Who Is “Most Likely” To Abuse Substances In Adolescence/Young Adulthood?

How can I protect my kid best I can?

As you might expect, this is a complicated question to answer simply, as there are so many factors at play that may affect a child’s decision to use legal or illegal substances.

While any person with or without official psychiatric disorder label can abuse substances, it is helpful to know who is at higher risk. Children who experience anxiety, depression, bipolar disorder, PTSD, ASD, panic disorder, ADHD, schizophrenia or emerging borderline personality disorder are at highest risk, according to the research; however, there are certain environmental variables that have been shown to increase risk such as: reduced self-esteem, early mental health struggles, experiencing a chaotic home life, reduced parental monitoring/supervision, receive poor academic or emotional support at school, feeling neglected or socially isolated, being characterized as “risk-takers” or impulsive, those with a genetic propensity for addiction, and those may come from a home with parental disorder and/or where substance abuse has been normalized. There have also been links between those children who being using e-cigarettes at a young age, spend excessive time on social media or playing video games, or have a history of an opioid prescription for pain during their childhood. This is all to say, that if you can control as least some of these factors and increase social connection, self-esteem, parental monitoring and substance use in the home as well as necessary medical and psychiatric care, there risk may be significantly reduced.

But let’s talk some of the specific some we know what to be mindful of. Overall lifetime prevalence of substance use disorders are double for those with co-occurring psychiatric disorders. In fact, about 56% of those who have bipolar and 47% of those who have schizophrenia/schizopreniform have abused substances at some point. Moreover, of those with documented substance use disorders, approximately 28% have clinical anxiety or depression and 35% have panic disorder. One study reported that for individuals with ADHD, they experienced increased alcohol, marijuana, and tobacco use, and were 3.3 times more likely to have used marijuana and 4.5 times more likely to have used other illicit drugs. Another study reported that students with ADHD reported greater difficulty in stopping drinking once started as well as higher rates of “blackouts.” The research is fairly clear that those with ADHD and anxiety/depression are more likely to self-medicate, either with prescription stimulants, or recreational drugs (uppers and/or downers), especially if more impulsive by nature. Of note, these rates tend to be higher for the who do not receive appropriate diagnosis and treatment for their mental disorders.

In terms of the combination of ADHD and anxiety, being prescribed medication can be easier and sometimes more cost effective as opposed to therapy; however, there is always some risk (though generally low in children) of abusing stimulants and/or benzodiazepines, so it is important to be aware of what prescriptions older more independent children have access to and if they are taking them as prescribed. As you can see, it is not uncommon for adolescents to fall within one or more of these categories. Children who feel safe, desired, valued, and in control are less likely to take such risks and/or be influenced by peers to engage in activities they otherwise would avoid.

More specifically, there are several protective factors that have been identified including: high self-esteem, strong religious beliefs, close friendships, parental involvement, academic motivation, strong community/neighborhood attachment, optimism, mindfulness, experiencing social anxiety (this can both be a risk factor and a protective factor), and structured schedule/activities. From a preventative viewpoint, the research has demonstrated that health/substance education, counseling, and emotional support have been crucial in delaying or preventing substance addictions. Additionally, creating community in neighborhoods and schools, impulse control and self-regulation training in schools, consequences and redirection for “deviant behavior” at home and school, and participation in structured programs like DARE and Communities That Care (CTC) have all been shown to be effective in prevention. Importantly, there are many treatments available for those who struggle with substance use disorders including: medications to aid in cessation/withdrawal, transcranial magnetic stimulation (TMS), cognitive-behavioral therapy (CBT), motivational interviewing (MI), and contingency management (CM).