The Relationship Between Adolescents and Addiction

Source: Finn Hafeman / iStock

By Anthony Nave

Substance use disorders (SUD) and compulsive behaviors, also labeled as process addictions, are not unique to any type of person or population, but there is an increased risk for adolescents to struggle with these types of disorders. One of the major factors for this is that adolescents go through many natural emotional and physical changes on top of academic and social pressures. All this can generate anxiety from parents and professionals who work with adolescents. As a result, when young clients come into my office for treatment, some of the common questions I hear from parents are, “Why did this happen?” “How do we know?" and “How do we talk about it and help?”

Why did this happen?

There is not one risk factor alone that leads to someone abusing substances or engaging in potentially compulsive behaviors such as gambling, shopping, sex, internet use, etc., but rather an imbalance of having more risk factors in your life than protective factors. Some examples of risk factors are the following:

• Family history of addiction
• Intergenerational trauma/genetics
• Poverty
• Medical struggles
• Insecure attachments
• History of abuse
• Death and loss
• Traumatic experiences

When several of these experiences occur for someone it acts as the perfect storm that can lead to the progression of substance abuse into substance use disorders for adolescents or adults.

Furthermore, there is an increased risk for adolescents to develop SUD and/or process addictions due to our natural stages of brain development. An adolescent brain differs from an adult brain in a few ways, starting with a less developed pre-frontal cortex paired with a more active limbic system. The pre-frontal cortex is an area of the brain that has multiple functions, including emotional regulation, abstract thinking and problem-solving, understanding of roles and relationships, and the ability to assess how much of something is a good thing. It allows us to brake or initiate “stop” functions in behaviors and actions when trying to survive each day. Our limbic system is an area of the brain that can generate a lot of emotions and neurotransmitters that motivate us to act and function as our “go” system.

How does our pre-frontal cortex develop?

For adolescents’ brains to fully mature they need to engage in a consistent variety of experiences in their daily lives, one of the most important being relational experiences. This is why, during adolescent development, we start to observe children associate less with primary caregivers and more with peers. This type of social interaction is so crucial that our brains have adapted by having a more active limbic system or “go” function that encourages children to take risks and create more experiences.

Essentially, a still-forming pre-frontal cortex when coupled with other mentioned risk factors elevates the likelihood of developing a substance use disorder.

The physical impact of addiction goes beyond cravings, insomnia, and weight fluctuations. SUD damages the brain, specifically the pre-frontal cortex, which never has a chance to fully develop if the addiction begins during adolescence. Knowing this can make starting the recovery process feel daunting, but change is possible for everyone.

How do we know?

The signs and symptoms of those struggling with SUD can be quite similar to the changes that occur for adolescents during puberty. Although it may be challenging, there are ways to identify if a loved one is struggling with drug or alcohol misuse. Keep in mind each SUD can have its own unique set of signs, symptoms, and behaviors associated with it.

Some of the clearer signs are finding substances, alcohol, empty bottles, old prescriptions (either their own or someone else's), vaporizers/vape pens/mods/tanks, bongs, pipes, syringes, spoons, modified soda cans, etc.… among their belongings or in their space. What else is noticeable at times is missing objects from others in the house, stolen money or credit cards, accrued debt, and other signs of trying to find objects or funds to buy substances or engage in compulsive behaviors.

As an adolescent’s use progresses, there will be a change in how they present physically and behaviorally, which often can be confused with puberty. The following are some of the most common indicators:

• Struggling to maintain passable hygiene and dressing in more unkempt clothing or less age-appropriate clothing
• Quickly gaining weight or beginning to lose weight
• Presenting as more hyperactive or flat
• Pupils pinpointed or dilated more consistently
• More frequent and intense mood swings
• Symptoms of previous struggles (if relevant) with other mental health disorders — such as Major Depressive Disorder, Generalized Anxiety, ADHD, PSTD, and eating disorders — intensifying, as SUD and process addictions are co-morbid and will increase symptoms for each other
• Sudden changes in their daily routine where they stop attending clubs, sports, band, classes, etc., and their performance suffers
• A shift in how adolescents interact with friends where they may engage in more isolation, or quickly change their circle of friends with little communication on why there was a sudden change
• Physical health symptoms, such as morning sickness, tremors, sweat, body aches, insomnia, and cravings as use progresses

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There are plenty of similarities to puberty, but the intensity of the changes will be a way to notice the difference paired with external signs such as substances or evidence of use in an adolescent’s environment.

How do we talk about substance use and help those struggling?

It may seem too simple, but the first way to prevent it or help is to make it OK to talk about and ask about substances and addictive behaviors in your home. This creates a warm holding environment where young adults have the chance to learn about risks and what can happen with continued abuse of substances. The next step is to make it comfortable to explore emotions because often adolescents experiment with substances as part of learning to socialize with peers, attempting to develop their own identity, or trying to find ways to cope with feelings they do not fully understand yet.

It will be a challenge, but part of creating a comfortable environment for adolescents to explore is to practice not rescuing without an invitation. Another part is ensuring you stay curious, which can encourage adolescents to come to you and express what they need help with. Skills that can help you in this process are what therapists use from Motivational Interviewing called “O.A.R.S.” which stands for open-ended questions, affirmations, reflections, and summaries. Using O.A.R.S. during any conversation with your loved one can help shift motivation to make a change or take action to try something new.

There are also things you should not do to avoid triggering an adolescent into being guarded and fearful of asking you for help. This is what Dr. Gottman calls the “Four Horseman” which are: Criticism, Contempt, Defensiveness, and Stonewalling. When we engage in any of these forms of communication, it is a quick way to end any productive result.

What treatment and resources are there?

It is not uncommon for adolescents to need more professional or community support if substance abuse has progressed from occasional abuse to a use disorder. There are a variety of community support resources such as 12-step groups for young adults through Alcoholics Anonymous (A.A.) or Narcotics Anonymous (N.A.), SMART Recovery Groups, and Dharma Recovery Groups. Clinical treatment is also available through a continuum of services that includes Detox and Residential programs, as well as outpatient programs that have Intensive Outpatient Programs (IOP) levels and lower levels of less intense care at the Outpatient Level (OP) which include individual therapy, group therapy, and psychiatric services with Medication Assisted Treatment (MAT).

Anthony Nave is an Approved Clinical Supervisor and Licensed Clinical Social Worker who holds master’s degrees in Educational Psychology and Clinical Social Work. He is advanced certified in Eye Movement Desensitization and Reprocessing (EMDR) and is an EMDR Consultant. He is also experienced in medication-assisted treatment, co-occurring disorders, and adolescent programming. At Mountainside, he oversees clinical programming for the full continuum of care and incorporates interpersonal neurobiology and a trauma-responsive framework into treatment and supervision.