• Experimenting. Today, teens may try alcohol, cigarettes, inhalants, or other drugs one or more times. But many of these teens never go any further than experimenting, and they usually do not have any problems as a result of their substance use.
• Substance abuse. For some teens, experimenting leads to regular or frequent use (abuse). Substance abuse results in problems at home (such as more arguments with parents), at school (such as failing grades), or with the law (such as driving under the influence or possessing illegal substances).
• Substance dependence (addiction). Teens can become physically and/or psychologically dependent on the substance. At this stage, use of the substance takes up a significant portion of the teen's activities, continues despite causing harm, and is difficult to stop. Addiction is an ongoing (chronic), progressive, and possibly fatal disease.

Many parents believe that teen substance use is just part of growing up and is not a problem unless it "gets out of hand." It is true that most teens do not have problems after experimenting with alcohol, cigarettes, inhalants, or other drugs. But all substances abused by teens stimulate the part of the brain that regulates pleasure, memory, learning, and emotions. The effects cause changes in a teen's alertness, perceptions, movement, judgment, and attention, making the teen more likely to:

• Engage in high-risk behaviors. Alcohol and drug use is a leading cause of death and disability from automobile accidents, suicide, violence, and drowning. Unprotected sex can lead to pregnancy and sexually transmitted diseases, including HIV.
• Use other drugs. Teens who use one substance are more likely to use others. Alcohol, cigarettes, and marijuana are considered gateway drugs because teens who use these substances are more likely to begin using other drugs.
• Be involved in violent crime or homicide.
• Commit suicide.
• Have difficulty at school or even drop out of school.
• Have legal problems, which may lead to jail sentences.
• Suffer health problems as a direct consequence of drug use. Heavy use of some drugs, such as ecstasy or methamphetamine, may cause permanent brain damage. In rare cases, even casual or first-time use of drugs such as inhalants, cocaine, or heroin can lead to sudden death.

Teen substance use can progress from occasional use (experimenting) to regular or frequent use, abuse, or physical and/or psychological dependence (addiction). If dependence develops, the teen may have problems maturing, resulting in difficulty establishing personal identity, forming healthy relationships, gaining physical and emotional independence, and preparing for the future.

The most serious consequence of teen substance use is the risk of addiction. Teens are at high risk for early development of addiction, especially if they start using drugs at a young age. In adults, addiction to a substance usually develops slowly, but a teen may rapidly progress from occasional use to addiction. Alcohol dependency and drug dependency require treatment for the person to stop using the substance. Recognizing the risk factors and signs of substance use can help you deal with a problem early, decreasing your teen's risk for becoming addicted.

You can recognize and deal with substance abuse in your teen by using the following techniques.

Is your teen using alcohol or drugs?

If you think your teen may be using substances, look for warning signs such as:

• Signs that suggest substance use. Watch for a decline in personal appearance or other evidence of substance use such as discarded chemical-soaked rags or drug paraphernalia.
• Changes in peer relationships. Peer influence has the greatest effect on whether your teen is using substances.
• Changes in home behavior that are more severe than expected from teenagers, such as aggressiveness or withdrawal.
• School problems that indicate a loss of interest or lack of involvement.

Has he or she experimented?

If you believe that your teen has begun experimenting with alcohol or other substances:

• Ask about use. Find out what substances he or she has tried, what effects the substances had, and how he or she feels about substance use. Listen carefully to what your teen liked about using the substance and why. The closeness of your relationship will determine the quality and accuracy of the information shared with you. Ask your teen about peers who provided drugs and peers with whom your teen used drugs.
• Share concerns. Talk about your concerns, not only about drug and alcohol abuse but about other problems that may be going on, such as school performance issues.
• Review expectations. Talk with your teen about the family rules concerning substance use and the consequences when rules are broken. If you do not want your teen to use any substances (including cigarettes and alcohol), make that clear. If you do not have a written plan for dealing with this issue, use the teen alcohol and drug plan form.
• Ask that he or she stop. Ask your teen to stop, especially if there is a strong family history of substance abuse or dependence. If your teen stops now, he or she probably will not develop a substance abuse problem.
• Provide drug education. This is an important time to provide additional drug information. Whether you or a doctor provides this information, talk about the immediate effects and consequences of using alcohol, inhalants, cigarettes, and/or other drugs. Don't talk only about long-term health problems.

Is it "getting out of hand"?

Your teen may be having difficulties in school, at home, with relationships, or with the law related to substance use, indicating a substance abuse problem. If you think your teen is using any substance, including alcohol, cigarettes, inhalants, or other drugs-regularly or daily-don't ignore it. This use is serious and should not be denied or minimized. Frequent or regular use of a substance can quickly lead to physical or psychological dependence-or dependency may have already developed.

To help your teen:

• Investigate. Look for evidence of your teen's use. Review the information on ways to identify use. (For more information, see the Is Your Teen Using Alcohol or Drugs? section of the topic Teen Alcohol and Drug Abuse.) If you suspect a specific drug, gather other information about that substance and its effects.
• Choose a time. Wait until he or she is not high (intoxicated) to confront your teen about using a substance. Talking to someone who is high on drugs or alcohol usually does not work and may make the situation worse.
• Ask about use. Find out what substances are being used, how often, in what setting, and where your teen is getting them. Your teen may be very reluctant to give you all this information.
• Have an evaluation. Talk with a doctor about an evaluation of your teen's substance use. Your teen may need treatment, and early treatment may prevent future alcohol and drug use problems.
• Get support. You may find it helpful to participate in a support group for family members of people with alcohol use problems, such as Al-Anon. There are Al-Anon meetings specifically for parents, and these meetings include discussions about family effects from alcohol and other substance use. Substance abuse is a family disease: all family members are affected by it, and they need some form of help to change the ways they react to the person who abuses substances.

Now that you have read this information, you are ready to recognize and deal with substance use in your teen.

Talk with a doctor

Talk with a doctor if you think your child or teen is using alcohol, cigarettes, inhalants, or other drugs. Ask for the doctor's help in dealing with your child or teen on this issue.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) National Clearinghouse for Alcohol and Drug Information (NCADI): http://ncadi.samhsa.gov/.