use disorders as laid out by the DSM-5 can be more normative for teenagers. For example, adolescents develop tolerance more quickly than adults. Additionally, withdrawal symptoms typically do not occur within adolescents because they usually appear after years of consistent use of drugs and alcohol. In regard to risky behavior while using, adults have more opportunity and likelihood of engaging in these activities.

People who are addicted to alcohol and/or other drugs have changes in their brain that affect the following areas:

  • Judgement
  • Decision-making
  • Learning
  • Memory
  • Behavioral Control
  • Relationships
  • Emotional Regulation
  • Activities of daily life (job, education, etc.)

How do I screen for it?

What are the treatment options?

Addiction treatment can be done via methods such as behavioral therapy, medication management, counseling, and detox.

For adolescents, treatment options include outpatient therapy/counseling, group therapy, medication management, detox, residential treatment, inpatient treatment, wilderness programs and boarding schools. Family treatment is more essential for adolescents than adults participating in treatment. Adolescents tend to be less motivated for sobriety than adults. As a result, it is important for the motivated party to be involved in treatment. Additionally, treatment programs are more limited for adolescents than adults. There are limited programs that provide inpatient detox, residential and inpatient treatment. There are also limited intensive outpatient programs for adolescents. It is important for adolescents to be involved in treatment programs that highlight family engagement as well as the incorporation of mental health. Adolescents are welcome at 12 step community meetings, yet it is important for parents to supervise their children during these meetings. Adolescents are not accepted to transitional or sober living homes.

Medication Management

Research shows that medications and behavioral treatment combined have the most success in treating substance use disorders. For example, when treating opioid use disorders, the first line of treatment should be medication which can then be combined with behavioral therapy.

Addiction and drug use have a direct effect on the chemical makeup of the brain, particularly on the areas that involve pleasure and motivation. The medications for addiction treatment work to restore balance among the chemicals in the brain that have been impacted by substance use. Medications can also be used to help individuals during the detoxification process; however, subsequent treatment following detox is necessary to reduce likelihood of relapse and improve recovery outcomes.

Behavioral Therapy

Treating substance use disorders with behavioral therapies involves the modification of behaviors and attitudes. In doing so, the individual should be more equipped to handle triggers or stressful situations without relapse. Additionally, behavioral therapy can increase effectiveness of medications. Universally, treatments must be tailored toward the individual’s unique needs and situation.

Additional Resources


Select References

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Clay, J. M., & Parker, M. O. (2020). Alcohol use and misuse during the COVID-19 pandemic: a potential public health crisis?. The Lancet. Public health, 5(5), e259.

Kar, S. K., Arafat, S., Sharma, P., Dixit, A., Marthoenis, M., & Kabir, R. (2020). COVID-19 pandemic and addiction: Current problems and future concerns. Asian journal of psychiatry, 51, 102064. Advance online publication. Retrieved from

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Marsden, J., Darke, S., Hall, W., Hickman, M., Holmes, J., Humphreys, K., ... & West, R. (2020). Mitigating and learning from the impact of COVID‐19 infection on addictive disorders. Addiction. Retrieved from

National Institute of Drug Abuse. (2014). Drugs, Brains, and Behavior: The Science of Addiction. NIH Pub No. 14-5605. Retrieved from

VARMA, R. (2020). Alcohol withdrawal management during the Covid-19 lockdown in Kerala. Indian Journal of Medical Ethics, V  (2), 105-106. Retrieved from

Volkow, N. D. (2020). Collision of the COVID-19 and addiction epidemics. Retrieved from