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Adolescence: A high-risk time for substance use disorders

Posted By Sharon Levy, MD, MPH & Siva Sundaram, BA On August 7, 2018 @ 10:30 am In Addiction,Adolescent health,Behavioral Health,Health,Parenting | Comments Disabled

Teens need to explore and challenge themselves to grow into independent adults, which sometimes involves taking risks. It can be a source of consternation and frustration for parents. But as it turns out, the adolescent brain is “deliberately” set up for risk-taking. The prefrontal cortex — the part of the brain involved in “executive functions” that support careful decision-making (like self-monitoring and impulse control) — does not fully develop until the mid-20s, long after the maturation of the emotional processing and reward-seeking centers in what is called the limbic system.

This helps explain why teens seek out highly stimulating and rewarding activities while seeming less wary of potential risks. While these characteristics make adolescents excellent learners, they also make them vulnerable, particularly when it comes to substance use.

Parents of adolescents face a tough dilemma about substance use: we may want our children to be abstinent, but what do we do if they are not? We know the stakes are high. The very features that make the adolescent brain good at learning from new experiences also make it vulnerable to loss of control over substance use, or addiction. Research suggests that people who start using substances at younger ages are more likely to develop substance use disorders later in life. (Medical professionals use “substance use disorder” as a more specific and less stigmatizing term for “addiction.” It simply refers to a pattern of substance use that is harmful, with a spectrum of severity.)

While parents can and should communicate clearly that non-use is the best decision for health, we simply can’t control every aspect of young people’s lives. Discovering that a child has used alcohol or other drugs provides only a small snippet of information. For some teens, sporadic substance use wanes over time without long-term consequences; for others, recurrent use may be part of a burgeoning substance use or mental health disorder. These two extremes deserve different responses, and open conversation is important for understanding context.

Ignoring or permitting substance use may enable ongoing use, while overly harsh punishment may diminish opportunities for honest and meaningful conversations between parents and children. Ideally, parents can find a way to set limits and expectations about substance use while preserving open channels for discussion. In an upcoming post we’ll share five important things to keep in mind when talking to your children about substance use.

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