Substance Use Disorder

Substance Use Disorders are mental health conditions where kids or teens use drugs or alcohol in unhealthy ways. These can include addictions, using substances in ways that disrupt normal life, and doing dangerous things because of the substances. Kids with Substance Use Disorders have trouble in school, work, or relationships because of their substance use. They also develop tolerance, meaning they need to use more of the substance to feel high or drunk. It is important to note that alcohol is illegal for children and teens under 18.

Kids and teens use substances for many reasons. They may start because of curiosity and peer pressure. Often, those who become regular users are trying to “solve a problem.” Substances can help them relax, deal with boredom, fit in socially, escape emotional or physical pain, deal with traumatic memories, relieve anxiety, sleep, wake up, lose weight, etc. Substance use is “reinforcing,” meaning a child is more likely to keep using them when they seem to help with a problem or need. It’s important for caregivers to understand what makes substances appealing to their child to address their use. When substance use is severe, it can be hard for any caregiver to address these issues and keep a child safe without professional help.

What are the symptoms of Substance Use Disorders?

“Substance use” ranges from initial use to more frequent use (and usually more consequences) and eventually to addiction. There are many Substance Use Disorders, ranging from the type of substance (e.g., alcohol, marijuana, prescription medicine) to the impact on the person. At the core of each disorder is problematic, repeated use of drugs or alcohol that leads to significant distress or impairment in the person’s life.

Even if a child’s or teen’s substance use doesn’t reach the level of a disorder, their use can still disrupt their daily life. A young person doesn’t need to be dependent on drugs or have withdrawal symptoms for the substance to have a big impact on school and/or social life.

Core Symptoms

– The alcohol or substance is taken in larger amounts and for longer than intended

– There is a “craving” or strong desire to use

– A lot of time is spent getting, using, or recovering from the substance

– Repeated failure to meet obligations at home, school, or work

– Continued use causes relationship problems

– The person develops tolerance, needing more to achieve the desired effect

– The person experiences withdrawal, or uses again to avoid withdrawal

– The person’s use and symptoms occur within a 12-month period

Associated Symptoms

– Loss of interest in hobbies or 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 teen’s alcohol or substance use must cause problems in school, social life, and/or dangerous behavior. Developing tolerance (needing more to feel drunk or high) and/or showing withdrawal symptoms are also signs that professional help may be needed.

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

Substance Use Disorder facts

Worldwide frequency of the condition:

– Environmental factors:* These include poverty, low family education 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 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 disorder is and how long the young person has had it.

The first step is to help the child or teen stop using the substance. In severe cases of addiction, a doctor might prescribe a supervised detoxification to help with withdrawal symptoms. This means the person gets support while they stop using the substance. This treatment might happen at home with a lot of structured therapy during the day. If the addiction has lasted a long time, the person might need to go to an inpatient substance abuse program.

After the child or teen stops using, several different kinds of therapy are often used together. This can include:

– Psychotherapy where the child or teen meets one-on-one with a therapist specializing 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 have even started using substances to avoid the symptoms of those disorders. Those other disorders need to be treated at the same time as the substance use disorder.

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., et al. (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., et al. (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., et al. (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., et al. (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)30337-730337-7)_

– 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., et al. (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., et al. (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., et al. (2020). Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ). _https://doi.org/10.23970/AHRQEPCCER225_